Obstructive Urolithiasis Research Articles

Ultrasonographic localization and mineral profile of urinary calculi in young and adult bovine

The study was conducted on 13 male bovine animals suffering from obstructive urolithiasis to evaluate the diagnostic approach, surgical outcome and mineral composition of uroliths. The animals were divided in two groups, Group I (n=8) of young animals and Group II (n=5) of adult animals. B-mode ultrasonography was done for locating the uroliths in penile urethra. All the animals were subjected to urethrotomy followed by ultrasonography at the suspected site of urolith lodgement. Ammonium chloride as urinary acidifier was given @ 50 mg/kg body weight orally for 60 days was found beneficial for preventing recurrence of uroliths. It was observed that urethra heals normally in three weeks if left unsutured and the majority of uroliths were present at tip of penis in Group I and in sigmoid flexure in Group II animals. Staphylococcus species were the most prevalent bacteria causing bovine urinary tract infections associated with urolithiasis in both groups. It was concluded that ultrasonography was efficient to localize uroliths in urethra in both groups of animals. On Fourier Transform Infrared Spectroscopy estimation, calcium carbonate, carbonate apatite in Group I whereas calcium carbonate in majority of Group II animals, were the most common types of minerals causing formation of uroliths.

Surgical management of urinary obstruction in young ruminants by tube cystotomy: A report of 24 cases

Objectives: To assess the efficacy of tube cystotomy along with medical dissolution of calaculi as a sole strategy for correction of obstructive urolithiasis in young ruminants. Materials and methods: Young bull calves (n=24; 10 Ongole claves and 14 Murrah buffalo calves) suffering from complete/partial urinary retention aging between 1 to 6 months were treated by tube cystotomy along with oral administration of ammonium chloride dosed at 10 gm/Kg body weight (bwt) orally for 15 days, streptopencillin dosed at 100 mg/10 Kg bwt through intramuscular (im) route for 5 days, and meloxicam dosed at 0.2 mg/Kg bwt through im route for 3 days. Results: Total 23 (95.83%) out of 24 calves started passing urine normally through the natural orifice 10-15 days postoperatively. None of the recovered animals (n=23) exhibited recurrence of symptoms, establishing the superiority of the technique in resolving the condition. Conclusion: Tube cystotomy, when performed at an early stage can prevent mortality of calves due to cystorrhexis, uroperitoneum and consequent uremia. This can avoid the painful and most tedious cysto-urethrotomy in young ruminants. http://doi.org/10.5455/javar.2016.c142

Laparoscopic Tube Cystotomy as a New Trend for Treatment of Obstructive Urolithiasis in Small Ruminants

The current study was planned to clarify the benefit from using laparoscopic tube cystotomy in treatment of obstructive urolithiasis especially in the cases that do not respond to urethral process amputation. For this purpose, 14 small ruminant cases were selected from 20 animals with obstructive urolithiasis. Another six cases that responded to urethral process amputation were also included. The disease was diagnosed based on clinical and ultrasonographic examinations. Laparoscopic tube cystotomy was performed by creating a diversion of urine from the urethra and voiding the urine temporarily from a foley catheter inserted inside the urinary bladder. In conclusion, this technique proved to be feasible in rams and bucks and can be used as an alternative to the open conventional tube cystotomy in cases of urine retention syndrome providing a minimal invasive tissue trauma and regaining the normal urination pathway in all treated cases.

