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Sample records for complex renal stones

  1. Retrograde Intrarenal Surgery for Complex Stones in a Toddler with Congenital Renal Anomalies: Technical Details

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    Murat Can Kiremit

    2015-07-01

    Full Text Available We report herein the management of a challenging case due to anatomic and stone-related complications in a 37-month-old Caucasian toddler with megacalycosis and complex stone in the left kidney and duplicated ureter on the right side.

  2. Screening renal stone formers for distal renal tubular acidosis

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    A group of 110 consecutive renal stone formers were screened for distal renal tubular acidosis (RTA) using morning fasting urinary pH (mfUpH) levels followed by a short ammonium chloride loading test in patients with levels above 6.0. In 14 patients (12.7%) a renal acidification defect was noted...... RTA in renal stone formers. Regardless of whether the acidification defect is primary or secondary to stone formation, however, all renal stone formers with distal RTA can expect to benefit from prophylactic alkaline therapy and it is recommended that the screening procedure, which is easy to use...

  3. Distal renal tubular acidosis in recurrent renal stone formers

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    Renal acidification ability was examined in 90 recurrent renal stone formers, using fasting morning urinary pH levels followed by a short ammonium chloride loading test in subjects with pH levels above 6.0. Fifteen patients (16.6%) revealed a distal renal tubular acidification defect: one patient......, this has important therapeutic implications. The pathological sequence in renal stone formers with dRTA is discussed....

  4. Antegrade ureteroscopic assistance during percutaneous nephrolithotomy for complete renal staghorn stone: Technique and outcomes

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    Yuh-Shyan Tsai

    2015-03-01

    Conclusion: Such an ancillary procedure might be suitable for the management of complete staghorn stones or other complex renal stones in patients in whom adequate intracalyceal space was not available for the creation of nephrostomy access.

  5. Evidence Report: Risk of Renal Stone Formation

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    Sibonga, Jean D.; Pietrzyk, Robert

    2017-01-01

    The formation of renal stones poses an in-flight health risk of high severity, not only because of the impact of renal colic on human performance but also because of complications that could potentially lead to crew evacuation, such as hematuria, infection, hydronephrosis, and sepsis. Evidence for risk factors comes from urine analyses of crewmembers, documenting changes to the urinary environment that are conducive to increased saturation of stone-forming salts, which are the driving force for nucleation and growth of a stone nidus. Further, renal stones have been documented in astronauts after return to Earth and in one cosmonaut during flight. Biochemical analysis of urine specimens has provided indication of hypercalciuria and hyperuricemia, reduced urine volumes, and increased urine saturation of calcium oxalate and calcium phosphate. A major contributor to the risk for renal stone formation is bone atrophy with increased turnover of the bone minerals. Dietary and fluid intakes also play major roles in the risk because of the influence on urine pH (more acidic) and on volume (decreased). Historically, specific assessments on urine samples from some Skylab crewmembers indicated that calcium excretion increased early in flight, notable by day 10 of flight, and almost exceeded the upper threshold for normal excretion (300mg/day in males). Other crewmember data documented reduced intake of fluid and reduced intake of potassium, phosphorus, magnesium, and citrate (an inhibitor of calcium stone formation) in the diet. Hence, data from both short-duration and long-duration missions indicate that space travel induces risk factors for renal stone formation that continue to persist after flight; this risk has been documented by reported kidney stones in crewmembers.

  6. Management of Asymptomatic Renal Stones in Astronauts

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    Reyes, David; Locke, James

    2016-01-01

    Introduction: Management guidelines were created to screen and manage asymptomatic renal stones in U.S. astronauts. The risks for renal stone formation in astronauts due to bone loss and hypercalcuria are unknown. Astronauts have a stone risk which is about the same as commercial aviation pilots, which is about half that of the general population. However, proper management of this condition is still crucial to mitigate health and mission risks in the spaceflight environment. Methods: An extensive review of the literature and current aeromedical standards for the monitoring and management of renal stones was done. The NASA Flight Medicine Clinic's electronic medical record and Longitudinal Survey of Astronaut Health were also reviewed. Using this work, a screening and management algorithm was created that takes into consideration the unique operational environment of spaceflight. Results: Renal stone screening and management guidelines for astronauts were created based on accepted standards of care, with consideration to the environment of spaceflight. In the proposed algorithm, all astronauts will receive a yearly screening ultrasound for renal calcifications, or mineralized renal material (MRM). Any areas of MRM, 3 millimeters or larger, are considered a positive finding. Three millimeters approaches the detection limit of standard ultrasound, and several studies have shown that any stone that is 3 millimeters or less has an approximately 95 percent chance of spontaneous passage. For mission-assigned astronauts, any positive ultrasound study is followed by low-dose renal computed tomography (CT) scan, and flexible ureteroscopy if CT is positive. Other specific guidelines were also created. Discussion: The term "MRM" is used to account for small areas of calcification that may be outside the renal collecting system, and allows objectivity without otherwise constraining the diagnostic and treatment process for potentially very small calcifications of uncertain

  7. EPR of some irradiated renal stones

    International Nuclear Information System (INIS)

    Koeseoglu, R.; Koeseoglu, E.; Koeksal, F.; Basaran, E.; Demirci, D.

    2005-01-01

    Some renal stones were investigated by electron paramagnetic resonance of their untreated, UV-photolyzed and gamma-irradiated states. Powder X-ray diffraction technique indicated that the renal stones were made mainly from CaC 2 O 4 , MgC 2 O 4 , MgCO 3 and NH 4 MgPO 4 .6H 2 O. Before radiation treatment, the renal stones yielded a signal that could be attributed to a C 2 O 4 - radical. UV-photolysis seems to slightly increase the intensity of this signal, but does not produce any new centres. Gamma-irradiation initially gives -CH 2 C (CH 3 )-R and CO 2 - radicals, and while the intensity of the -CH 2 C (CH 3 )-R signal decreases, the intensity of the CO 2 - signal increases as time elapses

  8. External Validation and Evaluation of Reliability and Validity of the Modified Seoul National University Renal Stone Complexity Scoring System to Predict Stone-Free Status After Retrograde Intrarenal Surgery.

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    Park, Juhyun; Kang, Minyong; Jeong, Chang Wook; Oh, Sohee; Lee, Jeong Woo; Lee, Seung Bae; Son, Hwancheol; Jeong, Hyeon; Cho, Sung Yong

    2015-08-01

    The modified Seoul National University Renal Stone Complexity scoring system (S-ReSC-R) for retrograde intrarenal surgery (RIRS) was developed as a tool to predict stone-free rate (SFR) after RIRS. We externally validated the S-ReSC-R. We retrospectively reviewed 159 patients who underwent RIRS. The S-ReSC-R was assigned from 1 to 12 according to the location and number of sites involved. The stone-free status was defined as no evidence of a stone or with clinically insignificant residual fragment stones less than 2 mm. Interobserver and test-retest reliabilities were evaluated. Statistical performance of the prediction model was assessed by its predictive accuracy, predictive probability, and clinical usefulness. Overall SFR was 73.0%. The SFRs were 86.7%, 70.2%, and 48.6% in low-score (1-2), intermediate-score (3-4), and high-score (5-12) groups, respectively (pR revealed an area under the curve (AUC) of 0.731 (95% CI 0.650-0.813). The AUC of the three-titered S-ReSC-R was 0.701 (95% CI 0.609-0.794). The calibration plot showed that the predicted probability of SFR had a concordance comparable to that of observed frequency. The Hosmer-Lemeshow goodness of fit test revealed a p-value of 0.01 for the S-ReSC-R and 0.90 for the three-titered S-ReSC-R. Interobserver and test-retest reliabilities revealed an almost perfect level of agreement. The present study proved the predictive value of S-ReSC-R to predict SFR following RIRS in an independent cohort. Interobserver and test-retest reliabilities confirmed that S-ReSC-R was reliable and valid.

  9. Simplified methods for the evaluation of the risk of forming renal stones and the follow-up of stone-forming propensity during the preventive treatment of stone-formation.

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    Grases, Fèlix; Costa-Bauzá, Antonia

    2016-02-01

    Renal lithiasis is a complex multifactorial disease in which recurrence is common. Thus, simple and reliable procedures are needed to evaluate patients with previous kidney stones to determine the risk of recurrence. In this paper we review simple biochemical procedures that can be used to determine the risk for renal stone formation when the stone is available or unavailable for analysis. Our present knowledge of renal lithiasis indicates that renal stones form due to several well-defined factors. Analysis of the renal stone itself can provide important information about clinical factors that require further investigation. When the stone is unavailable, it is necessary to perform a general evaluation of main urinary risk factors associated to renal stone formation, but this study should be complemented considering information related to direct familial antecedents, recidivant degree, radiological images, medical history, and life style habits. Finally, tools for patient follow-up of stone-forming propensity during the preventive treatment are discussed .

  10. Acute renal infarction Secondary to Atrial Fibrillation Mimicking Renal Stone Picture

    International Nuclear Information System (INIS)

    Salih, Salih Bin; Al-Durihim, H.; Al-Jizeeri, A.; Al-Maziad, G.

    2006-01-01

    Acute renal infarction presents in a similar clinical picture to that of a renal stone. We report a 55-year-old Saudi female, known to have atrial fibrillation secondary to mitral stenosis due to rheumatic heart disease. She presented with a two day history of right flank pain that was treated initially as renal stone. Further investigations confirmed her as a case of renal infarction. Renal infarction is under-diagnosed because the similarity of its presentation to renal stone. Renal infarction should be considered in the differential diagnosis of loin pain, particularly in a patient with atrial fibrillation. (author)

  11. Laparoscopic surgery for renal stones: is it indicated in the modern endourology era?

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    Andrei Nadu

    2009-02-01

    Full Text Available Purpose: To report the outcomes of laparoscopic surgery combined with endourological assistance for the treatment of renal stones in patients with associated anomalies of the urinary tract. To discuss the role of laparoscopy in kidney stone disease. Materials and Methods: Thirteen patients with renal stones and concomitant urinary anomalies underwent laparoscopic stone surgery combined with ancillary endourological assistance as needed. Their data were analyzed retrospectively including stone burden, associated malformations, perioperative complications and outcomes. Results: Encountered anomalies included ureteropelvic junction obstruction, horseshoe kidney, ectopic pelvic kidney, fussed-crossed ectopic kidney, and double collecting system. Treatment included laparoscopic pyeloplasty, pyelolithotomy, and nephrolithotomy combined with flexible nephroscopy and stone retrieval. Intraoperative complications were lost stones in the abdomen diagnosed in two patients during follow up. Mean number of stones removed was 12 (range 3 to 214. Stone free status was 77% (10/13 and 100% after one ancillary treatment in the remaining patients. One patient had a postoperative urinary leak managed conservatively. Laparoscopic pyeloplasty was successful in all patients according to clinical and dynamic renal scan parameters. Conclusions: In carefully selected patients, laparoscopic and endourological techniques can be successfully combined in a one procedure solution that deals with complex stone disease and repairs underlying urinary anomalies.

  12. Efficacy of the lithotripsy in treating lower pole renal stones.

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    Cui, Helen; Thomee, Eeke; Noble, Jeremy G; Reynard, John M; Turney, Benjamin W

    2013-06-01

    Use of extracorporeal lithotripsy is declining in North America and many European countries despite international guidelines advocating it as a first-line therapy. Traditionally, lithotripsy is thought to have poor efficacy at treating lower pole renal stones. We evaluated the success rates of lithotripsy for lower pole renal stones in our unit. 50 patients with lower pole kidney stones ≤15 mm treated between 3/5/11 and 19/4/12 were included in the study. Patients received lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter according to a standard protocol. Clinical success was defined as stone-free status or asymptomatic clinically insignificant residual fragments (CIRFs) ≤3 mm at radiological follow-up. The mean stone size was 7.8 mm. The majority of stones (66 %) were between 5 and 10 mm. 28 % of stones were between 10 and 15 mm. For solitary lower pole stones complete stone clearance was achieved in 63 %. Total stone clearance including those with CIRFs was achieved in 81 % of patients. As expected, for those with multiple lower pole stones the success rates were lower: complete clearance was observed in 39 % and combined clearance including those with CIRFs was 56 %. Overall, complete stone clearance was observed in 54 % of patients and clearance with CIRFs was achieved in 72 % of patients. Success rate could not be attributed to age, stone size or gender. Our outcome data for the treatment of lower pole renal stones (≤15 mm) compare favourably with the literature. With this level of stone clearance, a non-invasive, outpatient-based treatment like lithotripsy should remain the first-line treatment option for lower pole stones. Ureteroscopy must prove that it is significantly better either in terms of clinical outcome or patient satisfaction to justify replacing lithotripsy.

  13. Extracorporeal shock wave lithotripsy for renal stone with infundibular stenosis

    International Nuclear Information System (INIS)

    Lee, Won Hong; Son, Soon Yong; Kang, Seong Ho; Lee, Yong Moon; Yoon, Seok Hwan

    2006-01-01

    We analyzed retrospectively our experience to evaluate an effect of extracorporeal shock wave lithotripsy (ESWL) for renal stone with infundibular stenosis. From January 2002 to August 2005, 35 patients with renal stone with infundibular stenosis were treated with ESWL. The diagnosis of infundibular stenosis was made by intravenous pyelography or retrograde pyelography. The final follow-up check was performed by simple abdominal film or computed tomography and interview after 6 months to 24 months (mean 10 months). 7 (20.0%) of 35 patients was freed completely, but Stone free rate including less than 2 mm size was 80% (28/35). 30 (85.7%) patients became asymptomatic, 4 (11.4%) patients were continued, and 1 (2.9%) patient was required the percutaneous nephrostolithotomy. Although ESWL has a low complete stone free rate, We suggest that renal stone with infundibular stenosis should be treated with ESWL, because that is likely to produce a high symptom free and low complications

  14. Extracorporeal shock wave lithotripsy for renal stone with infundibular stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Hong; Son, Soon Yong; Kang, Seong Ho; Lee, Yong Moon [Asan Medical Center, Seoul (Korea, Republic of); Yoon, Seok Hwan [Dongnam Health College, Suwon (Korea, Republic of)

    2006-06-15

    We analyzed retrospectively our experience to evaluate an effect of extracorporeal shock wave lithotripsy (ESWL) for renal stone with infundibular stenosis. From January 2002 to August 2005, 35 patients with renal stone with infundibular stenosis were treated with ESWL. The diagnosis of infundibular stenosis was made by intravenous pyelography or retrograde pyelography. The final follow-up check was performed by simple abdominal film or computed tomography and interview after 6 months to 24 months (mean 10 months). 7 (20.0%) of 35 patients was freed completely, but Stone free rate including less than 2 mm size was 80% (28/35). 30 (85.7%) patients became asymptomatic, 4 (11.4%) patients were continued, and 1 (2.9%) patient was required the percutaneous nephrostolithotomy. Although ESWL has a low complete stone free rate, We suggest that renal stone with infundibular stenosis should be treated with ESWL, because that is likely to produce a high symptom free and low complications.

  15. Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Robert Marcovich

    2003-06-01

    Full Text Available Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.

  16. Screening and Management of Asymptomatic Renal Stones in Astronauts

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    Reyes, David; Locke, James; Sargsyan, Ashot; Garcia, Kathleen

    2017-01-01

    Management guidelines were created to screen and manage asymptomatic renal stones in U.S. astronauts. The true risk for renal stone formation in astronauts due to the space flight environment is unknown. Proper management of this condition is crucial to mitigate health and mission risks. The NASA Flight Medicine Clinic electronic medical record and the Lifetime Surveillance of Astronaut Health databases were reviewed. An extensive review of the literature and current aeromedical standards for the monitoring and management of renal stones was also done. This work was used to develop a screening and management protocol for renal stones in astronauts that is relevant to the spaceflight operational environment. In the proposed guidelines all astronauts receive a yearly screening and post-flight renal ultrasound using a novel ultrasound protocol. The ultrasound protocol uses a combination of factors, including: size, position, shadow, twinkle and dispersion properties to confirm the presence of a renal calcification. For mission-assigned astronauts, any positive ultrasound study is followed by a low-dose renal computed tomography scan and urologic consult. Other specific guidelines were also created. A small asymptomatic renal stone within the renal collecting system may become symptomatic at any time, and therefore affect launch and flight schedules, or cause incapacitation during a mission. Astronauts in need of definitive care can be evacuated from the International Space Station, but for deep space missions evacuation is impossible. The new screening and management algorithm has been implemented and the initial round of screening ultrasounds is under way. Data from these exams will better define the incidence of renal stones in U.S. astronauts, and will be used to inform risk mitigation for both short and long duration spaceflights.

  17. Effects of microgravity on renal stone risk assessment

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    Pietrzyk, R. A.; Pak, C. Y. C.; Cintron, N. M.; Whitson, P. A.

    1992-01-01

    Physiologic changes induced during human exposure to the microgravity environment of space may contribute to an increased potential for renal stone formation. Renal stone risk factors obtained 10 days before flight and immediately after return to earth indicated that calcium oxalate and uric acid stone-forming potential was increased after space flights of 4-10 days. These data describe the need for examining renal stone risk during in-flight phases of space missions. Because of limited availability of space and refrigerated storage on spacecraft, effective methods must be developed for collecting urine samples in-flight and for preserving (or storing) them at temperatures and under conditions commensurate with mission constraints.

  18. Renal and prostate stones composition in alkaptonuria: a case report.

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    Wolff, Fleur; Biaou, Ibrahim; Koopmansch, Caroline; Vanden Bossche, Marc; Pozdzik, Agnieszka; Roumeguère, Thierry; Cotton, Frédéric

    2015-12-01

    Alkaptonuria is a genetic disorder characterized by an accumulation of homogentisic acid due to an enzymatic defect of homogentisate 1,2 dioxygenase. The homogentisic acid is excreted exclusively by both glomerular filtration and tubular secretion leading to the renal parenchyma being exposed to high concentrations of homogentisic acid. The alkaptonuric patients are at higher risk of renal stones (and of prostate stones for males), usually in the later stages of the disease. We describe the case of a 51-year-old man whose renal and prostate stones were analyzed by X-ray diffraction and infrared spectroscopy, respectively. We review the cases of alkaptonuria (AKU) patients reported in the literature for whom the composition of kidney or prostate stones was assessed with physical or chemical techniques. In this paper, we also discuss the advantages and drawbacks of the different methodologies.

  19. Prevalence of renal uric acid stones in the adult.

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    Trinchieri, Alberto; Montanari, Emanuele

    2017-12-01

    The aim of this study was to estimate uric acid renal stone prevalence rates of adults in different countries of the world. PubMed was searched for papers dealing with "urinary calculi and prevalence or composition" for the period from January 1996 to June 2016. Alternative searches were made to collect further information on specific topics. The prevalence rate of uric acid stones was computed by the general renal stone prevalence rate and the frequency of uric acid stones in each country. After the initial search, 2180 papers were extracted. Out of them, 79 papers were selected after the reading of the titles and of the abstracts. For ten countries, papers relating to both the renal stone prevalence in the general population and the frequency of uric stones were available. Additional search produced 13 papers that completed information on 11 more countries in 5 continents. Estimated prevalence rate of uric acid stones was >0.75% in Thailand, Pakistan, Saudi Arabia, Iran, South Africa (white population), United States and Australia; ranged 0.50-0.75% in Turkey, Israel, Italy, India (Southern), Spain, Taiwan, Germany, Brazil; and uric acid stone formation. A hot and dry climate increases fluid losses reducing urinary volume and urinary pH. A diet rich in meat protein causes low urinary pH and increased uric acid excretion. On the other hand, uric acid stone formation is frequently associated with obesity, metabolic syndrome and diabetes type 2 that are linked to dietary energy excess mainly from carbohydrate and saturated fat and also present with low urine pH values. An epidemic of uric acid stone formation could be if current nutritional trends will be maintained both in developed countries and in developing countries and the areas of greater climatic risk for the formation of uric acid stones will enlarge as result of the "global warming".

  20. Retroperitoneoscopy for treatment of renal and ureteral stones

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    Rodrigo S. Soares

    2005-04-01

    Full Text Available OBJECTIVE: To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. MATERIALS AND METHODS: In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42% had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58% had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71% had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26% also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. RESULTS: Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49%, a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days. The mean length of retroperitoneal urinary drainage was 3 days (1-10 days. There were minor complications in 6 (17.6% patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94% became stone free. CONCLUSION: Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.

  1. Retroperitoneoscopy for treatment of renal and ureteral stones.

    Science.gov (United States)

    Soares, Rodrigo S; Romanelli, Pedro; Sandoval, Marcos A; Salim, Marcelo M; Tavora, Jose E; Abelha, David L

    2005-01-01

    To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42%) had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58%) had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71%) had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26%) also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49%), a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days). The mean length of retroperitoneal urinary drainage was 3 days (1-10 days). There were minor complications in 6 (17.6%) patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94%) became stone free. Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.

  2. Significance of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy in nonobstructive isolated renal pelvic stones.

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    Sozen, Sinan; Kupeli, Bora; Acar, Cenk; Gurocak, Serhat; Karaoglan, Ustunol; Bozkirli, Ibrahim

    2008-05-01

    To investigate the probable effect of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy (SWL) in patients with nonobstructive renal pelvic stones. The clinical records of patients with isolated renal pelvic stones who underwent SWL between 1996 and 2005 were reviewed. After excluding patients with obstruction leading to dilatation, major anatomic abnormalities, noncalcium stones, metabolic abnormalities, history of recurrent stone disease, multiple stones, and previous renal surgery, 153 patients were enrolled in the study. Lower pole infundibulopelvic angle (IPA) and infundibular length and width were measured from intravenous urography. Patients were classified into three groups according to stone burden (group 1, renal pelvis, and both in 50 (32.6%), 29 (18.9%), and 8 (5.2%) patients, respectively. There was no statistically significant difference in pelvicaliceal anatomic features except narrower IPA (P=0.02) in group 1 patients with residual stones. The falling of stone fragments to the lower calix in spite of the ureter whether clinically significant or not after SWL of pelvic stones initially seems to be related to stone burden rather than lower caliceal anatomy. However, existence of a more narrow IPA in group 1 patients with residual fragments led us to believe that lower-pole IPA can play a role in stone clearance, especially for smaller stones, probably because of smaller residual fragment size or the more mobile nature of the primary stone.

