Calculi In Upper Urinary Tract Research Articles

Study of factors predicting clinical outcomes of extracorporeal shock wave lithotripsy in Indian patients with upper urinary tract calculi

Background: Extracorporeal shock wave lithotripsy (ESWL) is an effective non-invasive method for managing urinary tract calculi. Present study was undertaken to evaluate factors that may influence ESWL clinical outcomes in Indian patients with urinary tract calculi.Methods: This prospective study was conducted at Department of Urology, Medical Trust Hospital Cochin, India in the period from September 2006 to March 2009. Sixty patients with upper urinary tract lithiasis having stone size between 5 to 25 mm were included and patients with ˃2 calculi, distal ureteric obstruction (not relieved), renal anomalies were excluded. All patients were treated with DIREX medical system lithotripter. Clinical outcome of ESWL was assessed by factors like site, size, density and skin-to-stone distance. After statistical analysis, p-value ≤0.05 was taken as the level of significance.Results: The overall success of ESWL was 82%. The final success of ESWL for sites like ureter, pelvis, mid or upper and lower calyx were 94.1%, 84%, 85.7% and 58% respectively (p = 0.095). The rate of fragmentation of stone after one session of ESWL for stone size ≤10 mm, 11 mm - 20 mm and ≥21 mm was 76.5%, 68.4% and 16.7% respectively (p=0.009). For stone density 751-1000 HU, 22.2% patients required ≥2 sessions to achieve stone free status (p<0.0005). Around 15.6% patients in skin-to-stone distance (SSD) ≤10cm required ≥2 sessions to achieve stone free status (p = 0.27).Conclusions: ESWL should be considered a primary modality of treatment in patients with calculi size ≤20 mm, density ≤ 1000 HU, pelvic, ureteric and upper and/or middle calyceal calculi and for SSD ≤10 cm.

Risk factors for repeat surgical intervention in pediatric nephrolithiasis: A Pediatric Health Information System database study

Successful surgical therapy for pediatric upper urinary tract calculi (UUTC) minimizes the need for repeat surgical interventions. However, staged procedures, whether planned or unplanned, are sometimes necessary. We assessed predictors of repeat intervention for children with UUTC using a nationwide administrative dataset. Using the Pediatric Health Information System (PHIS) dataset, we assessed children with UUTC undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) for an index stone from January 2010 to June 2015. Primary outcome was additional treatment for nephrolithiasis within 90 days. Patient and procedural variables were assessed as potential risks for retreatment. Multivariable logistic regression models were used to compare the risk of retreatment adjusting for potential confounding factors. A total of 2788 patients undergoing URS (2,216, 79.5%) and SWL (572, 20.5%) were identified. SWL, stenting at the index operation without pre-index stenting, chronic comorbidities, renal calculi, and age <5 years were independent risk factors for retreatment. Use of ureteral stenting, most commonly employed in URS, was also a strong predictor of retreatment. Odds for reintervention, adjusted by multivariate modeling, are shown in the Figure. Adjusting for measured confounders, SWL is associated with a 2.6-fold higher risk of repeat stone-related interventions. Additional patient-related factors also increase likelihood of retreatment. Intra-operative stent placement is a strong predictor of retreatment, perhaps serving as a marker for complex cases or planned staged procedures. Prospective studies are needed to assess comparative effectiveness of SWL and URS and improve mono-therapeutic success for children with UUTC.

SOFA and quick SOFA are more clinically useful scoring systems than SIRS in predicting mortality of patients with acute pyelonephritis associated with upper urinary tract calculi

SOFA and quick SOFA are more clinically useful scoring systems than SIRS in predicting mortality of patients with acute pyelonephritis associated with upper urinary tract calculi

Performance of Quick Sequential (Sepsis Related) and Sequential (Sepsis Related) Organ Failure Assessment to Predict Mortality in Patients with Acute Pyelonephritis Associated with Upper Urinary Tract Calculi

