Management Of Urolithiasis Research Articles

Detection of the mineral constituents in human renal calculi by vibrational spectroscopic analysis combined with allied techniques Powder XRD, TGA, SEM, IR imaging and TXRF

Detection of the mineral constituents in a batch of 310 samples of human urinary calculi (kidney stones-235 and bladder stones-75) combined with a semi-quantitative analysis has been presented on the basis of Fourier Transform based IR and Raman spectral measurements. Some of the observed characteristic IR and Raman bands have been proposed as ‘Marker Bands’ for the most reliable identification of the constituents. A detailed vibrational spectral analysis combined with a DFT level calculation for the functional groups in Calcium Oxalate Monohydrate (COM), Magnesium Ammonium Phosphate Hexahydrate (MAPH), Calcium Hydrogen Phosphate Dihydrate (CHPD), Penta-Calcium Hydroxy-Triphosphate (PCHT) and Uric Acid (UA) has been proposed. It has been shown that the identified mineral constituents as major or minor components can be deduced from the application of Lambert-Beer law of radiation absorption and results are in agreement with quantitative Spectral Data base. This simple method has the potential to be integrated into the management of Urolithiasis, a process of forming renal calculi in the kidney, bladder and/or urethra. Employment of powder XRD, TGA, SEM, TXRF and IR Imaging techniques has provided additional support for the proposed foolproof identification of the mineral constituents. Among the mineral constituents, Calcium Oxalate Monohydrate, Calcium Oxalate Dihydrate or their mixture account for 85% of the total number of samples; the remaining 15% and 5% samples contain Phosphate and Uric acid stones respectively.

Combined effect of polyacrylic acid and vitamin E in preventing calcium oxalate crystal deposition in the kidneys of experimental hyperoxaluric rats

Our study explores the combined effect of polyacrylic acid and vitamin E as prophylactic and curative agent against ethylene glycol (EG) induced calcium oxalate stone formation in Wistar rats. Male Wistar rats (54) were divided into nine groups, including control. The experimental groups were equally segregated into two for preventive study (4) and curative study (4). Urolithiasis was induced with 0.75% (v/v) EG in drinking water. Polyacrylic acid (10 mg/kg) and vitamin E (300 IU/day) were supplemented from day 1 for preventive and day 30 for curative studies. Restoration of urinary lithogenic factors (calcium, oxalate, phosphate, citrate and magnesium) and renal function (urea and creatinine in serum) by intervening agents were accomplished compared to urolithic rats (P < .001). Abnormal localization and increased expression of Tamm-Horsfall Protein, osteopontin and transferrin were observed in the kidneys of urolithic rats (P < .001) from immunohistochemistry and immunoblotting analysis. Polyacrylic acid and vitamin E supplementation have regulated the expression of the urinary macromolecules. Pro-inflammatory cytokines in kidney were significantly reduced (P < .001) by the intervening agents compared to urolithic rats. Therefore, polyacrylic acid and vitamin E in combination could be a potential formulation for better management of urolithiasis.

Burden and management of urolithiasis in a newly established urology unit of a tertiary hospital

Background: Urolithiasis is the third most common affliction of the urinary tract that constitutes a significant burden on the practice of urology. The incidence and prevalence of urolithiasis are increasing globally. Objective: To assess the burden, presentation, and management of urolithiasis in our hospital. Materials and Methods: It was a retrospective descriptive study of patients who were managed for urolithiasis at the urology unit of our hospital between January 2015 and December 2019. Ethical approval was obtained. Patients' bio-data, clinical features, treatment, and complications were extracted from their medical records and entered into the proforma. The generated data were analyzed using SPSS version 21.0. Results: Complete medical records of 68 patients were retrieved. This constituted about 40.6% of urologic patients managed within the period. Their age ranged from 9 to 86 years with the mean age of 43.2 years ± 8.8 standard deviation (SD). The M F was 1.8:1. Students were predominant (29.4%). Others were traders, housewives, civil servants, and farmers. The majority of the patients presented with flank pain (64.7%) and mostly had renal pelvis stone (35.3%). Others had bladder stone (16.2%) and stag horn calculus (11.8%). Nearly all our patients were treated by open surgeries (98.5%) and most (72.1%) did not have any postoperative complication. Conclusion: Urolithiasis constitutes significant workload for urologists in our environment predominantly affecting young and middle-age males. The stones were predominantly in the upper urinary tract with a significant number of stag horn calculi. Despite the non-availability of uroendoscopic facilities, the majority of our patients had good outcome.

