Stone Analysis Research Articles

Multidimensional Analysis of Urinary Stone Diseases in Pediatric Patients.

Objectives:Urinary tract stones are less common in children than in adults. Determining the etiology is the most important step to achieve successful treatment and prevent future recurrence. The aim of this study was to investigate the clinical characteristics and possible risk factors for urinary stone disease in pediatric patients.Methods:The data of 126 patients with urinary stone disease who were treated in a pediatric nephrology clinic between 2000 and 2014 were analyzed retrospectively. A total 126 patients were enrolled in the study: 70 (55%) male and 56 (45%) female patients were included. The complaints, age of diagnosis, family histories, and stone location were examined. Direct urine microscopic examination, complete urinalysis, and urine culture were performed for all of the patients. Calcium, uric acid, oxalate, citrate, magnesium, and cystine levels were measured in urine collected in a 24-hour period. Serum electrolyte, blood urea nitrogen, creatinine, calcium, phosphorus, uric acid, and albumin levels were measured. Urinary ultrasound was performed. Stone analysis was conducted using the X-ray diffraction method. The mean age of the patients was 55 months (range: 1-162 months) at presentation.Results:In all, 34% of the patients had a family history of urinary stone disease. The rate of previous urinary tract infection was 26%. It was determined that 34% of the patients had been taking vitamin D and 5% had been taking a high dose. Metabolic risk factors determined were: hypercalciuria in 41%, hypocitraturia in 30%, hyperoxaluria in 14%, hyperuricosuria in 10%, and cystinuria in 5%. Among the group, 81% of the patients had kidney stones, 6.5% had ureter stones, and 2.5% had bladder stones. Furthermore, it was determined that 45% of the stones were composed of calcium oxalate, 35% had calcium phosphate stones, 14.2% had uric acid stones, and 13.3% had cystine stones. In 52% of the cases, extracorporeal shock wave lithotripsy was performed, and 71% underwent surgical treatment.Conclusion:Metabolic evaluation and stone analysis should be performed to prevent future recurrences in children with urinary stone disease and lifelong follow-up should be emphasized.

The Effectiveness of Extracorporeal Shock Wave In Pediatric Renal Stones

Introduction: Renal stones are endemic in low income countries among children below 15 years old. This should not be underestimated due to high association with other morbidity and highly recurrence rate when compared with adults. Objective : To explore the Effectiveness of Extracorporeal Shock Wave In Pediatric Renal Stones. Methodology: Study the case of a child girl reported with renal stone, clinical and laboratory data were obtained , Radiological investigations as US and CT were done, The patient underwent dj stent, then patient received one session of Extracorporeal Shock Wave 4000 us guided storz eswl Lithotripsy for urinary Stones then uralyt-u pediatric dose and allpourinol 100 mg once daily then start to passing stones gravels Results: Follow up by CT for the patient after 3 months revealed no stone, renal scan split function from 12 to 18%. Conclusion: Renal stones could be presented even among pediatric group even with negative family history. Ultrasound is the first choice imaging modality for diagnosis of suspected renal stones , CT could be used for follow up. Dihydroxyadenine stones could be missed during routine diagnosis of renal stones so imaging is mandatory and stones analysis should be done.

Metabolic evaluation: who, when and how often.

To summarize recommendations of the guidelines of the American Urological Association and European Association of Urology, and our opinion on which urinary tract stone disease patients should be metabolically evaluated at which moment and how often. A standard metabolic evaluation should be performed in all stone formers to prevent recurrent disease. This includes a medical and lifestyle history, physical examination, basic urine and blood analysis, radiological examination and stone analysis. The latter should already be performed during surgery, especially when only a couple of fragments are sent for analysis. Supplementary, performing a 24-h urine analysis should be supported in all patients to understand the lithogenic process that will guide the according follow-up. When risk factors are found, an extended individualized metabolic evaluation should be performed to exclude underlying metabolic diseases and to start stone-specific recurrence prevention. Urologists should be trained in perioperative stone characterization, because it contains information of urinary environment at the times of stone formation and growth. The extensiveness and frequency of metabolic work-up and follow-up of stone formers should be tailored to the type of stone, severity of the disease, patient's comorbidities and medications.

