Multiple Ureteral Calculi Research Articles

Outcome of Upper Ureteric Stone Management by Semirigid Ureterorenoscope and Intracorporeal Pneumatic Lithotripsy

Objective: To evaluate the outcome of upper ureteric stone management using semirigid URS + ICPL. Materials and Methods: Patients undergoing URS + ICPL in patient department were included in the study. Total 38 patient were included in the study from March 2009 to June 2010 in National Institute of Kidney diseases & Urology, Dhaka. Stone size was 8 mm to 1.5 cm, patients were with good renal function, well excreation on both side, without any distal obstruction, infection or multiple ureteric calculi. The procedure was done under SAB.Cystoscopy was done for identification of ureteric orifice and guide wire was passed within ureteric orifice under visual monitoring.46 cm 10 Fr Storz Uretroscope was advanced next to the guide wire.At time a tortuous portion of the ureter was encountered a second guide wire was helpful. As soon as the stone was seen the pneymatic probe was pushed toward the stone.After fixing to the stone, pneumatic source was on and stone fragmentation was started. Care was taken to avoid injury of the ureter and keeping eye one stone fragment migration within the ureter was achieved. Placement of D-J stent was done at the conclusion of the procedure in most of the cases Result: The patients were followed upto 3 months post-operatively. Within immediate complications fever occured in 10 (26.3%) patients, severe haematurea occured in 8 (21.3%) patients, ureteral injury in 8 (21.3%) & ureteric perforation in 2 (4.8%) patients underwent URS+ ICPL. Stone clearance rate after 01 month of intervention was 30 (78.9%). Almost half of the patients developed UTI after 01 month of intervention. Pyelonephritis occured in 2 ( 4.8%) patient in this group. After 03 months of intervention 84.2% patients exibited complete clearance of stone. Only 02 (4.8%) patients developed ureteric stricture. Conclusion: For management of selective sized upper ureteric stone ureterorenoscopy with semirigid one using pneumatic source of energy is a good option for it’s high stone clearance & resonably low complications. Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.47-50

An unusual case of polymicrobial anaerobic bacteraemia in a male with ureteral calculi

Introduction: We describe an unusual case of anaerobic bacteraemia caused by Fusobacterium gonidiaformans and Peptoniphilus asacchacrolyticus, both commensal organisms normally found within human oropharyngeal, gastrointestinal and genitourinary tracts. Case presentation: One week following a routine colonoscopy with polypectomy, a 65‐year‐old male with renal calculi was admitted with a 3‐day history of severe abdominal pain and chills. He required urgent placement of a percutaneous nephrostomy tube. Urine cultures were negative but blood cultures were positive for Fusobacterium gonidiaformans and Peptoniphilus assachacrolyticus. Conclusions: We hypothesized that, following his colonoscopy, the patient developed transient bacteraemia with commensal gut organisms. In the setting of multiple ureteral calculi, this transient bacteraemia became a clinically significant infection, manifesting as acute ureterolithiasis with concurrent bloodstream infection. The routine collection of blood for anaerobic culture led to pathogen identification and appropriate antimicrobial therapy.

Transperitoneal laparoscopic ureterolithotomy for upper ureteral calculi: a report of 1171 cases

