Cystic Calculi Research Articles

Diagnosis and management of cystic calculi in a pug

Diagnosis and management of cystic calculi in a pug

Diagnostic ultrasonography and antimicrobial resistance of different pathogens associated with canine and feline lower urinary tract disorders

There is a significant issue concerning the dissemination of antimicrobial-resistant bacteria within companion animals. Urinary tract infections (UTIs) are a common problem in veterinary medicine for which empirical antibiotics are utilized. This study aimed to investigate the antimicrobial resistance of different uropathogens associated with UTIs in canine and feline cases. A total of 146 dogs and 162 cats suffered from lower urinary tract disorders were subjected to ultrasonographic and microbiological examination. Cystitis, urinary sediment, and cystic calculi are the most common ultrasonographic abnormalities associated with bacterial UTIs. Bacterial UTIs were obtained in 36.98 % and 25.92 % of cases in dogs and cats, respectively. A low rate of mixed infection was detected in canine cases (3.7 %). E. coli was the most prevalent pathogen isolated from 46.4 % and 66.7 % of canine and feline isolates, respectively followed by Proteus spp. in canine isolates (16.1 %) and Klebsiella spp. in feline isolates (14.3 %). Staphylococcus spp. was isolated from canine cases only with the detection of methicillin-resistant Staphylococcus pseudintermedius (MRSP) strains at 3.6 %. The majority of the isolated strains were resistant to various antibiotic classes, particularly β-lactams. All gram-negative bacteria were susceptible to amikacin, whereas gram-positive strains exhibited 100 % sensitivity to nitrofurantoin and linezolid. Different bacterial species displayed low resistance to carbapenems and fluoroquinolones. Multi-drug resistance was reported in canine and feline strains at 64.3 % and 54.8 %, respectively. These findings prove the crucial necessity to restrict antibiotic consumption depending on urine culture and antibiotic sensitivity tests.

Morphology, Pharmacognosy of Strychnos nux-vomica and S. potatorum and their Medicinal Importance in Traditional Systems: A Review

The species Strychnos nux-vomica and Strychnos potatorum Linn., which belong to the Loganiaceae family, are used in traditional medicine to treat gonorrhoea, leukorrhea, gastropathy, bronchitis, chronic diarrhoea, dysentery, renal and vesicle calculi, diabetes, conjunctivitis, scleritis, ulcers, and other eye diseases. This medicinal species has been highlighted in an effort through pharmacological and phytochemical research. The morphology, phenology, distribution, phytochemical analysis, and pharmacological screening of Strychnos potatorum and nux-vomica, two significant medicinal plants, are the subjects of the current review. The gathered data may serve as the foundation for its widespread application as a therapeutic agent in both conventional and alternative medicine.

Ureteroneocystostomy for treatment of struvite urolithiasis in a ferret.

To assess the clinical outcome of a ferret undergoing a ureteroneocystostomy for treatment of urolithiasis. A 10-month-old spayed female ferret. The ferret was evaluated for straining to urinate and defecate, hematochezia, and a rectal prolapse. Plain radiographs revealed large cystic and ureteral calculi. Clinicopathologic analyses indicated the ferret was anemic with an elevated creatinine concentration. Exploratory laparotomy defined bilateral ureteral calculi that were unable to be successfully moved into the bladder. A cystotomy was performed to remove a large cystic calculus. Serial abdominal ultrasonographic examinations showed progressive hydronephrosis of the left kidney and persistent pyelectasia of the right kidney secondary to bilateral ureteral calculi. This confirmed a left ureteral obstruction secondary to the distal calculus while the right ureter remained patent. A ureteroneocystostomy was performed to allow for left renal decompression. The ferret recovered well despite worsening hydronephrosis of the left kidney in the perioperative period. The ferret was discharged from the hospital 10 days after initial evaluation. At 3-week follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation of the left kidney and ureter. A ureteroneocystostomy successfully allowed renal decompression and ureteral patency in a ferret with urolithiasis. To the authors' knowledge, this is the first time this procedure has been reported in a ferret for treatment of a ureteral calculus obstruction and may result in good long-term outcome.

Surgical management of cystic duct stump calculi causing post-cholecystectomy syndrome: A prospective study.

