Surgical Stone Removal Research Articles

Domestic single-port robot-assisted laparoscopic surgery for pyelotomy combined with shockwave lithotripsy: the first case report

Introduction and Importance: Kidney stones are a common condition treated in urology departments and rank first among hospitalized patients. Staghorn kidney stones are a particular type of kidney stone that fill or occupy most of the renal collecting system. They have a large stone load and are often associated with recurrent urinary tract infections and chronic renal insufficiency. Case presentation: The authors report a case of single-port robot-assisted laparoscopic pyelotomy combined with EMS (Electromagnetic Shockwave Lithotripsy) for surgical stone removal, and discuss and analyze it based on published literature. A 75-year-old woman visited our hospital in January 2024 due to right waist pain and hematuria. Computed Tomography (CT) indicated a stone ~6.1×5.8×3.5 cm in the right renal pelvis and calyces. Staghorn kidney stones are challenging to remove surgically, have a low stone clearance rate, and are prone to recurrence, making them one of the most difficult issues in urological surgery. Combined treatment effectively reduces the number of skin-renal passages, decreases the occurrence of injuries and complications, and improves the success rate of lithotripsy and the stone-free rate. Therefore, the patient underwent single-port robot-assisted laparoscopic pyelotomy combined with EMS surgical lithotomy and was discharged 7 days after the operation. There were no complications postoperation, and follow-up showed that the stones were completely cleared without any residue. Clinical discussion: The treatment of staghorn kidney stones requires a comprehensive approach to reduce the number of skin-renal passages and the occurrence of complications. Single-port robot-assisted pyelotomy combined with EMS lithotripsy can ensure the effectiveness of the surgery while reducing risks and enhancing patient recovery. Conclusion: For staghorn kidney stones, single-port robot-assisted pyelotomy combined with EMS stone removal is a safe and effective procedure with a beautiful incision, fewer complications, and excellent patient outcomes.

Risk Factors of Asymptomatic Kidney Stone Passage in Adults with Recurrent Kidney Stones.

Kidney stones are a common health problem and are characterized by a high risk of recurrence. A certain number of kidney stones passed asymptomatically. Data regarding the frequency of asymptomatic spontaneous stone passages are limited. To assess the frequency of asymptomatic spontaneous stone passage and its covariates, we conducted a post-hoc analysis of the prospective randomized NOSTONE trial. All asymptomatic spontaneous stone passages were identified by comparing the total number of kidney stones on low-dose non-contrast CT imaging at the beginning and end of the study, considering symptomatic stone passages and surgical stone removal. The statistical analysis focused on the association of independent variables and the number of asymptomatic spontaneous stone passages using linear regression analyses. Of the 416 randomized patients, 383 with both baseline and end-of-study CT were included in this analysis. The median follow-up period was 35 months, the median patient age was 49 years (IQR:40 - 55), and 20% of the patients were female. A total of 442 stone events occurred in 209 out of 383 (55%) patients: 217 out of 442 (49%) were symptomatic spontaneous stone passages, 67 out of 442 (15%) were surgically removed stones, and 158 out of 442 (36%) were asymptomatic spontaneous stone passages. The median size of asymptomatic stones (2.4 mm; IQR:1.95-3.4) and the size of symptomatic stones (2.15 mm; IQR:1.68-2.79) that passed spontaneously were not significantly different (p=0.37). The number of asymptomatic spontaneous stone passages was significantly associated with a higher number of stones on CT at randomization (P=0.001). Limitations include the lack of data on stone size at the time of passage and overrepresentation of White men. Asymptomatic stone passage was common in patients with recurrent calcium-containing kidney stones. The higher the number of stones at presentation, the more likely it was that a kidney stone would spontaneously pass over time without causing any symptoms.

