Solitary Stones Research Articles

Prevalence and management of cholelithiasis: A clinical study

Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system. The present study determined cases of gall bladder stones. Materials & Methods: This study was conducted on 75 consecutive cases of cholelithiasis. All patients received antibiotics and routine post- operative care. Patient was properly examined in the postoperative period to note the development in any complication. Patients who undergone lap cholecystectomy were discharged on the third day and open cholecystectomy were discharged on the 7th day, Unless any complications. Patients were advised regarding diet, rest and to visit the surgical OPD for regular follow up. Results: Maximum cases was seen in age group 41-50 years (25) followed by 51-60 years (20). Out of 75 patients, males were 35 and females were 40. Common symptoms was pain in 70, nausea/ vomiting in 35, jaundice in 10 and dyspepsia in 20 patients. USG findings was solitary stone in 20, multiple stones in 60, bile duct stones in 12, thickening of gall bladder in 62, dilated bile duct in 13 and mass in 4 patients. 60 patients undergone laparoscopic cholecystectomy and 15 patients undergone open cholecystectomy. 6 patients had wound infection. 1 patient had post operative bile leak which was managed conservatively and patient recovered. 3 patients had bile duct injury which were repaired on the T-tube. Conclusion: Authors found that the incidence of gallstones was the highest in the 5th and 6th decades of the life with maximum incidence in the 5th decade. Gallstones disease is more common in female. The commonest symptom was pain abdomen and the commonest sign was tenderness in the right hypochondrium. Ultrasonography was the investigation of the choice. It showed multiple gallstones and thickening of the gallbladder in the majority of cases.

Long-term analysis of safety and efficacy of standard percutaneous nephrolithotomy in patients with solitary kidneys

To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in the treatment of patients with solitary kidney stones. The clinical data of 22 patients with solitary kidney stones treated with PCNL in Peking University People's Hospital from September 2008 to June 2014, with the follow-up data of more than 5 years were analyzed retrospectively. Perioperative indicators, postoperative stone free rate (SFR) and incidence of complications were recorded. Ultrasonography was used to evaluate the long-term stones recurrence rate. Serum creatinine and estimated glomerular filtration rate (eGFR) were used to assess the long-term renal function. In this group of 22 patients, the average age was (50.3±11.8) years, with 10 cases of anatomic solitary kidneys, 12 functional solitary kidneys, and the median stone diameter was 1.65 (1.1-3.9) cm. All the patients had multiple stones, including 7 cases of staghorn stones. The median pre-operative serum creatinine was 104.5 (60.0-460.0) μmol/L, and the mean eGFR was (60.3±29.4) mL/min, showing no statistically significant difference compared with that before surgery. The mean operative time was (88.2±42.0) min, and there were 11 cases of single-channel and double-channel PCNL. The median serum creatinine on the first day after surgery was 102.0 (63.0-364.0) μmol/L, and the mean eGFR was (58.0±25.1) mL/min. The mean postoperative hospital stay was (8.7±5.2) days. In this group, 5 patients (22.7%) presented short-term complications, among which 4 patients presented postoperative infection and massive hemorrhage at the same time, which improved after conservative treatment, and 1 patient presented pleural injury and improved after closed thoracic drainage. Two patients (9.1%) developed long-term complications, and ureteral stricture occurred 3 months after operation, which improved after balloon dilatation. The median follow-up time was 6.2 (4.7-11.1) years. The median serum creatinine at the last follow-up was 104.0 (72.4-377.0) μmol/L, and the mean eGFR was (60.1±23.7) mL/min, showing no statistically significant difference compared with that before surgery. Renal function decreased in 6 patients (27.3%). Initial and final SFR were 72.7% and 100%, respectively. During the 6.2-year follow-up, 9 patients (40.9%) experienced recurrence of kidney stone. After stone recurrence, 13 lithotomy surgeries were performed, and the SFR by the latest follow-up was 63.6%. This study had the longest follow-up time for patients with solitary kidney stones after PCNL reported at home and abroad. Ultrasound-guided standard PCNL was safe and effective in the treatment of solitary kidney stones. Long-term follow-up results showed that the recurrence rate of kidney stones was still high, but the long-term renal function was stable after operation, and some patients showed mild renal function decline.

