Cantharis dissolves calculus in the ureter of a kitten: case repor

Urolithiasis is a disease thatcan occur alone or together, obstruct the urinary flow, and even progress to the animal's death. Objective:The present study is to report the dissolution of calculus in the ureter in a kitten. Methodology: a feline, SRD, male, started at 3 months old with the signs of vomiting, constipation,and hematuria, presenting leukocytosis and increased serum urea. Two abdominal ultrasounds were performed 30 days apart and the third at 3 months. Results:Inthe first ultrasound there was hydronephrosis in the right kidney and dilation of the ureter and microlithiasis in the urinary bladder. The animalhad already been treated with antibiotic therapy and did not improve. Given these characteristics, Cantharis Vesicatoria30cH was administered, there was no more hematuria and when the drug was discontinued, the symptom returned. After 30 days of startinghomeopathic treatment, we repeated the ultrasound which showed 2 kidney stones, and a urinary bladder with cystitis associated with sandy lithiasis. BerberisVulgaris30cH was then administered for 15 days, after which both drugs were discontinued and theanimal remained asymptomatic. After 3 months the ultrasound was repeated which showed 2 kidney stones, Causticum6cH was inserted for 14 days to dissolvekidney stones, thus preventing the return of the initial symptoms. Conclusion:the treatment was beneficial for the patient, who was asymptomatic after the use of Causticum.Considering the natural history of the disease in cats and the high chance of recurrence of the disease, the recommendation was to monitor the organs through an annual ultrasound examination, in addition to encouraging water intake.

Urinary lithiasis: evaluation of the use of laser vs. Pneumatic ureteral lithotripsy

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Pattern of presentation and management of urolithiasis at federal medical centre, Nguru, Nigeria

Background: Urolithiasis has been with mankind since ancient time. Although it is more common in the developed world, the pattern of presentation in the developing countries is tending towards that of developed countries. Objectives: To evaluate the pattern of presentations and treatments offered to patients with urolithiasis over the last 2 years at Federal Medical Centre (FMC), Nguru.Materials and Methods: The study is a 2-year retrospective review of patients managed for urolithiasis at FMC Nguru. The patients' bio-data, pattern of presentation and radiological features of the stones, as well as the treatment given to the patients, were reviewed.Results: The records of 55 patients were reviewed; the mean age was 24.1 years with a range of 1.5 to 70years. The male to female ratio was 10:1. The most common presenting symptom was painful micturition in 21 patients (38.18%). The total number of stones extracted was 58, one patient had multiple right renal pelvic calculi, another had bilateral renal pelvic stone and the third patient had bladder and distal ureteric stone. Two patients (3.64%) expelled their calculi while awaiting surgery, the remaining 53 patients (96.36%) had opened surgical treatment. Most of the stones are in the bladder in 29 patients (52%). Twenty-one patients (38.18%) had upper urinary tract stones out of which 13 were in the renal pelvis.Conclusion: Urolithiasis is also common in the developing communities. Despite the changing pattern from lower to the upper tract in developed countries, we found lower tract stone dominating as seen in many underdeveloped. This may be attributable to yet to establish environmental or genetic factors

Epidemiology of urolithiasis consultations in the Paraíba Valley / Epidemiologia dos atendimentos por urolitíase no Vale do Paraíba

ABSTRACT Objective: to know the epidemiological profile of patients with urolithiasis in the Paraíba Valley region, identifying its prevalence and spatial distribution. Method: we conducted a cross-sectional study, by residence location in the Paraíba Valley, on morbidity data due to urolithiasis obtained from the DATASUS, covering the period between 2010 and 2012. We aimed at identifying the general, male and female prevalence of urolithiasis, the distribution by age, type of visit, year season and spatial distribution. Results: there were 1,901 visits for urolithiasis in the 35 municipalities of the Paraíba Valley in the three years studied, 52.3% of them of female patients. Of the total, 70.1% of the visits were emergency ones. The feminine visits (67.2%) were mostly also urgent (p <0.01). The overall prevalence for urolithiasis was 31.7/100,000. Male prevalence was 30.7/100,000, and the female, 32.7/100,000 (p>0.05). The prevalence ratio was 0.9 men for every woman. The age group with the highest prevalence was between 30 and 39 years, with 23.1%. Warm seasons concentrated 51.6% of cases, while 48.8% occurred in the cold ones (p>0.05) . Conclusion: women are more affected by urolithiasis than the male in the Paraíba Valley region, an unprecedented in the literature. There was no relationship between the year season and the disease. We identified municipalities where preventive actions of urinary lithogenesis are required.

