Size Of Calculi Research Articles

Extracorporeal shock wave lithotripsy as monotherapy for vesical calculi

BackgroundExtracorporeal shock wave lithotripsy (ESWL) is a well-established non-surgical treatment of urolithiasis. ESWL as a monotherapy to treat vesical calculi is still unfamiliar among many urologists, despite its early introduction in the 1990’s. ESWL monotherapy for vesical calculi was performed in our study in a unique fashion in supine position with full bladder unlike any other previous reported studies.MethodsWe aimed this study to report our experience with ESWL as a monotherapy in treating urinary bladder stones with a unique technique. A total of 29 patients with vesical calculi were treated with ESWL monotherapy from May 2021 to January 2023 using Dornier delta lithotripter in the supine position with the full bladder without per urethral catheterisation. Patients with stone size > 2.5cm or Hounsfield units > 1200 were excluded. Stone clearance was assessed with the help of fluoroscopy and ultrasonography on a second visit on day 7 after the procedure. Patients were followed up for 3 months.ResultsThe mean size of vesical calculus was 1.6 cm (SD 0.32), and the mean Hounsfield unit was 940 HU (SD 86.61). None of the study subjects required surgical intervention. The stone clearance was obtained in 93.1% after a single session. The remaining two patients (6.9%) required one more session of ESWL following which stone clearance was obtained. One patient had acute urinary retention, and five (17.2%) patients had mild haematuria.ConclusionESWL monotherapy is a safe and effective treatment option for vesical calculi, with minimal or no patient discomfort, when done in supine position without routine per urethral catheterisation as described in the study. It should be considered more often by practicing urologists for vesical calculi.

Improvement in the Outcome of Urolithiasis Medicine Section Patients using Traditional Indian Medicine: A Systematic Review and Meta-analysis

Introduction: Urolithiasis (UL) is a prevalent disorder that significantly burdens the global healthcare system. Except for acute surgical conditions, most kidney stones don’t show any symptoms during presentation. Patients with asymptomatic renal calculi frequently seek alternative treatments. Several Ayurvedic preparations mentioned in Ayurvedic compendia have shown encouraging results in patients after long-term use. However, the results of several Randomised Controlled Trials (RCTs) on the effectiveness of Ayurvedic preparations in UL vary. Aim: To conduct a systematic review and meta-analysis to assess the effectiveness of Ayurvedic preparations in patients with UL. Materials and Methods: The electronic databases Web of Science, PubMed, Cochrane Library, Embase, and ARP were searched upto August 2023 to recognise applicable studies. The modified Jadad Scale was used to assess the quality of the studies. The Cochrane Risk of Bias (RoB) tool was used to determine the RoB for randomised trials. Results: The search retrieved 1459 studies, but only 19 studies were found eligible for inclusion in the study. Statistical analysis revealed a substantial decrease in the number and size of calculi in 178 cases in the intervention group compared to only 101 events in the control group (OR: 3.03, 95% CI; 2.00, 4.61). It also showed a significant reduction in the size of stones, a significant improvement in haematuria with p=0.18, a highly significant improvement in dysuria with p=0.04, and highly significant relief in pain with p<0.0001. Conclusion: This review concludes that Ayurvedic drugs have optimistic results in the treatment of UL. More substantial clinical trials with a larger sample size must be conducted to generate stronger evidence for using Ayurvedic Medicines (AyM) as a treatment choice for UL.

Outcome and Safety of Thulium Fiber Laser for Urinary Stone Diseases - a Cross-sectional Study

Introduction: Thulium fiber laser (TFL) was introduced into the urological armamentarium as an alternative to Ho:YAG as an energy source. This study aims to assess the outcome and safety of RIRS using TFL in patients with proximal ureteric and renal stone requiring intervention.
 Methods: It was a hospital based cross-sectional study conducted in the Department of Urology of of Birat Medical College- Teaching Hospital over a period of 6 months (September 2022 to February 2023) in adults patients with stone size upto 20mm. The outcome and safety of the procedure was assessed for stone clearance, operative time, hospital stay and procedure related complications.
 Results: We included initial 50 cases. Mean age, calculus size, calculus volume and calculus density were 40.02± 13.97 years, 14.45±3.36mm, 534.46±209.53 mm3, 1046.96±236.88 HU respectively. Complete stone clearance was achieved in 92% (46 cases) with 8% CSRF (4 cases). Procedure related complications occurred in 12% (8) cases.
 Conclusions: The TFL as a newer energy source is safe and effective for lithotripsy during RIRS with acceptable complications.

