Treatment Of Renal Stone Disease Research Articles

Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units

Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. The stone location was the upper pole in 28 (7.6%) patients, the middle pole in 44 (12%), the pelvis in 98 (26.6%), the lower pole in 139 (37.8%), and multiple locations in 59 (16%) patients. A stoneless state was achieved in 277 (75.3%) units, while 91 units (24.7%) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p=0.012) and stone location (OR, 3.142; p=0.018). RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100% success rate reported in various studies. A full stoneless state was achieved in 277 (75.3%) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6%. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

Efficacy of Thoracic Segmental Spinal Anaesthesia in Percutaneous Nephrolithotomy: A Retrospective Observational Study

Introduction: Percutaneous Nephrolithotomy (PCNL) is a minimally invasive procedure for the treatment of renal stone disease, usually performed under General Anaesthesia (GA). Regional anaesthesia, specifically Thoracic Segmental Spinal Anaesthesia (TSSA), offers a suitable alternative to mitigate complications associated with GA. TSSA in PCNL has an advantage over conventional lumbar spinal anaesthesia in terms of better haemodynamic stability, attributed to the lesser amount of local anaesthetic drug required. However, its clinical utility is yet to be fully explored. Aim: To investigate the feasibility and efficacy of TSSA in patients undergoing PCNL by analysing their medical records. Materials and Methods: A retrospective observational study was conducted on 250 patients from January 2022 to July 2023 at GNRC Medical, Guwahati, India. Patients aged 20- 70 years with American Society of Anaesthesiology (ASA) I and II classification, undergoing PCNL with renal stones ≤40 mm, were included. TSSA was administered at the T9-T10 intervertebral space. Intraoperative parameters, degree of motor and sensory block, post-operative analgesia, patient and surgeon satisfaction were recorded. Descriptive statistics of the study were analysed in Microsoft excel and presented as mean with standard deviation or as numbers and percentages. Results: The patients in the study had a mean age of 41.08 years, Body Mass Index (BMI) of 25.52 kg/m2 , stone size of 25.73 mm, and surgical duration of 74.92 minutes. TSSA was associated with minimal intraoperative hypotension (6%) and bradycardia (8.9%), zero incidences of neurological complications, and did not require conversion to GA. Complete stone clearance was achieved in 89.6% of cases. Post-operative analgesia was excellent in 179 (71.6%) patients as they did not require any rescue analgesia within the first 24 hours. Patient and surgeon satisfaction were notably high. Conclusion: TSSA emerges as a safe and efficient alternative to GA in selected cases of PCNL. Patient and surgeon satisfaction, along with minimal post-operative complications, support its consideration and usage. However, the choice of anaesthesia should be individualised based on procedural complexities and patient characteristics.

Evaluation of RNA Based Biomarker Expression in Acute Kidney Injury after ESWL

Background Extracorporeal shock wave lithotripsy (ESWL) was introduced more than three decades as an authentic modern modality for the treatment of urinary stone disease. It is considered first choice of treatment for nearly all kinds of urinary tract calculi. Objective To evaluate the damage effect of ESWL on kidney tissue by measuring non-coding lncRNA profile in serum before and after ESWL session and assess their usefulness as diagnostic biomarkers for AKI and the relationship between the selected RNA based biomarker panel and clinicopathological changes of patients. Patients and Methods It is a prospective randomized control study assessing the damage effect of ESWL on kidney tissue by measuring non-coding lnc-RNA profile in serum before and after ESWL session(s) in 20 patients and compare it to control group of 20 healthy persons with no known urogenital disease and no known history of urologic pathology. Results The results favored outcomes of pre procedure lncRNA showed a statistically significant reduction after 48 hours after the procedure (p = 0.017). In comparison with control group the lncRNA showed a statistically significant difference between patients and controls at 2 hours and 48 hours after the procedure (p = 0.03 and 0.01, respectively). Conclusion Although ESWL is considered a safe and effective procedure in the treatment of renal stone disease yet it may cause acute renal injury. In this study, serum lncRNA rises significantly following acute renal injury caused by ESWL. Hence, serum lncRNA together with other kidney function tests as serum urea, creatinine can be used as acute renal injury markers following ESWL in patients with renal stone disease.