Remnant cystic duct stump calculi are an uncommon but important cause of 'post-cholecystectomy syndrome'. High index of suspicion is needed to diagnose this condition in a symptomatic post-cholecystectomy patient. We present our experience with the surgical management of this condition. This prospective study included 19 patients with residual gallstone disease who underwent completion cholecystectomy between August 2016 and October 2021. Investigations included abdominal ultrasound and magnetic resonance cholangiopancreatography. The demographic, clinical, surgical and early post-operative variables of these patients were prospectively maintained and analysed. The study included 14 women and 5 men. The mean age was 42.1 years (range, 14-80 years). The median duration between index surgery and completion cholecystectomy was 36 months (range, 2-178 months) (interquartile range, 105 months). The follow-up duration was 2 months. The initial surgery was open cholecystectomy in 17 and laparoscopic cholecystectomy in 2 patients. All patients with residual stump stone presented with pain, while 10 out of 19 patients complained of dyspepsia. Completion cholecystectomy could be performed laparoscopically in 16 cases, whereas 3 patients underwent open surgery. The mean operative time was 80 min (range, 55-140 min), and the mean blood loss was 100 ml (range, 50-160 ml). The mean hospital stay was 3 days (range, 2-10 days). No post-operative mortality or major morbidity was recorded in any of our patients. Laparoscopic excision of the cystic duct stump is feasible and safe even after previous open cholecystectomy. It is increasingly becoming the treatment of choice where expertise is available.

Case report on:- A case report on management and outcomes of vesicle calculi with right ureteric calculi

Stone diseases that affect the urinary system include urinary tract stones. One common disorder of the urinary system is stones in the urinary tract. According to where they occur, the four different types of stones are categorized as well as urethra, bladder, kidney, and ureteral stones. The patient healed fast and was released after receiving a series of systematic and successful treatments, including completing the one-stage operation. Whole urinary calculi can be eliminated after a single therapy, and urolithiasis persisting over the entire term is uncommon. After seven days of treatment, the clinical improvement response was outstanding and considerable. After receiving Unani therapy for a month without surgical intervention, a U.S.G. finding was suggestive of the absence of any calculi in the left kidney and ureter. The formulations prevented urinary supersaturation of lithogenic chemicals and proved safe and efficient. Clinical findings: For the past four years, problems included abdomen ache, frequency, hesitation, and a burning sensation while passing pee. There was a history of blood in the urine on several occasions. He then proceeded to Rural hospital Wardha. Diagnostic evaluation: After being admitted, the patient had an abdominal computed tomography (C.T.) scan.The findings revealed right ureteric calculi and vesicle calculi. The results of a routine urinalysis indicate that the blood's WBC count is 4,578/L and that the creatinine (Cr) level is 140 mmol/L. Therapeutic intervention: Catheterization and bilateral nephrostomy were our first treatments, which resulted in grey pyuria. Simultaneously, piperacillin-tazobactam was widely utilized as an anti-inflammatory agent. Outcome: The patient's health has improved once all interventions have been completed. The patient's lower abdomen pain and burning when urinating have subsided, and she is now stable. Conclusion: Rarely occurs urolithiasis with an entire challenging course.

Management of Gallbladder Remnant and the Cystic Duct Stump Calculi: A Retrospective Study

Introduction: Gall bladder remnant and cystic duct stump calculi are reality in the era of Laparoscopic Cholecystectomy (LC). Despite a seemingly uneventful cholecystectomy, nearly 15% patients continue to have biliary symptoms; the post-cholecystectomy syndrome (PCS); which can manifest anytime from few days to several years after surgery This study aims to assess the safety and feasibility of Laparoscopic exploration of gallbladder remnant calculi leading to PCS. Materials and Methods: In this study, surgical explorations was done in 25 patients. The study considered parameters like the operative time, conversion rate, post-operative complications, post-operative hospital stay and mortality in these patients. The duration of study was 2 years and the data was retrospectively reviewed. Results: 25 patients diagnosed as symptomatic gallbladder remnant were identified. The most common symptoms at presentation included right upper quadrant pain (80%), Jaundice(12%) Cholangitis (4%). Symptoms began from 6 months to 25 years after index cholecystectomy. Diagnostic modalities utilized in the evaluation of these patients demonstrated that MRCP were effective with sensitivities of 100%. Of the 25 patients, 22 (88%) had completion LC . 3 patients (12%) were converted to open cholecystectomy because of dense adhesions and non-identification of structures laparoscopically. Conclusion: Diagnosis of residual GB stone is difficult. In expert hands and standard approach , completion LC of the gallbladder remnant can be performed within a reasonable operating time. There is low conversion rate with minimal post-operative complications and shorter hospital stay and minimal morbidity. Completion cholecystectomy can be challenging but is highly effective.

