Lower Urinary Tract Stones Research Articles

Efficacy of Tamsulosin and Alfuzosin in Management of Distal Ureteral Stones

Introduction: Urinary tract calculi are the most frequent condition in urology clinics worldwide. The overall prevalence is about 5 % and lower urinary tract stones account for 70% among them. Medical expulsive therapy has been used to treat distal ureteric stone as it reduces symptoms and facilitates stone expulsion. The aim of this study is to evaluate and compare the efficacy of tamsulosin and alfuzosin as medical therapy in ureteric stones.
 Materials and Methods: A total of 87 patients with distal ureteral stones of size ≤10 mm were randomly divided into 3 groups. Group A patients (n-30) received 0.4 mg of tamsulosin daily, group B patients (n-29) received 10 mg of alfuzosin daily and group C patients (n-28) received 75 mg of diclofenac sodium. Patients in all groups received diclofenac sodium for one week and then as required. Follow-up was done on a weekly basis for 4 weeks. The stone expulsion rate, time for stone expulsion, and side-effects were recorded in each group.
 Results: The mean stone size (5.66, 5.79, 5.67) mm and age (29.1, 30.31, 29.4) were comparable in each group. The stone expulsion rate was 83.3%, 79.3%, and 50% in groups A, B, and C respectively. It showed that both the study groups (Group A and Group B) were effective than the control group (p-value 0.006 and 0.02 respectively) but there was no difference between tamsulosin and alfuzosin (p-value 0.69). The duration of stone expulsion was 11.5 days, 11.8 days, and 17.3 days for Group A, B, and C respectively. The drugs related side effects reported by patients were mild and transient.
 Conclusion: The use of tamsulosin and alfuzosin for the medical treatment of ureteric stones proved to be safe and effective and neither did have any significant benefits over the other.

Composition chimique des calculs urinaires et caractéristiques épidémiologiques associées en République Démocratique du Congo

To compare the chemical composition of the upper and lower urinary tract stones in Congolese patients, and to identify factors associated with the different types of stones. Stones from 119 patients originating from the upper tract and 75 from the lower tract were analyzed by infrared spectrophotometry. Among 119 patients with upper tract stones, age ranged from 10 to 81 years with a mean (SD) of 45.8 (13.6) years; males were the majority (55.5%). The main types of stones identified were whewellite (79%). For the 75 patients with lower apparatus stones, age ranged from 4 to 87 years with a mean (SD) of 51.6 (21.6) years; the majority were males (89.3%). The main types of stones were whewellite (44%) and anhydrous uric acid (22.7%). Overall, the factors associated with calcium oxalate included: site [4.95 (95% CI 2.35-10.44)] and diameter [3.03 (95% CI 1.45–6.25)]; patient's place of residence [0.05 (95% CI 0.01–0.29)] was associated with calcium phosphate. Infection stones were associated with; site [0.19 (95% CI 0.06–0.63)] and diameter [0.10 (95% CI 0.03–0.38)]. Finally, age 0.26 (95% CI 0.09–0.71) and stone site [0.23 (95% CI 0.07–0.68)] were associated with uric stones. The epidemiological and chemical profile of upper and lower tract stones were different. Several factors were associated with the chemical and crystalline composition of stones in the Democratic Republic of Congo.

Acute urinary retention in pediatric patients: one-single center experience

Acute urinary retention (AUR) in pediatrics is a rare disease with various causes. In this study, we were aimed to review and analyze cases of pediatric patients with AUR at Nanjing Children’s Hospital Affiliated to Nanjing Medical University. AUR was defined as the inability to void and associated bladder region pain and agitation that lasts more than 12 hours; or distended palpable bladder associated with pain. All children with AUR were alleviated with urethral catheterization or vesicopuncture. The past and current history, physical examination, laboratory tests and imaging modalities were reviewed and extracted by two independent authors. Finally, the basic characteristics, the causes of AUR and risking factors were analyzed. A total of 97 pediatric patients were included in our study. Lower urinary tract stones, neurological disorders and trauma were identified as the most common causes of the AUR in pediatrics in our center. For the boys, lower urinary tract stone was identified as the primary cause of AUR, whereas the prolapse of urethra was observed to be the first leading cause of AUR in girls. Ten patients underwent surgery, and five patients required continuous catheterization during follow-up. AUR in pediatrics was characterized by a variable etiology. Lower urinary tract stones, neurological disorders and trauma were identified as the most common causes of the AUR in pediatrics.