RESUMO Objetivo: conhecer o perfil epidemiológico dos pacientes com urolitíase, na região do Vale do Paraíba, identificando sua prevalência e distribuição espacial. Métodos: estudo transversal com dados de morbidade por local de residência decorrente de urolitíase no Vale do Paraíba, relativos ao período compreendido entre 2010 e 2012, obtidos do DATASUS. Os dados foram analisados para identificar a prevalência geral, masculina e feminina da urolitíase, a distribuição por idade, tipo de atendimento, estação do ano e sua distribuição espacial. Resultados: ocorreram 1901 atendimentos por urolitíase nos 35 municípios do Vale do Paraíba nos três anos estudados, sendo 52,3% dos pacientes do sexo feminino. Do total, 70,1% dos atendimentos foram em caráter de urgência. Os atendimentos femininos, na sua maioria (67,2%), também foram de urgência (p<0,01). A prevalência geral encontrada para a urolitíase foi 31,7/100.000 habitantes. A prevalência masculina foi 30,7/100.000 e a feminina de 32,7/100.000 (p>0,05). A relação de prevalência encontrada foi 0,9 homens para cada mulher. A faixa etária com o maior número de pacientes atendidos foi entre 30 e 39 anos, com 23,1% do total. Nas estações quentes ocorreram 51,6% dos atendimentos, enquanto nas frias 48,8% (p>0,05). Conclusões: foi possível identificar que na região do Vale do Paraíba o sexo feminino é mais acometido pela urolitíase do que o masculino, fato inédito na literatura. Não se encontrou relação entre a estação do ano e a doença. Foram identificados municípios onde ações de prevenção da litogênese urinária são necessárias.

Tratamento alternativo em gatos acometidos por DITUIF / Alternative treatment in cats affected by FLUTD

This report describes two cases of male cats affected by FLUTD (Feline lower urinary tract disease). The first patient had been affected by numerous relapses after passing through various therapeutic treatments and surgical interventions, and was subjected to the alternative protocol after being recommended for euthanasia, the second patient had no history of urinary tract disorders in the past, and was not subjected to any kind of previous treatment. The two patients had a significant improvement in their clinical condition, were not affected by relapses after participation in the alternative design, and were accompanied for about a year after their treatment.(AU)

Litíase urinária e gestação / Urolithiasis and pregnancy

A litíase urinária é frequentemente diagnosticada durante a gestação. O diagnóstico de nefrolitíase assintomática durante a gestação não requer medidas adicionais, apenas o seguimento do pré-natal normal. Contudo, quando ocorre cólica renal ou complicações decorrentes da litíase urinária, medidas adicionais tornam-se necessárias. Nestes eventos, mais comuns nos últimos meses de gestação, há particularidades relacionadas ao quadro clínico, diagnóstico e tratamento específicos para esta população de pacientes. O presente artigo tem como objetivo revisar estes aspectos de litíase urinária na gestação à luz do conhecimento atual e da experiência pessoal dos autores.

The diagnosis of urolithiasis during pregnancy is common, even though no additional measures are required in asymptomatic cases. Renal colic or complications of urinary lithiasis occur more frequently during the last months of pregnancy, and there are several particularities for the diagnosis and treatment of this subset of women. The present manuscript aim to review the current knowledge concerning this subject and present authors personal experience.

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. .

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.

