Urinary System Stones Research Articles

The results of two-years shock wave lithotripsy treatment in urinary system stones

Amac: Uriner sistem taslarinda vucut disi sok dalgasi ile tas kirma (SWL) tedavisi ile basari oranlari ve basariyi etkileyen faktorleri incelemek. Gerec ve yontem: Subat 2010 ile Aralik 2011 tarihleri arasinda Mustafa Kemal Universitesi Tip Fakultesi Uroloji Anabilim Dali\'nda uriner sistem taslari nedeni ile SWL tedavisi yapilan 101 hastaya ait bilgiler geriye donuk olarak incelendi. Hastalarin cinsiyetleri, tas lokalizasyonlari, tas bulunan bobrek, tas boyutlari, tedavi sonuclari, tassizlik oranlari belirlendi. Bulgular: Calismamiza 68(%67,3) erkek, 33(%32,7) kadin olmak uzere toplam 101 uriner sistem tasi olan hasta incelendi. Bobrek taslarinin lokalizasyona gore basari oranlarimiz tas boyutundan bagimsiz olarak alt kalikste %52,4, orta kalikste %68, ust kalikste %100, pelvis yerlesimli taslarda %76,5 olarak bulundu. Calismamizda tas boyutlarina gore basari oranlari 100 mm2\'den kucuk taslar icin %73,7, 100-200 mm2 arasi taslar icin %75, 200-300 mm2 arasi taslar icin %25ve 300 mm2\'den buyuk boyutundaki taslarda ise %50 olarak saptandi. Ureter bolgelerine gore SWL basari oranlarimiz ust ureterde %75, orta ureterde %76,9 ve alt ureterde %71,4 olarak bulundu. Sonuc: SWL\'de basari tas boyut ve lokalizasyonuna baglidir. Basari oranlarimiz tasin boyut ve lokalizasyonlarina gore degismekle beraber onceki raporlarla uyumlu bulunmustur.

USING BMI TO FIND THE INFLUENCE OF OBESITY AND OVER WEIGHT ON THE RECURRENCE OF URINARY STONES IN THE WESTERN REGION OF IRAQ

This study was carried out to discover influence of increase of body weight and hyper obesity in infection of urinary system and kidney stones by using BMI and compare it with the chemical variants in serum and urine in 24 hours for 200 patient which are infected with persistent urinary system stone and most of them are suffering from increase of body weight and hyper obesity. The results showed the role of these variants to forming the urine fluid until become saturated in some its components from the salts which produce crystals and precipitate to form the stones.In addition to clear decrease in inhibitors concentration in blood and urine. Rate of uric acid was (51 %) calcium oxalate (29%) calcium phosphate (13%) and Magnesium. Ammonium. Phosphate( M.A.P) (7%) increasing in rate of uric acid specially among of the patients which are suffering from increase weight and hyper obesity related to trophic quality in the region of the study and wrong trophic habits for patients, the greater infection rate was found in males may be due to influence of males and females hormones in the blood.Reduction of urine volume because exposure to hot weather and drink the liquid in a little amounts as well the acidic urine all of them important reasons to persistent the stones as well as variations in level of creatinine in blood and clearance of creatinine in blood and urine indicate to defect of glomeruler filtration as result for block out which caused by stone existence in the tubules of the kidney; also because of damage of the nephrone.

Challenging group of urinary system stones in childhood: Cystinuria

Challenging group of urinary system stones in childhood: Cystinuria

943 A NEW DISSOLVABLE MECHANICAL KNOT MAKING NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY A REALITY IN THE URINARY SYSTEM