Comparing 60 versus 120 shocks per minute for shock-wave lithotripsy of solitary renal calculi: A controlled randomized study

Objective: This study aimed to compare the difference in outcome of shock-wave lithotripsy (SWL) using a slow rate of 60 shocks per minute versus a rapid rate of 120 shocks per minute generated by an electromagnetic lithotripter for renal calculi. Methods: From May 2017 to June 2019, 156 patients ( Mage=38.7 years) with single radio-opaque renal stones smaller than 20 mm were included and randomly divided into two groups: group A, 78 patients who received 60 shocks per minute; and group B, 78 patients who received 120 shocks per minute. Patients were radiologically reviewed at 3 months for an outcome. Results: There was no statistically significant difference between mean stone area treated ( p=0.222) or additional analgesic use in the form of patient-controlled analgesia (PCA; alfentanil; p=0.82). A successful outcome was defined by fragments smaller than 4 mm or stone-free status. In group A, 60% of patients had a successful outcome compared with 61.4% in group B ( p=0.869) following a single treatment. Post-treatment complications were similar in both groups at 12% for group A and 10.7% for group B ( p=0.797). Conclusions: There was no statistically significant difference between the delivery of 60 and 120 shocks per minute during SWL for the treatment of solitary renal stones with a mean stone area of 62 mm2 regarding the outcome, complications or PCA use when using a Dornier Compact Delta II lithotripter.

A case of perforation of Meckel\u2019s diverticulum with enterolith

BackgroundPerforation of Meckel’s diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel’s diverticulum with one enterolith, which could not be accurately diagnosed by preoperative computed tomography.Case presentationA 16-year-old male patient with acute onset of severe abdominal pain and a localized muscle guarding in the right hypochondrium had a solitary stone detected in the right abdomen by radiography. Abdominal computed tomography revealed a saclike outpouching of the small intestine, which contained fluid levels and an enterolith, with a mesenteric inflammatory change in the right paraumbilical area. He was diagnosed with peritonitis due to appendicitis or Meckel’s diverticulitis with enterolith, and emergency operation was indicated. The perforated Meckel’s diverticulum was identified approximately 30 cm proximal to the ileocecal valve. The diverticulum was transected at the base and removed. The patient’s postoperative course was uneventful.ConclusionsIt is crucial for clinicians to thoroughly examine patients and appropriately request investigations that consider perforation of Meckel’s diverticulum as a possible diagnosis to facilitate prompt treatment.

Tadalafil versus Tamsulosin as a medical expulsive therapyfor solitary unilateral lower ureteric stone less than 1 cm: a prospective randomized study.

Tadalafil versus Tamsulosin as a medical expulsive therapyfor solitary unilateral lower ureteric stone less than 1 cm: a prospective randomized study.

Morphological and Biochemical Analysis of Gallstones in Lahore, Pakistan.

Introductions: Gallstones are formed within the gallbladder or in biliary tract. They can be termed as cholesterol stones whose major constituent is cholesterol or pigment stones which mainly are composed of bilirubin or there can be calcium and oxalate stones too. The aim of this study was to establish the composition of stones found within the gallbladder after cholecystectomy for symptomatic gallstones. Material and Methods: This study was conducted in a tertiary care hospital (Services Hospital Lahore) from 1st August-2017 to 30th June-2018. After examining the physical characteristics of the stones (color, number, shape and surface) were analyzed by semi- quantitative colorimetric analysis. Demographic data, morphology of stones and the percentage different chemical components were noted on pre-established performa and analyzed by SPSS software version 22. Results: A total 200 people were recruited in the study. The mean age of the patients was 37.82 ± 11.67 years. 90% patients were female and 10% patients were males. 10% cases had solitary stone while 90% cases had multiple stones. 25% patients had light brown stones, 30% had dark brown stones, 35% had gray stones and 10% had black stones. 85% cases had mixed stones whereas 15% had cholesterol stones. The mean percentages by weight of calcium, cholesterol, iron, phosphorus and bilirubin were 50± 10.59%, 27.45± 11.57%, 14.3± 6.28%, 13.25± 8.36% and 5.1± 2.46% respectively. Conclusion: It is concluded that gallstone disease is common in third decade of life and mixed stones is the most frequent variety of gallstones and calcium is the most abundant substrate of the gallstone

Shock wave lithotripsy, for the treatment of kidney stones, results in changes to routine blood tests and novel biomarkers: a prospective clinical pilot-study

