Urinary Stone Patients Research Articles

PD51-11 FACTORS PREDICTING SURGICAL INTERVENTION IN PEDIATRIC NEPHROLITHIASIS PATIENTS

INTRODUCTION AND OBJECTIVES: Nephrolithiasis is an increasingly common disease process often requiring extensive followup and care with significant economic ramifications. Computed tomography (CT) remains the preferred initial diagnostic modality due to its excellent sensitivity and specificity for stone disease. Medical expulsive therapy is a reasonable course of treatment for many patients but often results in a protracted clinical course. Concern regarding overutilization of CT with respect to increased radiation exposure and health care costs has been expressed. We sought to identify patients with known urinary tract calculi who undergo additional CT imaging between initial diagnosis and stone passage or intervention to determine if their management is altered by the additional imaging study. METHODS: Retrospective chart review of all urinary stone patients (by ICD-9 code) between January 2009 and January 2012 was performed. We identified those patients who had repeat CT imaging performed within six weeks of the initial urinary stone diagnosis for the same indication. Charts were examined to determine if additional information was gained through repeat CT imaging and if the repeat CT scan altered course of stone management. RESULTS: 1119 patients were identified. 128 patients (11%) met inclusion criteria with repeat CT scan. Repeat CT scan (within 6 weeks of initial diagnosis) resulted in a change in planned management in 9/128 patients (7%). Average additional radiation dose per patient was 36.9 mSv. Thirty-six patients underwent CT imaging for flank pain even after a ureteral stent had previously been placed. CONCLUSIONS: Many patients undergo unnecessary repeat CT imaging for kidney stones leading to increased cost and radiation exposure. Only 7% of patients who underwent repeat CT imaging had an alteration in the previously planned management for known kidney stones. Repeat imaging with CT is rarely necessary in the short-term management of nephrolithiasis. Following a diagnosis of nephrolithiasis, additional follow-up information and progress may be acquired through physical exam, laboratory values, and possibly ultrasound examination limiting cost and cumulative radiation exposure.

PD51-10 OVERUTILIZATION OF CT IMAGING IN PATIENTS WITH KNOWN URINARY TRACT CALCULI

INTRODUCTION AND OBJECTIVES: Nephrolithiasis is an increasingly common disease process often requiring extensive followup and care with significant economic ramifications. Computed tomography (CT) remains the preferred initial diagnostic modality due to its excellent sensitivity and specificity for stone disease. Medical expulsive therapy is a reasonable course of treatment for many patients but often results in a protracted clinical course. Concern regarding overutilization of CT with respect to increased radiation exposure and health care costs has been expressed. We sought to identify patients with known urinary tract calculi who undergo additional CT imaging between initial diagnosis and stone passage or intervention to determine if their management is altered by the additional imaging study. METHODS: Retrospective chart review of all urinary stone patients (by ICD-9 code) between January 2009 and January 2012 was performed. We identified those patients who had repeat CT imaging performed within six weeks of the initial urinary stone diagnosis for the same indication. Charts were examined to determine if additional information was gained through repeat CT imaging and if the repeat CT scan altered course of stone management. RESULTS: 1119 patients were identified. 128 patients (11%) met inclusion criteria with repeat CT scan. Repeat CT scan (within 6 weeks of initial diagnosis) resulted in a change in planned management in 9/128 patients (7%). Average additional radiation dose per patient was 36.9 mSv. Thirty-six patients underwent CT imaging for flank pain even after a ureteral stent had previously been placed. CONCLUSIONS: Many patients undergo unnecessary repeat CT imaging for kidney stones leading to increased cost and radiation exposure. Only 7% of patients who underwent repeat CT imaging had an alteration in the previously planned management for known kidney stones. Repeat imaging with CT is rarely necessary in the short-term management of nephrolithiasis. Following a diagnosis of nephrolithiasis, additional follow-up information and progress may be acquired through physical exam, laboratory values, and possibly ultrasound examination limiting cost and cumulative radiation exposure.

Should a 31/62-day target be applicable to urinary stone patients with indwelling stents?