Analysis of Urinary Stones Collected from Some Patients with X-Ray Diffraction, Fourier Transform Infrared Spectroscopy, and Scanning Electron Microscopy

This study aims to determine the urinary stones' chemical compositions, morphologies, and crystal size by using X-ray diffraction, scanning electron microscopy with energy dispersive X-ray, and Fourier transform infrared spectroscopy. This study has been conducted with 30 urinary stones from the 30 patients who were treated at the Department of Urology in Mersin University Hospital (Mersin, Turkey). With respect to the detected phase compositions, results were classified into four chemical groups: oxalates (43.3%), phosphates (13.3%), urates (6.7%), and mixed stone (36.7%).

Техноморфологический анализ каменной и костяной индустрии из культуросодержащего горизонта 2 многослойного местонахождения Курла I на Северном Байкале

Техноморфологический анализ каменной и костяной индустрии из культуросодержащего горизонта 2 многослойного местонахождения Курла I на Северном Байкале

Evaluation of the Stone Analysis Results of the Patients Who Underwent Ureterolithotomy

Evaluation of the Stone Analysis Results of the Patients Who Underwent Ureterolithotomy

GALL STONES;

Objectives: Recognition of various gall stones in the patients attending surgicalOPD by biochemical analysis of gall stones. Study design: Cross sectional study. Place &duration of study: ISRA Hospital, Hyderabad and Institute of Biochemistry Sindh UniversityJamshoro. Duration of study was 18 months. Methods: Cases were patients with gall stones whowere diagnosed on ultrasonography. Gall stone analysis was done from Institute of BiochemistrySindh University Jamshoro. A total of sixty nine subjects were included in the study. Results: Inthe present study the mean Age was 35.81+ 8.12 years. Frequencies in different age groups are15-24 (11.60%), 25-34 (24.64%), 35-44 (53.63%), 45-54 (8.69%), 55-64 (01.45%). Age distributionis shown in Graph III-1. In the present study 49(71.0%) were females and 20(29%) were maleswith the female to male ration of 2.45:1. gender distribution is shown in Graph III-2. In the presentfrequencies of different types of gall stones was, cholesterol stones 38(55.07%), pigmentedstones 20(28.99%) and mixed type of stones 11(15.94%). Frequencies of different types of gallstones is shown in Graph III-3. Conclusions: In our study the frequency of cholesterol gall stoneis more as compared to pigmented and mixed gall stones. A total of 55.07% of cholesterolgallstones were found in our study with the female predominance.

Systemic analysis of urinary stones from the Northern, Eastern, Central, Southern and Southwest China by a multi-center study

BackgroundTo provide some basis for the prevention of urinary stones in general population, we did a systemic analysis of urinary stones from Northern, Eastern, Central, Southern and Southwest China by a multi-center study.MethodsA total of 11,157 urinary stones from Northern, Eastern, Central, Southern and Southwest China were obtained and analyzed by Fourier transform infrared spectroscopy. Combined with scanning electron microscopy and X-ray energy spectrometer, urinary stones were classified into different types. Furthermore, the correlation between stone types and clinical characteristics, as well as their regional distribution were elucidated.ResultsCalcium oxalate stones were the most common type in each region, followed by calcium oxalate-calcium phosphate mixed stones, uric acid stones and calcium phosphate stones. The distribution of calcium oxalate stones were highest prevalence in Southwest China (67.9%, P < 0.05), followed by Eastern and Northern China. Anhydrous uric acid stones, with a constituent ratio of 19.3% in Southern China, and 13.7% in Central China, were significantly higher than that in other regions (P < 0.05). Elements analysis indicated varieties among stone types as well as distribution regions. Moreover, the clinical characteristics were highly correlated with stone types and anatomical locations but not their distribution regions.ConclusionsThe material and elements composition of urinary stones among different regions showed some varieties. Calcium oxalate stone has the highest constituent ratio in Southwest China, while anhydrous uric acid stone has the highest constituent ratio in Southern China. Moreover, the clinical characteristics were highly correlated with stone types and anatomical locations but not their distribution regions.