Structured reporting in radiology enables epidemiological analysis through data mining: urolithiasis as a use case

PurposeTo investigate the epidemiology and distribution of disease characteristics of urolithiasis by data mining structured radiology reports.MethodsThe content of structured radiology reports of 2028 urolithiasis CTs was extracted from the department’s structured reporting (SR) platform. The investigated cohort represented the full spectrum of a tertiary care center, including mostly symptomatic outpatients as well as inpatients. The prevalences of urolithiasis in general and of nephro- and ureterolithasis were calculated. The distributions of age, sex, calculus size, density and location, and the number of ureteral and renal calculi were calculated. For ureterolithiasis, the impact of calculus characteristics on the degree of possible obstructive uropathy was calculated.ResultsThe prevalence of urolithiasis in the investigated cohort was 72%. Of those patients, 25% had nephrolithiasis, 40% ureterolithiasis, and 35% combined nephro- and ureterolithiasis. The sex distribution was 2.3:1 (M:F). The median patient age was 50 years (IQR 36–62). The median number of calculi per patient was 1. The median size of calculi was 4 mm, and the median density was 734 HU. Of the patients who suffered from ureterolithiasis, 81% showed obstructive uropathy, with 2nd-degree uropathy being the most common. Calculus characteristics showed no impact on the degree of obstructive uropathy.ConclusionSR-based data mining is a simple method by which to obtain epidemiologic data and distributions of disease characteristics, for the investigated cohort of urolithiasis patients. The added information can be useful for multiple purposes, such as clinical quality assurance, radiation protection, and scientific or economic investigations. To benefit from these, the consistent use of SR is mandatory. However, in clinical routine SR usage can be elaborate and requires radiologists to adapt.Graphical abstract

Correlation Between Renal Calculus Disease and Iliac Bone Thickness on a Single Non-contrast CT Scan.

Background Renal calculi remain a major economic and health burden worldwideand are considered a systemic disorder associated with multiple other diseases. Several studies have observed that patients with idiopathic calcium renal stonesshow areduction in bone mass. This study aimed to evaluate bone mass reduction on a non-contrast CT scan study in a group of idiopathic calcium-containing renal calculus disease patients in comparison with subjects without renal calculus disease. Methodology This non-interventional, cross-sectional study included a total of 300 patients with 150 cases (with renal calculi) and 150 controls (without renal calculi). Patients were divided according to age groups of 18-40, 40-60, and more than 60 years. The renal calculus size and the mean iliac bone thickness were calculated, and Spearman's correlation test was used to determine the correlation between them. Results The mean iliac bone thickness was significantly lower in the cases (3.29 mm) compared to the controls (9.73 mm with a standard deviation of 1.341 mm). There was a statistically significant negative correlation between the size of the renal calculus and the mean iliac bone thickness. Conclusions Renal calculus disease associated with hypercalciuria caused by increased bone resorption is reflected by the decreased iliac bone thickness on CT scans. Our study used the iliac bone (cancellous bone) in predicting bone mass reduction which shows changes early in the course of the disease compared to the neck of the femur and lumbar vertebrae (compact bones). It helps in predicting osteoporosis early and prevents the progression of the disease through early and appropriate clinical and urological intervention.

Enormous Asymptomatic Intraoral Sialolithiasis: A Case Report.