BackgroundThe number of patients undergoing shock wave lithotripsy (SWL) for kidney stones is increasing annually, and as such the development of post-operative complications, such as haematuria and acute kidney injury (AKI) following SWL, is likely to increase. The aim of the study was to evaluate changes in routine blood and novel biomarkers following SWL, for the treatment of kidney stones.MethodsTwelve patients undergoing SWL for solitary unilateral kidney stones were recruited. From patients (8 males and 4 females) aged between 31 and 72 years (median 43 years), venous blood samples were collected pre-operatively (baseline), at 30, 120 and 240 min post-operatively. Routine blood tests were performed using a Sysmex XE-5000, and Beckman Coulter AU5800 and AU680 analysers. NGAL, IL-18, IL-6, TNF-α, IL-10 and IL-8 concentrations were determined using commercially available ELISA kits.ResultsSignificant (p ≤ 0.05) changes were observed in several blood parameters following SWL. NGAL concentration significantly increased, with values peaking at 30 min post-treatment (p = 0.033). Although IL-18 concentration increased, these changes were not significant (p = 0.116). IL-6 revealed a statistically significant rise from pre-operative up to 4 h post-operatively (p < 0.001), whilst TNF-α significantly increased, peaking at 30 min post-SWL (p = 0.05). There were no significant changes to IL-10 and IL-8 concentrations post-SWL (p > 0.05).ConclusionsChanges to routine blood tests and specific biomarkers, in the future, may be more useful for clinicians. In turn, identification of a panel of biomarkers could provide valuable data on “normal” physiological response after lithotripsy. Ultimately, studies could be expanded to identify or predict those patients at increased risk of developing post-operative complications, such as acute kidney injury or. These studies, however, need validating involving larger cohorts.

Factors Influencing the Subjective Symptoms of Submandibular Gland Sialolithiasis

Objectives: The aim of this study is to evaluate the factors affecting subjective symptoms, especially pain and swelling in submandibular gland sialolithiasis.&#x0D; Methods: We analyzed the computed tomographic (CT) findings of submandibular gland sialolithiasis (stone size/location/ number) and assessed white blood cell (WBC) (neutrophil/absolute neutrophil count) and erythrocyte sedimentation rate (ESR) to elucidate the correlation with subjective symptoms, especially swelling and pain.&#x0D; Results: Of the 82 patients, 45had a solitary stone. Thirty seven patients experienced pain and 73 patients had swelling. The number, location and size of the calculi were not associated with symptoms, especially pain and swelling. From logistic regression analysis, WBC (p=0.048) and the percentage of neutrophils (p=0.027) were associated with the presence of pain, but not swelling.&#x0D; Conclusion: To our knowledge, this is the first study to observe that both the location and size of stone are not significantly related to subjective symptoms, especially pain and swelling in submandibular gland sialolithiasis.&#x0D; Bangladesh Journal of Medical Science Vol.19(2) 2020 p.240-244

Does the degree of stone-induced hydronephrosis affect the outcome of shock-wave lithotripsy in patients with proximal ureteral stones?

Background Shock-wave lithotripsy (SWL) is an effective, well-established approach for treating ureteral calculi. Some studies have shown that patients with collecting system obstruction and ureteral stones had lower stone-free rates after SWL than patients with nonobstructed stones. In contrast, other studies acknowledge that stone-induced urinary obstruction does not decrease success with SWL for ureteral stones. The purpose of this study was to assess whether the degree of stone-induced hydronephrosis in patients with solitary proximal ureteral stones influences the outcome and clearance rates after SWL. Patients and methods This prospective study included 30 patients, with solitary proximal ureteric stones and different degrees of hydronephrosis, who were treated with SWL. Patients were divided into three groups according to the degree of stone-induced hydronephrosis. Group 1 (33.33%) had mild dilation, group 2 (33.33%) had moderate dilation, and group 3 (33.33%) had severe dilation. The Dornier MFL 5000 lithotripter was used to treat the patient groups. The results were compared in terms of stone-free rates, number of shock waves, number of sessions, incidence of complications, number of secondary interventions, and time to stone clearance. Results The average stone size was between 8 and 18 mm. The overall success rate was found to be 80% in patients with severe back pressure compared with 90 and 86.6% success rate in moderate and mild hydronephrosis groups, respectively (P=0.749). Furthermore, there was no statistical significance between the three studied groups regarding clearance time (P=0.721). Conclusions The degree of hydronephrosis secondary to proximal ureteral stones of between 6 and 20 mm has shown not to affect the duration till stone clearance or overall treatment success following SWL treatment.