Radiometric chronology and a morphometric analysis of a grinding stone with grooves from the Torihama shell mound

Radiometric chronology and a morphometric analysis of a grinding stone with grooves from the Torihama shell mound

The feasibility and safety of applying all-seeing needle in transurethral seminal vesiculoscopy

Objective To detect the feasibility and safety of applying all-seeing needle in transurethral seminal vesiculoscopy. Methods Retrospective analysis was made with clinical data of 32 patients of hemospermia treated with transurethral seminal vesiculoscopy using all-seeing needle from March 2016 to January 2018. The patients ' age was (38.8 ± 8.7) years (27-60 years) and the course of disease was (7.1±3.3) months (2-15 months). Ultrasound before operation showed heterogeneous echo, or expansion of the seminal vesicle. MRI showed hemorrhage of the seminal vesicle, or abnormal signal of the seminal vesicle. Patients had levofloxacin or mosisasin anti-infection therapy more than one month and remained uncovered. The operation was performed under subarachnoid anesthesia, and the patients took the lithotomy position. The F4.8 all-seeing needle entered the posterior urethra, the verumontanum was found, and the saline was slowly pushed with a syringe to maintain a clear view. Then, the ejaculatory duct opening was searched on both sides of the verumontanum. If the ejaculatory duct opening cannot be found in the normal position, we entered the needle into the prostatic utricle to find the possible ectopic opening. If the ejaculatory duct opening was still not found, at the 5 and 7 o'clock positions in the prostatic utricle, the needle was probed and punctured into the side wall of the ejaculatory duct. Visible puncture with all-seeing needle can effectively avoid penetrating blood vessels and reduce damage to tissues during puncture. In this study, the ejaculatory duct opening got accessed on the verumontanum in 14 cases, through ectopic openings within the prostatic utricle in 2 cases, and through artificial establishment in 5 and 7 o’clock positions within prostatic utricle in 16 cases. After entering the ejaculatory duct and seminal vesicle, we explored the cavities of the seminal vesicles. For stones or polyps, after replacing the outer sheath to F8, F1.9 stone retrieval basket was applied to remove stones or polyps, followed by rinsing the seminal vesicles with normal saline, 0.02% nitrofurazone, and then 160, 000 units of gentamicin into each seminal vesicle. For hemorrhage, after clearing up the blood, seminal vesicles were also washed with normal saline, nitrofurazone, and perfused with gentamicin. In the operation, prostatic utricle stone was found in 5 cases, and seminal vesicle stone was found in 7 cases. One case of seminal vesicle polyp was observed, and in 19 cases, seminal vesicle hemorrhage was seen. Results All the operations were accomplished successfully, the operation time was (55.0±11.3)min (35-82 min). There was no rectal injury or urethral injury during operation. The postoperative catheter was removed at 2 days postoperatively and the patients discharged on the 4th day after surgery. The length of hospital stay was (6.3±0.7) days (5-7 days). One patient had mild hematuria after removal of the urethral catheter and got improved spontaneously; one case developed epididymitis, which improved after anti-infective treatment. 6 cases made stone analysis, with 5 cases of magnesium ammonium phosphate hexahydrate, and 1 case of calcium oxalate dihydrate, calcium oxalate monohydrate and carbonate apatite mixed stones. One case of polyp was diagnosed by pathologists to be an inflammatory polyp. Follow-up was performed at 4, 6, 8, and 12 weeks after surgery. Hemospermia was cured in 24 cases, relieved in the other 8 cases at 8-week follow-up, who received oral antibiotic treatment afterwards. At the 12-week follow-up, the rest 6 cases in 8 got hemospermia recovered, with 2 cases still uncovered. Conclusions All-seeing needle is user-friendly and safe in transurethral seminal vesiculoscopy, with reliable short-term efficacy. Key words: Hemospermia; Seminal vesiculoscopy; All-seeing needle