Sialolithiasis is one of the most common diseases of salivary glands. More than 80% of the sialoliths occur in the submandibular gland. While most of the calculi are less than 10 mm in size, 7.6% are larger than 15 mm and are classified as giant sialoliths. We demonstrate a rare case of asymptomatic giant sialolith in the left Wharton's duct with a total atrophy of the left submandibular salivary gland. A 48-year-old female patient presented with lumping sensation for 1 month. A left mouth floor mass was found accidentally during examination and was later revealed to be a painless sialolithiasis. Image study revealed a giant sialolith in the left Wharton's duct with duct dilatation and left submandibular gland total atrophy. She underwent transoral sialolithotomy with removal of a huge stone, measuring 3.5 × 1.4 cm in size. Sialolithiasis usually presents with typical symptoms of the involved salivary gland, and the size of calculi is usually less than 20 mm. This is a rare case report of an asymptomatic giant sialolith in the Wharton's duct, causing left submandibular salivary gland total atrophy, and its diagnosis and management.

A Randomized Control Trial to Compare Hemodynamic Parameters of Patients Undergoing Percutaneous Nephrolithotomy Under Combined Spinal-Epidural and General Anesthesia in a Tertiary Hospital.

Percutaneous nephrolithotomy (PCNL) under epidural anesthesia has been reported to have few advantages over general anesthesia, like lower postoperative pain and less need for analgesics. There are limited studies on PCNL being performed under neuraxial anesthesia in supine position. Hence the present study was conceived to compare hemodynamic parameters in patients undergoing percutaneous nephrolithotomy (PCNL) in the supine position under combined spinal-epidural with general anesthesia (GA). A prospective, randomized control trial was conducted among 90 patients who were posted to undergo elective percutaneous nephrolithotomy in the the supine position, after obtaining Institutional Ethical Committee (IEC) approval and CTRI (Clinical Trial Registry - India) registration. Patients were randomly allotted to undergo surgery either under general anesthesia (group GA) or combined spinal epidural anesthesia (group CSE) by computer-generated random number method. Hemodynamic parameters, postoperative analgesic requirement and incidence of blood transfusion were recorded and analyzed. There was no significant difference between the two groups with respect to gender, ASA grade, surgery duration, calculus size and pulse rate. There was a statistically significant reduction in mean arterial pressure from 5 to 50 minutes of surgery and less incidence of blood transfusion in patients in the CSE group. Patients who underwent PCNL in the supine position under CSE required lesser analgesics postoperatively compared to those under general anesthesia. Combined spinal epidural analgesia can be used as an alternative to general anesthesia for patients undergoing PCNL in the supine position in view of less MAP and reduced postoperative analgesic and blood transfusion requirement.

COMPARATIVE STUDY OF MULTIDETECTOR COMPUTED TOMOGRAPHY (MDCT) WITH ULTRASONOGRAPHY IN ACCURATE DIAGNOSIS OF URETERIC CALCULUS SIZE.

Background The trend of imaging modalities used in the evaluation of urinary system stones had been changed recently due to the developments in computed tomography (CT) technology. The present study was Objective undertaken to nd the accuracy of multi-detector computerized tomography in comparison with ultrasonography for an accurate diagnosis of ureteric calculus size. Methodology Single centre hospital-based comparative cross-sectional study was conducted at Department of Radio-diagnosis, Sri Venkateshwara Medical College Hospital, and Research Centre, a tertiary care teaching hospital located in Ariyur, Puducherry. A total of 118 patients from February 2021 to September 2022 underwent unenhanced multidetector CT and ultrasound for the diagnosis of ureteric calculus size. The mean age was 38.8 ± 14.8 years and 74.5% were males and female to Results male ratio was 1.0:2.9. On CT scans stones were found in the vesicoureteric junction among 12.7% of patients. Ureteric calculi in the upper ureter, mid ureter, and lower ureter were found in 9%, 7%, and 32.2% of patients respectively. Other CT scan ndings included hydronephrosis in 6% of patients, hydroureteronephrosis in 60%, and perinephric fat stranding in 3.4% of patients. In ultrasound, 6% of patients had hydronephrosis and 60% of patients had hydroureteronephrosis. Among the 79 cases with ureteric calculi in CT, 35 cases were found on ultrasound. The sensitivity of diagnosing ureteric calculi using ultrasound is compared with CT and was found to be 44.30% with 100% specicity and 100% PPV, and 46.99% NPV This study concludes that Conclusion multidetector computerized tomography (MDCT) is more accurate when compared to Ultrasonography in the case of ureteric calculus. However, in positive cases of ureteric calculus in ultrasonography, there is no signicant difference in size noted in comparison with computed tomography.