Diagnosis dan Tatalaksana Rinolit Pada Pasien Lansia

Introduction: Rinolits are uncommon foreign bodies in the nose, which serve as a nidus for calcium salt deposition. Foreign bodies can be endogenous or exogenous in origin and can be asymptomatic for years before being discovered incidentally. If left untreated, stones can cause unilateral nasal obstruction, rhinorrhea, epistaxis, or in rare cases, progressive damage leading to septal/palatal perforation or oro-antral fistula. Surgical stone removal is an effective intervention with rare reports of complications. Case Report: A case of rinolit in a 72-year-old woman with complaints of left nasal congestion since 2 months ago with thick, smelly snot in the past 2 weeks is reported. History of foreign entry was denied. On examination of the sinistra nasal cavity, it was found that the nasal cavity was narrow, the inferior concha was edematous, there was a yellowish mass between the inferior concha and the septum, the media concha was difficult to assess, septal deviation was present, sekret was present, mucoid. The management given was extraction using forceps under local anesthesia. Conclusion: Rinolit is an uncommon clinical etiology which if undiagnosed can lead to complications; thus it is important to consider for any unilateral nasal symptoms of unclear origin.
 
 

Treatment of donors' asymptomatic small kidney stones and post-transplant outcomes: a meta-analysis.

Kidney donors with asymptomatic small kidney stones were increasingly accepted in kidney transplantation (KT) due to organ shortage and advances in endoscopic urology. However, recipients' clinical outcomes using these donors remained unclear. We conducted a meta-analysis to summarize transplant outcomes using these donors with asymptomatic small kidney stones. Finally, 15 retrospective studies were included. The prevalence of asymptomatic small kidney stones was 5.3% (95%CI 3.5-7.8%). After transplantation, low incidence of urinary fistula (0%, 95%CI 0-1.0%), obstruction (0%, 95%CI 0-1.1%), relapse of kidney graft stone (0.3%, 95%CI 0-2.5%), and delayed graft function (0.6%, 95%CI 0-3.5%) was reported. Pooled serum creatinine was 1.3 (95%CI 1.2-1.5) mg/dl and 1.4 (95%CI 1.2-1.6) mg/dl at post-transplant 1month and 1year, respectively. Notably, we observed numerically higher relapse rate after conservative management (1.8% [0-9.2%] vs 0% [0-1.8%]) but numerically higher DGF rate after surgical removal of asymptomatic stones (1.8% [0-7.0%] vs 0% [0-1.9%]). Overall, short-term transplant outcomes using kidneys with asymptomatic small stones were acceptable. However, long-term transplant outcomes remained unexplored. Well-designed prospective studies are also needed to compare the efficacy of conservative management with surgical removal of "donors' gifted" asymptomatic kidney stones.

Dynamics of inflammatory reaction markers in patients under endourological interventions

Introduction. Urolithiasis is one of the most widespread urological diseases and infectious complications remain one of the most common adverse events after surgical interventions for urolithiasis. Currently, in routine clinical practice in most clinics in the country, for the purpose of postoperative control and detection of infectious complications is used: a clinical blood test with assessment of the dynamics of the blood leukocyte count. Unfortunately, the current edition of the clinical guidelines does not contain recommendations on what indicators of postoperative follow-up examinations the clinician should focus on in order to identify infectious and inflammatory complications. For this reason, the study of the value of other markers of the inflammatory response appears to be an actual task.Objective. To assess the relationship between the dynamics of laboratory markers of infectious-inflammatory complications and the incidence of infectious-inflammatory response after endoscopic stone removal.Materials & methods. The prospective cohort study included 217 patients diagnosed with urolithiasis and underwent surgical removal of stones by endoscopic method. Of total patient numbers, 43 patients underwent ureteroscopy (URS) with lithotripsy, 152 patients underwent percutaneous nephrolithotripsy (PNL), and 22 patients underwent flexible ureterolithotripsy with lithotripsy. An analysis of demographics, clinical parameters and postoperative complications was performed as a descriptive analysis. Patients underwent a standard list of laboratory and instrumental examination methods. The mandatory control of body temperature was carried out t.i.d. daily. Before surgical treatment, indicators of WBC, LYMP, CRP, and ESR content were recorded on the first and second days after surgical treatment.Results. Postoperative fever was recorded in 40 (18.5%) patients. During the postoperative period, an increase in CRP and ESR was observed in both the fever and the normal temperature group, exceeding the reference values on the first day. At the same time, in the fever group (in 40 patients — 18.5%), a significantly higher increase in CRP and ESR was observed (685% vs 323%) for CRP and (146% vs 80%) for ESR. According to the results obtained in our study, CRP and ESR indicators demonstrate the most clinically significant dynamics in patients with postoperative fever, increasing by more than 500% and 100%, respectively.Conclusions. Endoscopic removal of urinary stones is a safe treatment option in patients with sterile urine cultures. After endoscopic stone removal, all patients experience such reactive changes in peripheral blood parameters as: an increase in the level of leukocytes, lymphopenia, an increase in ESR and CRP levels. Indicators of CRP and ESR demonstrate the most clinically indicative dynamics.

