Calculi In Upper Urinary Tract Research Articles

961 Mini-percutaneous nephrolithotomy for upper urinary tract calculi in children (report of 134 cases)

961 Mini-percutaneous nephrolithotomy for upper urinary tract calculi in children (report of 134 cases)

Surgical Decompression is Associated with Decreased Mortality in Patients with Sepsis and Ureteral Calculi

The combination of sepsis and ureteral calculus is a urological emergency. Traditional teaching advocates urgent decompression with nephrostomy tube or ureteral stent placement, although published outcomes validating this treatment are lacking. National practice patterns for such scenarios are currently undefined. Using a retrospective study design, we defined the surgical decompression rate in patients admitted to the hospital with severe infection and ureteral calculi. We determined whether a mortality benefit is associated with this intervention. Patient demographics and hospital characteristics were extracted from the 2007 to 2009 Nationwide Inpatient Sample. We identified 1,712 patients with ureteral calculi and sepsis. Multivariate logistic regression was performed to determine the association between mortality and surgical decompression. Of the patients 78% underwent surgical decompression. Mortality was higher in those not treated with surgical decompression (19.2% vs 8.82%, p <0.001). Lack of surgical decompression was independently associated with an increased OR of mortality even when adjusting for patient demographics, comorbidities and geographic region of treatment (OR 2.6, 95% CI 1.9-3.7). Absent surgical decompression is associated with higher odds of mortality in patients with sepsis and ureteral calculi. Further research to determine predictors of surgical decompression is necessary to ensure that all patients have access to this life saving therapy.

Clinical characteristics and risk factors for septic shock in patients receiving emergency drainage for acute pyelonephritis with upper urinary tract calculi

BackgroundAcute pyelonephritis (APN) is a common complication of ureteral obstruction caused by urolithiasis, and it can be lethal if it progresses to septic shock. We investigated the clinical characteristics of patients undergoing emergency drainage and assessed risk factors for septic shock.MethodsA retrospective study was performed of 98 patients (101 events) requiring emergency drainage at our urology department for obstructive APN associated with upper urinary tract calculi from January 2003 to January 2011. Clinical characteristics were summarized, and risk factors for septic shock were assessed by logistic regression analysis.ResultsObjective evidence of sepsis was found in 64 (63.4%) events, and 21 events (20.8%) were categorized as septic shock. Ninety-six patients recovered, but 2 patients died of septic shock. Multivariate analysis revealed that age and the presence of paralysis were independent risk factors for septic shock.ConclusionsAPN associated with upper urinary tract calculi is a severe disease that should be treated with caution, particularly when risk factors are present.

The Urination Patterns In Elderly Male Patients With Upper Urinary Tract Calculi

Objectives: We investigated the urination patterns in elderly male patients with upper urinary tract calculi. Methods: We enrolled 45 patients with upper urinary tract calculi and 52 patients without urinary tract calculi (as controls) who were over 60 years of age for this study. All of the patients had undergone the International Prostate Symptom Score diagnostic process via an interview. Results: No significant differences were observed in any of the parameters between these groups with regard to their voiding symptoms. However, the group with upper urinary tract calculi had significantly lower scores on their daytime urinary frequency, storage symptoms and total IPSS scores. The group with upper urinary tract calculi had significantly better results in the analysis of QOL. Conclusions: These data suggest that elderly males having upper urinary tract calculi might have fewer lower urinary tract symptoms as a result of the stone formation.

Do the applied shock wave numbers and the application side affect pancreatic exocrine functions in patients who have undergone extracorporeal shock wave lithotripsy for upper urinary tract calculi?

Aim: To investigate the effect of extracorporeal shock wave lithotripsy (ESWL) on the pancreatic exocrine functions related to the number of high-energy shock waves and the ESWL-applied kidney side for upper urinary tract stones. Materials and methods: Included in the study were 76 patients undergoing ESWL for proximal ureteral or kidney stones. The right kidney group (RKG) consisted of 40 patients who underwent ESWL for right kidney stones and the left kidney group (LKG) consisted of 36 patients who underwent ESWL for left kidney stones. Results: The observed changes in plasma amylase and lipase levels were not statistically significant compared with the pre-ESWL values in both groups. The relationship between the number of applied shock waves (SWs) and the serum amylase and lipase after ESWL showed a statistically significant positive correlation in the RKG but not in the LKG. Conclusion: There were no statistically significant differences between the pre- and post-ESWL serum amylase and lipase levels. However, a statistically significant positive correlation was found between the number of SWs applied and the post-ESWL amylase and lipase levels in the RKG. Although clinical and experimental studies have shown the safety of ESWL, avoiding excess sessions and an unnecessarily high number of SWs may be helpful in the prevention of the potential risks of ESWL.

