Bladder Lithiasis Research Articles

Extracorporeal Shock Wave Lithotripsy for Bladder Stones

Bladder lithiasis accounts for around 5% of all urinary tract stones diseases with typical symptoms dysuria, hematuria, urgency and intermittent urination. therapy, percutaneous procedures, and open surgical treatments have been replaced by transurethral lithotripsy. The aim of this study is to investigate the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of vesical lithiasis. A total of 47 patients underwent ESWL for bladder calculi, using the electromagnetic Dornier Lithotripter S. Stone and prostate size as well as postvoid urine residual was determined with sonography. The success of the procedure was determined in the absence of stone fragments after 4 weeks. The mean age of patients was 69.1 years (34–93 ± 11.43) with a median prostate size at 50.1 cm3 (0–85 ± 15.81) and an average postvoid residual at 131 ml (50–190 ± 32.82). The mean size of lithiasis was found 1.97 cm (1–4.5 ± 0.79) and the median number of impact waves 2704.34 (1800–3000 ± 293.37) with the average duration of session 20.63 min (15–25 ± 2.63). Only two patients received analgesic treatment and the mean pain visual analog scale score was 1.73 (0–4 ± 0.98). The stone-free rate was found at 76.5% (36/47) and no severe complications (Clavien–Dindo >2) were observed. ESWL is a safe and efficient alternative for the management of vesical lithiasis, especially for high-risk patients that are not candidates for a more invasive treatment.

Critical analysis of a multicentric experience with holmium laser enucleation of the prostate for benign prostatic hyperplasia: outcomes and complications of 10years of routine clinical practice.

To assess the perioperative outcomes of holmium laser enucleation of the prostate (HoLEP) in real-life practice and investigate the factors influencing the safety and effectiveness of the technique. Critical analysis of patients with benign prostate hyperplasia (BPH) treated with HoLEP over 10years of routine practice in three hospitals. Analysed variables included: preoperative characteristics (prostate size, active antiplatelet/anticoagulant therapy, blood parameters. prostate-specific antigen (PSA) level, maximum urinary flow rate [Qmax ], and International Prostate Symptom Score [IPSS]), intraoperative variables (operation time, concomitant removal of bladder calculi, and complications), early postoperative outcomes (change in blood parameters, catheterisation time, and hospital stay), and 12-month follow-up outcomes (change in IPSS, PSA level, and Qmax ). The analysis included 963 patients, aged 48-91years, with a mean (range) prostate size of 91(35-247)mL. The mean (sd) operation time was 77(29)min, and the hospital stay and catheterisation time were 4(2) and 1.3(2)days, respectively. In all, 56 patients (5.6%) required concomitant removal of bladder calculi and 36 (3.7%) were converted to open prostatectomy or transurethral resection of the prostate due to intraoperative complications. Patients had a significant decrease in haemoglobin and haematocrit, but no differences were seen between patients with and without anticoagulant/antiplatelet therapy and those with prostates ≥ and <100mL. The concomitant removal of bladder calculi and having a prostate ≥100mL resulted in a longer operation time, but did not influence the safety and effectiveness outcomes. HoLEP is suitable for real-life patients with BPH, irrespective of the presence of active treatment with anticoagulant/antiplatelet, bladder lithiasis or a prostate ≥100mL.

Percutaneous or Transurethral Cystolithotomy for Bladder Lithiasis: Which is Safer?

Introduction: Although the risk of urethral trauma while treating bladder stones is worrisome, evidence about the best treatment approach is scarce. The aim of this study is to compare the safety and efficacy of transurethral cystolithotomy and percutaneous suprapubic cystolithotomy in adults´ bladder lithiasis treatment.&#x0D; Methods: We retrospectively evaluated 120 patients (January 2012 to December 2017) who were surgically treated for bladder lithiasis with percutaneous suprapubic cystolithotomy (n= 20) and transurethral cystolithotomy (n= 100). Age, gender, calculi size, surgery duration, hospital stay, post-operative infections, haematuria, pain and urethral strictures were evaluated. Previous diagnosis of benign prostate hyperplasia and urethral strictures were also considered.&#x0D; Results: Both groups were homogeneous according to the pre-operative variables evaluated, including calculi dimensions and simultaneous diagnosis. Median surgery time in percutaneous suprapubic cystolithotomy and transurethral cystolithotomy were 65 and 58 minutes, respectively (p= 0.043). Pain and haematuria were similar in both groups. Median hospital stay was 2.0 days in both groups. Median follow-up time was 13 months. In the transurethral cystolithotomy, three patients (3%) developed urethral stricture while none of the patients treated with PSC developed urethral strictures during the follow-up (p= 0.435).&#x0D; Discussion: Percutaneous suprapubic cystolithotomy theoretically offers an advantage over transurethral cystolithotomy in terms of urethral trauma, although we did not observe a significant difference. However, it deserves to be considered, especially in patients with known urethral strictures that may hinder transurethral access. Further prospective studies with more patients may however confirm these theoretical advantages.

