Large Calculi Research Articles

Laparoscopic surgery for upper ureteral calculi in geriatric patients: 5 years experience

Objective We have reviewed the success of laparoscopic calculi surgeries in geriatric patients. Methods A retrospective analysis was performed on the laparoscopic ureterolithotomy surgeries performed at our central between January 2014 and January 2019 to treat upper ureteral calculi in geriatric patients. Among the patients who underwent these surgeries, we evaluated data on 24 cases whose records could be fully retrieved. Results The age interval of the patients was 60–73 years, and the mean age was 63 ± 3.43 years. The size of the calculi was 19–24 mm, and mean size was 20.2 ± 2.5 mm. Because stone disease was present previously, 5 of these patients underwent endoscopic intervention, whereas two underwent open surgery. Sixteen of these patients had a history of unsuccessful shock wave lithotripsy (SWL) or ureterorenoscopy. The calculi-free rate was 100%. According to the modified Clavien classification, no major perioperative and postoperative complications were observed. The duration of hospital stay was 1–3 days, and the mean duration of stay was 1.6 ± 0.9 days. Conclusion We believe that owing to the high success and low complication rates, laparoscopic ureterolithotomy can be the first option of treatment for geriatric patients with impacted large calculi, with a history of unsuccessful SWL or ureterorenoscopy (semirigid, flexible).

Female urethral diverticulum with large calculus: Presentation and management

Level of evidence: Not applicable for this multicentre audit

ShockPulse-SE vs. Trilogy Trial: Comparing the Performance of Two Intracorporeal Lithotripters for Removal of Large Renal Calculi

ShockPulse-SE vs. Trilogy Trial: Comparing the Performance of Two Intracorporeal Lithotripters for Removal of Large Renal Calculi

Comparative study of different modalities of treatment for large upper ureteric calculi

Background: Urolithiasis is one of the most common urological diseases and has become a worldwide health problem. Minimally invasive therapies such as extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, RIRS and laparoscopic surgery have revolutionized the treatment of ureteric calculi, altering surgical treatment dramatically.Methods: It was a prospective randomized study conducted between March 2012 to March 2017. 60 patients with large upper ureteric calculi of >15 mm in size were randomly selected for the study. Diagnosis was made using ultrasonography, plain X-ray KUB, IVU and spiral CT KUB. Patients were divided randomly into 4 groups of 15 patients each. Routine post-op X-ray KUB and USG were done for all the patients. All the data was recorded and analysed.Results: LAP group had the highest stone clearance rate (100%) in our study. The difference in stone clearance rate was statistically significant when compared with ESWL (73.33%) and URS group (66.7%), whereas no statistical significance was found between LAP and PCNL group (93.33%). URS group in our study had highest intra-operative complications (33.33%) and laparoscopic group had least number of complications. Post-procedural complications occurred in 1 patient (6.7%) in URS group, 2 patients in ESWL group (13.3%) and 1patient each in LAP and PCNL group (6.7%).Conclusions: Laparoscopic ureterolithotomy is a feasible and effective method of treating large (>15 mm) upper ureteric calculus. It is associated with least intra-operative complications and semirigid ureteroscopy has highest intra-operative complications.

Benefits to Students of Team-Based Learning in Large Enrollment Calculus

Team-Based Learning (TBL) uses a flipped classroom model and involves students working collaboratively in small groups, with peer assessments to promote group accountability. We implemented TBL in Calculus I in both large () and small () class settings. We investigated the impact of this form of instruction over two semesters (Fall 2015 and Fall 2016), and noticed improvement from the first implementation to the second. In Fall 2016, we observed many positive benefits to students, including exceptionally high class attendance, higher midterm and final exam scores than in non-TBL sections, and larger gains on the Calculus Concept Inventory than in non-TBL sections.

