Recurrent Stone Formers Research Articles

Changes in reservoir and motor-evacuatory function of the gallbladder in patients with asymptomatic cholecystolithiasis after organ-sparing surgery – laparoscopic cholecystolithotomy

Sonographic assessment of gallbladder structure and function in patients with gallstone disease needs further improvement not only to clarify the indications for organ-sparing operations such as laparoscopic cholecystolithotomy, but also to improve the results of surgical treatment of asymptomatic cholecystolithiasis by predicting probable restoration of motor-evacuatory function of the gallbladder and reduction of the number of recurrences of cholecystolithiasis. The aim of the study was to investigate changes in gallbladder structure and function in patients with asymptomatic cholecystolithiasis before and after laparoscopic cholecystolithotomy. Materials and methods. The study involved 33 patients with asymptomatic cholecystolithiasis. The majority of patients are women 82 % (n = 27), aged 23 to 54 years, mean age 48.0 ± 11.9 years. And there were 18 % of men (n = 6), aged 25 to 58 years, mean age 46.2 ± 12.4 years. Ultrasound examination of the abdominal organs was performed in all patients using Philips No. MA2540R and LOGIQ General Electric Ser No. 52993WX3 before and after laparoscopic cholecystolithotomy. During the examination, a sonographic assessment of the shape, size, contours, thickness of the gallbladder wall, as well as its relation with surrounding organs and vascular structures was performed. The size of the common bile duct, the number and size of stones in the gallbladder cavity, as well as its motor-evacuatory function were purposefully determined. Statistical processing of the material was performed using the Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. Indicators of gallbladder reservoir function before and after laparoscopic cholecystolithotomy did not differ significantly. There was a significant increase in the ejection fraction of the gallbladder from 54.5 ± 2.1 % to 64.4 ± 2.9 % (P = 0.0001) and a reduction in the “latency period” from 15.6 ± 2.5 min to 8.3 ± 1.7 min (P = 0.001). Conclusion. Adherence to sonographic indications (single gallstones, less than 3 mm wall thickness and ejection fraction over 50 %) in the selection of patients with asymptomatic cholecystolithiasis for laparoscopic cholecystolithotomy allows not only to preserve the reservoir and also improve the motor-evacuatory function of it, which reduces the risk of possible recurrent stone formation in close and long-term periods of observation.

How the diagnosis and the management of genetic renal phosphate leak impact the life of kidney stone formers?

Genetic renal phosphate leak is one of the rare disorders in recurrent stone formers with absorptive hypercalciuria. Diagnosis and appropriate management may change the life of patients. To provide answers on how and when to make the diagnosis of genetic renal phosphate leak and how medical management prevents the recurrences and changes patients' life, we conducted a retrospective study including nine patients with recurrent nephrolithiasis and a confirmed genetic mutation of a phosphate transporter between 2008 and 2019 in our multidisciplinary center at the Pitié Salpetriere Hospital, Paris, France. We compared the number and the annual rate of urological intervention before and after the diagnosis and management using the Wilcoxon test. A qualitative survey was done to evaluate the quality of life of patients. A total of 9 patients were included in this study. Patient baseline characteristics and elements supporting the diagnosis are described. We showed an effective decrease in urological intervention number (p = 0.0078) and annual rate (p = 0.0117) after the diagnosis and the appropriate management, and an improvement in the patients' quality of life. The diagnosis and the appropriate management of genetic renal phosphate leak disorder improve the quality of life by preventing stone recurrence and decreasing the number of surgical intervention.

