The variation in urinary calcium levels in adult patients with fracture and surgical intervention.

BACKGROUND: Generally, a higher calcium diet is fed to fracture patients after surgery. However, recent studies have indicated that higher dietary calcium intakes increase the risk of urinary stones for fracture patients. Therefore, this study aimed to observe the variation in urinary calcium levels among fracture patients who underwent surgery, based on fracture type, fracture location, age and gender. METHODS: A total of 768 subjects were enrolled in this study from 2012 to 2015 and were divided into 2 groups: group A (fracture patients who underwent surgery) and group B (normal patients without fracture). Urine samples were collected for a 24-h period (24-h urine), at multiple specific time points before and after surgery for group A, or after hospitalisation for group B. Subsequently, urine calcium was detected and the changes were evaluated according to fracture location, fracture type, age and gender, as well as the distribution of hypercalciuria. RESULTS: Compared with group B, the level of urine calcium in group A significantly increased at different time points during the study period (P < 0.05). There were significant differences in the changes in urine calcium levels according to fracture location, fracture type and age, but not gender. Further, there were more patients with hypercalciuria in group A at the different time points, compared with group B. CONCLUSION: Variation in urinary calcium among fracture patients that underwent surgery was of a regular pattern and hypercalciuria was also found in these patients. Therefore, a high-calcium diet and calcium supplements should be used with caution in this patient population.

Characterizing ceftriaxone-induced urolithiasis and its associated acute kidney injury: an animal study and Chinese clinical systematic review.

OBJECTIVE: To investigate the pathophysiological process of ceftriaxone-induced urolithiasis and its associated acute kidney injury (AKI) based on an animal study and summarize the main clinical characteristics based on a Chinese clinical systematic review. MATERIALS AND METHODS: Male Sprague-Dawley rats were randomly divided into five groups of six each according to different treatments including control; ceftriaxone; ceftriaxone with calcium; calcium; and ceftriaxone, calcium with citrate, respectively. The 24-h urine volume, serum creatinine (Scr) and blood urea nitrogen (BUN) were measured; kidney histological examination and stone analysis were performed. Systematic searches of the Chinese Knowledge Database were conducted for reports on ceftriaxone-induced urolithiasis and AKI. The eligibility of each full-text publication was accessed, and qualified data were extracted and reviewed. RESULTS: Kidney stones and a significantly low 24-h urine volume with increased high Scr and BUN levels were found in the group that received ceftriaxone combined with calcium. Citrate was able to inhibit these biochemical changes and stone formations. A total of 161 qualified patients were included in the Chinese clinical systematic review: The proportion of ceftriaxone-induced urolithiasis was 21.1, 19.3, 19.3, 39.1 and 1.2 % for ages <3, 3-6, 7-17, 18-60 and >60 years. 72.7 % developed acute kidney injury eventually. CONCLUSION: Ceftriaxone-induced urolithiasis was associated with a high risk of AKI. The pathophysiological process may be related to urinary obstruction and crystalline nephropathy. Citrate was able to inhibit stone formation and prevent further kidney injury.

Possible function of urinary pH and citrate on the ceftriaxone-induced nephrolithiasis.

OBJECTIVE: To test whether urinary pH and citrate is associated with ceftriaxone-induced kidney stone formation and if acidified urine could dissolve this kind of stone using an in vitro crystallization model. METHODS: Crystallization was induced by mixing ceftriaxone at the standard therapeutic urinary concentration to artificial urine. The response of different physiological pH and citrate on ceftriaxone-induced crystallization was measured by the depletion ratio of ceftriaxone in the process. Compositions of formed crystals were qualitatively and quantitatively analyzed. The effect of acidifying urine on dissolving of ceftriaxone-induced crystal was determined by the surplus ratio of ceftriaxone in the process. RESULTS: Compositional analysis showed that ceftriaxone-induced crystals were composed of calcium and ceftriaxone with a ratio of 1:1. Compared to the response to pH 6.0, ceftriaxone-induced crystallizations in artificial urine at pH 4.5 and 5.0 for 4 hours were significantly decreased, and more acid urine resulted in less crystallization. However, it made no significant change when pH increased to 6.5 and 7.0. In addition, ceftriaxone-induced crystals formed at pH 6.0 for 4 hours could be dissolved significantly when artificial urine was acidified to pH 5.0 and 4.5 for 1, 2, and 4 hours; and more time of dissolution and more degree of acidifying resulted in more dissolution. CONCLUSION: Our study suggests that urinary pH and citrate are probable factors associated with ceftriaxone-induced nephrolithiasis. On one hand, alkaline urine and hypocitraturia predispose ceftriaxone nephrolithiasis, and vice versa. On the other hand, acidifying urine could dissolve ceftriaxone-induced stones.