Predictive value of single-nucleotide polymorphism signature for nephrolithiasis recurrence: a 5-year prospective study.

Genetic variations are linked to kidney stone formation. However, the association of single nucleotide polymorphism (SNPs) and stone recurrence has not been well studied. This study aims to identify genetic variants associated with kidney stone recurrences and to construct a predictive nomogram model using SNPs and clinical features to predict the recurrence risk of kidney stones. We genotyped 49 SNPs in 1001 patients who received surgical stone removal between Jan 1 and Dec 31 of 2012. All patients were confirmed stone-free by CT scan and then received follow-up at least 5 years. SNP associations with stone recurrence were analyzed by Cox proportion hazard model. A predictive nomogram model using SNPs and clinical features to predict the recurrence risk of kidney stones was developed by use of LASSO Cox regression. The recurrence rate at 3, 5, 7 years were 46.8%, 71.2%, and 78.4%, respectively. 5 SNPs were identified that had association with kidney stone recurrence risk. We used computer-generated random numbers to assign 500 of these patients to the training cohort and 501 patients to the validation cohort. A nomogram that combined the 14-SNPs-based classifier with the clinical risk factors was constructed. The areas under the curve (AUCs) at 3, 5 and 7 years of this nomogram was 0.645, 0.723, and 0.75 in training cohort, and was 0.631, 0.708, and 0.727 in validation cohort, respectively. Results show that the nomogram presented a higher predictive accuracy than those of the SNP classifier or clinical factors alone. SNPs are significantly associated with kidney stone recurrence and should add prognostic value to the traditional clinical risk factors used to assess the kidney stone recurrence. A nomogram using clinical and genetic variables to predict kidney stone recurrence has revealed its potential in the future as an assessment tool during the follow-up of kidney stone patients.

Reflux-related Complications in Patients with Chronic Calculous Prostatitis and Benign Prostate Hyperplasia After Surgical Removal of Prostatic Hyperplasia and Stones