SURGICAL REMOVAL OF UROLITH BY PRESCROTAL URETHROTOMY IN A BULL: A CASE REPORT

Urolithiasis is a major disease of domestic animals all over the world. Uroliths occur in either sex, but obstructive urolithiasis is primarily a problem of male due to anatomical conformation of their urinary tract (Larson, 1996). Various factors influences the formation of stone in the urinary tract like diet, age, sex, breed, genetic makeup, season, soil, water, hormone levels, mineral and infection (Kalim et al., 2011). Once the calculi are formed in urinary tract, they may be lodged in any part of the urinary tract, thus leading to the retention of urine causes bladder distention, abdominal pain and eventual urethral perforation or bladder rupture with death from uremia or septicemia (Gasthuys et al., 1993). Urolithiasis is seen most often during winter and during severe weather conditions with limited water intake, especially when the water has a high mineral content. In male ruminants the urethral diameter becomes progressively smaller from the ischial arch toward the tip of the penis. The calculi most commonly lodge in the urethra at the distal sigmoid flexure where there is pronounced narrowing of the urethral diameter (Wolfe and Moll, 1998).

English

Clinical study over a period of seven months at referral University Veterinary Hospital in Kashmir, India, was done on male calves clinically affected with urolithiasis was undertaken to manage them surgically and to study the mineral and haemato biochemical profile in an attempt to find out the probable cause of the malady and to ascertain the possible role of calcium, magnesium and phosphorous shift in urine blood and calculi. During obstructive urolithiasis, alterations in haematobiochemical profile were of no clinical significance, however, increased blood urea nitrogen (BUN), Creatinine, Calcium, and Inorganic Phosphorus could form a good index to determine the severity of the disease. Struvite calculi are most common urinary calculi observed in calves with heavy concentrate feeding especially wheat bran. The study revealed that the calculi contain 70% phosphorous, 20% calcium and 10% oxalate. This was clinically substantiated by the proportionate decrease in blood Ca and urine Ca levels. However, levels of creatinine and urea in urine blood and calculi revealed calcium phosphorous and their interrelation during the phase of urolithiasis, it could be conceived that ingestion of a ruminant feed containing high amounts of phosphates by a ruminant, physiologically with a non-functional rumen results in high absorption of the phosphates. This results in depletion of calcium absorption and calcium being excreted through urine. Key words: Urolithiasis, Calves, biochemical, calculi.

Clinical management of dietary induced urolithiasis associated with balanoposthitis in a Boer goat

A Boer-Kajang cross male goat was presented to the Veterinary Hospital, University Malaysia Kelantan with a history of dysuria, hematuria and restlessness. The goat was intensively managed (confined to the pen) and fed with only palm kernel cake for the last three months. Physical examination revealed that the goat was dull, depressed, having an inflamed penis and prepuce with blood stained urine dripping from the penis. The differential diagnoses were obstructive urolithiasis, urinary tract infection and balanoposthitis. Based on the history, clinical signs, physical examination, urinalysis, ultrasonagraphy and feed analysis, the goat was diagnosed with obstructive urolithiasis and balanoposthitis. Treatment was instituted by amputation of the urethral process and retrograde urohydropulsion to relieve the blockade. Sulfadiazine-trimethoprim (Norodine®24) 15mg/kg, I.M; flunixin meglumine 2.2mg/kg, I.M; vitamin B complex 1ml/10kg, I.M and ammonium chloride 300mg/kg orally were administered. The goat responded well to treatment and was recovering well during a follow up visit.

An alternative surgical approach to treatment of obstructive urolithiasis in a ram

Urolithiasis is defined as calculi formation into the urinary tract. The aetiology is related to mineral imbalance in the diet and in most cases, successful treatment is achieved only through surgical procedures. Furthermore, the breeding ability could be impaired. This report describes the technique of cranial penile urethrostomy associated with partial penectomy performed for the treatment of urolithiasis in a ram. Although limited to cranial obstructions, this technique is low-costs, only the penile tissues are accessed, general anaesthesia is not required and breeding ability may be preserved.