Evolución histórica del tratamiento de la litiasis urinaria a propósito de una experiencia de 33 años del Servicio de Urología del Hospital Militar de Santiago / Historical evolution of urinary lithiasis treatment after a 33-year experience at the Urology Department of the Santiago Military Hospital

Introducción: La litiasis urinaria es una patología que acompaña al ser humano desde sus inicios. Para el tratamiento de esta enfermedad se han desarrollado diversas técnicas que han evolucionado con la tecnología de cada época. Así hemos visto que el método de elección ha variado cíclicamente, según la efectividad y cuan invasivo sea éste. Método: Se revisaron los libros de pabellón y la base de datos de litotricias extracorpóreas (LEC) del Servicio de Urología del Hospital Militar de Santiago considerando todos los procedimientos urológicos destinados al tratamiento de la urolitiasis, durante el periodo comprendido entre julio de 1978 y diciembre de 2011.Resultados: Se obtuvo un total de 5.762 pacientes tratados por urolitiasis, marcándose en la década de 1970 una preferencia por las técnicas abiertas y posteriormente, en 1986 con la llegada de un ureteroscópio rígido 11 Fr., una preferencia por las técnicas endoscópicas. Con la llegada del primer litotritor en 1990, la litotricia extracorpórea se convierte en el tratamiento más utilizado hasta la fecha. Conclusión: Los recursos son siempre escasos, especialmente en el contexto nacional. La Litotricia extracorpórea (LEC) es un método efectivo para la gran mayoría de los cálculos urinarios, esta disponible prácticamente en cualquier lado y requiere de pocos recursos en comparación a los otros métodos. Si se dispone de todos los medios, el tratamiento más adecuado es el que el médico tratante maneja mejor, el de más fácil acceso y aquél con el cual el paciente se siente mejor servido.

Introduction: Urolithiasis is a disease that has afected humans since the beginning of time. Diferent methods have been developed to treat this a iction, which have evolved depending on the technology of the time. Thus, it has been noticed that the preferred technique has changed in a cyclic manner depending on the e¬ ectiveness and invasiveness of the procedure. Methods: Surgery records as well as the Extracorporeal Shock Wave Lithotripsy data were analyzed at the Urology department at the Santiago Military Hospital. These included all urological procedures for the treatment of urolithiasis from July 1978 through December 2011.Results: A total of 5,762 patients were treated for urolithiasis. In the 1970s open techniques were the most practiced. Later, in 1986 an 11-Fr. rigid ureteroscope arrived at the urology department, and the endoscopic methods became the most practiced for this pathology. Along with the arrival of the first lithotripter in 1990, the extracorporeal shock wave lithotripsy becomes the most popular treatment for urinary calculi up to date. Conclusion: Economic resources are always limited, especially in Chile. Ergo, the extracorporeal shock wave lithotripsy is an efective therapy for most urinary calculi, it is easily available and is less expensive compared to other therapies. If all means are available, then the best treatment for urolithiasis will always be the one that the urologist has more experience, the best access, and the one which the patient feels more comfortable.

Evaluación del efecto antiurolitiásico e influencia en la función renal del extracto seco hidroalcohólico al 70% de Mikania cordifolia (L. f.) Willdenow en litiasis renal inducida en animales de experimentación / Evaluation of the anti-urolithic effect and influence on renal function of 70% hydroalcoholic dry extract of Mikania cordifolia (L. f.) Willdenow in induced kidney stones in experimental animals