Objective: Patients with urinary stone disease languish on waiting lists. They are often young and suffer morbidity and unemployment. Stone disease leads to sepsis, loss of renal units and even death. We aimed to assess the readmission rates and associated morbidity for patients with ureteric stents in situ secondary to stone disease. Patients and methods: Over 12 months 692 patients totalling 1114 admissions were admitted to our unit with a coded diagnosis of renal colic. Of the 692 individuals, 378 first presented as an emergency. The rest had elective first admissions. Results: Of the 378 emergency presentations, 78 were admitted between two and eight times. The total number of admissions for this group of 78 patients was 248. The average time interval was calculated from first emergency presentation to date of first elective treatment (52.3 days (range 2–281)) and from date of first emergency presentation to date of last treatment (63.6 days (range 2–281)). A total of 401 working days were lost. Conclusion: The management of patients with urinary stone disease needs serious reconsideration. We propose that patients with indwelling stents have a 31/62-day target similar to cancer patients due to the increased morbidity associated with loss of working days and the increased cost of readmissions to an overburdened health service.

PD36-09 RETROSPECTIVE COMPARISON OF FLUOROLESS AND CONVENTIONAL URETEROSCOPY

You have accessJournal of UrologyStone Disease: New Technology I1 Apr 2014PD36-09 RETROSPECTIVE COMPARISON OF FLUOROLESS AND CONVENTIONAL URETEROSCOPY Gaudencio Olgin, Gene O. Huang, Steven Engebretsen, Don C. Arnold, and D. Duane Baldwin Gaudencio OlginGaudencio Olgin More articles by this author , Gene O. HuangGene O. Huang More articles by this author , Steven EngebretsenSteven Engebretsen More articles by this author , Don C. ArnoldDon C. Arnold More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2446AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary stone patients are exposed to significant amounts of radiation during their initial work-up, surgical treatment, and follow-up. In an effort to reduce patient exposure to ionizing radiation, a technique for ureteroscopy was developed that eliminated the need for intraoperative fluoroscopy. The purpose of this study was to compare outcomes of this technique with a cohort of conventional ureteroscopic patients. METHODS A retrospective review of 50 consecutive patients undergoing ureteroscopy using a completely fluoroless technique was performed. Fluoroless procedures were performed by inserting guide wires and instruments using tactile feedback, direct visualization, and external visual cues to substitute for fluoroscopy. This cohort was compared to 50 conventional ureteroscopies performed during this same period. Patient characteristics, perioperative factors, complication rates, and stone-free rates were compared. RESULTS All fluoroless ureteroscopies were successfully performed without image guidance. In the fluoroless group the mean operative time was 59.2 minutes (25-121 min.), overall stone burden was 91.5 mm2 (14-480 mm2), complication rate was 4%, and repeat procedure rate was 8%. When compared to conventional ureteroscopy, there was no statistical difference between operative time, complication rate, repeat procedure rate, age, gender, ASA, BMI, and laterality. The fluoroless patients had statistically larger stone burden 91.5 vs. 56.5 mm2 (p = 0.042) and more stones located in the kidney (p=0.002). The mean fluoroscopy time in the fluoroless group was significantly lower 0 (range 0-0 sec) compared to the mean fluoroscopy time during conventional ureteroscopy 38.6 sec (range 5-156; p<0.001). CONCLUSIONS Fluoroless ureteroscopy results in similar patient outcomes compared to conventional ureteroscopy, but results in dramatically reduced fluoroscopy time. Application of techniques employed for this procedure may be particularly useful in younger or pregnant patients and may be used to significantly lower radiation exposure in all patients. Future studies will be necessary to establish optimal patient selection criteria. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e904 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Gaudencio Olgin More articles by this author Gene O. Huang More articles by this author Steven Engebretsen More articles by this author Don C. Arnold More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Place of non-contrast computed tomography for evaluation of flank pain and suspected urinary stone in emergency service