A0916 - The impact of promoter hypermethylation of VDR, CLDN, and CasR genes in recurrent stone formation

A0916 - The impact of promoter hypermethylation of VDR, CLDN, and CasR genes in recurrent stone formation

Методология дистанционного мониторинга пациентов с мочекаменной болезнью: разработка и первичная апробация

INTRODUCTION Urolithiasis is a clinically and socially significant disease that requires long-term follow-up in order to prevent stone recurrence. Currently, telemedicine consultations in the patient-doctor format are actively used in urology, however, the methodology, technological base and assessment of the efficiency of remote monitoring of the patient's health status are virtually not developed. AIM To provide basics for the methodology of remote monitoring of patients with urolithiasis for detailed comprehensive examination and comprehensive metaphylaxis of recurrent stone formation. MATERIALS AND METHODS A comprehensive clinical examination was carried out on the basis of the Institute of Urology and Human Reproductive Health, the National Medical Research Center on Urology and the Institute of Digital Medicine of FGAOU VO I.M. Sechenov First Moscow State Medical University during the period from 1st February to 1st December 2020. A total of 30 patients with urolithiasis were included in the study. Remote monitoring of health status was carried out using a portable analyzer ETTA AMP-01 on dipstick. Data transmission was performed through a mobile application, which is part of the NetHealth information system (www.nethealth.ru). The values and frequency of urine tests performed by the patient independently, as well as patient satisfaction and adherence to the monitoring technology were evaluated. Analytical, clinical, sociological and statistical research methods were used. RESULTS By systematizing published data and our own clinical experience, we have developed a model for remote monitoring of the health status of patients with urinary stone disease, which included a system of indications and contraindications, a program and an order of the monitoring, as well as a basic technological solution (medical devices and a hardware-software complex). In this study, median duration of remote monitoring was 168 days. According to the questionnaire, general positive assessment and desire to continue telemonitoring was seen in 100.0% of cases, while 86.7% of patients positively evaluated the technical accessibility and reliability of the system and 93.3% considered the quality and availability of medical care as high. CONCLUSION A methodology for remote monitoring of patients with urolithiasis has been developed with the aim of preventing recurrent stone formation. There was a high adherence of patients to remote monitoring with a tendency to decrease in values after 4 and 6 months. During these periods, it is necessary to carry out routine consultations by the physician who appointed remote monitoring in order to continue the follow-up program. There was a high satisfaction of patients with remote monitoring, and they pointed out the quality and availability of urological care owing to telemedicine technologies.

Diagnosis and treatment of primary hyperparathyroidism (20 years of own experience and literature review)

Background. Currently, primary hyperparathyroidism (pHPT) is the third most common endocrine disease after thyroid gland pathology and diabetes mellitus. Untimely diagnosis leads to a severe course of the disease with the development of disabling deformations — osteoporotic fractures, recurrent stone formation in the urinary tract, gastrointestinal bleeding, etc., as well as to an increased risk of premature death. The purpose of the study is to assess the dynamics of detection of thyroid disease (thyroid) for the period 2000–2019. Materials and methods. Since 2000, based on the surgical department of the clinic of the State Institution “V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine”, 205 surgeries have been carried out for pHPT (in 188 women and 17 men: 91.7 and 8.3 %). Results. Since 2008, there has been a steady increase in the number of cases. The incidence of pHPT in women increases with age and becomes significantly higher at the age of 50–69 years. At the same time, the gap between women and men is widening, the reason for which needs to be studied. The proportional ratio of the number of patients with asymptomatic and clinically pronounced course persists for 20 years and is approximately 2 : 1. In countries where blood calcium screening has been introduced, the proportion of asymptomatic forms reaches 80 %. The obtained data confirm the fact of untimely diagnosis of pHPT in Ukraine, which requires the introduction of large-scale population screening in the form of a questionnaire survey and study of serum calcium. Conclusions. A positive contribution to the timely detection of pHPT can be made by activating the work of postgraduate (continuous) education institutions in this direction, primarily the departments of endocrinology based on endocrinological clinics with surgical departments.