La presente investigación tuvo como objetivo evaluar el efecto de tipo antiurolitiásico y la influencia en la función renal del extracto seco hidroalcohólico al 70% de Mikania cordifolia. (L.f.) Wildenow administrado por vía oral en ratas Holtzman previa inducción de litiasis renal por el método de hiperoxaluria (inducida con solución de etilenglicol al 0.75% y cloruro de amonio al 0.5% durante 21 días). Se planteó un estudio cuasi experimental con postprueba únicamente y grupos intactos. Se utilizaron 42 ratas albinas hembras las cuales fueron distribuidas en 6 grupos (n=7): de los cuales un grupo se tomó como testigo negativo y a los otros 5 se les indujo la litiasis renal. Una vez inducida la litiasis se tomó un grupo como testigo positivo y a los otros 4 se les administraron tratamiento con el extracto de la planta en estudio, a las dosis de 300 y 500 mg/ kg de peso, ambas durante 14 días y 21 días. Concluido el tiempo de tratamiento, se obtuvieron las muestras de sangre, orina y tejido renal. Se midieron los siguientes indicadores: flujo urinario, creatinina en suero y orina, sodio y potasio en suero y orina, pH en orina, acido oxálico en orina y se realizó el estudio histológico del tejido renal. El análisis de resultados indicó que el tratamiento con el extracto de la planta en estudio a las dosis de 300 mg/Kg durante 21 días y 500 mg/Kg durante 14 y 21 días, incrementan el flujo urinario en un 75%, 77.78% y 66.69% respectivamente; y la depuración de creatinina en un 50.93%, 52.03% y 54.16% respectivamente, de forma significativa respecto al grupo testigo positivo; así mismo disminuye Jos niveles de ácido oxálico en orina en un 48%, 80% y 66.1 %(a las dosis de 300 mg/Kg durante 21 días y 500 mg/Kg durante 14 y 21 días respectivamente) de forma significativa respecto al grupo testigo positivo. Los resultados del análisis histopatológico indican que a las dosis de 300 mg/Kg durante 21 días y 500 mg/Kg durante 14 días, la presencia de microcristales es escasa, mientras que a la dosis de 500 mg/Kg de peso durante 21 no se evidencia presencia de microcristales en el tejido renal. Se concluye que el extracto seco hidroalcohólico preparado de los tallos y hojas de Mikania cordifolia. (L.f.) Willdenow. Presenta efecto antiurolitiasico y mejora la función renal a la dosis de 500 mg/kg de peso desde los 14 días de tratamiento y a la dosis de 300 mg/kg a los 21 días de tratamiento.

Evaluation of urolithiasis in Crohn's disease in Tunisian patients

To investigate the characteristics of urolithiasis associated with Crohn's disease [CD] in a sample of Tunisian population. We retrospectively studied 184 patients with CD to reveal any urolithiasis during evolution. Evidence for the presence of renal calculi was obtained from plain films, ultrasonography or intravenous urography and computed tomography. Renal calculi were found in only three patients with CD. All patients were woman. Mean time from diagnosis of CD to diagnosis of calculi was 22 months [range 6 to 48 months]. Clinical features were not specific. Calculi were bilateral in two cases. The rate of concurrent urolithiasis was very low in the present series of Tunisian patients. Although rare, efficient treatment and prevention of calculi formation are mandatory in CD patients'

Litiasis urinaria en niños hospitalizados. Centro Hospitalario Pereira Rossell 2006-2012 / Urinary stones in hospitalized children. Centro Hospitalario Pereira Rossell 2006-2012

La enfermedad litiásica puede comenzar en la infancia con manifestaciones escasas o atípicas. Su incidencia es menor que en adultos y es de difícil diagnóstico. La causa favorecedora (metabólica, infecciosa, malformativa, mixta) se encuentra con mayor frecuencia que en adultos. El objetivo es describir las características clínicas, la evolución y el tratamiento de los niños hospitalizados con litiasis urinaria en el CHPR.Se realizó un estudio descriptivo, retrospectivo entre el 1 de junio de 2006 y el 31 de mayo de 2012. Se incluyeron todos los niños de 1 mes a 14 años hospitalizados con diagnóstico de litiasis urinaria. Se analizó presentación clínica, causas predisponentes, tratamiento y evolución. La fuente de datos fueron las historias clínicas. Se hospitalizaron 20 niños, 12 varones y ocho mujeres, mediana 10,5 años. El dolor fue la presentación clínica más frecuente (n=17). La litiasis fue única en 11 casos y múltiple en 9. Se diagnosticó litiasis coraliforme con pionefrosis en dos niños y en otros dos nefrocalcinosis. Presentaron complicaciones obstructivas (n=15), infecciosas (n=4), insuficiencia renal aguda leve (n=3). Se hallaron causas predisponentes en 13 niños: metabólicas (n=9), infecciosas (n=4), malformativas (n=3); el estudio metabólico se realizó en 10 casos, siendo completo en tres de ellos. Recibieron tratamiento quirúrgico o litotricia 10 pacientes. Los niños con litiasis coraliforme y pionefrosis requirieron nefrectomía. Permanecen en seguimiento seis niños: tres persisten con litiasis y dos tienen nefrocalcinosis, uno de ellos con IRC moderada.Esta constituye la primera comunicación de litiasis urinaria en niños hospitalizados. Aunque se trata de un centro de referencia nacional, conocer la prevalencia y características de esta enfermedad requiere estudios multicéntricos. Una proporción importante de niños presentó complicaciones graves...