The objective: to analyze the effectiveness of prevention of reflux-related complications in patients with chronic calculous prostatitis and prostatic hyperplasia after surgical removal of prostatic hyperplasia and stones. Materials and methods. The study included patients 56–70 years old with prostatic hyperplasia and stones. They were divided into two groups. The first group included 28 patients who underwent a retrospective study of reflux pyelonephritis and epididymitis after surgical removal of hyperplastic tissues and stones of the prostate gland without the use of pathogenetically justified prophylaxis. The second group included 26 patients who underwent a study of reflux pyelonephritis and epididymoorchitis after surgical removal of hyperplastic tissues and stones of the prostate gland with the use of pathogenetic justified drug therapy. The patients underwent objective, laboratory, bacteriological and biochemical research, ultrasound examination of the prostate gland and bladder. Blood flow in the prostate gland was studied by Doppler. Results. In 14.2 % of patients in the first group, who received traditional medical treatment in the postoperative period, acute reflux pyelonephritis developed, in 17.8 % – epididymitis. Patients of the second group were prescribed one of the alpha1-adrenoceptor blockers and suppositories with a non-steroidal drug in the postoperative period together with traditional medical therapy. In patients of the second group, acute reflux pyelonephritis was not determined after surgical treatment, and epididymitis developed in 1 (3.3 %) of 26 persons. Conclusions. It has been determined that the prescription of alpha1-adrenoceptor blocker is an effective method of preventing of reflux-related pyelonephritis and epididymitis development in the patients in the early postoperative period after surgical removal of hyperplastic tissues and stones of the prostate gland in order to eliminate spastic obstruction, as well as prescription of non-steroidal drug to reduce the inflammatory process and edema in the prostate and bladder neck.

Astragalus membranaceus Extract Prevents Calcium Oxalate Crystallization and Extends Lifespan in a Drosophila Urolithiasis Model.

Approximately 1 in 20 people develops kidney stones at some point in their life. Although the surgical removal of stones is common, the recurrence rate remains high and it is therefore important to prevent the occurrence of kidney stones. We chose Astragalus membranaceus (AM), which is a traditional Chinese medicine, to study the prevention of urolithiasis using a Drosophila model based on our previous screening of traditional Chinese herbs. Wild-type Drosophila melanogaster Canton-S adult fruit flies were used in this study. Ethylene glycol (EG, 0.5%) was added to food as a lithogenic agent. The positive control agent (2% potassium citrate (K-citrate)) was then compared with AM (2, 8, and 16 mg/mL). After 21 days, the fruit flies were sacrificed under carbon dioxide narcotization, and the Malpighian tubules were dissected, removed, and processed for polarized light microscopy examination to observe calcium oxalate (CaOx) crystallization. Then, the ex vivo dissolution of crystals in the Malpighian tubules was compared between K-citrate and AM. Survival analysis of the EG, K-citrate, and AM groups was also performed. Both 2% K-citrate and AM (16 mg/mL) significantly inhibited EG-induced CaOx crystal formation. Mean lifespan was significantly reduced by the administration of EG, and the results were significantly reversed in the AM (8 and 16 mg/mL) groups. However, AM extract did not directly dissolve CaOx crystals in Drosophila Malpighian tubules ex vivo. In conclusion, AM extract decreased the ratio of CaOx crystallization in the Malpighian tubules and significantly ameliorated EG-induced reduction of lifespan. AM prevented CaOx crystal formation in the Drosophila model.

Инкрустирующий пиелит.

Introduction. Encrusted pyelitis is a rare clinical form of urolithiasis. It represents a formation of stones on the mucosa of collecting system because of violation of epithelial function. Encrusted pyelitis characterized by formation of multiple planar stones intimately soldered to the epithelial lining. Generally, accepted methods of surgical removal of stones is not effective in such case and different approach is required. Clinical case. Presented a clinical case of successful treatment of patient with encrusted pyelitis by chemolytic therapy. It carried out by irrigating the collecting system with a solution injected through nephrostomy drain. Discussion. Analysis of the literature on encrusted pyelitis shows that due to the rare occurrence of this pathology, there is no standardized approach to the treatment of this group of patients, and publications are limited to the analysis of clinical observations. A number of scientific papers confirmed effect of chemolytic therapy in these situations. Conclusion. A patient with encrusted pyelitis underwent several courses of chemolytic therapy with good results. Stone free status is achieved. It is important to note that chemolysis was effective only in relation to those stones that were on the way of the irrigation solution from the supply nephrostomy tube to the discharge one.

Is Mini Percutaneous Nephrolithotomy a Game Changer for the Treatment of Renal Stones in Children?