THE CONVERSION TO OPEN SURGERY IN LAPAROSCOPIC CHOLECYSTECTOMY

After more than 20 years from the beginning of laparoscopic surgery, laparoscopic cholecystectomy still holds a conversion rate of 5.1 % in the specialty literature. We have conducted a retrospective study based on the experience of the clinical unit of General Surgery within “Prof. Dr. A. Ionescu” Emergency Clinical Hospital, between 1997 and 2013. A number of 2,309 laparoscopic cholecystectomies were performed. The average age of the group was 47.3 years. Conversion was performed to a number of 58 patients (2.51%), out of which 74.13% women (no. = 43) and 26% men (no. 15). The average age of the patients to whom the conversion was performed was 57. Conversion to open cholecystectomy was more frequent in patients over 60 (no. 38). The main preoperative diagnosis in converted patients was acute lithiasic cholecystitis. Laparoscopic cholecystectomy is a safe method with optimal results, being considered the “gold standard” in the treatment of bladder lithiasis. Conversion to open surgery is an expression of the surgeon’s experience and wisdom.

25 - Is prostatic endoscopic surgery a “must” after stone endoscopic removal in patients with BPH and bladder lithiasis?

25 - Is prostatic endoscopic surgery a “must” after stone endoscopic removal in patients with BPH and bladder lithiasis?

A closer look at the health of cats showing urinary house-soiling (periuria): a case-control study.

The aim of this study was to perform a case-control medical evaluation of cats from multi-cat households presenting with inappropriate latrining and spraying behavior. Owners of 18 'spraying' and 23 'latrining' cats with normal control subjects available from the same households were recruited for a case-control study. Otherwise overtly healthy dyads (each dyad consisting of a case cat and a control cat) were brought together to the veterinary hospital of the University of São Paulo for a medical work-up (ie, physical examination, complete blood count, biochemical profile, urinalysis and urine culture, abdominal ultrasound of the urinary system and in females, where possible, cystoscopy). Medical problems were identified with similar frequency in the 'sprayers' (38.9%), 'latriners' (39.1%) and controls of the latrining group (26.1%), but not the controls of the spraying group (5.5%). The difference between 'cases' and 'controls' from spraying households was significant. Common potential health-related changes include renal insufficiency, cystitis and bladder lithiasis. Renal calculi, higher creatinine levels (within normal reference interval) and 'glomerulations' (detected during cystoscopy) were also found in the remaining sprayers and latriners that were considered clinically healthy. Post-cystoscopy, a new form of periuria occurred in two cats (one sprayer and one latriner). These results indicate that spraying or latrining behavior in the home, as well as living with a cat that is not using the litter box as a latrine, are all associated with a higher level of urinary tract abnormalities; living with a cat that is spraying, however, does not have this association. The findings also suggest that both forms of periuria might be associated with interstitial cystitis. We therefore conclude that all cats with periuria need to be carefully evaluated medically and that treatment of latrine-related problems should consider all cats in the house, whereas spraying may be more focused on the individual displaying the problem.

Cytokeratin 20 immunocytochemistry on urine sediments: A potential low-cost adjunct to cytology in the diagnosis of low-grade urothelial carcinoma.

Urine cytology is the corner-stone for the diagnosis of urothelial neoplasia; however, a substantial proportion of low-grade carcinomas are reported as inconclusive owing to scant cellularity and subtle cytological features. Biomarkers applied on urine sediment smears of such patients are likely to be clinically relevant. Access to Food and Drug Administration approved urinary biomarkers in resource limited setting is poor. Detection of cytokeratin 20 (CK20) in urine sediments, although still a research tool, is a promising marker as immunocytochemistry is performed regularly in several Indian laboratories. We tested the clinical utility of CK20 immunocytochemistry as a potential low-cost adjunct to urine cytology in diagnosis of low-grade urothelial carcinoma. One hundred and fifty fresh, voided urine specimens from 42 cases of biopsy proven urothelial neoplasia (14 high grade, 28 combined low-grade [n=26]) and low malignant potential [n=2]), and 20 non-neoplastic lesions were included in the study sample. Confident diagnosis of malignancy was possible in five (17.8%) low-grade malignancies. Thirteen of 16 (81.3%) low-grade malignancies with inconclusive cytology showed positive CK20 expression. This reduced the proportion of low-grade cases with inconclusive cytology from 57.1% to 10.7% (P=.021). In addition, we could correctly classify one case of bladder lithiasis with false positive urine cytology. Discrepant CK20 staining (positive) was seen in one patient with acute cystitis. CK20 expression in non-umbrella cells is a robust marker of urinary bladder carcinoma. It has potential clinical utility for identification of low-grade urothelial malignancy with inconclusive cytological diagnosis.