Technical Aspects and Clinical Outcomes of Robotic Ureteroscopy: Is It Ready for Primetime?

Robotic surgery in urology has already been widely employed in robotic-assisted laparoscopic surgery for minimally invasive procedures (MIS). We wanted to analyse rapidly developing robotic ureteroscopy (RoboURS) for the treatment of renal stone disease. A comprehensive literature review was performed for technical aspects and clinical outcomes of RoboURS. RoboURS has made significant breakthroughs with each model proving that this technology improves ergonomics and supports surgeon and instrument longevity while minimising musculoskeletal issues in retrograde intra-renal surgery (RIRS). Further randomised controlled trials are required to compare the efficacy of RoboURS vs manual flexible ureteroscopy (FURS). The cost-effectiveness will also need to be assessed prior to widespread acceptance into urological infrastructure and mainstream practice. RoboURS continues to evolve despite the limitations of infrastructure and cost-effectiveness. It holds the promise of a better future for surgeon longevity, reduced peri-operative morbidity and better workplace environment.

Classical xanthinuria: An uncommon cause of pediatric renal stone disease

Determination of the cause is important to optimize the treatment of renal stone disease. Hypercalciuria, uricosuria, hypocitraturia, and urinary tract infections alone or in combination may account for the etiology of majority of renal stones. Xanthine oxidase (XO) deficiency (classical xanthinuria) is a rare cause of pediatric urolithiasis. XO catalyzes the oxidation of hypoxanthine to xanthine and xanthine to uric acid in the last two steps of the purine degradation process. Very few cases have been reported from India. We describe a child with xanthinuria and recurrent renal stone disease.

The Predictive Factors for Readmission and Rehospitalization After Retrograde Intrarenal Surgery: The Results of RIRSearch Study Group.

Purpose: Retrograde intrarenal surgery (RIRS) is a safe and effective treatment option for upper urinary tract stones smaller than 2 cm. Although several studies have documented perioperative and postoperative complications related to RIRS, there exists limited data regarding the readmission and rehospitalization of patients after RIRS. The aims of the study were to document the rates of readmission and rehospitalization after RIRS and to determine the predictive factors for readmission and rehospitalization. Materials and Methods: In this study, we retrospectively analyzed patients who underwent RIRS for the treatment of renal stone disease and were unexpectedly readmitted to the hospital within 30 days after discharge. The hospital admission systems were used to determine readmissions and rehospitalizations. Readmission and rehospitalization rates, causes, and treatment procedures were evaluated. Univariate and multivariate analyses of clinicodemographic properties were performed to evaluate possible predictive factors for readmission and rehospitalization after RIRS. Results: A total of 1036 patients were included in the study. Of these patients, 103 (9.9%) were readmitted to the hospital. Among these readmissions, 35 patients (33.9%) were rehospitalized and 14 (13.6%) underwent surgical intervention. The most common reasons for readmission were renal colic and fever. The presence of preoperative pyuria (odds ratio [OR] 1.86), stone volume (OR 1.54), postoperative complications (OR 3.66), and stone-free status (OR 0.46) were predictive factors for readmission, whereas hospitalization time (OR 1.32), postoperative complications (OR 9.70), and stone-free status (OR 0.06) were predictive factors for rehospitalization after RIRS. Conclusion: Nearly 10% of patients who underwent RIRS were readmitted to the hospital within the first month after discharge, and some were rehospitalized. Preoperative pyuria, high stone volume, presence of postoperative complications, and low stone-free status predicted this readmission and rehospitalization. Clinicians must recognize these predictive factors and inform their patients about this possibility.

BIOCHEMICAL ANALYSIS OF STONES IN CASES OF URINARY TRACT CALCULUS

Background & Method: The present study was conducted at Department of General Surgery, Index Medical College, Hospital & Research Center, Indore (M.P.). A total of 30 study subjects (post operated cases of urolithiasis) were selected from the surgical ward in Index Hospital from period of 12 months with an aim to Biochemical Analysis of Stones in cases of Urinary Tract Calculus.
 Result: A total of 46 renal stones were analyzed, from 30 patients. In 30 patients, 18 were Males and 12 Females. The Bio-chemical analysis of renal stones revealed the presence of mixed stones with highest present of Calcium Oxalate stones, followed by uric acid stones.
 Conclusion: This study demonstrated that in Index Medical College and Hospital a significant proportion of renal stones were containing calcium oxalate as constituent and were non phosphate in composition. The study concluded that the biochemical composition of renal calculi is important during the treatment of renal stone disease and reducing the recurrence by avoiding promoters of stone formation.
 Keywords: Biochemical, Stones, Urinary Tract & Calculus.