The true stone composition and abnormality of urinary metabolic lithogenic factors of rats fed diets containing melamine.

To better understand the toxicity of melamine to humans, the stone composition and urinary metabolic lithogenic factors of rats fed diets containing melamine including the infant's melamine-induced stone composition were studied. Sixty 4-week-old male rats divided into three groups were, respectively, fed diets containing no melamine (control), 0.1% melamine, and 1% melamine for 4 weeks. At the end of experiment, the collected stones and 24-h urines from rats were, respectively, measured with compositions and metabolic lithogenic parameters. The stone from an infant who ingested melamine-adulterated formula was also included in compositional analysis. Across three groups, the stone was only detected in 1% melamine group, with composition of almost melamine different from the affected infant's stone composed of melamine and uric acid with a ratio of 1:2. Compared with control group, urine calcium and phosphate excretions were significantly increased in 1% melamine group. Urine uric acid excretion was significantly increased but citrate excretion was significantly decreased in 0.1% and 1% melamine groups. Urine oxalate excretion and pH were indicated without any significant difference. In addition based on urine physicochemical characters, melamine-uric acid stone seems difficult to be formed in the rats due to their characters of urine high-pH and low-uric acid. These results demonstrated that (1) the stone composition of rats fed melamine was not and could not be as that of infants fed melamine-adulterated formula, two species had a different mechanism of melamine-induced stone formation; (2) the exposure of melamine could result in abnormalities of urine metabolic lithogenic factors to rats, perhaps as well as human beings.

Metal artifacts reduction using monochromatic images from spectral CT: evaluation of pedicle screws in patients with scoliosis.

PURPOSE: To evaluate the effectiveness of spectral CT in reducing metal artifacts caused by pedicle screws in patients with scoliosis. MATERIALS AND METHODS: Institutional review committee approval and written informed consents from patients were obtained. 18 scoliotic patients with a total of 228 pedicle screws who underwent spectral CT imaging were included in this study. Monochromatic image sets with and without the additional metal artifacts reduction software (MARS) correction were generated with photon energy at 65keV and from 70 to 140keV with 10keV interval using the 80kVp and 140kVp projection sets. Polychromatic images corresponded to the conventional 140kVp imaging were also generated from the same scan data as a control group. Both objective evaluation (screw width and quantitative artifacts index measurements) and subjective evaluation (depiction of pedicle screws, surrounding structures and their relationship) were performed. RESULTS: Image quality of monochromatic images in the range from 110 to 140keV (0.97±0.28) was rated superior to the conventional polychromatic images (2.53±0.54) and also better than monochromatic images with lower energy. Images of energy above 100keV also give accurate measurement of the width of screws and relatively low artifacts index. The form of screws was slightly distorted in MARS reconstruction. CONCLUSIONS: Compared to conventional polychromatic images, monochromatic images acquired from dual-energy CT provided superior image quality with much reduced metal artifacts of pedicle screws in patients with scoliosis. Optimal energy range was found between 110 and 140keV.

Could infrared spectroscopy identify melamine-related stone using melamine-contained mixture as a reference?