BackgroundMini percutaneous nephrolithotomy (MPCNL) is a newer surgical procedure that has changed the management of paediatric renal stones. ObjectiveTo evaluate MPCNL morbidity and success rates for renal stones as a function of patient age in a paediatric cohort. Design, setting, and participantsThis was a retrospective case series that included 143 consecutive patients younger than 17 yr who underwent MPCNL at our institution between January 2016 and November 2020. The patients were categorised into three different age groups: <6 yr (n = 71, 49.7%), 6–11 yr (n = 44, 30.8%), and 12–17 yr (n = 28, 19.6%). MPCNL was performed in all patients through 16–20Fr tracts. Outcome measurements and statistical analysisThe stone-free rate, perioperative complications, tract number, operative time, postoperative haemoglobin change, and hospitalisation time were evaluated for each age group. Results and limitationsMPCNL was performed in 143 paediatric patients (88 boys and 55 girls; mean age 6.53 yr). The mean stone burden (± standard deviation) was 2.096 ± 1.01 cm in group one, 2.05 ± 1.05 cm in group two, and 3.46 ± 19.94 cm in group three; group three was significantly larger (p = 0.001). After a single MPCNL session, 92.42% of patients experienced complete stone clearance. All age groups were similar in terms of stone-free rate (p = 0.82), hospitalisation time (p = 0.94), postoperative haemoglobin change (p = 0.06), and perioperative complications (p = 0.62). However, stone size (p = 0.009), stone complexity (p = 0.001), number of access points (p = 0.03), and operative time (p = 0.009) were higher in the group aged 12–17 yr. ConclusionsMPCNL is an effective and safe procedure in younger as well as older children. Age should not be considered a limiting factor for MPCNL in children, and MPCNL should be considered the primary option for treating paediatric renal stones when PCNL is indicated. Patient summaryOur results show that surgical removal of kidney stones through an incision in the skin and using miniaturised instruments is an effective and safe procedure for children.

Sexual Dysfunction in Patients With Urinary Bladder Stones but no Bladder Outlet Obstruction.

Objective: To explore the correlates of sexual dysfunction and lower urinary tract symptoms (LUTS) in male patients with urinary bladder stones and to determine the effect of stone extraction on recovery of sexual function.Materials and Methods: A total of 87 male patients with primary bladder stones were studied from January 2015 to May 2016. All patients underwent pneumatic lithotripsy for bladder stones. Sexual dysfunction was assessed based on sexual function assessment scales. The relationship of bladder stones with sexual dysfunction or LUTS was assessed using a two-sample t-test. Postoperative improvement of sexual function was assessed by repeated measures Analysis of Variance (ANOVA).Results: Forty-one patients had primary bladder stones and 46 had secondary stones from the kidneys. Eighty-three of 87 patients (95%) had sexual dysfunction; 79 patients (91%) had both sexual dysfunction and LUTS. There was a significant association between bladder stones and sexual dysfunction, between sexual dysfunction and LUTS, and between bladder stone and LUTS (p < 0.05). There was no significant association between the course of illness, size and number of bladder stones, or urinary tract infection with sexual function (p > 0.05). In addition, among 83 patients with both bladder stone and sexual dysfunction, 61 patients (73%) had benign prostatic hyperplasia (BPH) and 22 patients (27%) had no BPH. On postoperative evaluation at 3 months, sexual dysfunction scores were significantly improved in 77 patients (88.5%)Conclusion: Patients with bladder stones have a high incidence of sexual dysfunction, particularly those with co-existing LUTS and BPH. About 1/3 patients without BPH had sexual dysfunction and surgical removal of bladder stones significantly improved sexual function and LUTS.