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011943 A NEW DISSOLVABLE MECHANICAL KNOT MAKING NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY A REALITY IN THE URINARY SYSTEM Jude Sauer, Heather Leigh, Idris Ocal, Erik Castle, Paul Andrews, and Mitchell Humphreys Jude SauerJude Sauer Victor, NY More articles by this author , Heather LeighHeather Leigh Victor, NY More articles by this author , Idris OcalIdris Ocal Phoenix, AZ More articles by this author , Erik CastleErik Castle Phoenix, AZ More articles by this author , Paul AndrewsPaul Andrews Phoenix, AZ More articles by this author , and Mitchell HumphreysMitchell Humphreys Phoenix, AZ More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.861AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The next frontier of minimally invasive surgery is natural orifice translumenal endoscopic surgery (NOTES). NOTES techniques involving the urinary system are uniquely limited as any permanent materials will serve as a nidus for encrustation, stone, or even fistula formation. The purpose of this research is to characterize a novel alloy that allows sutures to be mechanically tied while slowly dissolving in the urinary system though a NOTES platform. METHODS Three mature female survival pigs were used and sacrificed at 1, 2, and 3 weeks. The TK–5 (LSI SOLUTIONS Inc, Victor NY) device was used to place either titanium (Ti) or magnesium (Mg) knots on several different tissues though an open incision. Twenty two control Ti and 41 Mg knots were placed on the peritoneal surface of the stomach, left fallopian tube, bladder, inside the bladder, and used to close a cystotomy. The animals were observed for urine leak, stone formation, or complication and at sacrifice tissue was harvested for histopathological examination. RESULTS All animals survived with no adverse events or infections. All cystotomies were hermetic with no urine leaks. The tissue was collected showing similar phases of healing in response to both the Mg and Ti knots. Figures below indicate the Mg (embeded in tissue) vs the Ti knot with scanning electron microscopy. The magnesium knots began to dissolve by the first week, but maintained there holding strength and configuration through the third week. No encrustation of stones formed on any of the knots. CONCLUSIONS The use and safety of titanium has been widely exploited in the peritoneal space for many years, but when used in the urinary system stone formation results. The development of novel magnesium knots allows utilization in the urinary system without the risk of stone formation while providing equivalent holding strength and tissue healing. While more study is needed, this opens the urinary portal to NOTES applications through a reliable and safe method of closure. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e378-e379 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jude Sauer Victor, NY More articles by this author Heather Leigh Victor, NY More articles by this author Idris Ocal Phoenix, AZ More articles by this author Erik Castle Phoenix, AZ More articles by this author Paul Andrews Phoenix, AZ More articles by this author Mitchell Humphreys Phoenix, AZ More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment modalities for the upper urinary system stone disease in Turkey

Submitted (Geli tarihi): 28.07.2010 Accepted after revision (Duzeltme sonras kabul tarihi): 25.09.2010 Ozet Amac: Bu cal mada Turkiye genelinde 2008 y l nda ust uriner sistem ta hastal nda tercih edilen tedavi yaklamlar n belirlemeyi amaclad k. Gerec ve yontem: Ulkemizde Sosyal Guvenlik Kurumu’una ba l olarak sa l k hizmeti sunan kurumlar t bbi istek kay tlar n dijital olarak Sosyal Guvenlik Kurumu taraf ndan kontrol edilen ve toplumun %70’ini kapsayan bir veri havuzuna gonderirler. Bu veriler sa l k politikalar n n olu turulmas n h zland rmak icin ulusal sa l k otoritelerince analiz edilirler. Bu cal mada, bu havuzdan secilmi verileri kullanarak 2008 y l nda belirli bir zaman dilimi icinde (10 ay) uriner ta hastal na tedavi yakla mlar n de erlendirdik. Ulke geneline ait 1 y ll k verileri tahmin etmek icin, elde edilen veriler tum populasyona yans t lm t r. Ust uriner sistem ta hastal tedavisinde ac k cerrahi, perkutan nefrolitotomi (PCNL), ureteroskopi (URS) ve ok dalga litotripsi (ESWL) uzerine kantitatif veriler tahmin edilmi tir. Veriler hasta say s ndan cok i lem say s n ifade etmektedir. Bulgular: Bir y l icinde 751,844 urolojik giri im gercekle tirilmi , bunlar n %6.2’si uriner sistem ta hastal ile ili kili olmu tur. Ust uriner sistem ta hastal nedeniyle toplam 87,302 hastaya bir y l icinde cerrahi tedavi ya da ESWL tedavisi uygulanm t r. Cerrahi tedavi ve ESWL tedavisi s ras yla 46,619 (%53.3) ve 40,683 (%46.7) hastaya yap lm t r. Ust uriner sistem ta hastal icin tedavi yakla mlar aras nda ac k renal (%11) ya da uretral cerrahi (%6), PCNL (%17) ve ureterorenoskopik litotripsi (%66) farkl oranlarda uygulanm t r. Sonuc: Turkiye’de uriner sistem ta hastal icin uygulanan prosedurler tum urolojik i lemler aras nda onemli yer olu turmaktad r. Tum ust uriner ta tedavisinde ESWL oran yakla k %50’dir. Ac k bobrek cerrahisi %39 oran yla hala s k uygulanan bir i lemdir. Di er ulkelerden bildirilen verilerdeki guncel e ilime benzer olarak, Turkiye’de ilk tedavi secene i URS’dir.