Pathophysiology and Treatment of Cystinuria

Cystinuria is a relatively rare autosomal recessive disorder that manifests early in life and is associated with the development of kidney stones composed of cystine. It is due to mutations in two genes that are involved in the transport of cystine, neutral, and dibasic amino acids in the proximal tubule of the kidney. Patients are at risk for developing chronic kidney disease. Diagnosis is typically established with stone analysis and quantitative urinary cystine excretion. These patients may form extremely large stones requiring percutaneous nephrolithotomy. Stone-prevention strategies include dietary modifications (increased fluid intake and limitation of sodium and animal protein consumption), urine pH manipulation, and thiol-binding agents. These patients should be followed closely, and preemptive stone removal with ureteroscopy should be considered to limit the necessity for more invasive procedures. This review contains 2 figures and 38 references. Key Words: a-mercaptopropionyl glycine, amino acid transport, chronic kidney disease, cystinuria, SLC3A1, SLC7A9, thiol-binding agent, urinary pH manipulation

Pathophysiology and Treatment of Uric Acid Stones

Uric acid is the third most common stone composition and comprises 7 to 10% of all kidney stones sent for analysis. These stones are more common with increasing age and in men. Uric acid stone disease is associated with conditions such as the metabolic syndrome and type 2 diabetes mellitus. Uric acid is produced by the enzyme, xanthine oxidase and is the final product of purine metabolism in humans. Three main factors contribute to the formation of uric acid stones: low urine pH (the most important), hyperuricosuria (rare, includes conditions such as myeloproliferative disorders and Lesch-Nyhan syndrome), and low urine volume. Uric acid stones appear radiolucent on plain radiographs and are ultimately diagnosed via stone analysis. These stones may be treated with medical expulsive therapy, dissolution therapy, or surgical intervention depending on the size, location, and clinical presentation. Urine pH manipulation therapy with potassium citrate is the first-line treatment for the prevention of uric acid stones and attempts at dissolution. Allopurinol should not be offered as the first-line therapy for uric acid stones. This review contains 3 figures, 1 table and 38 references Key Words: ammonium, diabetes mellitus, epidemiology, management, metabolic syndrome, nephrolithiasis, pathophysiology, potassium citrate, uric acid, urine pH

57] Bacteriological analysis of urinary stones: correlation with preoperative cytobacteriological examination of urine

ObjectiveTo analyse the bacteriological correlation between preoperative cytobacteriological examination of urine (CBEU) and urinary calculi, and to evaluate the impact of chemical nature on the bacteriological stones.

76] Hereditary kidney stones: An experience of a nephrology department

Objective To determine clinical and metabolic characteristics and progression of hereditary urinary lithiasis. Genetic factors must be considered in the aetiological diagnosis of urinary lithiasis. Methods A retrospective study was conducted between 2008 and 2018, and 53 patients were included. Patients were referred to our department for aetiological investigation in 36 cases, for chronic renal failure in eight cases, and from paediatric departments to be followed-up in adulthood in nine cases. Results In all, 32 men and 21 women were enrolled in this study with a male/female sex ratio of 1.52. The mean (range) age at the time of diagnosis of the hereditary character of the urinary lithiasis was 29 years (4 days–63 years).The mean (range) delay between the onset of the lithiasis disease and the aetiological diagnosis was 10.5 (1–42) years. We noted 26 cases of cystinuria, 17 cases of primary hyperoxaluria type 1 with two mutations (I244T in 15 cases and 33–34 Insc in two cases), and 10 cases of renal tubulopathy. In all, 14 patients had chronic renal failure, of which five were in end-stage. Crystalluria was positive in 62% of the cases. The morpho-constitutional analysis of stones was conducted in 31 cases; oxalo-dependent lithiasis was identified in nine cases and cystine lithiasis in 22 cases. After a mean follow-up of 82 months for 43 patients, we noted normal renal function in 21 cases, chronic renal failure in 12 cases, and haemodialysis in nine cases, all with primary hyperoxaluria and transplantation in one case. Conclusion The aetiological diagnosis of hereditary urinary lithiasis was made with considerable delay. Cystinuria was the most frequent aetiology and primary hyperoxaluria was the most serious affliction.