Influence of bladder lithiasis on lower urinary tract dynamics in patients with spinal cord injury.

A prospective and a case-matched control study. To study the lower urinary tract dysfunction associated with bladder lithiasis in patients with spinal cord injury (SCI). Toledo (Spain). We have carried out a urodynamic study in 30 patients with SCI with lithiasis in their bladder before and 3 months after bladder endoscopic lithotripsy. This second study was compared with the urodynamic findings of a different group of 30 patients with SCI, without a history of bladder lithiasis, paired with cases by gender and date of urodynamic study. We have found that the prevalence of neurogenic detrusor overactivity (NDO) was significantly different after bladder lithotripsy, although the cystomanometric capacity was significantly increased. A group of patients with lithiasis showed a maximum flow rate, a voiding maximum detrusor pressure and the detrusor contractility parameter Wmax lower than that in controls. On the other hand, a voiding abdominal straining was found to be significantly greater than that in controls. Bladder lithiasis affects the presence of NDO in patients with SCI. Patients with SCI who develop bladder lithiasis present a lower detrusor contractility power compared with those who do not.

Treatment of bladder lithiasis using a percutaneous approach in a patient with Mitrofanoff conduit.

Treatment of bladder lithiasis using a percutaneous approach in a patient with Mitrofanoff conduit.

A laparoscopic approach to a large simple hepatic cyst a case report

Laparoscopic fenestration has recently been considered a standard procedure for non parasitic symptomatic liver cysts.The objective of our observation was to show the laparoscopic approach of a large cyst of the hepatic dome. A 54-year-old woman with no pathological history who consulted for chronic pain in the right hypochondrium. The radiological explorations had objectified a large hepatic cyst and an uncomplicated gall bladder lithiasis. Hydatid serology was negative. The treatment consisted of a wide fenestration by laparoscopy after careful puncture of the cyst in order to eliminate a parasitic pathology and an aspiration of around 1.8 liter of a brownish liquid, a cholecystectomy and the exteriorization of the cyst wall in an endobag. The histological study was in favor of a simple liver cyst. Laparoscopic fenestration is the reference treatment for symptomatic simple liver cysts, especially when the cysts are large or difficult to puncture under ultrasound.

Type IV rectal prolapse secondary to a long‐standing urinary bladder lithiasis in a donkey

SummaryRectal prolapse has been attributed to conditions generating tenesmus or increasing abdominal pressure in both horses and donkeys. This report presents the case of a 7‐year‐old gelded donkey that sustained a type IV rectal prolapse secondary to a long‐standing cystic calculus after several episodes of intermittent mucosal prolapse. Rectal prolapse was addressed first on an emergency basis by colorectostomy. After medical stabilisation, pain and straining management with repeated epidural drug administrations, a laparoscopic‐assisted cystotomy was performed one week later to remove the calculus. The donkey was discharged and resumed his normal life at pasture.

Radiographical Assessment of the Urinary System Diseases in Cats

Introduction: The urinary system is frequently diseased in cats. Although the radiographical technique is not the best choice for studying most of the urinary organs, it still remains a valuable tool particularly for ureteral, urinary bladder and urethral disorders. 1 Aims: This study aims to describe the aspects of urinary tract pathologies in cats with different urinary diseases, radiographicallydiagnosed. Materials and methods: Twenty-two cats were included in the study after a revision of the database of Interdepartmental Veterinary Radiology Centre of Naples and of Veterinary Radiological Laboratory of Iasi, in the period 2000-2012. Survey and contrast medium radiographs were taken in consideration. The diagnosis of the subjects included was also confirmed with other techniques (i.e. ultrasonography, surgery and/or necropsy). Results: Pathological findings that were diagnosed on survey radiographs included: changes in kidney size (2), renal and ureteral lithiasis (3), urinary bladder distension (4), and urinary bladder lithiasis (2).With contrast radiography (i.e. excretory urography and cystography), it was possible to diagnoserenal ectopia with fusion (1), cysts (1), and hydronephrosis (1), dilatation (2), and incompetence (1), urinary bladder cystitis (4) and tumors (2), and urethral stenosis (2). Conclusions: Considering the relative small number of cases, the present study, confirmed that the radiographical technique is not the best choice to image the urinary tract diseases. However, especially when accompanied by contrast studies, radiography demonstrates to be a reliable tool to diagnose urinary pathologies and it still maintains its importance, particularly when other techniques are not available.