BACKGROUND: Recently, a method of infrared spectroscopy analysis to identify melamine-contained stone was established by examining melamine powders mixed with true urinary stones. However, several studies demonstrated melamine could be interacted with cyanuric acid or uric acid in water through hydrogen bonds. It presents a hypothesis that the infrared spectrum of melamine-contained stone formed in urine is probably different from melamine-contained dry mixtures. This study is to testify is it true. METHODS: The melamine-related mixtures were, respectively, prepared by mixing powders of melamine with cyanuric acid or uric acid in equimolar ratio. The melamine-related precipitates mimicking its related stone formation were, respectively, prepared by mixing melamine with cyanuric acid or uric acid in water at the given conditions. Subsequently, the melamine-related mixtures and precipitates were analyzed by infrared spectroscopy. RESULTS: The wave-number positions of powder mixtures of melamine-cyanuric acid and melamine-uric acid were a combination of these of their individual ingredients. The typical wave-number positions of melamine were showed in two melamine-contained mixtures. In contrast, these positions were disappeared or shifted greatly in the two melamine-related precipitates. In total, the spectrum of precipitates of melamine with cyanuric acid and uric acid had significantly differences with their powder mixtures. CONCLUSIONS: Our results indicate the identification of melamine-related stone by infrared spectroscopy could not use the infrared spectrum of melamine-contained mixtures as a reference.

Comparison of renal function and metabolic abnormalities of cystine stone patients and calcium oxalate stone patients in China.

PURPOSE: To compare renal function and metabolic abnormalities of cystine stone patients and calcium oxalate stone patients in China. METHODS: Between 2008 and 2011, thirty cystine stone patients were involved in our study, and an equal number of age- and gender pair-matched patients with calcium oxalate stones. Non-stone forming individuals were elected as controls. The evaluation included blood chemistry studies and 24-h urine collection in both groups of patients. RESULTS: The cystine stone patients had higher mean values of serum blood urea nitrogen, urate and creatinine levels than patients in other two groups. With respect to urine risk factors, cystine stone patients had higher urinary citrate and lower urinary oxalate and creatinine than calcium oxalate stone patients. When compared to non-stone forming individuals, cystine stone patients had higher urinary urate excretion and lower urinary creatinine excretion. Metabolic abnormalities could be demonstrated in 80 % of the cystine stone patients and in 100 % of the calcium oxalate stone patients. We also compared urine risk factors among cystine stone patients with different urine cystine excretion (<1 mmol/24 h, 1-2 mmol/24 h and >2 mmol/24 h). No significant difference was found in urine risk factors among three groups. CONCLUSIONS: This study suggested that cystine stone patients were at greater risk for the loss of renal function than calcium oxalate stone patients, but the risk of the formation of calcium oxalate stones was lower. Our results also indicated that urinary cystine had little or no impact on the excretion of urine chemistries in cystine stone patients.

Residual aneurysm after metal coils treatment detected by spectral CT.

Digital subtraction angiography (DSA) is currently the gold standard for diagnosing the residue or recurrence of aneurysm after treatment, especially in the presence of metal coils. However, DSA is an invasive procedure which may cause additional trauma and economic burden to patients. Spectral CT imaging, as a newly introduced CT imaging mode, produces monochromatic image sets that is able to reduce beam-hardening and other metal-related artifacts, and has found its use in several clinical applications including brain imaging to reduce beam-hardening artifacts. In this study, we describe a case of spectral CT imaging in follow-up of the metal coils treatment and detection of a small leaf of residual aneurysm after metal coils treatment.

Could temporal window for the computed tomography hepatic venography (CTHV) be extended?: A comparative study between spectral and conventional CT using porcine models.

