Tract Calculi In Patients Research Articles

Efficacy and safety of flexible ureteral lithotripsy for upper urinary tract calculi in patients aged 80 years and older

Objective: To assess the efficacy and safety of flexible ureteral lithotripsy (FURL) for treating upper urinary tract calculi in patients ≥80 years. Methods: This study retrospectively analyzed the clinical data of 297 elderly patients who underwent FURL for unilateral upper urinary tract calculi at Beijing Hospital from January 2019 to September 2023. Patients were divided into elderly group (≥80 years) and low-middle aged group (≥60-<80 years). Propensity score matching (PSM) was used to match preoperative clinical data of patients. After PSM, the basic, perioperative and postoperative data of the two groups were compared. Results: After PSM, 116 patients were enrolled, including 58 patients in each group. The age [M (Q1, Q3)] of elderly group was 83.0 (81.0, 86.0) years, which included 29 males. The age of low-middle aged group was 69.5 (64.8, 74.0) years, which included 33 males. The duration of postoperative hospitalization [M (Q1, Q3)] in elderly group was longer than that in low-middle aged group [2 (1, 3) d vs 1 (1, 2) d, P=0.002]. Serious postoperative complications occurred in 3 cases in the elderly group and 1 case in the low-middle aged group, respectively, without surgical intervention. There was no significant statistical difference in stone-free rate (SFR) [79.3% (46/58) vs 84.5% (49/58)], operation time [M (Q1, Q3), 70.0 (48.3, 100.0) vs 65.0 (46.5, 101.2) min] and postoperative complication rate [25.9% (15/58) vs 22.4% (13/58)] between two groups (all P>0.05). Conclusions: In the treatment of upper urinary tract calculi in patients ≥80 years, the SFR, operation time and postoperative complication rate of FURL are comparable to those in low-middle aged elderly patients. FURL has good safety and effectiveness in the treatment of upper urinary tract calculi in patients ≥80 years.

Ultrasound-guided percutaneous nephrolithotomy for upper urinary tract calculi in patients with spinal deformity: a decade's experience.

To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous nephrolithotomy (PCNL) in managing upper urinary tract calculi in patients with spinal deformity based on our experience over the last decade. A retrospective study was conducted on patients with spinal deformity who were admitted to Beijing Tsinghua Changgung Hospital and collaborative hospitals from August 2004 to August 2017. Patients diagnosed with urolithiasis and who underwent US-guided PCNL, performed by the same surgeon, were included. Patients' data were collected and the following variables were analysed: age; sex; plain abdominal radiograph of the kidneys, ureters and bladder (KUB); computed tomography (CT); stone burden; evaluation of spinal anatomy; respiratory function; operative time; and postoperative findings. The severity of surgical complications was determined according to the modified Clavien classification system (MCCS). A total of 72 patients (41 males and 31 females) were included, with a mean (range) age of 35(21-69)years. The mean (range) stone diameter was 38(19-68)mm. Seven patients had bilateral PCNL, completed in staged surgery with a 1-week interval. Five kidneys received staged PCNL because of either large residual stones or the potential risk of a long operation time. In all, 19 patients underwent the surgery in a prone position, 29 lateral, nine oblique supine, and the other 27 in unconventional positions (lateral prone, lateral supine, and lateral jackknife position). All procedures were successfully completed with no major complications during the operation. The mean (SD) tract building time was 8.5(1.7)min. The mean (SD) stone disintegration time was 39.3(14.6)min. The mean (range) temperature and postoperative haemoglobin (Hb) drop on the first postoperative day were 37.6(36.7-39.2)°C and 1.5(0.2-4.3)g/dL, respectively. Four patients needed blood transfusions and none of the patients had septic shock or severe renal bleeding requiring angiographic renal embolisation or nephrectomy. A stone-free status was achieved in 71 kidneys (89.87%). Eight patients with residual fragments ≥4mm were either observed without treatment during follow-up or re-treated with shockwave lithotripsy (SWL) according to clinical significance. PCNL in patients with spinal deformities is challenging but safe and effective. US-guided puncture and access establishment has its unique advantages when such patients are placed in unconventional positions.