Laparoscopic Cholecystectomy of Gallbladder Stone Presenting as Empyema in a 9 Years-Old Boy: A Case Report

Background: The gall bladder stones (GBS) are common disease related to diet habit, obesity, hematological diseases, diabetes mellitus and receiving total parenteral nutrition. GBS is a rare cause of hospitalization of pediatric patients, but have been increasingly diagnosed in recent years due to widespread use of ultrasonography. The aim of this case report study is to determine the clinical presentation, risk factors, valuable diagnostic procedures and outcome of laparoscopic management of cholelithiasis in children. Case report: Our case is a 9 years-old boy with empyemic gallbladder complaining of attacks of colicky epigastric pain associated with recurrent vomiting. On abdominal palpation, there is positive sign of deep tenderness at hypochondrium area and positive murphy sign. He has central obesity with BMI 29.9, skin folds more than 3.5 cm and waist circumference more than 90 cm. He has History of high cholesterol and fatty diet and fast food habit, prolonged intake of vitamin D and positive family history. While, no other associated risk factors was detected in our patient. All laboratory investigations was within normal ranges even for his lipid profile. Although, empyema was present, no leukocytosis was detected. Abdominal ultrasound showed the gall bladder wall is slightly thick surrounded by pericholycystic fluid, solitary gall bladder stone of 3 cm size and normal CBD. While, post-operative histopathological examination revealed thick wall gallbladder with multiple tiny stones of cholesterol type. The patient was treated with laparoscopic cholecystectomy with promising outcome and no complications. Conclusion: Pediatric surgeons should consider cholecystolithiasis as from differential diagnosis of abdominal pain associated with vomiting in children. Empyema of gallbladder should be considered once murphy sign is positive in such child patients. Child obesity, fatty diet, vitamin D deficiency and family history are possible risk factors. Ultrasonography is the mainstay of diagnosis. Laparoscopic cholecystectomy is the appropriate management for symptomatic cholelithiasis in children.

Punctures versus shocks: a comparison of renal functional and structural changes after percutaneous nephrolithotomy and shockwave lithotripsy for solitary renal stone

Objective: To evaluate renal functional and structural changes following percutaneous nephrolithotomy and shockwave lithotripsy for solitary non-obstructing non-staghorn renal stone. Materials and methods: Patients with solitary unilateral non-staghorn renal stones who were planned for percutaneous nephrolithotomy (20 patients) and shockwave lithotripsy (20 patients) were prospectively evaluated for renal functional and structural changes 60 days after the procedure and complete clearance of stones. Tc99-dimercaptosuccinic acid was used to assess cortical scarring and Tc99-diethylenetriamine pentaacetic acid and Tc99-levo levo ethylecysteine were used for glomerular filtration rate calculations, respectively. Results: The mean stone size was 24.4 mm and 13.7 mm in the percutaneous nephrolithotomy group and the shockwave lithotripsy group, respectively. No new cortical scars developed in either of the groups on Tc99-dimercaptosuccinic acid scan. Both the treated and untreated kidneys showed an overall insignificant fall in glomerular filtration rate in both the groups. The number of patients showing significant deterioration in the individual glomerular filtration rate in both the treated and untreated renal unit was more in the shockwave lithotripsy group. Conclusion: Both percutaneous nephrolithotomy and shockwave lithotripsy are comparable in terms of adverse effects on renal parenchyma and renal function. Level of evidence: Not applicable for this multicentre audit.

Epidemiology of Upper Tract Urolithiasis and ESWL Treatment in Kumasi, Ghana

Background: The incidence of upper tract urolithiasis is rising worldwide and treatment options have improved to include extracorporeal shock-wave lithotripsy (ESWL), percutaneous nephrolitothomy (PCNL) and ureterorenoscopy (URS) but sub- Saharan Africa has lagged behind the rest of the world. Open stone surgery was the main surgical treatment for upper tract stones in Kumasi until the introduction of ESWL five years ago. This study was conducted to evaluate ESWL in the management of upper tract urolithiasis in Kumasi, Ghana.&#x0D; Materials and methods: We prospectively analyzed all patients treated for upper tract urolithiasis at the Bomso Specialist Hospital in Kumasi from January 1, 2014, to December 31, 2017. Patients with upper tract stone of 2cm or less underwent ESWL. Data was obtained on patient demographics, stone characteristics, outcome of ESWL and analyzed with PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.&#x0D; Results: There were 170 patients with upper tract urinary stones over the study period with a male: female ratio of 2:1. The mean age was 46.5 years. Inadequate fluid intake (&lt;3L/day) was the most common predisposing factor, seen in 45.3% of the patients and the commonest symptom was flank pain, seen in 134 (78.8%) patients. There were 149 (87.6%) patients with solitary stones, mostly in the kidney 115 (67.6%). A total of 142 (83.5%) patients underwent ESWL with successful stone clearance in 120 patients. The most common complication of ESWL was flank pain 36 (25.4%).&#x0D; Conclusions:ESWL is effective for treatment of upper tract urolithiasis and should be available to selected patients in sub- Saharan Africa.

