Treatment Of Urinary Calculi Research Articles

Identity parameters on traditionally used Antiurolithiatic Herb - Scoparia Dulcis Linn.

Introduction: Scoparia dulcis Linn. locally known as Manithumbe Gida belongs to Scophularaceae family and used in medicine by the traditional practitioners for the treatment of urinary calculi. Materials and Methods: Matured plants are collected from Udupi district and authenticated. Macro-microscopic features, physico-chemical standards, HPTLC and secondary metabolites were recorded as per standard guidelines. Result: TS of leaf has shown the presence of mesophyll and bi-collateral vascular bundles. Outer cork tissue, a layer of cortex and conjoint collateral closed vascular bundles and central pith are inclusions of stem TS. Pitted and reticulate vessels are characteristic features of plant powder. Physico-chemical standards and presence of alkaloids, carbohydrates, tannin and coumarins were indicative of its chemical nature. HPTLC fingerprints are a record of its different chemical constituents. Thus the quality monograph prepared on this drug beneficial in future research.

Role of CT scan in the diagnosis and treatment of urinary calculus

Urinary calculus is a common disease of urinary system. With the improvement of people′s living standard, the incidence rate of urinary calculus increased year by year. Compared with other methods, spiral CT has a great advantage in the diagnosis of urinary calculus. The current commonly used examinations including spiral CT plain scan, low dose spiral CT scan, CT urography, and dual source dual energy CT imaging. The advantages and characteristics of different types of CT are analyzed and compared, which is helpful for clinicians to choose the most proper examination, to make the most of the advantages of various checks, so as to improve the accuracy of diagnosis and effectiveness of treatment. Key words: Urologic diseases; Calculi; Tomography, spiral computed; Diagnosis; Treatment outcome

Ethno-botanical medicines used for urinary stones in the Urmia, Northwest Iran

IntroductionEthnomedicinal studies are one of the important routes to find potential medicinal plants for drug discovery purposes. In this study, we aimed to consider ethnopharmacological remedies used for urinary stones in Urmia, northwest Iran. MethodsThis work was based on interviews and questionnaires with traditional healers. All the mentioned medicinal herbs were collected and identified with the help of traditional healers in the city and suburb. ResultsThere were 47 traditional healers working in the spice shops (Attari) in Urmia and 35 of them agreed to cooperate with us. 16 medicinal herbs from 13 families were mentioned by traditional healers. Brassicaceae, Fabaceae and Rosaceae were the predominant families with 2 plants most commonly reported. The most commonly used part was the aerial parts (41.1%). Also, the main method of preparation was decoction (72.7%). Five plants were mentioned by more than 70% of traditional healers as treatment for urinary calculi. Alhagi camelorum Fisch had the highest Frequency of Citation (FC) percentage 88% while the least FC percentage was exhibited by Alyssum desertorum Stapf. and Ruta graveolens L. which was 20%. ConclusionPharmacological activities of reported plants in this study were searched in published works all around the globe. Findings show that most of examined in-vitro, in-vivo or human to prevent or treat urinary calculi. Also, for some plants, although no direct evidence exists for urinary calculi, it is likely that they may have an effect on urinary stones because of their active ingredients.

Diuretic effects of Mitragyna parvifolia Korth. root extract and its therapeutic efficacy against experimental urolithiasis in rats

Aim: To evaluate the diuretic efficacy of alcohol extract of Mitragyna parvifolia root (a substitute of Kadamba) and determine its anti-urolithiatic activity in Wistar rats. Methods: Alcohol extract of M. parvifolia root was evaluated for diuretic activity at doses 200 and 400 mg/kg. Parameters such as volume, pH, sodium, potassium, chloride and creatinine content of urine were measured. Urolithiasis was induced in rats by administering 1% v/v ethylene glycol in drinking water for 28 d with ammonium chloride 1% w/v for the first 3 d. The alcohol extract at doses 200 and 400 mg/kg were administered from the 15th day onwards as curative regimen. Parameters evaluated were pH and content of oxalate, calcium, magnesium, phosphate and uric acid in urine. Serum parameters blood urea nitrogen, calcium and creatinine were also measured. GSH, MDA, SOD and catalase were estimated in kidney homogenates. Histopathological examination of the kidneys was also performed. Results: The alcohol extract of M. parvifolia root failed to show significant diuretic activity. However the extract significantly (P < 0.001) normalized the elevated levels of urine and serum parameters in lithiatic rats. There was a significant improvement in antioxidant status of the kidney as well. Conclusion: Results of this study indicate that M. parvifolia root is useful for the treatment of urinary calculi.