Introducing 3D printed models of the upper urinary tract for high-fidelity simulation of retrograde intrarenal surgery

PurposeTraining in retrograde intrarenal surgery for the treatment of renal stone disease is a challenging task due to the unique complexity of the procedure. This study introduces a series of 3D printed models of upper urinary tract and stones designed to improve the training process.MethodsSix different models of upper urinary tract were algorithmically isolated, digitally optimized and 3D printed from real-life cases. Soft and hard stones in different sizes were produced from 3D printed moulds. The models were fitted onto a commercially available part-task trainer and tested for retrograde intrarenal surgery.ResultsEach step of the procedure was simulated with extraordinary resemblance to real-life cases. The unique anatomical intricacy of each model and type of stones allowed us to reproduce surgeries of increasing difficulty. As the case-load required to achieve proficiency in retrograde intrarenal surgery is high, benchtop simulation could be integrated in training programs to reach good outcomes and low complication rates faster. Our models match incredible anatomical resemblance with low production cost and high reusability. Validation studies and objective skills assessment during simulations would allow comparison with other available benchtop trainers and the design of stepwise training programs.Conclusions3D printing is gaining a significant importance in surgical training. Our 3D printed models of the upper urinary tract might represent a risk-free training option to hasten the achievement of proficiency in endourology.

English

The present study was designed to evaluate the antiurolithiatic activity of selected plants extracts (Achyranthes aspera, Lawsonia inermis, Ficus benghalensis, Raphnus sativus and Macrotyloma uniflorum). The methanol extract of selected plants was analysed for in-vitro antiurolithiatic activity using nucleation, aggregation and growth assay of calcium oxalate (CaOX) monohydrate crystals. The nucleation, aggregation and growth of CaOx crystals were significantly inhibited by all selected plant extracts. The highest inhibition of CaOX nucleation was shown by R. sativus (55.21±1.9%) followed by M. uniflorum (53.91±1.1%) and the least by F. benghalensis (43.63±0.8%) at 1.0 mg/mL. The highest inhibition of calcium CaOX aggregation was shown by R. sativus (61.6±1.6%) which was very close to Cystone (63.28±2.5%). The growth of CaOX was highly inhibited by A. aspera (42.17±1.0%) followed by M. uniflorum (40.27±1.4%) with lowest inhibition by F. benghalensis (31.44±1.4%) as compared to Cystone (43.35 ±0.9%). The study showed that the selected plants showed the significant antiurolithiatic activity against CaOX crystals, which could be a potential source for the treatment of renal stone disease. Key words: Antiurolithiatic, calcium oxalate, nucleation, aggregation, methanol extracts.

Different approaches among physicians to treat pediatric stone disease: a survey-based study.

Pediatricians, surgeons and subspecialties as pediatric urology and nephrology are involved in the diagnosis and treatment of pediatric renal stone disease (RSD). The aim of this study was to determine diagnostic and treatment approaches, of different disciplines, and to assess differences in their routine diagnostic and treatment protocols. A questionnaire was designed and administered to the participants of the RSD sessions in national congresses of all disciplines in 2017 to evaluate the diagnostic and treatment routines of specialties (surgeons and pediatricians) and subspecialties (pediatric nephrologists and pediatric urologists) for RSD. A total, of 324 questionnaires were analyzed, from 88 pediatricians (27 %), 121 urologists (37 %), 23 pediatric surgeons (7 %), 54 pediatric nephrologists (17 %), and 38 pediatric urologists (12 %). Both groups agreed on the necessity of metabolic evaluation. For distal ureter stones that were ≥ 6 mm; surgeons preferred ureteroscopy (URS), pediatricians preferred shock wave lithotripsy (SWL) (p < 0.001) and subspecialties preferred URS for the treatment (p = 0.636). For lower calix stones less than 1 cm surgeons and subspecialists preferred SWL, while pediatricians preferred hydration (p < 0.001, p = 0.371). For the stone between 1.1 and 2 cm, surgeons preferred intrarenal surgery (RIRS) and SWL, pediatricians preferred SWL (p = 0.001). For larger stones, surgeons and subspecialists preferred percutaneous nephrolithotomy (PCNL), and pediatricians preferred SWL (p = 0.458 p = 0.001). Pediatric urologist chose low-dose computerized tomography as a diagnostic radiologic evaluation (p = 0.029). There are differences between the disciplines who take an active role in diagnosis and treatment of RSD.