Practice of Berberis vulgaris and Lycopodium clavatum in urolithiasis: A systemic review

Urolithiasis is the most common disease of urinary tract found worldwide with approaches for its treatment that include the use of various synthetic and natural drugs or surgery in the conventional system of medicine. This systemic review was taken up to evaluate the efficacy of Berberis vulgaris and Lycopodium clavatum in the treatment of urolithiasis. Total 1471 articles were evaluated and after that 7 articles including case reports and studies were selected for systemic review and results. Total 195 patients were treated in these 7 studies and case reports, 7 patients were treated successfully with Berberis vulgaris. Patients treated with Lycopodium clavatum were 188 and the patients treated successfully were 98 (52.6%). Stone as large as 23 mm was expelled using Lycopodium clavatum. Both these homeopathic remedies showed positive results in treating kidney stones and can be a successful alternative of surgical and non-surgical removal of kidney stones

Emergency department and hospital revisits after ambulatory surgery for kidney stones: an analysis of the Healthcare Cost and Utilization Project

Our objective was to identify the rate of revisit to either emergency department (ED) or inpatient (IP) following surgical stone removal in the ambulatory setting, and to identify factors predictive of such revisits. To this end, the AHRQ HCUP ambulatory, IP, and ED databases for NY and FL from 2010 to 2014 were linked. Cases were selected by primary CPT for shock-wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL) with accompanying ICD-9 for nephrolithiasis. Cystoscopy (CYS) was selected as a comparison group. The risk of revisit was explored using multivariate models. The overall unplanned revisit rate following stone removal was 6.4% (4.2% ED and 2.2% IP). The unadjusted revisit rates for SWL, URS, and PNL are 5.9%, 6.8%, and 9.0%, respectively. The adjusted odds of revisit following SWL, URS, and PNL are 1.93, 2.25, and 2.70 times higher, respectively, than cystoscopy. The majority of revisits occurred within the first two weeks of the index procedure, and the most common reasons for revisit were due to pain or infection. Younger age, female sex, lower income, Medicare or Medicaid insurance, a higher number of chronic medical conditions, and hospital-owned surgery centers were all associated with an increased odds of any revisit. The most important conclusions were that ambulatory stone removal has a low rate of post-operative revisits to either the ED or IP, there is a higher risk of revisit following stone removal as compared to urological procedures that involve only the lower urinary tract, and demographic factors appear to have a moderate influence on the odds of revisit.

Urinary Calculi: A Microbiological and Biochemical Analysis at a Tertiary Care Hospital in Eastern Nepal.

Background The occurrence of urinary tract infection in presence of urolithiasis is frequently noted; however, microbial agents of urolithiasis and their antimicrobial susceptibility patterns remain underinvestigated. This study aimed to identify the microorganisms isolated from urine and stone matrices to determine their antimicrobial susceptibility, to find the association between the pathogens of urine and stone matrices, and to perform the biochemical analysis of stones. Methods A total of 88 cases of urolithiasis admitted for elective stone removal at Department of surgery, B.P. Koirala Institute of Health Sciences (BPKIHS), were enrolled. Preoperative urine culture and postoperative stone culture were performed. Isolation, identification, and AST were done by the standard microbiological technique. Further qualitative biochemical analysis of stones was also attempted. Result Among 88 stone formers recruited, culture of urine, whole stone, and nidus yielded the growth of bacteria 44, 32, and 30, respectively. Bacteria isolated from urine culture correlated with those from stone matrices with a sensitivity of 90%, specificity of 79.69%, PPV of 63.64%, and NPV of 95.45%. Escherichia coli (46.7%) was the most common bacteria followed by Klebsiella pneumoniae (16.7%) and Proteus mirabilis (13.3%) from urine and stone cultures. Almost all the uropathogens isolated were susceptible to commonly used antibiotics. Calcium oxalate (84.1%) was common biochemical constituent found in stone formers followed by calcium oxalate + phosphate (8%). Conclusions The association of microorganism isolated from urine and nidus culture was significant that can predict the source of infective stone; however, in some cases, microorganisms and the antimicrobial susceptibility pattern from urine and nidus were different. This study emphasizes the use of appropriate antimicrobial agents to prevent the regrowth of residual stones and minimize the risk of infectious complications after surgical removal of stones.