Age distribution and composition analysis of 198 female cases with urinary calculi

Objective To analyze the age distribution and stone composition of female patients with urinary calculi, and to provide the direction and ideas for clinical treatment. Methods 198 patients with urinary calculi were selected.The age, stone parts of patients were recorded, the stone composition was analyzed. Results In this study, there were 198 female patients with urinary calculi, 2 cases≤25 years old, accounting for 1.01%, 20 patients >25~45 years, accounting for 10.10%, 109 patients >45~65 years, accounting for 55.05 %, >65 years old patients in 67 cases, accounting for 33.84%.The main components of calcium stones were calcium carbonate components, carbonated apatite components, magnesium hexahydrate phosphate components, uric acid components, cystine components.The calcium oxalate composition stone in 158 cases, accounting for 79.80%.There were 135 cases (68.18%) of carbonate-containing apatite.8 cases of magnesium sulfate hexahydrate, accounting for 4.04%.40 cases of uric acid-containing stones, accounting for 20.20%.12 cases of cystic acid containing stones, accounting for 6.06%.198 female cases with stones were divided into mixed stones and simple stones.The mixed stones were mainly calcium oxalate + carbonate apatite, calcium oxalate + urate, calcium oxalate + cystine, carbonate apatite + magnesium phosphate hexahydrate, calcium oxalate + carbonated apatite + uric acid, calcium oxalate + carbonate apatite + cystine, carbonate apatite + magnesium phosphate hexahydrate + uric acid) .The simple stones were mainly calcium oxalate, carbonated apatite, uric acid and uric acid.According to the main components of the stone, they were divided into 131 cases of calcium oxalate, uric acid-based 23 cases, cystine-based 8 cases, 21 cases of carbonate apatite, magnesium phosphate hexahydrate mainly in 15 cases.According to the position of urinary tract stones, they were divided into upper urinary tract stones in 171 cases, 27 cases of lower urinary tract stones. Conclusion Female urinary tract stones in patients with high incidence in postmenopausal and old age, according to different components of stones should avoid the relevant dietary intake in order to avoid recurrence. Key words: Urinary calculi; Age distribution; Principal component analysis; Female

The association of benign prostatic hyperplasia with lower urinary tract stones in adult men: A retrospective multicenter study

ObjectiveTo examine the relationship between benign prostatic hyperplasia (BPH) and the presence of lower urinary tract stones. MethodsWe retrospectively reviewed the records of men with lower urinary tract stones who presented to three clinical centers in Korea over a 4-year period. We divided the patients into two groups based on the location of urinary stones: Group 1 (bladder calculi) and Group 2 (urethral calculi). We compared the characteristics of both groups and performed univariate and multivariate analyses with a logistic regression model to investigate the relationship between BPH and lower urinary tract stones. ResultsOf 221 patients, 194 (87.8%) had bladder calculi and 27 (12.2%) had urethral calculi. The mean age of Group 1 was higher than that of Group 2 (68.96 ± 12.11 years vs. 55.74 ± 14.20 years, p < 0.001). The mean prostate volume of Group 1 was higher than that of Group 2 (44.47 ± 27.14 mL vs. 24.70 ± 6.41 mL, respectively, p < 0.001). Multivariate logistic regression showed that age (OR = 1.075, 95%CI: 1.023–1.129) and prostate volume (OR = 1.069, 95%CI: 1.017–1.123) were independently associated with increased risk for bladder calculi. Upper urinary tract stones and/or hydronephrosis conferred a 3-fold risk for urethral calculi (OR = 3.468, 95%CI: 1.093–10.999). ConclusionAge and prostate volume are independent risk factors for bladder calculi. In addition, men with upper urinary tract disease are at greater risk for urethral calculi, which may migrate from the upper urinary tract rather than from the bladder.

MP01-16 METABOLIC SYNDROME INCREASES THE RISK FOR CALCIUM OXALATE STONE FORMATION: RESULTS FROM A NATIONWIDE SURVEY ON UROLITHIASIS IN JAPAN