Alterações ultrassonográficas renais e vesicais de ovinos confinados e suplementados com cloreto de amônio

Resumo: A incidência da urolitíase obstrutiva em ovinos é elevada, principalmente em machos confinados, tanto para produção de carne, quanto reprodutores de alto valor genético. A acidificação urinária é um dos métodos para prevenção desta enfermidade e pode ser realizada de forma eficaz com a suplementação de cloreto de amônio (CA) na dieta. Utilizaram-se 100 ovinos, machos não castrados, mestiços (Ile de France X White Dorper), confinados, com idade aproximada de três meses. Constituíram-se três grupos experimentais: Grupo 21CA (n=40) que recebeu 400mg/kg/PV de cloreto de amônio/animal/dia, por 21 dias consecutivos; Grupo 42CA (n=40) que foi suplementado com 400mg/kg/PV de cloreto de amônio/animal/dia, por 42 dias consecutivos; Grupo controle (n=20), que não recebeu CA. A alimentação consistiu de ração total, composta por 15% de feno triturado e 85% de concentrado, água e sal mineral ad libitum. Após 14 dias de adaptação à alimentação e ao ambiente, os Momentos (M) de avaliação clínica, colheita de sangue e exame ultrassonográfico foram realizados com intervalo de sete dias, sendo M0 (imediatamente antes do início do tratamento com cloreto de amônio), M1 (sete dias após), M2 (14 dias após), M3 (21 dias após o início do tratamento e suspensão do cloreto de amônio em Grupo 21CA), M4 (28 dias após), M5 (35 dias após) e M6 (42 dias após), totalizando 56 dias de confinamento. As dosagens de ureia e creatinina não evidenciaram alteração na função renal, embora a ureia estivesse acima dos valores de referência para espécie ovina. Observaram-se imagens ultrassonográficas compatíveis com cálculos vesicais e dilatação de pelve renal. No Grupo 21CA, 15% (6/40) dos animais apresentaram cálculos vesicais; no Grupo 42CA, 5% (2/40); e no Grupo controle, 20% (4/20) dos cordeiros. Visibilizaram-se também imagens sugestivas de sedimentos e cristais em 31% (31/100) dos animais examinados. A ultrassonografia permitiu a visibilização de alterações renais e vesicais, porém não relacionados ao quadro clínico de urolitíase obstrutiva, revelando-se como um exame complementar de grande relevância para o diagnóstico precoce de alterações no sistema urinário de ovinos.

Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis: matched pair comparison with elective ureteroscopy.

The outcomes of ureteroscopy (URS) after urgent decompression and antibiotics for patients who initially present with urosepsis because of obstructive urolithiasis have not been previously evaluated. The aim of this study was to compare the outcomes and complications of URS in patients with a recent history of sepsis with those without sepsis. The study included 138 patients who underwent URS for stone removal from January 2004 to September 2011 at a university medical center. A matched-pair analysis was performed using three parameters (age, sex, and race) to compare outcomes and complications between 69 patients who had sepsis vs a matched cohort who did not have sepsis before URS. The study included 138 patients, 88 (64%) females and 50 (36%) males with a median age of 57.5 years (range 18-88 years). Patients with previous sepsis had similar patient characteristics and stone-free rates (81% vs 77%) compared with patients without previous sepsis (P>0.05). Patients with previous sepsis, however, had a significantly higher complications rate (20% vs 7%), longer hospital length of stay (LOS), and longer courses of postoperative antibiotics after URS (P<0.05). Sepsis developed postoperatively in two patients with diabetes (one with and one without previous sepsis), and postoperative fever developed in five patients with previous sepsis. URS after decompression for urolithiasis-related sepsis has similar success but higher complication rates, greater LOS, and longer course of postoperative antibiotics. This is important in counseling patients who present for definitive URS after urgent decompression for urolithiasis-related sepsis.