OBJECTIVE: To investigate the feasibility of extending the acceptable temporal window for hepatic venography with dual-energy spectral CT imaging. METHODS: Five normal pigs anesthetized intramuscularly were scanned on a multislice CT (GE Discovery HD750 CT) after bolus contrast injection. Twelve CT scans with dual-energy spectral imaging mode were performed on each pig with a 10-second interval. Both conventional polychromatic and monochromatic image sets were reconstructed. The optimal energy level for hepatic vein imaging was selected from the monochromatic image sets based on the contrast-to-noise ratio (CNR) analysis. Subjective assessment of image quality was performed on volume-rendering images at 12 imaging points in time. RESULTS: The CNRs for hepatic veins in the polychromatic, default monochromatic 65 keV, and the optimal energy images were 2.24 ± 1.09, 3.48 ± 1.73, and 6.72 ± 2.56, respectively, with a significant difference among 3 groups (P < 0.001). There was no acceptable temporal window for imaging hepatic veins in the polychromatic group, but a peak plateau existed. The temporal window in the 65-keV group was 20 seconds, whereas it was 70 seconds in the optimal energy group. CONCLUSIONS: Compared with conventional polychromatic CT images, monochromatic images provided superior CNR for hepatic veins and 3.5 times temporal window of hepatic venography in spectral CT.

The effect of plum juice on the prevention of struvite calculus formation in vitro.

OBJECTIVES: To evaluate the effect of plum juice on struvite calculus formation in vitro and to explore the effect of plum juice on urease-producing bacteria and urease activity. The compliance of available drugs is low for struvite calculus after surgical treatment and functional food may represent a good choice as an alternative therapy. MATERIALS AND METHODS: Antibacterial activity was assessed using a microdilution antimicrobial susceptibility test. Urease activity was determined by measuring ammonia production. Struvite crystals were induced by Proteus mirabilis in artificial urine with natural and pH-adjusted plum juice. The optical density (OD)(600) and pH of artificial urine were examined, as well the shape and weights of crystals. RESULTS: Natural plum juice showed an antibacterial effect on urease-producing bacteria, whereas the pH-adjusted juice did not. A concentration-dependent inhibition on urease activity was found for both natural and pH-adjusted juice. Natural plum juice at a high concentration of 0.5% showed an obvious inhibition on the increase of OD(600) and pH of the artificial urine, and crystal formation was prevented by up to or more than 8 h, depending on the concentration of juice. Crystal weight in the natural plum juice groups was decreased in a concentration-dependent manner. The pH-adjusted plum juice did not show any effect on OD(600) and pH, although the presence of juice changed the crystal habit, indicating that the juice slowed the growth rate of crystals. CONCLUSIONS: Natural plum juice at high and moderate concentrations prevented the formation of P. mirabilis-induced crystals for up to 8 h in artificial urine. Although pH-adjusted and low-concentration natural juice did not prevent the occurrence of crystals, both types of juice slowed their growth rate.

[Establishment of a rat model of low calcium diet related hyperoxaluria].

OBJECTIVE: To establish a rat model of low calcium diet related hyperoxaluria and explore its features. METHODS: By means of randomized blocks design, totally 24 SD male rats were divided into low calcium diet group, medium calcium diet group, and high calcium diet group. Each group was sequentially fed on different calcium diets for 3 days. The urinary volume within 24 hours was recorded, the consistency of urinary oxalate by high-efficiency liquid chromatography, and the consistency of urine creatinine by automatic biochemical analyzer. The consistency was corrected to the output of urinary oxalate of rats in 24 hours, and the results were evaluated by repeated measurement of variance analysis and multivariate analysis of variance. RESULTS: The output of urinary oxalate of rats in 24 hours varied with time (F=7.893, P0.05). The output of urinary oxalate of rats in 24 hours varied with group division (F=3.565, P<0.05). The output of urinary oxalate in 24 hours in three groups on the third day was significantly higher than that on the first day (P<0.05). CONCLUSION: By controlling the calcium intake, we successfully established the model of low calcium diet related hyperoxaluria in rat.

Comparison of efficacy of German and Chinese electromagnetic shock wave lithotripters: Dornier Compact S vs Huikang MZ-SWL-V.