The Third International Consensus Definitions for Sepsis and Septic Shock Task Force proposed a new definition of sepsis based on the SOFA (Sequential [Sepsis-related] Organ Failure Assessment) score and introduced a novel scoring system, quickSOFA, to screen patients at high risk for sepsis. However, the clinical usefulness of these systems is unclear. Therefore, we investigated predictive performance for mortality in patients with acute pyelonephritis associated with upper urinary tract calculi. This retrospective study included 141 consecutive patients who were clinically diagnosed with acute pyelonephritis associated with upper urinary tract calculi outside the intensive care unit. We evaluated the performance of the quickSOFA, SOFA and SIRS (systemic inflammatory response syndrome) scores to predict in-hospital mortality and intensive care unit admission using the AUC of the ROC curve, net reclassification, integrated discrimination improvements and decision curve analysis. A total of 11 patients (8%) died in the hospital and 26 (18%) were admitted to the intensive care unit. The AUC of quickSOFA to predict in-hospital mortality and intensive care unit admission was significantly greater than that of SIRS (each p <0.001) and comparable to that of SOFA (p = 0.47 and 0.57, respectively). When incorporated into the baseline model consisting of patient age, gender and the Charlson Comorbidity Index, quickSOFA and SOFA provided a greater change in AUC, and in net classification and integrated discrimination improvements than SIRS for each outcome. Decision curveanalyses revealed that the quickSOFA and SOFA incorporated models showed a superior net benefit compared to the SIRS incorporated model for most examined probabilities of the 2 outcomes. The in-hospital mortality rate of patients with a quickSOFA score of 2 or greater and a SOFA score of 7 or greater, which were the optimal cutoffs determined by the Youden index, was 18% and 28%, respectively. SOFA and quickSOFA are more clinically useful scoring systems than SIRS to predict mortality in patients with acute pyelonephritis associated with upper urinary tract calculi.

Pediatric hospitalizations for upper urinary tract calculi: Epidemiological and treatment trends in the United States, 2001–2014

The incidence of urolithiasis in the pediatric population in the United States has steadily been increasing over the past few decades. Few studies to date have examined trends in the hospitalization and inpatient surgical treatment of urolithiasis in the pediatric population using nationally representative data. The aim was to evaluate nationwide trends in the rates of pediatric hospitalization and inpatient surgical activity for upper urinary tract calculi (UUTC) in the United States from 2001 to 2014. The National Inpatient Sample (NIS) databases for 2001-2014 were queried. Hospitalizations for patients younger than age 18 (excluding newborns), with principal discharge diagnoses of kidney or ureteral calculi were selected. Surgical procedures during hospitalization were identified. Hospitalization and surgical activity data were analyzed using trends tests, chi-square statistics, and multivariable logistic regression as appropriate. Of an estimated 30.2 million pediatric hospitalizations during the study period, 44,369 overall (147 per 100,000) were for UUTC. The total number and proportion of UUTC hospitalizations per 100,000 all-cause admissions significantly decreased between 2001 and 2014 (p<0.0001) (figure). Surgical intervention was undertaken in 19,946 (45%) of UUTC hospitalizations, with significantly increasing frequency over the study interval (p<0.0001). Urinary tract drainage was the most frequently performed surgical intervention. On multivariable analysis, significant predictors of a higher likelihood of undergoing inpatient surgical intervention during hospitalization for UUTC included older age, female gender, deficiency anemias, hypertension, neurologic disorders, paralysis, and hospitalization after 2001. The declining trend in hospitalization for UUTC likely reflects a shift toward outpatient care for routine cases, reserving hospitalization for sicker patients or those with complications of urolithiasis. Similar to previous studies, we also observed that girls were significantly more likely than boys to be hospitalized for stone disease, and that majority of the stone activity in the pediatric population was in children aged 15-17 years. We also observed a sharp increase in the proportion of hospitalized patients who underwent surgical intervention between 2001 and 2014, but the primary driver of this trend remains uncertain. Pediatric hospitalizations for UUTC in US children significantly decreased between 2001 and 2014, while of those hospitalized the proportion who underwent stone-related surgical intervention significantly increased over the same period. Ashifttowards outpatient care, reserving hospitalization and inpatient surgical care for sicker patients, those with urolithiasis-related complications, or those who fail conservative management, is a possible explanation for these observed trends.