Efeito da suplementação de cloreto de amônio sobre os equilíbrios eletrolítico e ácido-básico e o pH urinário de ovinos confinados

A incidência da urolitíase obstrutiva em ovinos é elevada, principalmente em machos confinados, tanto para produção de carne, quanto reprodutores de alto valor genético. A acidificação urinária é um dos métodos para prevenção desta enfermidade e pode ser realizada de forma eficaz com a suplementação de cloreto de amônio na dieta, que pode propiciar a instalação de acidose metabólica. A hemogasometria avalia o equilíbrio ácido-básico sanguíneo de forma prática e fácil. Neste trabalho, avaliou-se o efeito do cloreto de amônio sobre o equilíbrio ácido-básico e eletrolítico de ovinos em confinamento para quantificar a acidose metabólica desenvolvida. Utilizaram-se 100 ovinos, machos, confinados, com idade aproximada de três meses. Constituíram-se três grupos experimentais: Grupo I (n=40), recebeu 400mg/kg/PV de cloreto de amônio/animal/dia por 21 dias consecutivos, momento da interrupção da administração do acidificante urinário (M3) e continuidade do acompanhamento clinico até o final do experimento (M6); Grupo II (n=40), 400mg/kg/PV de cloreto de amônio/animal/dia por 42 dias consecutivos; Grupo III (n=20), não recebeu cloreto de amônio durante todo o período do experimento. Os Momentos (M) de colheita de amostras e avaliação clínica foram estabelecidos com intervalo de sete dias, sendo M0 (imediatamente antes do início do tratamento com cloreto de amônio), M1 (sete dias após), M2, M3, M4, M5 e M6, totalizando 56 dias de confinamento. A alimentação consistiu de ração total, composta por 15% de feno triturado e 85% de concentrado, água e sal mineral ad libitum. Após adaptação de 15 dias à dieta de confinamento, colheram-se de todos os animais amostras de urina para mensuração do pH, e sangue venoso para hemogasometria, nos diferentes momentos. A acidificação urinária foi mantida enquanto houve a administração de cloreto de amônio nos grupos GI e GII. Os valores de Na+ e K+ permaneceram dentro da normalidade para a espécie. O cloreto de amônio provocou acidose metabólica hiperclorêmica compensada nos grupos GI e GII, comprovada pelos valores reduzidos de HCO3-, EB e SID, pelos valores elevados de Cl- e pelo pH normal. Concluiu-se que o cloreto de amônio apesar de provocar diminuição da reserva alcalina no organismo, não interferiu com o desenvolvimento dos animais, podendo ser empregado como agente preventivo da urolitíase obstrutiva em ovinos.