  3. 21 CFR 876.4650 - Water jet renal stone dislodger system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Water jet renal stone dislodger system. 876.4650... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4650 Water jet renal stone dislodger system. (a) Identification. A water jet renal stone dislodger system is a device used to...

  4. Treatment options for active removal of renal stones

    NARCIS (Netherlands)

    Warmerdam, G.J.J.; Laet, De K.; Wijn, R.P.W.F.; Wijn, P.F.F.

    2012-01-01

    This study provides an update on the technological aspects of the methods for active removal of renal stones. Currently, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are the available options. Findings are based upon recent literature from

  5. [Solitary stones of the lower renal calyx: how to treat?

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    Martov, A G; Ergakov, D V; Andronov, A S; Dutov, S V; Takhaev, R A; Kil'chukov, Z I; Moskalenko, S A

    2017-06-01

    The choice of treatment for the stones of the lower renal calyx is one of the challenging issues of modern urology. The aim of this retrospective and prospective study was to investigate the clinical effectiveness and safety of 3 modern minimally invasive techniques for treating renal stones: percutaneous (PNL) and transurethral (TNL) nephrolithotripsy and extracorporeal shock wave lithotripsy (ESWL) in patients with solitary lower calyx stones sized from 10 to 15 mm. The study included 136 patients with symptomatic stones of the lower calyces, who underwent ESWL, PNL and TNL from November 2010 to the present day. The criteria for inclusion in the study were: the presence of a solitary stone of the lower calyx, the stone size of 10 mm to 15 mm, the performance of the classical (standard) PNL in the prone position (puncture access 28-30 Fr) and the follow-up examination at 3 months after the operation. Forty-six patients underwent ESWL, 49 - PNL, and 41 - TNL. Postoperative follow-up was done at 3 months and included a plain radiography, ultrasound and non-contrast-enhanced computed tomography. The stone free rate (SFR) was used as a criterion for the effectiveness of the intervention, where the stone size of 3 mm was taken as the upper limit for the possible presence of fragments. Besides, the rate of repeat interventions, complications and subjective assessment of patients treatment satisfaction (0 to 10) by using visual analogue scale (VAS) were investigated. The effectiveness analysis of the three methods for treating the lower calyx stones sized 10-15 mm showed that PNL was no more effective than TNL (SFR 95.9% and 85.4%, respectively), but both methods were significantly more effective than ESWL (SFR 69.5%). 29.3% of patients who underwent TNL required repeat interventions (TNL or ESWL), while among those treated with ESWL, 45.6% required repeat ESWL sessions. PNL resulted in stone clearance in one stage. Postoperative inflammatory complications were most

  6. Obesometric factors associated with increased skin-to-stone distances in renal stone patients.

    Science.gov (United States)

    Allard, Christopher B; Shuster, Anatoly; Pinthus, Jehonathan H; Farrokhyar, Forough; Raees, A; Patlas, Michael; Matsumoto, Edward D; Whelan, J Paul

    2012-12-01

    Obese patients are at increased risk for renal stones as well as treatment failures due to increased skin-to-stone distances (SSD) and harder stone compositions. We investigated the relationships between obesometric parameters (body mass index [BMI], body fat distribution and obesity-related hormone levels) with SSD and stone hardness. We prospectively enrolled patients undergoing stone interventions at our institution. Computed tomography (CT) scans were analyzed; adipose tissue was identified according to Hounsfield units (HU) and separated into subcutaneous (SAT) and visceral (VAT) components. The pixels were averaged at three levels to calculate fat distribution: %VAT = (VAT)/(VAT + SAT). SSD was measured and HU were used as a surrogate for stone hardness. Obesity-related hormones leptin and adiponectin were measured by ELISA. Seventy-nine patients were prospectively enrolled. Mean BMI and %VAT were 30.02 kg/m2 and 40.13 kg/m2. Mean leptin and adiponectin levels were 17.5 ng/mL and 7.67 mcg/mL indicating high risk for metabolic consequences of obesity. Females had greater proportions of subcutaneous fat than males (%VAT 28.4 versus 46.94, p r = 0.454, p = 0.008). Obese patients with %VAT > 40 versus stone compositions as measured by HU than non-diabetics (982.86 versus 648.86, p = 0.001). Obesometric parameters such as BMI, body fat distribution, and the presence of diabetes mellitus are important considerations in the management of renal stone disease. A large proportion of subcutaneous fat, which can be estimated by physical examination, predicts SSD among obese patients and may aid treatment decisions in patients, particularly those without pre-treatment CT scans. Further studies are needed to refine the role of obesometrics in personalizing treatment decisions.

  7. Probabilistic Modeling of the Renal Stone Formation Module

    Science.gov (United States)

    Best, Lauren M.; Myers, Jerry G.; Goodenow, Debra A.; McRae, Michael P.; Jackson, Travis C.

    2013-01-01

    The Integrated Medical Model (IMM) is a probabilistic tool, used in mission planning decision making and medical systems risk assessments. The IMM project maintains a database of over 80 medical conditions that could occur during a spaceflight, documenting an incidence rate and end case scenarios for each. In some cases, where observational data are insufficient to adequately define the inflight medical risk, the IMM utilizes external probabilistic modules to model and estimate the event likelihoods. One such medical event of interest is an unpassed renal stone. Due to a high salt diet and high concentrations of calcium in the blood (due to bone depletion caused by unloading in the microgravity environment) astronauts are at a considerable elevated risk for developing renal calculi (nephrolithiasis) while in space. Lack of observed incidences of nephrolithiasis has led HRP to initiate the development of the Renal Stone Formation Module (RSFM) to create a probabilistic simulator capable of estimating the likelihood of symptomatic renal stone presentation in astronauts on exploration missions. The model consists of two major parts. The first is the probabilistic component, which utilizes probability distributions to assess the range of urine electrolyte parameters and a multivariate regression to transform estimated crystal density and size distributions to the likelihood of the presentation of nephrolithiasis symptoms. The second is a deterministic physical and chemical model of renal stone growth in the kidney developed by Kassemi et al. The probabilistic component of the renal stone model couples the input probability distributions describing the urine chemistry, astronaut physiology, and system parameters with the physical and chemical outputs and inputs to the deterministic stone growth model. These two parts of the model are necessary to capture the uncertainty in the likelihood estimate. The model will be driven by Monte Carlo simulations, continuously

  8. [Clinical study of influential factors on renal scarring after ESWL monotherapy for renal stone disease].

    Science.gov (United States)

    Ishito, Noritaka; Takamoto, Hitoshi; Kunitomi, Kimito; Satoh, Eiichi; Ishii, Ayano; Shiotuka, Youichi; Sako, Shinichi; Ohta, Naoki; Araki, Tohru

    2002-11-01

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

  9. Percutaneous nephrolithotomy for the treatment of radiolucent renal stones in children: is it different opaque stone treatment?

    Science.gov (United States)

    Adanur, Şenol; Ziypak, Tevfik; Sancaktutar, Ahmet Ali; Tepeler, Abdülkadir; Reşorlu, Berkan; Söylemez, Haluk; Dağgülli, Mansur; Özbey, İsa; Unsal, Ali

    2014-02-01

    We aimed to evaluate the effectiveness of percutaneous nephrolithotomy (PNL), stone-free rates, and related complications in children with radiolucent renal stones. A total of 56 patients aged auxillary treatment method was detected as 94.6%. The total complication rate was 19.6% (11 patients). No adjacent organ injury was observed. All of the complications that occurred were minor according to the Clavien classification (Clavien Grades I-II). PNL can be applied to radiolucent pediatric renal stones in children with similar success, and complication rates as noted for radiopaque stones.

  10. Association between some CT characteristics of renal stones and extracorporeal shockwave lithotripsy success rate

    Directory of Open Access Journals (Sweden)

    Saedi D

    2012-06-01

    Conclusion: We strongly suggest performing densitometry in bone window for renal stones on pre-ESWL NCCT scanning and using an alternative treatment other than ESWL for stone densities greater than 740 HU.

  11. Open stone surgery: a still-in-use approach for complex stone burden.

    Science.gov (United States)

    Çakici, Özer Ural; Ener, Kemal; Keske, Murat; Altinova, Serkan; Canda, Abdullah Erdem; Aldemir, Mustafa; Ardicoglu, Arslan

    2017-06-30

    Urinary stone disease is a major urological condition. Endourologic techniques have influenced the clinical approach and outcomes. Open surgery holds a historic importance in the management of most conditions. However, complex kidney stone burden may be amenable to successful results with open stone surgery. In this article, we report our eighteen cases of complex urinary stone disease who underwent open stone removal. A total of 1701 patients have undergone surgical treatment for urinary stone disease in our clinic between July 2012 and July 2016, comprising eighteen patients who underwent open stone surgery. Patients' demographic data, stone analysis results, postoperative clinical data, and stone status were evaluated retrospectively. The choice of surgical approach is mostly dependent on the surgeon's preference. In two patients, open surgery was undertaken because of perioperative complications. We did not observe any Clavien-Dindo grade 4 or 5 complications. Three patients were managed with a course of antibiotics due to postoperative fever. One patient had postoperative pleurisy, one patient had urinoma, and two patients had postoperative ileus. Mean operation time was 84 (57-124) minutes and mean hospitalization time was 5.5 (3-8) days. Stone-free status was achieved in 15 patients (83.3%). Endourologic approaches are the first options for treatment of urinary stone disease. However, open stone surgery holds its indispensable position in complicated cases and in complex stone burden. Open stone surgery is also a valid alternative to endourologic techniques in all situations.

  12. The study on the factors for detection of renal stone on ultrasound

    International Nuclear Information System (INIS)

    Sim, Hyun Sun; Jung, Hong Ryang; Lim, Cheong Hwan

    2006-01-01

    Renal stones are common and typically arise within the collecting system. The renal sinus are contains the collection system, the renal vessels, lymphatcs, fat, and fibrous tissue. Because of the compression of all the large echoes in signal processing, the echo from the renal stone generally cannot be distinguished from large echoes emanating from normal structures of the renal sinus. Use of ultrasonography has been difficult for detecting small renal stone without posterior shadowing and chemical composition of stone. The aim of study was measuring for posterior acoustic shadowing to a stone for various scan parameter and it examines a help in renal stone diagnosis. The stone was place on sponge examined in a water bath with a 3.5 MHz or 7.5 HMz transducer (LOGIQ 400, USA). First, tested a variety of gain. Second, tested a variety of dynamic range. Third, tested a variety of focal zone. Fourth, measuring of the echo level for low and high frequency for depth. 1) Average echo level was 98 for low total gain (10 dB) and was 142 for high total gain (40 dB). Posterior acoustic shadowing of renal stone was clear for low gain. 2) Average echo level was 129 for low dynamic range (42 dB) and was 101 for high dynamic range (72 dB). Posterior acoustic shadowing of renal stone was clear for high dynamic range. 3) When stone is in focal zone of transducer, definite posterior acoustic shadow is identified. 4) Stone was clear appeared for high frequency (7.5 MHz) than low frequency (3.5 MHz) and it is not distorted. The demonstration of an posterior acoustic shadow of renal stone dependents on several technical factors such as gain, dynamic range, focus, and frequency. This various factors are a help in renal stone diagnosis

  13. ORIGINAL PAPER ORIG ORIG Percutaneous stone removal

    African Journals Online (AJOL)

    Percutaneous nephrolithotomy (PCNL) is an effective procedure to treat patients with complex renal stones,. e.g. staghorn calculi and stones greater than 20 mm in diameter. The treatment of choice for small, less com- plex renal stones is extracorporeal shock-wave litho- tripsy (ESWL).1 We have treated renal stones mainly.

  14. [Factors affecting residual stones after percutaneous nephrolithotomy in patients with renal calculus].

    Science.gov (United States)

    Qiao, Mingzhou; Zhang, Haifang; Zhou, Chenlong

    2015-11-24

    To explore the factors affecting the residual stones after percutaneous nephrolithotomy (PCNL) in patients with renal calculus. A retrospective analysis was performed for 1 200 patients who were affected by renal calculus and treated with PCNL between Jan 2008 and May 2014 in People's Hospital of Anyang City. Among those patients, 16 were diagnosed as bilateral renal stone and had two successive operations. The size, location and number of stones, previous history of surgery, the degree of hydronephrosis, urinary infection were included in the univariate analysis. Significant factors in univariate analysis were included in the multivariate analysis to determine factors affecting stone residual. A total of 385 cases developed stone residual after surgery. The overall residual rate was 31.7%. In univariate analysis, renal pelvis combined with caliceal calculus (P=0.006), stone size larger than 4 cm (P=0.005), stone number more than 4 (P=0.002), the amount of bleeding more than 200 ml (P=0.025), operation time longer than 120 minutes (P=0.028) were associated with an increased rate of stone residual. When subjected to the Cox multivariate analysis, the independent risk factors for residual stones were renal pelvis combined with caliceal calculus (P=0.049), stone size larger than 4 cm (P=0.038) and stone number more than 4 (P=0.018). Factors affecting the incidence of residual stones after PCNL are the size, location and number of stones. Larger size stone and the presence of renal pelvis combined with caliceal calculus are significantly associated with residual stones. Nevertheless, stone number less than 4 indicates an increased stone clearance rate.

  15. Is Tamsulosin Effective after Shock Wave Lithotripsy for Pediatric Renal Stones? A Randomized, Controlled Study.

    Science.gov (United States)

    Shahat, Ahmed; Elderwy, Ahmad; Safwat, Ahmed S; Abdelkawi, Islam F; Reda, Ahmed; Abdelsalam, Yasser; Sayed, Mohamed; Hammouda, Hisham

    2016-04-01

    We assessed the effect of tamsulosin as an adjunctive therapy after shock wave lithotripsy for pediatric single renal pelvic stones. A total of 120 children with a unilateral single renal pelvic stone were included in a prospective randomized, controlled study. All children were randomized to 2 equal groups. Group 1 received tamsulosin (0.01 mg/kg once daily) as adjunctive therapy after shock wave lithotripsy in addition to paracetamol while group 2 received paracetamol only. Stone clearance was defined as no renal stone fragments or fragments less than 3 mm and no pelvicalyceal system dilatation. Our study included 69 boys and 51 girls with a median age of 3.5 years and a median stone size of 1.2 cm. There was no statistically significant difference between groups 1 and 2 in stone or patient criteria. Of the children 99 (82.5%) achieved stone clearance after the first session, including 50 in group 1 and 49 in group 2. All children in each group were cleared of stones after the second session. The overall complication rate was 14.2%. There was no statistically significant difference between single session stone clearance rates (p = 0.81) and complications rates (p = 0.432) in either group. On multivariate analysis using logistic regression smaller stone size (p = 0.016) and radiopaque stones (p = 0.019) were the only predictors of stone clearance at a single shock wave lithotripsy session. Tamsulosin therapy did not affect stone clearance (p = 0.649). Tamsulosin does not seem to improve renal stone clearance. Smaller and radiopaque renal stones have more chance of clearance after shock wave lithotripsy for pediatric single renal pelvic stones. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. MSCT renal stone protocol; dose penalty and influence on management decision of patients: Is it really worth the radiation dose?

    Directory of Open Access Journals (Sweden)

    Ahmed Hamimi

    2016-03-01

    Conclusions: Considering time is of the essence; MSCT renal stone protocol using low dose technique is crucial in the management of renal stone in acute setting including the diagnosis and management decision.

  17. Our experience with percutaneous nephrolithotomy in pediatric renal stone disease.

    Science.gov (United States)

    Oral, İlknur; Nalbant, İsmail; Öztürk, Ufuk; Can Şener, Nevzat; Yeşil, Süleyman; Göksel Göktuğ, H N; Abdurrahim İmamoğlu, M

    2013-03-01

    In this paper, we present our experience with percutaneous nephrolithotomy (PNL) in a pediatric patient group. From June 2007 to September 2010, we performed PNL on 57 pediatric patients. children with a mean age of 7.56 (1-15) years. Study population consisted of 30 male, and 27 female children with a mean age of 7.56 (1-5) years. Mean stone burden was calculated to be 312.2 (95-1550) mm(2). Percutaneous access was performed under fluoroscopy. Tract dilatation was accomplished with 20 F Amplatz dilators. Pneumatic lithotripsy was used to fragment the renal calculi. Mean operating time was 34 (3-80) minutes. With a single session of PNL, complete stone-free rates were achieved in 55 (96.4%) patients. Residual fragments were remained in 2 (3.5%) patients. Two patients had a febrile episode without signs and symptoms of bacteremia. Subcostal access was used in all of the patients, and none of the patients had any complications. Based on our experience, we conclude that PNL is a safe and effective method in the management of pediatric stone disease.

  18. Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones.

    Science.gov (United States)

    Al-Ansari, Abdulla; As-Sadiq, Khalid; Al-Said, Sami; Younis, Nagy; Jaleel, Osama A; Shokeir, Ahmed A

    2006-01-01

    To evaluate the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones. Between January 2000 and December 2003, 427 patients with single or multiple renal stones (ESWL monotherapy using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments ESWL auxiliary procedures were required in 36 patients (8.4%). Post-ESWL complications were recorded in 16 patients (3.7%). Of the 10 prognostic factors studied, 5 had a significant impact on the success rate, namely: renal morphology, congenital anomalies, stone size, stone site and number of treated stones. Other factors including age, sex, nationality, stone nature (de novo or recurrent) and ureteric stenting had no significant impact on the success rate. The success rate of ESWL for the treatment of renal stones could be predicted by stone size, location and number, radiological renal features and congenital renal anomalies.

  19. Association of staphylococcus cohnii subspecies urealyticum infection with recurrence of renal staghorn stone

    OpenAIRE

    Shahandeh, Zahra; Shafi, Hamid; Sadighian, Farahnaz

    2015-01-01

    Background: Stphylococcus cohnii is an organism of coagulase negative species which is considered as normal flora. However, it has been isolated from urinary tract infections and surgical prostheses but its relation with staghorn stones has not been reported, yet. Case Presentation: A 50-years-old woman presented with left renal staghorn stone in June 2014. She had bilateral staghorn stones 7 years ago. Staphylococcus cohnii subspecies urealyticum were detected from a removed stone. After 7 y...

  20. Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones.

    Science.gov (United States)

    Inoue, Takaaki; Murota, Takashi; Okada, Shinsuke; Hamamoto, Shuzo; Muguruma, Kouei; Kinoshita, Hidefumi; Matsuda, Tadashi

    2015-09-01

    This study was performed to evaluate the impact of pelvicaliceal anatomy on stone clearance in patients with remnant fragments in the lower pole after flexible ureteroscopy and holmium laser lithotripsy (fURSL) for renal stones >15 mm. This retrospective study included 67 patients with radiopaque residual fragments (>2 mm) in the lower pole after fURSL for large renal stones (>15 mm). The preoperative infundibular length (IL), infundibular width (IW), infundibulopelvic angle (IPA), and caliceal pelvic height (CPH) were measured using intravenous urography. Multivariate analysis was performed to determine whether any of these measurements affected stone clearance. Of the 67 patients, 55 (82.1%) were stone free (SF) 3 months after fURSL. The anatomic factors significantly favorable for an SF status were a short IL, broad IW, wide IPA, and low CPH. On multivariate analysis, the IPA had a significant influence on an SF status after fURSL (p=0.010). An IPA renal stones according to our multivariate analysis. Additional studies are required to further evaluate the characteristics of the pelvicaliceal anatomy influencing stone clearance.

  1. Renal stone in crossed fused renal ectopia and its laparoscopic management: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Santosh Agrawal

    2016-01-01

    Full Text Available Management of renal stone in crossed fused renal ectopia (CFRE is difficult because of abnormal location, malrotation, and its relations with vertebral column and small bowel. Management is not standardized because of the paucity of literature and variable anatomy. We managed an 8-year-old boy with multiple renal stones in right side crossed kidney by laparoscopic pyelolithotomy and nephro pyeloscopy with the help of ureteroscope. Until now, there is only one prior report of laparoscopic pyelolithotomy in CFRE. We share our experience in this case and review the literature regarding the management of kidney stones in this rare anomaly.

  2. Programmatic Considerations to Reduce the Risk of Adverse Renal Stone Events in Spaceflight

    Science.gov (United States)

    Antonsen, Erik; Pietrzyk, Robert

    2017-01-01

    Introduction: Microgravity exposure may alter the likelihood that astronauts will experience renal stones. The potential risk includes both acute and chronic health issues, with the potential for significant impact on mission objectives. Methods: To understand the role of the NASA's Human Research Program (HRP) research agenda in both preventing and addressing renal stones in spaceflight, current astronaut epidemiologic data and a summary of programmatic considerations are reviewed. Results: Although there has never been a symptomatic renal stone event in a U.S. crewmember during spaceflight, urine chemistry has been altered - likely due to induced changes in renal physiology as a result of exposure to microgravity. This may predispose astronauts to stone formation, leading the HRP to conduct and sponsor research to: 1) understand the risk of stone formation in space; 2) prevent stones from forming; and 3) address stones that may form by providing novel diagnostic and therapeutic approaches. Discussion: The development of a renal stone during spaceflight is a significant medical concern that requires the HRP to minimize this risk by providing the ability to prevent, diagnose, monitor and treat the condition during spaceflight. A discussion of the risk as NASA understands it is followed by an overview of the multiple mitigations currently under study, including novel ultrasound techniques for stone detection and manipulation, and how they may function as part of a larger exploration medical system.

  3. Evaluation of stone volume distribution in renal collecting system as a predictor of stone-free rate after percutaneous nephrolithotomy: a retrospective single-center study.