OBJECTIVES: To compare the treatment efficacy of Dornier Compact S and a Chinese electromagnetic shock wave lithotripter (Huikang MZ-SWL-V) in a large series. METHODS: We retrospectively reviewed the outcome of shock wave lithotripsy (SWL) in 13,954 consecutive patients with upper urinary tract stones from December 1996 to December 2008 with Dornier Compact S (9124 cases) and Huikang MZ-SWL-V (4830 cases). An intramuscular injection of 50 mg pethidine was given to the patients with Dornier Compact S but not to those with Huikang MZ-SWL-V. Treatment outcomes were assessed by the stone-free rate at three months, the retreatment rate, the auxiliary procedure rate, and the effectiveness quotient. The pain scores were evaluated by visual analog scales, where 0 = pain and 10 = unbearable pain. RESULTS: The overall stone-free rate at 3 months, retreatment rate, and ancillary procedure rate for Dornier Compact S were 95.9%, 13.4%, and 2.2%, respectively, and they were 85%, 29.6%, and 10.2%, respectively, for Huikang MZ-SWL-V. The overall efficiency quotients of Dornier Compact S and Huikang MZ-SWL-V were 83% and 60.8%, respectively. However, the pain scores in the Dornier group (6-10) were higher than those in the Huikang group (1-5). Three clinically significant subcapsular hematomas were detected in the Dornier group but there were none in the Huikang group. CONCLUSIONS: Dornier Compact S is more effective than Huikang MZ-SWL-V, but SWL with Huikang machine could be performed with milder pain and without analgesia, and a lower significant hematoma rate was observed in Huikang group.

Infrared spectroscopic analysis of urinary stones (including stones induced by melamine-contaminated milk powder) in 189 Chinese children.

AIM: The aim of the study was to investigate the composition of the stones in Chinese children with urolithiasis, including peculiar stones induced by melamine-contaminated milk powder. MATERIALS AND METHODS: Between 1999 and 2009, 189 urinary stones from children of East China were received at our institution. Among them, 12 stones were received from pediatric stone formers with a history of consuming melamine-contaminated milk powder in 2008; and the remaining stones were defined as "natural" stones. All stones were analyzed by Fourier transform infrared spectroscopy. RESULTS: Among 177 "natural" stones, whewellite stone (49.72%) was observed most frequently followed by weddellite stone (15.25%), uric acid anhydrous stone (9.6%), carbapatite stone (9.04%), cystine stone (9.04%), ammonium acid urate stone (4.52%), struvite stone (2.26%), and sodium urate stone (0.56%). Twelve young children who consumed melamine-contaminated milk powder were younger than 3 years, and their stones were composed of a mixture of uric acid dihydrate and ammonium acid urate based on Fourier transform infrared spectroscopy. In addition, the stones were radiolucent and could be dissolved by urine alkalinization. CONCLUSIONS: Our study emphasizes the relatively high rate of calcium oxalate stones and cystine stones, and the relatively low rate of struvite stones in Chinese children with urolithiasis. The stones caused by melamine-contaminated milk powder are composed of the mixture of uric acid dihydrate and ammonium acid urate.

Infrared spectroscopic analysis of 5,248 urinary stones from Chinese patients presenting with the first stone episode.

A series of 5,248 urinary stones was analyzed by Fourier transform infrared spectroscopy between 1999 and 2008. This study evaluated the percentage of each stone type and the association with sex and age in Chinese stone formers presenting with the first stone episode. The overall sex ratio (male:female) was 2.34:1. Results showed that the preponderant type of stone was calcium oxalate, followed by carbapatite, anhydrous uric acid, struvite and cystine. Struvite stones in this study accounted for a relatively low rate compared to that reported by others. Of 5,248 stones, only 38.1% had one component, 42.5% consisted of two components, and 20.4% consisted of three components. Our results also showed the higher percentage of carbapatite stones in females than in males and the increment of anhydrous uric acid stones with age. In addition, the percentage of calcium oxalate stones decreased with increase in the percentage of carbapatite stones over the period.

Comparison of efficacy and safety of shockwave lithotripsy for upper urinary tract stones of different locations in children: a study of 311 cases.