The Application of Suctioning Flexible Ureteroscopy With Intelligent Pressure Control in Treating Upper Urinary Tract Calculi on Patients With a Solitary Kidney

To investigate the usage of intelligently pressure-controlled flexible ureteroscopy (URS) in managing upper urinary tract calculi in patients with a solitary kidney. Forty patients with a solitary kidney and upper urinary tract calculus were included in this study. All the patients underwent suctioning URS with intelligent control of renal pelvic pressure by connecting pressure-measuring suctioning ureteral access sheath to an irrigation and suctioning platform. Treatment outcome and perioperative data were collected. The mean operative time was 25.2 ± 14.5 minutes. The mean hospital stay was 4.7 ± 1.4 days. The stone-free rate at 4 weeks after surgery was 87.5%, and it was 92.5% at 12 weeks after surgery. Two patients (5%) experienced complications of fever postoperatively. There were no complications of elevated serum creatinine, severe bleeding, sepsis, stone street, ureteral mucosa stripping, and ureteral stenosis. It is safe and efficient to use the intelligently pressure-controlled flexible URS in treating upper urinary tract calculi for patients with a solitary kidney with advantages of high lithotripsy efficacy and low complication rate.

Lost and Found Unusual Location of a Urinary Tract Calculus = فقد ثم تم العثور عليه موقع غير عادي لحصوة في المجرى البولي

A 41-year-old male patient presented to the Emergency Department (ED) of Sultan Qaboos University Hospital (SQUH) complaining of left flank pain of one day’s duration which was colicky and increasing in intensity. There was no history of fever, nausea or vomiting or other significant medical history; however, a similar episode had occurred previously. The patient’s vital signs were stable and he was afebrile. Physical examination of the abdomen was non-contributory; routine microscopic urinalysis was normal. In view of the suspicion of left renal colic, he was referred for a non-contrast enhanced computed tomography (NCCT) scan, the gold standard at SQUH to assess urinary tract calculi in patients presenting with renal colic. The scan showed significant left perinephric fat stranding and mild left hydroureteronephrosis and evidence of periureteric fat stranding around the left ureter. No calculi could be identified in the left kidney or the left ureter. There was a direct inguinal hernia on the right side which contained part of the urinary bladder and a small radio-opaque calculus. These findings suggested the recent passage of a left ureteric stone into the bladder and the migration of this stone into the herniated part of the urinary bladder. It is also possible that the patient had passed out the ureteric stone via the urethra, and that the stone in the herniated bladder was an incidental finding. Clinically, the pain decreased over the period of observation in the ED, and the patient was discharged. At Urology Clinic follow-ups, there was no recurrence of pain, and the patient was managed conservatively. Inguinal hernias can be direct or indirect; the Hesselbach triangle is usually the site for direct inguinal hernias. On CT, the direct inguinal hernia lies medial to the inferior epigastric artery.1 A total of 1–3% of all inguinal hernias involve the bladder;2 in obese men aged 50–70 years, the incidence may reach 10%.3 Inguinal hernias generally occur on the right side.2 Urinary bladder hernias are mostly diagnosed incidentally during hernia surgeries,4 or during imaging.2 The herniated parts of the urinary bladder can contain tumors or calculi.2,5 These may migrate from upper tracts or form de novo in the hernia due to stasis. CT is the best modality for the diagnosis and evaluation of inguinoscrotal urinary bladder herniation after injection of intravenous contrast. The post-processing of the CT using 3D reconstructions can demonstrate the contents of the hernia and its relationships.6 Our patient’s calculus, could possibly have passed from the left ureter. However, it is possible that it may instead have travelled to the herniated component of the urinary bladder and been overlooked, especially as the herniated part of the bladder was small and did not significantly distort the urinary bladder in the pelvis. Therefore, we suggest that the protocol for the routine NCCT of the kidney, ureter and bladder for urolithiasis should extend below the pubic symphysis so as not to miss posterior urethral calculi or calculi in unusual areas.

Flexible ureteroscopy and holmium laser lithotripsy for treatment of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease

The objective of the study was to investigate the safety and efficacy of flexible ureteroscopy and holmium laser lithotripsy for the management of patients with autosomal dominant polycystic kidney disease (ADPKD) and associated nephrolithiasis. Between 2005 and 2010, flexible ureteroscopic stone treatment was attempted in 13 patients with ADPKD. Two patients had bilateral renal stones. Most of the stones were located in the renal pelvis and/or calices with a stone size 1.7 cm in the largest diameter. The success rate and morbidity and complications were recorded. A total of 45 intrarenal calculi with a mean stone size of 5.6 mm (range 3-17) were identified. The mean number of stones per patients was 3.2 (range 2-5). The mean number of primary procedures was 1.2 (range 1-2). The overall stone-free rates after one and two procedures were 84.5 and 92.3%, respectively. Complications occurred in three procedures and consisted of low-grade fever in one procedure, flank pain in another procedure and stent pain in another procedure. No patient died. Flexible ureteroscopy with holmium laser lithotripsy is a safe and effective method for the treatment of patients with ADPKD and associated nephrolithiasis.