Advantages of foley catheter for nephrostomy tube after minimally invasive percutaneous nephrolithotomy

To assess the advantages and nursing experience of foley catheter for nephrostomy tube after minimally invasive percutaneous nephrolithotomy (mPCNL). Methods: From October 2015 to April 2016, the clinical data of 137 patients, who were diagnosed with upper urinary tract calculi and need to perform mPCNL, were collected and randomized into 2 groups: a foley catheter group (research group, n=69) and a normal nephrostomy tube group (control group, n=68). The patients in research group used foley catheter for nephrostomy tube, while those in the control group used normal nephrostomy tube. Bleeding volume, the days of bleeding, pipes shedding and pain degree were compared, and the experience of the nursing process was summarized. Results: The bleeding volume, the days of bleeding in the research group were significantly lower than those in the control group (both P<0.01). The pipes shedding rate in the research group were lower than that in the control group (P<0.05). There was no significant difference in postoperative pain scores between the 2 groups (P>0.05). There was no other complications and discomfortable symptoms in the experimental group. Conclusion: The use of foley catheter for nephrostomy tube after mPCNL is safe, and it can decrease the bleeding volume and pipes shedding rate. It doesn't increase the patient's postoperative pain and can reduce the difficulty and risk for postoperative nursing.

MP66-17 RISK FACTORS FOR REPEAT SURGICAL INTERVENTION IN PEDIATRIC NEPHROLITHIASIS: A PEDIATRIC HEALTH INFORMATION SYSTEM® DATABASE STUDY.

Summary Introduction Successful surgical therapy for pediatric upper urinary tract calculi (UUTC) minimizes the need for repeat surgical interventions. However, staged procedures, whether planned or unplanned, are sometimes necessary. We assessed predictors of repeat intervention for children with UUTC using a nationwide administrative dataset. Methods Using the Pediatric Health Information System (PHIS) dataset, we assessed children with UUTC undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) for an index stone from January 2010 to June 2015. Primary outcome was additional treatment for nephrolithiasis within 90 days. Patient and procedural variables were assessed as potential risks for retreatment. Multivariable logistic regression models were used to compare the risk of retreatment adjusting for potential confounding factors. Results A total of 2788 patients undergoing URS (2,216, 79.5%) and SWL (572, 20.5%) were identified. SWL, stenting at the index operation without pre-index stenting, chronic comorbidities, renal calculi, and age Conclusions Adjusting for measured confounders, SWL is associated with a 2.6-fold higher risk of repeat stone-related interventions. Additional patient-related factors also increase likelihood of retreatment. Intra-operative stent placement is a strong predictor of retreatment, perhaps serving as a marker for complex cases or planned staged procedures. Prospective studies are needed to assess comparative effectiveness of SWL and URS and improve mono-therapeutic success for children with UUTC. Download : Download high-res image (217KB) Download : Download full-size image Figure Odds of repeat intervention, adjusted on multivariate analysis.

Safety and efficacy of staged retrograde intrarenal surgery for large stone burden of renal stones in selected patients: A single-center experience