PURPOSE: To compare the efficacy and safety of Shockwave lithotripsy (SWL) for upper urinary tract stones of various locations in children. METHODS: Between 1997 and 2008, a total of 311 children (average age: 7.9 ± 4.4 years, ranged from 6 months to 16 years) with upper urinary tract stones were treated by SWL using Dornier Compact S lithotripter at our department. Of those patients, 196 had renal stones (pelvic, 53; upper and mid calices, 75; lower calices, 68) with an average size of 9.42 ± 7.1 mm, and 115 had ureteral stones (proximal, 53; mid, 16; distal, 46) with an average size of 7.38 ± 5.87 mm. RESULTS: Overall stone-free rates of renal stones and ureteral stones at 3 months were 95.8% and 94.8% with 83.5% and 79.5% of efficacy quotient (EQ), respectively. In renal stone groups, the EQ for renal pelvic stones was 89.2%, for middle and upper calyx stones was 92.5%, which was higher than 71.9% for lower calices stones. In ureteral stone groups, the 82.3% of EQ for proximal ureteral stones and 83.0% for distal ureteral stones were higher than 63.6% for middle ureteral stones. Patients with larger stones had significant higher re-treatment rate (P < 0.05) and lower EQ than small stone groups. No serious side effect happened in the study. CONCLUSIONS: SWL for both renal stones and ureteral stones in pediatric group have comparable efficacy and safety, except that stones in lower calices and middle ureters have lower EQ than those in other locations.

[A modified rat model for infection-induced stone formation].

OBJECTIVE: To employ a newly modified rat model for infection-induced bladder stone formation. METHODS: 24 adult male Sprague Dawley rats were divided into 3 groups, model group (n=12), sham operation group (n=8) and control group (n=4). The surgical procedures were performed aseptically under anesthesia (25% Ultane 1.0 g/kg). The bladder in model group was exposed through a short lower midline abdominal incision, the puncture needle (G18) with guideline was inserted aseptically into bladder, a metal wire, which have been contaminated by the Proteus mirabilis, was put into the puncture canal, then implanted into the bladder lumen through the guideline. In the sham operated group the puncture needle (G18) with guideline was inserted into bladder without metal wire implanted into the bladder. There was no any operation in control group. The rats were sacrificed by excessive anesthesia at 21 days post challenge. The bladder were removed aseptically and inspected for evidence of urolithiasis. RESULTS: On Day 2 after surgery, two rats died in model group, no rats died in other groups. Twenty-one days after surgery, all of rats in model group developed various-sized bladder stones. There was no stone formation in sham operation group and control group. All stones were verified by infrared spectroscopy and optical crystallography. These stone were struvite stone. CONCLUSION: This model has a less trauma, faster recovery and excellent stone formation so that it may be used for the study of infection stone.

Sciaticum majus foramen and sciaticum minus foramen as the path of SWL in the supine position to treat distal ureteral stone.

The purpose of the study is to evaluate the efficacy and safety of shock wave lithotripsy (SWL) using sciaticum majus foramen and sciaticum minus foramen as the path to treat distal ureteral stone in supine position. Between December 2006 and November 2008, 243 cases of distal urinary calculi were treated in our department using SWL or ureteroscopy. 189 cases for SWL were treated in supine position. The shockwave target on the stone in distal ureter via sciaticum majus foramen and sciaticum minus foramen, avoiding the sacroiliac joint. 54 cases were underwent ureteroscopy combined with holmium:YAG laser lithotripsy. The stone-free rate and the efficacy quotient (EQ) for SWL and ureteroscopy was 81.5%, 0.68; 94.4%, 0.78; respectively (p = 0.02). The retreatment rate for SWL and ureteroscopy was 14.6%, 0, respectively. The number of the shocks ranged from 600 to 3,000 (mean 2,566.3 ± 378.8). The energy per pulse of SWL ranged from 8 to 12 kV (mean 10.7). SWL in the supine position using sciaticum majus foramen and sciaticum minus foramen as the path is a choice of the treatment of distal ureteral stones with an excellent success rate and low side effect.

Greater and lesser ischiadic foramina as path of shock wave lithotripsy for distal ureteral stone in children.