Manual removal of a rare cystic calculus concurrent with recurrent hemorrhagic cystitis in an Arabian mare: A case report

A nine-year-old Arabian mare was presented with symptoms of frequent hematuria, dysuria, pollakiuria and urine dribbling. This report describes a manual removal procedure of a cystic urolith in an Arabian mare. A complete blood count showed a slight reduction in hemoglobin. Renal function tests showed high normal ranges in BUN. The urine sample was very cloudy and had a specific gravity of (1.019) with alkaline pH. The chemical examination showed high hemoglobin concentration with glucose traces. The microscopic examination showed a high number of pus cells and red blood cells with few numbers of rounded epithelial cells. Bacterial culture revealed Klebsiella spp and as a result of the sensitivity test, sensitivity to amoxicillin/ clavulanic acid, amikacin and gentamicin was determined. Cystoscopy revealed a large cystic urolith cranioventrally on the left wall of the urinary bladder. The apex vesicae was inflamed, with blood sludge. The definitive diagnosis was chronic hemorrhagic cystitis caused by a large cystic urolith. As a result, it was concluded that the removal of relatively large calculi through the urethra in the mare, while providing some protection to the bladder neck and urethral mucosa, has been effective with minimal complications.

Cystic calculus in a mare due to a misplaced uterine glass marble

SummaryA 9‐year‐old Quarter Horse mare was referred for evaluation of continuous oestrus, polyuria and suspected pyometra after a glass marble was placed in the uterus by the owner. Palpation per rectum and transrectal ultrasonography confirmed the presence of a spherical object, but it was not possible to discern whether it was located within the lumen of the uterus or urinary bladder. Thus, an endoscopic examination of both uterus and bladder was carried out and a spherical, spiculated surface urolith was found on the floor of the bladder. The cystic urolith with suspected marble core was removed using a 12‐mm specimen retrieval bag with endoscopic guidance. Follow‐up with the owner one month after discharge revealed that the mare had not shown any signs of discomfort while urinating nor signs of oestrus.

Risk factors for urinary bacterial growth in dogs with congenital portosystemic shunts: 66 cases (1997-2019).

To identify risk factors for urinary bacterial growth in dogs with confirmed congenital portosystemic shunts on which a quantitative urine culture was performed. Sixty-six dogs were included in this retrospective cross-sectional study. Medical records were reviewed from 1997 through 2019. Variables of interest included age, sex and sexual status, clinical signs for a urinary tract infection, blood urea concentration, urinalysis abnormalities, ultrasound abnormalities of the urinary tract, and previous treatment. Univariable and multivariable analyses were performed. The median age of the dogs was one year (range: 0.2-11.0 years). Urinary tract ultrasound abnormalities (cystic calculi and cystic debris) were reported in 50 dogs (75.7%). Abnormalities on urinalysis included pyuria in nine dogs (13.6%), bacteriuria in 13 dogs (19.7%), and haematuria in 26 dogs (39.4%). The median urine specific gravity was 1.021 (range: 1.004-1.052). Sixteen dogs (24.2%) had a positive quantitative urine culture. Based on multivariable analysis, bacteriuria (Odds ratio, 116; 95% CI, 9.6-1393; P=< 0.001) was the only variable significantly associated with a significantly increased odds for a positive quantitative urine culture. Clinical and subclinical bacteriuria can occur in dogs with congenital portosystemic shunts. In this group of dogs, bacteriuria was a risk factor for urinary bacterial growth.

Management of Gallbladder Remnant and the Cystic Duct Stump Calculi: a Retrospective Study

Management of Gallbladder Remnant and the Cystic Duct Stump Calculi: a Retrospective Study

Complications in pediatric laparoscopic cholecystectomy: systematic review.