Shear Wave Elastographic Alterations in the Kidney After Extracorporeal Shock Wave Lithotripsy.

Extracorporeal shock wave lithotripsy (ESWL) is a method used frequently for the treatment of renal stone disease. Although its safety is proven, there are still concerns about its unwanted effects on kidneys. In this prospective study, we aimed to evaluate renal tissue alterations with shear wave elastography (SWE) after ESWL. We also studied the correlation between SWE and resistive index (RI) changes. The study included 59 patients who underwent ESWL treatment for renal stone disease. We performed SWE and color Doppler ultrasonography to calculate SWE and RI values before, 1 hour after, and 1 week after lithotripsy treatment. A binary comparison was performed by the Bonferroni test. The correlation between SWE and RI values was evaluated by a Pearson correlation analysis. The patients included 26 women (44.1%) and 33 men (55.9%). Their ages ranged from 20 to 65 years (mean ± SD, 45.0 ± 1.1 years). Stone diameters ranged from 7 to 19 mm (mean, 13.0 ± 0.5 mm). There was a significant difference in SWE values before and 1 hour after lithotripsy treatment (P = .001; P < .01). In the follow-up measurement 1 week after treatment, this difference disappeared (P > .99; P > .05). Resistive index values increased significantly 1 hour after lithotripsy treatment and returned to prelithotripsy values 1 week after treatment. In the correlation analysis, SWE and RI values were not correlated. Measurements of alterations in SWE values after ESWL can provide useful information about renal tissue injury.

Development and internal validation of a nomogram for predicting stone-free status after flexible ureteroscopy for renal stones.

To develop and internally validate a preoperative nomogram for predicting stone-free status (SF) after flexible ureteroscopy (fURS) for renal stones, as there is a need to predict the outcome of fURS for the treatment of renal stone disease. We retrospectively analysed 310 fURS procedures for renal stone removal performed between December 2009 and April 2013. Final outcome of fURS was determined by computed tomography 3 months after the last fURS session. Assessed preoperative factors included stone volume and number, age, sex, presence of hydronephrosis and lower pole calculi, and ureteric stent placement. Multivariate logistic regression analysis with backward selection was used to model the relationship between preoperative factors and SF after fURS. Bootstrapping was used to internally validate the nomogram. Five independent predictors of SF after fURS were identified: stone volume (P < 0.001), presence of lower pole calculi (P = 0.001), operator with experience of >50 fURS (P = 0.026), stone number (P = 0.075), and presence of hydronephrosis (P = 0.047). We developed a nomogram to predict SF after fURS using these five preoperative characteristics. Total nomogram score (maximum 25) was derived from summing individual scores of each predictive variable; a high total score was predictive of successful fURS outcome, whereas a low total score was predictive of unsuccessful outcome. The area under the receiver operating characteristics for nomogram predictions was 0.87. The nomogram can be used to reliably predict SF based on patient characteristics after fURS treatment of renal stone disease.