Nephroscopic surgery versus ureteroscopic surgery in minimally invasive percutaneous nephrolithotomy for urinary calculus in 138 patients

Objective To explore the efficacy and safety of nephroscopie surgery and ureteroscopic surgery in minimally invasive percutaneous nephrolithotomy for urinary calculus in 138 patients.Methods The clinical data on 138patients with urinary calculus who had undergone minimally invasive percutaneous nephrolithotomy from January 2008 to January 2011 were retrospectively analyzed.68 patients received nephroscopic surgery( NS )and 70 received ureteroseopic surgery ( US ).The average diameter of the stones was 3.6 cm in NS group and 3.4 cm in US group.In NS group,30patients had staghorn calcuti,24 had multiple calyceal stones,and 19 had pelvic stones and upper ureteral stones while in US group 28 patients had staghorn calcuti,21 had multiple calyceal stones,and 22 had upper ureteral stones.Surgical duration,blood loss,rate of stone removal,proceudre-related complications,postoperative use of analgesics,rate of fever,and length of hospital stay were compared between the two gor ups.Results Both procedures were successful in all the patients and no severe complications occurred.NS group was superior to US group in Surgical duration,blood loss,rate of stone removal,postoperative use of analgesics,rate of fever,and length of hospital stay ( P＜ 0.05 ).Conclusions Minimally invasive nephroscopic surgery is a noval,safe,effective technique in the treatment of urinary calculus and is worth popularizing. Key words: Urinary Calculus; Invasive percutaneous nephrolithotripsy; Nephroscopy; Ureteroscopy

Role of Paneeya Kshara of Certain Indigenous Formulation (Anandayoga) in the Management of Mootrashmari

Ashmari (Urinary calculus) is the disease of Mutravaha Srotas (Urinary system) as described in Sushruta Samhita; which is included in the Mahagada (Incurable disorder). In modern urology practice the different methods for treatment of urinary calculus were developed due to its high recurrence. So the main aim of study was to treat as well as to avoid the recurrence in the Mootrashmari. In the study kshara was selected due to its multiple properties Chedana (Excision), Bhedana (Incision), Lekhana (Scraping), Shodhana (Cleaning), Ropana (Healing) etc. This Ananadyoga [paneeya Kshara (oral alkali preparation)] contains extract of 5 ingredients, which were Sesamum indicum, Achyranthus aspera, Butea frondosa, Musa sapientum and Emblica officinale. Total 20 patients were treated with Ananadyoga in extract form of 250mg capsule twice daily for 60 days. After completion of the treatment it was found that all patients were free from abdominal pain, dysurea was relieved in 14 patients. Out of 24 stones, 16 stones had reduced in their size considerably and 8 stones remained unchanged in their size. Lastly it has been concluded that kshara of five ingredients (Anandyoga) showed good result in the treatment of Mootrashmari without untoward effect.

Extracorporeal Shock Wave Lithotripsy (Eswl) in Infant Urolithiasis Management

Purpose We evaluated the efficiency of ESWL in the treatment of urinary calculi in children under 2 years old. Material and Methods Forty five renal units of forty patients (29 boys, 11 girls, median age: 10 months range: 10 days- 24 months), were treated with ESWL for urolithiasis (median age: 13 months range: 3-24 months) under sedation. Stones were in lower calyx in 14, mid calyx in 15, upper calyx in 6, the renal pelvis,in 21, the proximal ureter in one patient. The mean stone burden was 76,8±55 mm 2 (16 - 247 mm 2 ).Efficiency of treatment is calculated with Efficiency quotient (EQ: stone-free% X 100/ (100% + %re-treatment rate+% auxiliary procedures) formula. Results 59 ESWL sessions (mean:1,33±0,67,range1-4) were performed. Stone free (SF) rate was 82,2% (37/45), clinical insignificant residual fragment (CIRF) rate was 17,7% and ESWL failure was not observed in any patients. Mean EQ was 0,64. There was no significant statistical association between the locations, size and the number of successfully treated calculi (table). SF CIRF Total Renal Units (n) 37 8 45 Median Age (months) 11 9 10 Mean Calculus Size (mm2) 77,76 72,62 76,8 Mean SWL Session 1.29 1.37 1.33 Mean Shock Number 1400 1375 1382 Mean Maximum Energy 1.59 1.4 1.53 Mean Average Energy 1 0,97 0,99 Calculus Localization (%) EQ Pelvis 85,7% 14,28% 0.69 21 Upper pole 83,3% 16,7% 0.63 6 Middle pole 80% 20% 0,50 15 Lower pole 78,6% 21,4% 0,58 14 Proximal ureter 100% 1 1 Conclusions ESWL is a safe and a very efficient treatment method in infant age group.All of the patients presented with a complete or partial response. Complete stone clearance was possible 82,2%. There was no marked difference in different locations in this age group.