The Effects of Hydronephrosis and Stone Burden on Success Rates of Shockwave Lithotripsy in Pediatric Population

To evaluate the efficacy of shockwave lithotripsy (SWL) with a third-generation SWL machine in the pediatric age group and to determine the effects of stone burden and the degree of hydronephrosis on the results. Two hundred and sixty children with urinary system stones were treated with Siemens Lithostar Modularis Uro-Plus. The patients were divided into three groups according to stone burden (group 1: <100 mm(2); group 2: 101-200 mm(2); group 3: >200 mm(2)) and into four groups according to the degree of hydronephrosis (group 0: absent; group 1: mild; group 2: moderate; group 3: severe). These groups were compared in terms of the success rate of SWL. Two hundred and seventy-nine renoureteral units of 260 patients were treated with 402 SWL sessions. The average stone burden was 98.2 mm(2) (range: 11-525). The overall success rate was 87.5%. According to stone burden, the success rate was 93.1% in group 1, 85.5% in group 2, and 60% in group 3 (p < 0.001). According to the degree of hydronephrosis, the success rate was 93.8% in group 0, 89.6% in group 1, 73.3% in group 2, and 64.3% in group 3 (p < 0.001). The average energy, number of shockwaves, number of sessions, retreatment rate, auxiliary procedure rate, and overall efficacy quotient were 1.76 units, 2260, 1.4, 33%, 8.2%, and 0.62, respectively. SWL is an effective treatment method in selected patients in pediatric age group. However, percutaneous nephrolithotomy can be the first alternative for stones larger than 200 mm(2). It should also be kept in mind that the success rate of SWL decreases when the degree of hydronephrosis increases.

Histamine 1 Receptor Antagonist in Symptomatic Treatment of Renal Colic Accompanied by Nausea: Two Birds With One Stone?

The pain-relieving efficacy of antagonists of histamine 1 (H1) receptors that are widely found in the ureter and that cause contractions in renal colic was presented in comparison with a placebo. Eighty-six patients who presented to the emergency service because of renal colic accompanied by nausea, and who had urinary system stones detected were included in the study. The patients were separated into 2 groups by double-blind, random assignment. The 45 patients in group 1 received 50 mg intramuscular (IM) dimenhydrinate. The 41 patients in group 2 received 2 mL IM saline solution as a placebo. The visual analogous scale (VAS) values were detected at referral of the patients and at 10, 20, and 30 minutes of therapy to detect the pain intensity. Verbal descriptive scale (VDS) was used for evaluation of nausea and vomiting before and after the therapy. VAS values were statistically quite low in group 1 at 10, 20, and 30 minutes of therapy. VDS scores were also statistically significantly low in group 1 at 30 minutes of treatment. Dimenhydrinate, which is an ethanolamine group H1 receptor blocker, appeared to be effective compared with the placebo in relieving renal colic pain and nausea and vomiting symptoms in patients. Comparative studies with other analgesics will be useful for determining how to use this agent for analgesic purposes in renal colic.

