Obstructive Urolithiasis Research Articles

Assessing the safety of ureteral stent placement for obstructive urolithiasis in patients during the COVID-19 pandemic.

Patients with an active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] infection are at a higher risk of post-operative mortality. In this retrospective case-control study, we analyzed the post-operative safety of patients undergoing cystoscopy with ureteral stent placement for obstructing ureteral calculi who tested positive for COVID-19. We retrospectively identified patients who underwent cystoscopy and ureteral stent placement between June 5, 2020 and December 31, 2022 as an add-on case. Patients were stratified by whether they had a positive COVID-19 test on admission. Baseline characteristics were compared using Students t-test for continuous variables and Pearson chi-square test for categorical variables. Univariate and multivariate logistic regression analysis was performed to identify predictors of postoperative 30-day mortality. A total of 1,408 patients underwent add-on cystoscopy with ureteral stent placement for an obstructing calculus, of which 55 (3.9%) patients had a positive COVID-19 test. When stratified by COVID-19 status, both groups were similar with regards to age, sex, race, co-morbidities, indications, procedure duration, and type of anesthesia administered. Of the 137 patients that were admitted to the intensive care unit (ICU), 9 patients were COVID-19 positive (16.4% vs. 9.5%, P=0.09). On multivariate logistic regression, patients with COVID-19 had a higher odds of 30-day mortality [odds ratio (OR) =7.06; 95% confidence interval (CI): 2.03-24.47; P=0.002] when controlling for age, co-morbidities, vaccination status, anesthesia type, and indication for the stent. Patients that underwent cystoscopy and ureteral stent placement for an obstructing ureteral stone with a concurrent COVID-19 diagnosis had an increased risk of perioperative 30-day mortality.

Validation of a reference interval for symmetric dimethylarginine in healthy goats and its comparison to values in goats with obstructive urolithiasis.

Symmetric dimethylarginine (SDMA), a sensitive biomarker for detecting renal injury, has not been characterized in goats. Obstructive urolithiasis (OU) is the most common urinary tract disease in male small ruminants. Establish an SDMA reference interval (RI) in healthy adult goats and describe SDMA concentrations in goats with OU. We hypothesize that the SDMA RI in healthy adult goats will be similar to that of other adult veterinary species and that SDMA can be utilized to assess the renal function of goats experiencing OU. Fifty-five healthy adult male and female goats from a university herd were enrolled for SDMA RI development. Twenty male and female goats from a university herd were enrolled for validation of the SDMA RI established. Thirteen male goats diagnosed with OU were enrolled. Clinical trial. Serum samples for all animals enrolled were collected and analyzed for SDMA using an immunoassay (IDEXX Laboratories, Inc); goats with OU had additional blood work analyzed (PCV, total solids, and serum biochemistry). Symmetric dimethylarginine and other values in goats with OU were analyzed and compared at specific time points. The SDMA RI for healthy, adult goats is 8.03 μg/dL (90% CI 4.81-11.04) to 25.93 μg/dL (90% CI 22.88-28.97). There was no correlation identified between serum creatinine and SDMA in goats with OU. The SDMA RI for adult goats is higher than in other adult large animal species. Use of SDMA in goats with OU is not useful in assessing their renal function.

An Assessment of Indian Livestock Owners’ Selective Management Practices for Risk Amelioration of Obstructive Urolithiasis in Water Buffalo Male Calves

An Assessment of Indian Livestock Owners’ Selective Management Practices for Risk Amelioration of Obstructive Urolithiasis in Water Buffalo Male Calves

High plasma magnesium and phosphorus levels and their correlation with struvite urolithiasis in buffaloes