Clinical Evaluation Of Ashmarihar Kasaya In The Management Of Urolitiasis (Mutrashmari)

Urolithiasis is the most common urinary tract problem affecting people globally. Efforts have been made continuously since past, for a safe &amp; effective treatment for this alarming disease. The best and latest modern treatment for this disease is invasive surgery which requires hospital stay, pain and post-operative complications. In this context an Ayurvedic classical formula Ashmarihar Kasaya (Siddhayoga SamgrahaCh.18) is described as an effective drug in management of urolithiasis (mutrashmari). So a study was performed on account of above statement. The result was assessed by using a series of parameter and it was found that Ashmarihar Kasayais highly significant in relieving most of the signs &amp; symptoms. Also, the drug is found effective in removal of small (≤ 5mm) stones and reduce the size of big (6-10mm) stones present in ureter, bladder and kidney.

Antiurolithiatic Activity of Casaurina equisetifolia Leaf Mediated Nanoparticles

Urolithiasis is a complex process that occurs from series of several physiochemical event including supersaturation, nucleation, growth, aggregation and retention with the kidneys. Data from in vitro, in vivo and clinical trials reveals that phytotherapeutic agents could be useful as either alternative or an adjunct therapy in the management of urolithiasis. Casaurina equisetifolia have been reported to possess antiurolithiatic property by various folk lore practitioners. The in vitro antiurolithiatic study of the whole plant of C. equisetifolia through titrimetric and turbidity method was performed to check their potential in dissolving calcium oxalate crystals using Neeri as a standard compound. The aqueous extract and alcoholic extract of Gamma treated samples showed relatively higher dissolution of 70% of stones. Alcoholic extract of NPs and Gamma treated samples showed more dissolution than aqueous extract.

Primary Ureteroscopy for Diagnosing and Treating Acute Urolithiasis During the COVID-19 Pandemic

Purpose: The purpose of this study was to investigate the management of acute urolithiasis during index admission by primary ureteroscopy (P-URS) during coronavirus disease-2019 (COVID-19) pandemic. With the rise in prevalence of urolithiasis, the focus has shifted to manage patients presenting with acute ureteric colic during their first admission rather than using temporary measures such as emergency stenting (ES) or nephrostomies which are followed by deferred ureteroscopic procedures Deferred Ureteroscopy (D-URS). We compared the results of ES with P-URS procedures in terms of quality and cost benefits during COVID-19 pandemic. Materials and Methods: Data were collected prospectively from April 2020 to March 2021 for all emergency urolithiasis procedures performed including ES and P-URS. The quality assessment was based in relation to patient factors including the number of procedures per patient, number of days spent at hospital, number of days off work, and expertise of person operating. Cost analysis included theater expenses, hospital stay charges, and loss of working days. Results: This study revealed that the average stay of patients on index admission who had an ES was 1.35 days compared to 1.78 days in patients who underwent P-URS. Patients who had ES had to undergo D-URS and spent another average of 1.5 days in the hospital. Overall, additional expenditure in patients who did not undergo primary ureterorenoscopy was on an average in the range of £1800 (excluding loss of work for patients, who needed to return for multiple procedures). Conclusion: We conclude that the approach of P-URS and management of stones in index admission is very effective in both improving quality of patients (during the COVID-19 pandemic) and bringing down cost expenditure effectively.