A case report on meal time syndrome

&lt;p class="abstract"&gt;Sialolithiasis is the formation of calculi within the parenchyma of salivary gland or its duct. These cases present with pain and swelling of salivary gland. The exact aetiology of salivary stones is not completely understood and various hypotheses have been put forward. They include agglomeration of sialomicroliths, anatomical variations of salivary ducts and altered biochemical composition of saliva. Here we are reporting a case of 45 year old gentleman with a giant sialolithiasis in submandibular region. He came with pain and pus discharge from left side of floor of mouth for one week. On inspection a bludge was seen in left side of floor of mouth. On bimanual palpation, a stony hard mass was felt which was tender and not mobile. Under local anaesthesia surgical removal of stone done. Sialoliths are equally distributed between left and right side of the oral cavity. Mean size of sialolith is reported as six to nine mm and they infrequently measure more than 1.5 cm. The majority of salivary calculi is formed from phosphate and oxalate salts. Sialography allows whole duct system to be visualised, demonstrating calculi of all sizes and also the glandular percentage. Sialodochotomy is a well-reported technique for the intra-oral removal of ductal stones, including giant calculi. Giant sialolith is a rare entity worth reporting. Though conventional methods are still useful for diagnosis and therapy many innovative techniques are evolving around it.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Ultrasonographic prediction of the location of the proximal submandibular stones relative to the lingual nerve for the strategic transoral surgery

Introduction Transoral surgical removal of the proximal submandibular stones has been performed to preserve the gland. Application of ultrasound could extend the indication of transoral surgery to the impalpable proximal stones. However, technical unfamiliarity of ultrasound scanning and anatomical complexity of proximal submandibular area can be hurdles for the general application of ultrasound guided transoral surgery. The objectives of this study were to assess the feasibility of preoperative ultrasonographic determination of the location of stone relative to the lingual nerve (LN) and to find optimal surgical approach for the proximal submandibular stones. Methods We retrospectively reviewed the medical records of 170 patients who were diagnosed as proximal submandibular stones and treated ultrasonography-guided transoral surgery from Mar 2011 to May 2018. Three patients had bilateral stones. The posterior edge of mylohyoid (PM) was used as the preoperative ultrasonographic criterion to classify the proximal submandibular stones into 3 types: stones anterior to PM (type I), stones crossing PM (type II), and stones posterior to PM (type III). The correlation between ultrasonographic and operative findings was investigated. Results Preoperative ultrasonography determined the proximal stones as type I in 40 (23.8%) cases, as type II in 69 (41.1%) cases, and as type III in 59 (35.1%) cases. According to the operative records, the stones were approached medially to the LN in 58 (34.5%) cases and laterally to the LN in 110 (65.5%) cases. In type 1 stones, 90% of stones were approached medially to the LN, while in type 2 and 3 stones, 78.3% and 88.1% of stones were approached laterally to the LN during transoral surgery, respectively. The surgical approaches were significantly different in relation to preoperative ultrasonographic classification of the proximal submandibular stones (P Conclusion Optimal transoral surgical approach relative to the lingual nerve can be selected based upon preoperative ultrasonographic findings of the proximal submandibular stones.