To evaluate clinical outcomes and values of transperitoneal laparoscopic ureterolithotomy. A total of 1171 patients with upper ureteral calculi were recruited during September 1999 to February 2012. The etiologies included impacted calculi (n = 1100), non-impacted calculi (n = 71), multiple ureteral calculi (n = 51) and combined small calculi in unilateral kidney (n = 139). Maximum diameter of calculi was 1.5 (0.8-2.6) cm. All patients underwent transperitoneal laparoscopic ureterolithotomy and double J stent was implanted intraoperatively. Two cases were converted into open operation. Calculi moving up into pelvis occurred in 27 cases. And 25 cases converted into laparoscopic pyelolithotomy and stones were removed successfully. Two cases received extra extracorporeal shock wave lithotripsy postoperatively. The remaining 1142 cases were treated successfully with an operative duration of 56.1 (26-160) min and an estimated volume of blood loss at 45.2 (10-250) ml. The period of drainage tube was 3.1 (1-7) days. Postoperative hospitalization stay was 4.8 (3-9) days. One patient suffered urine leakage and healed at Day 6 days post-operation. Ten cases suffered D-J stent bladder non-arrival or retraction and double J stents were extracted by ureteroscopy. One case suffered paralytic ileus and recovered 7 days later. Another case suffered severe hematuria. No intestine or adjacent viscera injury was observed. The follow-up period of 827 cases was 7.3 (24-108) months. Among 12 cases of ureteral stricture, ureteral dilation (n = 7) and ureteral anastomosis (n = 3) were performed. For 5 cases of renal atrophy, 3 underwent nephrectomy because of recurrent lumbago or persistent urinary infection. Transperitoneal laparoscopic ureterolithotomy has the advantages of minimal morbidity, little postoperative discomfort and high stone clearance rate over open surgery. It should be widely adopted for the patients with upper ureteral impacted calculi.

ゾニサミド投与中に短期間で両側腎尿管結石を生じた重症心身障害児の1例

Zonisamide is an antiepileptic drug mainly used in patients with refractory epilepsy. One of the urological adverse effects caused by zonisamide is urinary lithiasis. We reported bilateral urinary lithiasis with zonisamide developed for a short period of time. A 10 year-old girl had been treated with zonisamide for intractable epilepsy for nine years. She progressively developed microscopic hematuria as well as crystalluria while being hospitalized for ventriculoperitoneal shunt infection. A computed tomography (CT) showed bilaterally hydronephrotic kidneys obstructed by multiple ureteral calculi. What was impressive was the fact that any single urinary calculus was not identified in a CT image taken just three weeks prior to this event. Then the diagnosis was made of zonisamide-induced bilateral urinary calculi and zonisamide treatment was discontinued. However, since the deterioration of renal function and left-sided hydronephrosis progressed, we performed the construction of right-sided percutaneous nephrostomy (PNS) and the transurethral placement of a left ureteral stent. Subsequently her condition was stabilized and all of these stones were discharged. The analysis of these stones showed mainly calcium phosphatic calculus. We eventually removed both the right PNS and the left ureteral stent. Since then, there has not been any recurrence thus far. We need to recognize the risk of progressively developing renal calculi during zonisamide treatment for a relatively short period of time in the face of dehydration.

Spontaneous steinstrasse from multiple ureteric calculi

Spontaneous steinstrasse from multiple ureteric calculi

Antegrade flexible ureteroscopy in supine position for impacted multiple ureteric calculi

Flexible retrograde ureteroscope is now being widely used in endoscopic management of the urinary calculi. We report technique of supine ante grade flexible ureteroscopy in treating impacted upper and mid ureteric calculi in a pediatric patient. A six year-old boy with a history of acute right ureteric colic was investigated and found to have right upper and middle impacted ureteric calculi. He was planned for ureteroscopy, but the intramural part of the ureter could not be dilated. Hence, a decision was taken to do an antegrade flexible ureteroscopy in the supine position. An antegrade renal access was established in the supine position using ultrasound- guided puncture, a 22 Fr Amplatz was placed after serial dilatation of the tract and the stones were accessed using a flexible ureteroscope. The stones were then disintegrated using holmium laser. The ureter was stented at the end of the procedure. IVU done after six months revealed normal right kidney.

Two Unusual Cases of Multiple Ureteral Calculi: Reported at the meeting of the Danish Radiological Society held on Oct. 27th, 1921

Two Unusual Cases of Multiple Ureteral Calculi: Reported at the meeting of the Danish Radiological Society held on Oct. 27th, 1921

Two Unusual Cases of Multiple Ureteral Calculi (Reported at the Meeting of the Danish Radiological Society Held on Oct. 27Th 1921)

Two Unusual Cases of Multiple Ureteral Calculi (Reported at the Meeting of the Danish Radiological Society Held on Oct. 27Th 1921)