MP18-09 COMPARISON OF INTRAOPERATIVE TO LAB-BASED STONE COMPOSITION ANALYSIS AND IMPACT ON MEDICAL MANAGEMENT

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-09 COMPARISON OF INTRAOPERATIVE TO LAB-BASED STONE COMPOSITION ANALYSIS AND IMPACT ON MEDICAL MANAGEMENT Nilang Shah, Sriniwasan Mani, and Noah Canvasser Nilang ShahNilang Shah More articles by this author , Sriniwasan ManiSriniwasan Mani More articles by this author , and Noah CanvasserNoah Canvasser More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Appropriate medical management of recurrent kidney stone formers is reliant on both a stone analysis and a 24-hour urine collection. However, the accuracy of lab-based compositional stone analysis can be variable due to the amount of stone sample provided and differences in analytic methods. During ureteroscopy, given the ability to assess the entire stone for color, durility, how it fragments, and homogeneity or heterogeneity, a unique opportunity exists to predict stone composition. The present study focused on comparing the intraoperative stone composition to lab-based assessment and its subsequent effect on medical management. METHODS: Data was collected on all patients undergoing ureteroscopy from July 2019 until July 2020 for the treatment of renal and/or ureteral stones. During ureteroscopy we extract all stone fragments and submit all for stone analysis. Patient demographics, stone sizes, intraoperative assessment, lab-based stone analysis, initial post-operative 24-hour urinalyses and medical management were recorded. Primary outcome was the accuracy of the intraoperative assessment for dominant (≥50%) stone type and all constituents. Secondary outcome was the accuracy of the intraoperative assessment to guide management of the 24-hour urine abnormality. RESULTS: A total of 187 patients underwent ureteroscopy. Table 1 lists patient demographics and stone details (include age, race, % gender, target stone size, % bilateral, etc.). Intraoperative assessment matched the lab analysis in 97 patients (overall 51%). In the non-matching cases, the intraoperative assessment matched the majority composition of the stone in 64 cases (overall 34%), but not all constituents were identified. The most common inaccuracy was not identifying a calcium phosphate component in a calcium oxalate dominant stone (20%). Overall, intraoperative assessment guided medical management accurately in 88% of cases. CONCLUSIONS: Intraoperative stone assessment serves as a useful adjunct during ureteroscopy. Although accuracy for the dominant stone type and all stone constituents was only 51%, the assessment accurately guides medical management in most cases. This can be helpful in cases where obtaining a complete stone sample is not possible. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e321-e321 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nilang Shah More articles by this author Sriniwasan Mani More articles by this author Noah Canvasser More articles by this author Expand All Advertisement Loading ...

Characterization of Biofilm Producer Nanobacteria Isolated from Kidney Stones of Some Egyptian Patients.

<b>Background and Objective:</b> Nanobacteria (NB) appear to contribute to many calcifying diseases including kidney stones which represent a common problem with inadequate prevention exist. NB framing itself with a mineral coat that assists as a primary defence shield against the immune system, antibiotics. This study aims to collect and detect nanobes from different kidney stones from patients with active urolithiasis then investigated the anti-nano-bacterial activity of some antibiotics alone or in combination with extracts of irradiated herbs of certain medicinal plants which will represent a new approach to therapy for patients with kidney stones. <b>Materials and Methods:</b> Total of 32 nanobes were isolated from 54 kidney stones. Fourier Transforms Infrared Spectroscopy (FTIR) revealed that calcium and phosphate are the main components of stones. Scanning Electron Microscopy (SEM) with Energy-dispersive X-ray spectroscopy (EDX) and Transmission Electron Microscope (TEM), showed that nanobes were Gram-ve cocci with size ranged from (375:600 nm). The biofilm production ability of nanobes was estimated qualitatively and quantitatively. <b>Results:</b> The results revealed that all were strong biofilm producers. Further, the antibiotic susceptibility test indicates their resistance towards most of the tested antibiotics. Molecular identification of the strong biofilm producer isolates by ribosomal ribonucleic acid (rRNA) revealed that it is indicated by 85.37% to <i>Bartonella apis</i> strain PEB0122. <b>Conclusion:</b> The findings of the current study evidenced that combination treatment between Doxycycline (DO) and water extract of khella exhibited a significant reduction in biofilm formation ability of the strongest producers nanobes. Therefore, this treatment can play a role in enhancing public health, especially with patients who suffer from recurrent kidney stone formation.