Abstract Aim. With an intent to present our experience with the non-contrast computed tomography (CT) during the work-up of patients admitted with acute urinary complaints in the emergency service, we reviewed our clinical and non-contrast CT imaging data of patients presented with flank pain and suspected urinary stone. Methods. Clinical and non-contrast CT with ultrasound examinations performed at our Emergency and Radiology Departments in 2011 were reviewed retrospectively in 102 adult urinary stone patients in acute conditions. Results. In 102 patients with suspected urinary stones, 95 had urinary stones detected with non-contrast CT. Ultrasonography provided helpful findings for the evaluation of calyceal dilatation and hydronephrosis. There was no specific side and level preference of urinary stones in the urinary tract. There was no hydronephrosis in for the percent of urinary stone patients. The BUN and creatinine levels in the patients with multiple urinary stones were higher than those in the patients with single urinary stones (p<0.05). Although single urinary stone was more common, overall there was no specific propensity of single and multiple urinary stones to kidney, ureter, and bladder. Conclusions. In this study, we attempted to reveal the efficacy of non-contrast CT during the diagnosis of urinary stones in patients presenting to the Emergency Department in acute conditions. According to our findings, non-contrast CT with ultrasound is diagnostic modality for patients with urinary stones in the Emergency Department. Further studies are needed to shed light on the long-term effects of the choice of this pathway on the clinicoradiologic diagnosis of urinary stone patients. According to our findings, non-contrast CT with ultrasound is diagnostic modality for patients with urinary stones in the Emergency Department. Further studies are needed to shed light on the long-term effects of the choice of this pathway on the outcome of urinary stone patients. Keywords: Urinary stone, emergency department, non-contrast computed tomography, ultrasonography Ozet Amac. Acil servise akut uriner sikayetlerle basvuran hastalarin incelenmesi sirasinda kontrastsiz bilgisayarli tomografi (BT) ile ilgili tecrubelerimizi sunmak amaci ile yan agrisi ile gelen ve supheli uriner tasi olan hastalarin klinik ve kontrastsiz (BT) verilerini degerlendirdik. Yontem. Klinik, kontrastsiz BT ve ultrasonografi (US) incelemeleri 2011 yilinda acil ve radyoloji departmanlarinda yapilan 102 adet eriskin akut uriner tas hastasinda retrospektif olarak degerlendirildi. Bulgular. Degerlendirilen 102 olgunun 95 tanesinde kontrastsiz BT'de tasi mevcuttu. Ultrasonografi kaliks dilatasyonu ve hidronefrozun degerlendirilmesinde yardimci bulgular sagladi. Uriner sistemde uriner taslarin spesifik bolgesi ve seviye tercihi bulunmamaktaydi. Multipl uriner tasi olan hastalarda BUN ve kreatinin seviyeleri tek uriner tasi olan hastalardan daha yuksekti (p<0,05). Tek uriner tas sayisi daha sik oldugu halde tek ve multipl taslarin bobrek, ureter ve mesanede bulunma orani ozellik gostermiyordu. Sonuclar. Bu calismada akut durumlarda Acil servise basvuran hastalarda uriner taslarin tanisi sirasinda kontrastsiz BT'nin etkinligini gostermeyi amacladik. Bizim bulgularimiza gore US ile birlikte kontrastsiz BT Acil serviste uriner tasli hastalar icin tanisal modalitedir. Uriner tasli olgularin klinikoradyolojik tanilari uzerinde onerdigimiz yolun tercih edilmesinin etkilerini aydinlatmak icin daha fazla calismalara ihtiyac vardir. Anahtar sozcukler: Uriner tas, acil servis, non-kontrast bilgisayarli tomografi, ultrasonografi

Silicate Urolithiasis during Long-Term Treatment with Zonisamide

Silicate urinary calculi are rare in humans, with an incidence of 0.2% of all urinary calculi. Most cases were related to excess ingestion of silicate, typically by taking magnesium trisilicate as an antacid for peptic ulcers over a long period of time; however, there also existed unrelated cases, whose mechanism of development remains unclear. On the other hand, zonisamide, a newer antiepileptic drug, is one of the important causing agents of iatrogenic urinary stones in patients with epilepsy. The supposed mechanism is that zonisamide induces urine alkalinization and then promotes crystallization of urine components such as calcium phosphate by inhibition of carbonate dehydratase in renal tubular epithelial cells. Here, we report a case of silicate urolithiasis during long-term treatment with zonisamide without magnesium trisilicate intake and discuss the etiology of the disease by examining the silicate concentration in his urine.