Perioperative patient radiation exposure in the endoscopic removal of upper urinary tract calculi

Perioperative patient radiation exposure in the endoscopic removal of upper urinary tract calculi

Nephrostomy Tube Placement After Percutaneous Nephrolithotomy: Critical Evaluation Through a Prospective Randomized Study

To evaluate the hemostatic and drainage functions of the nephrostomy tube after percutaneous nephrolithotomy through a prospective randomized study. Additionally, the effect of nephrostomy tube placement on postoperative pain, hospital stay, and the success and complication rates was assessed. The present study was designed to include 100 patients with upper urinary tract calculi who were prospectively randomized to tubeless (group 1) and standard (group 2) PCNL using closed envelopes. The hemoglobin and hematocrit deficits, development of hematuria and hematoma, and blood transfusion rate were compared to assess the hemostatic effect. The drainage effect was evaluated by comparing the incidence of postoperative urinary leakage, urinoma, and/or hydrothorax development. A total of 123 patients were assessed for eligibility, and 100 fulfilled the study requirements. The hemoglobin and hematocrit deficits were comparable. Significant hematuria and/or hematoma were recorded in 5 and 4 patients in groups 1 and 2, respectively. Blood transfusion was required in 5 and 6 patients in groups 1 and 2, respectively. One patient with chronic kidney disease in the tubeless group required abdominal exploration because of respiratory embarrassment and a large hematoma. Transient urinary leakage was recorded in 2 and 31 patients in groups 1 and 2, respectively (P < .05). No urinoma developed. Hemothorax developed in 1 patient in the tubeless group with supracostal puncture. Postoperative pain was significantly less in the tubeless group. No statistically significant difference was found in the success rate, morbidity, or hospital stay between the 2 groups. The hemostatic and drainage functions of the nephrostomy tube were modest. However, the tubeless approach might be not suitable for the patients with chronic kidney disease or a supracostal approach.

Treatment of pyonephrosis with upper urinary tract calculi

To improve the treatment of pyonephrosis with upper urinary tract calculi (UTC). A total of 49 UTC patients with pyonephrosis were selected at our hospital during May 2004 to February 2010. Among them, 22 cases were treated with transurethral ureteroscope lithotripsy followed by tube internal drainage while another 27 cases underwent percutaneous nephrolithotomy. No such complications as septicemia and septic shock occurred during the first stage of external and internal drainage. The bacteremic symptoms of chill or fever occurred in 3 cases during the second stage of percutaneous nephrolithotomy and pyelolithotomy/ureterolithotomy (11.1%). There were 3 cases of nephrectomy. A follow-up period of 3 months to 5.5 years showed that all 33 cases had a varying degree of recovered renal functions. And there was no nephrectomy. The keys to a successful surgical treatment of pyonephrosis with upper urinary tract calculi are early diagnosis, timely drainage and relief of obstruction. Ureteroscopic lithotripsy, double-J placement and percutaneous nephrostomy drainage are excellent for relieving obstruction. As a safe procedure with minor complications, it creates proper conditions for a second stage operation.

Emergency ureteroscopic treatment for upper urinary tract calculi obstruction associated with acute renal failure: feasible or not?

Emergency ureteroscopic treatment for upper urinary tract calculi obstruction associated with acute renal failure: feasible or not?

Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors?

New generation flexible ureterorenoscopes offer an improved deflection mechanism and a stiffer sheath compared to their predecessors. We aimed to determine if these improvements in design lead to a higher efficacy in the treatment of nephrolithiasis. Ninety patients with upper urinary tract calculi were included into a retrospective analysis. Twenty-nine cases were treated with the conventional flexible ureterorenoscope (11274 AA, Karl Storz Endoscopy, Germany) and 61 cases were treated with the new generation device (Flex-X, Karl Storz Endoscopy). Patients' and stone characteristics, intraoperative data, treatment success and complications were retrieved from the charts and compared between the two groups. Preoperative data were comparable in both groups. Whereas stone access was also comparable (97 vs. 100%; n.s.), immediate treatment success was significantly higher for the new flexible scope (70 vs. 38%; p=0.003). For the subgroup of lower pole stones, stone access was possible in 94 versus 100% (n.s.) and treatment success was 31 versus 69% (p=0.0004) for the conventional and the new generation device, respectively. No major complications were observed, minor complications were comparable in both groups. Our study suggests an advantage of the new generation flexible ureterorenoscopes compared to their predecessors. They offer an increased stone free rate especially in the treatment of lower pole stones. It seems therefore advisable to switch to the latest generation flexible devices.