ObjectiveManagement of patients with upper ureteral and renal urolithiasis is challenging for endourologists. Since the advancements in endourological equipment/devices, retrograde intrarenal surgery (RIRS) has become an attractive, widespread technique for upper urinary tract stone manipulation, owing to its advantage of being noninvasive with higher stone clearance rate and less pain compared with traditional shock wave lithotripsy (SWL) and percutaneous nephrolithotripsy (PNL). However, the outcome and complication of staged RIRS for large stone burden (> 2.0 cm) management for renal stones still need to be reported. A total of 172 cases of renal calculi were treated by RIRS in a single center; among these, 22 had renal stone size larger than 2.0 cm. In this work, we present our experience and treatment outcomes of these patients. Materials and methodsBetween August 2015 and January 2016, we enrolled 172 patients with upper urinary tract calculi who underwent RIRS with holmium laser lithotripsy performed by one surgeon in a singer center. Based on a medical record review, we collected data pertaining to the outcomes and complications of RIRS. ResultsA total of 172 patients with upper urinary tract stones were included in this study (113 male and 59 female patients). All patients underwent RIRS with holmium laser lithotripsy procedure. The overall stone-free rate (SFR) was 90.6%. The average stone size was 0.8 cm with average operation time of 89.7 minutes. Average hospital stay was 2.7 days. The average pain score was 2.38/10 by the Numerical Rating Scale. In the large stones size subgroups, the SFR of stone burden between 2.0 cm and 3.0 cm was 80.2%, and the SFR of stone burden over 3.0 cm was 45.0% by single RIRS. Ten of 22 patients underwent two-staged RIRS and their SFR improved from 45.0% to 76.5%. No major complications (Clavien III–V) were noted in the study groups. ConclusionTo the best of our knowledge, RIRS for large renal stone manipulation is an effective and safe treatment modality currently. In our study, the single RIRS SFR was superior to PNL or SWL even when the stone burden was between 2.0 cm and 3.0 cm (80.2%). For those patients whose stone burden was over 3.0 cm or for those with comorbidities, staged RIRS resulted in a lower complication rate, reduced hospital stay, and better SFR (76.5%).

Chemical composition of urinary stones in Rahim Yar Khan and adjacent districts of Sindh and Baluchistan

Aim: To find out the constituents of the urinary stones, so that preventive measures would be taken against recurrence. Patients and methods: A total No. of 200 consecutive patients with upper urinary tract calculi, that were operated in the urology and general surgical wards of Sh. Zayed Hospital Rahim Yar Khan were included in the study. In addition to Rahim Yar Khan the patients also came from adjacent districts of Sindh and Baluchistan. Qualitative Chemical analysis was carried out using Merchognost (Germany) urinary calculi analysis kit. All the tests were performed according to the instruction of manufacturers of the kit. Results: Stone samples were collected from 200 patients, out of these 138 (69%) were male and 62 (31%) of patients were female with male to female ratio 2.2:1 age range was between 9-72 years. Results of stone analysis indicate that calcium oxalate is the most common ingredient found in 100% of the stone samples. In 83% of patients it was found mixed with other varieties of stones while in 17% samples it was seen in pure form. Uric acid was the second most common ingredient seen in 73% of patients mixe d with calcium oxalate and magnesium ammonium phosphate but it was not found as pure form. Magnesium Ammonium phosphate found in 13% of stones samples in mixed form only, not as isolated stone.

National Practice Pattern and Time Trends in Treatment of Upper Urinary Tract Calculi in Korea: a Nationwide Population-Based Study.

Despite high prevalence of upper urinary tract calculi (UUTC), there are few studies regarding patterns of care in Asian populations. We investigated treatment patterns and time trends in patients with newly diagnosed UUTC in Korea using the National Health Insurance database that includes de-identified claims from a random 2% sample of the entire population (> 1 million people). A total of 14,282 patients who received active treatments, including shock wave lithotripsy (SWL), ureteroscopic surgery (URS), percutaneous nephrolithotomy (PNL), and uretero/pyelolithotomy (UPL), for newly diagnosed UUTC between 2003 and 2013 were included. The number of primary and all treated cases of UUTC significantly (43% and 103.3%, respectively) increased over the 10-year period. While patients undergoing SWL, URS, PNL, and UPL as primary treatment increased by 43.7%, 31.9%, 87.5%, and 0%, respectively, the relative proportion undergoing each treatment remained constant over the 10 years (SWL > 90%, URS 4.5% to 7.8%, PNL 0.4% to 1.0%, and UPL < 0.4%, respectively). Multinomial logistic regression analysis showed that age > 40 years (compared to age < 30 years) was significantly associated with URS, PNL, and UPL, rather than SWL, while patients living in urban or suburban/rural areas (compared to metropolitan) were significantly less likely to undergo URS and PNL. In summary, the majority of Korean patients underwent SWL as primary treatment for UUTC, and the predominant use of SWL remained steady over a 10-year period in Korea. Our results will be valuable in examining treatment patterns and time trends in Korean UUTC patients.