Factors Affecting the Outcome of Extracorporeal Shock Wave Lithotripsy for Unilateral Urinary Stones in Children: A 17-Year Single-Institute Experience

PurposeExtracorporeal shock wave lithotripsy (ESWL) is a first-line treatment for pediatric urinary stone disease. We aimed to determine the factors affecting the outcome of ESWL for unilateral urinary stones in children.Materials and MethodsA total of 81 pediatric patients aged 0 to 16 years with urinary stones treated by ESWL from January 1995 through May 2012 were retrospectively reviewed. All patients were required to have unilateral urinary stone disease. Children who underwent other surgical procedures before ESWL were excluded. Outcomes evaluated after ESWL were the stone-free rate at 3 months after ESWL, success within a single session, and success within three sessions. Factors affecting the success within three sessions were also analyzed.ResultsThe final analysis was for 42 boys and 22 girls (mean age, 9.2±5.2 years). Of these 64 patients, 58 (90.6%) were treated by ESWL without other surgical procedures and 54 (84.4%) were successfully treated within three ESWL sessions. In the multivariate analysis, multiplicity (odds ratio [OR], 0.080; 95% confidence interval [CI], 0.012 to 0.534; p=0.009) and large stone size (>10 mm; OR, 0.112; 95% CI, 0.018 to 0.707; p=0.020) were significant factors that decreased the success rate within three ESWL sessions.ConclusionsMost of the pediatric urinary stone patients in our study (90.6%) were successfully treated by ESWL alone without additional procedures. If a child has a large urinary stone (>10 mm) or multiplicity, clinicians should consider that several ESWL sessions might be needed for successful stone fragmentation.

Twenty-four-hour urine constituents in stone formers: A study from the northeast part of Peninsular Malaysia

Urolithiasis is a common disease with increasing incidence and prevalence world-wide, probably more common in industrialized countries. The metabolic evaluation of 24-h urine collection has been considered as part of the management of urinary stone patients. The aim of this study was to evaluate the 24-h urine constituents in stone formers and its relation to demographic data in the northeast part of Peninsular Malaysia. One hundred and six patients were recruited in this study from two hospitals in the same geographical region; 96 patients fulfilled the inclusion criteria and an informed consent was obtained from all subjects. The 24-h urine was collected in sterile bottles with a preservative agent and calcium, oxalate, citrate, uric acid, magnesium and phosphate were tested using commercial kits on a Roche Hitachi 912 chemistry analyzer. The age (mean ± SD) of 96 patients was 56.45 ± 13.43 years and 82.3% of the patients were male while 17.7% were female. The 24-h urine abnormalities were hypercalciuria (14.5%), hyperoxaluria (61.4%), hypocitraturia (57.2%), hyperuricouria (19.7%), hypomagnesuria (59.3%) and hyperphosphaturia (12.5%). Hyperoxaluria (61.4%) was the most common abnormality detected during the analysis of 24-h urine constituents in contradiction to industrial countries, where hypercalciuria was the most common finding. The high frequencies of hypomagnesuria and hypocitraturia reflect the important role of magnesium and citrate in stone formation and their prophylactic role in the treatment of urinary stone disease in the given population.

Efficacy of Percutaneous Nephrostomy During Flexible Ureteroscopy for Renal Stone Management

PurposePreoperative percutaneous nephrostomy (PCN) can be applied to urinary stone patients with pyelonephritis as well as obstructive uropathy; thus, some patients undergo flexible ureteroscopy (fURS) in the presence of a PCN tube. We evaluated the effectiveness of PCN during fURS for the management of renal stones.Materials and MethodsWe retrospectively analyzed 130 consecutive patients who underwent fURS for renal stones between January 2009 and December 2011. All fURS procedures were performed by a single experienced surgeon. The patients were divided into two groups depending on the presence of PCN during the surgery: patients with PCN (group 1, n=41) and patients without PCN (group 2, n=89). To evaluate operative outcomes, we compared success rates, operative times, and complication rates. We defined success as the absence of any residual stones in the kidney or stone fragments less than 2 mm that were too small to be extracted during follow-up.ResultsThere were no significant differences in age, sex, body mass index, stone laterality, burden, or location between the two groups. The mean operative times of groups 1 and 2 were 50.1 and 58.3 minutes, respectively (p=0.102). The success rates of groups 1 and 2 were 95.1% and 82.0%, respectively (p=0.044). There was no statistically significant difference in the complication rate between groups 1 and 2 (p=0.888).ConclusionsFlexible ureteroscopy in the presence of PCN produced a superior outcome in terms of the success rate without increasing the operative time or complication rate. PCN may be helpful to induce better outcomes of fURS.