PURPOSE: We evaluated the efficacy and safety of shock wave lithotripsy in the supine position through the greater and lesser ischiadic foramina as a path of shock wave to treat distal ureteral stones in young children. MATERIALS AND METHODS: We treated 22 young children with distal urinary calculi using the Dornier Compact S lithotriptor between 1997 and 2007. The study population consisted of 15 boys and 7 girls 6 months to 7 years old (mean +/- SD 5.4 +/- 2.1 years). Stone size ranged from 5 to 16 mm (mean 6.8). All patients were treated in the supine position under dissociative anesthesia with ketamine. The focused shock wave targeted the stone in the distal ureter through the greater and lesser ischiadic foramina. RESULTS: Number of shocks ranged from 600 to 3,000 (mean +/- SD 2,346.2 +/- 483.7). Energy per pulse ranged from level 4 to 5 (mean 4.5). Treatment time varied from 20 to 40 minutes (mean 31). Stone-free rate at 2 weeks after lithotripsy was 77.3%, which increased to 100% at 3 months after a single lithotripsy session. No serious side effects were observed. CONCLUSIONS: Shock wave lithotripsy in the supine position through the greater and lesser ischiadic foramina as the path of shock wave treats distal ureteral stones in young children with an excellent success rate and few side effects.

Efficacy of extracorporeal shock wave lithotripsy for ureteral stones in children.

PURPOSE: In this study, we retrospectively analyzed our experience with extracorporeal shock wave lithotripsy (ESWL) in children with ureteric stones. MATERIALS AND METHODS: Between 1997 and 2008, 115 children with ureteral stones were treated by ESWL in our department. There were 67 boys and 48 girls with a mean age of 7.2 + or - 4.3 years. There were 53 (46.1%) patients with proximal ureteric stones, 16 (13.9%) with mid-ureteral stones and 46 (40.0%) with distal ureteral stones. The stone size ranged from 4 to 21 mm with a mean of 7.38 mm. Children with proximal stones were treated in the supine position, while children with mid and distal ureteric stones were treated in the prone or supine position. RESULTS: Stone-free rate at 3 months was 94.8%, the re-treatment rate 15.7%, and overall efficacy quotient (EQ) was 83%. SWL failed in six children (5.2%). There was no significant difference in stone-free rates at 3 months between different groups classified by location and stone size. There were no serious side effects. CONCLUSIONS: Our results indicate that ESWL with highly satisfactory stone-free rates and negligible complications can be considered as a first-line treatment for ureteric stones in the pediatric age group.

Efficacy of selective alpha1D-blocker naftopidil as medical expulsive therapy for distal ureteral stones.

PURPOSE: Naftopidil is a specific alpha1D-adrenergic receptor antagonist. We performed the current randomized, controlled study to determine the expulsive role of naftopidil for distal ureteral stones. MATERIALS AND METHODS: From March 2006 to January 2007, 60 patients with distal ureteral stones were randomly divided into groups 1 and 2. Group 1 served as the control and underwent watchful waiting, while group 2 received 50 mg naftopidil daily in the morning. All patients were instructed to drink a minimum of 2 l water daily. The stone expulsion rate and time, potential side effects of naftopidil, number of pain episodes and requirements for pain medication were documented during the 14-day followup. RESULTS: All patients in groups 1 and 2 completed the study. There was no difference between the groups in patient age, sex and stone size. The stone expulsion rate was significantly higher in group 2 than in group 1 (90.0% vs 26.7%, p <0.01). No significant difference in expulsion time was noted between the groups. No patients experienced obvious naftopidil side effects or ureteral colic. Multivariate analysis using a Cox proportional hazards model indicated that the probability of expulsion was increased 5.263 times (95% CI 2.304-12.024) in group 2 compared with that in group 1 (p <0.001). CONCLUSIONS: The selective alpha1D-blocker naftopidil can significantly facilitate spontaneous passage of distal ureteral stones with few side effects, providing a new choice for medical expulsive therapy.