Comparative Study of Efficacy of Kutaja Beeja Churna and Ayurvedic Herbal Compound in the Management of Mutrashmari (Urolithiasis)- A Research Protocol

Introduction: Acharya Sushruta, the father of surgery has included Ashmari in Astamahagada due to its fatal nature. “Ashman” the Sanskrit word, literally means “structure resembling stone”. While the word ‘Ari' means ‘enemy,' so it refers to a sickness in which stones grow and inflict intense pain, as if caused by an adversary. Mutrashmari can be associated with Urolithiasis which is the third most common affliction of the urinary tract. Acharya Sushruta has described medicinal treatment in the initial stage of the disease and advised that surgery to be done only on failure of conservative treatment and when death becomes inevitable if not operated. In Yogaratnakar, Ashmari chikitsa, Kutaja is described to be more effective in the treatment of Mutrashmari. Need of study: In modern medicine, the treatment of urinary stones is non surgical as well as surgical interventions but both have some limitations and also stone formation reoccurs after removal. There is a need for safe, cost effective and simple method of management of urolithiasis which is curative as well as preventive. Aim: Comparative assessment of efficacy of Kutaja Beeja Churna and Ayurvedic Herbal Compound in the management of Mutrashmari (Urolithiasis). Materials and Methods: A randomised control trial (single blind parallel) with 1:1 ratio on 2 groups and will be conducted in Mahatma Gandhi Ayurved College Hospital and Research Centre Salod (Hi) Wardha. Expected duration of the study is one and half year (February 2022 - August 2023). Approval from the Institutional Ethical Committee has been taken and for this trial the registration number is CTRI/2021/09/036297. For statistical analysis Wilcoxon signed-rank test, Mann Whitney U test, Student’s t-test and the Statistical Package for the Social Sciences (SPSS) software will be used in the study. After doing drug analysis, a total of 60 patients fulfilling the inclusion criteria will be selected and distributed in two groups having 30 each. In group A, Kutaja Beeja Churna and in group B, Ayurvedic Herbal Compound will be given twice a day for 45 days. Assessment will be done on day 15, 30 and 45 and after the intervention; follow-up will be taken on days 60 and 90. Results will be drawn from the observations of subjective parameters like pain and dysuria and objective parameters like size of the stone, site of the stone and haematuria.

Diagnostic value of multidetector computed tomography for detection of complication after extracorporeal shock-wave lithotripsy

Background Urolithiasis represents one of the most common urogenital disorders. Extracorporeal shock-wave lithotripsy (ESWL) has changed the management of urolithiasis. ESWL has many complications, including cardiac dysrhythmia, bacteriuria, bleeding, steinstrasse, renal colic, and urosepsis. Multidetector computed tomography (MDCT) allows reliable detection and quantification of post-ESWL complications. Aims The aim of this work was to evaluate post-ESWL sequel by CT and to rule out complications. Patients and methods In total, 30 patients with renal stones received treatment with ESWL. Patients came after undergoing ESWL procedure and suffering from clinical complaints to the Department of Diagnostic Radiology in Tanta University Hospital examination center. Results All patients included in our study were evaluated by MDCT to detect complications after ESWL. We found that 10 cases had multiple stone fragments along the course of the ureter that was called steinstrasse. Urinary-tract infections in six (20%) cases. Two cases had signs of inflammation with steinstrasse. Six cases had renal hematoma. We found a significant value. No significant value between the incidence of complications and systolic blood pressure and also diastolic blood pressure. We found significant differences between the incidence of complications and high fasting blood sugar, especially urinary-tract infection. MDCT-diagnosed pyelonephritis has high white blood cell count in urine more than 100. Red blood cell significantly increased in urine analysis of cases with renal hematoma and pyelonephritis. Conclusion MDCT is considered the most accurate noninvasive imaging tool not only for diagnosis of urinary-tract stone but also detection of complications after ESWL.