The impact of metabolic risk management on recurrence of urinary stones

Introduction: Urinary stone disease is a common urologic problem and recurrence in stone formation is a very familiar issue to urologists. Although recurrence in stone formation has been linked to metabolic abnormalities, it can be accessible by metabolic risk analysis studies.Methods: Herein, we present our experience in metabolic risk management on recurrence of urinary stones for 10 years in Akdeniz University School of Medicine department of Urology. We retrospectively analyzed Akdeniz University Urinary Stone Database between dates of January 2000 and December 2010. We found over 3500 patients who were managed by SWL (shock wave lithotripsy) or PCNL (percutaneus nephrolithotripsy) or URS (Ureterorenoscopic lithotripsy) or open surgery.Results: 525 patients’ metabolic risk analysis was ordered due to recurrent urinary stone disease. Only 134 (25.5 %) current metabolic analysis were returned. Mean patient age was 32.2 years (range: 19-82 years).Patients were 103 male and 31 female. Stone analysis results were CaOx monohydrate in 48 (35.8 %), CaOx dihydrate in 8 (5.9 %), CaOx mono and dihydrate in 70 (52.2 %), uric acid in 3, CaOx monohydrate and uricacid in 2, cystine in 2, and struvite in 1 patient, respectively. The metabolic risk analysis showed some abnormality in 54 (40.2 %) patients.Conclusion: Although compliance to metabolic risk analysis studies is low among recurrent urinary stone formers, some significant metabolic abnormalities could be detected in those who are effectively screened.Recurrence of urinary stones in patients who are started on appropriate metabolic management can be prevented.

Urinary Stone Analysis in a Patient with Hyperuricemia to Determine the Mechanism of Stone Formation

In order to determine the mechanism of urinary stone formation in patients with hyperuricemia, we analyzed the crystal components and matrix proteins in a urinary stone from such a patient. Micro-area X-ray spectrometry and infrared (IR) spectroscopy suggested that the outside of the stone was composed of calcium oxalate monohydrate (COM) and the inside of uric acid (UA). Proteomic analysis identified 37 and 14 proteins from the inside and outside of the stone, respectively, as matrix proteins. The proteins that were identified in an ethylenediaminetetraacetic acid (EDTA) fraction were able to bind calcium ions. Thus, calcium-binding proteins may play a significant role in the formation of urinary stones in patients with hyperuricemia.

Evaluation of biochemical urinary stone composition and its relationship to tap water hardness in Qom province, central Iran

PurposeThe aim of this study was to evaluate the biochemical stone composition in general population of Qom province, central Iran, and its relationship with high tap water hardness.Materials and methodsIn a prospective study, from March 2008 to July 2011, biochemical analysis of urinary stones in patients living in Qom province for at least 5 years was performed. Stones were retrieved by spontaneous passage, endoscopic or open surgery, and after extracorporeal shockwave lithotripsy. Demographic findings and the drinking water supply of patients were evaluated and compared with biochemical stone analysis.ResultsStone analysis was performed in 255 patients. The most dominant composition of urinary stones was calcium oxalate (73%), followed by uric acid (24%), ammonium urate (2%), and cystine (1%). The peak incidence of urinary stone was in patients in their forties. Overall male to female ratio was 4.93:1.ConclusionThe dominant stone composition in inhabitants of central Iran, where tap water hardness is high, was calcium oxalate stones. On the basis of this study, biochemical urinary stone composition of Qom does not differ from other regions of Iran with lower water hardness.

Clinical implication of peri-operative urine bacterial examination in upper urinary tract stone

Objective To analyze the bacterial distribution and resistance in upper urinary tract stone patients, then choose suitable antibiotics and reduce infectious complications accordingly.Methods Middle flow urine, infectious stone and the end of kidney drainage tube were taken for culture in 148 patients who underwent percutaneous nephrolithotomy between January 2009 to September 2010. Antibiotics were used according to the culture results and the complications secondary to infection were analyzed. Results Urinary pathogens presented in 38 (25.7%) patients before operation.There were 112 strains of bacteria. The predominant strains included: Escherichia coli (17 cases,11.5%), Staphylococcus epidermidis (4 cases) and Proteus mirabillis (4 cases). Escherichia coli and Proteus mirabillis were common in stone culture. Staphylococcus epidermidis (5 cases),Pseudomonas aeruginosa (5 cases) and Staphylococcus haemolytcus (5 cases) were found in renal drainage tube culture which were positive in 25 patients. Imipenem, cefepime, vacomycin, nitrofurinton were sensitive and commonly used antibiotics. Forty-one patients (27.7 %) had fever postoperatively, including 10 positive for middle urine culture and 9 positive for drainage tube culture. One infective shock was diagnosed postoperatively. Conclusions Gram-negative bacilli are predominant in the upper urinary tract stone patients preoperatively. Gram-positive ones are common postoperatively.Suitable antibiotics, based on middle flow urine culture, could reduce urinary infective complications. Key words: Urinary calculi; Microbial sensitivity test; Perioperative period