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2017MP01-16 METABOLIC SYNDROME INCREASES THE RISK FOR CALCIUM OXALATE STONE FORMATION: RESULTS FROM A NATIONWIDE SURVEY ON UROLITHIASIS IN JAPAN Akinori Iba, Yasuo Kohjimoto, Takashi Iguchi, Shimpei Yamashita, Satoshi Nishizawa, Kazuro Kikkawa, and Isao Hara Akinori IbaAkinori Iba More articles by this author , Yasuo KohjimotoYasuo Kohjimoto More articles by this author , Takashi IguchiTakashi Iguchi More articles by this author , Shimpei YamashitaShimpei Yamashita More articles by this author , Satoshi NishizawaSatoshi Nishizawa More articles by this author , Kazuro KikkawaKazuro Kikkawa More articles by this author , and Isao HaraIsao Hara More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.091AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent epidemiologic studies have shown an increased prevalence of kidney stones in patients with metabolic syndrome (MetS). We have reported that the clustering of MetS traits is associated with greater severity of kidney stone disease (Am J Kidney Dis 61: 923-929, 2013). The aim of the present study is to clarify which stone composition is associated with MetS. METHODS We retrospectively analyzed detailed clinical data from 30,448 patients with urolithiasis enrolled in the 6th Nationwide Survey on Urolithiasis in Japan conducted in 2005. Patients with lower urinary tract stones, struvite stones, cystine stones, other types of rare stone composition, unknown stone composition, or hyperparathyroidism and those younger than 15 years were excluded. According to the types of stone composition, the severity of kidney stone disease, assessed by the number of existing stones (single/multiple) and number of stone episodes (first time/recurrent), and abnormalities in urine constituents were examined by the number of MetS traits (obesity, hypertension, dyslipidemia, and diabetes). RESULTS A total of 4,440 patients included in the final analyses were classified into four groups: calcium oxalate (CaOx) (n=3213), CaOx + calcium phosphate (CaP) (n=881), CaP (n=115), uric acid (UA) (n=191). The proportions of patients with recurrent and/or multiple stones significantly increased with the number of MetS traits only in patients with CaOx stone (P < 0.01, table 1). However, similar associations were not observed in patients with other stone compositions. In patients with CaOx stone, there was a significant and stepwise increase in the odds of recurrent and/or multiple stones after adjustment for age and sex. In patients with 3 or 4 MetS traits, the odds was 1.8-fold greater compared with patients with 0 traits (OR, 1.78; 95% CI, 1.29-2.42). In addition, the presence of MetS traits was associated with significantly increased odds of having hypercalciuria in patients with CaOx stone after adjustment for age and sex. CONCLUSIONS In patients with CaOx stone, MetS trait clustering is associated with greater severity of the disease and increased urinary calcium excretion. These results suggest that CaOx stone disease should be regarded as a systemic disorder linked to MetS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e7 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Akinori Iba More articles by this author Yasuo Kohjimoto More articles by this author Takashi Iguchi More articles by this author Shimpei Yamashita More articles by this author Satoshi Nishizawa More articles by this author Kazuro Kikkawa More articles by this author Isao Hara More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urinary tract stone development in patients with myelodysplasia subjected to augmentation cystoplasty.

Patients with myelodysplasia who have undergone augmentation cystoplasty are at risk for urinary tract stones. We sought to determine the incidence and risk factors for stone development in this population. The charts of 40 patients with myelodysplasia who have undergone augmentation cystoplasty were reviewed. None had a prior history of urinary tract stones. All patients were seen on an annual basis with plain abdominal imaging, renal ultrasonography, and laboratory testing. Statistical analysis included a multivariable bootstrap resampling method and Student's t-test. Fifteen (37.5%) patients developed stones, 14 with bladder stones and 1 with a solitary renal stone, at a mean of 26.9 months after augmentation. Five (33.3%) developed recurrent bladder stones. The patient with a renal stone never developed a bladder stone. The mean follow-up for the stone formers was 117.2 months and for non-stone formers was 89.9 months. The stone incidence per year was 6.8%. Risk factors included a decline in serum chloride after augmentation (P = .02), female sex, younger age at time of augmentation, longer time period since augmentation, and bowel continence. A significant proportion of patients with myelodysplasia subjected to augmentation cystoplasty develop urinary tract stones, predominantly in the bladder. Dehydration may play a role in development of lower urinary tract stones as the decline in serum chloride suggests contraction alkalosis, which could lead to constipation and improved bowel continence. Therefore, improved hydration should be a goal in this cohort.

Characterization of Urolithiasis in Patients Following Lower Urinary Tract Reconstruction with Intestinal Segments.

Urinary diversion and augmentation cystoplasty are associated with long-term complications, including metabolic derangements, infectious complications, and urolithiasis. The aim of this series was to characterize upper and lower urinary tract (LUT) calculi in this population. A retrospective chart review was performed on all patients with a history of urinary diversion or augmentation cystoplasty who subsequently underwent treatment for urolithiasis between January 1998 and May 2015. Data collected included demographics, perioperative characteristics, type of reconstructive procedure, urine culture, stone analysis, and metabolic evaluation. A statistical analysis was performed. Ninety-nine patients were identified with a history of urolithiasis and incontinent urinary diversion (28), neobladder (21), continent cutaneous diversion (12), and augmentation cystoplasty (38). LUT stones were more common than upper tract stones in all except for incontinent diversions, which only had one lower tract stone (p = 0.0001). Twenty-three percent of stones were metabolic. Several metabolic derangements were noted, including hypocitraturia (100%), elevated urine pH (100%), low urine volume (70%), and hyperoxaluria (35%). There was a 44% rate of recurrent urolithiasis. Given the high rate of stone recurrence among patients with a history of urinary diversion and augmentation cystoplasty, all measures should be taken to prevent recurrent stones. In addition to actions aimed to prevent infectious stones such as bladder and pouch irrigation, we recommend these patients undergo a full metabolic workup with targeted dietary changes and medical therapies.