    Science.gov (United States)

    Atalay, Hasan Anıl; Canat, Lutfi; Bayraktarlı, Recep; Alkan, Ilter; Can, Osman; Altunrende, Fatih

    2017-06-23

    We analyzed our stone-free rates of PNL with regard to stone burden and its ratio to the renal collecting system volume. Data of 164 patients who underwent PNL were analyzed retrospectively. Volume segmentation of renal collecting system and stones were done using 3D segmentation software with the images obtained from CT data. Analyzed stone volume (ASV) and renal collecting system volume (RCSV) were measured and the ASV-to-RCSV ratio was calculated after the creation of a 3D surface volume rendering of renal stones and the collecting system. Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free rates; also we assessed the predictive accuracy of the ASV-to-RCSV ratio using the receiving operating curve (ROC) and AUC. The stone-free rate of PNL monotherapy was 53% (164 procedures).The ASV-to-RCSV ratio and calyx number with stones were the most influential predictors of stone-free status (OR 4.15, 95% CI 2.24-7.24, renal collecting system, which is calculated using the 3D volume segmentation method, is a significant determinant of the stone-free rate before PCNL surgery. It could be used as a single guide variable by the clinician before renal stone surgery to predict extra requirements for stone clearance.

  4. Association of staphylococcus cohnii subspecies urealyticum infection with recurrence of renal staghorn stone.

    Science.gov (United States)

    Shahandeh, Zahra; Shafi, Hamid; Sadighian, Farahnaz

    2015-01-01

    Stphylococcus cohnii is an organism of coagulase negative species which is considered as normal flora. However, it has been isolated from urinary tract infections and surgical prostheses but its relation with staghorn stones has not been reported, yet. A 50-years-old woman presented with left renal staghorn stone in June 2014. She had bilateral staghorn stones 7 years ago. Staphylococcus cohnii subspecies urealyticum were detected from a removed stone. After 7 years, recurrence staghorn stone in her left kidney was diagnosed and patient underwent another surgery. The patient had several attacks of cystitis during these 7 years. The results of stone and urine cultures revealed staphylococcus cohnii subspecies urealyticum. This case report emphasizes a possible association between staphylococcus cohnii subspecies urealyticum infection and recurrence renal staghhorn stone.

  5. Pathophysiology of incomplete renal tubular acidosis in recurrent renal stone formers: evidence of disturbed calcium, bone and citrate metabolism

    DEFF Research Database (Denmark)

    Osther, P J; Bollerslev, Jens; Hansen, A B

    1993-01-01

    Urinary acidification, bone metabolism and urinary excretion of calcium and citrate were evaluated in 10 recurrent stone formers with incomplete renal tubular acidosis (iRTA), 10 recurrent stone formers with normal urinary acidification (NUA) and 10 normal controls (NC). Patients with iRTA had...

  6. Characterization of complex renal cysts

    DEFF Research Database (Denmark)

    Graumann, Ole; Osther, Susanne Sloth; Osther, Palle Jörn Sloth

    2010-01-01

    Abstract Objective. Complex renal cysts represent a major clinical problem, since it is often difficult to exclude malignancy. The Bosniak classification system, based on computed tomography (CT), is widely used to categorize cystic renal lesions. The aim of this study was to evaluate critically...... available data on the Bosniak classification. Material and methods. All publications from an Entrez Pubmed search were reviewed, focusing on clinical applicability and the use of imaging modalities other than CT to categorize complex renal cysts. Results. Fifteen retrospective studies were found. Most...

  7. A prospective randomized trial of open surgery versus endourological stone removal in patients of staghorn stones with chronic renal failure

    Directory of Open Access Journals (Sweden)

    Anant Kumar

    2001-01-01

    Conclusion: In view of the better clearance rate and lesser cost of treatment, open surgery still has a place in the management of staghorn stones with chronic renal failure even in a tertiary urological center. However postoperative pain and a larger scar cannot be ignored.

  8. Technique and value of three dimensional reconstruction of stones in the renal pelvis using spiral CT

    International Nuclear Information System (INIS)

    Fink, B.K.; Fink, U.; Pentenrieder, M.; Kohz, P.; Englmeier, H.K.; Schmeller, N.

    1994-01-01

    5 patients with staghorn calculi in the renal pelvis were examined by spiral CT. From the raw data three dimensional reconstructions of the stones were obtained. In all patients it was possible to compare the three dimensional model with the stone following performance of percutaneous lithopaxy and endoscopic removal of the fragments. In all cases the three dimensional reconstruction provided a realistic image of the stones and was of practical value for the urologist for preoperative diagnosis and intraoperative control. (orig.) [de

  9. Role of alpha-1 blocker in expulsion of stone fragments after extracorporeal shock wave lithotripsy for renal stones

    International Nuclear Information System (INIS)

    Pirzada, A.J.; Anwar, A.; Javed, A.; Memon, I.; Mohammad, A.

    2011-01-01

    Background: Renal stone disease is a significant and worldwide health problem. Recent advances in stone management have allowed kidney stones to be treated using extracorporeal shock wave lithotripsy (ESWL), uretero-renoscopy (URS), and percutaneous nephrostolithotomy (PCNL). Recently, medical expulsion therapy (MET) has been investigated as a supplement to observation in an effort to improve spontaneous stone passage rates. Patients and Methods: This study was a randomized, controlled, prospective study to determine whether the administration of Alpha-1-adrenergic receptor antagonists as an adjunctive medical therapy, increases the efficacy of ESWL to treat renal stones. Sixty patients with renal stones of 0.5-1.5 Cm in size (average size 1.2 Cm) were included in this study underwent ESWL followed by administration of Alpha-1-adrenergic receptor antagonists at department of Urology Liaquat National Hospital Karachi from Feb 2008 to Sept 2008. This was a comparative study and patients were divided into two groups. In group A patients received conventional treatment Diclofenac sodium, Anti Spasmodic (Drotaverine HCl) as required and Proton Pump inhibitor (Omeprazole 20 mg) once daily after shock wave lithotripsy. In group B patients received alpha-1 blocker, Alfuzosin HCl 5 mg twice daily in addition to conventional treatment. All patients were instructed to drink a minimum of 2 litres water daily. Ultrasound guided Dornier Alpha Impact Lithotripter was utilised for shock wave lithotripsy. Results: Of the 60 patients, 76.7% of those receiving Alfuzosin and 46.7% of controls had achieved clinical success at 1 month (p=0.01). The mean cumulative diclofenac dose was 485 mg per patient in the Alfuzosin group and 768 mg per patient in the control group (p=0.002). This difference was statistically significant. Conclusion: Alfuzosin therapy as an adjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal

  10. Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis

    International Nuclear Information System (INIS)

    Wang, Li-Jen; Wong, Yon-Cheong; Chuang, Cheng-Keng; Chu, Sheng-Hsien; Chen, Chih-Shou; Chiang, Yang-Jen; See, Lai-Chu

    2005-01-01

    The aim of our study is to analyze the relationships between the characteristics of renal stones determined by unenhanced helical computed tomography (UHCT) and their outcomes after extracorporeal shock wave lithotripsy (ESWL) as well as to predict ESWL outcomes of renal stones by their UHCT characteristics with the use of multivariate analysis. During a 7-month period, 80 adult patients with renal stones underwent ESWL as well as UHCT both before and 3 months after ESWL. Of the 80 patients, 42 patients were classified as ESWL successes and 38 as ESWL failures based on their post-ESWL UHCT findings. For pre-ESWL UHCT, a stone number of more than 2 (P=0.0236), a maximal stone size of greater than 12 mm (P 3 (P 3 (P=0.0003), the presence of nonround/oval stones (P=0.0072) and a maximal stone density of more than 900 HU (P=0.0430) were statistically significant predictors of a failure outcome for ESWL. Thus, the analysis of stone characteristics of renal stones by UHCT is helpful in selecting appropriate patients undergoing ESWL for favorable outcomes and reduces the overall costs of the treatment of renal stones. (orig.)

  11. Renal stone associated with the ketogenic diet in a 5-year old girl with intractable epilepsy.

    Science.gov (United States)

    Choi, Ji Na; Song, Ji Eun; Shin, Jae Il; Kim, Heung Dong; Kim, Myung Joon; Lee, Jae Seung

    2010-05-01

    In this paper, we report on a 5-year-old girl who developed a renal stone while following the ketogenic diet to treat refractory seizure disorder. Three months after initiating the ketogenic diet, she developed severe abdominal pain and vomiting. The spot urine calcium-to-creatinine (Ca/Cr) ratio and 24-hour urine evaluation showed hypercalciuria. Computed tomography (CT) imaging revealed a stone in the right ureteropelvic junction, resulting in hydronephrosis of the right kidney. The renal stone disappeared 5 days after conservative treatment; the patient's microscopic hematuria resolved concurrently. In light of this case report, we recommend regularly monitoring the urine Ca/Cr ratio with ultrasonography for further development of renal stones in patients following the ketogenic diet. If these patients exhibit evidence of symptomatic hypercalciuria or cyristalluria, liberalization of fluid restriction and urine alkalization using oral potassium citrate should be considered.

  12. Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Li-Jen; Wong, Yon-Cheong [Chang Gung University, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taipei (Taiwan); Chuang, Cheng-Keng; Chu, Sheng-Hsien; Chen, Chih-Shou; Chiang, Yang-Jen [Chang Gung University, Department of Urology, Chang Gung Memorial Hospital, Taipei (Taiwan); See, Lai-Chu [Chang Gung University, Department of Biostatistics Center, Chang Gung Memorial Hospital, Taipei (Taiwan)

    2005-11-01

    The aim of our study is to analyze the relationships between the characteristics of renal stones determined by unenhanced helical computed tomography (UHCT) and their outcomes after extracorporeal shock wave lithotripsy (ESWL) as well as to predict ESWL outcomes of renal stones by their UHCT characteristics with the use of multivariate analysis. During a 7-month period, 80 adult patients with renal stones underwent ESWL as well as UHCT both before and 3 months after ESWL. Of the 80 patients, 42 patients were classified as ESWL successes and 38 as ESWL failures based on their post-ESWL UHCT findings. For pre-ESWL UHCT, a stone number of more than 2 (P=0.0236), a maximal stone size of greater than 12 mm (P<0.0001), a stone burden of more than 700 mm{sup 3} (P<0.0001), a maximal stone density of more than 900 HU (P=0.0008) and nonround/oval stones (P=0.0007) were associated with ESWL failure outcomes. Multivariate analysis demonstrated that a stone burden of more than 700 mm{sup 3} (P=0.0003), the presence of nonround/oval stones (P=0.0072) and a maximal stone density of more than 900 HU (P=0.0430) were statistically significant predictors of a failure outcome for ESWL. Thus, the analysis of stone characteristics of renal stones by UHCT is helpful in selecting appropriate patients undergoing ESWL for favorable outcomes and reduces the overall costs of the treatment of renal stones. (orig.)

  13. In vitro differentiation of renal stone composition using dual-source, dual-energy CT

    International Nuclear Information System (INIS)

    Zhou Changsheng; Zhang Longjiang; Xu Feng; Qi Li; Zhao Yan'e; Zheng Ling; Huang Wei; Liu Youhuang; Lu Guangming

    2012-01-01

    Objective: To evaluate the ability of dual-source. dual-energy CT in differentiating uric acid stones from non-uric acid stones with infrared spectroscopy as reference standard. Materials and Methods: Urinary calculus from 308 patients were scanned in first generation dual-source CT with dual-energy mode between July 2011 and June 2012. Renal Stone application was used to analyze their composition. The uric acid stones color were coded red and non-uric acid stones were blue. CT values were measured in 60 selective urinary calculus including 30 uric acid stones and 30 non-uric acid stones. The accuracy of dual energy CT to differentiate uric acid and no-uric acid stones was calculated. Results: Of 308 patients, 60 patients had uric acid stones and 248 non-uric acid stones. No difference was found for uric acid stone at 80 kV and 140 kV (375.8±69.2 HU vs. 374.1±69.4 HU; t=-0.217, P=0.830), while CT values of non-uric acid stones were higher at 80 kV than those at 140 kV (1455.1±312.4 HU vs. 1039.6±194.4 HU; t=-12.16. P<0.001). CT values of non-uric acid stones at 80 kV, 140 kV, and average weighted images (1455.1±312.4 HU, 1 039.6±194.4 HU, and 882.0±176.4 HU, respectively) were higher than those of uric acid stones (375.8±69.2 HU, 374.1±69.4 HU, and 366.3±80.1 HU, respectively; P<0.001). With infrared spectrum findings as reference standard, the accuracy of dual energy CT in differentiating uric acid stones from non-uric acid stones was 100%. Conclusions: Dual-source, dual-energy CT can accurately differentiate uric acid stones from non-uric acid stones, and plays an important role in treatment planning of renal stones. (authors)

  14. Efficacy of commercialised extracorporeal shock wave lithotripsy service: a review of 589 renal stones.

    Science.gov (United States)

    Nielsen, Tommy Kjærgaard; Jensen, Jørgen Bjerggaard

    2017-07-27

    Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. The purpose of the present is to investigate the efficacy of a commercialised ESWL service, being performed as an outsourced treatment using a mobile lithotripsy system on an outpatient basis. Furthermore, the study aims to evaluate the risk of needing treatment with an internal ureteral double-J stent (JJ) after ESWL treatment. During an eight-year period, 461 patients with a total of 589 renal stones were treated using a mobile lithotripsy system at a single Danish institution. A commercial company performed all treatments using a Storz Modulith SLK® system. Each stone was prospectively registered according to size, intra renal location and the presence of a JJ at the time of treatment. The number of required ESWL treatments and auxiliary procedures were retrospectively evaluated. The success rate after the initial ESWL procedure was 69%, which increased to an overall success rate of 93% after repeated treatment. A negative correlation was found between stone size and the overall success rate (r = -0.2, p ESWL procedure. No significant difference was observed between the stone size or intra renal location and the risk of needing treatment with JJ after ESWL. Commercialised ESWL treatment can achieve an overall success rate of more than 90% using a mobile lithotripsy system. As expected, an inverse relation between stone size and success rate was found. Patients who do not require treatment with a JJ prior to ESWL will only rarely need treatment with a JJ after ESWL, irrespective of stone size and intra renal stone location.

  15. Frequency and factors effecting non clearance of lower pole renal stones

    International Nuclear Information System (INIS)

    Ullah, A.; Zubair, M.; Khan, N.; Malik, A.

    2015-01-01

    Renal stone disease is a major health hazard in Pakistan and extra-corporeal shockwave lithotripsy is one of comprehensive method used to treat these stones. The aim of this study is to determine the frequency of factors affecting the non-clearance of stone fragments of lower pole renal stone after extra corporeal shockwave lithotripsy. The study was done with the objective to determine the frequency the spatial anatomical factors which can influence the non-clearance of lower pole stone fragments after ESWL. Methods: One and nineteen (119) patients with lower pole renal stone less than 10 mm were subjected to maximum 3 sessions of extracorporeal shock wave lithotripsy. KUB radiographs, ultrasonography and intravenous urography were used as investigative tools for lower pole renal calyceal anatomy. X ray KUB and ultrasound were done after a week for clearance. Data was analysed with the help of SPSS version 10.0 and presented in the forms of tables and graphs. Results: There were 77 (64.71%) males and 42 (35.29%) females. Infundibulo-pelvic angle (IPA)>40 degree was present in 93 (78.15%), Infundibular length (IL) <22 mm in 107 (89.92%) and Infundibular width (IW) >4 mm was present in 100 (84.03%) patients. The frequency of stone non clearance was noted in 31 (26.05%). Infundibulo-pelvic angle (IPA)>40 degree (p=0.000), Infundibular length (IL)<22 mm (p=0.001) and Infundibular width (IW)>4 mm (p=0.046) were significant variables affecting stone clearance. Conclusion: The frequency of non-clearance of lower calyx of kidney stone is 26.05%. The clearance of fragments of the lower calyx kidney stones is affected by three spatial anatomical factors, i.e., Infundibulopelvic angle, Infundibular width and infundibular length. (author)

  16. Combined retrograde flexible ureteroscopic lithotripsy with holmium YAG laser for renal calculi associated with ipsilateral ureteral stones.

    Science.gov (United States)

    Cocuzza, Marcello; Colombo, Jose R; Ganpule, Arvind; Turna, Burak; Cocuzza, Antonio; Dhawan, Divyar; Santos, Bruno; Mazzucchi, Eduardo; Srougi, Miguel; Desai, Mahesh; Desai, Mihir

    2009-02-01

    The purpose of this study was to evaluate the effectiveness of combined ureteroscopic holmium YAG lithotripsy for renal calculi associated with ipsilateral ureteral stones. Between August 2002 and March 2007, retrograde flexible ureteroscopic stone treatment was attempted in 351 cases. Indication for treatment was concurrent symptomatic ureteral stones in 63 patients (group I). Additional operative time and perioperative complication rates were compared to a group of 39 patients submitted to ureteroscopic treatment for ureteral calculi exclusively (group II). Mean ureteral stone size was 8.0 +/- 2.6 mm and 8.1 +/- 3.4 mm for groups I and II, respectively. Mean operative time for group I was 67.9 +/- 29.5 minutes and for group 2 was 49.3 +/- 13.2 minutes (p stone size was 10.7 +/- 6.4 mm, overall stone free rate in group I was 81%. However, considering only patients with renal stones smaller than 15 mm, the stone free rate was 88%. Successful treatment occurred in 81% of patients presenting lower pole stones, but only 76% of patients with multiple renal stones became stone free. As expected, stone free rate showed a significant negative correlation with renal stone size (p = 0.03; r = -0.36). Logistic regression model indicated an independent association of renal stones smaller than 15 mm and stone free rate (OR = 13.5; p = 0.01). Combined ureteroscopic treatment for ureteral and ipsilateral renal calculi is a safe and attractive option for patients presenting for symptomatic ureteral stone and ipsilateral renal calculi smaller than 15 mm.

  17. Study of renal stones complications in 200 patients in Tabriz, Iran

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    Hamid Noshad

    2014-11-01

    Full Text Available Introduction: Urinary stones are the third most common disease of the urinary. Renal stones may lead to some preventable complications. This study was designed to investigation and prediction of these complications. Methods: In this cross-sectional study, 200 patients with kidney stones were enrolled. Kidney stone was confirmed and proven in all patients referred to Sina and Shaikh Al-Rais clinics. Their demographic characteristics like gender, age, stone number, stone type, renal failure and bio-chemistry data were evaluated. Results: Of 200 patients, 130 cases (65.0% were male and 70 cases (35.0% were female. The mean age of patients was 41.30 ± 16.06 years. Type of stone was (when evaluation was possible was mixed (11.5%. However, the type of stone was not analyzed in 112 cases (56.0%. Among complications, recurrent infection was seen (16.0%, and staghorn stones were seen in 2.5% of patients. Dialysis was positive in 3 patients (1.5%. History of surgery was positive in 3 patients (1.5%. Extracorporeal shock wave lithotripsy (ESWL history was positive in 8%. In evaluated patients, the mean level of calcium was 8.83 ± 0.27, phosphorus was 4.60 ± 0.33, parathyroid hormone (PTH was 35.20 ± 14.22, uric acid was 4.98 ± 1.57, creatinine was 1.38 ± 1.02 and blood urea nitrogen level was 16.69 ± 11.54 mg/dl. Staghorn stones are significantly associated with progression to renal failure and subsequent complications such as hemodialysis (P = 0.001, surgery (P = 0.001. Recurrent infection was more frequent in calcium-containing stones (P = 0.001 and ESWL undergoing patients (P = 0.030. Stone numbers were more than 3 in hemodialyzed (HD patients (P = 0.001. Uric acid stones were more seen in HD patients (P = 0.170. Conclusion: According to results hemodialysis and recurrent infections are seen in patients with renal stones, and they may be detected in earlier with close periodic follow-up.

  18. Changes in renal uptake of Tc-99m methylene diphosphonate (MDP) in stone-forming rats

    International Nuclear Information System (INIS)

    McAfee, J.G.; Thomas, F.D.; Roskopf, M.; Ritter, K.; Lyons, B.; Lilien, O.M.; Schoonmaker, J.E.

    1984-01-01

    A pyridoxine (vitamin B6)-deficient diet in rats was used as a model of early renal lithiasis to find out if stone-formers could be identified from control animals by differences in the biodistribution of Tc-99m MDP. The mean renal uptake of this agent at 3 hours was about 70% higher in test animals than in controls, but there was considerable overlap between the upper limits of the normal range and lower values in stone-formers. If these results were valid for humans, the metabolic abnormality in males with early stone-forming disease could not be identified with certainty by in vivo measurements of Tc-99m MDP renal uptake alone. However, the skeletal uptake of MDP in the stone-forming animals was depressed by 28 to 35%, compared with control rats. Consequently, the renal to skeletal MDP concentration ratio was invariably elevated in stone-formers beyond the 95 percentile normal range. Unexpectedly, 76% of the pyridoxine-deficient animals had a higher accumulation of MDP in the myocardium than the upper limit of the normal range. The pyridoxine-deficient diet induced no remarkable early changes in the biodistribution or renal clearance of I-131 Hippuran

  19. Diagnosis of rare inherited glyoxalate metabolic disorders through in-situ analysis of renal stones

    Science.gov (United States)

    Jacob, D. E.; Grohe, B.; Hoppe, B.; Beck, B. B.; Tessadri, R.

    2012-04-01

    The primary hyperoxalurias type I - III constitute rare autosomal-recessive inherited disorders of the human glyoxylate metabolism. By mechanisms that are ill understood progressive nephrocalcinosis and recurrent urolithiasis (kidney stone formation) often starting in early childhood, along with their secondary complications results in loss of nephron mass which progresses to end-stage renal failure over time. In the most frequent form, end-stage renal failure (ESRF) is the rule and combined liver/kidney transplantation respectively pre-emptive liver transplantation are the only causative treatment today. Hence, this contributes significantly to healthcare costs and early diagnosis is extremely important for a positive outcome for the patient. We are developing a stone-based diagnostic method by in-detail multi-methods investigation of the crystalline moiety in concert with urine and stone proteomics. Stone analysis will allow faster analysis at low-impact for the patients in the early stages of the disease. First results from combined spectroscopic (Raman, FTIR)and geochemical micro-analyses (Electron Microprobe and Laser Ablation ICP-MS) are presented here that show significant differences between stones from hyperoxaluria patients and those formed by patients without this disorder (idiopathic stones). Major differences exist in chemistry as well as in morphology and phase composition of the stones. Ca/P ratios and Mg contents differentiate between oxalate-stones from hyperoxaluria patients and idiopathic stones. Results show that also within the different subtypes of primary hyperoxaluria significant differences can be found in stone composition. These imply differences in stone formation which could be exploited for new therapeutic pathways. Furthermore, the results provide important feedback for suspected but yet unconfirmed cases of primary hyperoxaluria when used in concert with the genetic methods routinely applied.