A Rare Case Of A Giant Urethral Calculus

Introduction: A urinary calculus in the urethra is rarely seen and usually encountered in men with urethral stricture or diverticulum. Herein, we are reporting a rare case of a giant calculus in the anterior urethra of a male patient. Case report: A 39-year-old male presented with acute retention of urine and a hard dull aching mass in the anterior perineum. On examination, a hard mass of 5x4x3cm was palpable in the perineum at the base of the scrotum. X-ray of the pelvis showed a stone in the anterior urethra. Urethrotomy with stone removal was done. The postoperative period was uneventful. Conclusion: A large primary urethral calculus is very rare and may form in the urethra when a urethral stricture or a diverticulum is present. INTRODUCTION Most of the urinary system stones are located in the upper urinary system. They are uncommon in the urethra (1,2,3), usually get formed proximally and get stuck in urethra or may rarely get formed primarily in urethra (2). Urethral calculi represent less than 1% of all urinary stone disease (3). Giant urethral calculi are even rarer. Most urethral calculi migrate from the urinary bladder. Urethral calculi may get formed primarily in the urethra proximal to a urethral stricture or in a diverticulum. The majority of urethral calculi occur in males (4) and urethral calculus is an extremely rare finding in females (1). We describe a case of a giant urethral stone, impacted in the urethra of a 39-year-old male. CASE REPORT A 39-year-old, otherwise healthy male patient presented to the surgical clinic with acute urinary retention. He had also been complaining of a hard mass in the anterior perineum for the past 8 years. The patient had been having onand-off history of burning micturition associated with fever for 6 years. Two episodes of hematurea were noted by the patient in the last 10 months. He was apparently alright 8 years back. There was no history of pelvic trauma in the past. On examination, the urinary bladder was distended up to the level of the umblicus. A hard mass of 5x4x3cm was palpable in the anterior perineal region at the base of the scrotum. It was painless, causing mild discomfort only. General physical examination did not reveal any abnormality. Routine metabolic work-up and the renal function tests were normal. Urine culture did not show any growth. Levels of serum parathyroid hormone and serum calcium were within normal range. Digital rectal examination did not detect any abnormality. Plain X-ray of the pelvis showed a large calculus in the anterior urethra. Plain X-ray and ultrasound scans of the kidney, ureter and bladder area were all normal. A Rare Case Of A Giant Urethral Calculus 2 of 4 Figure 1 Figure 1: Urethrotomy for removal of stone Figure 2 Figure 2: Foley's catheter being passed through the urethra Figure 3 Figure 3: Specimen of stone after removal Urgent surgical removal of the stone was planned because of its large size. Urethro-lithotomy was done. A stone weighing 75g was removed. Chemical analysis of the stone revealed the presence of triple phosphates. DISCUSSION Urethral stones are encountered infrequently in urological practice and the studies published in the literature consist of small series and several case reports. Most of the urinary stones are located in the upper urinary system and urethral calculi as such are uncommon (1%) (1,3). Depending upon their site of origin, urethral stones are classified as (a) primary or autochthonous and (b) secondary or migrating (5,6,7). Secondary stones are more common than primary stones and have migrated from higher up in the urinary tract (5,6,7,8). Urethral calculi are usually small (5,6). Giant urethral calculi are rare. The majority of urethral calculi occur in males (4). Urethral calculi may be completely asymptomatic or may be accompanied by one of the following symptoms: perineal or penile pain, frequency, urgency, diminished urinary stream, dribbling, hematuria or/and urethral discharge due to infection. The patient may present with acute retention of urine with insignificant past history. The diagnosis is based on clinical history and relevant investigations (5,6,7,8). Management of urethral calculi varies according to site and size and associated urethral disease. Retrograde manipulation into the urinary bladder followed by litholapaxy or lithotripsy is a suitable procedure for posterior urethral calculi. Anterior urethral calculi can be treated with instillation of 2% lidocaine jelly or ventral meatotomy according to their localization. Giant urethral calculi should be treated with open surgery. Besides, if the urethra has an associated stricture or has been damaged by prior attempts of extraction, stone removal and urethroplasty are preferable (3). CORRESPONDENCE TO DR. ONKAR SINGH RESIDENT SURGICAL OFFICER DEPARTMENT OF SURGERY M.G.M MEDICAL COLLEGE & M.Y.H GROUPS OF HOSPITALS INDORE, MADHYA PRADESH, INDIA-452001 (CONTACT NO. 91-98937-77321) (Email: dronkarsingh@gmail.com )

Body mass index, body fat percentage, and the effect of body fat mass on SWL success