MP82-14 TEMPORAL TREND OF MEDICAL UTILIZATION AND COST FOR UPPER AND LOWER URINARY TRACT STONE DISEASES, 2000-2010: A POPULATION-BASED STUDY IN TAIWAN

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2016MP82-14 TEMPORAL TREND OF MEDICAL UTILIZATION AND COST FOR UPPER AND LOWER URINARY TRACT STONE DISEASES, 2000-2010: A POPULATION-BASED STUDY IN TAIWAN Han-Yu Weng, Che-Yuan Hu, Kuo-How Huang, and Hong-Chiang Chang Han-Yu WengHan-Yu Weng More articles by this author , Che-Yuan HuChe-Yuan Hu More articles by this author , Kuo-How HuangKuo-How Huang More articles by this author , and Hong-Chiang ChangHong-Chiang Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2155AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urolithiasis, a prevalent disease with high recurrence rate, is associated with a high cost to society. In this study, we aim to investigate the medical utilization and costs of urolithiasis in Taiwan using a nationwide population-based database. METHODS This study is based on Taiwan's National Health Insurance Research Database (NHIRD), which contains the data of all medical beneficiary claims from 22.72 million enrollees, accounting for nearly 99% of Taiwan’s population. We selected subjects whose claims records included the diagnosis of upper (UUT) and lower urinary tract (LUT) stone diseases to analyze the medical utilization and costs during the period, 2000-2010. RESULTS There were significantly rising trends in the annual medical visits and costs for stone disease over the 11-year period (r2=0.25; p=0.050 and r2=0.63; p=0.001, respectively). The rate of medical care visits for stone disease increased by 7.5% from 1,513 in 2000 to 1,627 in 2010 per 100,000 subjects. Similarly, the medical cost of stone disease increased by 31.7% from $113.7 million dollars in 2000 to $149.7 million dollars in 2010. UUT stones consists of 97.9% of medical costs for stone disease. There were rising trends in the medical utilization and costs for UUT stone disease during the period by increasing 9.9% in medical care visits/100,000 subjects and by 31.1% increase in medical costs. For LUT stone disease, the declining trend in the medical utilization is not significant; however, the medical costs disease significantly increased by 21.6% during the 11-year period. CONCLUSIONS The present study provides important information on the increasing trends in medical utilization and cost of stone disease in Taiwan. It helps to quantify the burden of urolithiasis and to establish the strategies to reduce the cost of urolithiasis. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1078 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Han-Yu Weng More articles by this author Che-Yuan Hu More articles by this author Kuo-How Huang More articles by this author Hong-Chiang Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Acute Urinary Retention due to Impacted Urethral Meatal Stone - An Infrequent Entity in Children

Introduction Acute urinary retention in children is a relatively uncommon entity. There are various causes that leads to acute retention but are poorly defined in the literature [1,2]. Most common cause of acute retention of urine in children is lower urinary tract stone in one report [1] and neurological disease in another report [2]. Here we present a case of boy who presented with acute retention of urine due to impacted meatal stone. Case Presentation: An 8 year old boy came to emergency surgical unit with complain of sudden onset inability to pass urine and severe pain in lower abdomen since 12 hours, there was no history of trauma to abdomen and perineum, and haematuria. Clinical examination reveal palpable bladder and impacted urethral meatal stone (Figure 1), child was taken to emergency operation theatre and ventral meatotomy and extraction of stone was done, post operatively urinary catheter was kept for 24 hours. Stone analysis reveal presence of calcium and oxalate.This case highlight a seldomnly seen but still common mechanical cause of sudden onset urinary retention in boys, importance of thorough clinical examination of genitalia, planned surgical procedure to reduce the complication and stone analysis to know and treat any metabolic cause of it.

THE COMPOSITION OF URINARY STONES IN CENTRAL SINDH

ABSTRACT: Objective: To determine chemical analysis of urinary stones of central sindh. Study design : Prospective and randomized study. Setting: Department of Surgery and Pathology of Peoples University of Medical and Health Sciences Nawabshah . Duration of study: Three years from May2008 to May 2011. Material and Methods: Total 106 urolith patients who underwent open stone surgery were included in the study. EDTA Titration used for determination of calcium ions and determination of oxalate, phosphate, magnesium, ammonia, uric acid and cystine stones was carried out using spectrophotometer. These patients were asked to fill out a proforma with parameters of age, sex, radiological location of stone and chemical composition of surgically recovered stones. The stone analysis findings were reviewed and compared with other reported series Results: In this study 75(70.75%) patients were male and 31 (29.25%) female. Male to female ratio was of 2.41:1. The age ranged from 1 to 70 years with the mean of 22.69 years. The peak incidence of upper urinary tract stone in 20-30 years and lower urinary tract stones in both sexes was under 10 years. Anatomical location of stone showed 48(45.29%) renal, 13(12.26%) ureteric and 45(42.45%) bladder calculi. Chemical analysis revealed 56(52.8%) calcium oxalate, 7(6.6%) calcium phosphate, 11(10.3%) ammonium urate, 18(16.9%) uric acid, 13(12.2%) Sturvite and 1(0.9%) cystine calculi. Conclusion: It was concluded that urolithiasis is predominantly male disease. No age group was spared to stone disease. Calcium oxalate, uric acid, ammonium urate and mixed calculi are the main types in our study due to poor nutritional status, poverty and inadequate health facilities. Considering that knowledge of stone composition is of utmost importance to modify the incidence of urolithiasis. Keywords: Chemical composition, Urolithiasis.