  20. CT Texture Analysis of Ex Vivo Renal Stones Predicts Ease of Fragmentation with Shockwave Lithotripsy.

    Science.gov (United States)

    Cui, Helen W; Devlies, Wout; Ravenscroft, Samuel; Heers, Hendrik; Freidin, Andrew J; Cleveland, Robin O; Ganeshan, Balaji; Turney, Benjamin W

    2017-07-01

    Understanding the factors affecting success of extracorporeal shockwave lithotripsy (SWL) would improve informed decision-making on the most appropriate treatment modality for an individual patient. Although stone size and skin-to-stone distance do correlate with fragmentation efficacy, it has been shown that stone composition and architecture, as reflected by structural heterogeneity on CT, are also important factors. This study aims to determine if CT texture analysis (CTTA), a novel, nondestructive, and objective tool that generates statistical metrics reflecting stone heterogeneity, could have utility in predicting likelihood of SWL success. Seven spontaneously passed, intact renal tract stones, were scanned ex vivo using standard CT KUB and micro-CT. The stones were then fragmented in vitro using a clinical lithotripter, after which, chemical composition analysis was performed. CTTA was used to generate a number of metrics that were correlated to the number of shocks needed to fragment the stone. CTTA metrics reflected stone characteristics and composition, and predicted ease of SWL fragmentation. The strongest correlation with number of shocks required to fragment the stone was mean Hounsfield unit (HU) density (r = 0.806, p = 0.028) and a CTTA metric measuring the entropy of the pixel distribution of the stone image (r = 0.804, p = 0.039). Using multiple linear regression analysis, the best model showed that CTTA metrics of entropy and kurtosis could predict 92% of the outcome of number of shocks needed to fragment the stone. This was superior to using stone volume or density. CTTA metrics entropy and kurtosis have been shown in this experimental ex vivo setting to strongly predict fragmentation by SWL. This warrants further investigation in a larger clinical study for the contribution of CT textural metrics as a measure of stone heterogeneity, along with other known clinical factors, to predict likelihood of SWL success.

  1. Stone-free-rate after extracorporeal shockwave lithotripsy in the management of pediatric renal stones in lower pole and other locations - a comparative study

    International Nuclear Information System (INIS)

    Iqbal, N.; Muhammad, S.; Akhter, S.

    2016-01-01

    To determine a difference in the stone-free-rate among different renal locations in children after extracorporeal shockwave lithotripsy (ESWL). Study Design: A descriptive study. Place and Duration of Study: Urology Department, Shifa International Hospital, Islamabad, Pakistan, from January 2007 to June 2015. Methodology: The study included children who underwent ESWL, divided into three groups based on location of stones in kidney as group A (lower pole stones), group B (upper and mid pole stones) and group C (renal pelvis stone), respectively. ESWL was done by standard technique using Storz Modulith SLX lithotripter 3rd generation. Data was collected by chart review. SPSS version 16 was used for data analysis. Results: Among 76 children with mean age of 7.55 +-4.16 years, 55 (72.4%) were males whereas 21 (27.6%) were females. Mean stone size was 1.08 +-0.59 cm. There were 34, 17 and 25 cases in groups A, B and C, respectively. PostESWL stone-free-rate was 47% in lower pole stones, 70.58% in upper and mid pole stones, and 68% in renal pelvis stones. Hematuria was seen in one patient from each group, sepsis in two patients from each of the mid pole/upper pole and lower pole group, while Steinstrasse in one patient from each group. (author)

  2. Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

    Science.gov (United States)

    Singal, Rikki; Dhar, Siddharth

    2018-01-01

    The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

  3. Renal papillary attenuation differences between primary and recurrent idiopathic calcium stone disease patients.

    Science.gov (United States)

    Cakiroglu, B; Eyyupoglu, S E; Tas, T; Esen, T; Acar, O; Aksoy, S H

    2014-06-01

    The aim of this paper was to investigate whether renal papillae of patients with nephrolithiasis are more radiodense than that of control patients and to evaluate the predictability of urolithiasis using papillary density differences between stone and non-stone formers. Renal papillary Hounsfield Unit (HU) measurements were conducted at the level of upper pole, middle region and lower pole of both kidneys in a total of 126 primary (group 1), 133 recurrent (group 2) stone disease patients and 108 controls (group 3). Mean patient age did not differ significantly between groups (P>0.05). Mean stone diameters (±SD) were 5.0±3.1 mm (3-9 mm) and 6.1±3.3 mm (3-15 mm) for primary and recurrent groups, respectively and group distributions and variances were similar (P>0.05). Mean papillary attenuation values (±SD) were 27.26±9.30 (4.00-56.00) in group 1, 30.42±9.88 (12.00-64.00) in group 2 and 25.83±2.72 (20.30-32.56) in the control group. The difference between the mean papillary attenuation value of the primary stone disease group and the control group was statistically insignificant (P=0.104). When the control group and the recurrent stone group was compared without variances, in terms of the mean renal papillary attenuation value, a statistical significance was achieved (P=0.000). With increasing renal papillary HU values, the risk of recurrent calcium stone disease is increased.

  4. Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients

    Directory of Open Access Journals (Sweden)

    V. A. Mezentsev

    2005-04-01

    Full Text Available INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the

  5. Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management.

    Science.gov (United States)

    Cai, Jian-liang; Zhang, Yi; Sun, Guo-feng; Li, Ning-chen; Yuan, Xue-li; Na, Yan-qun

    2013-10-01

    Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen. Thirty catechumen, included 17 attending physicians and 13 associate chief physicians, were selected for study. The trainees first underwent 1-hour basic training to get familiar with the instrument and basic procedures, then followed by 4-hour practice on virtual reality simulators. Before and after the 4-hour training, all trainees undertake an assessment with task 7 program (right low pole calyces stone management). We documented for each trainee the total time of procedure, time of progressing from the orifice to stone, stone translocation and fragmentation time, laser operate proficiency scale, total laser energy, maximal size of residual stone fragments, number of trauma from the scopes and tools, damage to the scope and global rating scale (GRS). The proficiency of this training program was analyzed by the comparison of the first and second assessment outcomes. Significant improvement was observed in retrograde flexible ureteroscopy management of renal stone on virtual reality simulators after finishing the 4 hour special-purpose training. This was demonstrated by improvement in total procedure time ((18.37±2.59) minutes vs. (38.67±1.94) minutes), progressing time from the orifice to stone ((4.00±1.08) minutes vs. (13.80±2.01) minutes), time of stone translocation ((1.80±0.71) minutes vs. (6.57±1.01) minutes), fragmentation time ((4.43±1.25) minutes vs. (13.53±1.46) minutes), laser operate proficiency scale (8.47±0.73 vs. 3.77±0.77), total laser energy ((3231.6±401.4) W vs. (5329.8±448.9) W), maximal size of residual stone fragments ((2.66±0.39) mm vs. (5.77±0.63) mm), number of trauma from the scopes and tools (3.27±1.01 vs. 10.37±3.02), damage to the scope (0 vs

  6. Flexible Ureterorenoscopy versus Mini-Percutaneous Nephrolithotomy for the Treatment of Renal Stones.

    Science.gov (United States)

    Ergin, Giray; Kirac, Mustafa; Kopru, Burak; Ebiloglu, Turgay; Biri, Hasan

    2018-04-22

    To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneousnephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones. This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative andpostoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient. Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones.

  7. Renal geology (quantitative renal stone analysis) by 'Fourier transform infrared spectroscopy'.

    Science.gov (United States)

    Singh, Iqbal

    2008-01-01

    To prospectively determine the precise stone composition (quantitative analysis) by using infrared spectroscopy in patients with urinary stone disease presenting to our clinic. To determine an ideal method for stone analysis suitable for use in a clinical setting. After routine and a detailed metabolic workup of all patients of urolithiasis, stone samples of 50 patients of urolithiasis satisfying the entry criteria were subjected to the Fourier transform infrared spectroscopic analysis after adequate sample homogenization at a single testing center. Calcium oxalate monohydrate and dihydrate stone mixture was most commonly encountered in 35 (71%) followed by calcium phosphate, carbonate apatite, magnesium ammonium hexahydrate and xanthine stones. Fourier transform infrared spectroscopy allows an accurate, reliable quantitative method of stone analysis. It also helps in maintaining a computerized large reference library. Knowledge of precise stone composition may allow the institution of appropriate prophylactic therapy despite the absence of any detectable metabolic abnormalities. This may prevent and or delay stone recurrence.

  8. Influences of renal stone surgeries on renal function; Evaluation of renal function with sup 99m Tc-DMSA renal scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Katayama, Yasushi (Niigata Univ. (Japan). School of Medicine)

    1991-10-01

    From 1984 to 1990, {sup 99m}Tc-DMSA renal scintigraphy was performed before and after nephrolithotomy (15 cases), pyelolithotomy (15 cases), percutaneous nephrolithotripsy (PNL: 15 cases) and extracorporeal shock wave lithotripsy (ESWL: 16 cases, 17 kidneys) in order to evaluate of influences of renal stone surgeries on split renal function. DMSA renal uptake change ratio of treated kidneys of nephrolithotomy (-24.94{+-}5.60%) was significantly lower than that of PNL (-0.06{+-}3.92%), pyelolithotomy (-4.08{+-}4.79%) (p<0.01) and ESWL (-7.72{+-}3.87%) (p<0.05). The average change ratios of contralateral kidneys were as follows: PNL 4.80{+-}4.21% nephrolithotomy 4.67{+-}4.73%, pyelolithotomy -1.46{+-}5.39% and ESWL -2.02{+-}4.44%. One to 3 weeks after PNL, the cold area on the renal image was found in 10 (66.7%) of 15 cases. In cases of ESWL, DMSA renal uptake decreased even 4-10 weeks (mean 7 weeks) after treatment. In conclusion, possibility of deterioration of renal function after ESWL was suggested. (author).

  9. Hyaluronan Biology and Regulation in Renal Tubular Epithelial Cells and its Role in Kidney Stone Disease

    NARCIS (Netherlands)

    M. Asselman (Marino)

    2008-01-01

    textabstractRenal stone disease is a widespread problem afflicting more and more people throughout the world. Epidemiological studies show an increase in incidence and prevalence rates. In North America and Europe the yearly incidence is estimated to be about 0.5% 1, 2. The prevalence of kidney

  10. Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

    Science.gov (United States)

    Gündüz, Metin; Sekmenli, Tamer; Ciftci, İlhan; Elmacı, Ahmet Midhat

    2017-01-01

    We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in

  11. Pulp Stone, Haemodialysis, End-stage Renal Disease, Carotid Atherosclerosis

    OpenAIRE

    Patil, Santosh; Sinha, Nidhi

    2013-01-01

    Objectives: The aim of this study was to determine the relationship between the presence of pulp calcification and carotid artery calcification on the dental panoramic radiographs in End Stage Renal Disease (ESRD) patients who were on haemodialysis.

  12. Acoustic sensing of renal stone fragmentation in extracorporeal shockwave lithotripsy

    OpenAIRE

    Fedele, Fiammetta

    2008-01-01

    This thesis describes the research carried out by the author on the exploitation of acoustic emissions detected during extracorporeal shockwave lithotripsy (a non-invasive procedure for the treatment of urinary stones) to develop a new diagnostic system. The work formed part of a research project on lithotripsy undertaken by the University of Southampton in collaboration with Guy's and St Thomas' NHS Foundation Trust (London) and a UK based company, Precision Acoustics Ltd (Dorche...

  13. Uricosuric effect of Roselle (Hibiscus sabdariffa) in normal and renal-stone former subjects.

    Science.gov (United States)

    Prasongwatana, Vitoon; Woottisin, Surachet; Sriboonlue, Pote; Kukongviriyapan, Veerapol

    2008-05-22

    The Roselle (Hibiscus sabdariffa) was investigated for its uricosuric effect. A human model with nine subjects with no history of renal stones (non-renal stone, NS) and nine with a history of renal stones (RS) was used in this study. A cup of tea made from 1.5 g of dry Roselle calyces was provided to subjects twice daily (morning and evening) for 15 days. A clotted blood and two consecutive 24-h urine samples were collected from each subject three times: (1) at baseline (control); (2) on days 14 and 15 during the tea drinking period; and (3) 15 days after the tea drinking was stopped (washout). Serum and 24-h urinary samples were analyzed for uric acid and other chemical compositions related to urinary stone risk factors. All analyzed serum parameters were within normal ranges and similar; between the two groups of subjects and among the three periods. Vis-à-vis the urinary parameters, most of the baseline values for both groups were similar. After taking the tea, the trend was an increase in oxalate and citrate in both groups and uric acid excretion and clearance in the NS group. In the RS group, both uric acid excretion and clearance were significantly increased (pRoselle calyces. Since the various chemical constituents in Roselle calyces have been identified, the one(s) exerting this uricosuric effect need to be identified.

  14. The outcome of open renal stone surgery calls for limitation of its use ...

    African Journals Online (AJOL)

    I. Khalaf

    In the past two decades, advances in endoscopic management of nephrolithiasis ..... remain a viable option in those countries for some time [7]. Complex stone .... than risk the potential need for multiple, less invasive procedures. In our report ...

  15. The role of imaging in the diagnosis and management of renal stone disease in pregnancy

    International Nuclear Information System (INIS)

    Masselli, G.; Weston, M.; Spencer, J.

    2015-01-01

    The distinction of pain in pregnancy due to urolithiasis from that related to physiological dilation of the renal tract is a common conundrum as renal colic is one of the commonest causes for non-obstetric pain in pregnancy. Ultrasound is the first-line imaging test but although it may demonstrate renal dilation, it may not show the cause. Magnetic resonance imaging (MRI) is able to make the distinction. Physiological dilation will show smooth tapering of the ureter in the middle third as it is compressed between the gravid uterus and the retroperitoneum. Obstruction due to calculi causes renal enlargement and perinephric oedema. When a stone is lodged in the lower ureter, a standing column of dilated ureter will be seen below the physiological constriction. The stone itself may be shown. Computed tomography (CT) is an acceptable alternative if there is a contraindication to MRI, but even low-dose regimes involve some ionising radiation. This paper serves to highlight the role of MRI compared to US and CT in the imaging of renal colic in pregnancy. Multidisciplinary collaboration between obstetricians, urologists, and radiologists is required for effective management. - Highlights: • Ultrasound and MR imaging are the preferred investigations for renal colic during pregnancy. • MR imaging helps differentiate physiologic from obstructive hydronephrosis when ultrasound is inconclusive. • If MR imaging cannot be performed, low-dose CT may be necessary.

  16. Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study.

    Science.gov (United States)

    ElSheemy, Mohammed S; Elmarakbi, Akram A; Hytham, Mohammed; Ibrahim, Hamdy; Khadgi, Sanjay; Al-Kandari, Ahmed M

    2018-03-16

    To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann-Whitney, Chi square or Fisher's exact tests as appropriate in addition to logistic regression analysis. P PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm 2 ; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm 2 ), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm 2 ), but not with single stones or stone burden ≤ 2 cm 2 .

  17. Effect of potential renal acid load of foods on urinary citrate excretion in calcium renal stone formers.

    Science.gov (United States)

    Trinchieri, Alberto; Lizzano, Renata; Marchesotti, Federica; Zanetti, Giampaolo

    2006-02-01

    The aim of this study was to investigate the influence of the potential renal acid load (PRAL) of the diet on the urinary risk factors for renal stone formation. The present series comprises 187 consecutive renal calcium stone patients (114 males, 73 females) who were studied in our stone clinic. Each patient was subjected to an investigation including a 24-h dietary record and 24-h urine sample taken over the same period. Nutrients and calories were calculated by means of food composition tables using a computerized procedure. Daily PRAL was calculated considering the mineral and protein composition of foods, the mean intestinal absorption rate for each nutrient and the metabolism of sulfur-containing amino acids. Sodium, potassium, calcium, magnesium, phosphate, oxalate, urate, citrate, and creatinine levels were measured in the urine. The mean daily PRAL was higher in male than in female patients (24.1+/-24.0 vs 16.1+/-20.1 mEq/day, P=0.000). A significantly (P=0.01) negative correlation (R=-0.18) was found between daily PRAL and daily urinary citrate, but no correlation between PRAL and urinary calcium, oxalate, and urate was shown. Daily urinary calcium (R=0.186, P=0.011) and uric acid (R=0.157, P=0.033) were significantly related to the dietary intake of protein. Daily urinary citrate was significantly related to the intakes of copper (R=0.178, P=0.015), riboflavin (R=0.20, P=0.006), piridoxine (R=0.169, P=0.021) and biotin (R=0.196, P=0.007). The regression analysis by stepwise selection confirmed the significant negative correlation between PRAL and urinary citrate (P=0.002) and the significant positive correlation between riboflavin and urinary citrate (P=0.000). Urinary citrate excretion of renal stone formers (RSFs) is highly dependent from dietary acid load. The computation of the renal acid load is advisable to investigate the role of diet in the pathogenesis of calcium stone disease and it is also a useful tool to evaluate the lithogenic potential of

  18. Alopecia universalis, renal stones, and hyperuricemia: A familial or an unfamiliar association

    Directory of Open Access Journals (Sweden)

    Kalachand Jana

    2014-01-01

    Full Text Available Alopecia Universalis is an autoimmune disorder which sometimes may be associated with other autoimmune diseases like vitiligo, atopic dermatitis and endocrine disorders like hypothyroidism. In less than 2% of cases it may be associated with nephrotic syndrome although the underlying etiology has not been reported. We report here one similar case that had alopecia universalis beginning at the age of 17 years and simultaneously developed hyperuricemia. His son also developed alopecia universalis and renal stones at an early age of 10 years. The case represents one of the rare forms of alopecia namely alopecia universalis in two generations of the same family. Apart from this the case highlights the presence of renal stones probably due to hyperuricemia in both the generations which invokes a need to investigate any association of hyperuricemia with alopecia universalis.

  19. Safety and efficacy of staged retrograde intrarenal surgery for large stone burden of renal stones in selected patients: A single-center experience

    Directory of Open Access Journals (Sweden)

    Cheng-Feng Lin

    2017-06-01

    Conclusion: To the best of our knowledge, RIRS for large renal stone manipulation is an effective and safe treatment modality currently. In our study, the single RIRS SFR was superior to PNL or SWL even when the stone burden was between 2.0 cm and 3.0 cm (80.2%. For those patients whose stone burden was over 3.0 cm or for those with comorbidities, staged RIRS resulted in a lower complication rate, reduced hospital stay, and better SFR (76.5%.

  20. The effects of previous open renal stone surgery types on PNL outcomes.

    Science.gov (United States)

    Ozgor, Faruk; Kucuktopcu, Onur; Ucpinar, Burak; Sarilar, Omer; Erbin, Akif; Yanaral, Fatih; Sahan, Murat; Binbay, Murat

    2016-01-01

    Our aim was to demonstrate the effect of insicion of renal parenchyma during open renal stone surgery (ORSS) on percutaneous nephrolithotomy (PNL) outcomes. Patients with history of ORSS who underwent PNL operation between June 2005 and June 2015 were analyzed retrospectively. Patients were divided into two groups according to their type of previous ORSS. Patients who had a history of ORSS with parenchymal insicion, such as radial nephrotomies, anatrophic nephrolithotomy, lower pole resection, and partial nephrectomy, were included in Group 1. Other patients with a history of open pyelolithotomy were enrolled in Group 2. Preoperative characteristics, perioperative data, stone-free status, and complications were compared between the groups. Stone-free status was defined as complete clearance of stone(s) or presence of residual fragments smaller than 4 mm. The retrospective nature of our study, different experience level of surgeons, and lack of the evaluation of anesthetic agents and cost of procedures were limitations of our study. 123 and 111 patients were enrolled in Groups 1 and 2, respectively. Preoperative characteristics were similar between groups. In Group 1, the mean operative time was statistically longer than in Group 2 (p=0.013). Stone-free status was significantly higher in Group 2 than in Group 1 (p=0.027). Complication rates were similar between groups. Hemorrhage requiring blood transfusion was the most common complication in both groups (10.5% vs. 9.9%). Our study demonstrated that a history of previous ORSS with parenchymal insicion significantly reduces the success rates of PNL procedure.

  1. The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones.

    Science.gov (United States)

    Resorlu, Berkan; Oguz, Ural; Resorlu, Eylem Burcu; Oztuna, Derya; Unsal, Ali

    2012-01-01

    To evaluate the impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery (RIRS) for lower pole renal stones and determine which of these factors can be used to select patients who will benefit from RIRS. We evaluated 67 patients who underwent RIRS between 2009 and 2010 for isolated lower pole renal stones. The infundibular length (IL), infundibular width (IW), pelvicaliceal height (PCH), and infundibulopelvic angle (IPA) were measured by preoperative intravenous urogram. Success was defined as either complete clearance or clearance with insignificant residual fragments≤3 mm in size at 2-months follow-up. Mean IL was 26.7±7.9 and 28.2±5.3 mm, mean PCH was 20.7±6.6 and 23.2±4.9 mm in stone-free and non-stone-free patients, respectively. These were slightly larger in the non-stone-free group but not statistically significant (P=.140 and P=.072, respectively). Mean IW was 5.8±3.5 and 5.6±2.2 mm in stone-free and non-stone-free patients, respectively, which had no significant impact on the stone-free rate (P=.719). There were significant differences between the groups in terms of stone length (P=.001) and IPA (P=.003). The mean IPA was 49.37±11.83 and 37.61±13.22 mm in stone-free and non-stone-free patients, respectively. In addition to the influence of stone size, lower pole anatomy, especially IPA, has a significant impact on stone clearance for lower pole stones after RIRS. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Use of the Escape nitinol stone retrieval basket facilitates fragmentation and extraction of ureteral and renal calculi: a pilot study.