In this issue – August 2014

Bovine viral diarrhoea virus (BVDV) type 1 is endemic in Australian cattle populations, costing the national industry an estimated AUD57.9 million annually.1 BVDV control programs based on identifying and removing persistently infected cattle have been efficiently and effectively implemented in Europe and are gaining pace in New Zealand. This review discusses the challenges to BVDV control in Australia, including availability of infrastructure, reliability and availability of diagnostic tests, stakeholder compliance and the potential of other species, particularly sheep, to act as a potential reservoir host for the virus. Network analysis of the movements and connections of Australian beekeepers showed the nomadic beekeeper network was fragmented into 34 disconnected components.2 The largest component network linked 288 locations from Duaringa in central Queensland to Nelson in the far south-west of Victoria. Almond orchards and lucerne seed production were locations of major hive congregations driven by the opportunity to provide paid pollination services. In the 3 months after completion of almond pollination, movement of hives occurred to 49 locations spread over >2000 km, ranging from south-east Queensland to southern Victoria. This highlights how rapidly pests or diseases could spread if introduced to major congregation areas. The authors discuss the implications of these findings for improving surveillance and disease control policy for the honeybee industry. A study conducted at Charles Sturt University reports that Echinococcus granulosus is still present in Tasmania and being transmitted at low levels between dogs and cattle, although provisional eradication of E. granulosus from Tasmania was declared in 1996.3 Faecal samples from 1425 rural domestic dogs from Tasmania to south-eastern Queensland were tested for the presence of E. granulosus and other intestinal helminth infections. A total of 45 dogs (3.2%) were found to be E. granulosus coproantigen-positive, with 24 of these dogs originating from Tasmania and 16 from NSW. Three of the Tasmanian dogs were also positive for E. granulosus on coproPCR. The study also found that owner behaviour perpetuates the transmission of E. granulosus. Most owners did not deworm their dogs frequently enough to ensure they could never have a patent infection of E. granulosus. In addition, approximately 45% of the dog owners surveyed reported feeding offal of lambs or mutton and whole rabbits to their dogs, and >74% of owners admitted their dogs had opportunities to access carcases of wildlife or livestock. This month's case report is the first reported case of leucocyte adhesion deficiency type III (LAD III) in a dog in Australia and the first reported case of LAD III in a mixed-breed dog worldwide.4 This condition is attributable to a mutation in the KINLIN-3 gene that impairs activation of β-integrins, resulting in absence of neutrophil chemotaxis and adhesion and platelet adhesion and aggregation. Affected patients exhibit recurrent infections, marked leucocytosis and a severe bleeding tendency causing increased mucosal haemorrhage and prolonged postoperative haemorrhage. The authors describe the clinical signs, diagnosis and management of LAD III in a 16-month-old male German Shepherd × Rottweiler dog. A survey of Thoroughbred and Standardbred trainers investigated the magnitude of and risk factors associated with horse wastage in the Australian racing industry during the 2002–03 race year.5 The results showed an overall exit rate of around 40% in Thoroughbred and Standardbred stables. Poor performance was the most commonly reported reason for leaving, followed by illness/injury. Unsuitable temperament/behaviour was less frequently reported. A larger percentage of Standardbreds than Thoroughbreds went to different trainers or directly to knackeries, while a higher percentage of Thoroughbreds went to stud, auctions or entered ridden equestrian pursuits. Statistically significant risk factors influencing the destinations of both Thoroughbred and Standardbred racing horses included whether the trainer owned the horses, horse sex and age and reasons for leaving. A study conducted at Oregon and Colorado State Universities reviewed the clinical features and factors associated with short- and long-term survival of New World camelids with acquired urethral obstruction caused by urolithiasis.6 The most common clinical signs included straining to urinate, dribbling urine and anorexia, which are also frequently observed in small ruminants with obstructive urolithiasis. Prognosis appeared to be worse and occurrence of complications appeared to be more frequent than in small ruminants, particularly after tube cystostomy and bladder marsupialisation. Incomplete urethral obstruction at admission and surgical treatment were associated with increased odds of short-term survival. Recurrence of urethral obstruction had a poor prognosis for long-term survival.

Diagnosing urolithiasis in small ruminant colic cases

During lethargic sheep or goat consultation, obstructive urolithiasis is a differential diagnosis to be specifically investigated and ruled out rather than a chance problem of occasional occurrence. The problem arises often as a primary dietary-induced disorder, but can also develop after an acute dehydrating illness, indigestion and even the result of direct urinary tract trauma. Complete obstruction is recognised much more commonly in the male than the female, although uroliths may form and cause inflammatory clinical signs in either sex. A history of stranguria, vocalisation, waxing and waning lethargy are regular historical complaints from the client. Stranguria is often misinterpreted as tenesmus or intestinal obstruction. Signalment, history, and physical examination are often sufficient for diagnosis, however some additional diagnostic tests such as ultrasound, bloodwork and abdominocentesis can assist in confirmation, therapeutic planning and prognosis. Multiple treatment options have been described for clinical cases, however, with the cost of individual treatment and limitations of success, prevention should always be part of overall case management.

Tube cystostomy for management of obstructive urolithiasis in ruminants

Aim: The aim of this study was to evaluate the simple tube cystostomy procedure for management of urethral obstruction cases in ruminants. Materials and Methods: Tube cystostomy was used to treat a total of 58 ruminants, which included 35 buffalo calves and 23 goats. Diagnosis of the disease was made with the history of anuria, clinical signs, and physical examinations. Physical parameters like heart rate, respiratory rate, rectal temperature dehydration status of animals by skin tenting test, and intraoperative findings were compared. Results: Young ruminants were most commonly affected and the mean age was 4-5 months in both species. Only male were considered for the study in which buffalo calves were not castrated but in goat's 73.91% animal were castrated and 34.7% not castrated. Rupture of bladder was more common in buffalo calves as compared to goats. The confirmed cases of obstructive urolithiasis were selected for tube cystostomy with Foley's catheter. Postoperatively all cases were administered with broad spectrum antibiotic, anti-inflammatory agent, and caliculolytic agents like ammonium chloride. Postoperative complications recorded only in 10 animals and remaining 48 animals had an uneventful recovery. Conclusion: Tube cystostomy is a simple and effective procedure particularly in intact urinary bladder, which can be adopted at field level.