Validity of Administrative Coding in Identifying Patients With Upper Urinary Tract Calculi

Administrative databases are increasingly used for epidemiological investigations. We performed a study to assess the validity of ICD-9 codes for upper urinary tract stone disease in an administrative database. We retrieved the records of all inpatients and outpatients at Johns Hopkins Hospital between November 2007 and October 2008 with an ICD-9 code of 592, 592.0, 592.1 or 592.9 as one of the first 3 diagnosis codes. A random number generator selected 100 encounters for further review. We considered a patient to have a true diagnosis of an upper tract stone if the medical records specifically referenced a kidney stone event, or included current or past treatment for a kidney stone. Descriptive and comparative analyses were performed. A total of 8,245 encounters coded as upper tract calculus were identified and 100 were randomly selected for review. Two patients could not be identified within the electronic medical record and were excluded from the study. The positive predictive value of using all ICD-9 codes for an upper tract calculus (592, 592.0, 592.1) to identify subjects with renal or ureteral stones was 95.9%. For 592.0 only the positive predictive value was 85%. However, although the positive predictive value for 592.1 only was 100%, 26 subjects (76%) with a ureteral stone were not appropriately billed with this code. ICD-9 coding for urinary calculi is likely to be sufficiently valid to be useful in studies using administrative data to analyze stone disease. However, ICD-9 coding is not a reliable means to distinguish between subjects with renal and ureteral calculi.

Initial Experience with a New Dual-Shockwave Lithotripter in the Management of Upper Urinary Tract Calculi

Initial Experience with a New Dual-Shockwave Lithotripter in the Management of Upper Urinary Tract Calculi

Particle motion in unsteady two-dimensional peristaltic flow with application to the ureter

Particle motion in an unsteady peristaltic fluid flow is analyzed. The fluid is incompressible and Newtonian in a two-dimensional planar geometry. A perturbation method based on a small ratio of wave height to wavelength is used to obtain a closed-form solution for the fluid velocity field. This analytical solution is used in conjunction with an equation of motion for a small rigid sphere in nonuniform flow taking Stokes drag, virtual mass, Faxén, Basset, and gravity forces into account. Fluid streamlines and velocity profiles are calculated. Theoretical values for pumping rates are compared with available experimental data. An application to ureteral peristaltic flow is considered since fluid flow in the ureter is sometimes accompanied by particles such as stones or bacteriuria. Particle trajectories for parameters that correspond to calcium oxalates for calculosis and Escherichia coli type for bacteria are analyzed. The findings show that retrograde or reflux motion of the particles is possible and bacterial transport can occur in the upper urinary tract when there is a partial occlusion of the wave. Dilute particle mixing is also investigated, and it is found that some of the particles participate in the formation of a recirculating bolus, and some of them are delayed in transit and eventually reach the walls. This can explain the failure of clearing residuals from the upper urinary tract calculi after successful extracorporeal shock wave lithotripsy. The results may also be relevant to the transport of other physiological fluids and industrial applications in which peristaltic pumping is used.

Staged Retrograde Endoscopic Lithotripsy as Alternative to PCNL in Select Patients with Large Renal Calculi