    Science.gov (United States)

    Kesler, Stuart S; Pierre, Sean A; Brison, Daniel I; Preminger, Glenn M; Munver, Ravi

    2008-06-01

    Advances in ureteroscope and stone basket design have catapulted ureteroscopy to the forefront of surgical stone management; however, persistent problems such as stone migration continue to challenge urologists. The Escape nitinol stone retrieval basket (Boston Scientific, Natick, MA) is a stone basket designed to capture calculi and facilitate simultaneous laser lithotripsy in situ. We report our initial experience with the Escape basket for the management of urinary calculi and compare the use of this device with other methods of optimizing ureteroscopic stone management. A prospective evaluation of 23 patients undergoing ureteroscopic holmium:yttrium-aluminum-garnet laser lithotripsy of urinary calculi was performed at two institutions by two surgeons (R.M. and G.M.P). The Escape basket was used to prevent retrograde ureteral stone migration or to facilitate fragmentation and extraction of large renal calculi. Patient demographics and perioperative parameters were assessed. Twenty-three patients (16 men, 7 women), with a mean age of 55.5 years (range 33-74 yrs) were treated for renal (n = 9) or ureteral (n = 14) calculi. The mean stone diameter was 1.4 cm (range 0.4-2.5 cm), mean fragmentation time was 44.1 minutes (range 10-75 min), and mean energy used was 3.1 kJ (range 0.4-10.6 kJ). No complications were encountered. Eighty-seven percent (20/23) of patients were rendered completely stone free after ureteroscopic laser lithotripsy using the Escape basket. Of the three patients with residual calculi, one patient with a 2.5-cm renal calculus had residual fragments larger than 3 mm, and two patients with large renal calculi had residual fragments smaller than 3 mm. The Escape basket appears to be safe and effective in preventing stone migration and facilitating ureteroscopic laser lithotripsy and stone extraction.

  3. Kidney stone matrix proteins ameliorate calcium oxalate monohydrate induced apoptotic injury to renal epithelial cells.

    Science.gov (United States)

    Narula, Shifa; Tandon, Simran; Singh, Shrawan Kumar; Tandon, Chanderdeep

    2016-11-01

    Kidney stone formation is a highly prevalent disease, affecting 8-10% of the human population worldwide. Proteins are the major constituents of human kidney stone's organic matrix and considered to play critical role in the pathogenesis of disease but their mechanism of modulation still needs to be explicated. Therefore, in this study we investigated the effect of human kidney stone matrix proteins on the calcium oxalate monohydrate (COM) mediated cellular injury. The renal epithelial cells (MDCK) were exposed to 200μg/ml COM crystals to induce injury. The effect of proteins isolated from human kidney stone was studied on COM injured cells. The alterations in cell-crystal interactions were examined by phase contrast, polarizing, fluorescence and scanning electron microscopy. Moreover, its effect on the extent of COM induced cell injury, was quantified by flow cytometric analysis. Our study indicated the antilithiatic potential of human kidney stone proteins on COM injured MDCK cells. Flow cytometric analysis and fluorescence imaging ascertained that matrix proteins decreased the extent of apoptotic injury caused by COM crystals on MDCK cells. Moreover, the electron microscopic studies of MDCK cells revealed that matrix proteins caused significant dissolution of COM crystals, indicating cytoprotection against the impact of calcium oxalate injury. The present study gives insights into the mechanism implied by urinary proteins to restrain the pathogenesis of kidney stone disease. This will provide a better understanding of the formation of kidney stones which can be useful for the proper management of the disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Renal stone characterization using high resolution imaging mode on a photon counting detector CT system

    Science.gov (United States)

    Ferrero, A.; Gutjahr, R.; Henning, A.; Kappler, S.; Halaweish, A.; Abdurakhimova, D.; Peterson, Z.; Montoya, J.; Leng, S.; McCollough, C.

    2017-03-01

    In addition to the standard-resolution (SR) acquisition mode, a high-resolution (HR) mode is available on a research photon-counting-detector (PCD) whole-body CT system. In the HR mode each detector consists of a 2x2 array of 0.225 mm x 0.225 mm subpixel elements. This is in contrast to the SR mode that consists of a 4x4 array of the same subelements, and results in 0.25 mm isotropic resolution at iso-center for the HR mode. In this study, we quantified ex vivo the capabilities of the HR mode to characterize renal stones in terms of morphology and mineral composition. Forty pure stones - 10 uric acid (UA), 10 cystine (CYS), 10 calcium oxalate monohydrate (COM) and 10 apatite (APA) - and 14 mixed stones were placed in a 20 cm water phantom and scanned in HR mode, at radiation dose matched to that of routine dual-energy stone exams. Data from micro CT provided a reference for the quantification of morphology and mineral composition of the mixed stones. The area under the ROC curve was 1.0 for discriminating UA from CYS, 0.89 for CYS vs COM and 0.84 for COM vs APA. The root mean square error (RMSE) of the percent UA in mixed stones was 11.0% with a medium-sharp kernel and 15.6% with the sharpest kernel. The HR showed qualitatively accurate characterization of stone morphology relative to micro CT.

  5. Effects and outcome of Tamsulosin more than just stone clearance after extracorporeal shock wave lithotripsy for renal calculi

    International Nuclear Information System (INIS)

    Qadri, S. S. U.; Khalid, S. E.; Mahmud, S. M.

    2014-01-01

    Objective: To determine the effect of Tamsulosin, as adjunctive medical therapy after Extracorporeal Shock Wave Lithotripsy for renal stones on rate of stone clearance, clearance time, pain intensity during stone clearance, steinstrasse formation and auxiliary surgical intervention required. Method: A prospective randomized controlled study was carried out in 120 patients who underwent ESWL for renal stones of 0.5-2.0 cm. They were randomized into study and control group in which Tamsulosin 0.4mg/day was given in former as an adjunctive medical therapy. All patients underwent ESWL every 2 weeks until complete stone clearance for 8 weeks. The parameters assessed were stone clearance, clearance time, pain intensity and effect on steinstrasse. Results: Of the 120 patients 60 were in each group. The stone clearance rate was greater in study than in control group, 58(96.7%) vs. 48(80%) respectively, (p<0.004). The mean stone clearance time was observed earlier in study group as compared to control group with significant statistical difference in stone size between 0.6-1.5 cm. The mean intensity of pain patients experienced according to Visual analogue scale (VAS) was significantly less in study group (p<0.002). The rate of steinstrasse formation was observed to be higher in control than in study group 15(25%) vs 6(10%) respectively(p<0.003), while its spontaneous clearance was higher in study group than in control group 83.3% vs 33.3% (p<0.03). Conclusion: Tamsulosin significantly increases stone clearance after shock wave lithotripsy for renal stones. It also appeared to facilitate earlier stone clearance, reduces severity of pain, reduces the incidence of steinstrasse formation and tends to facilitate its spontaneous clearance. (author)

  6. Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group.

    Science.gov (United States)

    Prezioso, Domenico; Strazzullo, Pasquale; Lotti, Tullio; Bianchi, Giampaolo; Borghi, Loris; Caione, Paolo; Carini, Marco; Caudarella, Renata; Ferraro, Manuel; Gambaro, Giovanni; Gelosa, Marco; Guttilla, Andrea; Illiano, Ester; Martino, Marangella; Meschi, Tiziana; Messa, Piergiorgio; Miano, Roberto; Napodano, Giorgio; Nouvenne, Antonio; Rendina, Domenico; Rocco, Francesco; Rosa, Marco; Sanseverino, Roberto; Salerno, Annamaria; Spatafora, Sebastiano; Tasca, Andrea; Ticinesi, Andrea; Travaglini, Fabrizio; Trinchieri, Alberto; Vespasiani, Giuseppe; Zattoni, Filiberto

    2015-07-07

    stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. HYPEROXALURIA: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults) reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. HYPERURICOSURIA: In patients with renal calcium stones the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not clearly demonstrated. HYPOCITRATURIA: The administration of alkaline-citrates salts is recommended for the medical treatment of renal stone-formers with hypocitraturia, although compliance to this treatment is limited by gastrointestinal side effects and costs. Increased intake of fruit and vegetables (excluding those with high oxalate content) increases citrate excretion and involves a significant protection against the risk of stone formation. Citrus (lemons, oranges, grapefruit, and lime) and non citrus fruits (melon) are natural sources of dietary citrate, and several studies have shown the potential of these fruits and/or their juices in raising urine citrate levels. There are enought basis to advice an adequate fluid intake also in children. Moderate dietary salt restriction and implementation of potassium intake are useful in limiting urinary calcium excretion whereas dietary calcium restriction is not recommended for children with nephrolithiasis. It seems reasonable to advice a balanced consumption of fruit and vegetables and a low

  7. Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

    Directory of Open Access Journals (Sweden)

    Domenico Prezioso

    2015-07-01

    different origin decreases calciuria, but their impact on the urinary stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. Hyperoxaluria: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. Hyperuricosuria: In patients with renal calcium stones the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not clearly demonstrated. Hypocitraturia: The administration of alkaline-citrates salts is recommended for the medical treatment of renal stone-formers with hypocitraturia, although compliance to this treatment is limited by gastrointestinal side effects and costs. Increased intake of fruit and vegetables (excluding those with high oxalate content increases citrate excretion and involves a significant protection against the risk of stone formation. Citrus (lemons, oranges, grapefruit, and lime and non citrus fruits (melon are natural sources of dietary citrate, and several studies have shown the potential of these fruits and/or their juices in raising urine citrate levels. Children: There are enought basis to advice an adequate fluid intake also in children. Moderate dietary salt restriction and implementation of potassium intake are useful in limiting urinary calcium excretion whereas dietary calcium restriction is not recommended for children with nephrolithiasis. It seems

  8. Retroperitoneoscopic pyelolithotomy: A minimally invasive alternative for the management of large renal pelvic stone

    Directory of Open Access Journals (Sweden)

    Saurabh Sudhir Chipde

    2014-01-01

    Full Text Available Introduction: Large stones in renal pelvis can be treated with percutaneous nephrolithotomy (PCNL or pyelolithotomy (either by open or laparoscopic techniques. PCNL is difficult in undilated system. For pyelolithotomy, laparoscopy is more preferable over the open surgery. Surgeons are more familiar with the tansperitoneoscopic anatomy than retroperitoneoscopic one, but retroperitoneoscopic approach can be attempted if we anticipate the problems in the transperitoneal route. Case: A fifty years old gentleman presented to us with the complaint of dull aching right flank pain. On ultrasonographic examination, he was found to have a large stone in renal pelvis with minimal hydronephrosis and thickened omentum on right side. Xray KUB showed a large radio-opaque shadow in renal area. We did the CECT-Urogram of the patient to know the detailed anatomy, which showed a stone of 5.3 x 3.7 cm in right extra-rena pelvis without hydronephrosis and a large focal area of marked fat stranding in omentum on the right side in mid and lower abdomen with swirling of fat stranding on the superior aspect suggestive of omental infarction and torsion. Due to undilated caliceal system, we preferred laparoscopic surgery over the PCNL in this patient. As whole of the omental tissue was stuck on right side we decided to proceed with transperitoneoscopic route instead of retroperitoneoscopic one. The DJ stent was inserted preoperatively.The surgery was performed in the flank position with three ports, one 10mm port just antero-inferior to tip of 12th rib for camera and two 5mm working ports, one at anterior axillary line and other at renal angle. We created the retroperitoneal space with the customized balloon, made with the glove-fingure. Results: The operative time was 1 hour 40 minutes, and there were no intra or post-operative complications. The stone was removed in toto. Patient was orally allowed on first postoperative day and foleys was removed on second day. patient

  9. Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi.

    Science.gov (United States)

    Wiesenthal, Joshua D; Ghiculete, Daniela; D'A Honey, R John; Pace, Kenneth T

    2010-08-01

    Shock wave lithotripsy (SWL) is considered the first line treatment for the majority of patients with renal and ureteric calculi, with success rates from contemporary series varying from 60 to 90%. Success is dependent on many patient and stone-related factors. We conducted a retrospective analysis of mean stone CT density (MSD) and skin-to-stone distance (SSD) to determine their influence on the success of SWL of renal and ureteric calculi. Data from all patients treated at the St. Michael's Hospital Lithotripsy Unit from May 2004 to June 2009 were reviewed. Analysis was restricted to those patients with a pre-treatment non-contrast CT scan conducted at our center demonstrating a solitary renal or ureteric calculus 900 HU (OR = 0.49, CI: 0.32-0.75) and SSD >110 mm (OR = 0.49, CI: 0.31-0.78) were both significant predictors of outcome. We have identified in a large series of renal and ureteric calculi that both MSD and SSD can reliably predict SWL outcomes. This data can be used in combination with other patient and stone-related factors to facilitate optimal treatment-based decisions and provide patients with more accurate single-treatment success rates for SWL.

  10. MICROBIOTA URINE BEFORE AND AFTER LITHOTRIPSY FOR RENAL STONES

    Directory of Open Access Journals (Sweden)

    Y. L. Naboka

    2013-01-01

    Full Text Available Extracorporeal shock wave lithotripsy (ESWL in spite of the low invasiveness and high efficiency is accompanied by an infectious- inflammatory complications and renal parenchymal injury . Dynamics of microbial spectrum urine and the impact of postoperative antibiotic therapy currently remains unexplored. The study included 30 patients subjected to ESWL. Bacteriological study was midstream morning urine before ESWL, 1, 3 days after ESWL, and midstream urine in the first urination after ESWL. All patients were divided into 2 groups. Group I consisted of patients (46.7% with antibiotic therapy . Group II patients (53.3 % antibiotic therapy was performed. In most cases (97.8 % were bacteriuria , while in 75% of cases highlighted in the various options bacterial associations representation aerobic- anaerobic mixed infection, among which was dominated by non-clostridial anaerobic bacteria in all samples. Revealed that after ESWL microbial spectrum urine does not change in any case within 3 days , except for Enterobacteriaceae, but the frequency of occurrence and level of bacteriuria vary for different periods after surgery and fees or absence of antibiotic therapy.

  11. The Guy's stone score--grading the complexity of percutaneous nephrolithotomy procedures.

    Science.gov (United States)

    Thomas, Kay; Smith, Naomi C; Hegarty, Nicholas; Glass, Jonathan M

    2011-08-01

    To report the development and validation of a scoring system, the Guy's stone score, to grade the complexity of percutaneous nephrolithotomy (PCNL). Currently, no standardized method is available to predict the stone-free rate after PCNL. The Guy's stone score was developed through a combination of expert opinion, published data review, and iterative testing. It comprises 4 grades: grade I, solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy; grade II, solitary stone in upper pole or multiple stones in a patient with simple anatomy or a solitary stone in a patient with abnormal anatomy; grade III, multiple stones in a patient with abnormal anatomy or stones in a caliceal diverticulum or partial staghorn calculus; grade IV, staghorn calculus or any stone in a patient with spina bifida or spinal injury. It was assessed for reproducibility using the kappa coefficient and validated on a prospective database of 100 PCNL procedures performed in a tertiary stone center. The complications were graded using the modified Clavien score. The clinical outcomes were recorded prospectively and assessed with multivariate analysis. The Guy's stone score was the only factor that significantly and independently predicted the stone-free rate (P = .01). It was found to be reproducible, with good inter-rater agreement (P = .81). None of the other factors tested, including stone burden, operating surgeon, patient weight, age, and comorbidity, correlated with the stone-free rate. The Guy's stone score accurately predicted the stone-free rate after PCNL. It was easy to use and reproducible. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Treatment of Moderate Sized Renal Pelvis Calculi: Stone Clearance Time Comparison of Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery.

    Science.gov (United States)

    Ercil, Hakan; Alma, Ergun; Bas, Okan; Sener, Nevzat Can; Vuruskan, Ediz; Kuyucu, Faruk; Unal, Umut; Gören, Mehmet Resit; Evliyaoglu, Yalcin

    2016-03-05

    To compare the stone clearance times in patients undergoing extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for single radiopaque renal pelvis stones 10-20 mm in size. The results of this study may guide urologists and patients and aid in selecting the optimal preoperative treatment. Between January 2013 and February 2015, we conducted a retrospective study and collected data from 333 patients treated with SWL (n = 172) or RIRS (n = 161). We included successfully treated patients with a single radiopaque renal pelvis stone 10-20 mm in size to calculate stone clearance times. The average stone size for the SWL group was 14.62 ± 2.58 mm and 14.91 ± 2.92 mm for the RIRS group. The mean Hounsfield unit (HU) of the patients was 585.40 ± 158.39 HU in the SWL group and 567.74 ± 186.85 HU in the RIRS group. Following full fragmentation, the mean stone clearance time was 26.55 ± 9.71 days in the SWL group and 11.59 ± 7.01 days in the RIRS group (P < .001). One of the most overlooked parameters in urinary stone treatments is stone clearance. We believe this study will shed light for those who aim to conduct larger randomized prospective studies. .

  13. Has the pelvic renal stone position inside the upper loop of JJ stent any influence on the extracorporeal shock wave lithotripsy results?

    Science.gov (United States)

    Pricop, Catalin; Serban, Dragomir N; Serban, Ionela Lacramioara; Cumpanas, Alin-Adrian; Gingu, Constantin-Virgil

    2016-01-01

    JJ stents are often encountered in patients with pelvic renal stones referred for shock wave lithotripsy, most of them being placed either for obstructive renal pelvic stones or for ureteric stones mobilized retrograde during the JJ stent insertion. The aim of the study was to determine whether the relative stone position in the upper loop of the JJ stent during extracorporeal shock wave lithotripsy (SWL) influences the efficiency of the procedure. The study was designed as a prospective cohort study on 162 patients addressing the same urological department, with single renal pelvic stone (primary or mobilized to the renal pelvis during the insertion of JJ stent), smaller than 15 mm, with JJ stent, treated by SWL using a second generation spark gap lithotripter, 18 kV, 3000 waves/session. Patients were divided in three groups according to the relative position of the stone to the upper loop of the JJ stent as appears on plain X-ray: stone-inside-loop, loop-crossing-stone and stone-outside the loop. The SWL success rate was the primary outcome of the study. p Value, Chi square and Kruskal-Wallis tests were used for statistical analysis. For stone-inside-loop cases, SWL efficiency was 22.7 versus 42 % for all the other cases (p = 0.002). Other factors for decreased SWL success rate were: higher stone radio-opacity, larger JJ of stent and obese patients. Study limitation is represented by the relative small study group and by the evaluation of stone density using plain X-ray instead of computer tomography. For pelvic renal stones having the same density characteristics studied by plain X-ray, the SWL efficiency is lower in stone-inside-loop cases comparing with the other positions. The overall stone free rate for renal pelvic stones could be explained by the second generation lithotripter used for all procedures.

  14. Comparative Study between Slow Shock Wave Lithotripsy and Fast Shock Wave Lithotripsy in the Management of Renal Stone

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    AKM Zamanul Islam Bhuiyan

    2013-01-01

    Full Text Available Background: Renal calculi are frequent causes of ureteric colic. Extracorporeal shock wave lithotripsy is the most common treatment of these stones. It uses focused sound waves to break up stones externally. Objective: To compare the efficiency of slow and fast delivery rate of shock waves on stone fragmentation and treatment outcome in patients with renal calculi. Materials and Methods: This prospective study was done in the department of Urology, National Institute of Kidney diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2006 to June 2007. Total 90 patients were treated using the Storz Medical Modulith ® SLX lithotripter. Patients were divided into Group A, Group B and Group C – each group having 30 subjects. Group A was selected for extracorporeal shockwave lithotripsy (ESWL by 60 shock waves per minute, Group B by 90 shock waves per minute and Group C by 120 shock waves per minute. Results: Complete clearance of stone was observed in 24 patients in Group A and 13 patients in both Group B and Group C in first session. In Group A only 3 patients needed second session but in Group B and Group C, 12 and 8 patients needed second session. In Group A only one patient needed third session but third session was required for 3 patients in Group B and 5 patients in Group C for complete clearance of stone. In Group A, subsequent sessions were performed under spinal anesthesia and in Group B under sedation and analgesia (p>0.001. Mean number of sessions for full clearance of stones in group A was 1.37 ± 0.85, in Group B was 1.8 ± 0.887 and in Group C was 2.0 ± 1.083. Significant difference was observed in term of sessions among groups (p>0.05. In first follow-up, complete clearance of stones was seen in 24 patients in Group A and 13 in both Group B and Group C. In second follow-up, 3 patients in Group A, 12 in Group B and 8 in Group C showed complete clearance of stones. It was observed that rate of stone clearance was higher in Group A

  15. Contemporary Management of Medium-Sized (10-20 mm) Renal Stones: A Retrospective Multicenter Observational Study.

    Science.gov (United States)

    Kiremit, Murat Can; Guven, Selcuk; Sarica, Kemal; Ozturk, Ahmet; Buldu, Ibrahim; Kafkasli, Alper; Balasar, Mehmet; Istanbulluoglu, Okan; Horuz, Rahim; Cetinel, Cihangir Ali; Kandemir, Abdulkadir; Albayrak, Selami

    2015-07-01

    To evaluate contemporary management approaches to medium-sized (10-20 mm) renal stones. A total of 935 patients treated for medium-sized renal stones (10-20 mm) between July 2012 and March 2014 were included in the study program. Contemporary minimally invasive approaches applied in the management of such stones were evaluated and compared. The cohort consisted of 561 male (60%) and 374 female (40%) patients. Of the 935 patients with medium-sized renal calculi, 535 (57.2%) were treated with shockwave lithotripsy (SWL), 201 (21.4%) with retrograde intrarenal surgery (RIRS), 110 (11.7%) with minimally invasive percutaneous nephrolithotomy (miniperc), and the remaining 89 (11.7%) patients with micropercutaneous nephrolithotomy (microperc). In the SWL group, stones were located mostly in the pelvis (51%), while in the miniperc and microperc groups, they were located mainly in the lower pole (46%, 53%, respectively). Stone-free rates after a single session were 77.2%, 86.1%, 88.8%, and 83.6% in the SWL, RIRS, microperc, and miniperc groups, respectively. Although no serious complications (above Clavien level III) were noted in any of the groups evaluated, Clavien I to II complications were common in the miniperc group. Although SWL is the preferred treatment option for patients with medium-sized (10-20 mm) renal stones, endourologic methods also have been found to have a significant role. Relatively lower complication rates along with higher stone-free status observed with the RIRS technique compared with percutaneous approaches have made this method a valuable option in the management of such stones in recent years.