Analysis of Urinary Stone Composition: A Retrospective Single Center Study during the Last Five Years (2009-2013)

Purpose Analysis of urinary stone composition is essential for treatment and prevention of urolithiasis. We evaluated the effect of age, gender, and stone location on urinary stone components during the last five years. Materials and Methods We conducted a retrospective analysis of the medical records of 375 patients ranging in age from 15 years old to 93 years old (241 males and 134 females) who underwent conventional or endoscopic surgery, shock wave lithotripsy, or passed their stones spontaneously between 2009 and 2013. Stone analysis was performed using a chemical analysis method to determine the molecular composition of each stone. Results Of the 375 patients with urolithiasis, 152 patients (40.5%) had predominantly calcium oxalate, 85 patients (21.5%) had uric acid, 17 patients (4.5%) had calcium phosphate, 17 patients (4.5%) had magnesium ammonium phosphate, 16 patients (4.3%) had calcium carbonate, and 86 patients (22.9%) had mixed stone type. There was a decreasing prevalence of calcium oxalate stone with age group (42.5% in young adult (20-39 years, n=40), 45.0% in adult (40-60 years, n=151), and 32.7% in elderly (≥60 years, n=180) as opposed to increasing prevalence in uric acid stone (7.5% in young adult, 15.2% in adult and 32.2% in elderly). Uric acid stones were more common in males and in lower urinary tract stones. Conclusions In this study, the incidence of calcium oxalate decreased with age and that of uric acid increased with age and in male. In comparison of the results of previous studies for several decades, the incidence of uric acid increased in the last five years.

Association of Metabolic Syndrome Traits and Severity of Kidney Stones: Results From a Nationwide Survey on Urolithiasis in Japan

Although metabolic syndrome and its individual components have been associated with kidney stone disease, whether the clustering of metabolic syndrome traits increases the severity of kidney stone disease has not been examined in a large-scale study. Cross-sectional analysis. Data were obtained from 30,448 patients enrolled in the 6th Nationwide Survey on Urolithiasis in Japan conducted in 2005. Patients with lower urinary tract stones, struvite stones, cystine stones, or hyperparathyroidism and those younger than 15 years were excluded. Number of metabolic syndrome traits (obesity [body mass index ≥25 kg/m(2)], diabetes, hypertension, and dyslipidemia). Severe form of kidney stone disease, defined as recurrent and/or multiple stones, and abnormalities in urine constituents (hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitraturia). 11,555 patients were included in the final analyses. Proportions of patients with recurrent and/or multiple stones were 57.7%, 61.7%, 65.2%, 69.3%, and 73.3% with 0, 1, 2, 3, and 4 metabolic syndrome traits, respectively (P < 0.001). There was a significant and stepwise increase in the odds of recurrent and/or multiple stones after adjustment for age and sex. In patients with 4 metabolic syndrome traits, the odds was 1.8-fold greater compared with patients with 0 traits (OR, 1.78; 95% CI, 1.22-2.66). In addition, the presence of metabolic syndrome traits was associated with significantly increased odds of having hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitraturia after adjustment for age and sex. Cross-sectional design, absence of dietary data, ill-defined diagnostic criteria for metabolic syndrome traits, and missing data for the majority of participants. Metabolic syndrome trait clustering is associated with greater severity of kidney stone disease; increased urinary calcium, uric acid, and oxalate excretion; and decreased urinary citrate excretion. These results suggest that kidney stone disease should be regarded as a systemic disorder linked to metabolic syndrome.