Percutaneous nephrolithotomy (PCNL) is currently the gold standard for management of large renal calculi. PCNL is associated, however, with a higher complication rate, degree of risk, and longer recovery period compared with ureteroscopy. In a selected group of patients who were not ideal candidates for PCNL because of extenuating health factors, a staged retrograde endoscopic approach was used to manage upper urinary tract calculi. We conducted a retrospective review of 23 patients (selected because of comorbidities, obesity, anatomy, and previous treatment failure as poor candidates for PCNL) who underwent staged retrograde endoscopic lithotripsy to manage upper urinary tract calculi. Lithotripsy was based on the application of small-diameter fiberoptic ureteroscopes and the holmium laser. Successful therapy was defined as total fragmentation of stone burden on repeated imaging. Data were analyzed using descriptive statistics. Of the 468 patients who underwent ureteroscopy at our institution from 2003 to 2006, 23 patients (52% men, 57.70 +/- 11.44 years of age) were treated with retrograde endoscopic procedures for upper urinary tract calculi (52.2% lower pole). Stone burden at the initial procedure was 2.13 +/- 2.34 stones with a total linear length of 30.91 +/- 14.28 mm and an estimated total stone volume of 12,040.78 +/- 11101.54 cc (median value, 7,234.00 cc). There were no intraoperative complications; three patients were admitted postoperatively for observation. Ten 43.5%) patients (progressed to second-stage procedures (34.6 +/- 10.8 days apart). After repeated imaging, 73.9% of patients were stone free (88% lower pole), and 8.7% progressed to further intervention. Total linear stone length <4 cm and estimated calculus volume > or =15,000 cc predicted treatment failure (40%, 42.9%). Percutaneous methods of managing renal stones have an increased rate of complications compared with ureteroscopy. In patients with complex medical histories, upper urinary tract calculi <4 cm can be safely and effectively managed using a staged retrograde endoscopic approach.

Ureteroscopic Laser Lithotripsy for Upper Urinary Tract Calculi With Active Fragment Extraction and Computerized Tomography Followup

Management of fragments generated by ureteroscopic laser lithotripsy remains controversial. In this study we explored the impact of active fragment extraction after ureteroscopic laser lithotripsy on stone clearance. A total of 69 patients with 3 or less upper urinary tract calculi (5 to 15 mm) demonstrated on preoperative CT were prospectively evaluated. Stones were translocated to a dependent upper pole calix where laser lithotripsy was performed. An attempt was made to clear all fragments using tipless stone baskets. One month after surgery stone clearance was evaluated exclusively with noncontrast spiral CT. In 58 patients undergoing surgery on protocol, average stone burden was 9.4 +/- 3.4 mm and was significantly smaller in 44 patients with stones in a solitary location (8.5 +/- 2.9 mm) than in 14 patients with stones in multiple locations (12.3 +/- 3.2 mm, p <0.001). Primary stone location was categorized as renal nonlower pole (in 16), renal lower pole (in 19) and proximal ureter (in 23). Average operative time (43.7 +/- 18.4 minutes) was unaffected by stone location or multiplicity after controlling for stone size (p >0.05). Stone clearance rates were not affected by stone location or multiplicity, with overall success rates of 54%, 84% and 95% at fragment thresholds of 0, 2 and 4 mm, respectively (p >0.05). Ureteroscopic laser lithotripsy with active fragment extraction was time efficient and highly effective. Sensitive postoperative imaging reveals the challenge of achieving a true stone-free state. We were unable to demonstrate an impact of stone location on stone-free rates.

181Efficacy and safety of a new generation ESWL machine in the treatment of upper urinary tract calculi

181Efficacy and safety of a new generation ESWL machine in the treatment of upper urinary tract calculi

IN VIVO ASSESSMENT OF FREE RADICAL ACTIVITY DURING SHOCK WAVE LITHOTRIPSY USING A MICRODIALYSIS SYSTEM: THE RENOPROTECTIVE ACTION OF ALLOPURINOL

Shock wave lithotripsy is believed to cause renal damage directly through cellular injury from high energy shock waves and indirectly through vascular injury and resultant ischemia, which gives rise to oxygen free radical compounds. The transient and volatile nature of free radicals and derived products makes their detection difficult. Moreover, certain medications may provide a protective effect against shock wave lithotripsy induced renal parenchymal injury. We introduced an innovative microdialysis system for in vivo sampling of interstitial fluids that can be analyzed for free radical mediated lipid peroxidation products after shock wave lithotripsy treatment in the swine model. In addition, this system was used to test the antioxidant or renoprotective action of allopurinol. Ten juvenile swine were assigned to a nonmedicated control group that underwent shock wave lithotripsy or to a group that was premedicated with allopurinol before shock wave lithotripsy. Each group of animals underwent shock wave lithotripsy to the lower pole of the right kidney and received a total of 10,000 shock waves. Dialysate fluid was collected at 1,000-shock wave increments via probes surgically implanted into the lower pole of the right and left kidneys before lithotripsy. Samples were immediately preserved in liquid nitrogen and subsequently analyzed for the presence and concentration of conjugated diene levels, a measure of lipid peroxidation. Five additional juvenile swine were assigned to a sham treated group that did not undergo shock wave lithotripsy. Dialysate fluid was collected from the lower pole of the right and left kidneys to establish baseline or pre-lithotripsy levels of conjugated dienes. After shock wave lithotripsy conjugated diene levels increased almost 100-fold over that in the right kidneys of the nonmedicated control group. The difference was statistically significant compared to levels in the contralateral untreated kidneys (p <0.01). Right kidneys in the group premedicated with allopurinol did not demonstrate an increase in conjugated diene levels during shock wave lithotripsy. The results of this study confirm shock wave lithotripsy induced free radical activity as well the antioxidant and protective nature of allopurinol. The newly described microdialysis system enables real-time sampling of interstitial fluids during shock wave lithotripsy. It represents a unique method for assessing free radical formation and evaluating the protective effects of additional antioxidant medications.