Hiperoxaluria primaria en tres hermanos / Primary hyperoxaluria in three brothers

La hiperoxaluria es responsable de 2%-20% de las causas metabólicas de litiasis en niños y adolescentes. Esta puede ser secundaria o primaria(HP), en este último caso es tipo I o tipo II, de herencia autosómica recesiva. El objetivo es analizar diagnóstico y evolución en dos hermanos con HP tipo I y un tercero con alta probabilidad. El primer caso presentó a los 9 años un cólico nefrítico con litiasis múltiples bilaterales y una IRA leve. Presentaba hiperoxaluria de 214 mg/1,73 m2. Se descartaron causas secundarias. El estudio genético demostró dos copias de la mutación IIe244Thr. Los otros dos pacientes se presentaron en forma similar, a edades de 8 y 17 años. La piridoxina a altas dosis descendió los niveles de oxaluria como está descrito en un tercio de los casos. El tiempo de evolución es 7,3 y 1 año respectivamente. Persisten actualmente con litiasis bilaterales, sin nefrocalcinosis ni alteraciones del medio interno. La severidad de la HP tipo I es variable, hay formas de presentación temprana con litiasis recurrente y falla renal crónica en la infancia o en la adolescencia; otras de inicio tardío en edad adulta. Se trata de una enfermedad grave, progresiva, cuyo diagnóstico temprano con estudio metabólico completo puede mejorar el pronóstico,fundamentalmente en aquellos que responden a la piridoxina. El manejo de la litiasis y sus complicaciones es fundamental para evitar la IRC. Cuando ésta se desarrolla, la diálisis agresiva y el trasplante hepatorrenal son las opciones terapéuticas. Es el primer informe de casos confirmados de hiperoxaluria primaria en nuestro país...

Optimization of environmental and nutritional conditions of oxalate degrading bacteria leading to high oxalate degrading activity

Bacterial that mineralize and/or convert oxalates to biomass was suggested as an important modulators in the biological carbon cycle. The mesophilic Burkholderia cepacia, isolated from Egyptian soil was tested for the secretion of oxalate decarboxylase. Nutritional conditions were investigated to optimize bacterial growth and oxalate decarboxylase production including different carbon and nitrogen sources, metal ions, substrate concentrations, in addition to different environmental factors such as the incubation time, pH, temperature, and agitation. The effect of Burkholderia cepacia on the urinary oxalate level in vitro and checking of plasmid DNA were also conducted. Optimum biomass and enzyme production were achieved using modified Schlegel's basal mineral medium containing 0.4% potassium oxalate after 72 hrs of incubation at 30[degree sign]C, pH 7-9 with 1 05 rpm agitation. Among the organic nitrogen sources investigated, ammonium nitrate found to be the best inducer of oxalate decarboxylase, while peptone repressed enzyme activity. Among the carbon sources tested, while peptone repressed enzyme activity. Among the carbon sources tested, inositol maximized the enzyme production. Zn[2+] enhanced oxalate decarboxylase activity, while Hg[2+] strongly inhibited enzyme production. Burkholderia cepacia exhibits good influence in diminishing the urinary oxalate level in idiopathic calcium oxalate urolithiasis patients. Burkholderia cepacia has a megaplasmid [genomic] DNA with a size of 12, 437.6 bp