Therapeutic evaluation of Safoof-e-Pattharphori with Sharbat Bazoori Motadil in patients of renal stone

Abstract Introduction: Stone formation is one of the common urological disorders; the Unani system of medicine provides an immense treasure of single and compound formulations for the safe management of urolithiasis. The objective of the study is to evaluate the effect of Unani medicine formulation Safoof-e-Pattharphori with Sharbat Bazoori Motadil in patients of Hasat-ul-Kulya (renal stone) as conservative treatment. Materials and Methods: This was a single-arm, open-labeled, pre and post without-control clinical trial entailing 30 diagnosed cases of Hasat-ul-Kulya (renal stone) up to 10 mm diagnosed by ultrasonography (USG), belonging to 18–65 years of age, either sex, and who had agreed to sign the informed consent form and follow up the protocol. The patients were exposed with Unani formulation, i.e., 5 g of Safoof-e-Pattharphori orally once daily with 50 ml of Sharbat Bazoori Motadil up to 45 days with three follow-ups. The assessments of subjective parameters were done at every 15th day of follow-up using an arbitrary scale. The assessments of objective parameters were carried out before and after the trial. The results were analyzed statistically using Wilcoxon signed-rank test, Student’s paired t-test (two-tailed), and proportion test. Results: The subjective parameters like pain in the abdomen showed significant relief with P &lt; 0.001. Objective parameters such as USG abdomen showed significant results (P &lt; 0.001). The size of the stone showed a statistically significant reduction (P &lt; 0.001). No significant adverse changes were observed in safety parameters during and after the trial. Conclusion: It can be concluded that the Unani formulation Safoof-e-Pattharphori with Sharbat Bazoori Motadil is safe and effective in renal stone treatment.

Оценка эффективности лечения мочекаменной болезни способом литотрипсии

This literature review aims to analyze the efficacy of different variants of lithotripsy as a main surgical method for the management of urolithiasis. We have conducted a large-scale search of both Russian and foreign publications and clarified the main parameters used to determine treatment efficacy. We have provided a rationale for the implementation of some integral parameter that will encompass no only the effectiveness of calculi fragmentation (number of procedures/operations, structure and size of calculi, complications, etc.), but also patients' quality of life after lithotripsy and the financial component of inpatient treatment.

A Review on Antiurolithiatic (Pashanabeda) Effects of Herbal and Marine Resources

Urolithiasis (urinary calculi) is stone development in bladder, urinary tract and kidney. The rise in frequency and occurrence of kidney stones is talking point all over the world. 12% of the global population suffer from urinary stone formation. The phenomenon effect of urolithiasis is lowered by using the pashanabeda elements. Pashanabeda (Pashan: stone; bheda: to break) is a Sanskrit locution which implies the breakage of stone. The adverse reactions caused due to man made drugs has prompted to rejoin with the natural safe medication. The evolution of plant-based therapeutics has shown terrific notice and demand as an modernistic drug entities all over the sphere. The present review aims the investigators to easily identify and develop plant and marine resources beneficial in management of urolithiasis.

Management of urolithiasis with individualised homoeopathy – A case report

Introduction: The population of the North-eastern region of India is prone to develop renal stones, and the prevalence and recurrence rate of renal stone disease is thus higher. A stone more than 0.5 cm diameter can cause painful ureteric obstruction. Stones of size more than 0.7 cm almost always require surgical intervention, as believed in conventional medicine. Repeated surgical interventions may remove obstruction but may not be a solution for altering the tendency for renal stone formation. Homoeopathy, an alternative system of medicine can offer holistic approach in treating such cases non-invasively. Case Summary: A 32 years old male patient presented with continuous severe pain in the left renal region for 15 days. A 1.0 × 0.4 cm calculus was found in the left distal ureter causing mild left-sided hydronephrosis as per computed tomography (CT) scan. According to symptoms similarity, homoeopathic medicine Tabacum was prescribed followed by Belladonna. Subsequently, the stone was expelled through urine. The pain was completely relieved, and the CT scan report showed no abnormality. On the basis of the patient’s constitution Calcarea carbonica was prescribed to remove the tendency to form the renal stone. This case of renal stone suggests that homoeopathic medicine can enable expulsion of a relatively bigger renal stones and check recurrence. However, more conclusive researches are required.