Percutaneous Nephrolithotomy (Pcnl) in Paediatric Stones: A Single Centre Experience

Purpose In Pakistan there is a high prevalence of Urolithiasis both in adults as well as in children. Minimally invasive techniques for the treatment of urinary calculi in children are recommended due to an increased probability of stone recurrence. Percutaneous nephrolithotomy (PCNL) is an established technique used in children with renal calculi. We report our experience with PCNL for treating nephrolithiasis in children. Material and Methods Clinical records of children who underwent PCNL procedures for renal calculi from June 2004 to June 2009 were reviewed. A total of 500 children with renal calculi were treated with PCNL. Patients had pre-operative blood and urine analysis, ultrasonography of kidneys, ureter, bladder and X-ray IVU or CT KUB. Tract was made in prone position using fluoroscopy and ultrasound. 22 to 26 Fr sheaths with 18.0, 20.5 and 24 Fr nephroscope were used accordingly. Ultrasound and pneumatic lithoclast alone or in combination were used for stone fragmentation.variabe assesed included patient's age, sex and stone burden. PCNL route, calyceal access and number of tracts also recorded.we reviewed operative time, Hb drop, stone clearance and complications. Results 500 PCNL procedures were performed. Patient's age at operation ranged from 8 months to 15 years with 35% children of pre school age group (≤ 5 years of age). M: F ratio of 2.3: 1. Stone burden ranged from 3.1 ± 3.7 cm2 with stone clearance rates of 89% with monotherapy. During the procedure mean Hb drop was 1.36 ± 0.8 gm% while 14.6% patients required blood transfusion. Intra and post operative complications included conversion to open surgery in 2.6% (due to failed tract or excessive bleeding), extravasation of fluid in 3.6% and uro sepsis in 1.6%. Conclusions Percutaneous nephrolithotomy is a suitable and safe procedure in children including pre-school age group for both simple and complex stones.

Laser-induced lithotripsy and photodynamic therapy in urology – A short introduction to current laser applications

Abstract Laser-induced lithotripsy and photodynamic therapy (PDT) are among the most important laser applications in urology. Laser lithotripsy has revolutionized urinary calculi treatment. Today, Ho:YAG laser lithotripsy using a small-caliber ureteroscope can be considered to be the first choice for treatment of ureteral calculi. In contrast to laser-induced lithotripsy, PDT is not yet firmly established in urological clinical routine. However, preclinical and clinical trials with PDT in urology are showing promise in the treatment of malignancies at multiple sites. The present article gives a review of the literature from both fields and discusses the current status of laser lithotripsy and PDT in urology.

Clinical Observation on Treatment of 32 Cases of Urinary Calculi with Lithagogue Decoction Combined with Western Medicine

Objective To observe clinical effect of treating urinary calculi with Lithagogue decoction combined with western medicine. Methods 32 cases patients with urinary calculi were randomly recruited into a control group and a treatment group. The control group was treated with anisodamine, ivgtt, and progesterone, im, and the treatment group was treated with lithagogue decoction based on the control group. The clinical effect was observed in both groups. Results The clinical effect was 93.8% and 68.7% in the treatment group and the control group respectively, the difference showing statistic significance (χ~2=3.459, P<0.05) .Conclusion The treatment of urinary calculi with Lithagogue decoction combined with western medicine is better than with western medicine only. Key words: Urinary calculi; Lithagogue decoction

MP-12.15: Ureteroscopic Lithotripsy for the Treatment of Urinary Calculi in Infants and Young Children