Предикторы успеха выполнения уретеролитотрипсии.

Urolithiasis is one of the most common diseases seen by urologists. In 28% of patients with kidney stones, the disease is symptomatic. The benefits of ureteral stone extraction include minimal invasiveness, a shorter postoperative recovery time, and a favourable safety profile. Aim: to compare and evaluate the relationship between the density of the ureter, the density of the calculus, its localization and the value of the creatinine level and predicting the success of ureterolithoextraction. Materials and methods. In total, 125 ureteral lithotripsy procedures were performed (42 in women and 83 in men). Initially, the patients were divided into two groups. In the first group, ureteral stone extraction was performed in 97 patients. The second group included 28 patients with ureteral stent placement, without ureteral lithotripsy. In percentage terms, the increase in mean calculus size in the groups (10%) was less significant than the increase in ureter density under the calculus (65%). Results. There was no relationship between the ureter density under the calculus and the residence time of the calculus in the ureter. However, there is a relationship between the residence time of the calculus and the anatomical narrowing of the ureter, which may affect the success of the procedure. Elevated creatinine levels in the group with initial ureteral stent placement may indicate impaired urine passage from the kidney. Conclusions. Routine measurement of the ureter density under the calculus during MSCT may be an additional parameter in determining the surgical treatment method.

Incidental Finding of Bladder Carcinoma during Stone Removal: A Rare Correlation and Upcoming Physician Challenge

Vesical calculi and bladder carcinomas have rarely been correlated and addressed in the literature. Recent publications have noted an association between the two as an upcoming physician challenge. Vesical calculi are now categorized as an etiological factor in bladder carcinogenesis. Chronic bladder stones appear to play a pivotal role in the disruption of the bladder mucosal epithelium. Bladder carcinomas' findings tend to be incidental during stone removal; multiple large-scale studies are needed to identify dysplastic changes at an earlier stage. Screening biopsies and cystoscopies aid in the preliminary diagnosis of bladder tumors. Despite vesical calculi comprising 5% of the cases of urinary tract stones, no effective rationale has been developed to prevent this lethal complication of prolonged stone disease. The size and weight of calculi have been identified as determinants of neoplastic changes. Urinary tract infections have been strongly correlated with the concomitant occurrence of bladder stones. Repeated UTIs may warrant the need to diagnose the presence of calculus and initiate therapeutic intervention. Active surveillance will likely be beneficial for patients with a chronic history of frequent UTIs and bladder stone disease.

Tubeless versus conventional minimally invasive percutaneous Nephrolithotomy: A comparative study

PCNL (Percutaneous Nephrolithotomy) and MPCNL (Miniaturized Percutaneous Nephrolithotomy) are minimally invasive surgical procedures used to treat kidney stones. Both PCNL and MPCNL are effective treatments for kidney stones, but the choice of procedure depends on the size, location, and number of stones, as well as the patient's medical history and overall health. The present study was aimed to assess the safety and efficacy of tubeless PCNL compared to conventional PCNL in terms of Postoperative pain, hospital stay, Drop in Haemoglobin levels, Operative time, Stone free rate, Post operative fever. Methodology: A Prospective comparative interventional study has been done in Department of Urology, Mamata Super Specialty Hospital, Khammam with a total of 50 patients who were randomized into two groups of 25 each undergoing tubeless mini PCNL and conventional mPCNL respectively. Results: The mean age was 43.76 years and 41.92 years for mini PCNL and conventional mPCNL groups respectively, the mean calculus size in the tubeless PCNL group was 2.028 cm, while in the conventional PCNL group, it was 2.452 cm. There was significantly lesser operative time taken in conventional PCNL group when compared with Tubeless PCNL group. Stone free clearance rate 97% in tubeless PCNL. The mean hospital stay in tubeless PCNL group was significantly more than that in conventional PCNL. Conclusion: Both tubeless mPCNL and conventional mPCNL had similar surgical outcomes, but tubeless mPCNL had reduced surgery time, stone clearance, and hospital stay, indicating its potential for wider use.