Complementary and Alternative Medicine Use in First-time and Recurrent Kidney Stone Formers

To describe the patterns of complementary and alternative medicine (CAM) among patients with kidney stones and analyze the alkali content of commonly used CAM therapies. We prospectively conducted structured interviews with patients who presented to a specialty stone clinic for the management of kidney stones. Open-ended questions were used to elicit information regarding CAM knowledge, formulation/dosing, and patterns of use. Several common CAM therapies were then analyzed for their alkali, organic anion, and sugar content. Of 103 subjects, 82 (80%) patients reported knowledge of CAM and 52 (50%) reported using CAM. Patients with recurrent kidney stones were more likely to report using CAM than patients with first-time episodes (56% vs 26%, P = 0.04). Some respondents reported their condition decreased in severity or frequency since starting CAM therapy (17%) and improvements in pain (12%). Total alkali content per serving of the tested supplements was 0 mEq (Stonebreaker), 1.5 mEq (Ocean Spray Cranberry Juice Cocktail), 4.7 mEq (Lakewood Pure Cranberry Juice), 0.6 mEq (Braggs Apple Cider Vinegar), 11.9 mEq (LithoBalance), 9.5 mEq (Simply Grapefruit Juice), 19.8 mEq (KSP-Key Lime), and 20.2 mEq (KSP-Very Berry). Patients with kidney stones may use CAM to alleviate symptoms or prevent recurrence. Commercially available CAM therapies may contain comparable alkali content to commonly prescribed citrate therapy. These data suggest that providers should be prepared to discuss the role of CAM with their patients.

Effect of a Probiotic Supplement Containing Lactobacillus Acidophilus and Bifidobacterium Animalis Lactis on Urine Oxalate in Calcium Stone Formers with Hyperoxaluria: A Randomized, Placebo-controlled, Double-blind and In-vitro Trial.

To determine the effect of a probiotic supplement containing native Lactobacillus acidophilus (L. acidophilus) and Bifidobacterium animalis lactis (B. lactis) on 24-hour urine oxalate in recurrent calcium stone formers with hyperoxaluria. Moreover, the in-vitro oxalate degradation capacity and the intestinal colonization of consumed probiotics were evaluated. The oxalate degrading activity of L.acidophilus and B.lactis were evaluated in-vitro. The presence of oxalyl-CoA decarboxylase (oxc) gene in the probiotic species was assessed. One hundred patients were randomized to receive the probiotic supplement or placebo for four weeks. The 24-hour urine oxalate and the colonization of consumed probiotics were assessed after weeks four and eight. Although the oxc gene was present in both species, only L.acidophilus had a good oxalate degrading activity, in-vitro. Thirty-four patients from the probiotic and thirty patients from the placebo group finished the study. The urine oxalate changes were not significantly different between groups (57.21 ± 11.71 to 49.44 ± 18.14 mg/day for probiotic, and 56.43 ± 9.89 to 50.47 ± 18.04 mg/day for placebo) (P=.776). The probiotic consumption had no significant effect on urine oxalate, both in univariable (P=.771) and multivariable analyses (P =.490). The consumed probiotics were not detected in the stool samples of most participants. Our results showed that the consumption of a probiotic supplement containing L.acidophilus and B. lactis did not affect urine oxalate. The results may be due to a lack of bacterial colonization in the intestine.

Laparoscopic removal of intravesically inserted transobturator tape.

The aim of this video is to provide a step-by-step description of our approach to the surgical management of intravesically localized transobturator tape after previous failure of repeated cystoscopic tape resection. This video presents a patient with tape erosion to the urinary bladder after repeated cystoscopic tape resection, recurrent stone formation, and repeated lithotripsy, with recurrent urinary tract infections and overactive bladder (OAB) with urgency incontinence. During the laparoscopy procedure tape was identified in the left obturator muscle, cut near the obturator muscle, and dissected up to the bladder wall. Afterward, a vertical 2-cm incision was made in the bladder wall, the stone was removed, and the rest of the tape was dissected from the bladder wall. A two-layer suture of the bladder wall was performed. The postoperative course was uneventful. In follow-up visits 3 and 6months after surgery the patient was continent with no symptoms of OAB. Cystoscopic resection of protruded mesh is inadequate in many cases. In such cases the mesh should be removed from the urinary bladder wall completely. Laparoscopy allows minimally invasive complete removal of the tape, combining resection of the extravesical and intravesical parts of the tape.