ShRNA Constructs Targeting IGFBP-3 Alleviate Age Related Erectile Dysfunction in the Rat

We investigated whether injecting shRNA constructs targeting IGFBP-3 in the penis of old rats would improve erectile function. The most validated IGFBP-3 shRNA plasmid vector (pGPU6/GFP/Neo-shIGFBP-3) was prepared and injected in penile corpus cavernosum tissue. A total of 30 old (age 24 months) male Sprague Dawley® rats were randomly divided into 3 groups, including 10 each that received phosphate buffered saline only (100 μl), pGPU6/GFP/Neo-shNC (100 μg) and the most validated plasmid constructs pGPU6/GFP/Neo-shIGFBP-3 (100 μg). At 4 weeks the erectile response was measured as intracavernous pressure. The percent ofsmooth muscle in corpus cavernosum tissue was evaluated. Nitric oxide synthase activity and the cGMP concentration in penile tissue were also analyzed. IGFBP-3 was estimated in penile tissue by Western blot, real-time reverse transcriptase-polymerase chain reaction and immunohistochemistry. pGPU6/GFP/Neo-shIGFBP-3 corrected the impaired erectile response in aged rats compared with the response in those injected with phosphate buffered saline and pGPU6/GFP/Neo-shNC (each p <0.01). The percent of cavernous smooth muscle was increased in the pGPU6/GFP/Neo-shIGFBP-3 group. Nitric oxide synthase activity and the cGMP concentration were also significantly increased in rats treated with pGPU6/GFP/Neo-shIGFBP-3. IGFBP-3 shRNA effectively reduced IGFBP-3 mRNA and protein expression in penile corpus cavernosum tissue. Decreasing IGFBP-3 expression by plasmid expressed shRNA improved erectile function in aged rats. The therapy may modulate smooth muscle integrity and increase the cGMP concentration. This may be a new direction for treating erectile dysfunction in clinical practice.

Efficacy and safety of the phytotherapeutic drug Canephron&amp;reg; N in prevention and treatment of urogenital and gestational disease: review of clinical experience in Eastern Europe and Central Asia

Efficacy and safety of the phytotherapeutic drug Canephron® N in prevention and treatment of urogenital and gestational disease: review of clinical experience in Eastern Europe and Central Asia Corrigendum Naber KG. Research and Reports in Urology. 2013;5:39–46. Page 42, a new first sentence should be added to the Conclusion section as follows:"The three months administration of the herbal remedy for prevention of acute pyelonephritis in children was as effective as the prophylaxis using nitrofurantoin." On page 42, left column, in the Prevention and treatment of renal stone disease in adults section, the number of patients should be amended as follows:"In the two publications by Chernenko et al, a total of 110 patients with urolithiasis were treated for 8 weeks, and 25 patients served as control." Also on page 42, right column, upper paragraph, instead of "One month after cessation of treatment…", this should say "After one month of treatment…".Read the original article

Management of 1-2 cm renal stones.

Introduction:The preferred treatment of >1cm stone is shockwave lithotripsy (SWL), while that of stone <2 cm is percutaneous nephrolithotomy (PCNL), but treatment of 1-2 cm renal stones is a controversial issue. We searched the literature to present a comprehensive review on this group.Material and Methods:Pubmed search of literature was done using the appropriate key words. We separately discussed the literature in lower polar and non lower polar stone groups.Results:For non lower polar renal stones of 1-2 cm, SWL is preferred approach, while for the lower polar stones; literature favors the use of PCNL. Retrograde intrarenal surgery (RIRS) is emerging as a promising technique for these calculi.Conclusions:Treatment of renal stone disease depends on stone and patient related, as well as on renal anatomical factors. Treatment should be individualized according to site of stone and available expertise.

Renal Stone Disease

1. Charles P. McKay, MD* 1. *Associate Pediatric Program Director, Department of Pediatrics, Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC. After completing this article, readers should be able to: 1. Discuss the major risk factors for renal stone disease in children. 2. Perform and interpret the evaluation of a child who has suspected or proven renal stone disease. 3. Provide dietary advice for the child who has renal stone disease, including fluid intake goals. 4. Prescribe potassium citrate or thiazide diuretics appropriately in the treatment of renal stone disease. 5. Recognize the conditions of cystinuria, primary hyperoxaluria, and struvite stones. A 9-year-old boy is referred by his primary care physician for evaluation of abdominal pain and blood in the urine after playing on a trampoline. His past medical history is negative for renal disease, and he takes no medications. A complete dietary history reveals that he eats a lot of fast food and drinks about 1 glass of milk daily. His father and grandfather have a history of renal stones. Findings on his physical examination are unremarkable. A serum chemistry profile yields normal results, and the urinalysis shows a specific gravity of 1.030, pH of 6.5, and the presence of a large amount of blood but no protein. Microscopic examination shows numerous eumorphic red blood cells and calcium oxalate crystals. Spiral computed tomography (CT) scan without contrast shows two very dense stones in the pelvis of the right kidney and one stone in the left kidney. There is moderate hydronephrosis on the left, and a 3-mm stone seen in the left ureter is recovered 24 hours later by straining the urine. Stone analysis shows elements of calcium oxalate, calcium phosphate, and uric acid. Three weeks later, a 24-hour urine collection demonstrates elevated supersaturation for calcium oxalate, low …