Laparoscopic cholecystectomy (LC) is the gold standard for surgical management in symptomatic children, but it is not without complications, bile duct injury being among the most feared. This study reviewed the complications of LC in children. MEDLINE/PubMed, CENTRAL and Lilacs were reviewed for LC. Studies in patients ≤ 18years of age published in English, Portuguese or Spanish were selected by two independent reviewers. Data were collected for patients' characteristics, surgical information, complications, mortality and follow-up. Twenty-four papers were identified and offered 2783 patients. Mean age was 11years (3months-18years). In the 93/2783 (3.3%) complications, single-port procedures were associated with seven (7.5%), 3/4-port with 81 (87.1%) and the number of ports were not specified in five. Routine cholangiography was not part of the protocol in any of the reports. Complications included wound issues (n = 24), perforation (n = 14), bleeds (n = 13), biliary tree complications (n = 9), sickle cell crisis (n = 8), fever (n = 6), leaks (n = 4), pain (n = 3), nausea/emesis (n = 3) and others (n = 9). Two of these patients had a history of obesity and cholecystitis and only two biliary tree lesions were diagnosed intra-operatively. Seventeen cases (18.3%) required re-intervention: 15 surgical and two endoscopic. Issues related to biliary tree included: common bile duct lesion (n = 6), biliary fistula (n = 3), clip dislocation from cystic duct (n = 1), cholangitis (n = 1) and calculus (n = 1). There was no mortality, and the mean follow-up period was 10.3months (1month-5years). LC is safe in children and, although most complications are minor, almost 1/5 complications require interventions, mostly due to bleeding and biliary tree complications. Mortality has not been reported in pediatric LC.

Successful treatment of seminal vesicle calculi and prostatic utricle calculi by transurethral seminal vesiculoscopy.

To investigate the outcomes of transurethral seminal vesiculoscopy (TSV) for the treatment of seminal vesicle calculi (SVC), prostatic utricle calculi (PUC) and combination of them, a retrospective review on 27 patients with SVC and/or PUC who complained of intractable haematospermia was conducted. Patient demographics, disease duration, operation time, stone location and complications were recorded. The calculi in the seminal vesicle and/or prostatic utricle were removed by holmium laser lithotripsy and/or basket extraction. The stone composition was determined in 19 of 27 patients using Infrared spectroscopy. The average age and disease duration of patients were 39.4 years and 23.1 months respectively. The mean operative time was 78.5 min. We detected SVC, SVC and PUC, and PUC in 59.3% (16/27), 33.3% (9/27) and 7.4% (2/27) patients respectively. The stones were mainly composed of calcium oxalate dehydrate (COD), carbonate apatite (CA), COD and calcium oxalate monohydrate (COM), CA and magnesium ammonium phosphate, CA and COM, and COD and uric acid in 42.1% (8/19), 21.1% (4/19), 15.8% (3/19), 15.8% (3/19), 5.3% (1/19) and 5.3% (1/19) cases respectively. No intraoperative and post‐operative complications were noted. These results suggested that SVC and PUC can be diagnosed and treated using TSVs.

Laparoscopic Completion Cholecystectomy for Residual Gallbladder and Cystic Duct Stump Stones: Our Experience and Review of Literature

Post cholecystectomy syndrome (PCS) is a term used for the persistence of antecedent symptoms following cholecystectomy. The etiology is mainly non-biliary but remnant gallbladder or cystic duct stump calculi may be the cause in some patients. Ultrasonography is the initial imaging modality but MRCP provides a more accurate diagnosis and serves as a roadmap during surgery. Such patients need a completion cholecystectomy for relieving their symptoms. The study included 41 patients who underwent laparoscopic completion cholecystectomy (LCC) at two health institutions of our state by the same team of operating surgeons over a period of 7 years from January 2013 to December 2019. All the patients included had previously undergone open cholecystectomy at different health centers and reported to us with PCS. The data regarding presentation, imaging, intraoperative findings, complications, and follow-up after LCC were noted and analyzed. Laparoscopic completion cholecystectomy was successfully done in 38 patients (92.6%) and 3 (7.3%) cases had to be converted to open procedure. No major bile duct injury was encountered in any case and there were no mortalities. The majority of the patients (36 patients 87.8%) had complete resolution of symptoms after completion cholecystectomy. Laparoscopic completion cholecystectomy in the hands of an expert laparoscopic surgeon is a safe alternative with good outcomes and acceptable complication rates.

A patient with cystic duct remnant calculus treated by laparoscopic surgery combined with near-infrared fluorescence cholangiography

BackgroundThe recurrence of symptoms present before cholecystectomy may be caused by a cystic duct remnant. The resolution of cystic duct remnant syndrome may require surgical resection, but identification of the duct remnant during laparoscopic surgery may be difficult because of adhesions following the previous procedure. Open surgery, which is more invasive than laparoscopic surgery, is frequently chosen to avoid bile duct injury.Case presentationThe patient was a 24-year-old woman with previous laparoscopic cholecystectomy for chronic cholecystitis and repeated attacks of biliary colic. The postoperative course was uneventful, but computed tomography revealed a remnant cystic duct calculus. Ten months after surgery, the patient returned to our department for right hypochondriac pain. Laparoscopic remnant cystic duct resection was performed with intraoperative near-infrared (NIR) fluorescence cholangiography to visualize the common bile duct and remnant cystic duct. The postoperative course was uneventful and the patient was discharged on day 3 after surgery. At the 6-month follow-up, she had no recurrence of pain.ConclusionLaparoscopic surgery with NIR cholangiography is a safe and effective alternative for the removal of a cystic duct remnant calculus after cholecystectomy.