Efficacy of an Herbal Preparation Based on Lovage, Rosemary, and Centaury on Patients After Extracorporal Shockwave Lithotripsy

Study objective: to study the effect of a herbal preparation containing a standardised BNO 1040 extract* (based on lovage root, rosemary leaves and aerial parts of centaury) on the extracorporeal shockwave lithotripsy (ESWL) results in patients with urolithiasis (UL).
 Methodology. 150 patients with UL (aged 18–65 years) treated with ESWL method were divided into 2 equal groups. The main group (n = 75) received standard recommendations and herbal preparation (12 months). The control group (n = 75) received standard recommendations only. The following was evaluated: time and degree of elimination of fragments; the presence of pain and leukocyturia; recurrent stone formation.
 Results. The elimination of fragments was observed up to 14 days in 94.7 % of patients in the main group versus 76 % of patients in the control group. Renal colic was observed in 6.7 % of patients in the main group versus 10.7 % of patients in the control group; cases of leukocyturia were observed within 14 days in 10.7 % versus 22.7 %, respectively. During the year, a recurrent lithiasis was diagnosed in 6.7% of patients in the main group and in 16 % of patients in the control group.
 Conclusion. The use of BNO 1040 extract in combination with ESWL: contributes to more rapid and safe elimination of fragments of the calculi and reduces the risk of recurrent stone formation.

Prevalence of Vitamin D Inadequacy in Urolithiasis Patients.

IntroductionThe role of vitamin D in kidney stone disease is unclear. Current evidence and existing studies are inconsistent and inconclusive. The objective of this study is to assess the prevalence of vitamin D (VD) inadequacy (VDI) and metabolic abnormalities in urolithiasis patients presenting to a tertiary care center.Materials and methodsThis is a prospective case-control study of 200 patients divided into two groups - Group 1: 100 urolithiasis patients (case group), and Group 2: 100 non-urolithiasis patients (control group) - which was conducted from January 2016 to January 2017. Demographic, clinical data, parathyroid level, serum 25-hydroxy VD [25(OH)D], and metabolic stone work-up were recorded and analyzed. ResultsPatient demographics were comparable in both groups. The prevalence of vitamin D inadequacy in urolithiasis patients was 95% as compared to 57% in the control group. The mean value ± SD of serum vitamin D in urolithiasis patients (16.5 ± 8.6 ng/mL) was significantly lower than in non-urolithiasis patients (28.7 ± 8.3 ng/mL) (p = <0.0001). Thirty-seven percent of the patients were recurrent stone formers. Hyperparathyroidism was observed in 77% of the patients and 71% of them were secondary to VDI.ConclusionUrolithiasis patients were found to have an increased prevalence of deficient VD related to secondary hyperparathyroidism.

Metabolic investigation of stone formers

Metabolic investigation of stone formers Abstract. Once a kidney stone has passed, patients must be carefully evaluated in order to identify the underlying cause of the disease and to guide preventive measures and treatment. General recommendations can be offered to all kidney stone formers, but personalized counseling and follow-up adaptations need to be guided by in-depth assessment. Metabolic evaluation for recurrent stone formers is based on 24 h urine collection. This allows a comprehensive understanding of the dietary habits of the patient and helps identifying treatable metabolic diseases and renal tubulopathies. Additional specific assessments may include urine acidification test (in case of suspected partial renal distal tubular acidosis), characterization of hypercalciuria or osteodensitometry. Metabolic evaluation often needs to be repeated over time to guide therapeutic interventions, both dietetic and drug-related.

Effect of dietary treatment and fluid intake on the prevention of recurrent calcium stones and changes in urine composition: A meta-analysis and systematic review.