1813 EVALUATION OF RISK FACTORS FOR PROGNOSIS OF TEMPORARY RENAL IMPAIRMENT AFTER SECONDARY EXTRACORPORAL SHOCK WAVE LITHOTRIPSY (ESWL) IN RENAL STONE TREATMENT

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal III1 Apr 20101813 EVALUATION OF RISK FACTORS FOR PROGNOSIS OF TEMPORARY RENAL IMPAIRMENT AFTER SECONDARY EXTRACORPORAL SHOCK WAVE LITHOTRIPSY (ESWL) IN RENAL STONE TREATMENT Christian Weißflog, Sven Oehlschläger, and Manfred Wirth Christian WeißflogChristian Weißflog More articles by this author , Sven OehlschlägerSven Oehlschläger More articles by this author , and Manfred WirthManfred Wirth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1738AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES ESWL as primary treatment of renal stone disease leads traceable (animal experiment, change of tubulary enzymes of human kidneys) to temporary renal impairment. The correlation between age, comorbidic factors (hypertension, diabetes, chronic ischaemic heart disease) and elevated levels of retention parameters is well known. With respect to different treatment opportunities (ureterorenoscopic stone extraction, ureterolithotomy) a predictable model to calculate renal impairment prior to ESWL would be of pathbreaking interest. This might lead to an alternative therapy without or with less renal impairment. METHODS 111 patients were examined with primary ESWL. 63 underwent immediate secondary ESWL. We analysed for age, sex, body mass index, body surface, stone location (side; upper, medium and lower calyx, ureteral stones excluded), creatinine and GFR prior (0) and after first (1) and second ESWL (2), prior stone treatment, hypertension, diabetes, chronic ischaemic heart disease, flouroscopy time for stone localisation, amount and intensity of shock waves, stone size, sonografic skin-stone-distance, renal stasis and in situ DJ-uretercatheter. RESULTS There was a non-significant decrease between GFR 0 vs. GFR 1. The significant decrease of GFR 0 vs. GFR 2 (p<0.01, table 1) was correlated with sex, age and arterial hypertension. Patients with decrease > 6 points in GFR after secondary ESWL, can be predicted with the logit sum model. The probability of decreased GFR has been calculated by summing up the regression-coefficients (table 2) and including it into the following formula of the logit transformation: p = exp(logit sum)/(1+exp(logit sum)), result in percent. table 1 - GFR mean ± SD (ml/min/1,73m2) prior to ESWL (0) 98,7±22,5 after 1. ESWL (1) 97,5±20,6(p<0,08) after 2. ESWL (2) 93,4±21,1(p<0,01) table 2 - variable regression-coefficient p Intercept -4.5125 creatinine prior to ESWL 0.0317 0.0309 GFR prior to ESWL 0.0446 0.0023 BMI -0.1538 0.0472 hypertension 1.2910 0.0076 CONCLUSIONS The study showed a significant decrease of GFR after secondary ESWL. Patients at risk can be predicted by using our evaluated statistic model. Those patients might profit of a conditioning of renal function or an optimized treatment of hypertension prior to ESWL. Dresden, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e703-e704 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Weißflog More articles by this author Sven Oehlschläger More articles by this author Manfred Wirth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