Flexible ureteroscopic laser lithotripsy for upper urinary tract stone disease in patients with spinal cord injury.

The objective of this study is to present the outcomes of flexible ureteroscopic laser lithotripsy (URS) for upper urinary tract stone disease in spinal cord injury (SCI) patients performed by a single surgeon. A retrospective analysis was performed for SCI patients treated with flexible URS for proximal ureter and kidney stone disease by a single surgeon between 2003 and 2013. Patient characteristics, operative outcomes, metabolic evaluation, and stone analyses were assessed in detail. A total of 27 URS procedures were performed for urolithiasis in 21 renal units of 19 patients. The mean age was 52.1 ± 15.6 years (16-72) and mean BMI was 29.2 ± 7.3 kg/m(2) (20-45.7). Etiology of SCI was trauma (n: 10), multiple sclerosis (n: 6), cerebrovascular accident (n: 1), or undetermined (n: 2). The mean stone size was 15.9 ± 8.6 (6-40) mm. In the 27 URS procedures, stones were located in the ureter (n: 5), the kidney (n: 14), and both areas (n: 8). Mean hospitalization time was 2.0 ± 2.4 (0-10) days. Postoperative complications were observed in 6 cases (22.2%). Three major complications included urosepsis (n: 1) and respiratory failure (n: 2), that were observed postoperatively and required admission to the intensive care unit. The 2 minor complications were hypotension, fever and UTI, and required medical treatment. Fourteen (66.6%) of the 21 renal units were stone free. Calcium phosphate carbonate (n: 9) and struvite (n: 5) were the primary stone compositions detected. Hypocitraturia (n: 6), hypercalciuria (n: 5), hypernaturia (n: 5), hyperoxaluria (n: 4), and hyperuricosuria (n: 1) were common abnormalities in 24-h urine analysis. Ureteroscopic laser lithotripsy can be an effective treatment modality for SCI patients with upper urinary tract calculi.

97 Factors predicting success of second shock wave lithotripsy for upper urinary tract calculi

97 Factors predicting success of second shock wave lithotripsy for upper urinary tract calculi

Risk Factors of Sepsis in Obstructive Acute Pyelonephritis Associated with Urinary Tract Calculi

Purpose: The aim of this study is to identify the risk factors for development of sepsis in patients with obstructive acute pyelonephritis (APN) associated with urinary tract calculi. Materials and Methods: Between January 2004 and December 2013, 73 patients with obstructive APN associated with upper urinary tract calculi were admitted to our institution. Medical records of 73 patients (14 men and 59 women, mean age of 57 years) were reviewed retrospectively. The risk factors for sepsis were analyzed using multivariate logistic regression analysis. Results: Of 73 patients, 37 (50.7%) developed sepsis. Old age and history of hypertension were more common in the sepsis group than in the non-sepsis group (p<0.001 and p=0.018). The white blood cell count, neutrophil count, plateletto-lymphocyte ratio, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein level were significantly higher in the sepsis group (p=0.011, p=0.001, p=0.042, p<0.001 and p=0.006, respectively). Lymphocyte count, platelet count, and albumin level were significantly lower in the sepsis group (p<0.001, p=0.008 and p<0.001, respectively). Multivariate logistic regression analysis indicated that old age (odds ratio [OR], 2.13; p=0.023), decrease in serum albumin level (OR, 4.27; p=0.041), and high NLR (OR, 3.83; p=0.037) were independent risk factors for development of sepsis. Conclusions: Elderly patients with obstructive APN associated with urinary tract calculi who have low serum albumin levels and high NLR should be treated carefully against development of sepsis.

