Calculi Of Size Research Articles

Ayurvedic management of renal cyst – A case study

Introduction: Renal cysts are detected more easily in elderly people due to the widespread use of abdominal computed tomography (CT), abdominal ultrasonography (USG), and magnetic resonance imaging. The importance of renal cysts arises from their augmented detection in elderly populations with the pervasive use of CT and abdominal USG. In Ayurveda, renal cyst has been interpreted with the name of Granthi where Vata-Kapha dominant Tridosha is involved. Very less scientific data is available depicting the effect of Ayurvedic intervention in such cases. Main Clinical Finding: A confirmed case of renal cyst of size 15 mm × 16 mm was seen in the lower calyx of the left kidney, a calculus of size 2.3 mm with mild upper hydroureteronephrosis, increased parenchymal echogenicity suggestive of Grade 1 fatty liver and gallbladder is distended with multiple hyperechogenic foci suggestive of calculus largest measuring of 13mm. Diagnosis: The patient was a diagnosed case of a renal cyst of size 15 mm × 16 mm in the lower calyx of the left kidney with a calculus of size 2.3 mm with mild upper hydroureteronephrosis with Grade 1 fatty liver and calculus largest measuring of 13 mm in the gallbladder based on USG findings. Interventions: The patient was treated with Ayurvedic medicines such as Chandraprabha Vati, Kanchnara Guggulu, Lavan Bhaskara Churna, Samsamani Vati, Kumaryasava, and Gokshuradi Guggulu. Outcome: Complete remission of the renal cyst with calculi along with Grade 1 fatty liver was observed after 6 months of treatment. Conclusion: This case study demonstrates the potential and usefulness of Ayurveda in the management of renal cysts.

Correlation between Expulsion of Distal Ureteric Calculus with CRP Level, WBC Count and Neutrophil Percentage among the Patients attending on Manipal Teaching Hospital, Pokhara (Retrospective Study)

Introduction: Urolithiasis is a common medical diagnosis that doctor encounters in the outpatients and emergency departments. The prevalence of renal stone disease has increased steadily over the past decades. There are different modalities of treatment of ureteric calculus. However, most of the distal ureteric calculus passes spontaneously thus the application of invasive procedure at the early stage can be considered overtreatment.Methods: The 68 patients of the surgical department, Manipal teaching hospital, Pokhara, with distal ureteric calculus of ≤ 8mm, who were under the treatment Tamsulosin Hydrochloride 0.4mg once daily for 2 weeks or till the expulsion of stone from 1st October 2017 to 30th September 2018 (one year period) were retrospectively evaluated for the spontaneous stone expulsion rate and its association with serum CRP level, WBC count and Neutrophil percentage. The patients were divided into 2 groups i.e. spontaneously ureteric stone expelled group and non expelled group. Furthermore, for statistical analysis, each group were subdivided according to normal and elevated serum CRP level, white blood cell count and neutrophil percentage. The associations between these factors and ureteral stone passage were then examined.Results: Most of the cases were in the age group of 21-40 years with the mean age of 40.09 ± 16.11, where 57.4% of patients were male. Among all mean duration of symptoms was 6 days. The ratio of left to right stone was 1.26:1. Out of 68 patients, 80.9% of the patient’s distal ureteric stone was passed out spontaneously with medical expulsion therapy. There were statistically significant (p<0.001) association between normal serum CRP level, White cell counts and neutrophil percentage with the expulsion of distal ureteric calculus with size ≤ 8mm.Conclusion: There is a higher expulsion rate of distal ureteric calculus of size ≤ 8mm with the patient of the normal level of serum CRP level, White cell counts and neutrophil percentage than that of abnormal level.

Role of Tamsulosin with or without Deflazacort to facilitate stone clearance after ESWL: a single-center randomized controlled study

BackgroundExtracorporeal shock wave lithotripsy (ESWL) is the treatment of choice for upper tract calculi of moderate size. After ESWL, various factors affect the passage of small fragments through ureter like fragment’s size and location. To facilitate fragment passage, a lot of medications have been tried and few have stood the test of the time. In this prospective study, we evaluated the role of Tamsulosin with or without Deflazacort versus no treatment after ESWL for ureteric and renal stones in terms of requirement of the number of ESWL sessions, stone clearance rate, stone expulsion time and analgesia requirements.ResultsPatients presenting between age-groups of 18–70 years with solitary renal/ureteric calculus of size between 6 and 15 mm in major axis with Hounsfield unit less than 1000 were recruited in one of the three groups (A, B and C) randomly. Patients in Group A were prescribed Tamsulosin (0.4 mg once daily) with Deflazacort (30 mg once daily), Group B were given Tamsulosin (0.4 mg once daily), and Group C received no treatment (analgesics SOS and hydration therapy) after undergoing ESWL. Two hundred and twenty-five patients were recruited in Group A, and 240 patients were recruited in Group B and Group C each. There was an insignificant difference for required mean ESWL sessions and stone clearance rate between three groups. There was an early clearance of stone fragments in Group A than in Groups B and C, and it was statistically significant between Group A and Group C, specifically in the subgroup of stone size 10.1–15 mm. The requirement of mean analgesic tablets difference was significant between Groups A and C.ConclusionsTamsulosin with Deflazacort decreases the number of required ESWL sessions and improves complete stone clearance, but the difference is not significant. There were significant improvement in facilitating early stone clearance and decrease in requirement of mean analgesic tablets after ESWL with Tamsulosin and Deflazacort. Thus, Tamsulosin with Deflazacort can be used safely to facilitate stone clearance without increased complication rate.

A case of multiple urinary calculi

A patient with urinary calculi of sizes 16 mm in the right renal pelvis and 9 mm in the right mid-ureter, presenting with complaints of pain in right iliac region extending to genitals and legs with dribbling urine and painful micturition reported in the OPD of the Central Research Institute for Homoeopathy, Kottayam, Kerala. Patient had not undergone treatment before. Based on the presenting symptoms Nux vomica 30C was prescribed, which proved to be effective in the dissolution and expulsion of both the stones.

A Giant Ileal Conduit Calculus after Radical Cystectomy

Radical cystectomy with ileal conduit is one of the treatment options for patients with muscle invasive carcinoma bladder. Giant ileal conduit calculus is a very rare complication. A 60-year-old male had undergone radical cystectomy with ileal conduit about 12 years back and now presented left gross hydrourereteronephrosis with perinephric collection and features of renal failure. We performed drainage of perinephric collection followed by left sided percutaneous nephrostomy and patient's condition improved gradually. Later on, we performed contrast-enhanced computed tomography (CT) intravenous urogram and nephrostogram which revealed a huge calculus of size 9 cm × 5 cm in the ileal conduit. Calculus was removed by open surgery by incising the conduit over antimesenteric border. Above presentation is a sequel of a huge ileal conduit calculus obstructing left ureter. Calculus formation can result from stomal stenosis, metabolic acidosis, small bowel syndrome, recurrent infection, any foreign body like a staple or nonabsorbing suture material. These patients require close surveillance with X-ray kidney, ureter, and bladder for a longer period after the urinary diversion. In doubtful cases, helical CT may be useful. Giant ileal conduit calculus is a very uncommon presentation after radical cystectomy.