Characterization of renal stone composition by using fast kilovoltage switching dual-energy computed tomography compared to laboratory stone analysis: a pilot study.

To prospectively examine the diagnostic performance of fast kilovoltage switching dual-energy computed tomography (DECT) in characterization of in vivo renal stone composition compared with postoperative stone analysis. Consecutive consenting patients scheduled for endoscopic kidney stone surgery in a tertiary referral hospital from June 2015 to January 2016 were enrolled. Patients were preoperatively scanned with single-source, fast kilovoltage switching DECT. Stone compositions were determined regarding the effective atomic number measurements. Results of the stone compositions from DECT were compared to postoperative infrared spectroscopy stone analysis as the standard reference. For the 39 patients enrolled in the study, DECT was able to detect uric acid stone with sensitivity of 88.9% and specificity of 100%. There was 100% positive predictive value, 96.8% negative predictive value, and 97.4% accuracy. For non-contrast CT scan, sensitivity was 88.9%, specificity was 96.7%, positive predictive value was 88.9%, negative predictive value was 96.7%, and accuracy was 94.8%. Of the 39 samples examined, 21 (54%) were single composition, whereas 18 (46%) were combined. Single composition stones were correctly characterized by DECT in 100% (8/8) for uric acid. Whereas the result of uric acid stone containing stone discrimination in mixed composition was not so good with Zeff alone, iodine imaging can compensated this fault. DECT provides excellent accuracy in characterizing uric acid stone compositions. With the addition of iodine image, all of uric acid-containing stones can be determined by the DECT.

Calculi in the Prostatic Surgical Bed as a complication after Holmium Laser Enucleation of the Prostate.

To report de novo calculi in the prostatic surgical bed as a complication of Holmium laser enucleation of the prostate (HoLEP). Patients who underwent HoLEP and were enrolled in our Benign Prostatic Hyperplasia (BPH) Database Registry from July 2008 to December 2015 were reviewed. Cases of calculi removal in the prostatic surgical bed were identified. Clinical data, including preoperative evaluation, postoperative symptoms with a detailed history, urinalysis, pathology, cystourethroscopy, and stone analysis were collected and described. Eight patients were identified including one patient who underwent HoLEP at another hospital. Among the 877 patients in our BPH database, 7 (0.8%) underwent calculi removal in the prostatic surgical bed. Median age was 67.0 years. Median prostatic volume was 75.5mL. The most common symptom was severe stabbing urethral pain (n = 4), with a median of 13 months after HoLEP. Calculi were pedunculated in the prostatic surgical bed or in the bladder neck with a small mucosal connection. Pathology of the resected tissue showed granulation tissueformation and dystrophic calcification. Calculi in the prostatic surgical bed or the bladder neck after HoLEP have never been reported previously. Although it is very rare, recurrent urethral pain, persistent pyuria, and recurrent gross haematuria are signs for further investigation. Cystourethroscopy should be performed to rule out the presence of stones. Careful history taking and having an index of suspicion are important for the diagnosis.