Формула оценки размера камня (ФОРК) почки у детей разных возрастных групп.

Introduction. The choice of surgical treatment with kidney stone disease directly depends on the size of the kidney stones. According to clinical guidelines for the treatment of urolithiasis in children, the size of a kidney stone in adult patients is used to determine tactics. Normally, the longitudinal size of the kidney of a child, for example, 1-3 years old, is 2 times smaller than that of an adult, and the width of the child's ureter is 37% less than the width of the adult's ureter. But anatomical and age differences in children (infant, preschool, school and adolescence) are not taken into account. Existing prognostic nomograms for urolithiasis (Dogan, Onal, CMUN, SKS, Guy's Stone Score, S.T.O.N.E, and CROES) that are validated for use in children also do not take this into account. Thus, the size of a kidney stone, as a criterion for choosing an effective and safe method of surgical treatment, needs to be clarified. The purpose of the study: to define the concept of a large kidney stone in children of different age groups. Materials and methods. We analyzed clinical guidelines, domestic and foreign publications on the use of «kidney stone size» in children of different ages and the principles of substantiation of the term large kidney stone. 320 histories of percutaneous nephrolitholopaxy (PNL) from 2008-2019 were retrospectively and perspectively analyzed. aged from 1 to 17 years, the average age of patients is 6.6 years. The average calculus size was 26 (15-58) mm. Number of patients in different age groups: toddlers 1-3 y/o – 73, pre-school child 3-5 y/o. – 71, school child 6-12 y/o – 79, adoloscents 12-18 y/o – 97. By type of calculus: single –125 (39.1%), multiple – 68 (21.3%), K1, K2 – 46 (14.3%), K3, K4 – 81 (25.3%). The weight of the patients ranged from 8–94 kg, the average weight was 21 kg, the height was from 73–180 cm, and the average height was 120 cm. The length of the child's kidney depends on his age, the formula for calculating the length of the kidney (cm) = 6.79 + 0.22 x age (g)) Result. KSS-CDA: Kidney stone size in children different ages was proposed: KSS-CDA = (stone size (mm)/the kidney length (mm))*100%. KSS-CDA makes the interpretation of the size of kidney stones in children from different age groups objective. The definition of "Large" kidney stone is used if the size of the stone is 20% or more of the longitudinal size of the kidney in children. For example, a child is 1 year 7 months old, the stone is 15 mm, the length of the kidney is 69 mm. The SSEF is 21.74%, this kidney stone can be described as «large». The «medium» stone size is 10-20% (6-14 mm), small <10% (6 mm). Conclusion. The presented study is the first in domestic and foreign literature, during which the age characteristics of children were taken into account. The reason for the reduction in the lower limit of kidney stone size used to select surgical treatment in children compared with current recommendations was explained. For the first time, KSS-CDA allows to standardize an objective criterion for determining large, medium and small kidney stones in children different ages. The prospective use of FORK in the future will allow adapting clinical guidelines and nomograms for KSD in children.

Studi kasus : Urolithiasis pada kucing milky di klinik DRD veteriner

Urolithiasis is a disorder of the urinary tract or urinary tract due to the presence of stones or calculi or crystals. These calculi can cause blockages to injury to the urinary tract. Specific clinical manifestations in this case are non-specific and highly variable, depending on the size, number, and location of calculi. Urolithiasis is generally followed by hematuria, dysuria, and stanguria. Milky cat came on 19 May 2022 at DRD Veterinary Veterinary Clinic with conditions of Hematuria, stranguria, and dysuria. When the temperature was measured using a thermometer, the temperature was 36.3 oC indicating the cat's temperature had decreased. examination to help diagnose milky cases by means of microscopic examination of urine, hematology and urinalysis, catheter insertion and cystotomy surgery.