BackgroundUrolithiasis is a common urinary tract disease in buffaloes, almost exclusively affects young males, and has significant economic and production impacts. We have investigated hemato-biochemical and urinary changes in an attempt to deduce their correlation with struvite urolithiasis in buffaloes. MethodsTen male buffalo calves with obstructive urolithiasis were used. Blood samples were used for hematology and elemental analysis. Urine samples were used for physico-chemical examination, microscopy, and elemental analysis. Uroliths were subjected to chemical functional group determination using the FTIR spectroscopy. ResultsThe mean neutrophil, leukocyte, and neutrophil-to-lymphocyte ratio was significantly (p < 0.05) higher in urolithic buffaloes than in healthy controls. The mean blood calcium and magnesium concentrations were significantly (p < 0.05) lower and higher in urolithic buffaloes than in healthy controls, respectively. Mean blood phosphorus concentration and calcium-phosphorus ratio were found to be non-significantly (p > 0.05) higher and lower in urolithic buffaloes than in healthy controls, respectively. The urine pH was highly alkaline. Multiple prismatic lid-shaped crystals, along with erythrocytes, leukocytes, and epithelial cells, were found in urine. The mean urinary magnesium and phosphorus concentrations were non-significantly (p < 0.05) higher in urolithic buffaloes than in healthy controls. A positive correlation of magnesium (r = 0.864, p = 0.001) and phosphorus (r = 0.849, p = 0.002) concentrations between the blood and urine was observed in urolithic buffaloes. The FTIR spectra of uroliths were similar to those of magnesium ammonium phosphate hexahydrate, MgNH4PO4·6H2O or struvite. ConclusionThe findings suggest that high plasma magnesium and phosphorus concentrations have a positive correlation with struvite urolithiasis in buffaloes.

Pharmacokinetics of oral phenazopyridine in goats with obstructive urolithiasis

Phenazopyridine, an azo dye and urinary bladder analgesic widely used in human medicine, is commonly used for ancil­lary pain management in the treatment of goats with obstruc­tive urolithiasis. Despite its common use in these patients, there are no published studies on the pharmacokinetic param­eters, safety, or efficacy of phenazopyridine in caprine patients. The aim of this study was to determine the pharmacokinetic pa­rameters of oral phenazopyridine administration in goats with obstructive urolithiasis following tube cystostomy surgery

Comparative evaluation of conventional and ultrasound assisted tube cystotomy for obstructive urolithiasis in cattle

The aim of this study was to evaluate the efficacy of conventional and ultrasound assisted tube cystotomy techniques for obstructive urolithiasis in 12 cattle by allowing two groups. Group-I, animals were subjected to conventional tube cystotomy, whereas in group- II, ultrasound assisted tube cystotomy was performed using Foley’s catheter under deep sedation with xylazine hydrochloride and local infiltration anaesthesia. Clinically, all animals showed urethral pulsation, dribbling of urine, futile attempts, bellowing, congested mucous membrane, sunken eyes, dry muzzle and teeth grinding. Non-significant changes were observed in haematological and biochemical values, however neutrophilia and alkaline pH of urine was prominent. Ultrasound assisted tube cystotomy technique consumed less time (40.00±1.29 min) with small incision and minimal bleeding as compared to conventional tube cystotomy.

Minimal Invasive percutaneous tube cystostomy using three-way Foley Catheter for management of obstructive urolithiasis in goats

Minimal Invasive percutaneous tube cystostomy using three-way Foley Catheter for management of obstructive urolithiasis in goats

Modified tube cystostomy technique for management of obstructive urolithiasis in small ruminants: procedure and outcome in 17 sheep and goats.

To describe the surgical technique and clinical outcome of small ruminants treated for obstructive urolithiasis using a modified tube cystostomy (MTC) technique. 15 goats and 2 sheep treated with an MTC between March 2018 and February 2023. Animals were diagnosed with obstructive urolithiasis on the basis of history, physical examination, and ultrasonographic examination. An MTC was performed with sedation and a local block. Postoperative medical management was instituted to help reestablish urethral patency, and Foley catheters were removed after successful urination. Animals were hospitalized an average of 3 nights (range, 0 to 14 nights). Complications included urine spillage in the abdomen and accidental deflation of the Foley balloon. Six animals were euthanized due to poor prognosis or failure to regain urethral patency. Foley catheters were removed an average of 15.7 days postoperatively in animals that regained urethral patency. Long-term (> 1-month) follow-up was available for 8 animals, with an average postoperative survival time of 19.4 months (range, 1 to 58 months). Four animals were lost to long-term follow-up. This MTC technique is an effective means of catheterizing the urinary bladder in small ruminants. It can be performed under field conditions and serve as a standalone procedure for providing temporary urine egress. Patient size is limited by the length of the introducer, and an intact, distended urinary bladder and plan for reestablishing urethral patency are important considerations.