Upper Urinary Tract Calculi in Senegal: A Comparative Study between Open Surgery and Endoscopy, a Review of 89 Cases

Objective: The aim was to assess the place of endourologic intervention in our practice and compare it to open surgery in the management of upper urinary tract calculi in Senegal. Patients and Methods: This was a retrospective study conducted at both the Principal and Grand Yoff Hospitals of Dakar from January 2009 to December 2013 in which 89 patients with upper urinary tract calculi were mobilized. All patients with symptomatic upper urinary tract colic symptoms were included. Results: Eighty-nine were followed up during the study period, 63 men and 36 women (sex of ratio 1.2). The average age was 44 years with extremes 22 - 75 years. Forty two patients, including 28 men and 14 women (sex ratio 1: 2) were treated with open surgery. The mean age was 42.75 years (4 - 75 years). The average duration of hospitalization after open surgery was 8 days (4 - 60 days). The mean stone size in open surgery was 23 mm (5 mm - 45 mm). Complications noted were: 2 cases of urinomas (4.76%), 1 case of lower back fistula (2.38%), 1 case of renal pelvis fistula (2.38%) and 1 case (2.38%) of infection. Forty seven patients including 35 men (55.6%) and 12 women (46.2%) were treated by endourology. The average length of hospital stay was 2 days (2 d - 3 d). The average stone size treated by endourology was 13 mm (5 mm - 40 mm). No complications were observed in this group. The cost of open surgery was a third of that of endourology. Conclusion: Endoscopic surgery, as is observed from industrialized countries occupies a prominent place in the treatment of upper urinary tract calculi in Senegal; however, the only limiting factor encountered is the cost which remains out of reach for patients and burdening the budgets of our hospitals with limited means.

Success Factors of Extracorporeal Shock Wave Lithotripsy (ESWL) for Renal &amp;amp; Ureteric Calculi in Adult

The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) between October 2008 and July 2012. Eighty five patients were lost on follow up. The remaining (n = 332). All patients were >18 yr of age. Siemens and SLX-F2 electromagnetic machines were used to impart shock waves. Patients were stratified according to localization (pelvic, calyceal, or ureteral stones) and stone size (up to 10 mm, 10 - 20 mm, and >20 mm). Result: The overall success rate was 251/332 (75.6%) achieve stone free status. Repeated ESWL sessions were needed in 258 (61.9%). Of eleven variables were studied including age, sex, side, location (pelvic, calyx, ureter), ureteric stent, previous renal surgery, stone size, number of shock waves, opacity of stone, renal system state, and type of lithotripter, three variables were significantly affect the success rate namely stone size, number of shock waves and location of stone. Conclusions: ESWL remains one of the most commonly utilized treatments for patients with upper urinary tract calculi; Stone diameter, location, and number of shock waves, are the most important predictors determining stone clearance after ESWL of renal and ureteric calculi. To optimize treatment outcomes with ESWL the presence of treating urologist is essential to optimize the final result.

Recent management of urinary stone disease in a pediatric population.

The incidence of stone disease has been increasing and the risk of recurrent stone formation is high in a pediatric population. It is crucial to use the most effective method with the primary goal of complete stone removal to prevent recurrence from residual fragments. While extracorporeal shock wave lithotripsy (ESWL) is still considered first line therapy in many clinics for urinary tract stones in children, endoscopic techniques are widely preferred due to miniaturization of instruments and evolution of surgical techniques. The standard procedures to treat urinary stone disease in children are the same as those used in an adult population. These include ESWL, ureterorenoscopy, percutaneous nephrolithotomy (standard PCNL or mini-perc), laparoscopic and open surgery. ESWL is currently the procedure of choice for treating most upper urinary tract calculi in a pediatric population. In recent years, endourological management of pediatric urinary stone disease is preferred in many centers with increasing experience in endourological techniques and decreasing sizes of surgical equipment. The management of pediatric stone disease has evolved with improvements in the technique and a decrease in the size of surgical instruments. Recently, endoscopic methods have been safely and effectively used in children with minor complications. In this review, we aim to summarize the recent management of urolithiasis in children.

Predictors of septic shock in obstructive acute pyelonephritis

PurposeAcute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi.MethodsWe retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis.ResultsOverall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock.ConclusionPatients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.