Antiurolithiatic activity of Didymocarpous pedicellata R. Br.

Didymocarpous pedicellata R.Br. (Gesneriaceae), also known as stone flower, is a valuable medicinal plant growing in the subtropical Himalayas (India). It is traditionally used for treating kidney and bladder stones and is the main ingredient of herbal formulations used to treat kidney stones, such as Cystone and Safoof-e-Pathr Phori (SPP). The present study explored the antiurolithiatic effect of Didymocarpous pedicellata leaves (DPL) in urolithiasis caused by ethylene glycol in Wistar male rats. The EG-induced urolithiasis group exhibited significantly higher (P < 0.001) serum creatinine, blood urea nitrogen, tissue lipid peroxidation, and urinary calcium levels, and significantly lower (P < 0.001) urinary potassium and sodium levels than the standard control group. DPL treatment (200 and 300 mg/kg) exhibited significantly (P < 0.001) lower urine and serum markers than toxicant rats. The histological investigation demonstrated refractile crystals and extensive damage to proximal tubules causing dilation in EG-induced urolithiasis rats. However, Didymocarpous pedicellata treatment of 300 mg/kg exhibited the absence of crystals and reduced kidney tissue damage, thus protecting against urolithiasis and nephrotoxicity. Therefore, DPL (300 mg/kg) is useful in the management of urolithiasis.

Osteogenezis imperfekta tanılı pediatrik hastada ultra-mini perkütan nefrolitotomi

Osteogenesis imperfecta (OI) is a rare, inherited disease group with genetic and clinical diversity. There is a defect in the type 1 collagen structure. Increasing bone fragility, osteopenia, and skeletal deformities can be seen. Surgical applications in patients with OI may cause complications such as spinous process injury in vertebrates or bone fracture. Therefore, in the management of pediatric urolithiasis, the decision of surgery should be carefully considered, and safe techniques that shorten the procedure time should be preferred. Percutaneous nephrolithotomy (PCNL) operation is the first choice for large kidney stones in adult patients. Along with the technological advances, more minimally invasive approaches such as mini-PCNL, ultra-mini-PCNL, and micro-PCNL have been developed, and these methods are safely used in pediatric patients due to their low morbidity. Because of its potential risks, urinary stone surgery in OI patients has rarely been reported in the literature. This study presents a 4-year-4-month-old girl with OI and kidney stone, whom we performed ultra-mini-PCNL. Keywords: endourology, urolithiasis, pediatric urology, ultra mini pcnl

Evaluation of Galdakao-modified Valdivia Position in Combined Simultaneous Access to Upper and Lower Urinary Tract Pathologies

Abstract Background Simultaneous retrograde and antegrade endoscopic combined intrarenal surgery in modified supine lithotomy positions offer significant progress in the endoscopic management of urolithiasis. The operative time has been significantly reduced. Aim of the Work To evaluate the Galdakao-modified Valdivia position in simultaneous handling of upper and lower urological pathologies in the same units. Patients and Methods The evaluation for the Galdakao-modified Valdivia position regarding the benefits in different upper and lower urological diseases was the aim of our prospective randomized clinical trial that will started on April 2017 and ended by April 2019. Results The study has included 60 patients comprising males and females. Conclusion We believe that GMSV provided a great versatility in the treatment for urolithiasis along the whole urinary tract, ante-retrograde access, treatment of uretero-ileal strictures in patients with urinary diversions or neobladders, missed double j stent, bilharizoma of the ureter and bladder mass involving the ureteric orifice. Also, the advantage provided by this approach to the surgeon, patient and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.