ВОПРОСЫ МЕТАФИЛАКТИКИ НЕФРОЛИТИАЗА У ДЕТЕЙ В ЭНДЕМИЧЕСКОМ ОЧАГЕ

Objective: Improving the diagnosis, treatment and metaphylaxis of nephrolithiasis in children. Methods: Under observation was 201 patients with nephrolithiasis aged from one to 14 years. The following risk factors were identified: urological diseases in the immediate family, which was accompanied by metabolic disorders (68.5%); abnormalities of the urinary tract (37%); the age of mothers over 40 (43.3%); related marriages (16.7%). Results: Conducted conservative treatment was effective only in 14 patients with small kidney stones, in other cases, an open surgical removal of stones: pyelolithotomy (98), sparing nephrolithotomy (68), calicolithotomy (11). Nephroureterectomy with calculous pyonephrosis performed on four patients (1.9%). With obstructive purulent calculous pyelonephritis, a radical technique of primary nephrolithotomy with nephrostomy was used. For the purpose of metaphylaxis, after discharge from the hospital, systematic observations of children conducted in a polyclinic. Conclusion: The main metaphylaxis measures for urolithiasis at the outpatient stage should be aim to the sanation of the urinary tract, normalization of urine pH, correction of metabolic disturbances, and treatment of concomitant somatic diseases. Keywords: Urolithiasis, prophylaxis, operative treatment, metaphylaxis, ambulatory care.

Parathyroid Adenoma: Presented with Generalized Bone Pain and Multiple Pathological Fractures in a 29 Yrs Lady- A Case Report

One of the common reasons of primary hyperparathyroidism is parathyroid adenoma. This can present in different ways- diffuse bone pain, multiple stones in the body warranting repeated surgery, renal failure, abdominal discomfort, depressed mood etc. Here we present a young women presented with surgical removal of gall stone and renal stones, pathological fractures and her generalized bodyache was treated for rheumatological cause for a long time. After surgical removal of adenoma he got back to life within couple of months.J Dhaka Medical College, Vol. 26, No.1, April, 2017, Page 83-85

Application of TXRF and XRPD techniques for analysis of elemental and chemical composition of human kidney stones

Total reflection X‐ray fluorescence analysis and X‐ray powder diffraction were used for elemental and chemical composition analysis of 83 samples of human kidney stones. Samples came from patients after surgical removal of stones. Elements such as P, K, Ca, Fe, Zn, Ni, Br, Sr, and Pb were determined in all samples. Other elements Mg, S, Cl, Ti, V, Cr, Mn, Cu, Se, Rb, I, and Bi were found in some of the analyzed kidney stones (censoring effect). Descriptive statistics were calculated for all elements paying particular attention to the censored elements. From diffraction measurements, the following crystalline substances were determined in the stones: apatite, struvite, uric acid, weddellite, whewellite, magnesium phosphate, and calcium phosphate. Information of chemical composition was applied to classify the analyzed kidney stone into four groups. Statistical analysis of the results included multigroups comparison, testing of element concentration distribution, and elemental correlations in the dependence of kind of kidney stones. The presented studies are part of wider microbiological studies focusing on the correlation between different kinds of bacteria and fungi presented in the samples of kidney stones and their elemental as well as chemical composition. Information on stone composition can be helpful in understanding kidney stone formation and complemented by additional metabolic blood and urine tests. This, in turn, can lead to appropriate medical treatment together with the reduction of the risk as regards forming new stones.

Spontaneous Bilateral Femoral Neck Fracture Rare Presentation of a Metabolic Bone Disease

A 50 year old woman was observed at the emergency department after falling from her own height after sudden failure of the lower limbs, which led to bilateral femoral neck fracture. She has had multiple repeated urinary tract infections, nephrolithiasis with several admissions in urology department and extracorporeal lithotripsy episodes with shock waves. She also had history of surgical removal of kidney stones. The Laboratory tests revealed high calcemia (13.2 mg/dl) and alkaline phosphatase (445); normal phosphate and magnesium, normal Calcitonin; high parathyroid hormone(> 2500 pg / ml). Hyperparathyroidism caused by a parathyroid adenoma was diagnosed after ultrasound, biopsy and scintigraphy were performed. Radiographs revealed classic and severe bone findings in PHPT, features which were common in the past but are thought to be rare at this modern age. Parathyroidectomy was performed at the same time as a bilateral cemented total hip arthroplasty. She developed the hungry-?bone syndrome 5 days postoperatively, which resolved with administration of bisphosphonates, calcium and D vitamin.