Extracorporeal Shock Wave Lithotripsy for Large Common Bile Duct and Pancreatic Duct Stones: Efficacy, Safety and Analysis of Factors That Favor Stone Fragmentation

Abstract Background: Extracorporeal shockwave lithotripsy (ESWL) with subsequent endoscopic extraction of residual fragments is an established treatment option in technically challenging situations for extraction of pancreatic and common bile duct calculi. Common bile duct (CBD) stone fragmentation rates of 71 to 95% have been reported with ESWL, leading to final duct clearance rates of 70 to 90%. While complete clearance of 76% and partial clearance of 17% of pancreatic duct calculi have been documented with ESWL, our study was undertaken to investigate the efficacy and safety of ESWL in clearance of difficult bile duct and large pancreatic duct calculi. Methods: The study population consisted of 61 patients who had either large or difficult bile duct calculi or large pancreatic duct calculi documented on ultrasonography abdomen or magnetic resonance cholangiopancreatography (MRCP). All patients were subjected to ESWL sessions with endoscopic nasobiliary drainage (ENBD) placement till stones got fragmented. Results: A total of 1,284 patients underwent ERCP for either choledocholithiasis or pancreatic duct calculi during the study period (June 2015 to December 2016). Out of them 61 patients had either large or difficult CBD calculi or large pancreatic duct calculi. Forty (65.57%) had choledocholithiasis (Group-A) and 21 (34.42%) had chronic calcific pancreatitis (Group-B). CBD was cleared in 37 patients (92.5%) and 3 patients (7.5%) underwent surgical intervention. Main pancreatic duct (MPD) was cleared in all patients with clearance rate of 100%. Conclusions: ESWL is an effective and safe method for clearance of difficult CBD and pancreatic duct calculi. Combined efficacy of duct clearance is >90%. Complications are minimal and managed conservatively.

Попытка эндоскопического лечения высокой обтурационной кишечной непроходимости, обусловленной билиарными конкрементами

The interest of the above clinical case is that cholecysto-duodenal fistula, which arose against the background of cholelithiasis and caused high obstructive small intestinal obstruction by biliary calculi migrated from it, is a very rare complication of gallstones and was diagnosed at the preoperative stage. Patient B, 75 years old, was admitted to GBUZ “KKB No. 2” in Krasnodar on July 21, 2016 with a diagnosis of Cholelithiasis. Chronic calculous cholecystitis. Choledocholithiasis. High small bowel obstruction? The first step was performed diagnostic esophagogastroduodenoscopy. When endoscopy at the output level of the LDPC, along the back wall, a wall defect in the form of a cholecysto-duodenal fistula with visualization of the gallbladder cavity is determined. At the level of the lower horizontal branch of the duodenum, there are mobile multiple biliary concrements that completely overlap the lumen of the duodenum. It was decided to perform endoscopic mechanical litoextraction of these stones. With the Dormia basket probe, movable duodenal calculi were captured and removed. After deleting the mobile calculus data, we found a large calculus that completely covered the duodenal lumen. An attempt was made to electrohydraulic lithotripsy of this large calculus of duodenum. The calculus was fragmented. But when trying to hold an endoscope for calculus fragments, in order to capture them with a basket of Dormia, the ischemic wall of the duodenum perforated. The patient was transferred to the operating room, where laparotomy, duodenotomy, removal of the wedged calculus of the lower horizontal branch of the duodenum, suturing of the duodenum defect were performed. On day 12 after surgery, the patient was discharged from the hospital in a satisfactory condition.

PD42-07 RISK FACTORS FOR SEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY IN THE UNITED KINGDOM

INTRODUCTION AND OBJECTIVES:Percutaneous nephrolithotomy (PCNL) is routinely utilized in the management of large renal stones and staghorn calculi. PCNL is more efficacious when compared to other t...

On the Efficacy of Open Educational Resources: Parametric and Nonparametric Analyses of a University Calculus Class.