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL). In the first group (26 children), ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children) the electromagnetic EMSE 220 F-XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7 percent) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23 percent), brief hematuria (< 24 h) resolved with increased fluid intake in 5 (19.2 percent), while slightly elevated body temperature (< 38°C) occurred in 4 (15.3 percent). Four children (15.3 percent) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7 percent). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26 percent), brief hematuria (< 24 h), resolved with increased fluid intake in 4 (21 percent) and slightly elevated body temperature (< 38°C) monitored for 48 hours occurred in 6 (31.5 percent). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.

Cólico renal en el embarazo: experiencia en Complejo Asistencial Barros Luco / Symptomatic urolithiasis in pregnancy: a Barros Luco Health Complex experience

Objetivos: Revisar nuestra experiencia en el diagnóstico y manejo de la patología litiásica urinaria sintomática durante el embarazo y exponer una revisión actualizada de la literatura. Materiales y métodos: Se realizó un estudio descriptivo retrospectivo que incluyó a 37 pacientes. Se revisaron fichas clínicas de las pacientes embarazadas con diagnóstico de egreso hospitalario correspondiente a cólico renal, urolitiasis, nefrolitiasis o ureterolitiasis de la Unidad de Medicina Materno Fetal del Hospital Barros Luco, entre los años 2005 y 2007. Las variables extraídas y analizadas fueron: edad, paridad, la edad gestacional, el tipo de parto, prematuridad, antecedentes de urolitiasis, presentación clínica, lateralidad, laboratorio, imagenología, confirmación litiásica, ubicación del cálculo, tratamiento inicial y manejo posparto. Resultados: La edad promedio de las pacientes fue de 27,2 años. La edad gestacional promedio fue de 20 semanas. Multiparidad fue del 62 por ciento y el 35 por ciento tenía antecedentes de urolitiasis previa. El 97 por ciento de las pacientes presentó dolor lumbo-abdominal tipo cólico al ingreso, en 56,8 por ciento de casos al lado derecho. El 73 por ciento de los embarazos estaban en el 2° o 3er trimestre. El 8 por ciento presentó parto prematuro. El estudio imagenológico fue requerido en 24 pacientes (65 por ciento) incluyó a la ultrasonografía y una paciente además requirió de radiografía abdominal simple y RNM. De éstas se confirmó litiasis en el 30 por ciento (62,5 por ciento en el riñón, 25 por ciento uréter distal y 12,5 por ciento en ambas ubicaciones). Todas las pacientes se manejaron inicialmente con tratamiento médico. Una paciente requirió un catéter doble “J”, y sólo 2 pacientes requirieron ureterolitotomía después del parto. Conclusiones: La litiasis urinaria sintomática durante el embarazo, a pesar de un enfrentamiento multidisciplinario, continúa siendo un desafío diagnóstico y terapéutico. Los síntomas y...

Objectives: To review our experience in diagnosis and management of symptomatic urolithiasis during pregnancy and present an updated review of the literature. Materials and methods: A retrospective descriptive study including 37 patients was made. We reviewed medical records of pregnant patients with hospital discharge diagnosis of renal colic, urolithiasis, nephrolithiasis or ureterolithiasis from the Maternal Fetal Medicine Unit of Barros Luco Hospital, between 2005 and 2007. Extracted and analyzed variables were age, parity, gestational age, type of delivery, prematurity, history of urolithiasis, clinical presentation, laterality, laboratory findings, imaging, urolothiasis confirmation, location of calculi, initial treatment and postpartum management. Results: Patients average age was 27.2 years. Average gestational age was 20 weeks. Multiparity was 62 percent and 35 percent had prior history of urolithiasis. At admission, 97 percent of patients had lumbo-abdominal colic pain and 56.8 percent of cases was on the right side. 73 percent of pregnancies were in the 2nd or 3rd trimester. 8% had preterm labor. Imaging studies were required in 24 patients (65 percent) and included ultrasonography. Simple abdominal radiography and MRI were requires in one patient. Of these patients, calculi was confirmed in 30 percent (62.5 percent in the kidney, 25 percent distal ureter and 12.5 percent in both locations). All patients were managed initially with medical treatment. One patient required a double J stent and only 2 patients required ureterolithotomy after delivery. Conclusions: Symptomatic urolithiasis during pregnancy, despite multidisciplinary assess, remains a diagnostic and therapeutic challenge. Symptoms and signs are still the most important elements for establishing the diagnosis. If suspected, ultrasound evaluation is recommended. Conservative management is still the first choice of treatment because most cases resolve spontaneously. Installation of a...