Percutaneous nephrolithotomy for upper urinary tract calculi in patients with deformity of spine

Objective To evaluate the efficacy and safety of standard percutaneous nephrolithot-omy (PCNL) for patients with deformity of spine. Methods Between Aug 2003 and May 2009, 35 patients of upper urinary tract calculi with scoliosis and kyphosis had undergone PCNL accessed by two steps dilation to 24F tract with ultrasound guidance. Clinical data were analyzed retrospectively. Results The pereutaneous renal access was successfully established in 35 patients under ultrasound guidance and immediate lithotripsy was performed. Prone position 9 units,lateral position 14 units,and other unconventional position 14 units. 34 (91.9 %) units were operated by single access and 3 (8.1%) by double in one session. The mean first accessing time was (8. 5±1.7)min, and stone management time was (39.3±14.6)min. The stone-free rate after the first operation was 86.5%, 2 kidneys ac-cepted another PCNL to remove the residual calculi, and the last stone-free rate was 91.9%. 2 cases needed transfusion. No injury of adjacent organs or urosepsis occurred. No severe complications oc-curred. Conclusions Standard PCNL for calculi in patients with deformity of spine accessed by two steps dilation to 24 F tract with ultrasound-guided puncture could be effective and safe. Special indi-vidual operative position and experienced clinical technique are needed. Key words: Kidney calculi; Endoscopy; Lithotripsy; Deformity of spine

Extracorporeal shock wave lithotripsy of upper urinary tract calculi in patients with cystectomy and urinary diversion

Objectives To present our experience with extracorporeal shock wave lithotripsy (ESWL) in the management of upper urinary tract calculi in patients with urinary diversion. Methods Between March 1989 and June 2004, 27 patients with radical cystectomy and urinary diversion were treated using ESWL for upper urinary tract calculi using the Dornier MFL 5000 lithotripter. The mean length of the stones was 11 ± 3.1 mm and the mean width was 8.8 ± 3.5 mm. The follow-up protocol included plain abdominal x-ray and renal ultrasonography every 2 weeks until complete stone clearance. All follow-up data were collected and analyzed after 3 months. Success was defined as the absence of residual stones or the presence of insignificant gravel less than 4 mm. Results Retreatment was required in 12 patients (44.4%). Failure to disintegrate the stones was recorded in 2 cases (7.4%) and significant residual stones were recorded in 1 (3.7%). Post-ESWL renal obstruction was observed in 2 cases (7.4%). Secondary procedures were needed in 5 cases (18.5%). Two percutaneous nephrolithotomy and one antegrade ureteroscopy were performed for treatment of ESWL failure. One open ureterolithotomy and one antegrade ureteroscopy were performed for treatment of post-ESWL renal obstruction. Thus, the overall success rate of ESWL monotherapy in the treatment of upper urinary tract stones was 81.5% (22 of 27). Conclusions ESWL monotherapy proved to be a valuable option in the treatment of upper tract lithiasis in patients with urinary diversion. However, it may cause renal obstruction, and antegrade endoscopic maneuvers should be available.

Safety and Efficacy of Holmium: Yag Laser Lithotripsy in Patients With Bleeding Diatheses

We assessed the safety and efficacy of ureteroscopy and holmium:YAG laser lithotripsy for treating upper urinary tract calculi in patients with known and uncorrected bleeding diathesis. We retrospectively reviewed the charts at 2 tertiary stone centers to identify patients with known bleeding diathesis who were treated with holmium:YAG laser lithotripsy for upper urinary tract calculi. A total of 25 patients (29 upper urinary tract calculi) underwent ureteroscopic holmium laser lithotripsy. Bleeding diathesis involved warfarin administration for various conditions in 17 patients, liver dysfunction in 3, thrombocytopenia in 4 and von Willebrand's disease in 1. The mean international normalized ratio, platelet count and bleeding time were 2.3, 50 x 109/l. and greater than 16 minutes in patients on warfarin and in those with liver dysfunction, thrombocytopenia and von Willebrand's disease, respectively. Overall the stone-free rate was 96% (27 of 28 cases) and 29 of 30 procedures were completed successfully without significant complication. In a patient treated concomitantly with electrohydraulic lithotripsy significant retroperitoneal hemorrhage required blood transfusion. Upper tract urinary calculi in patients with uncorrected bleeding diathesis can be safely managed by contemporary small caliber ureteroscopes and the holmium laser as the only modality of lithotripsy. Ureteroscopic holmium laser lithotripsy without preoperatively correcting hemostatic parameters limits the risk of thromboembolic complications and costs associated with an extended hospital stay. Avoiding electrohydraulic lithotripsy is crucial for decreasing bleeding complications in this cohort of patients.