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) for investigating the effect of dietary treatment and fluid intake on the prevention of recurrent calcium stones and changes in urine composition. PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases (updated November 2020) were searched for studies with the following keywords: diet, fluid, recurrent, prevention, randomized controlled trials, and nephrolithiasis. The search strategy and study selection process was conducted by following the PRISMA statement. Six RCTs were identified for satisfying the inclusion criteria and enrolled in this meta-analysis. Our result showed that low protein with or without high fiber diet intervention does not decrease the recurrence of stone upon comparing with control groups (RR = 2.32, 95% CI = 0.42-12.85; P = 0.34) with significant heterogeneity among the studies (I2 = 81%, P = 0.02). But normal-calcium, low protein, low-salt diet had recurrences did reduced the recurrence compared to normal-calcium diet. And the fluid intake has a positive effect on prevention of recurrent stone formation (RR = 0.39, 95% CI = 0.19-0.80; P = 0.01) with insignificant heterogeneity among the studies (I2 = 9%, P = 0.30). The different components of urine at baseline were reported in four studies. Upon reviewing the low protein with or without high fiber dietary therapy groups, it was found that there were no obvious changes in the 24-hour urine sodium, calcium, citrate, urea, and sulfate. In conclusion, our study shows that the only low protein with or without fiber does not affect recurrence, but low Na, normal Ca diet has a marked effect on reducing recurrence of calcium stone. And fluid intake shows a significant reduction in the recurrence of calcium stone.

Инструменты IT-медицины в модификации образа жизни пациентов с мочекаменной болезнью

Introduction. Treatment and especially prevention of recurrent stone formation is a relevant topic for scientific research. One of the principles of metaphylaxis is lifestyle modification for example assessment and correction of food stereotypes, physical activity, sleep and rest mode, and rejection of bad habits. Materials and Methods. We analyzed the functionality of electronic tools available today for patients in the Russian Federation, such as: portable gadgets and medical devices. Results. The review presents modern technologies that allow monitoring, including remote monitoring, for patients with urolithiasis. Examples are given in the form of activity trackers, portable devices – urinary analyzers of various manufacturers, portable ultrasound devices, analyzers of the level of uric acid, nitrates, water hardness, «smart» scales. The spectrum of states in urolithiasis has been analyzed for the correct use of these devices. Conclusion. The technological innovations presented in this review open up new opportunities for increasing compliance in patients with urolithiasis. These innovations can become the basis for the implementation of the principles of «medicine 4P» on the example of urolithiasis for the implementation of promising opportunities.

Success rate of repeat flexible ureteroscopy following previous failed access: An analysis of stent duration.

Approximately 8% of patients that undergo therapeutic or diagnostic ureteroscopy will have the procedure aborted and ureter stented due to failed access. The primary objective of this study was to assess mean stent duration prior to repeat ureteroscopy and to calculate the associated successful access rate. This retrospective, descriptive study evaluated all patients undergoing interval ureteroscopy following a failed procedure by endourologic surgeons at the University of Alberta from 2016-2018. Patients declining interval ureteroscopy, or those with malignant/known ureteral strictures were excluded from the study. The primary outcome measures were median time to salvage ureteroscopy and the rate of successful access of the repeat procedure. A total of 119 patients were identified as having a failed ureteroscopy during our study period. First-time and recurrent stone formers accounted for 64 (53.8%) and 47 (39.5%) patients, respectively. Median stent duration to second procedure was 17 days (average 20, range 10-84). Most patients had their repeat ureteroscopy at 14 days or greater (81.5%); 22 (18.5%) patients had their repeat ureteroscopy between 10 and 13 days. The success rate of a second ureteroscopy after stenting was 99.2% (118/119). Ureteric stenting following failed ureteroscopy leads to exceedingly high rates of successful access at interval procedure (99.2%). The standard duration of ureteric stenting employed at our institution is two weeks. Of the patients that underwent an accelerated second procedure (between 10-13 days of stenting), all had successful access at their interval procedure.

Asymptomatic Cholelithiasis in Children: Management Dilemma.