Electrical conductivity and total dissolved solids in urine

The objective of this paper is to study the relevance of electrical conductivity (EC) and total dissolved solids (TDS) in early morning and random samples of urine of urinary stone patients; 2,000 urine samples were studied. The two parameters were correlated with the extent of various urinary concrements. The early morning urine (EMU) and random samples of the patients who attended the urinary stone clinic were analysed routinely. The pH, specific gravity, EC, TDS, redox potential, albumin, sugar and microscopic study of the urinary sediments including red blood cells (RBC), pus cells (PC), crystals, namely calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), uric acid (UA), and phosphates and epithelial cells were assessed. The extent of RBC, PC, COM, COD, UA and phosphates was correlated with EC and TDS. The values of EC ranged from 1.1 to 33.9 mS, the mean value being 21.5 mS. TDS ranged from 3,028 to 18,480 ppm, the mean value being 7,012 ppm. The TDS levels corresponded with EC of urine. Both values were significantly higher (P < 0.05) in the EMU samples than the random samples. There was a statistically significant correlation between the level of abnormality in the urinary deposits (r = +0.27, P < 0.05). In samples, where the TDS were more than 12,000 ppm, there were more crystals than those samples containing TDS less than 12,000 ppm. However, there were certain urine samples, where the TDS were over 12,000, which did not contain any urinary crystals. It is concluded that the value of TDS has relevance in the process of stone formation.

Stone symptoms and urinary deposits

There is a general belief among the public and clinicians that urinary stone problem is always associated with symptoms like pain, dysuria and haematuria. Many patients stop medical treatment when they are symptom free and return with excruciating pain, dysuria and haematuria either alone or in combination. The objective of this study was to determine stone activity in an individual patient by assessing the urinary deposits at the time of the visit to the stone clinic and correlate with the presence or absence of symptoms at that time. 418 patients who attended the stone clinic in 2007 with proved urinary stone disease, including stone, colic and crystalluria, were studied. Presence or absence of symptoms at the time of presentation was recorded. Minimum of two samples of urine was collected (early morning and random) to assess the presence and extent (1-5) of urinary deposits namely red blood cells (RBC), pus cells (PC), calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), uric acid and phosphate. The scores obtained were correlated with the presence or absence of symptoms by logistic regression. Of the 418 patients studied, 238 had symptoms and 180 had no symptoms. The total score of the deposits of patients with symptoms was 1,215 with a mean of 3.39 per patient against the score of 350 in the patients without symptoms with a mean of 2.99. This difference was not statistically significant. The total values and mean scores of the urinary deposits of all patients grouped together were RBC 561 (3.51), PC 434 (3.29), COM 177 (3.34), COD 237 (3.25), phosphate 113 (3.23) and uric acid 43 (1.95). Comparison of the total values and mean scores of the deposits of the patients with and without symptoms showed the variations as RBC 428 (3.51) versus 133 (3.5) PC 341 (3.38) versus 93 (3.0), COM 143 (3.25) versus 34 (3.78), COD 190 (3.88) versus 47 (1.96), phosphate 76 (3.3) versus 37 (3.1) and uric acid/ammonium urate 37 (1.95) versus 6 (2.0). Of these, the RBC, PC, uric acid and phosphates were not significantly different between the two groups. However, the presence of COD was significantly more in patients with symptoms (P < 0.05) and COM was significantly more in patients without symptoms (P < 0.05). It is concluded that the presence or absence of symptoms does not alter the presence and extent of urinary deposits significantly in the urinary stone patients. COD was more in symptomatic patients and COM was more in the asymptomatic patients. This contrast could be due to the morphology of the COD crystal which is dipyramidal and produces injury to urolthelium whereas COM is dumbbell shaped and produces lesser injury and lesser symptoms.