Open educational resources (OER), which are free and openly licensed educational materials, have been a widely discussed topic in response to high textbook costs, the need for more pedagogical flexibility, and inequality in access to educational materials. In this study we examine the efficacy of OER through a quantitative analysis of the impact of OER on student final exam performance in a large calculus course. Our dataset affords us a relatively large sample size, allows us to classify students in both treatment and control groups, and includes a variety of covariates that allow us to control for multiple correlated factors. We estimate causal treatment effects using several econometric approaches. Our study adds the following insights into the research on OER efficacy: (i) OER materials do not, in general, lead to any significant change in student final exam performance; and (ii) OER materials have a significantly positive impact on both international students and Pell Grant eligible students.

Rare case of a large pancreatic duct calculus causing pancreatitis

Rare case of a large pancreatic duct calculus causing pancreatitis

“Vaginal Delivery”: A Novel Extraction Route for Large Renal Calculi Encountered During Laparoscopic Pyeloplasty

Background: To describe a simple, novel stone extraction technique using the transvaginal route for large renal calculi encountered during laparoscopic/robotic pyelolithotomy. Methods: After a standard approach laparoscopic pyelolithotomy in a patient with a large (42 × 36 mm) pelvic calculus, Anderson-Hynes pyeloplasty was performed. A transverse posterior colpotomy was performed laparoscopically with the assistance of the Colpassist Vaginal Positioning Device (Boston Scientific) and the calculus was extracted, intact, through the vagina with the aid of an endoscopic retrieval bag. The vaginal incision was then closed intra-corporeally. A systematic review on the topic was also performed. Results: The stone was removed in its entirety through an occult vaginal incision. There were no complications reported and the patient was stone free at follow-ups. Conclusions: This simple, novel technique is an easily reproducible method, for the removal of large urinary calculi during either traditional laparoscopic or robotic-assisted laparoscopic stone surgery in the appropriate female patient. It avoids the need for additional abdominal incisions or complex techniques involving lithotripsy which may be more complicated and time consuming. All previously published stone extraction techniques for large calculi (greater than 20 mm) within this systematic review are also critically appraised.

On the Efficacy of Open Educational Resources

Open educational resources (OER), which are free and openly licensed educational materials, have been a widely discussed topic in response to high textbook costs, the need for more pedagogical flexibility, and inequality in access to educational materials. In this study we examine the efficacy of OER through a quantitative analysis of the impact of OER on student final exam performance in a large calculus course. Our dataset affords us a relatively large sample size, allows us to classify students in both treatment and control groups, and includes a variety of covariates that allow us to control for multiple correlated factors. We estimate causal treatment effects using several econometric approaches. Our study adds the following insights into the research on OER efficacy: (i) OER materials do not, in general, lead to any significant change in student final exam performance; and (ii) OER materials have a significantly positive impact on both international students and Pell Grant eligible students.

Giant gall stone: a rare finding performed with open cholecystectomy

Very few cases of a giant gall stone (>50mm) are reported worldwide. Author reported a case of a gall stone measuring 80x44x41mm in a 64 years old female who underwent open cholecystectomy at our institution. Gall stones measuring more than 30mm are associated with a higher risk of developing gall bladder carcinoma and any patient who is harbouring a large calculus requires cholecystectomy. Large gall stones when detected on abdominal sonography throw a reasonable surgical challenge as on usual basis, laparoscopic cholecystectomy is an ideal approach for intervention in cholelithiasis. Giant gall stones are also associated with a wide spectrum of diseases including Bouveret syndrome, colonic ileus etc. Once a surgery is planned for a giant gall stone, open procedure is better than laparoscopic cholecystectomy as the latter is difficult to perform owing to the large size of calculus and associated adhesions in the region of Calot’s triangle. It further saves the patient from unnecessary conversion to open procedure that may occur subsequently in due course of surgery that involves a giant calculus.