Investigating raised white cells, sepsis and antibiotic administration in obstructive urolithiasis: A retrospective cohort analysis

Objectives: Patients with obstructive ureteric calculi frequently present with leucocytosis, prompting empirical antibiotic treatment. Evidence for antibiotics in these cases is limited. This study investigated whether leucocytosis is a reliable marker of sepsis in obstructive urolithiasis, and assessed factors associated with sepsis after emergency department (A&amp;E) discharge, including antibiotic administration. Methods: Retrospective data collection was performed on all patients with computed tomography (CT)-proven ureteric calculi presenting to a single centre A&amp;E between October 2019 and October 2020. Data were collected on patient demographics, comorbidities, stone factors, serum and urinalysis and relevant culture results. Multivariable regression analysis assessed significant correlations for immediate/delayed sepsis, serum leucocytes and antibiotic administration. Results: In total, 392 patients (298:98 M:F) met the inclusion criteria. Raised leucocytes were found in 212 patients (54.4%) with 24 patients (6.1%) admitted immediately with sepsis, and 12 (3.1%) returning with sepsis. In total, 83 patients received antibiotics, of whom 57 (68.7%) had no immediate or delayed sepsis. Multivariable regression showed immediate sepsis significantly associated with stone size, presence and degree of type 2 diabetes ( p &lt; 0.012). Re-presentation with sepsis significantly correlated with female gender and multiple stones ( p &lt; 0.039) with antibiotic administration showing no benefit. Raised leucocytes showed no relation to immediate sepsis or delayed sepsis ( p &gt; 0.33). Conclusions: Leucocytosis alone is not a reliable marker of sepsis with obstructing ureteric stones. Septic patients are more likely to have severe diabetes with larger stones; female patients with multiple calculi are more likely to re-present with sepsis. In our cohort, antibiotics did not prevent re-presentation with sepsis and should not be given unnecessarily. Level of evidence: Level 4

Winning strategies against urolithiasis

Urolithiasis is a multifactorial disease of male ruminants caus­ing significant economic loss and compromise of animal wel­fare. Known risk factors include anatomic factors, urine pH, water intake, dietary composition and genetic factors. Clinical cases of obstructive urolithiasis may be treated using a variety of medical and surgical interventions, including tube cystos­tomy, perineal urethrostomy, urinary bladder marsupialization and modifications of these procedures designed to optimize pa­tient outcome. Preventative measures aimed at the known risk factors include addressing body water balance, mineral compo­sition of the diet and anatomical factors.

Survey the Effect of Educational Intervention Based on Mobile Short Message Service (SMS) on Self-Care in Patients with Type 2 Diabetes Referring to the Diabetes Clinic in Khorram Abad City

Background: The highlighting of possible risk factors for urinary colonization in patients with obstructive urolithiasis that needed double J catheters implanted to preserve renal function. Methods: We performed a descriptive, retrospective study, carried out in the Urology Department of the Bucharest Central Military Hospital, between January 2020 and January 2022 and included 168 patients with urolithiasis who required the insertion of double J catheters. We studied the bacteriological profile, using both urine and JJ catheter samples. Results: We obtained a double J catheter colonization rate of 32% (54 patients) and 29% of urinary colonization (49 patients). The rate of urinary colonization is higher in patients with colonized ureteral catheters regardless of sex, age, and associated comorbidities. At the same time, we noticed an increased rate of urinary colonization in patients associated with diabetes, hypertension, and chronic kidney disease. Conclusions: The prevalence of urinary colonization in patients with double J catheters was 29%. The colonization of the JJ catheters, as well as the association with chronic diseases, such as diabetes, hypertension, and CKD (Chronic Kidney Disease), show an increased risk of urinary colonization.

Risk Factors for Urinary Colonization in Patients with Double J Catheters Implanted for Treating Obstructive Urolithiasis

Background: The highlighting of possible risk factors for urinary colonization in patients with obstructive urolithiasis that needed double J catheters implanted to preserve renal function. Methods: We performed a descriptive, retrospective study, carried

Use of Digital Healthcare Communication to Improve Urologists' Surveillance of Lithiasis Patients Treated with Internal Urinary Drainage Pre- and Post-COVID-19 Period.

The COVID-19 pandemic has greatly affected lithiasis patients, which has led to an increase in the number of internal stents that have been installed. In this paper, two studies were carried out, a clinical study and a quantitative study. The aim of the first study was to evaluate the incidence and the prevalence of bacterial urinary colonization in patients with obstructive urolithiasis who needed internal stents implanted. In the second study, a multiple linear regression was created to identify the opinion of urologists regarding the importance of using digital technologies to improve the communication process. The result of the clinical study illustrates that the prevalence of urinary colonization in patients with internal stents carried out for obstructive urolithiasis was 35%, with this value being influenced by co-infection with COVID-19. The results of the quantitative study illustrated the fact that urologists are open to using new online technologies to facilitate communication with patients. The results have high importance for both doctors and patients, illustrating the main factors that have the ability to influence the communication process. The hospital managers should take into account the results obtained in this study when they choose to use certain online communication technologies with patients.