Outcomes and peri-operative complications of robotic pyelolithotomy.

Standard of care for large or complex renal stones is percutaneous nephrolithotomy. Robotic pyelolithotomy, however, may be a feasible alternative, but limited data exist on its outcomes and complications. Our study objective was to describe the outcomes and peri-operative complications of robotic pyelolithotomy for complex renal calculi. We performed a retrospective analysis of robotic pyelolithotomy at our tertiary academic institution from 2015 to 2018. Demographics, stone clearance rates, complications, estimated blood loss, operative time, and length of stay were reported. 15 patients were included with a median age of 59years (SD 15.3, 27-80) and BMI 25kg/m2 (SD 4.6, 20.9-35.7). Median follow-up was 4months. Median stone size was 3cm (SD 1.2cm, 2-5cm). Concomitant pyeloplasty was performed in 2 patients, complete stone clearance in 11 (73%) cases and 4 out of 5 (80%) with a solitary stone. Median operative time was 191.5min (SD 64.8min, 110-303min), with no open conversion. Median EBL was 70ml (SD 65ml, 20-250ml) and median length of stay was 1day (SD 1day, 1-5days). Median change in creatinine and eGFR were - 0.02mg/dl and + 3ml/min/1.73m2. There were no cases of sepsis or post-operative fever and only one case of transfusion. Robotic pyelolithotomy appears safe and effective. Ultimately, less bleeding, lower septicemia, renal parenchymal preservation, and favorable stone-free rates in a single procedure make this as an attractive option in the management of select patients with large renal stone disease.

Endoscopic intact removal of medium-size- or multiple bladder stones with the use of transvesical laparoendoscopic single-site surgery

ObjectivesTo determine the feasibility and safety of performing transvesical laparoendoscopic single-site surgery (T-LESS) in patients with medium-size, hard stones or multiple stones with high burden.MethodsIn this case series study, 12 patients (11 males and one female) with a mean age of 66.8 years were operated on from February 2016 to May 2017 due to bladder calculi, using the T-LESS approach with a single-port device (Tri-Port + , Olympus, Germany). Indications for this procedure were hard, medium-size, solitary stones after previous unsuccessful endoscopic lithotripsy or the presence of multiple high-burden stones. In two patients, additional procedures (diverticulectomy or a ureterocele incision) were performed simultaneously.ResultsAll stones were removed intact. No serious complications were observed. The mean operative time was 46 min and the postoperative hospital stay was 22 h. The mean diameter of the largest stone and the mean stone volume of each case were 24 mm and 11 cm3, respectively. At the mean follow-up time of 15 months, there was significant improvement of the symptoms.ConclusionsThe T-LESS technique is an efficient, safe and minimally invasive procedure for intact bladder stone removal in selected patients. The method avoids the risk of urethral injury. Nevertheless, further investigation is needed to assess the wider applicability of the procedure.

Renal stone composition does not affect the outcome of percutaneous nephrolithotomy in children.

We sought to investigate the association between renal stone composition and percutaneous nephrolithotomy outcomes in pediatric patients and define the characterization of the stone composition. The data of 1157 children who underwent percutaneous nephrolithotomy between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. The study population comprised 359 children (160 girls, 199 boys) with stone analyses. Patients were divided into five groups according to the stone composition [group 1: calcium oxalate; group 2: calcium phosphate; group 3: infection stones (magnesium ammonium phosphate, ammonium urate); group 4: cystine; group 5: uric acid, xanthine stones]. Patient characteristics, perioperative, postoperative, and stone characteristics were compared considering the stone composition. There were no significant differences between the groups concerning age, sex, side involved, preoperative hematocrit levels, and solitary renal unit. Patients with cystine stones were more likely to have a history of stone treatment. Groups 2 and 5 had mostly solitary stones. However, group 3 had staghorn stone more often, and group 4 frequently had multiple stones. Overall stone-free rate (79.4%) was similar among the groups. Although stone composition was related to blood transfusion and prolonged operative and fluoroscopy screening times on univariate analysis, it was not a significant predictor of them on multivariate analysis. Stone composition was not a predictor of outcomes of pediatric percutaneous nephrolithotomy. However, cystine and infection stones, which are larger and filled multiple calyxes due to the nature of stone forming, were more challenging cases that need multiple tracts.