IMPROVING ERECTILE FUNCTION BY SILENCING PHOSPHODIESTERASE-5

We investigated whether phosphodiesterase-5 (PDE5) can be down-regulated by a specific small interfering RNA (siRNA) and whether this would improve erectile function. A PDE5 siRNA encoding oligonucleotide was inserted into pSUPER-retro vector, resulting in the siRNA expressing construct, pPDE5-silencer. The construct was packaged into oncoretroviral particles and then transduced into rat cavernous smooth muscle cells (CSMCs). Cells were examined for PDE5 expression by reverse transcriptase-polymerase chain reaction, Western blotting and immunofluorescence microscopy. Cells were then treated with 10 microM sodium nitroprusside (SNP) and examined for cyclic guanosine monophosphate (cGMP) at 0, 10, 30, 60 and 240 minutes. The siRNA expressing cassette was transferred from the oncoretrovirus to lentivirus, which was then injected into rat penises. Three months later erectile function was examined by electrostimulation and PDE5 expression in cavernous smooth muscle was determined by immunohistochemistry. CSMCs transfected with pPDE5-silencer (CSMC plus siRNA) showed an 88.2% decrease in PDE5 compared with CSMCs transfected with control vector (CSMCs plus vector). Within 10 minutes of SNP treatment cells (CSMCs, CSMCs plus vector and CSMCs plus siRNA) showed similar sharp increases in cGMP. However, while cGMP levels in CSMCs and CSMCs plus vector returned to almost baseline in 1 hour, the cGMP level in CSMCs plus siRNA remained high even 4 hours after SNP treatment. Rats injected with the siRNA expressing lentivirus showed increased electrostimulated erectile function, as measured by peak intracorporeal pressure and the intracorporeal pressure increase, compared with rats injected with control lentivirus. PDE5 expression was decreased in the siRNA treated cavernous smooth muscle. PDE5 expression could be decreased by siRNA, resulting in prolonged cGMP accumulation and improved erection.

体外衝撃波結石破砕術 (ESWL) 単独療法後の腎瘢痕形成に関与する臨床的因子の検討

ESWL is now widely used for the treatment of renal stone disease. Although ESWL has many advantages for patients' quality of life, few reports have demonstrated the long-term outcomes of the alterations of renal morphology after ESWL. We reported renal scarring after ESWL monotherapy in patients with renal calyceal stones. In this study, we evaluated a large series of patients' cohort treated at our institution, and assessed the causal effect of ESWL on the late occurrence of renal scar formation. ESWL was performed with EDAP (LT-01,02) that generates shock wave energy by piezoelectric discharge. We analyzed the records of 285 kidneys treated between Dec. 1986 and Nov. 1998. Renal scarring was noted in 44 kidneys and not in 241 kidneys with periodical ultrasonography. We compared the backgrounds of the two groups using chi-square or non-parametric analysis. The Kaplan-Meier method and Cox regression model determined the analysis of renal scar formation. Univariate and multiple regression analysis revealed that the total amount of ESWL emission and hyperuricemia independently affected the probability of renal scar formation. Over-emission of ESWL (over 10,000 shots) must be care for the prevention of renal scarring in patients with renal calyceal calculi, especially when associated with hyperuricemia. After ESWL, periodical checkups with ultrasonography will provide useful information for the clinical diagnosis of renal scarring.

Comparative costs of the various strategies of urinary stone disease management

New technology is a major determinant of total healthcare costs. The assessment of alternative technologies from a cost-effectiveness perspective is important, although other considerations may finally determine which technology is used. The alternatives of extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrostolithotomy (PCNL) for the treatment of renal stone disease were compared by studying 1000 cases of ESWL and 133 cases of PCNL using a noncontemporaneous cohort study with PCNL representing the earlier cohort. The effectiveness, defined by success and stone-free rates, was higher with PCNL than with ESWL (96% success vs. 70%); PCNL was also accompanied by a lower burden of additional therapy, whereas ESWL had a higher retreatment rate. From the perspective of a third-party payer, total costs per case of ESWL ($2,746) were lower than those of PCNL ($4,087), but the figure varies with the annual volume. These represent the costs for complete treatment of a patient, including the costs of alternative technology such as PCNL or ureteroscopy that may ultimately be necessary in a patient initially managed by ESWL. The cost for a single ESWL treatment was $2,226 (at a volume of 1000 cases per year), but this increased to $2,746 when costs of retreatment and alternative treatment were prorated to each patient treated. The relative contribution of capital costs to the total cost of ESWL was always less than total professional fees and was only 12% at a volume of 2000 cases/year. Therefore ESWL is less expensive but it is also less effective in rendering patients stone-free.