  16. Percutaneous nephrolithotomy vs. extracorporeal shockwave lithotripsy for treating a 20-30 mm single renal pelvic stone.

    Science.gov (United States)

    Hassan, Mohammed; El-Nahas, Ahmed R; Sheir, Khaled Z; El-Tabey, Nasr A; El-Assmy, Ahmed M; Elshal, Ahmed M; Shokeir, Ahmed A

    2015-09-01

    To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20-30 mm single renal pelvic stone. The computerised records of patients who underwent PNL or ESWL for a 20-30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged PNL. The re-treatment rate (75% vs. 5%), the need for secondary procedures (25% vs. 4.7%) and total number of procedures (three vs. one) were significantly higher in the ESWL group (P PNL group (95% vs. 75%, P PNL (US$ 1120 vs. 490; P PNL was more effective than ESWL for treating a single renal pelvic stone of 20-30 mm. However, ESWL was associated with fewer complications and a lower cost.

  17. Furosemide/Fludrocortisone Test and Clinical Parameters to Diagnose Incomplete Distal Renal Tubular Acidosis in Kidney Stone Formers.

    Science.gov (United States)

    Dhayat, Nasser A; Gradwell, Michael W; Pathare, Ganesh; Anderegg, Manuel; Schneider, Lisa; Luethi, David; Mattmann, Cedric; Moe, Orson W; Vogt, Bruno; Fuster, Daniel G

    2017-09-07

    Incomplete distal renal tubular acidosis is a well known cause of calcareous nephrolithiasis but the prevalence is unknown, mostly due to lack of accepted diagnostic tests and criteria. The ammonium chloride test is considered as gold standard for the diagnosis of incomplete distal renal tubular acidosis, but the furosemide/fludrocortisone test was recently proposed as an alternative. Because of the lack of rigorous comparative studies, the validity of the furosemide/fludrocortisone test in stone formers remains unknown. In addition, the performance of conventional, nonprovocative parameters in predicting incomplete distal renal tubular acidosis has not been studied. We conducted a prospective study in an unselected cohort of 170 stone formers that underwent sequential ammonium chloride and furosemide/fludrocortisone testing. Using the ammonium chloride test as gold standard, the prevalence of incomplete distal renal tubular acidosis was 8%. Sensitivity and specificity of the furosemide/fludrocortisone test were 77% and 85%, respectively, yielding a positive predictive value of 30% and a negative predictive value of 98%. Testing of several nonprovocative clinical parameters in the prediction of incomplete distal renal tubular acidosis revealed fasting morning urinary pH and plasma potassium as the most discriminative parameters. The combination of a fasting morning urinary threshold pH 3.8 mEq/L yielded a negative predictive value of 98% with a sensitivity of 85% and a specificity of 77% for the diagnosis of incomplete distal renal tubular acidosis. The furosemide/fludrocortisone test can be used for incomplete distal renal tubular acidosis screening in stone formers, but an abnormal furosemide/fludrocortisone test result needs confirmation by ammonium chloride testing. Our data furthermore indicate that incomplete distal renal tubular acidosis can reliably be excluded in stone formers by use of nonprovocative clinical parameters. Copyright © 2017 by the American

  18. The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones

    NARCIS (Netherlands)

    Tefekli, Ahmet; Tepeler, Abdulkadir; Akman, Tolga; Akçay, Muzaffer; Baykal, Murat; Karadağ, Mert Ali; Muslumanoglu, Ahmet Y.; de la Rosette, Jean

    2012-01-01

    The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large

  19. The outcome of extracorporeal shockwave lithotripsy for renal pelvic stone with and without JJ stent--a comparative study.

    Science.gov (United States)

    Mohayuddin, Nazim; Malik, Hamad Afzal; Hussain, Manzoor; Tipu, Salman Ahmed; Shehzad, Asad; Hashmi, Altaf; Naqvi, Syed Ali Anwar; Rizvi, Syed Adibul Hasan

    2009-03-01

    To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and without JJ stent. A comparative cross sectional study was carried out at Sindh Institute of Urology and Transplantation from January 2007 to January 2008. Eighty patients with renal pelvic stone measuring 2cm +/- 2mm were selected for treatment with Extra Corporeal Shockwave Lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral renal stones with negative urine cultures. Patients with renal failure and children were excluded. They were divided into two groups of 40 each. Group A patients underwent ESWL without a JJ stent and in Group B a JJ stent was placed before ESWL. SLX F2 electromagnetic ESWL machine was used to impart shock waves. 3000 shockwaves were given in a session. Both the groups were compared for renal colic, steinstrasse, fever, lower urinary tract symptoms (LUTS) emergency room visits and hospital admissions, stone clearance, number of ESWL sessions, auxilliary procedures, (percutaneous nephrostomy or ureterorenoscopy) and cost. Ureteric colic occurred in 13 (32.5%) patients in group A and in 3 (7.5%) patient in group B. Steinstrasse developed in 4 (10%) patients with out JJ stent and in 3 (7.5%) patients with JJ stent. Fever was encountered in 1 (2.5%) patient in group A and in 3 (7.5%) patient in group B. Mean emergency room visits were 2.1 per patient in group A and 0.7 per patient in group B. Stone clearance occurred in 33 (82.5%) patients in group A and 31 (77.5%) in group B. In group B lower urinary tract symptoms were found in 50% versus 20% in group A. Auxillary procedure was performed in one (2.5%) patient each in both groups. Pre ESWL JJ stenting for a 2 cm +/- 2 mm renal stone was not beneficial in terms of steinstrasse, fever, stone clearance and number of ESWL sessions. However ureteric colic was significantly less in the stented group. Lower urinary tract symptoms (LUTS) was also significantly

  20. A low or high BMI is a risk factor for renal hematoma after extracorporeal shock wave lithotripsy for kidney stones.

    Science.gov (United States)

    Nussberger, Fabio; Roth, Beat; Metzger, Tobias; Kiss, Bernhard; Thalmann, George N; Seiler, Roland

    2017-06-01

    The purpose of this study was to evaluate risk factors for renal hematoma after extracorporeal shock wave lithotripsy (SWL) for kidney stones in a matched case-control analysis of a subgroup of patients recruited from a prospective randomized cohort. Between 06/2010 and 03/2013, 418 patients underwent SWL with the MODULITH ® -SLX-F2-lithotripter for kidney stones. In 39/418 patients (9 %), ultrasound at post-treatment day 1 revealed renal hematomas. For 37 of these patients, a matched group without hematoma could be selected according to the following matching criteria: age, gender, number and energy of shock waves, stone burden and localization. Risk factors for renal hematoma after SWL were compared between the two groups. The rates of diabetes, stopped anticoagulant/antiplatelet medications and arterial hypertension were not different between the two groups (p > 0.2). The skin-kidney distance was virtually the same in both groups (p = 0.5). In the hematoma group, significantly more patients had a high (>30: n = 16) as well as a low (hematomas after SWL. Patients with a high (>30) or low (<21.5) BMI had a higher risk for renal damage after SWL. Therefore, alternative endoscopic treatment options should be considered in these patients.

  1. Retrograde intrarenal surgery versus percutaneous lithotripsy to treat renal stones 2-3 cm in diameter.

    Science.gov (United States)

    Zengin, Kursad; Tanik, Serhat; Karakoyunlu, Nihat; Sener, Nevzat Can; Albayrak, Sebahattin; Tuygun, Can; Bakirtas, Hasan; Imamoglu, M Abdurrahim; Gurdal, Mesut

    2015-01-01

    Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P = 0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P = 0.520). RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

  2. Retrograde Intrarenal Surgery versus Percutaneous Lithotripsy to Treat Renal Stones 2-3 cm in Diameter

    Directory of Open Access Journals (Sweden)

    Kursad Zengin

    2015-01-01

    Full Text Available Objective. Retrograde intrarenal surgery (RIRS performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL. However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P=0.061. The respective complication rates (evaluated using the Clavien system were 13.5% and 8.8% (P=0.520. Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

  3. Peeping into human renal calcium oxalate stone matrix: characterization of novel proteins involved in the intricate mechanism of urolithiasis.

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    Kanu Priya Aggarwal

    Full Text Available BACKGROUND: The increasing number of patients suffering from urolithiasis represents one of the major challenges which nephrologists face worldwide today. For enhancing therapeutic outcomes of this disease, the pathogenic basis for the formation of renal stones is the need of hour. Proteins are found as major component in human renal stone matrix and are considered to have a potential role in crystal-membrane interaction, crystal growth and stone formation but their role in urolithiasis still remains obscure. METHODS: Proteins were isolated from the matrix of human CaOx containing kidney stones. Proteins having MW>3 kDa were subjected to anion exchange chromatography followed by molecular-sieve chromatography. The effect of these purified proteins was tested against CaOx nucleation and growth and on oxalate injured Madin-Darby Canine Kidney (MDCK renal epithelial cells for their activity. Proteins were identified by Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF MS followed by database search with MASCOT server. In silico molecular interaction studies with CaOx crystals were also investigated. RESULTS: Five proteins were identified from the matrix of calcium oxalate kidney stones by MALDI-TOF MS followed by database search with MASCOT server with the competence to control the stone formation process. Out of which two proteins were promoters, two were inhibitors and one protein had a dual activity of both inhibition and promotion towards CaOx nucleation and growth. Further molecular modelling calculations revealed the mode of interaction of these proteins with CaOx at the molecular level. CONCLUSIONS: We identified and characterized Ethanolamine-phosphate cytidylyltransferase, Ras GTPase-activating-like protein, UDP-glucose:glycoprotein glucosyltransferase 2, RIMS-binding protein 3A, Macrophage-capping protein as novel proteins from the matrix of human calcium oxalate stone which play a critical role in kidney stone

  4. Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial.

    Science.gov (United States)

    Ye, Zhangqun; Zeng, Guohua; Yang, Huan; Tang, Kun; Zhang, Xiaochun; Li, Hong; Li, Weibing; Wu, Zhong; Chen, Lingwu; Chen, Xingfa; Liu, Xiankui; Deng, Yaoliang; Pan, Tiejun; Xing, Jinchun; Wang, Shusheng; Cheng, Yue; Gu, Xiaojian; Gao, Wenxi; Yang, Jianggen; Zhang, Yonghai; Mi, Qiwu; Qi, Lin; Li, Jiongming; Hu, Weilie; Liang, Peiyu; Sun, Zhaolin; Xu, Changbao; Long, Yongfu; Liao, Yongbin; Liu, Siping; Liu, Guoqing; Xu, Xun; He, Wei; Chen, Zhiqiang; Xu, Hua

    2017-11-12

    Recent large high-quality trials have questioned the clinical effectiveness of medical expulsive therapy using tamsulosin for ureteral stones. To evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo. We conducted a double-blind, placebo-controlled study of 3296 patients with distal ureteral stones, across 30 centers, to evaluate the efficacy and safety of tamsulosin. Participants were randomly assigned (1:1) into tamsulosin (0.4mg) or placebo groups for 4 wk. The primary end point of analysis was the overall stone expulsion rate, defined as stone expulsion, confirmed by negative findings on computed tomography, over a 28-d surveillance period. Secondary end points included time to stone expulsion, use of analgesics, and incidence of adverse events. Among 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; ptamsulosin for the treatment of large distal ureteral stones (>5mm). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (ptamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5mm, but no effect for stones ≤5mm. In this report, we looked at the efficacy and safety of tamsulosin for the treatment of distal ureteral stones. We find that tamsulosin significantly facilitates the passage of distal ureteral stones and relieves renal colic. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  5. Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study.

    Science.gov (United States)

    Assimos, Dean; Crisci, Alfonso; Culkin, Daniel; Xue, Wei; Roelofs, Anita; Duvdevani, Mordechai; Desai, Mahesh; de la Rosette, Jean

    2016-04-01

    To compare outcomes of ureteric and renal stone treatment with ureteroscopy (URS) in patients with or without the placement of a preoperative JJ stent. The Clinical Research Office of the Endourological Society (CROES) URS Global Study collected prospective data for 1 year on consecutive patients with ureteric or renal stones treated with URS at 114 centres around the world. Patients that had had preoperative JJ stent placement were compared with those that did not. Inverse-probability-weighted regression adjustment (IPWRA) was used to examine the effect of preoperative JJ stent placement on the stone-free rate (SFR), length of hospital stay (LOHS), operative duration, and complications (rate and severity). Of 8 189 patients with ureteric stones, there were 978 (11.9%) and 7 133 patients with and without a preoperative JJ stent, respectively. Of the 1 622 patients with renal stones, 590 (36.4%) had preoperative stenting and 1 002 did not. For renal stone treatment, preoperative stent placement increased the SFR and operative time, and there was a borderline significant decrease in intraoperative complications. For ureteric stone treatment, preoperative stent placement was associated with longer operative duration and decreased LOHS, but there was no difference in the SFR and complications. One major limitation of the study was that the reason for JJ stent placement was not identified preoperatively. The placement of a preoperative JJ stent increases SFRs and decreases complications in patients with renal stones but not in those with ureteric stones. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  6. What is the best option for 10-20mm renal pelvic stones undergoing ESWL in the pediatric population: stenting, alpha blockers or conservative follow-up?

    Science.gov (United States)

    Telli, Onur; Gokce, Mehmet Ilker; Ozturk, Erdem; Suer, Evren; Mermerkaya, Murat; Afandiyev, Faraj; Ozcan, Cihat; Guclu, Adil Gucal; Soygur, Tarkan; Burgu, Berk

    2015-09-01

    In this study we aimed to identify the effect of three different modalities (stenting, doxazosin and conservative follow-up) on stone free rates and complication rates for 10-20mm renal pelvic stones in pediatric patients who underwent shock wave lithotripsy. In this study data from 241 renal units (RUs) of 195 consecutive patients with 10-20mm renal pelvis stones were analyzed retrospectively. There were 3 groups in the study; 56 (23.2%) RUs with ureteral stenting were categorized as group 1, and 39 (16.2%) RUs that received doxazosin were categorized as group 2. The remaining 146 (60.6%) RUs without history of ureteral stenting or alpha-blockers usage were categorized as group 3. Patient demographics, stone characteristics, stone free rates (SFRs), time to stone expulsion and complications were documented and compared in each group. Mean age of the population was 6.6 years and mean stone size was 13.8 ± 2.9 mm. Demographic characteristics of the 3 groups were not significantly different. SFRs of the three groups were 89.2%, 87.1% and 82.1% (p = 0.275). Mean time to stone expulsion for groups 1 and 2 were 17.4 and 21.8 days respectively and significantly lower than that in group 3 (31.3 days). Ureteral stenting or doxazosin for shockwave lithotripsy (SWL) is not superior to watchful waiting in terms of SFR and complications however both modalities shorten the stone expulsion time for 10-20mm renal pelvis stones in the pediatric population. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones.

    Science.gov (United States)

    Resorlu, Berkan; Unsal, Ali; Ziypak, Tevfik; Diri, Akif; Atis, Gokhan; Guven, Selcuk; Sancaktutar, Ahmet Ali; Tepeler, Abdulkadir; Bozkurt, Omer Faruk; Oztuna, Derya

    2013-12-01

    To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) for 10-20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications. A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments PNL, and RIRS (p PNL and RIRS (21.9 vs 5.7 vs 8.7%, respectively; p PNL, and RIRS were 7.6, 22.1, and 10.9%, respectively (p PNL group received blood transfusions, while none of the patients in RIRS and SWL groups transfused. Hospitalization time per patient was 1.3 ± 0.5 days in the RIRS group, while it was 2.6 ± 0.9 days in the PNL group (p PNL group compared to RIRS (145.7 ± 101.7 vs 28.7 ± 18.7 s, and 57.5 ± 22.1 vs 43.1 ± 17 min, respectively). For treatment of moderate-sized radiolucent renal stones, RIRS and PNL provide significantly higher success and lower retreatment rate compared with SWL. Although PNL is effective, its biggest drawback is its invasiveness. Blood loss, radiation exposure, hospital stay, and morbidities of PNL can be significantly reduced with RIRS technique.

  8. Modified totally tubeless percutaneous nephrolithotomy: Is it an effective and safe treatment option for renal and upper ureteral stones?

    Science.gov (United States)

    Chung, Ho Seok; Jung, Seung Il; Yu, Ho Song; Hwang, Eu Chang; Oh, Kyung Jin; Kwon, Dong Deuk; Park, Kwangsung

    2016-01-01

    We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL) without indwelling ureteral stent would minimize postoperative discomfort without complications. To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL). Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001). Group 2 and group 3 had a lower analgesic requirement (p = 0.010). Immediate postoperative hemoglobin change (p = 0.001) and tube site complications (p = 0.001) were more common in group 1. Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.

  9. Flexible ureteroscopy versus percutaneous nephrolithotomy as primary treatment for renal stones 2 cm or greater

    Directory of Open Access Journals (Sweden)

    Akar EC

    2013-01-01

    Full Text Available Erin Akar, Bodo E KnudsenDepartment of Urology, Ohio State University Wexner Medical Center, Columbus, OH, USAAbstract: The purpose of this review, based on the current evidence in the literature, is whether ureteroscopy (URS is a comparable primary treatment option to the current gold standard of percutaneous nephrolithotomy (PCNL for the treatment of large kidney stones 2 cm or greater. The lack of prospective randomized trials directly comparing URS and PCNL makes comparison challenging. The numerous studies are not standardized in terms of their definition of stone-free or how stone size is reported. In order to standardize comparison of results, we used a stone-free definition of <4 mm after one procedure per imaging of the author’s choice, since how each patient was imaged postoperatively was not reported. The results from the literature show that moderately large stones from 2 to 3 cm treated ureteroscopically have similar outcomes to PCNL. Stone-free rates with URS decrease when stone size is above 3 cm. Our interpretation of the literature suggests that a current limitation of URS is that multiple procedures for URS would be required to achieve comparable stone-free rates to PCNL, particularly for stones greater than 4 cm.Keywords: ureteroscopy, percutaneous nephrolithotomy, lithotripsy, urinary calculi

  10. Clinical experience in treatment of complex intrahepatic bile duct stones by regular hepatectomy

    Directory of Open Access Journals (Sweden)

    WU Xiao

    2016-09-01

    Full Text Available Objective To investigate the clinical effect of regular hepatectomy in patients with complex intrahepatic bile duct stones. Methods A retrospective analysis was performed for the clinical data of 98 patients with complex intrahepatic bile duct stones who were treated in our hospital from January to December, 2013. The distribution characteristics of intrahepatic bile duct stones, clinical manifestations, extent of operation, time of operation, complications, and surgical outcome were analyzed. Results All the 98 patients completed regular hepatectomy. Of all patients, 37 underwent choledocholithotomy with T-tube drainage and segmental hepatectomy, 6 underwent resection of the left lateral lobe of the liver, 1 underwent left hemihepatectomy, 7 underwent resection of a single hepatic segment in the right lobe of the liver combined with segmental hepatectomy, 45 underwent combined segmental hepatectomy of the left and right lobes of the liver, and 2 underwent biliary-enteric basin anastomosis after hilar bile duct reconstruction. No patients died during the perioperative period. The mean time of operation was 65.0±5.0 min, and the mean intraoperative blood loss was 83.0±6.2 ml. No patients experienced residual stones after surgery. Of all patients, 5 (5.1% experienced complications, among whom 3 experienced bile leakage and 2 experienced blood exudation on the surface of the wound in the liver; 3 patients were diagnosed with intrahepatic cholangiocarcinoma by postoperative pathological examination. All the patients for followed up for 5 years, and 11 (11.2% experienced recurrence of stones after surgery. Conclusion Regular hepatectomy is safe and effective in the treatment of complex intrahepatic bile duct stones, with few complications and a low recurrence rate of stones. Therefore, it holds promise for wide clinical application.

  11. Benign renal complex cysts: MR imaging

    International Nuclear Information System (INIS)

    Levy, P.; Helenon, O.; Melki, P.; Paraf, F.; Chauveau, D.; Chretien, Y.; Moreau, J.F.

    1994-01-01

    The aim of this study was to assess the magnetic resonance imaging (MRI) characteristics of 13 benign complex renal cysts using T1 and T2-weighted images and contrast-enhanced images. The results have been compared to CT and ultrasonographic findings in all cases and correlated with histopathologic datas in 12 cases. Five groups have been defined according to the MR features. Group 1: homogeneous low signal intensity on T1-weighted images and homogeneous high signal intensity on T2-weighted images mimicking simple cyst (n = 2); group 2: homogeneous high signal intensity on both T1 and T2-weighted images mimicking hemorrhagic cyst (n = 1); group 3: characterized by high signal intensity on T1-weighted images and fluid-iron level on T2-weighted images (n = 3); group 4: characterized by fluid-iron level on both T1 and T2-weighted images (n = 3); group 5: pseudotumoral feature: heterogeneous signal intensity and/or wall contrast enhancement (n = 3). Among the 13 indeterminate lesions on ultrasonography and CT, MRI was of diagnostic value in 8 cases, whereas the 5 remaining cases remained indeterminate on MR images. Our results suggest that MRI can be useful in the diagnosis of benign complex cyst of the kidney presenting as indeterminate cystic lesion on other modalities. (authors). 40 refs., 7 figs., 2 tabs

  12. Influence of Superplasticizer-Microsilica Complex on Cement Hydration, Structure and Properties of Cement Stone

    Science.gov (United States)

    Ivanov, I. M.; Kramar, L. Ya; Orlov, A. A.