Extracorporeal shock wave lithotripsy; outcome in pediatric urolithiasis

[1] To determine the efficacy of extra-corporeal shock wave lithotripsy with reference to stone size, site and radiodensity in children. [2] To determine acute early complications during and following extra-corporeal shock wave lithotripsy in children. Analytical case series study. Fifty patients of either sex below the age fourteen [14 years] having renal, ureteric and bladder stones between 5-20 mm in size along with their long axis presented to department of urology Shaikh Zayed Hospital Lahore during the period of one year extending from 02-02-2008 to 02-02-2009 were included in this study. Children with serum creatinine level greater than or equal to 3mg/dl, obstruction distal to the stone, patient with active bleeding disorders, uncorrected hypertension, patient unfit for general anaesthesia, untreated urinary tract infection and patients with gross anatomical anomaly were excluded from study. All the patients were given shock waves under intravenous sedation or general anaesthesia in a standard manner on out door basis. All the children were evaluated for stone clearance and early complications at first 24-72 hours. At the end of three months ESWL treatment was considered successful, if the patients were stone free or had residual fragments 4 mm or less in size. Out of the fifty patients, 40 [80%] were males and 10 [20%] females with male to female ratio of 4.1. The age range of patients was 2-14 years [mean +/- SD 9.24 +/- 3.48 years]. Thirty three patients [66%] had renal stones, 7 [14%] ureteric and 10 patients [20%] had bladder stones. Single successful treatment session was noted in 22 patients [44%], 18 patients [36%] received two sessions and 10 patients [20%] required three sessions for successful stone fragmentation. Seventeen patients did not show stone clearance even after three sessions within three months follow-up. Twenty one patients [42%] felt pain after lithotripsy session, and they were given injectable analgesia and the pain settled, haematuria in 17 patients [34%], impacted stone in five [10%], ureteric colic and urinary tract infection in three, three cases respectively and only one case developed steinstrasse. Twenty patients [40%] developed minor complications of anaesthesia, like nausea, vomiting which relieved with injectable antiemetics

Development of a urinary lithiasis localizer mechanism to couple ultrasound and extracorporeal lithotripsy equipment in canine model

INTRODUCTION: Due to the evolution of extracorporeal lithotripsy equipment (ESWL) and presently, the fact that most part of the equipment does not present ultrasound to localize urinary calculi, a system that allows adapting ultrasound equipment to ESWL equipment was developed, disposing only of fluoroscopy. Thus, this equipment was developed and was tested in urinary stones in canine models, to check its precision in relation to fluoroscopy. METHOD: Seven male dogs were utilized with the introduction, in the bladder through the ureteral route, of chalkstones, with initial localization by fluoroscopy, with a further ultrasound coincidence check localization of the vesical stones, being submitted to ESWL with a 3-hour, 21 days and 60 days follow-up after the procedure. RESULTS: Success of localization in all animals was verified presenting elimination of stones in the first micturitions, after ESWL. No complications were verified in those animals for 60 days. CONCLUSION: We verified that this equipment can lead to an update of the equipment that use only fluoroscopy, increasing in this way, their technical capacity in the treatment of urinary calculi, mainly in cases of non-radiopaque stones.