Effect of Body Mass Index on complications and success rates of percutaneous nephrolithotomy-A tertiary care hospital experience.

Urolithiasis is prevalent globally. Over time, innovation in endoscopic instruments and miniaturization has untangled the interventional strategy for carrying out remedial surgical procedures for renal stones. However, studies have been scarce as for sequelae of Percutaneous Nephrolithotomy (PCNL) in varying body mass index group patients in the developing world. We aimed to report success rates and complications in different BMI groups. This was a retrospective study wherein data of 359 patients was reviewed in charts. These patients went through PCNL at our department from July 2011 till September 2019. Three groups of patients were made in agreement with WHO BMI classification. Information concerning study variables was noted in designated and then processed in SPSS version 16 for the statistical computations. On the whole, the mean age of patients was 44.6± 14.4 years. While the mean calculus size was 3.1± 1.4 cm. Moreover, the majority of stones in all the three groups belonged to Guy's stone score 1 and 2 (see Table-I). The overall mean procedure time and inpatient stay were almost comparable in the obese group. The highest stone-free rate was observed in the normal weight group (77.69 %), however, stone-free status in overweight and obese groups was not comparatively too lower (p=0.74). Complication rates were being close among the three groups. PCNL can be ventured with safety and in an effectual manner for attaining stone treatment goals alike in obese and non-obese group patients.

Outcomes of Retrograde Intrarenal Surgery in Renal Calculi of Varying Size

The patient with the large renal calculi is recommended with retrograde intrarenal surgery by the physicians. It is minimally invasive approach for the treatment. Objective: The study was conducted for evaluation of the intraoperative and postoperative complications associated with the retrograde intrarenal surgery RIRS. The stone free rate rates were also compared. Methods: The 231 patients who visited the Urology department of our teaching hospital were included in the study. The duration of this study was from January 2021 to June 2021. The patients were divided into six groups. The calculi of dimension 1-9 mm were included in the group 1, while 10-19 mm were included in the group 2, 20-29 mm were included in group 3. The calculi of dimension 30-39 mm were included in group 4, the calculi of dimension 40-49 mm in group 5, while calculi greater than 50mm dimension were included in the group 6. The post-operative complications were reported while six-month follow months. Results: Out of the 231 patients included in the study. According to the study smallest size of calculi observed to be 3 mm and the largest size of calculi was found to be 60 mm. The average size of the calculi came out to be 22.9 ± 11.2 mm. The adverse events were observed in different groups. 11% of the patients reported some intraoperative negative effects. There were 31 patients that showed post procedure complications but these complications were later on found to be gone leaving no adverse side effect. 10% patients that undergo repetitive RIRS to clear the stones and were later-on confirmed stone free. Conclusion: For the treatment and management of the renal stones that are more than 20 mm in size RIRS is an encouraging option. There was a size dependent enhancement in the complications that take place after the procedure. There was no case of stone related events reported in patients that took care of follow up sessions to get rid of residual stones.

Comparative Evaluation of Diagnostic Quality in Native Low-dose CT without and with Spectral Shaping employing a Tin Filter in Urolithiasis with implanted Ureteral Stent.