Prediction of calcium level in melamine-related urinary calculi with helical CT: diagnostic performance evaluation and clinical significance

The aim of the study was to investigate the relationship between CT-attenuation and stone calcium level in melamine-related urinary calculi (MRUC). A total of 25 MRUC with known composition and calcium level were included (11 uric acid stones, 2 calcium oxalate stones and 12 mixture stones of uric acid and calcium oxalate). Of all, 18 renal stones accepted alkalization therapy except for 5 lower urinary tract stones and 2 stones of unknown position. With well-matched composition, 61 adult urinary stones were included as controls. Every stone was scanned by helical CT (80 kV/120 kV, 300 mA, pitch 0.625 mm) and the highest CT-attenuation value measured. CT-attenuation values of MRUC increased gradually from uric acid stones, mixture stones to calcium oxalate stones, but were always lower than the values of controls. Furthermore, a strong positive correlation was found between stone CT-attenuation value and stone calcium level (n = 25, r (80kV) = 0.883, p = 0.000; r (120kV) = 0.855, p = 0.000). Compared with alkalization-therapy-alone group, stone CT-attenuation values and stone calcium level in the comprehensive-therapy group were significantly greater (CT(80kV) 1,057 ± 639 vs. 172 ± 61 HU, p = 0.001; CT(120kV) 783 ± 476 vs. 162 ± 60 HU, p = 0.001; Ca 19.83 ± 7.48% vs. 1.30 ± 1.51%, p = 0.000). Fisher's exact test suggested that the stones with higher CT-attenuation values tended to resist alkalization when 400 HU served as the cutoff value (P (80kV) = 0.002, P (120kV) = 0.000). In conclusion, the study was the first to illustrate that the CT-attenuation value could reflect calcium level in MRUC and found that stones with higher CT-attenuation value were not amenable to alkalization because they probably contained greater calcium. For those patients, we believe that comprehensive therapy will be the best choice.

2053 ASSOCIATION BETWEEN UROLITHIASIS AND FOOD INTAKE BASED ON DATA FROM A JAPANESE NATIONAL SURVEY

You have accessJournal of UrologyStone Disease: Basic Research1 Apr 20112053 ASSOCIATION BETWEEN UROLITHIASIS AND FOOD INTAKE BASED ON DATA FROM A JAPANESE NATIONAL SURVEY Takahiro Yasui, Atsushi Okada, Kazumi Taguchi, Yasuhiko Hirose, Fujii Yasuhiro, Kazuhiro Niimi, Masayuki Usami, Ryosuke Ando, Shuzo Hamamoto, Takahiro Kobayashi, Masahito Hirose, Yasunori Itoh, Keiichi Tozawa, and Kenjiro Kohri Takahiro YasuiTakahiro Yasui Nagoya, Japan More articles by this author , Atsushi OkadaAtsushi Okada Nagoya, Japan More articles by this author , Kazumi TaguchiKazumi Taguchi Nagoya, Japan More articles by this author , Yasuhiko HiroseYasuhiko Hirose Nagoya, Japan More articles by this author , Fujii YasuhiroFujii Yasuhiro Nagoya, Japan More articles by this author , Kazuhiro NiimiKazuhiro Niimi Nagoya, Japan More articles by this author , Masayuki UsamiMasayuki Usami Nagoya, Japan More articles by this author , Ryosuke AndoRyosuke Ando Nagoya, Japan More articles by this author , Shuzo HamamotoShuzo Hamamoto Nagoya, Japan More articles by this author , Takahiro KobayashiTakahiro Kobayashi Nagoya, Japan More articles by this author , Masahito HiroseMasahito Hirose Nagoya, Japan More articles by this author , Yasunori ItohYasunori Itoh Nagoya, Japan More articles by this author , Keiichi TozawaKeiichi Tozawa Nagoya, Japan More articles by this author , and Kenjiro KohriKenjiro Kohri Nagoya, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2284AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To clarify regional variations in incidence and the association between nutrition and urolithiasis in Japan, we evaluated epidemiological data from a nationwide survey. METHODS Correlations between the average intake of various types of food (cereals, sugars, legumes, other vegetables, fruits, fish, meat, eggs, and dairy products) and urinary stone incidence were examined by region. Data obtained from all patients who were diagnosed by urologists in the year 2005 as having urinary tract stones were separately analyzed according to hospital size, irrespective of admission and treatment in each prefecture (n = 92,797 patients at 702 hospitals). Data were obtained from the Japanese Society on Urolithiasis Research. We estimated the annual incidence and composition of urinary tract stones in 47 prefectures and 12 districts in Japan, calculated according to hospital size. We examined the association between urinary stone incidence and data from the national nutritional survey for each district, as collected by the Japanese Ministry of Health, Labour and Welfare. RESULTS Approximately 203.1 and 9.1 patients per 100,000 citizens had upper and lower urinary tract stones, respectively. The incidence of upper urinary tract stones was higher in southern Kyushu and Kinki, and lower in eastern Tohoku and Kanto compared with the national average (figure). These results were similar to previous findings. The incidence of upper urinary tract stones correlated negatively with intake of fruit (r = −0.72) and positively with intake of sugar (r = 0.47) and eggs (r = 0.54). There is no correlation between urolithiasis and the other foods. CONCLUSIONS The incidence of urinary stones is higher in areas of low fruit and high sugar intake. These data are useful as a basis for investigating the risk and nutritional factors associated with urinary tract stones. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e822 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takahiro Yasui Nagoya, Japan More articles by this author Atsushi Okada Nagoya, Japan More articles by this author Kazumi Taguchi Nagoya, Japan More articles by this author Yasuhiko Hirose Nagoya, Japan More articles by this author Fujii Yasuhiro Nagoya, Japan More articles by this author Kazuhiro Niimi Nagoya, Japan More articles by this author Masayuki Usami Nagoya, Japan More articles by this author Ryosuke Ando Nagoya, Japan More articles by this author Shuzo Hamamoto Nagoya, Japan More articles by this author Takahiro Kobayashi Nagoya, Japan More articles by this author Masahito Hirose Nagoya, Japan More articles by this author Yasunori Itoh Nagoya, Japan More articles by this author Keiichi Tozawa Nagoya, Japan More articles by this author Kenjiro Kohri Nagoya, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical Pattern of Urinary Stone Disease in Our Setting