MP23-04 IMPACT OF THE TIMING OF PERCUTANEOUS NEPHROSTOMY ON THE PROGNOSIS IN PATIENTS WITH OBSTRUCTIVE UROLITHIASIS WITH SEPSIS

You have accessJournal of UrologyCME1 Apr 2023MP23-04 IMPACT OF THE TIMING OF PERCUTANEOUS NEPHROSTOMY ON THE PROGNOSIS IN PATIENTS WITH OBSTRUCTIVE UROLITHIASIS WITH SEPSIS Ji Eun Yu, Ye Chan Joo, Young Seop Chang, Jin Bum Kim, Hong Wook Kim, Hyung Joon Kim, and Dong Hoon Koh Ji Eun YuJi Eun Yu More articles by this author , Ye Chan JooYe Chan Joo More articles by this author , Young Seop ChangYoung Seop Chang More articles by this author , Jin Bum KimJin Bum Kim More articles by this author , Hong Wook KimHong Wook Kim More articles by this author , Hyung Joon KimHyung Joon Kim More articles by this author , and Dong Hoon KohDong Hoon Koh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate how time to percutaneous nephrostomy insertion impacts on prognosis of patients with obstructing ureteral stones with sepsis. METHODS: Using a database from 2017 to 2021, we evaluated patients who visited emergency department with obstructive uropathy due to urinary stones and underwent percutaneous nephrostomy insertion. We classified patients in two groups, whom met quick sequential organ failure assessment (qSOFA) score of lesser than two, and qSOFA score of two or more, and retrospectively investigated patients. The aim of this study is to understand how time to percutaneous nephrostomy insertion affects the prognosis, including total length of stay, need for intensive care unit. RESULTS: Total 96 patients met the criteria. 70 patients had qSOFA score of lesser than two, and 26 patients had qSOFA score of two or more. Overall, 37 patients have positive urine culture. Mean time to percutaneous nephrostomy insertion was 229 minutes, and mean length of stay was 18.11 days. There was no difference between groups in clinical values. In group of qSOFA score of lesser than two, there was no correlation between the time to procedure and length of stay, but in group of qSOFA score of two or more, hospitalization days was significantly shorter in patients of percutaneous nephrostomy before 4 hours than patients whom underwent procedure after 4 hours. CONCLUSIONS: In patients with obstructive uropathy with high risk of sepsis, length of stay would be decreased as time to percutaneous nephrostomy insertion shortened. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e307 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ji Eun Yu More articles by this author Ye Chan Joo More articles by this author Young Seop Chang More articles by this author Jin Bum Kim More articles by this author Hong Wook Kim More articles by this author Hyung Joon Kim More articles by this author Dong Hoon Koh More articles by this author Expand All Advertisement PDF downloadLoading ...

High urinary trace element concentrations: A possible indicator of urolithiasis in goats?

BackgroundUrolithiasis is a common urinary tract disorder among male goats. The role of trace elements in the crystallization of supersaturated urine has garnered considerable interest in other species, whereas their role in urolithogenesis has not been studied so far in goats. This study investigated the possible roles of urinary trace elements (Mn, Fe, Cu, and Zn) in the pathogenesis of urolithiasis in goats. Materials and methodsEight male goats with obstructive urolithiasis were used in the study. A celiotomy with tube cystostomy was performed after the diagnosis. Urine samples collected intra-operatively were used for physico-chemical examination, microscopy, and trace element quantification by atomic absorption spectroscopy. Urinary sediments were also used for chemical functional group determination by Fourier-transform infrared (FTIR) spectroscopy. ResultsMultiple coffin-top-shaped urinary crystals were observed in all the goats. Mean urinary Mn, Fe, and Zn concentrations were significantly (P < 0.05) higher in urolithic goats than in healthy controls. The mean urinary Cu concentration was found to be non-significantly higher in urolithic goats than in healthy controls. FTIR spectroscopy confirmed the presence of PO43−, NH4+, and OH− chemical functional groups in the selected urinary sediments. ConclusionsThe findings suggest that high urinary Mn, Fe, Cu, and Zn concentrations in goats play a role in the urolithogenesis of phosphate stones.