Long-Term Incidence and Risks for Recurrent Stones Following Contemporary Management of Upper Tract Calculi in Patients with a Urinary Diversion

Purpose The long-term rate of stone recurrence following contemporary minimally invasive management of calculi was determined in patients with urinary diversion and to identify specific risk factors for these recurrences. Materials and Methods We followed for a minimum of 12 months 25 patients (29 renal units) with upper tract calculi associated with urinary diversion, and treated with extracorporeal shock wave lithotripsy and/or percutaneous nephrostolithotomy. The risk of recurrent stones at 5 years was determined by a Kaplan-Meier estimate, while potential risk factors for recurrence were analyzed using a log-rank comparison. Results Stones recurred in 8 patients (32 percent) 18 to 61 months (mean 27.0) after treatment. The risk of new stone formation after 5 years was estimated to be 63.3 percent and was significantly greater in patients with recurrent bacteriuria after treatment. Neither stone history, type of procedure used, stone composition nor radiographic status of completion of treatment significantly influenced this risk. Conclusions Contemporary management of upper tract calculi in patients with a urinary diversion is associated with a high recurrence rate, especially among those with recurrent bacteriuria, regardless of whether the patient is initially rendered stone-free. Continued close surveillance and antibiotic prophylaxis seem to be essential in this high risk patient population.

Long-Term Incidence and Risks for Recurrent Stones Following Contemporary Management of Upper Tract Calculi in Patients with a Urinary Diversion

Long-Term Incidence and Risks for Recurrent Stones Following Contemporary Management of Upper Tract Calculi in Patients with a Urinary Diversion

Effect of Urinary Intestinal Diversion on Urinary Risk Factors for Urolithiasis

We investigated the effect of urinary intestinal diversion on risk factors for calcium urolithiasis, such as calcium, phosphate, magnesium, uric acid, oxalate and citrate, in 3 groups of patients (Kock pouch, Indiana pouch and ileal conduit). Mean urinary volume was not significantly different among the 3 groups. Mean serum creatinine and 24-hour creatinine clearance in the continent reservoir group were better than in the ileal conduit group. Mean urinary excretion of calcium, phosphate and magnesium was significantly greater in the continent reservoir group than in the ileal conduit group. Although calcium excretion had a positive correlation with 24-hour creatinine clearance, calcium excretion per ml. per minute creatinine clearance still showed a significant difference. Increased calcium excretion is considered to reflect metabolic disturbances resulting from reabsorption of urinary solutes through the intestinal segments. Overall, there was no significant difference in the urinary parameters between the Kock and Indiana pouch groups. While mean urinary oxalate and citrate were within the normal range in all 3 groups, more than a third of the patients in each group were hypocitraturic (less than 100 mg. per day). In none of the 3 groups did the levels of urinary calcium, phosphate and magnesium, as well as other urinary risk parameters show any correlation with the duration of diversion. In summary, our study indicated that the continent urinary reservoir causes a long-term increase in urinary excretion of calcium, phosphate and magnesium. These urinary metabolic alterations might promote the formation of calcium urolithiasis as well as infectious stones. The degree of metabolic alterations may be greater with a continent reservoir than with an ileal conduit.

Management of Upper Tract Calculi in Patients with Tubularized Urinary Diversions

In a retrospective review of patients with urinary diversion who presented to our stone center during a 3.5-year period 9 underwent 20 procedures for suspected stone episodes. Eventual outcome was excellent in all but 1 patient. In particular, all attempts at retrograde trans-stomal manipulation were successful. We present our cases, and note the technical considerations and management principles. Frequently, these patients are best served by a combination of percutaneous antegrade, trans-stomal retrograde and/or extracorporeal shock wave lithotripsy.