Percutaneous Nephrolithotomy as Minimally Invasive Treatment of Urinary Calculi

Abstract The management of urolithiasis has radically changed over the past two decades. Open surgery has been almost completely replaced by minimally invasive procedures. Percutaneous nephrolithotomy (PCNL) is considered to be the first line of treatment for large renal stones. Its use is associated with a multitude of complications. A thorough bibliographic search was performed for this review. Although PCNL comes with higher morbidity, its efficacy is unbeaten by other minimally invasive modalities. Improved skills and modifications of the procedure may reduce the probability of adverse outcomes. However, it is still associated with complications, even life-threatening ones. Since its introduction more than 30 years ago, PCNL has claimed its position as the minimally invasive procedure of the first choice for the treatment of large and complex renal stones. PCNL numbers are rising in recent years.

Comparison of a single-use, digital flexible ureteroscope with a reusable, fiberoptic ureteroscope for management of patients with urolithiasis.

Ureteroscopy is one of the commonest procedures performed to manage urolithiasis. Flexible ureteroscopy has been traditionally based on reusable, fiber-optic ureteroscopes. Technology advancements permitted the development of single-use scopes with digital image. The aim of this study is to compare efficacy and safety between a reusable, fiberoptic ureteroscope with a single-use, digital scope. We collected data based on chart review from a prospectively collected database on a tertiary, high-volume hospital in Greece. Baseline, perioperative and postoperative data were gathered and analyzed. Chi-square and Fisher's exact test was used to compare qualitative data and unpaired t-test for continuous data, with a statistical significance set at a = 0.05. 40 patients underwent flexible ureteroscopy with a single- use digital scope, while 37 with the reusable scope. The two groups were matched regarding baseline characteristics and stone-related parameters. After data analysis, a shorter operative time in favor of single-use flexible ureteroscope was detected (45 vs 65 min, p = 0.001), while safety was also in favor of this type of scope with a significantly higher immediate stonefree rate (70% vs 43%, p = 0.005). Overall complications did not differ between the two groups, although a lower sepsis rate was detected in patients treated with single-use scope. Our findings indicate that single-use, digital ureteroscopes are a viable alternative for flexible ureteroscopy and management of urolithiasis, especially in centers with deficient facilities for sterilization and ensured funds for more expensive reusable scopes.

Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.

Comparison between different techniques for management of renal stones in horseshoe kidneys

Abstract Objective To report the operative management , intra and post operative complications and subsequent stone-free rates of patients with urolithiasis in a horseshoe kidneys. Materials and Methods We retrospectively reviewed all patients presenting to our centre with a horseshoe kidney and urolithiasis over a 20-year period. The stone burden, surgical management, complications and stone clearance rates were recorded. Results In all, 80 patients with urolithiasis in horseshoe kidney were treated. Percutaneous nephrolithotomy (PCNL) was used in 28 patients. 12 patients had laparoscopic assisted PCNL , 8 had flexible ureteroscopy and 18 had laparoscopic pyelolithotomy . PCNL was used for large stones = (mean digitized surface area= 614.32 mm 2 ) and required one to four stages to achieve an overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of PCNL procedures. only 33% of patients treated with flexible ureteroscopy was cleared from stones in one session and surprisingly, 89% of patients treated with laparoscopic pyelolithotomy was stone free after one session Complications were minimal, with 15% minor and 3% major complications in the PCNL group only.. Conclusions Appropriate management of urolithiasis within the horseshoe kidney depends not only on stone burden, but also on stone location, calyceal configuration and malrotation. Stones can be cleared successfully in almost all patients providing that all techniques are available to the operating surgeon.

Personalized stone approach: can endoscopic combined intrarenal surgery pave the way to tailored management of urolithiasis?

article: Personalized stone approach: can endoscopic combined intrarenal surgery pave the way to tailored management of urolithiasis? - Minerva Urology and Nephrology 2021 August;73(4):428-30 - Minerva Medica - Journals