The Nowhere Stone: Unusually Located Intrahepatic Calculi in a Patient with Low Phospholipid-associated Cholelithiasis Syndrome

ABSTRACTIntrahepatic calculi or hepatolithiasis is an uncommon phenomenon which is found in relatively higher rates in eastern Asian countries. Patients usually present with features of cholangitis or intrahepatic abscess and are at risk for developing cholangiocarcinoma. Correct diagnosis and management often pose challenges. A 42-year-old female presented with a history of episodic upper abdominal pain since 8 years. Initial imaging studies showed evidence of biliary calculi, but were confounding in their localization. Magnetic resonance cholangiopancreatography showed two large calculi in the right biliary system proximal to the confluence, along with choledocholithiasis. Endoscopic retrograde cholangiopancreatography and common bile duct clearance were done; however, the patient underwent hepatic sectionectomy as a curative procedure. ABCB4 mutation was detected on DNA analysis and hence aided in making the diagnosis of low phospholipid-associated cholelithiasis. Additional imaging studies are warranted in doubtful cases. Difficult accessibility of the calculi may often limit endoscopic therapeutic options and pave the way for surgical interventions. As there is an increased risk of cholangiocarcinoma in these patients, regular follow-up is essential.

Case report of staghorn calculus in a pediatric patient

ABSTRACT This article reports a case of large volume asymptomatic staghorn calculus, and a brief revision of this rare pathology is done. A two-yearold male patient was diagnosed with staghorn calculus and hydronephrosis in the left kidney. The patient underwent surgical therapy with pyelolithotomy, pyeloplasty and placement of a double-J catheter, without complications. Staghorn calculi occupy the pelvis and renal calyces. Their incidence in children is lower than in adults. The average age at diagnosis is between 7 and 10 years. The etiology for calculi is diverse; in children under 4 years, it is especially related with infectious factors and hydronephrosis. The standard procedure for treatment is percutaneous nephrolithotomy.

Effects of Calcium Oxalate on Expression of Clusterin and Lower Urinary Tract Symptoms in Prostatitis and Benign Prostatic Hyperplasia Patients with Calculi.

BackgroundProstatic calculi are common in urological treatments. Our major purpose in the present study was to explore the occurrence and composition of prostatic calculi, and investigate the effect of calcium oxalate (CaOx) on clusterin expression and lower urinary tract symptom (LUTS) in prostatitis and benign prostatic hyperplasia (BPH) patients with calculi.Material/MethodsFrom December 2016 to January 2017, a total of 79 prostatitis patients aged more than 50 years were enrolled. The patients were divided into 3 groups: group A had small calculi (discrete, small echoes); group B had large calculi (large masses of multiple echoes, much coarser), and group C had no calculi. Immunohistochemical analysis was performed to evaluate the tissue scores. The clusterin expression was detected by quantitative real-time CR (qRT-PCR), Western blot, and immunofluorescence.ResultsAccording to multifactor analysis, age was significantly associated with prostatic calculus. The composition of prostatic calculus was an independent factor of LUTS. The clusterin expression was elevated in group B. The mRNA and protein levels of clusterin in prostatitis and BPH patients with stones were obviously higher than those in prostatitis and BPH patients without stones. CaOx enhanced clusterin expression in a dose-dependent manner.ConclusionsLarge prostatic calculi were associated with LUST. Furthermore, CaOx enhanced clusterin expression, leading to large prostatic calculi. These results may provide a therapeutic strategy for prostatitis and BPH.

Labour dystocia: Vesical calculus can be the cause

Obstructed labour is a well-known clinical entity in maternity units, cephalopelvic disproportion being the most common cause. Here, we report a rare case of obstructed labour resulting from a large vesical calculus. The patient was a referred case from a district hospital for delayed progress of labour. The diagnosis of large vesical calculus causing labour obstruction was made by doing a vaginal examination. On vaginal examination, a large calculus of apparent size ~7 cm . 6 cm was palpated behind the anterior vaginal wall, which was preventing the descent of the head of the fetus. An emergency caesarean section was performed with simultaneous removal of vesical calculus by cystotomy. The postoperative period was uneventful.