The efficacy of potassium citrate based medical prophylaxis for preventing upper urinary tract calculi: a midterm followup study

The efficacy of potassium citrate based medical prophylaxis for preventing upper urinary tract calculi: a midterm followup study

URETHRAL OBSTRUCTION DUE TO PROTRUDING PROSTATIC CALCULI

No AccessJournal of UrologyClinical Urology: Case Reports1 Jul 1999URETHRAL OBSTRUCTION DUE TO PROTRUDING PROSTATIC CALCULI TAKAO KAMAI, TSUGUHIRO TOMA, HIDETO KANO, and DAISUKE ISHIWATA TAKAO KAMAITAKAO KAMAI More articles by this author , TSUGUHIRO TOMATSUGUHIRO TOMA More articles by this author , HIDETO KANOHIDETO KANO More articles by this author , and DAISUKE ISHIWATADAISUKE ISHIWATA More articles by this author View All Author Informationhttps://doi.org/10.1097/00005392-199907000-00044AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "URETHRAL OBSTRUCTION DUE TO PROTRUDING PROSTATIC CALCULI." The Journal of Urology, 162(1), pp. 163–164 References 1 : The crystalline composition of prostatic calculi. Brit. J. Urol.1974; 46: 533. Google Scholar 2 : Urinary lithiasis: etiology, diagnosis, and medical management. In: . Philadelphia: W. B. Saunders Co.1998: 2661. chapt. 91. Google Scholar From the Department of Urology, Showa General Hospital, Tokyo, Japan© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 162Issue 1July 1999Page: 163-164 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information TAKAO KAMAI More articles by this author TSUGUHIRO TOMA More articles by this author HIDETO KANO More articles by this author DAISUKE ISHIWATA More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of upper urinary tract calculi with ureteroscopic techniques

Objectives. To evaluate our experience in treating 155 patients with upper urinary tract calculi ureteroscopically. The treatment of urinary calculi has remained the most frequent application of ureteroscopy. Miniaturization of semirigid and flexible ureteroscopes has permitted easier access to calculi throughout the urinary tract. Methods. Ureteroscopic stone treatment was attempted in 155 patients with upper urinary tract calculi between November 1995 and March 1997. Fifty-nine (38.1%) patients had renal calculi, 82 (52.9%) ureteral, and 14 (9%) had both renal and ureteral calculi. Both semirigid and flexible ureteroscopes were used for treatment (rigid alone in 21 [13.5%], flexible in 64 [41.3%], and both rigid and flexible in 70 [45.2%] patients). Lithotripsy was required in 122 (79%) of the patients. The holmium:yttrium-aluminum-garnet laser was used in 113 (92.6%) of these patients. Results. All patients with ureteral calculi (29 proximal, 19 mid, and 34 distal) were successfully cleared after one endoscopic procedure except for 1 patient with a proximal ureteral calculus who had a 4-mm residual fragment in the kidney. Of the 59 patients with renal calculi, 47 (79.7%) were totally clear of stones 1 month after treatment. The remaining 12 (20.3%) patients had evidence of residual calculi 3 to 4 mm or less in diameter. In patients with combined renal and ureteral calculi, 11 of 14 (78.6%) were rendered stone free. The remaining 3 (21.4%) patients had evidence of residual calculi 4 mm in diameter. Overall, 95% of the patients were treated in an outpatient setting. Morbidity was low, with no evidence of stricture. Conclusions. Ureteroscopy and laser lithotripsy in experienced hands are a safe and reliable method for the treatment of ureteral and even intrarenal calculi.