MP-12.15: Ureteroscopic Lithotripsy for the Treatment of Urinary Calculi in Infants and Young Children

Treatment of complicated upper urinary calculi with Ho: YAG laser lithotriptor by minimally invasive percutaneous nephrolithotomy

Objective To investigate the clinical outcomes of Ho: YAG laser lithotripter with minimal-ly invasive percutaneous nephrolithotomy incomplicated upper urinary calculi treatment. Methods Totally 12 eases of patients with upper ureteral calculi and 25 eases of renal calculi patients were treated with Ho: YAG laser lithotriptor by minimlly invasive percutaneous nephrolithotomy. Results All the upper ureteral calculi patients achieved stone-free at 1 session. And polypus( 1 ease) ,granulation(9eases) ,granulations wraped up(2 eases) were reseeted with Ho: YAG laser vaporization ablation. Of 25 eases with renal calculi 20 achieved stone free at 1 session. The remained stones ranged from 0. 5 to 0. 8 cm in 5 patients were expectorated in 1 month(2 eases treated by medicine and 3 eases treated by ESWEL). The overall successful stone fragmentation rate with stone-free ex-peetoration of the ureteral and renal calculi was 86. 4% ( 32/37 ). All the patients recovered well postoperatively and no major complications observed. Conclusion The technique of Ho: YAG laser lithotriptor with minimally invasive pereutaneous nephrolithotomy is safe and effective for the treatment of complicated upper urinary calculi, especially accompanied with polypus and granulation, and has advantages of minimal trauma and easy recovery. Key words: Minimally invasive percutaneous nephrolithotomy; Ho: YAG laser lithotriptor; Complicated Upper urinary calculi

Effects of Extracorporeal Shock Wave Energy on Normal Murine Microcirculation

Shock wave energy generated for medical purposes is characterized by a biphasic pressure pulse, whereby a cavitation phenomen is induced causing the formation of tiny vesicles. As these microvesicles collapse a multidirectional fluid stream is induced within the tissue. Recently the application spectrum of extracorporeal shock waves (esw) has been widened from treatment of urinary calculi and bony non-union to soft tissue pathologies such as chronic wounds and flap ischemia. The aim of this study was to assess the effects of esw energy on normal microcirculation.

4.05] Ho:YAG laser lithotripsy: Intraoperative settings and technical aspects

Objective To assess and evaluate the intraoperative power settings during clinical laser lithotripsy using the Ho:YAG laser in respect to calculus formation, size and position. Material and methods In total 145 operations for 99 solitary and 46 multiple kidney and ureter stones were retrospectivly analyzed. Laser fibers with core diameters of 220, 365 and 600 μm were used. Results Mean stone size was 10 mm2, mean operation time was 90 min, mean laser-related fragmentation time (lrft) was 365 s. There was a correlation between stone position throughout the collecting system, the overall operating time, the laser-related fragmentation time and the applied laser power (mJ). Overall applied laser power did also correlate with the predominant calculus composition. Conclusion In Ho:YAG laser treatment of urinary calculi, operation- and laser-related fragmentation times are directly related to stone size, composition and position.

Minimally invasive surgical procedures treated urinary calculi caused by melamine in infants

Objective To report experience of minimally invasive surgery of urinary calculi caused by melamine in infants. Methods Retrospectively reviewed the treatments and outcomes of 36 cases with urinary calculi caused by melamine from November 2007 to October 2008. 13 girls and 23 boys aged 8 to 36 months after daily consumption for six month or more of milk products tainted with melamine. These infants underwent MPCNL, ureteroscopic lithotripsy and placement of ureteral stent, respectively. Results The operations were performed successfully in all patients. Five cases underwent MPCNL. Ureteroscopic lithotripsy were performed in fourteen cases. Seventeen cases were placed of ureteral stents. No major complications like hemorrhea, perforation and organic injury were noted. The postoperative hospital stays were 3 to 10 days. All cases were followed up for 1 to 12 months. Calculus had no recurrence. Hydronephrosis and hydroureterosis disappeared or lightened. Growth and development were normal. Conclusions Various kinds of minimally invasive surgical procedures is safe and effective treatments for urinary calculi caused by melamine in infants, applicable in calculi with urinary obstruction especially. Key words: Melamine; Infant; Urinary calculi; Endoscopy

Traitement par laparoscopie rétropéritonéale d’un amas lithiasique intradiverticulaire caliciel symptomatique

Treatment of urinary calculi in caliceal diverticular is indicated when they are symptomatic. Minimally invasive techniques, in particularly laparoscopic approach, occupy an increasingly important place in the urological therapeutic armamentarium and have changed from an open surgical approach to endoscopic treatment for the management of symptomatic caliceal diverticular calculi. Herein, we report the case of a woman with symptomatic calculi in an upper caliceal diverticular managed by retroperitoneal laparoscopic approach.