Evaluation of Different Surgical Techniques for the Management of Bovine Obstructive Urolithiasis

Thirty clinical cases of obstructive urolithiasis in cattle calves were managed by three surgical techniques i.e., tube cystostomy with polyvinyl chloride catheter (group AI), tube cystostomy with Foley’s catheter (group AII) and cystostomy with indwelling urethral catheterization (group B). All the animals were given litholytic agents, antiinflammatory drugs, antibiotics and urine acidifiers postoperatively. These surgical techniques were evaluated on the basis of time taken for each kind of surgery, initiation/free flow of urine, removal of catheters following free flow urination, postoperative complications and overall success rate. Tube cystostomy with Foley’s catheter was found the quickest and easiest technique. The median time of onset of free flow of urine from the external urethral orifice in the animals of group AI and AII was 9 days with the range of 4-12 and 5-13 days respectively. The main postoperative complications recorded include: catheter dislodgement (one animal each in all the groups), catheter loss (one animal each in group AI and B), catheter blockade (one animal each in group AI and B and 3 animals in group AII), and urethral rupture (one animal in group AI and 2 animals in group AII). The survival rate was higher in the animals of group A; however the recovery rate without post-operative complications was higher in the animals of group B.

Clinical Appraisal of 48 Cases of Obstructive Urolithiasis in Buffalo Calves Treated with Tube Cystostomy and Urethrotomy

Clinical Appraisal of 48 Cases of Obstructive Urolithiasis in Buffalo Calves Treated with Tube Cystostomy and Urethrotomy

Incidence and Management of Obstructive Urolithiasis in Buffalo Calves and Goats

A total of 125 animals including male buffalo calves (n=83) and buck (n=42) with ob - structive urolithiasis were prospectively studied. Most often males aged between 2 and 8 months (mean age 5 months) were affected, with young ones being more commonly affected. Prevalence was maximum in extreme winter and summer. Cystorrhexis was observed in 16.45% of buffalo calves and 5.56% in case of goats. All the animals were treated surgically by tube cystostomy. Simultane- ously urinary acidifiers and calculolytic drugs were given to dissolve the calculi. Majority of the cases showed uneventful recovery.

Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull

BackgroundIn male cattle, rupture of the urinary bladder is usually associated with urethral obstruction by uroliths. Less common causes include urethral compression or stricture. This case report describes the findings in a young Limousion breeding bull with rupture of the urinary bladder because of urethral compression by a haematoma after coccygeal fracture.Case presentationThe bull had been introduced into a 40-head Red-Holstein herd one week before being injured. One week after introduction to the herd, the bull had an acute onset of anorexia and he was referred to the clinic. There was marked abdominal distension, reduced skin turgor and enophthalmus. The serum concentration of urea and creatinine was increased. Ultrasonographic examination revealed severe ascites and abdominocentesis yielded clear yellow fluid with high urea and creatinine concentrations, which supported a diagnosis of uroperitoneum. The bull was euthanatized because of a poor prognosis. Postmortem examination revealed a comminuted fracture of the first two coccygeal vertebrae associated with a massive haematoma that obstructed entire pelvic cavity. The haematoma compressed the urethra thereby preventing outflow of urine, which resulted in a 5-cm tear ventrally at the neck of the bladder. It was assumed that the newly-introduced bull had sustained the vertebral fractures when he was mounted by a cow.ConclusionsThe present case study serves to expand the differential diagnosis of urinary bladder rupture. Therefore, in addition to obstructive urolithiasis, compression and stricture of the urethra might be considered in male cattle with uroperitoneum.