The origins of nomadic pastoralism in the eastern Jordanian steppe: a combined stable isotope and chipped stone assessment

The circumstances in which domestic animals were first introduced to the arid regions of the southern Levant and the origins of nomadic pastoralism have been the subject of considerable debate. Nomadic pastoralism was a novel herd management practice with implications for the economic, social and cultural development of Neolithic communities inhabiting steppe and early village environs. Combining faunal stable isotope and chipped stone analyses from the eastern Jordanian Neolithic steppic sites of Wadi Jilat 13 and 25, and ‘Ain Ghazal in the Mediterranean agricultural zone of the Levantine Corridor, we provide a unique picture of the groups exploiting the arid areas.

Anatomic variations and stone formation.

The pathophysiological mechanisms in kidney stone formation are insufficiently understood. In order to achieve a better understanding of the complexity of stone formation, studies evaluating anatomical variations in the renal papillae have been performed. This review intends to illuminate recent findings. Moreover, new techniques to improve the understanding and interpretation of crystallization mechanisms are reviewed. Due to improvements of digital ureteroscopes, detailed endoscopic mapping of renal papillae is now possible. Connections between papillary morphology and histopathological changes in different subsets of stone formers have been documented. The formation of kidney stones seems to take place in relation to Randall's plaques, Ducts of Bellini or by free formation. Additionally, theories of kidney stone formation because of vascular injury or inflammatory events in the papillae have been suggested. Novel techniques including improved digital endoscopic visualization, microcomputed tomography (CT), electron microscopy and energy dispersive compositional analyses of kidney stones seem essential in the search for effective and reliable methods to understand stone forming processes, which ultimately should result in effective measures for more personalized stone prevention strategies in the future.

Small-angle X-ray scattering (SAXS) and nitrogen porosimetry (NP): two novel techniques for the evaluation of urinary stone hardness.

To evaluate urinary stones using small-angle X-ray scattering (SAXS) and nitrogen porosimetry (NP). Traditionally, stones are categorized as hard or soft based on their chemical composition. We hypothesized that stone hardness is associated not only with its chemical composition but also with its internal architecture. SAXS and NP are well-known techniques in material sciences. We tested whether SAXS and NP are applicable for evaluating human urinary stones and whether they provide information at the nanoscale level that could be useful in clinical practice. Thirty endoscopically removed urinary stones were studied. Standard techniques for stone analysis were used to determine the stone composition. SAXS was used to evaluate the solid part of the stone by measuring the crystal thickness (T) and the fractal dimension (Dm/Ds), while NP was used to evaluate the porosity of the stone, i.e., the pore radius, pore volume, and specific surface area (SSA). All stones were successfully analyzed with SAXS and NP. Each stone demonstrated unique characteristics regarding T, Dm/Ds, pore radius, pore volume, and SSA. Significant differences in those parameters were seen among the stones with almost identical chemical compositions. The combination of high T, high SSA, low Dm/Ds, low pore volume, and low pore radius is indicative of a hard material and vice versa. SAXS and NP can be used to evaluate human urinary stones. They provide information on stone hardness based on their nanostructure characteristics, which may be different even among stones with similar compositions.

Analysis and classification of kidney stones based on Raman spectroscopy.

The number of patients with kidney stones worldwide is increasing, and it is particularly important to facilitate accurate diagnosis methods. Accurate analysis of the type of kidney stones plays a crucial role in the patient's follow-up treatment. This study used microscopic Raman spectroscopy to analyze and classify the different mineral components present in kidney stones. There were several Raman changes observed for the different types of kidney stones and the four types were oxalates, phosphates, purines and L-cystine kidney stones. We then combined machine learning techniques with Raman spectroscopy. KNN and SVM combinations with PCA (PCA-KNN, PCA-SVM) methods were implemented to classify the same spectral data set. The results show the diagnostic accuracies are 96.3% for the PCA-KNN and PCA-SVM methods with high sensitivity (0.963, 0.963) and specificity (0.995,0.985). The experimental Raman spectra results of kidney stones show the proposed method has high classification accuracy. This approach can provide support for physicians making treatment recommendations to patients with kidney stones