    2017-11-01

    According to the study results, the influence of complex additives based on microsilica and superplasticizers on the processes of the heat release, hydration, hardening, formation of the structure and properties of cement stone was determined. Calorimetry, derivatography, X-ray phase analysis, electronic microscopy and physical-mechanical methods for analyzing the properties of cement stone were used for the studies. It was established that plasticizing additives, in addition to the main water-reducing and rheological functions, regulate cement solidification and hardening while polycarboxylate superplasticizers even contribute to the formation of a special, amorphized microstructure of cement stone. In a complex containing microsilica and a polycarboxylate superplasticizer the strength increases sharply with a sharp drop in the capillary porosity responsible for the density, permeability, durability, and hence, the longevity of concrete. All this is a weighty argument in favor of the use of microsilica jointly with a polycarboxylate superplasticizer in road concretes operated under aggressive conditions.

  13. Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis.

    Science.gov (United States)

    Mi, Yuanyuan; Ren, Kewei; Pan, Haiyan; Zhu, Lijie; Wu, Sheng; You, Xiaoming; Shao, Hongbao; Dai, Feng; Peng, Tao; Qin, Feng; Wang, Jian; Huang, Yi

    2016-08-01

    The objective of the study was to systematically review the efficacy and safety of flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal stone ESWL (WMD = 2.13, 95 % CI 1.13-4.00, P = 0.02). F-URS is associated with higher SFR, lower APR and RR than ESWL. F-URS is a safe and effective procedure. It can successfully treat patients with stones for 1-2 cm, especially for lower pole stone, without increasing complications, operative time and hospital stay. F-URS can be used as an alternative treatment to ESWL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.

  14. Multimodality Renal Failure in a Patient with OEIS Complex

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    Jonathan D. Santoro

    2015-10-01

    Full Text Available Omphalocele-exstrophy of the bladder-imperforate anus-spinal defect (OEIS complex is a rare constellation of clinical abnormalities with wide phenotypic presentation. We describe a case of a preterm neonate with OEIS complex with acute renal failure, and the challenges in diagnosis and management of this patient as renal failure can be a multifactorial process when encountered with this rare complex.

  15. Renal autotransplantation--a possibility in the treatment of complex renal vascular diseases and ureteric injuries.

    Science.gov (United States)

    Hau, Hans Michael; Bartels, Michael; Tautenhahn, Hans-Michael; Morgul, Mehmet Haluk; Fellmer, Peter; Ho-Thi, Phuc; Benckert, Christoph; Uhlmann, Dirk; Moche, Michael; Thelen, Armin; Schmelzle, Moritz; Jonas, Sven

    2012-12-31

    We report our contemporary experiences with renal autotransplantation in patients with complicated renal vascular diseases and/or complex ureteral injuries. Since its first performance, renal autotransplantation has been steadily improved and become a safe and effective procedure. Between 1998 and 2006, 6 renal autotransplantations in 6 patients were performed at the University Medical Center of Leipzig. After nephrectomy and renal perfusion ex vivo, the kidney was implanted standardized in the fossa iliaca. The vessels were anastomized to the iliac vessels, the ureter was reimplanted in an extravesical tunneled ureteroneocystostomy technique according to Lich-Gregoir. Demographic, clinical, and laboratory data of the patients were collected and analyzed for pre-, intra-, and postoperative period. Indications for renal autotransplantation were complex renovascular diseases in 2 patients (1 with fibromuscular dysplasia and 1 with Takayasu's arteritis) and in 4 patients with complex ureteral injuries. The median duration of follow-up was 9.7 years (range: 5.6-13.3). The laboratory values of our 6 patients showed improvements of creatinine, urea and blood pressure levels in comparison to the preoperative status at the end of follow-up period. The present study reports excellent results of renal autotransplantation in patients with renovascular disease or complex ureteric injuries. After a median follow-up of 9.7 years all 6 patients present with stable renal function as well as normal blood pressure values. Postoperative complications were observed with a rate comparable to other studies.

  16. Acute management of stones

    DEFF Research Database (Denmark)

    Jung, Helene; Osther, Palle J S

    2015-01-01

    INTRODUCTION: Stone management is often conservative due to a high spontaneous stone passage rate or non-symptomatic calyceal stones that do not necessarily require active treatment. However, stone disease may cause symptoms and complications requiring urgent intervention. MATERIAL AND METHODS: I...... with careful consideration of stone size and location, symptoms, patient comorbidity and radiation dose. CONCLUSION: In case of infective hydronephrosis, compromised renal function or persistent pain despite adequate analgesic treatment acute intervention is indicated....

  17. Modified totally tubeless percutaneous nephrolithotomy: Is it an effective and safe treatment option for renal and upper ureteral stones?

    Directory of Open Access Journals (Sweden)

    Ho Seok Chung

    2016-12-01

    Full Text Available Introduction: We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL without indwelling ureteral stent would minimize postoperative discomfort without complications. Aim : To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. Material and methods: From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL. Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. Results: There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001. Group 2 and group 3 had a lower analgesic requirement (p = 0.010. Immediate postoperative hemoglobin change (p = 0.001 and tube site complications (p = 0.001 were more common in group 1. Conclusions : Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.

  18. A paracrine mechanism involving renal tubular cells, adipocytes and macrophages promotes kidney stone formation in a simulated metabolic syndrome environment.

    Science.gov (United States)

    Zuo, Li; Tozawa, Keiichi; Okada, Atsushi; Yasui, Takahiro; Taguchi, Kazumi; Ito, Yasuhiko; Hirose, Yasuhiko; Fujii, Yasuhiro; Niimi, Kazuhiro; Hamamoto, Shuzo; Ando, Ryosuke; Itoh, Yasunori; Zou, Jiangang; Kohri, Kenjiro

    2014-06-01

    We developed an in vitro system composed of renal tubular cells, adipocytes and macrophages to simulate metabolic syndrome conditions. We investigated the molecular communication mechanism of these cells and their involvement in kidney stone formation. Mouse renal tubular cells (M-1) were cocultured with adipocytes (3T3-L1) and/or macrophages (RAW264.7). Calcium oxalate monohydrate crystals were exposed to M-1 cells after 48-hour coculture and the number of calcium oxalate monohydrate crystals adherent to the cells was quantified. The expression of cocultured medium and M-1 cell inflammatory factors was analyzed by enzyme-linked immunosorbent assay and quantitative polymerase chain reaction, respectively. The inflammatory markers MCP-1, OPN and TNF-α were markedly up-regulated in cocultured M-1 cells. OPN expression increased in M-1 cells cocultured with RAW264.7 cells while MCP-1 and TNF-α were over expressed in M-1 cells cocultured with 3T3-L1 cells. Coculturing M-1 cells simultaneously with 3T3-L1 and RAW264.7 cells resulted in a significant increase in calcium oxalate monohydrate crystal adherence to M-1 cells. Inflammatory cytokine changes were induced by coculturing renal tubular cells with adipocytes and/or macrophages without direct contact, indicating that crosstalk between adipocytes/macrophages and renal tubular cells was mediated by soluble factors. The susceptibility to urolithiasis of patients with metabolic syndrome might be due to aggravated inflammation of renal tubular cells triggered by a paracrine mechanism involving these 3 cell types. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  19. Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone.

    Science.gov (United States)

    Mishra, Shashikant; Sharma, Rajan; Garg, Chandrapraksh; Kurien, Abraham; Sabnis, Ravindra; Desai, Mahesh

    2011-09-01

    • To evaluate the results of miniperc vis-à-vis standard PNL in the treatment of stones of 1-2 cm in size. Miniperc may represent a reasonable procedure in patients with nonbulky urolithiasis offering a similar outcome as standard percutaneous nephrolithotomy (PNL) with advantage of reduced morbidity. • 55 procedures including 27 miniperc and 28 standard PNL were performed for renal stones 1-2 cm in size. Pediatric patient, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity patients were excluded from the study. • The parameters studied were demography, operative time, postoperative analgesic requirement, hemoglobin drop, complications and stone clearance. • Mean tract size was 18.2 ± 2 F (15-20) and 26.8 ± 2 F (24-30), P value PNL, respectively. Holmium LASER and pneumatic lithotripter were the main energy sources used in miniperc and standard PNL, respectively. • Miniperc operative time was longer than that of standard PNL (45.2 ± 12.6 vs 31 ± 16.6 min, P= 0.0008 respectively). • Conversely, there was an advantage of miniperc over standard PNL in terms of a significantly reduced hemoglobin drop (0.8 ± 0.9 vs 1.3 ± 0.4 gram%, P= 0.01), analgesic requirement (55.4 ± 50 vs 70.2 ± 52 mg tramadol, P= 0.29) and hospital stay (3.2 ± 0.8 vs 4.8 ± 0.6 days, P ≤ 0.001), respectively. • Intra- operative conversion of the procedure into a tubeless PNL was significantly more in the miniperc group (P ≤ 0.001). The miniperc and standard PNL group had clearance rates of 96% and 100%, respectively at 1 month follow up. • This study demonstrated significant advantages of the miniperc procedure in terms of reduced bleeding leading to a tubeless procedure and reduced hospital stay. • The stone free rates and the complications were similar in either group. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  20. A Novel Decision Aid to Support Informed Decision-Making Process in Patients with a Symptomatic Nonlower Pole Renal Stone <20 mm in Diameter.

    Science.gov (United States)

    Gökce, Mehmet İlker; Esen, Barış; Sancı, Adem; Akpınar, Cağrı; Süer, Evren; Gülpınar, Ömer

    2017-07-01

    Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.

  1. Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones

    Directory of Open Access Journals (Sweden)

    Fábio César Miranda Torricelli

    2015-02-01

    Full Text Available The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL. The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.

  2. Renal blood flow in sepsis: a complex issue

    OpenAIRE

    Molitoris, Bruce A

    2005-01-01

    The clinical complexity of sepsis and the regional variability in renal blood flow present a difficult challenge for the clinician or investigator in understanding the role and clinical importance of reduced blood flow in the pathophysiology of sepsis-induced acute renal failure. Understanding the role of regional microvasculature flow and interactions between endothelium and white blood cells in the local delivery of oxygen and substrates is of critical importance. Therefore, measuring total...

  3. The preservation of urine samples for determination of renal stone risk factors

    Science.gov (United States)

    Nicar, M. J.; Hsu, M. C.; Johnson, T.; Pak, C. Y.

    1987-01-01

    A preservation technique for urine specimens before determination of stone risk factors was evaluated. The purpose of these experiments was to prove the effectiveness of the preservatives used to prevent changes in the concentrations of those constituents measured. Measured concentrations in fresh specimens were compared with those in the same specimens after storage with the preservatives. Refrigeration at 4 degrees C up to five days was appropriate in a laboratory setting, as no significant changes in urinary concentrations occurred. Refrigeration, however, did not offer a convenient method for shipping. Chemical preservation was found to be an effective alternative to refrigeration. Thymol prevented changes in concentration of pH, citrate, uric acid, sulfate, sodium, potassium, and cyclic AMP, while a mixture of hydrochloric (HCl) acid and boric acid prevented changes in calcium, magnesium, phosphorus, oxalate, ammonium, and creatinine. Thus, the addition of thymol or HCl/boric acid to urine specimens will prevent significant changes in the concentrations of stone risk factors.

  4. Robotic partial nephrectomy for complex renal tumors: surgical technique.

    Science.gov (United States)

    Rogers, Craig G; Singh, Amar; Blatt, Adam M; Linehan, W Marston; Pinto, Peter A

    2008-03-01

    Laparoscopic partial nephrectomy requires advanced training to accomplish tumor resection and renal reconstruction while minimizing warm ischemia times. Complex renal tumors add an additional challenge to a minimally invasive approach to nephron-sparing surgery. We describe our technique, illustrated with video, of robotic partial nephrectomy for complex renal tumors, including hilar, endophytic, and multiple tumors. Robotic assistance was used to resect 14 tumors in eight patients (mean age: 50.3 yr; range: 30-68 yr). Three patients had hereditary kidney cancer. All patients had complex tumor features, including hilar tumors (n=5), endophytic tumors (n=4), and/or multiple tumors (n=3). Robotic partial nephrectomy procedures were performed successfully without complications. Hilar clamping was used with a mean warm ischemia time of 31 min (range: 24-45 min). Mean blood loss was 230 ml (range: 100-450 ml). Histopathology confirmed clear-cell renal cell carcinoma (n=3), hybrid oncocytic tumor (n=2), chromophobe renal cell carcinoma (n=2), and oncocytoma (n=1). All patients had negative surgical margins. Mean index tumor size was 3.6 cm (range: 2.6-6.4 cm). Mean hospital stay was 2.6 d. At 3-mo follow-up, no patients experienced a statistically significant change in serum creatinine or estimated glomerular filtration rate and there was no evidence of tumor recurrence. Robotic partial nephrectomy is safe and feasible for select patients with complex renal tumors, including hilar, endophytic, and multiple tumors. Robotic assistance may facilitate a minimally invasive, nephron-sparing approach for select patients with complex renal tumors who might otherwise require open surgery or total nephrectomy.

  5. Management of lower pole renal stones: the devil is in the details.

    Science.gov (United States)

    Resorlu, Berkan; Issi, Yasar; Onem, Kadir; Germiyanoglu, Cankon

    2016-03-01

    Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) are highly effective treatment options for lower pole stones up to 2 cm. Selecting the best treatment modality represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages. Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques.

  6. A comparative study of artificial neural network and multivariate regression analysis to analyze optimum renal stone fragmentation by extracorporeal shock wave lithotripsy

    Directory of Open Access Journals (Sweden)

    Goyal Neeraj

    2010-01-01

    Full Text Available To compare the accuracy of artificial neural network (ANN analysis and multi-variate regression analysis (MVRA for renal stone fragmentation by extracorporeal shock wave lithotripsy (ESWL. A total of 276 patients with renal calculus were treated by ESWL during December 2001 to December 2006. Of them, the data of 196 patients were used for training the ANN. The predictability of trained ANN was tested on 80 subsequent patients. The input data include age of patient, stone size, stone burden, number of sittings and urinary pH. The output values (predicted values were number of shocks and shock power. Of these 80 patients, the input was analyzed and output was also calculated by MVRA. The output values (predicted values from both the methods were compared and the results were drawn. The predicted and observed values of shock power and number of shocks were compared using 1:1 slope line. The results were calculated as coefficient of correlation (COC (r2 . For prediction of power, the MVRA COC was 0.0195 and ANN COC was 0.8343. For prediction of number of shocks, the MVRA COC was 0.5726 and ANN COC was 0.9329. In conclusion, ANN gives better COC than MVRA, hence could be a better tool to analyze the optimum renal stone fragmentation by ESWL.

  7. Is an excretory urogram mandatory in patients with small to medium-sized renal and ureteric stones treated by extra corporeal shock wave lithotripsy?

    Directory of Open Access Journals (Sweden)

    Akhtar Sobia

    2004-04-01

    Full Text Available Abstract Background An intravenous urogram (IVU has traditionally been considered mandatory before treating renal and ureteric stones by extracorporeal shock wave lithotripsy (ESWL. This study was designed to see whether there is a difference in complications and the need for ancillary procedures in patients managed by ESWL for renal and ureteric calculi, according to preoperative imaging technique. Methods This retrospective study compared 133 patients undergoing ESWL from January 2001 to July 2002. Patients were divided into three groups according to the preoperative imaging technique used: i IVU; ii non-contrast enhanced helical computed tomography (UHCT; and iii ultrasound (US + X-ray kidney, ureter and bladder (KUB. The groups were matched in terms of age and gender, as well as location, side and size of stones. Results There was no statistically significantly difference for number of ESWL sessions, number of shock waves and use of ancillary procedures between the three groups. The stone-free rate was 98% for the IVU and UHCT groups, and 97% for the US + X-ray KUB group. Conclusions The complication rate and need for ancillary procedures was comparable across the three groups. Patients imaged by UHCT or US + X-ray KUB prior to ESWL for uncomplicated renal and ureteric stones do not require IVU.

  8. A comparative study of artificial neural network and multivariate regression analysis to analyze optimum renal stone fragmentation by extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Neeraj K Goyal, Abhay Kumar; Sameer Trivedi

    2010-01-01

    To compare the accuracy of artificial neural network (ANN) analysis and multivariate regression analysis (MVRA) for renal stone fragmentation by extracorporeal shock wave lithotripsy (ESWL). A total of 276 patients with renal calculus were treated by ESWL during December 2001 to December 2006. Of them, the data of 196 patients were used for training the ANN. The predictability of trained ANN was tested on 80 subsequent patients. The input data include age of patient, stone size, stone burden, number of sittings and urinary pH. The output values (predicted values) were number of shocks and shock power. Of these 80 patients, the input was analyzed and output was also calculated by MVRA. The output values (predicted values) from both the methods were compared and the results were drawn. The predicted and observed values of shock power and number of shocks were compared using 1:1 slope line. The results were calculated as coefficient of correlation (COC) (r2 ). For prediction of power, the MVRA COC was 0.0195 and ANN COC was 0.8343. For prediction of number of shocks, the MVRA COC was 0.5726 and ANN COC was 0.9329. In conclusion, ANN gives better COC than MVRA, hence could be a better tool to analyze the optimum renal stone fragmentation by ESWL (Author).

  9. Anatomy of the collecting system of lower pole of the kidney in patients with a single renal stone: a comparative study with individuals with normal kidneys.

    Science.gov (United States)

    Zomorrodi, Afshar; Buhluli, Abulfazel; Fathi, Samad

    2010-07-01

    At least 5% of women and 12% of men during their lives will experience renal colic, at least once. Many theories have been suggested for the etiology of renal stones and variations in the anatomy of the collecting system have been suggested to have a role in stone formation. This study was conducted to examine the role of variation of lower pole collecting system in patients with lower pole kidney stone and compared the same in normal persons (kidney donors). Investigation for the anatomy of the lower pole of the kidney (angle between lower infundibulum and pelvis, length and diameter of the infundibulum and number and pattern distribution of calyces) was carried out using intravenous pyelogram (IVP) in 100 cases with urinary stone (study cases) and 400 persons with normal kidneys (control subjects). The study was a retrospective cross-sectional case control study. Results were analyzed by Mann-Whitney and independent sample chi square tests. The mean infundibulum-pelvic angle (IPA) in control subjects and in patients was 112.5 +/- 10.7 and 96.6 +/- 28.8, respectively. There was significant correlation between reduced angle and stone formation (P= kidney (IPIL) in controls and study patients was 22.5 +/- 4.1 and 27.5 +/- 7.7, respectively, which was statistically significant (Pkidney (LPCN) in controls and study patients was 2.6 +/- 0.6 and 3 +/- 0.9, respectively, which was statistically significant (P = or anatomy was more common in patients with lower pole kidney stone and should be considered a risk factor for forming lower pole kidney stone.

  10. Chromosomal aberrations and exposure doses during extracorporeal shock wave lithotripsy for renal ureteral stones

    International Nuclear Information System (INIS)

    Shao Songsheng; Feng Jialin; Weng Zhigen; Jiang Qingqi; Wang Guomin; Zhang Yuanfang; Zhang Renan

    1991-01-01

    The radiation dose and the chromosomal aberrations of peripheral lymphocytes were studied in 20 patients during ESWL. The dose was measured with calibrated thermoluminescent dosimeters. Primary results showed an average skin exposure 4.50 x 10 -3 C/kg per case. The dose level is smilar to that of the patients under-going routine fluoroscopic examination. Therefore, the radiation exposure with patients from the ESWL procedure should be considered acceptable. As chromosome changes, to reduce the radiation dose is important for the radiation cytogentics. The factors influencing exposure levels include stone characteristics and physician experience

  11. RIRS versus mPCNL for single renal stone of 2-3 cm: clinical outcome and cost-effective analysis in Chinese medical setting.

    Science.gov (United States)

    Pan, Jiahua; Chen, Qi; Xue, Wei; Chen, Yonghui; Xia, Lei; Chen, Haige; Huang, Yiran

    2013-02-01

    The aim of the study was to compare the clinical outcome and the cost-effectiveness between retrograde intra renal surgery (RIRS) and mini-percutaneous nephrolithotripsy (mPCNL) for the management of single renal stone of 2-3 cm in Chinese medical setting. From May 2005 to February 2011, 115 patients with solitary renal calculi were treated either by RIRS or mPCNL. 56 patients were in RIRS group while 59 were in mPCNL group. Patients' demographics between the two groups, in terms of gender, age, BMI, history of ESWL as well as stone side, stone location and stone size were comparable. Peri-operative course, clinical outcome, complication rates and medical cost were compared. The effective quotient (EQ) of two groups was calculated. Data were analyzed using Fisher's exact test, Chi-square test and Student's t test. EQ for RIRS and mPCNL were 0.52 and 0.90. The initial stone-free rate (SFR) of RIRS group and mPCNL group was 71.4 and 96.6 %, respectively (P = 0.000). The mean procedure number was 1.18 in RIRS group and 1.03 in mPCNL group, respectively (P = 0.035). The operative time for RIRS was longer (P = 0.000) while the mean hospital stay was shorter (P = 0.000). There was no statistical difference in peri-operative complications between the groups. The initial hospitalization cost, laboratory and radiology test cost of RIRS group were lower (P = 0.000). However, counting the retreatment cost in the two groups, the total medical expenditure including the overall hospitalization cost, overall laboratory and radiology test cost and post-operative out-patient department (OPD) visit cost was similar between two groups. In conclusion, with similar total medical cost, mPCNL achieved faster stone clearance and lower retreatment rate without major complications, which implied higher cost-effectiveness for the treatment of single renal stone of 2-3 cm in Chinese medical setting. RIRS is also a safe and reliable choice for patients having contraindications or

  12. Physical rehabilitation in complex therapy of the ureter stones patients in the Truskavets health resort area

    Directory of Open Access Journals (Sweden)

    Shologon R.P.

    2010-05-01

    Full Text Available Efficiency of rehabilitation measures is considered in complex therapy with the use of differentiated methods of medical physical education for patients with stones of ureter. Under a supervision there was 143 patients. 93 patients were made basic group, 50 patients - control. From them 51 (56 % are men and 42 (54% are women. Age of patients made from 20 to 60 years. A sanatorium-resort rehabilitation is recommended with the use of the differentiated methods of medical gymnastics. Application of method improved the indexes of the functional state of buds and overhead urinary ways. Frequency of advancement and output of concrements is also megascopic.