Obstructive urolithiasis in farm animals

Obstructive urolithiasis in farm animals

P-067 Long and short term survival following obstructive urolithiasis in small ruminants – A retrospective analysis of treatment outcomes in a veterinary hospital

P-067 Long and short term survival following obstructive urolithiasis in small ruminants – A retrospective analysis of treatment outcomes in a veterinary hospital

The role of serum and urinary markers in predicting obstructing ureteral stones and reducing unjustified non-contrast computerized tomographic scans in emergency departments.

The reported yield of non-contrast computed tomography (NCCT) in assessing flank pain and obstructive urolithiasis (OU) in emergency departments (EDs) is only ~ 50%. We investigated the potential capability of serum and urinary markers to predict OU and improve the yield of NCCT in EDs. All consecutive ED patients with acute flank pain suggestive of OU and assessed by NCCT between December 2019 and February 2020 were enrolled. Serum white blood cells (WBC), C-reactive protein (CRP) and creatinine (Cr) levels, and urine dipstick results were analyzed for association with OU, and unjustified NCCT scan rates were calculated. NCCTs diagnosed OU in 108 of the 200 study patients (54%). The median WBC, CRP, and Cr values were 9,100/µL, 4.3mg/L, and 1mg/dL, respectively. Using ROC curves, WBC = 10,000/µL and Cr = 0.95mg/dl were the most accurate thresholds to predict OU. Only WBC ≥ 10,000/µL (OR = 3.7, 95% CI 1.6-8.3, p = 0.002) and Cr ≥ 0.95mg/dl (OR = 5, 95% CI 2.3-11, p < 0.001) were associated with OU. Positive predictive value and specificity for detecting OU among patients with combined WBC ≥ 10,000 and Cr ≥ 0.95 were 83% and 89%, respectively. Patients negative to the serum markers criteria underwent significantly more unjustified NCCTs (p = 0.03). The negative predictive value of the serum criteria for justified NCCT scanning was 81%. WBC and Cr may be valuable serum markers in predicting OU among patients presenting to EDs with acute flank pain. They may potentially reduce the number of unjustified NCCT scans in the ED setting.

Urolitíase em suíno: Relato de caso

Urolithiasis is a pathological process that is characterized by the presence of stones or concretions in the urinary system, which can affect any and all species of animal. The present study consists of a case report involving a mini pig breed, diagnosed with non-obstructive urolithiasis and who underwent surgical intervention for the invasive treatment of the condition. The materials and methods include tests and statements related to the patient's treatment stages, ranging from laboratory tests to the postoperative period. The results showed that there was a possibility of the patient evolving into an obstructive urolithiasis, with a penectomy being the ideal surgical procedure for the treatment of the swine. Furthermore, the study supports the discussion of the use of surgical techniques in small to non-conventional animals, enriching it based on the medical-veterinary literature available on urolithiasis in swine, and filling gaps about the knowledge of this phenomenon, including the interventions, protocols adopted, drugs administered and other processes and procedures for rehabilitation. The conclusions reached identified the need to carry out future studies on urolithiasis in swine, given a general lack of publications in the national and international scientific literature on this phenomenon.

The Current State of Knowledge Regarding the Use of Double J Catheters in Treating Obstructive Urolithiasis

"Urinary lithiasis is a common pathology in the modern era. Its significance lies in the possible complications that may arise as well as in its potential for recurrence. The treatment and prevention of recurrences of urinary lithiasis often require the intervention of several specialists: urologists, nephrologists, endocrinologists, nutritionists, biochemists, etc. In the last 20 years, the treatment strategy for urinary lithiasis has changed, with minimally invasive methods replacing laparoscopic or open surgery. These are effective and have rare complications. Whichever treatment method is chosen, it may be necessary to temporarily divert the upper urinary tract by inserting double J catheters for preventive, curative, or palliative purposes. Ureteral catheters have had to be improved over time to avoid two major incidents: their migration and colonization. Various materials were used, varying the shape, size, length, guide as well as approaches. The urinary infection-urolithiasis association is frequent, without always being able to specify the cause-effect relationship. The rate of urinary colonization appears to be influenced by the presence of stent colonization as well as the time since the implant. The association of chronic diseases or emergency insertion is associated with an increased risk of urinary colonization. Complications induced by the time of the double J catheter being implanted are rare, and minor and disappear with its removal. In the case of failure to insert a double J ureteral catheter, the alternative would be to perform an ultrasound-guided percutaneous nephrostomy. Double J ureteral catheter insertion is an effective minimally invasive option in the treatment of obstructive urolithiasis. "