Rare cases of bladder stones

We present here two special cases of urolithiasis. The first one shows a giant bladder lithiasis resulting in severe renal insufficiency in a 63-year-old patient, who had previously had nicturia (2-3 times), occasional episodes of urinary frequency and burning micturition, in the absence of renal colic, hematuria or interrupted urination. The second case referes to an 85-year-old man suffering from prostatic enlargement and bladder stones, hospitalized to undergo intervention of trans-vesical prostatic adenomectomy, during which two star-shaped stones were found without obvious symptoms.

Tratamento cirúrgico da litíase vesical: revisão de literatura

Bladder stones are rare and most cases occur in adult men with bladder outlet obstruction. Currently, there are few data on the best treatment of this disease. The aim of this review is to discuss some aspects of pathogenesis and treatment approaches for bladder lithiasis. A comprehensive search of the database of the "National Library of Medicine" /pubmed was conducted with the following key words and descriptors: "bladder" or "vesical" associated with "calculus", "stone" or "lithiasis", and "cistolithotripsy ". One hundred and seventy-one articles were identified. The articles were independently assessed by two reviewers with expertise in urolithiasis. They were included in the study when the results, complications and follow-up were clearly reported. In the end, 32 studies met the inclusion criteria. Several options for the treatment of bladder lithiasis are available, but no randomized trials comparing them. Different rates of calculus-free patients are described in each of them, as follows: extracorporeal shock wave lithotripsy (75-100%), transurethral cistolithotripsy (63-100%), percutaneous cistolithotripsy (89-100%) and open surgery (100 %). The percutaneous approach has lower morbidity, with similar results to the transurethral treatment, while extracorporeal lithotripsy has the lowest rate of elimination of calculi and is reserved for patients at high surgical risk.

Definitely NOT Just another Hernia

A 77-year-old male presented to our emergency department (ED) with a 3-hour history of acute severe lower abdominal pain, inability to void, a swollen scrotum, and one episode of vomiting. His relevant past medical history included: hypertension, diabetes mellitus, and distant right inguinal hernia repair. Vital signs were: 96.4° F, 101, 22, and 205/90. Examination revealed a normal abdomen and an irreducible left inguinal hernia. Foley catheter placement yielded a scant amount of infected urine that stopped flowing almost immediately and did not resume despite catheter flushing and repositioning. Additional laboratory data did not identify the cause of the patient’s symptoms. An abdominopelvic computed tomography (CT) was performed (Figures 1 and ​and2)2) after which the patient underwent emergent operative reduction of his incarcerated scrotal cystocele. Figure 1. Scrotal cystocele-transverse view. Bladder entering inguinal canal. Arrow marks focal volvulus. Figure 2. Asterisk marks distal obstructed bladder. Complete bladder herniation into an inguinal hernia sac is referred to as a scrotal cystocele. This very rare condition is previously unreported in the emergency medicine literature. Some bladder involvement occurs in 1 – 4% of all inguinal hernias1 and is often an incidental (generally benign) operative finding. Patients with partial bladder herniation may report “double phase micturition.” This occurs when the patient voids then passes more urine by applying pressure to their hernia.2 Scrotal cystocele can be associated with bilateral hydronephrosis, acute renal failure, bladder lithiasis and necrosis, vesicoureteral reflux, and scrotal abscess.1 This inherently serious condition mimics the far more common inguinal hernia containing fat or bowel. Risk factors include: patients over 50 years of age, males, and obesity. ED ultrasound may strongly suggest or confirm the diagnosis. CT is definitive. Due to its associated morbidity, emergency physicians should consider scrotal cystocele in males with obstructive uropathy and an associated inguinal hernia.