38] Efficacy of silodosin on the outcome of semi-rigid ureteroscopy for management of large distal ureteric calculi: single-blinded placebo-controlled randomised trial

ObjectiveTo evaluate the efficacy of administration of silodosin, as a new α-adrenergic blocker (AAB), on the success rate of semi-rigid ureteroscopy (URS) for the management of large distal ureteric stones.

Prostate Calculi Causing Crepitus on Physical Exam

Crepitus on digital rectal examination is a rare physical exam finding, but can be clinically concerning in a patient with infective symptoms and may prompt extensive workup for severe infection with a gas-forming organism. Historical urologic literature suggests that this finding typically relates to large prostatic calculi, however. Here we present a case of significant prostatic stone burden in a symptomatic patient causing crepitus in the prostate on physical exam.

A Rare Case of Acute Cholangitis in a Young Male with Tropical Chronic Pancreatitis-Induced Pancreatic Adenocarcinoma with Metastasis to the Liver

Tropical chronic pancreatitis (TCP) is a rare and poorly understood variant of chronic pancreatitis. It is typically diagnosed in young, nonalcoholic patients in tropical regions such as southern Asia, often presenting with abdominal pain, and leading to several complications, including diabetes, malnutrition, and pancreatic adenocarcinoma. Though the link between chronic pancreatitis and cancer is established, the risk for malignancy is highest in those with rare causes of chronic pancreatitis. We present a case of TCP-induced pancreatic adenocarcinoma complicated by acute cholangitis. A 34 year-old Bangladeshi male with TCP complicated by diabetes and stage IV pancreatic adenocarcinoma with liver metastasis, s/p whipple procedure, and 3 cycles of adjuvant Gemcitabine and Abraxane presented with acute worsening of chronic abdominal pain. Labs were remarkable for elevated liver enzymes and a marked increase in CA 19-9. CT Abdomen/Pelvis revealed progression of metastatic disease in the liver and upper abdomen, including the peritoneum and anterior abdominal wall. His pain persisted despite EUS-guided celiac plexus block, but became acutely worse on hospital day 15 when he became febrile, jaundiced, and with blood cultures growing E. Coli, Klebsiella, and Aeromonas. Due to concern for acute cholangitis secondary to stenosis of hepaticojejunostomy, he was taken for ERCP. The biliary system was not successfully identified, so he then underwent IR-guided placement of a biliary drain via percutaneous transhepatic cholangiography, which showed central biliary stenosis and severe bilateral ductal dilation. He was subsequently placed in hospice due to his poor prognosis. The etiology of TCP is multifactorial, but also associated with a mutation of the SPINK1 gene, which causes parenchymal damage by lowering the threshold for trypsin activation. Characteristic radiographic findings include a dilated pancreatic duct with large intra-ductal calculi, pancreatic calcifications, and pancreatic atrophy. Data suggests that only 5% of patients with a 20-year history of chronic pancreatitis develop cancer, but 17% of patients with TCP develop malignancy, which is significantly higher than the near 0% risk of malignancy in those with chronic alcoholic pancreatitis. TCP is a rare disease that potentiates many long-term complications that can significantly increase mortality in an otherwise young and healthy population.1273_A.tif Figure 1: Marked dilation of pancreatic duct measuring up to 18 mm (blue arrow) that terminates at the pancreatic head due to a large calcification (red arrow).1273_B.tif Figure 2: Fine needle aspiration of mass at pancreatic head (blue arrow) and dilated CBD measuring up to 13mm (red arrow).1273_C.tif Figure 3: Multiple hepatic metastatic lesions (blue arrows) and invasion of the pancreatic head mass into the anterior abdominal wall (red arrow).