Clinical application of physical vibration lithecbole in upper urinary calculi after extracorporeal shock-wave lithotripsy

Objective To observe the curative effect of external physical vibration lithecbole (EPVL) therapy after extracorporeal shock-wave lithotripsy (ESWL) in upper urinary calculi.Methods A total of 133 patients of upper urinary calculi with randomly divided into 2 groups after ESWL therapy during the period of 2012 October to 2013 February.The EPVL group (66 cases) used the physical vibration lithecbole treatment,and the natural lithecbole group (67 cases) used the method by drinking water,adding exercise and other natural lithecbole method.Of the EPVL group,6 of the stones were located in the upper or middle calyx,13 in renal pelvis,16 in lower renal calyx and 31 in ureter,the stone diameter was 10-15 mm.Of the natural lithecbole group,8 of the stones were located in the upper or middle calyx,17 in renal pelvis,15 in lower renal calyx and 27 in ureter,the stone diameter was 10-15 mm.The clinical data of the curative effect,side-effect,and complications were collected and analyzed systematically.Results In the EPVL group,the average times of lithagogue treatment was 2.6 times,51 patients (77％) expelled stones on the day of lithecbole,and the stone free rate in a week was 79％ (52/66).Especially,81％ (13/16) of the lower renal calyx expelled stones on the day of lithecbole,and the stone free rate in a week was 88％ (14/16).Whereas,30 patients (45％) in the natural lithecbole group expelled stones on the day of ESWL,and the stone free rate in a week was 49％ (33/67) ; the lower renal calyx stone expulsion rate on the day of ESWL was 33％ (5/15),and the stone free rate in a week was 40％ (6/15).The curative effects were significantly different between the 2 groups (P＜ 0.05).There were no serious complications in both groups.Conclusions EPVL machine can significantly promote the stone expulsion after ESWL.Compared with traditional methods,EPVL therapy has a better curative effect,especially on lower renal calyx stones.EPVL is a safe and noninvasive treatment. Key words: Lithotripsy; External physical vibration lithecbole; Calculus of upper urinary tract; Stone expulsion rate; Stone free rate

Clinical effectiveness of the PolyScope™ endoscope system combined with holmium laser lithotripsy in the treatment of upper urinary calculi with a diameter of less than 2 cm

The aim of this study was to evaluate the clinical value of the PolyScope™ endoscope system in the treatment of upper urinary calculi with a diameter of <2 cm. A total of 86 patients hospitalized with upper urinary tract calculi were included. The patients were placed under general or spinal anesthesia and in a lithotomy position. Following the dilation of the ureter, a guide wire was inserted under the direct vision of an F8/9.8 rigid ureteroscope, and an F12/14 flexible ureteral access sheath was positioned along the guide wire. Holmium laser lithotripsy was subsequently performed, using an F8.0 ‘PolyScope’ modular flexible ureteroscope. Plain film of the kidney-ureter-bladder (KUB) was performed 1 day subsequent to the surgery, in order to determine the result of the lithotripsy and the position of the double-J stent which was inserted after after holmium laser lithotripsy. In addition, in certain patients, KUB radiography was performed 2–4 weeks subsequent to the surgery, and extracorporeal shockwave lithotripsy (ESWL) was performed if the diameter of the residual stones was >6 mm. Lithotripsy was successful in 77 patients and the duration of the surgery ranged between 25 and 80 min (mean duration, 42 min). Little bleeding was observed. Three patients presented with a slight fever following the surgery; however, no ureteral perforation, high fever or septicemia was observed among the patients following anti-inflammatory treatment. The stone-free rate (SFR) of the single-pass lithotripsy was 89.5% (77/86) and the SFR with ESWL was 96.5% (83/86). The study demonstrated that the F8 modular flexible ureteroscope was safe, convenient and effective for the lithotripsy of upper-tract calculi.

657 It's getting hot in here! Monthly variation in emergency department visits for upper urinary tract calculi in the United States

657 It's getting hot in here! Monthly variation in emergency department visits for upper urinary tract calculi in the United States