Photmicrography of urinary deposits in stone clinic

The importance of routine urine deposit study has not been projected satisfactorily in literature. This paper analyses the findings of urine microscopy of urinary stone patients who attended the stone clinic. A total number of 800 patients who attended the urinary stone clinic during the years 2005-2007 were selected for the study. Each patient had two samples of urine studied; early morning urine (EMU) and random. The patients were classified into different groups as proved stone patients (304), colic patients (289) and crystalluria patients (207). They were further classified as pre-treatment group and post-treatment group. The patients had chemotherapy depending on the biochemical abnormalities. The urine samples were centrifuged and the deposits examined under the low-power and high-power magnifications of the binocular microscope. The appropriate fields were photographed using a micro-photographic camera. 23% of the urinary samples studied contained deposits (36% of the EMU and 16% of the random samples). The most common deposits were red blood cells (RBC) (17%), pus cells (PC) (13%), calcium oxalate monohydrate (COM) crystals (7%), calcium oxalate dihydrate (COD) crystals (11%), uric acid crystals (2%), amorphous phosphates (1%), epithelial cells (13%) and sperms (7%). The unusual deposits included ammonium urate and cystine. Comparison of the results of deposits with those of 473 deposits from other laboratories showed that the present reports showed much more deposits than the outside ones. Deposits were more in the male patients (25%) compared to the females (19%). 83% of the patients with significant deposits had symptoms at the time of collection of sample, while 17% were not symptomatic. Among the patients with crystals, 53% had RBC associated and 49% had PC. RBCs were seen most in the COD crystal group. PC alone were seen in 2% and all were females. Percentage of urinary deposits was more in the pre-treatment group (32%) than in the post-treatment group (17%). Extent of crystalluria was more in the colic group (38%) compared to the crystalluria (22%) and stone (13%) groups. It is concluded from the study that accurate assessment of the urinary stone patient lies in a proper microscopic evaluation. It is mandatory that EMU should be examined as there is greater chance of identifying crystals and other deposits. Centrifuged deposits showed more deposits and these should be standards in urine examination. Regular urine deposit examination should be performed in all patients coming for follow-up.

Pattern of family history in stone patients

Genetic predisposition to urolithiasis is a much discussed topic. The objective of this paper is to identify the types of family members of proved urinary stone patients, who have a history of urinary stone formation. The study population consisted of 2,157 urinary stone patients interviewed in 2003-2007 in the urinary stone clinic. Family members with stone history were classified as group 1--first order single (one person in the immediate family-father, mother, siblings, or children), group 2--first order multiple (more than one member in the above group), group 3--second order single (one person in the blood relatives in family--grandparents, grandchildren, uncles, aunts, cousins, etc.) and group 4--second order multiple (more than one member in the above group). Of the 2,157 patients studied, 349 patients gave positive history of stone disease constituting 16.18%. Of these, 321 were males and 28 were females. Subdivision of the family members showed that 282 patients (80.80%) had single family member with stones and the rest 67 (19.20%) had multiple family members with history of stone disease. Group 1 which constituted one family member in the immediate family had 255 involvements (father: 88, mother: 16, brother: 135, sister: 2, son: 10, and daughter: 4); Group 2 with multiple members in the immediate family constituted 51 relatives; of these, father and brother combination was the most common with 35 occurrences. Group 3 with one person in the distant relatives in family namely grandparents, grand children, uncles, aunts, cousins, etc. constituted 27 occurrences and Group 4 with more than one member in the distant family constituted 16 occurrences. It is concluded that single family member involvement was more than multiple involvements. Males predominated. Stone occurrence was more in the immediate family members than distant relatives. Brothers formed the most common group to be involved with stone disease. Study of stone risk in the family members should be centred on brothers and sons of stone patients.

Evaluation of Urolithiasis: A Link between Stone Formation and Diabetes Mellitus?