Radiographic features of suspected suture-associated cystic calculi in dogs.

This retrospective case series describes the radiographic features of suspected suture-associated cystic calculi in six dogs with a history of at least one or multiple prior cystotomies. One of the dogs presented twice. Suspected suture-associated cystic calculi were multifocal, short, predominantly linear mineral opacities localized in the center of the urinary bladder on abdominal radiographs. One patient (n=1) presented with multifocal round, pin point, and linear radiopaque calculi. The calculi were all calcium oxalate in composition. On gross examination, the calculi had a hollow center. Six cystotomies used monofilament absorbable suture material (polydioxanone [n=4] or poliglecaprone 25 [n=1]) in prior cystotomies. Suture material in two of the cases was unknown. Suspected suture-associated cystic calculi are a rare occurrence in veterinary medicine but should be considered in dogs that have a history of prior cystotomy, hollow core on gross analysis, and radiographic evidence of mineral opaque, predominantly linear, cystic calculi.

BILATERAL SEMINAL VESICLE CALCULI: A CASE REPORT

Seminal vesicle calculi are rare and so usually remain undiagnosed. Most of the patients with seminal vesicle calculus present with hematospermia, ejaculatory pain, perineal or testicular pain, or low volume of ejaculate. Hematospermia is the most common symptom present in 70% of the cases. Patients may have ejaculatory ductal obstruction secondary to bilateral seminal vesicle calculi and may present with impaired fertility and azoospermia. We present the case of a 41-year-old male who presented with ejaculatory pain of 6 months duration. On evaluation with ultrasonography and magnetic resonance imaging, a diagnosis of bilateral seminal vesicle calculi was made. The patient underwent bilateral transutricular seminal vesiculoscopy with laser lithotripsy.

The management and composition of symptomatic seminal vesicle calculi: aetiological analysis and current research.

To report our experience in the diagnosis, minimally invasive treatment, and composition of seminal vesicle calculi (SVC). In the present study, we evaluated 20 patients who were admitted to our hospital from January 2013 to January 2018. All the patients were diagnosed with intractable haematospermia and SVC. The diagnosis was further confirmed by seminal vesiculoscopy. SVC were removed by basket extraction; with larger SVC fragmented by holmium laser before extraction. Scanning electron microscopy, X-ray diffraction, and infrared spectroscopy were used to determine the SVC composition. All operations were completed successfully without surgical complications. SVC were mostly composed of hydroxyapatite and protein, suggesting that they were produced by infections. Seminal vesiculoscopy is a simple, minimally invasive technique that can be used for diagnostic confirmation and treatment of seminal vesiculitis with SVC. This study improves our understanding of SVC and provides a theoretical basis for the prevention of postoperative recurrence of SVC.

A case of persistent haematospermia secondary to seminal vesicle calculi in an ageing male

Seminal Vesicle (SV) calculi are a rare pathology. Clinical presentation usually consists of nonspecific perineal pain and haematospermia. Adjuncts to aid diagnosis include US, MRI, and Vesiculography. This rare condition can be treated conservatively, however, surgical options are becoming more advanced with Vesiculoscopy now being the gold standard. Here, we present a case of a SV calculi treated conservatively.

Radiographic and Ultrasonographic Evaluation of the Urinary System Disorders in 14 Numbers of Dog

The present investigation was carried out to describe the complementary use of radiography and ultrasonography in the diagnosis of various urinary system disorders in dog to study the radiographic and ultrasonographic appearances of the organs. The study materials were composed of 14 dogs of different breed, age and sex having urinary system disorders. The urethral calculi were diagnosed in 5 male dogs with plain radiography. Cystic calculi could be diagnosed in 3 dogs and both radiography and ultrasonography were found equally good. Cystitis in 2 dogs could be confirmed with ultrasonography. Renal cyst in two dogs and tumour in the urinary bladder could be diagnosed with ultrasonography.