In the present study, we investigated the effects of the Body Mass Index (BMI), the Body Fat Percentage (BFP), and the Body Fat Mass (BFM) on success of SWL, prospectively. The BMI, BFP, BFM values of patients, who were treated by SWL due to upper urinary system stone disease (pelvis renalis, upper ureter, kidney lower and upper calices) between January and December 2005 in our hospital's urolithiasis center, were measured. Patients with stones smaller than 5 mm or larger than 20 mm and patients who had a stone localized somewhere other than in the upper urinary system, were not included in the study. Patients evaluated to be clinically successful according to the SWL were put in group 1, and the other patients who were not successful were included in group 2. About 158 (97 male, 61 female) patients aged between 16 and 92 (mean 36.69 (+/-13.22) years), put on SWL therapy due to presence of upper urinary system stone disease, were included in the study. While the mean BMI was 23.97 +/- 0.4 in group 1 and 25.98 +/- 0.5 (P = 0.02) in group 2, BFP was 23.85 +/- 0.8 in group 1 and 29.19 +/- 1.1 (P = 0.001) in group 2, and BFM was determined to be 16.74 +/- 0.7 and 21.19 +/- 1.01 (P = 0.001) in group 2. Regarding all the parameters (BMI, BFP, BFM), the statistical analyses carried out between the groups showed significant differences. BFP and BFM parameters are also important factors along with the BMI in providing a successful SWL treatment. All the parameters should be considered regarding the success of the treatment and the patients should be informed.

Bone mineral density measurement in patients with recurrent normocalciuric calcium stone disease

To investigate bone mineral densitometry findings in patients with normocalciuric urinary system stone disease, we compared 150 patients with normocalciuric calcium stone disease (group 1) and 60 subjects of a control group (group 2). The patients were compared according to bone mineral content (BMC), bone area (BA), bone mineral density (BMD), T-score and Z-score values of femur neck, total femur and lumbar spine (L2-L4) by dual energy absorptiometry. We found that 76.6% of the patients in group 1 and 20.0% in group 2 had low BMD; 11.3% of patients in group 1 had osteoporosis and 65.4% had osteopenia. In the control group, there was no osteoporosis, but 20.0% of the subjects had osteopenia. In group 1, there was hyperoxaluria in 26.0% of patients, hypocitraturia in 15.3% of patients, hyperuricosuria in 6.0% of patients, both hypocitraturia and hyperoxaluria in 8.6% of patients in a 24-h urine analysis. Urine analysis was normal in 44.0% of patients. Our results showed a severe loss of bone mass in patients with urinary system normocalciuric calcium stone disease. Thus, the necessary precautions concerning bone mass protection should be taken and the patients should be informed about this issue.

A Comparison Study between Theophylline and Placebo in Passage of Ureteral Stones

Considering the high prevalence of urinary system stones and that non-medical treatments have more costs and side effects, we decided to evaluate the effect of theophylline in the passage of ureteral stones. One hundred and fifty patients with ureteral stones were assigned into groups A and B, whose age, sex, size of stone, and location of stone were matched together. Patients' ages ranged from 17 to 67 years. In group A theophylline (200 mg BID) was administered and group B received placebo for six weeks. Both groups were followed up by visits every fortnight and radiological assessment was performed at the end of the sixth week. The proportion of patients whose stones were passed was compared between the two groups. In group A with theophylline consumption 46 out of 75 (61.3%) passed their stones. The mean duration between the initiation of the treatment with theophylline and stone passage was18.3 days. In group B with placebo, the stone passage occurred in 31 out of 75 (41.3%) patients (p<0.032) and the mean duration was 24.8 days (p<0.05). With regard to the findings of this study, it seems that theophylline can increase the rate of ureteral stone passage and as well, accelerate it.

Uropathogens and urinary tract concretion formation and catheter encrustations

Infection stones (ammonium magnesium phosphate) and catheter encrustations have a common cause—urease producing microorganisms. With their rapid growth and frequent recurrences, infection stones are among the most troublesome of urinary system stones. For many patients with a long-term indwelling catheter, encrustations can be a severe problem. Urine composition is important, because, urine calcium enhances the crystallization process and urine citrate inhibits it. The role of non-urease producing microorganisms in stone forming processes is not well understood. Stones can now be successfully treated with a low morbidity index by percutaneous stone surgery or extracorporeal shock wave lithotripsy (ESWL) and recurrence of stone formation is then avoided by prolonged antibiotic treatment and oral citrate. Catheter encrustations and damage caused by ammonia released during urease activity can, however, be a serious problem in patients with indwelling catheters and our remedies are unsatisfactory.