Management of duct obstruction in transplanted submandibular glands

BackgroundSubmandibular gland (SMG) transplantation is a successful treatment approach for patients with severe dry eye. However, duct obstruction can occur post-transplant. MethodsWe studied nineteen patients with duct obstruction of transplanted SMGs, including five interventional modalities: stone removal; secretory stimulation (to mimic "internal irrigation" with substantial secretory flow); irrigation; surgical opening of stenosis and orifice reconstruction; cephalic vein bypass and Wharton's duct reconstruction. ResultsA solitary stone was found and removed in one patient. Duct blockages like mucus plug were cleared by secretory stimulation in three patients, and by normal saline irrigation in two grafts. In the remaining 13 patients, irrigation failed and surgical opening was performed. Orifice reconstruction succeeded in six of the eight patients, whose stenosis was near the orifice. Wharton's duct reconstruction was successful in two of the five cases where stenosis was located in the middle segment of the duct. ConclusionTransplanted SMGs obstruct for various reasons. Stone, which is easy to diagnose and treat, should be excluded first. Non-organic blockage and stenosis were semblable in clinic. Therefore, subsequent steps should be a diagnostic/therapeutic trial of secretory stimulation, followed by irrigation; failure of these interventions suggests the diagnosis of duct stenosis, necessitating surgical recanalization.

A comparison between low dose and standard dose computed tomography scan in detection of urolithiasis

Background: Computed tomography (CT) (standard and low-dose CT [LDCT] scan) has become the reference technique in medical imaging for urinary calculi, to diagnose, plan treatment, and explore differential diagnosis of renal colic. Objective: This study was done to compare the low-dose nonenhanced CT scan with standard dose CT scan in the detection of urolithiasis. Materials and Methods: Cross-sectional study conducted from 2017 to 2018 in Al-Hilla teaching general hospital on 60 patients undergone unenhanced (native) spectral detector CT (SDCT) and LDCT, the patients were scanned by Siemens CT system, 64 slice using automated tube current modulation, all CT scan were performed without oral or intravenous contrast. Results: This study showed that 93 stones detected by SDCT scan and 89 stones detected by LDCT scan, mean age of patients 44.2 ± 7.3 and mean of body mass index 26.3 ± 3.1, male constitute 56.6% (34) and female 43.4% (26). In 46.6% of patients had stone in the left side and 53.4% show stone in right side, most of patients presented solitary stone which appear 73.4%, 11.6% of patients had double stone, 5% had triple stone, 6.6% had four stones, and 3.45% had 5 or more stone at investigation, 10.8% of stones lie in ureter, 7.6% of stones in renal pelvis, 13.9% in upper calyx, 28% in lower calyx, and 39.7% lie in middle calyx, according to size of stones 11.9% of stones had size 20 mm. In standard CT scan, the current mean was 283.2 while in LDCT scan the mean was 126.1 mA, sensitivity is (93%) and specificity (100%) of LDCT in reference SDCT. Conclusion: LDCT scans provide effective methods of identifying and evaluating urinary tract stones, high diagnostic accuracy, sensitivity, and specificity are maintained despite significant radiation dose reduction compared to standard dose CT.

Supine Percutaneous Nephrolithotomy in the Galdako-Modified Valdivia Position: A High-Volume Single Center Experience.