Spectral shaping employing a tin filter can be used for dose reduction in CT of the abdomen in patients with urolithiasis. As ureteral stents may be in direct contact with the calculus, a good image quality is mandatory. The goal of this study was to obtain data of the effect of tin filtering on image quality and dose in patients with urolithiasis in direct contact with ureteral stents. 84 examinations (conventional low dose vs. modified low dose protocol with tin filtering, randomized) were performed in 65 patients (48 men, 17 women, age 55.0 ± 15.2 years (18-90 years), maximum of one examination per protocol). Image quality and visibility of the calculus was rated on a 5-point-Likert scale by 2 experienced radiologists. Quantitative indicators of image quality were signal-to-noise-(SNR) and contrast-to-noise-ratios (CNR) as well as a figure-of-merit (FOM). With a non-inferiority margin of 0.5 points of the 5-point Likert scale, there was non-inferiority of the examinations with tin filter regarding image quality (95 % CI 4.1-4.3, rejection limit 3.5). Non-inferiority regarding visibility of the calculus could be shown (calculus size: 1-2.4 mm: 95 % CI3.39-4.12; limit 2.73; 2.4-3.8mm: 95 % CI 4.09-4.47; limit 3.65; > 3.8mm: all maximal ratings). Average values of CNR were significantly higher using tin filters (17.0 vs. 10.6). Doses were significantly reduced in the modified protocol (effective dose 1.2 mSv vs. 1.5 mSv; size-specific dose estimate 2.33 mGy vs. 3.09 mGy) with non-significant effect in the subgroup of patients with BMI ≥ 35. Even with direct contact between a calculus and ureteral stent, radiation reduced examinations by spectral shaping by tin filters are non-inferior to examinations without tin filtering at a concurrent significant dose reduction. · Spectral shaping by tin filter is suitable for dose reduction.. · The image quality in patients with ureteral stents with tin filtering is non-inferior to that in a conventional low-dose protocol.. · Axer B, Garbe S, Hadizadeh DR. Comparative Evaluation of Diagnostic Quality in Native Low-dose CT without and with Spectral Shaping employing a Tin Filter in Urolithiasis with implanted Ureteral Stent. Fortschr Röntgenstr 2022; 194: 1358 - 1366.

MO348: Methylene Blue Beneficial Effect in Treatment of Renal Calculi in Patient With Recurrent Urinary Tract Infection

Abstract BACKGROUND AND AIMS Assessment of efficacy of fixed combination of cranberry and sage extract with methylene blue (MBC) in dose of 30 mg twice daily in the prevention and management of chronic renal calculous disease. METHOD In 87 patients who complained recurrent urinary tract infection (UTI)—55 pts with pyelonephritis and 32 with cystitis—at least three episodes in 12 months, the impact of 3 months treatment of MBC with on renal calculi was investigated. All patients were older than 18 years without any biochemical or congenital kidney abnormalities, coagulopathies with size of renal stone over 10 mm. Simultaneous administration of phenothiazine derivatives, SSRI, MAO, tricyclic or any other antidepressants we excluded. A total of 39 (45%) of the patients with a history of nephrolithotomy in the past were included. RESULTS In most cases, patients were supervised during 12 months with 2–3 courses of MBC during the year. A total of 18 pts (21%) have passed no further stones with dramatic improvement of quality of life, and 47 (54%) have improved clinically with reduction of calculi size. A total of 79 pts (91%) reported overall clinical improvement of UTI symptoms and quality of life. The main disadvantage during MBC administration could be discoloration of the urine in light blue or green color. No side or adverse effects were observed during the whole period of the trial. CONCLUSION Methylene blue could be a promising solution in the management of patients with multiple small renal calculi, especially with necessity to reduce the level of concomitant infection without antibiotic and may be useful in the prevention of new stone formation.

Antiurolithiatic Activity On The Fruits of Coccinia Indica Ethylene Glycol Induced Lithiatic In Rats

In the present most typical affliction is found in individuals, calcium oxalate is a significant constituent of most urinary stones. Coccinia indica (Cucurbitaceae) is found in a hotter and damp piece of India. It is seen that a major number of phytoconstituents revealed that flavonoids, triterpenoids, and from various plants showed antiurolithiatic action altogether diminishing the size of calculi in the kidneys and improving the discharge of calcium, phosphate, and oxalate. The point of this research was to examine the impact of alcoholic extract product concentrates of Coccinia indica on urolithiasis in male rats. This work aims to collect, identify, and authenticate the plant and separate the phytochemical parts present in the alcoholic extract of Coccinia indica, and characterize its phytochemical nature by qualitative and quantitative preliminary screening and elucidation of the structure by chemical analysis of spectral data. Later that to survey the calcium oxalate crystallization restriction by in-vivo method using male Wistar albino rats.