Objectives: To study the basic clinical pattern of urinary stone disease in our setting.Study design: Descriptive study.Setting: Department of surgery of Nawabshah Medical College Nawabshah over a period of 4 years between August 2003to August 2007.Subjects: A total of 257 urolith patients with different stone burden enrolled in the study.Methodology: Structured and standardized history and clinical investigations collected in all of urolith patients. Thediagnosis of stone disease was based on history, physical examination followed by KUB x-ray, ultrasonography and IVU .Allpatients subjected to open stone surgery. The data were analyzed prospectively with outcome measures of gender, stonelocation, clinical presentation and operative procedures.Results: Out of 257 patients 181 (70.42%) were male and 76 (29.56%) female with male to female ratio of 2.3:1.The ageranged from 1 year to 80 with the mean of 25.8 years. The peak incidence of upper urinary tract stones was in 20-30 yearswhile lower urinary tract stones in both sexes were under 10 years (Table 1). Anatomical distribution of stone showed 116(45.16%) renal, 21 (8.17%) ureteric, 108 (42%) bladder and 12 (4.66%) urethral calculi (Table 2). The commonest clinicalpresentation was that of pain in 67.31% of patients associated with haematuria in 26.7% of cases. Clinical urinary tractinfection (UTI) was in 15% and 8.9% of patients had spontaneous stone passage (lithuria). The symptoms of bladder outletobstruction (BOO) including retention of urine were in 7% of cases. Calculus anuria was in 1.9% of cases and 8.1% patientshad asymptomatic stones. Bilithiasis (chole-nephrolithiasis) was in 5% of cases (Table 3). Open stone surgery included 84(32.68%) simple pylolithotomies, 15 (5.83%) extended pylolithotomies, 6 (2.33%) pylolithotomy and pyloplasty, 5 (1.94%)nephrolithotomy, 6 (2.33%) nephrectomies, 21 (8.17%) uretrolithotomy, Cystolithotomy was 113 (43.96%) cystolithotomy, 2(0.77%) urethrolithotomy and meatotomy in 5 (1.94%) of patients.Conclusion: Urolithiasis is increasing problem with high frequency of bladder stones and male predominance in our part ofSindh province. Open surgery is still needed to treat the patients where modern and minimally invasive therapeutic modalitiesare out of reach and non-availability in public sector. Establishment of modern stone clinics in rural setup is the need oftoday’s medical practice.Keywords: Urinary calculi, Clinical profile, Open stone surgery.

Analysis of urinary calculi composition by infrared spectroscopy: a prospective study of 625 patients in eastern China

Urolithiasis is a common urologic disease whose prevalence is about 1-20% and increasing throughout the world. The recurrence rate after treatment is more than 50%. Urinary stone analysis is important in determining the possible etiology and the pathophysiology of stone formation. A better understanding of the stone composition may help prevent urinary stone formation. From March 2007 to December 2008, physical analysis of urolithiasis in patients who lived in eastern China for more than 5 years and underwent surgery or shock wave lithotripsy in our hospital or passed their stones spontaneously was carried out using the Fourier transform infrared spectroscopy (FT-IR). Clinical and demographic findings were evaluated and compared with the stone components. Stone analysis was performed in 625 patients. The FT-IR evaluation showed that 234 (37.4%) were pure, and the most frequent was calcium oxalate (33.9%), followed by calcium phosphate (2.7%), and uric acid (0.8%). 391 (62.6%) were mixed stone, calcium oxalate (43.2%) was the most commonly major component, followed by calcium phosphate (16.3%), cystine (1.3%), uric acid (1.1%), and struvite (0.6%). Uric acid (p = 0.029) was the major component found more frequently in men, while struvite (p = 0.037) was more frequent in women. Uric acid (p = 0.031) was more common in lower urinary tract stones, and its formers with the mean age of 55 years were older than those with other components (p = 0.039). In eastern China, the most commonly found pure stone was calcium oxalate, while the most frequent mixed stone was calcium oxalate and calcium phosphate mixture. Stone location, gender, and age may influence stone component.