To describe the technique and outcomes of supine percutaneous nephrolithotomy (PCNL) in the Galdako-modified Valdivia position. Prospective data were collected from 303 patients undergoing PCNL in the Galdako-modified Valdivia position at our institution between 2007 and 2015. We report our technique with outcomes of operative times, stone-free rate (SFR), and complications. A total of 202 solitary stones with a mean size of 17.19 ± 5.82 mm, 42 stones in multiple calices, and 57 staghorns were treated. Mean operative time was 79.79 ± 35.72 minutes. A total of 244/303 (80.5%) patients had clearance or <2 mm stone on postoperative CT. Minor complications (Clavien-Dindo Classification [CDC] 1-2) occurred in 59 (19.5%) cases and major complications (CDC ≥3) occurred in 22 (7.3%) cases. Five (1.7%) cases required postoperative blood transfusion for bleeding complications. We demonstrate that PCNL in a high-volume center to be safe and efficacious in the Galdalko-modified Valdivia position. We show equivalent SFR and complication rates to large studies of prone PCNL, with potential to decrease operative time. In particular, supine position is optimum for obese or high-risk patients with complex stone disease, because of ease of positioning and lower theoretical risk of anesthetic complications.

Multiple sialolithiasis of submandibular gland: a case report

Objective: Sialolithiasis is a common disease of the salivary glands. Sialolithiasis occurs mainly in the submandibular gland (80–90%) and to a lesser extent in the parotid gland (5–20%). Sialoliths may be single or multiple. Multiple sialolith in the submandibular gland are rare. Seventy to 80% of cases feature solitary stones; only about 5% of patients have three or more stones. Patients commonly experience pain and/or swelling.Methods: A 51-year-old male came to Department of Oral and Maxillofacial Surgery with a swelling and pain at the right submandibular. The panoramic radiograph showed a radiopacity mass with well-defined in right submandibular. The Ultrasonographic interpretation showed hypoechoic inhomogeneous mass with multiple calcification.The submandibular gland removal was performed by extraoral approach.Result:Multiple sialolith in the submandibular gland are rare. A surgical approach for removal of sialolith in the submandibular gland could be intraoral or extraoral. In this case report, we described five stones in the submandibular gland. which were removed by extraoral approach.Conclusion: There are various methods available for the management of salivary stones. In this case report, removal of the submandibular gland with the stone should still be preferred as the gold standard of treatment and could avoid recurrence of this medical condition.

Solitary stones of the lower renal calyx: how to treat?

The choice of treatment for the stones of the lower renal calyx is one of the challenging issues of modern urology. The aim of this retrospective and prospective study was to investigate the clinical effectiveness and safety of 3 modern minimally invasive techniques for treating renal stones: percutaneous (PNL) and transurethral (TNL) nephrolithotripsy and extracorporeal shock wave lithotripsy (ESWL) in patients with solitary lower calyx stones sized from 10 to 15 mm. The study included 136 patients with symptomatic stones of the lower calyces, who underwent ESWL, PNL and TNL from November 2010 to the present day. The criteria for inclusion in the study were: the presence of a solitary stone of the lower calyx, the stone size of 10 mm to 15 mm, the performance of the classical (standard) PNL in the prone position (puncture access 28-30 Fr) and the follow-up examination at 3 months after the operation. Forty-six patients underwent ESWL, 49 - PNL, and 41 - TNL. Postoperative follow-up was done at 3 months and included a plain radiography, ultrasound and non-contrast-enhanced computed tomography. The stone free rate (SFR) was used as a criterion for the effectiveness of the intervention, where the stone size of 3 mm was taken as the upper limit for the possible presence of fragments. Besides, the rate of repeat interventions, complications and subjective assessment of patients treatment satisfaction (0 to 10) by using visual analogue scale (VAS) were investigated. The effectiveness analysis of the three methods for treating the lower calyx stones sized 10-15 mm showed that PNL was no more effective than TNL (SFR 95.9% and 85.4%, respectively), but both methods were significantly more effective than ESWL (SFR 69.5%). 29.3% of patients who underwent TNL required repeat interventions (TNL or ESWL), while among those treated with ESWL, 45.6% required repeat ESWL sessions. PNL resulted in stone clearance in one stage. Postoperative inflammatory complications were most prevalent among patients who underwent TNL (26.8%). Bleeding requiring hemotransfusion was observed only after PNL (14.3%). Obstructive complications were observed in all study groups. For them, internal stenting was most often performed after ESWL (10.9%), puncture nephrostomy - after TNL (7.3%). Statistically significantly higher VAS measured quality of life was found after ESWL (7.9) and PNL (7.0) compared with THL (4.8). All three methods (PNL, TNL and ESWL) for treating lower calyceal stones sized from 10 to 15 mm are quite effective. Using them separately or in combination allows most patients to safely achieve a stone-free state.