POS-459 EXAMINING THE EFFECT OF CALCULI SHAPE AND DIMENSION ON URETER OUTFLOW RATES USING AN ARTIFICIAL 3D PRINTED KIDNEY

Kidney stone disease is a urological disorder that affects about 12% of the world population. A deeper understanding of the underlying etiologies and effects which this condition generates, such as alterations in renal hemodynamics, is essential for developing models to study this disorder. Several experimental approaches have been employed, and recent developments in 3D printing offer an exciting opportunity to mimic impediments to urine flow characteristics caused by calculi. Here we present one such simplified model. A 3D artificial renal model was developed using SolidWorks 2019 software ( to provide the template (Figure 1a) for the bioprinted scaffolds (Figure 1b). Spherical and elliptical kidney stones, ranging from 0 to 6 mm, mimic calculi embedded in the artificial ureter designed with flexible plastic tubing (Figure 1C). A mechanical circulation pump was then used to induce urine flow (Figure 1D). Flow velocities were obtained using different geometries of 3D printed kidney stones. Flow magnitude and characteristics were compared to understand the effect of having different geometries on the distribution of urinary flow (Figure 1E). The minimum flow velocities for spherical and elliptical stones were 0 and 34.1 cm/sec for 5 and 4 mm stone sizes, respectively. Surprisingly, elliptical kidney stones showed an increase in the flow velocity at the maximum elliptical stone size of 6 mm (54.39 cm/sec) due to the nature of its geometry. For the case of the spherical shape, it converged to (0 cm/sec). Figure 1. The 3D artificial renal model outlining: SolidWorks 2019 organ template (a); (b) the bioprinter model; (c) spherical and elliptical artificial kidney stones embedded in the ureter; (d) mechanical circulation pump was then used to induce urine flow; and an outline of the variations in volumetric floe rate with calculi size. The results from this study provide insight on ways to create simplified artificial organ models that simulate hemodynamic observed in Kidney stone disease and can be used to develop more sophisticated reverse-engineered artificial 3D-printed kidney models.

Incidence of Positive Bile Culture and most Common Pathogen involved after Laparoscopic Cholecystectomy in patients of Cholelithiasis

Background: Laparoscopic cholecystectomy is commonly performed for cholelithiasis. In spite of strict aseptic technique and preoperative antibiotic prophylaxis, there is risk of port site wound infection. Aim: To study the incidence of positive bile culture and the most common pathogen involved after laparoscopic cholecystectomy in patients of cholelithiasis and its correlation with port site wound infection. Study design: Cross sectional study Setting and duration: Bahawal Victoria Hospital Bahawalpur, from 01-01-2019 to 31-12-2020. Method: One hundre patients of cholelithiasis between 18-75 years of age underwent laparoscopic cholecystectomy. Prophylactic antibiotic was given. Bile with gall bladder was collected and sent for culture. Bacterial growth was recorded as positive bile culture. Organism type was recorded. Stone/stones size was also measured. Data was collected on a proforma which included demographics details like name, age, gender, BMI, clinical features, size of calculi, culture report (positive bile culture if some bacteria is isolated and negative no growth) and type of bacteria isolated and frequency of port site wound infection. Data was analyzed on SPSS version 21. Results: The mean age of the patients was 42.44±16.58 years and male to female ratio of the patients was 1:1.8. The mean BMI of the patients was 25.93±4.67 kg/m2. Bile culture for bacteria was positive in 30(30%) patients and the most common organism was E coli 13(43.33%.78%). Positive bile culture was detected in 20 (20%) male patients and 10 female patients. There was significant correlation between positive bile culture and gender (p value < 0.001). Port site wound was infected in 6 (6%) patients and in all the patients bile culture was also positive. Conclusion: Bile culture was positive in 30% patients of cholelithiasis undergoing laparoscopic cholecystectomy and wound infection was present in 6% patients and all the 6% patients were bile culture positive . Keywords: Cholelithiasis, Culture, Organism, Laparoscopic cholecystectomy