Clinico- sonographic evaluation based surgical management of urolithiasis in young calves

The objectives of study were to screen the calves as stone and non-stone formers, to manage the calves with obstructive urolithiasis by diversified surgical approaches based on clinical and sonographic assessment. The study was conducted in bovine calves (n=27), manifesting clinical urolithiasis. All these animals and 52 calves of age group 3 to 18 months presented with any form of ailments were included in screening as normal and stone former. Anamnesis, clinical and physical examinations, ultrasonography, peri operative and post operative observations and, complications were recorded. On the basis of clinical symptoms, ultrasonographic findings of urinary system, duration of obstruction and position of calculi, were divided into five groups of 6 animals each except group T having 3 animals and most suited surgical procedure, that is, in dwelling Normograde catheterization,tube cystostomy, cystostomy and uretotomy,trocarization and Percutaneous catherizati on and abdominocentesis were awarded. The highest occurrence was found in the age group of under one year (60%) followed by 40% above one year. Cross bred calves were most affected (70%). Duration of illness in calves varied from 24 to 120 h. The rectal temperature increased slightly at different postoperative intervals in all the groups. The heart rate and respiration rate showed a gradual decrease at different postoperative intervals and became normal towards end of study. In 90% cases small multiple irregular and smooth concretions were retrieved. The calves suffering from obstructive urolithiasis had the history of feeding on diets containing wheat bran, commercial cattle feed, rice bran and rice straw few days before manifesting symptoms. Trocharization followed by peritoneal catheterization helped to prolong the life of the severely diseased animals and made them more suitable for major surgery subsequently. Key words: Urolithiasis, abdominocentesis, trocarization, ultrasonography.

Renal Deterioration Index: Preoperative Prognostic Model for Renal Functional Outcome After Treatment of Bilateral Obstructive Urolithiasis in Patients with Chronic Kidney Disease

Patients who present with varying severity of obstructive urolithiasis behave differently after the treatment. Some patients recover with improved renal function while others progress to renal failure. Our objective was to objectively quantify which patients would progress to renal failure after treatment for obstructive urolithiasis. A prospective analysis of 167 patients with renal failure from bilateral obstructive urolithiasis who were treated and subsequently followed for at least 1 year was performed. Failure was defined as glomerular filtration rate (GFR) values less than 15 mL/min at 1 year follow-up. All patients had preoperative placement of a percutaneous nephrostomy tube for at least 5 days before treatment with either ureteroscopy or percutaneous nephrolithotomy. Multiple logistic regression analysis of affecting parameters was performed. A renal deterioration index (RDI) was constructed based on scores assigned to varying severity of multivariate significant factors and the receiver operating characteristic (ROC) curve was analyzed. There were 48(28.7%) patients who progressed to CKD stage V at 1-year follow-up. Combined cortical width (≤ 0.001), proteinuria (0.01), positive urine culture (0.004), and nadir preoperative GFR postbilateral percutaneous nephrostomy (0.016) were statistically significant factors affecting renal deterioration on multivariate analysis. RDI has a high ROC curve (AUC=0.90) for predicting renal functional outcome. Combining these parameters in a prediction table yielded a RDI score ≥ 12 being associated with high odds risk (odds ratio=11.2) of treatment failure. RDI ≥ 12 is associated with renal deterioration after appropriate treatment of bilateral obstructive urolithiasis.

Urinary Retention Caused by a Urethral Cystine Stone in a 10-Month-Old Infant

Urinary retention resulting from urolithiasis in early infancy is an extremely rare event. Cystine stone formation in those younger than 1 year is also a rare condition. We report a case of urinary retention caused by a urethral cystine stone in a 10-month-old male infant. Obstructive urolithiasis should be considered one of the reasons of decreased urine output in infants.