Avicenna's Canon of Medicine and Modern Urology: part I: bladder and its diseases.

Studying the Avicenna's Canon of Medicine, provides noteworthy information on the subjects related to urology. Some examples of these amazing items have been confirmed by the modern urology: explaining the 2-stage function of the bladder (filling and emptying stages); indirect pointing to a scientific law, named later as the Laplace's law, which is applicable to bladder physiology and explains intravesical pressure stability; describing the bladder layers and strength of the urothelial layer, which was later proved to be due to the tight junctions; describing the intramural ureter and its antireflux mechanism; scientific classifying the urethral and bladder diseases; and describing meticulously the semiology and epidemiology of bladder calculi. Avicenna has also pointed to inversion therapy in the treatment of urinary calculi, grating sign in bladder calculi, manipulation methods for treatment of bladder calculi, and finally, the Crede maneuver. His methodology is completely scientific, based on experiments and truly a basis of the modern medicine. This article is a review of Avicenna's views in medicine and their comparison with the modern urology.

Demographics, Stone Characteristic, and Treatment of Urinary Calculi at the 47th Combat Support Hospital during the First 6 Months of Operation Iraqi Freedom

There are few publications describing urolithiasis in deployed military personnel. Renal colic was the most common urologic indication for air evacuation from the 47th Combat Support Hospital during the first 6 months of Operation Iraqi Freedom and we describe our observations and experience herein. Institutional review board approval was obtained to create a database of patients presenting to the 47th Combat Support Hospital with urolithiasis. Patient demographics, stone characteristic, imaging modality, urinalysis results, treatment course, and outcomes were evaluated for 182 patients. Sixty percent of patients qualified for conservative treatment and spontaneous stone passage was documented in 28%. We conclude that conservative therapy is safe and appropriate initial treatment for the majority of deployed personnel with urinary calculi, however, many patients were lost to follow-up. No patient treated conservatively required admission for sepsis, azotemia, or other serious stone-related complication.

Development of a urinary lithiasis localizer mechanism to couple ultrasound and extracorporeal lithotripsy equipment in canine model

Due to the evolution of extracorporeal lithotripsy equipment (ESWL) and presently, the fact that most part of the equipment does not present ultrasound to localize urinary calculi, a system that allows adapting ultrasound equipment to ESWL equipment was developed, disposing only of fluoroscopy. Thus, this equipment was developed and was tested in urinary stones in canine models, to check its precision in relation to fluoroscopy. Seven male dogs were utilized with the introduction, in the bladder through the ureteral route, of chalkstones, with initial localization by fluoroscopy, with a further ultrasound coincidence check localization of the vesical stones, being submitted to ESWL with a 3-hour, 21 days and 60 days follow-up after the procedure. Success of localization in all animals was verified presenting elimination of stones in the first micturitions, after ESWL. No complications were verified in those animals for 60 days. We verified that this equipment can lead to an update of the equipment that use only fluoroscopy, increasing in this way, their technical capacity in the treatment of urinary calculi, mainly in cases of non-radiopaque stones.

Is shock wave lithotripsy safe in bleeding diathesis?

OBJECTIVE: To assess the safety of shock wave lithotripsy (SWL) in treatment of urinary calculi, in patients with bleeding diathesis. MATERIALS AND METHODS: From 1996 to 2004, seven patients with bleeding diathesis were treated by SWL for urolithiasis. Change of oral anticoagulants to heparin (low molecular heparin) and substitution of deficient coagulation factors was done on the day of treatment. RESULTS: Two out of seven patients had mild hematuria, which settled within 48 hours. None of them required transfusion. Six out of seven were stone-free at one month. None of them required any secondary procedure. CONCLUSION: SWL is a safe method for the treatment of urolithiasis in patients with bleeding diathesis, provided deficient coagulation factors are corrected.