Introduction: The pathogenesis of calcium oxalate stone formation is not completely understood. Recently, an influence of vascular phenomena like arteriosclerosis on the crystallization process was hypothesized. Thus, stone formation should be more common in patients with diabetes mellitus (DM) who are at risk of developing angiopathy. The aim of the study was to determine the prevalence of urolithiasis (UL) in patients with DM and to identify specific risk factors. Material and Methods: 350 patients with DM were evaluated with respect to DM-related history, and a total of 179 patients was included (83 female, 96 male; age 23–84 years). All patients were interviewed to assess the history of stone formation. These data were compared to epidemiological data in Germany. Results: The overall prevalence of UL in the diabetic group was 7.82% (vs. 4.73% in Germany, p = 0.0485; binominal test). The prevalence was significantly higher in patients with coronary heart disease (25%; p < 0.0001; Fisher‘s exact test). We could not demonstrate an increased prevalence of UL for patients with occlusive arterial disease or arterial hypertension as diabetic nephropathy was not a risk factor for developing urinary lithiasis (p = 0.7184, p = 1.000, p = 0.6266, respectively; Fisher’s exact test). Thiazide medication lowered the prevalence of stone formation (p = 0.0399; Fisher’s test). Calcium or magnesium supplementation did not influence stone formation significantly (p = 0.5279; p = 1.000; respectively; Fisher’s test). Conclusions: In Germany, patients with DM are at higher risk of UL compared with patients without diabetes. We demonstrated a significantly higher prevalence of urinary stones in patients with coronary heart disease. These findings are consistent with the hypothesis that urinary stone formation has a vascular pathogenesis in part.

Determination of urinary stone composition based on stone morphology: a prospective study of 325 consecutive patients in an emerging country

Urolithiasis is a common disease that is increasing throughout the world. This study aimed at determining the composition of urinary stones in patients with renal lithiasis in an emerging country. A morphological analysis was performed on 340 urinary stones from 325 consecutive patients from Brazil with lithiasis. Among the 340 stones analyzed, 34.7% were pure. The most frequent stone was calcium oxalate (CaOx) (59.3%), followed by uric acid (23.7%). CaOx was more frequently seen in women (p=0.024), while uric acid was more common in men (p<0.001). Among the mixed stones, CaOx (67.1%) was the most frequent major component, followed by carbapatite (11.2%) and struvite (7.9%). CaOx (p<0.001) and uric acid (p=0.014) were more frequently the major components in men, while carbapatite (p<0.001) and struvite (p=0.011) were more frequent in women. The major component of both pure and mixed stones was CaOx (65.1%), followed by uric acid (10.9%), carbapatite (10%), struvite (6.7%), ammonium urate (5.1%), cystine (1.8%) and protein (0.4%). These findings may be related to regional factors, such as weather and nutritional habits.

Antegrade Pyelography Versus Unenhanced Multidetector CT in the Assessment of Urinary-Tract Stones after Percutaneous Nephrostomy Insertion: A Prospective Blinded Study

In patients with a percutaneous nephrostomy tube (PCN) inserted for symptomatic stone disease, antegrade pyelography is an accepted modality to assess the collecting system and residual stone status prior to PCN removal. Recently, unenhanced multidetector CT (UMDCT) has shown its superiority for the assessment of urinary-tract stones. Comparison of UMDCT with antegrade pyelography has never been done; hence, our aim was to compare the two methods for the assessment of urinary stones in patients with a PCN. Between July 2004 and July 2005, we prospectively imaged 49 consecutive patients with known urinary-tract stone disease who had PCN (27 men and 22 women; average age 57 +/- 20 years; range 4-88 years). All patients underwent UMDCT and antegrade pyelography within 24 hours. Both examinations were prospectively and blindly evaluated by two attending radiologists for the presence, location, and size of urinary-tract stones. According to the findings of both imaging modalities, 18 patients were stone free, and 31 patients had urinary stones. In 20 of the latter 31 patients (64.5%), the urinary stones were diagnosed only by UMDCT. Antegrade pyelography missed renal as well as ureteral stones, with a significant mean size (5.1 x 6.2 mm, and 6 x 5.3 mm, respectively). Antegrade pyelography missed radiolucent (8/20) as well as radiopaque (12/20) stones. In 11 of the 31 patients (35.5%), urinary stones were diagnosed by both UMDCT and antegrade pyelography. The average size of these renal stones was 6 x 11 mm, and the mean ureteral stone size was 11 x 13 mm. In 64% (7/11), the stones were radiolucent and in 36% (4/11) radiopaque. There was no patient in whom urinary stones were diagnosed by antegrade pyelography but missed by UMDCT. Unenhanced multidetector CT is more accurate than antegrade pyelography via a PCN for the assessment of urinary-tract stones, with the advantage of reducing the risks of contrast injection side effects.