Aims and Objectives:The incidence of cholelithiasis is now increasing in children. Besides hemolytic diseases, there are also nonhemolytic conditions and idiopathic group. A large number of children belong to asymptomatic group who do not present with gallstone-related symptoms. There is no consensus in the management of these children. The aim of this study is to evaluate the role of elective cholecystectomy in asymptomatic cases to prevent complications which leads to more morbidity.Materials and Methods:One hundred and seventy-eight children were treated over a period of 12 years and they were divided into two groups according to their age at presentation. Sixty-four children below 5 years belonged to Group A and 114 children between 5 and 12 years belonged to Group B. About 71.8% of children of Group A and 49.1% of children of Group B were asymptomatic. Cholecystectomy was advised in all cases of Group B and all symptomatic cases of Group A. In Group A asymptomatic cases, ursodeoxycholic acid (UDCA) was given for 6–12 months and followed up.Results:Laparoscopic cholecystectomy was performed in all cases except in five cases where conversion to open surgery was done as there was gross adhesions due to previous laparotomy. Of 46 asymptomatic cases of Group A, the stone disappeared in seven cases, 12 children developed symptoms, and there was no change in 27 patients. Stone reappeared again in three of seven children who were managed by cholecystectomy. Cholecystectomy was also performed in 12 cases that developed symptoms. In the rest of the 27 children, cholecystectomy was advised after 1 year trial of UDCA. Cholecystectomy was advised in both symptomatic and asymptomatic cases of Group B. Sixteen of 56 asymptomatic cases did not agree for cholecystectomy and 12 of them returned with complications. Endoscopic retrograde cholangio-pancreaticography (ERCP) and stone extraction was performed in four cases. In all the acute cases, cholecystectomy was performed after a period of conservative management.Conclusion:UDCA can be tried in the smaller age group below 5 years, but there is a chance of recurrent stone formation. Elective laparoscopic cholecystectomy should be the choice in all asymptomatic cases to prevent complications.

Современные принципы хирургического лечения мочекаменной болезни

The article presents historical data showing the following: how methods for the treatment of urolithiasis have been developed and improved; how endoscopic equipment has been introduced and modernized; how the prevention of postoperative complications and metaphylaxis of recurrent stone formation have changed recently. Approaches to choosing the surgical treatment method depend on many individual factors (localization, concretion size and density, the presence of complicating disease factors) and are personalized. Attention to this problem is focused because of the large number of patients suffering from urolithiasis (at least 3% of the population). Modern diagnostics and treatment technologies are able to sanitize and get rid of the stone of almost any patient, as the working-age population suffers from it, as a rule — these are highly qualified specialists who are forced to be treated for a long time due to urolithiasis complications or relapse. The general social significance of this disease, which can haunt a person throughout life, determines the need to study the pathogenetic mechanisms of stone formation, methods of metaphylaxis and to reduce the number of invasive methods for removing urinary tract concretions, which have many dangerous complications leading to a decrease in working capacity. KEYWORDS: urolithiasis, kidney, surgical treatment, shock wave lithotripsy, ureterorenoscopy, contact ureterolithotripsy, percutaneous nephrolitholapaxy. FOR CITATION: Berezhnoy A.G., Dunaevskaya S.S. Modern surgical methods for the treatment of urolithiasis. Russian Medical Inquiry. 2021;5(3):118–122. DOI: 10.32364/2587-6821-2021-5-3-118-122.

Thiazide and thiazide-like diuretics in nephrolithiasis.

Thiazide and thiazide-like diuretics are widely used for the management of hypercalciuria among stone-forming patients. Although the effects of different thiazides should be relatively similar in terms of prevention of stone recurrence, their potency and side effects may differ. However, there is scarce data concerning the metabolic and bone effects of these agents among recurrent nephrolithiasis patients with hypercalciuria. The aim of this update article was to compare our experience in the use of thiazide and thiazide- like diuretics with that of the current literature, concerning their anticalciuric properties and consequent reduction of recurrent stone formation. Their impact on bone mass and potential side effects were also discussed.

Bladder stone on non-absorbable sutures twenty years after a female sterilization

Foreign body in the urinary bladder causes recurrent infection and stone formation. This is an unusual case report of a bladder stone formed on a non-absorbable suture 20 years after a female sterilization. It was detected with ultrasound and pelvic X-Ray. Laparotomy was done for its completed removal as cystoscopy failed to remove it. This case highlights that abdominal- pelvic scan and pelvic x-ray in addition to a urine test, should be included in the early part of the investigation in the management of recurrent urinary tract infection to exclude the possibility of the bladder stone.