Outpatient Simultaneous Treatment of Benign Prostatic Hyperplasia and Bladder Lithiasis with GreenLight™ and Holmium Laser

To evaluate our experience in the combined treatment of benign prostatic hyperplasia (BPH) and bladder lithiasis with GreenLight(™) and holmium laser, respectively, on an outpatient basis. From August 2006 to May 2009, 20 patients with prostatic hyperplasia and bladder lithiasis were treated. First, the lithiasis was treated, and then the GreenLight laser vaporization of the prostate was performed, both at the same surgical time and under general anesthesia. Discharge of patients was scheduled 3 to 4 hours after completion of the procedure. The procedure was simultaneously completed in 19 of 20 patients. The mean stone size was 2.3 (1-4) cm, and the mean prostate volume was 56.5 (30-108) cc. The mean operating time was 115 (50-190) minutes. There was a significant percentage change in maximum flow, postmicturition residual volume, and International Prostate Symptom Score, which were 129.5%, 88.4%, and 68.3%, respectively. All patients were stone free after the procedure. The combined transurethral treatment of BPH associated with bladder lithiasis by means of GreenLight laser vaporization and holmium laser lithotripsy on an outpatient basis can be performed safely and yields excellent results.

UP-03.090 Endoscopic Extraction of Bladder Lithiasis Through a Mitrofanoff Continent Diversion: A New Surgical Procedure

Bladder-stone formation is common problem following continent urinary diversion with augmentation cystoplasty. We describe a minimally invasive technique using electro hydraulic vesicolithotripsy via a Mitrofanoff conduit.

Incidental Findings of Nongynecologic Pathology in Transvaginal US Examination

To show that an exhaustive examination of the pelvis is necessary to obtain further information about other pelvic organs beyond the internal genitalia. We describe the most representative incidental findings of nongynecologic pathology found at a transvaginal US scan, all of which were realized in our institution in the last 5 years. We studied the anatomic structures next to the internal genitalia. In intestinal pathology we found affection of the small bowel, such as intestinal invagination; and of the large intestine also, inflammatory pathology is the most common, such as sigmoiditis and proctitis. Also, pathologies of the urinary tract were found several times, including obstruction-induced bladder dysfunction, ureteral and bladder lithiasis, polyps, tumors and diverticula among others. The most often vascular lesion was pelvic varicocele. Finally, those pathologies and anatomic variations were characterized as miscellaneus, including pelvic kidney, retroperitoneal lipoma and peritoneal carcinomatosis. Transvaginal US scan should not be limited only to the evaluation of the genital organs, but also be used to make an integral examination of the pelvis. This procedure allows, frequently, to diagnose extragynecologic lesions in patients who have pelvic discomfort or pain, or those who are asymptomatic.

Prospective Comparative Study of Endoscopic Management of Bladder Lithiasis: Is Prostate Surgery a Necessary Adjunct?

To present the results of a prospective study comparing transurethral cystolithotripsy and simultaneous transurethral resection of the prostate (TURP), with transurethral cystolithotripsy and medical treatment of benign prostatic hyperplasia. The traditional dogma that bladder lithiasis constitutes an absolute indication for prostatic surgery has recently been questioned. A total of 64 patients with bladder calculi were included in the present study. In all patients, stone clearance was achieved transurethrally. The patients in group 1 (n=32) underwent TURP during the same session, and the patients in group 2 (n=32) underwent medical therapy for benign prostatic hyperplasia (tamsulosin plus finasteride). The mean follow-up was 28.23±8.84 months. No statistically significant differences were found between the 2 groups regarding the preoperative parameters (age, International Prostate Symptom Score, prostatic volume, peak urinary flow rate, postvoid residual urine volume, prostate-specific antigen level, and bladder stone characteristics). Both groups experienced statistically significant postoperative improvements in the International Prostate Symptom Score, peak urinary flow rate, and postvoid residual urine volume. However, patients in group 1 experienced a more pronounced improvement in the International Prostate Symptom Score (P=.02) and peak urinary flow rate (P=.001). In total, 11 patients in group 2 underwent TURP during follow-up, with medical management considered to have failed. Multivariate logistic regression analysis revealed the postvoid residual urine volume as an independent risk factor that predicted the need for TURP in group 2 patients (odds ratio 1.033, 95% CI for odds ratio 1.007-1.060, P=.014). The findings of the present study have provided useful information on the natural history of bladder lithiasis, particularly in the context of improved patient consultation.

Idiopathic Infantile Bladder Lithiasis from Roman Antiquity

Idiopathic Infantile Bladder Lithiasis from Roman Antiquity