Metabolic stone composition in Egyptian children

The composition of urinary stones in children depends on socioeconomic conditions, geography and dietary habits. Pediatric urolithiasis remains endemic in developing countries. The aim of this study was to analyze stone composition in an Egyptian patient population. We analyzed prospectively urinary stones from 100 consecutive children (73 males, 27 females), aged 14 months to 12 years. The stones were located in the upper urinary tract in 78%, lower urinary tract in 19% and both in 3%. Male patients had more lower urinary tract stones. On presentation 67% had flank pain and 37% had hematuria. Stones were treated by open surgery in 69% of patients, shockwave lithotripsy in 20% and endoscopic extraction in 13%. The components of the upper urinary tract calculi were calcium oxalate (47%), ammonium acid urate (26%) and calcium carbonate (21%), whereas the main components of the lower urinary tract calculi were ammonium acid urate (27.2%), struvite (27.2%) and calcium carbonate (22.7%). Urinary tract infection was involved in the development of one third of the stones. Endemic stones were present in 17% of patients, and stones of metabolic origin in 15%. The etiology of stone formation remained unknown in one third of patients. The epidemiological profile of urinary stones in Egyptian children can now be considered intermediate between developing countries where dietary deficiencies are the main causes and developed countries where infectious and metabolic calculi are observed.

結石分析を施行した尿路結石症の臨床的検討

Stone analysis is an important examination for treatment and prevention of recurrence in urolithiasis. A twenty-six years clinical study of patient with urinary stone formers performed stone analysis was conducted. 1,108 stone formers (male 726, female 382) who performed stone analysis from 1977 to 2002 was conducted. Location of the stone, sex, age, treatment and stone analysis was examined in this study. Phase 1 is from 1977 to 1983 mainly performed open surgery, phase 2 is from 1984 to 1992 mainly performed endoscopic surgery, and phase 3 is from 1993 to 2002 mainly performed extracorporeal shock wave lithotripsy (SWL). Analytic numbers per year increased, especially phase 3. In the treatment of upper urinary tract (UUT) stone, open surgery, endoscopic surgery and SWL was carried out 78.4%, 72.8% and 71.4% of all cases in each phase. Many transurethral lithotripsy were performed for lower urinary tract (LUT) stone. The numbers of UUT and LUT stone were 1,007 and 101 cases. The frequency of LUT stone was higher than that found in a nationwide urolithiasis survey carried out in Japan in 1995. The male-female ratio of UUT stone was 2.35:1, 1.74:1 in phase 2 and 3. The frequency of female increased in phase 2 more than that in phase 3. The incidence of calcium oxalate stone was increased, calcium phosphate stone and infectious stone was significantly decreased in UUT and calcium containing stone in LUT was decreased. The average age for incidence of UUT stone rose in man step by step. The frequency in male was significantly higher than that in female under 50's, not significantly higher over 50's in calcium oxalate with calcium phosphate stone former (p = 0.009). In the present study, the clinical features were as follows : important urinary stone analysis, high frequency of LUT stone, high frequency in females, tendency to aging, high frequency of calcium containing stone in LUT, resolution of the difference in male and female over 50's in calcium oxalate with calcium phosphate stone former.

Metabolic factors in the causation of urinary tract stones in patients with enterocystoplasties

Stones are a common complication of the storage of urine in intestinal reservoirs. Previous studies have identified predisposing physical characteristics in the reservoirs. Biochemical and dietary factors have been little investigated. Fifteen patients (6 males and 9 females) who had undergone various enterocystoplasty operations and who had subsequently formed either upper or lower urinary tract stones were investigated. The programme has been previously described and included stone, blood and urine analysis and dietary review. Comparison was made with 15 age- and sex-matched idiopathic stone formers with normal bladders. Stones were infective in origin in 86% of cases, and 14% were sterile. Metabolic screen showed that 80% of enterocystoplasty patients had risk factors for at least three different types of stone. All patients had raised pH (mean 6.93) and hypocitraturia. Five had a raised alkaline phosphatase. Raised serum and urinary calcium, hyperoxaluria and hyperuricosuria were found in 33% of patients. Five had a 24-h urine volume below 1.6 l/day. All patients had a high risk index (PSF) for phosphatic stones and 12 also for calcium oxalate stones. Compared to age-and sex-matched idiopathic stone-formers, the urine had a higher pH, sodium and protein excretion and a lower calcium and citrate excretion. Although the patients were already selected as stone-formers, the data show that metabolic and dietary factors are present. They may be as important in the aetiology of the stones, as the already recognised factors of infection and poor reservoir drainage. Investigation should include such factors, the presence of which may be taken into account in a prophylactic regime.