  13. Renal manifestations of primary hyperparathyroidism

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    Anurag Ranjan Lila

    2012-01-01

    Full Text Available Primary hyperparathyroidism (PHPT is associated with nephrolithiasis and nephrocalcinosis. Hypercalciuria is one of the multiple factors that is implicated in the complex pathophysiology of stone formation. The presence of a renal stone (symptomatic or asymptomatic categorizes PHPT as symptomatic and is an indication for parathyroid adenomectomy. Progression of nephrocalcinosis is largely reversible after successful surgery, but the residual risk persists. PHPT is also associated with declining renal function. In case of asymptomatic mild PHPT, annual renal functional assessment is advised. Guidelines suggest that an estimated glomerular filtration rate (eGFR < 60 ml / minute / 1.73 m 2 is an indication for parathyroid adenomectomy. This article discusses how to monitor and manage renal stones and other related renal parameters in case of PHPT.

  14. Advances in percutaneous stone surgery

    OpenAIRE

    Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

    2015-01-01

    Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, ...

  15. Advances in percutaneous stone surgery.

    Science.gov (United States)

    Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

    2015-01-01

    Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, exit strategies, and post-operative antibiotic prophylaxis.

  16. H+, Water and Urea Transport in the Inner Medullary Collecting Duct and Their Role in the Prevention and Pathogenesis of Renal Stone Disease

    Science.gov (United States)

    Wall, Susan M.; Klein, Janet D.

    2008-09-01

    The inner medullary collecting duct (IMCD) is the final site within the kidney for the reabsorption of urea, water and electrolytes and for the secretion of H+ before the luminal fluid becomes the final urine. Transporters expressed in the IMCD contribute to the generation of the large ion gradients that exist between the interstitium and the collecting duct lumen. Thus, the luminal fluid within the human IMCD can reach an osmolality of 1200 mOsm/kg H2O and a pH of 4. This ability of the human nephron to concentrate and acidify the urine might predispose to stone formation. However, under treatment conditions that predispose to stone formation, such as during hypercalciuria, the kidney mitigates stone formation by reducing solute concentration by reducing H2O reabsorption. Moreover, the kidney attenuates stone formation by tightly controlling acid-base balance, which prevents the bone loss, hypocitraturia and hypercalciuria observed during metabolic acidosis by augmenting net H+ excretion by tightly regulating H+ transporter function and through luminal buffering, particularly with NH3. This article will review the ion transporters present in the mammalian IMCD and their role in the prevention and in the pathogenesis of renal stone formation.

  17. Worldwide Impact of Warmer Seasons on the Incidence of Renal Colic and Kidney Stone Disease: Evidence from a Systematic Review of Literature.

    Science.gov (United States)

    Geraghty, Robert M; Proietti, Silvia; Traxer, Olivier; Archer, Matthew; Somani, Bhaskar K

    2017-08-01

    Several studies have examined the link between temperature or monthly seasonal variations and urolithiasis. The majority of these studies have demonstrated a link between higher ambient monthly temperatures and the incidence of renal colic and kidney stone disease (KSD). However, a worldwide trend on this association has not been explored and we perform a systematic review to examine the effect of seasonal variations on renal colic and KSD. A systematic review of the literature for a 26-year period (1990-2017) was conducted on all studies reporting on the effect of seasonal variations and its link to KSD. Two reviewers independently extracted the data from each study, which were analyzed using SPSS version 24. A total of 59 studies were identified, and after screening, 13 were included in this review. The studies ranged in duration from 1 to 9 years (mean: 5.5 years) and included seasonal/monthly variations for proven stones or lithotripsy treatments or emergency department presentations with renal colic. Except for one study, there was a statistically significant association between higher monthly mean temperatures and the incidence of KSD-related events reported from the United Kingdom, South Korea, the United States, Saudi Arabia, Italy, Spain, Taiwan, Japan, and New Zealand. Worldwide trends on the incidence of renal colic and KSD seem be affected by seasonal variation favoring warmer months, with data suggesting that higher ambient temperature has an association with KSD.

  18. Long-term follow-up after choledochojejunostomy for bile duct stones with complex clearance of the bile duct

    NARCIS (Netherlands)

    Gouma, D. J.; Konsten, J.; Soeters, P. B.; Von Meyenfeldt, M.; Obertop, H.

    1989-01-01

    In this retrospective study, the long-term follow-up of patients undergoing choledochojejunostomy (Roux-en-Y) for bile duct stones with complex clearance of the bile duct is evaluated. Bile duct exploration and subsequent choledochojejunostomy (Roux-en-Y) was performed in 43 patients (median age 67

  19. Renal manifestations of primary hyperparathyroidism

    OpenAIRE

    Lila, Anurag Ranjan; Sarathi, Vijaya; Jagtap, Varsha; Bandgar, Tushar; Menon, Padma S.; Shah, Nalini Samir

    2012-01-01

    Primary hyperparathyroidism (PHPT) is associated with nephrolithiasis and nephrocalcinosis. Hypercalciuria is one of the multiple factors that is implicated in the complex pathophysiology of stone formation. The presence of a renal stone (symptomatic or asymptomatic) categorizes PHPT as symptomatic and is an indication for parathyroid adenomectomy. Progression of nephrocalcinosis is largely reversible after successful surgery, but the residual risk persists. PHPT is also associated with decli...

  20. Complex cystic renal masses: characterization with contrast-enhanced US.

    Science.gov (United States)

    Ascenti, Giorgio; Mazziotti, Silvio; Zimbaro, Giovanni; Settineri, Nicola; Magno, Carlo; Melloni, Darwin; Caruso, Rosario; Scribano, Emanuele

    2007-04-01

    To prospectively compare contrast material-enhanced ultrasonography (US) with computed tomography (CT) in the classification of complex cystic renal masses with the Bosniak system. Ethics committee approval and written informed consent were obtained. Forty patients (17 women, 23 men; age range, 31-77 years) with 44 complex cystic renal masses detected with conventional US were prospectively examined by using second-harmonic US with a second-generation contrast agent and multiphasic helical CT. Thirty-six patients had one lesion, and four patients had two lesions. Surgical resection in nine patients and imaging follow-up in 31 patients were used to determine the outcome. On contrast-enhanced US images, masses were classified as Bosniak category II (n = 18), IIF (ie, lesions were classified as category II and follow-up was needed) (n = 16), III (n = 7), or IV (n = 3) lesions. On CT images, masses were classified as Bosniak category II (n = 24), IIF (n = 10), III (n = 7), or IV (n = 3) lesions. Interobserver agreement was high (kappa = 0.86, P < .001) for classification with US. Complete concordance between the readers was found for classification with CT. Complete concordance between contrast-enhanced US and CT was observed in the differentiation of surgical and nonsurgical complex cysts. Complete concordance among the three readers in the assessment of vascularity with contrast-enhanced US was found. Interobserver agreement in the evaluation of enhancement on CT images was high (kappa = 0.88, P < .001). Concordance between contrast-enhanced US and CT in the evaluation of vascularization was high (kappa = 0.77, P < .001). The study data suggest that contrast-enhanced second-harmonic US is appropriate for renal cyst classification with the Bosniak system.

  1. Meier–Gorlin syndrome: An additional Egyptian patient with gastroesophageal reflux, hydronephrosis, renal stones and hypoplastic labia majora and minora with clitromegaly

    Directory of Open Access Journals (Sweden)

    Rabah M. Shawky

    2016-10-01

    Full Text Available We report a 4.5 year old female child with the classical triad of Meier–Gorlin syndrome (microtia, absent patella and short stature with normal mentality. She had small triangular face, long peaked nose, high nasal bridge, bilateral low set very small ears (microtia, retromicrognathia, high arched palate, maxillary hypoplasia, decayed teeth, and bilateral partial syndactyly between 2nd and 3rd toes. Our patient had a gastroesophageal reflux, renal stones, hydronephrosis and hypoplastic labia majora and minora with clitromegaly.

  2. Intraperitoneal stone migration during percutaneos nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Akif Diri

    2014-12-01

    Full Text Available Percutaneos nephrolithotomy (PNL is the standard care for renal stones larger than 2 cm. The procedure has some major and minor complications. Renal pelvis laceration and stone migration to the retroperitoneum is one of the rare condition. We report the first case of intraperitoneal stone migration during PNL.

  3. The Nubian Complex of Dhofar, Oman: an African middle stone age industry in Southern Arabia.

    Directory of Open Access Journals (Sweden)

    Jeffrey I Rose

    Full Text Available Despite the numerous studies proposing early human population expansions from Africa into Arabia during the Late Pleistocene, no archaeological sites have yet been discovered in Arabia that resemble a specific African industry, which would indicate demographic exchange across the Red Sea. Here we report the discovery of a buried site and more than 100 new surface scatters in the Dhofar region of Oman belonging to a regionally-specific African lithic industry--the late Nubian Complex--known previously only from the northeast and Horn of Africa during Marine Isotope Stage 5, ∼128,000 to 74,000 years ago. Two optically stimulated luminescence age estimates from the open-air site of Aybut Al Auwal in Oman place the Arabian Nubian Complex at ∼106,000 years ago, providing archaeological evidence for the presence of a distinct northeast African Middle Stone Age technocomplex in southern Arabia sometime in the first half of Marine Isotope Stage 5.

  4. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in management of lower-pole renal stones with a diameter of smaller than 15 mm.

    Science.gov (United States)

    Kirac, Mustafa; Bozkurt, Ömer Faruk; Tunc, Lutfi; Guneri, Cagri; Unsal, Ali; Biri, Hasan

    2013-06-01

    The aim of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PNL) in management of lower-pole renal stones with a diameter smaller than 15 mm. Between December 2009 and July 2012, the patients with the diagnosis of lower-pole stones were evaluated by ultrasonography, intravenous pyelography and computed tomography. The records of 73 evaluable patients who underwent mini-PNL (n = 37) or RIRS (n = 36) for lower-pole (LP) stones with diameter smaller than 15 mm were reviewed retrospectively. Of the 73 patients, 37 underwent mini-PNL and 36 underwent RIRS. The stone-free rates were 89.1 and 88.8 % for mini-PNL and RIRS groups, respectively. The mean operation time was 53.7 ± 14.5 in the mini-PNL group but 66.4 ± 15.8 in the RIRS group (P = 0.01). The mean fluoroscopy times and hospitalization times were significantly higher in the mini-PNL group. There was no major complication in any patient. RIRS and mini-PNL are safe and effective methods for treatment of LP calculi with a diameter smaller than 15 mm. RIRS is a non-invasive and feasible treatment option, and has also short hospitalization time, low morbidity and complication rate. It may be an alternative of mini-PNL in the treatment LP calculi with smaller than 15 mm.

  5. Bosniak Classification for Complex Renal Cysts Reevaluated: A Systematic Review.

    Science.gov (United States)

    Schoots, Ivo G; Zaccai, Keren; Hunink, Myriam G; Verhagen, Paul C M S

    2017-07-01

    We systematically evaluated the Bosniak classification system with malignancy rates of each Bosniak category, and assessed the effectiveness related to surgical treatment and oncologic outcome based on recurrence and/or metastasis. In a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) criteria, we selected 39 publications for inclusion in this analysis and categorized them into 1) surgical cohorts-all cysts treated surgically and 2) radiological cohorts-cysts with surgical treatment or radiological followup. A total of 3,036 complex renal cysts were categorized into Bosniak II, IIF, III and IV. In surgical and radiological cohorts pooled estimates showed a malignancy prevalence of 0.51 (0.44, 0.58) in Bosniak III and 0.89 (0.83, 0.92) in Bosniak IV cysts, respectively. Stable Bosniak IIF cysts showed a malignancy rate of less than 1% during radiological followup (surveillance). Bosniak IIF cysts, which showed reclassification to the Bosniak III/IV category during radiological followup (12%), showed malignancy in 85%, comparable to Bosniak IV cysts. The estimated surgical number needed to treat to avoid metastatic disease of Bosniak III and IV cysts was 140 and 40, respectively. The effectiveness of the Bosniak classification system for complex renal cysts was high in categories II, IIF and IV, but low in category III, and 49% of Bosniak III cysts was overtreated because of a benign outcome. This surgical overtreatment combined with the excellent outcome for Bosniak III cysts may suggest that surveillance is a rational alternative to surgery. This will require further study to assess whether surveillance of Bosniak III cysts will prove safe. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. CT-Guided Microwave Ablation of 45 Renal Tumors: Analysis of Procedure Complexity Utilizing a Percutaneous Renal Ablation Complexity Scoring System.

    Science.gov (United States)

    Mansilla, Alberto V; Bivins, Eugene E; Contreras, Francisco; Hernandez, Manuel A; Kohler, Nathan; Pepe, Julie W

    2017-02-01

    To develop a scoring system that stratifies complexity of percutaneous ablation of renal tumors. Analysis was performed of 36 consecutive patients (mean age, 64 y; range, 30-89 y) who underwent CT-guided microwave (MW) ablation of 45 renal tumors (mean tumor diameter, 2.4 cm; range, 1.2-4.0 cm). Technical success and effectiveness were determined based on intraprocedural and follow-up imaging studies. The RENAL score and the proposed percutaneous renal ablation complexity (P-RAC) score were calculated for each tumor. Technical success was 93.3% (n = 42). Biopsy of 38 of 45 renal tumors revealed 23 renal cell carcinomas. Median follow-up period was 9.7 months (range, 2.9-46.8 months). There were no tumor recurrences. One major complication, ureteropelvic junction stricture, occurred (2.6%). The P-RAC score was found to differ statistically from the RENAL score (t = 3.754, df = 44, P = .001). A positive correlation was found between the P-RAC score and number of antenna insertions (r = .378, n = 45, P = .011) and procedure duration (r = .328, n = 45, P = .028). No correlation was found between the RENAL score and number of MW antenna insertions (r = .110, n = 45, P = .472) or procedure duration (r = .263, n = 45, P = .081). Hydrodissection was significantly more common in the P-RAC high-complexity category than in low-complexity category (χ 2 = 12.073, df = 2, P = .002). The P-RAC score may be useful in stratifying percutaneous renal ablation complexity. Further studies with larger sample sizes are necessary to validate the P-RAC score and to determine if it can predict risk of complications. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  7. COMPARATIVE STUDY OF CULTURE AND SENSITIVITY PATTERNS OF PRE OPERATIVE MID STREAM URINE WITH RENAL PELVIC URINE AND STONE TO PREDICT UROSEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY: A PROSPECTIVE CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Bhargava Vardhana Reddy

    2015-11-01

    Full Text Available INTRODUCTION : Percutaneous nephrolithotomy (PCNL is the most frequently performed surgery for stone disease at our institution. Nearly 100 PCNL procedures are being performed in a year at our institution. Septicemia following PCNL can be catastrophic despite sterile preoperative urine and prophylactic antibiotics. Infected stones, obstructed kidneys , and comorbidit y have been held responsible. In this study we analyzed various culture specimens, namely Mid - stream urine (MSU, renal pelvic urine and crushed stones. MATERIALS AND METHODS : We performed a prospective clinical study in all our patients undergoing PCNL b etween January 2013 and December 2014. MSU was sent for culture and sensitivity testing (C&S one day prior to surgery. Percutaneous access into the ipsilateral pelvicaliceal system is achieved under image intensification using a fine, 14 gauge Kellet need le. Urine from the pelvicaliceal system is first aspirated and sent as pelvic urine C&S. Stone fragments are collected to be proces0sed for C&S. The data collected were divided into 3 main groups, that is MSU C&S, pelvic urine C&S and stone C&S. RESULTS : A total of 83 patients were included in the study, of this MSU C&S was positive in 9/83 (10.8% patients, Pelvic C&S in 10 /73 (13.7% patients and Stone C&S in 25/83 (30.1% patients. Out of 25 cases of stone culture positive patients 17 patients develope d Systemic Inflammatory Response Syndrome (SIRS but only 2 patients developed SIRS in MSU C & S positive patients. CONCLUSIONS: The results of our study suggest that positive stone C&S is the better predictor of potential urosepsis than MSU. Stone cultur e is available only after surgery but appears to be the best guide for antibiotic therapy in case of sepsis. So the routine collection of stone for C&S will be beneficial

  8. Comparison of escalating, constant, and reduction energy output in ESWL for renal stones: multi-arm prospective randomized study.

    Science.gov (United States)

    Rabah, Danny M; Mabrouki, Mohamed S; Farhat, Karim H; Seida, Mohamed A; Arafa, Mostafa A; Talic, Riyadh F

    2017-06-01

    This study was designed to find out the optimized energy delivery strategy in Shock Wave Lithotripsy (SWL) that yield to the best stone-free rate (SFR). In this clinical trial, 150 consecutive patients were randomized into three groups: (a) Dose escalation, 1500 SW at 18 kV, followed by 1500 SW at 20 kV then 1500 SW at 22 kV. (b) Constant dose, 4500 SW at 20 kV. All patients undergo plain X-ray film of the urinary tract at day 1, 14, and 90 to assess stone-free rate (SFR) which was defined as no stones or painless fragments less than 4 mm. (c) Dose reduction, 1500 SW at 22 kV, followed by 1500 SW at 20 kV and then 1500 SW at 18 kV. The three treatment groups were comparable in terms of age, sex, stone size and distribution of the kidneys, and the need for Double J stent use. On day 90, the SFR achieved was 82, 90, and 84 % in the escalating, constant, and reduction energy groups, respectively. However, this rate was not statistically significant (x 2  = 1.38, p level = 0.28). At a slow rate of 60 shocks, there was no difference in stone-free rate between different voltages at 1, 14, and 90 days. Our randomized clinical trial showed no statistically significant difference in SFR between the three groups while using the slow SWL rate. Our trial is the first randomized trial comparing the three strategies. As such, a dose adjustment strategy while delivering SWL in slow rate was not recommended.

  9. Update in the classification and treatment of complex renal injuries.

    Science.gov (United States)

    Reis, Leonardo Oliveira; Kim, Fernando J; Moore, Ernest E; Hirano, Elcio Shiyoiti; Fraga, Gustavo Pereira; Nascimento, Barto; Rizoli, Sandro

    2013-01-01

    The "Evidence-Based Telemedicine - Trauma and Acute Care Surgery" (EBT-TACS) Journal Club performed a critical review of the literature and selected three up-to-date articles on the management of renal trauma defined as American Association for the Surgery of Trauma (AAST) injury grade III-V. The first paper was the proposal for the AAST grade 4renal injury substratification into grades 4a (Low Risk) and 4b (High Risk). The second paper was a revision of the current AAST renal injury grading system, expanding to include segmental vascular injuries and to establish a more rigorous definition of severe grade IV and V renal injuries.The last article analyses the diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set in the USA. The EBT-TACS Journal Club elaborated conclusions and recommendations for the management of high-grade renal trauma.

  10. Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Mingchao Li

    Full Text Available Although some trials assessed the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after extracorporeal shock wave lithotripsy (ESWL, the role of the α-blocker in facilitating upper urinary calculi expulsion after ESWL remain controversial.To determine the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after ESWL.A literature search was carried out using the PubMed database, EMBASE and the Cochrane Library database to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality. Pooled effect estimates were obtained using a fixed- and random-effects meta-analysis.The meta-analysis included 23 RCTs, α-blocker significantly enhanced expulsion rate of upper urinary tract calculi after ESWL (P<0.00001; RR 1.21; 95% CI 1.12-1.31, significantly promoted steinstrasse expulsion (P=0.03; RR 1.25; 95% CI 1.03-1.53, significantly shortened the discharge time of upper urinary tract calculi (P=0.0001; MD -2.12; 95% CI -3.20--1.04, significantly reduced the patient's pain VAS score (P=0.001; RR -1.0; 95% CI -1.61--0.39. Compared with the control group, dizziness (P=0.002; RR 5.48; 95% CI 1.91-15.77, anejaculation (P=0.02; RR 12.17; 95% CI 1.61-91.99 and headache (P=0.04; RR 4.03; 95% CI 1.04-15.72 in the α-blocker group was associated with a higher incidence.Treatment with α-blocker after ESWL appears to be effective in enhancing expulsion rate of upper urinary tract calculi, shortening the discharge time of upper urinary tract calculi, reducing the patient's pain. The side effects of α-blocker were light and few.

  11. Frequency of stone clearance after extracorporeal shockwave ...

    African Journals Online (AJOL)

    Objective: To determine the rate of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for renal stones in adult patients with renal insufficiency. Subjects and methods: This is a cross-sectional descriptive study of 117 adult patients who underwent ESWL. The indications for ESWL were determined by the ...

  12. Ultrasonic propulsion of kidney stones.

    Science.gov (United States)

    May, Philip C; Bailey, Michael R; Harper, Jonathan D

    2016-05-01

    Ultrasonic propulsion is a novel technique that uses short bursts of focused ultrasonic pulses to reposition stones transcutaneously within the renal collecting system and ureter. The purpose of this review is to discuss the initial testing of effectiveness and safety, directions for refinement of technique and technology, and opinions on clinical application. Preclinical studies with a range of probes, interfaces, and outputs have demonstrated feasibility and consistent safety of ultrasonic propulsion with room for increased outputs and refinement toward specific applications. Ultrasonic propulsion was used painlessly and without adverse events to reposition stones in 14 of 15 human study participants without restrictions on patient size, stone size, or stone location. The initial feasibility study showed applicability in a range of clinically relevant situations, including facilitating passage of residual fragments following ureteroscopy or shock wave lithotripsy, moving a large stone at the ureteropelvic junction with relief of pain, and differentiating large stones from a collection of small fragments. Ultrasonic propulsion shows promise as an office-based system for transcutaneously repositioning kidney stones. Potential applications include facilitating expulsion of residual fragments following ureteroscopy or shock wave lithotripsy, repositioning stones prior to treatment, and repositioning obstructing ureteropelvic junction stones into the kidney to alleviate acute renal colic.

  13. The development of a technological complex in deposits of dimension facing stone

    Directory of Open Access Journals (Sweden)

    Filipova N.P.

    2016-12-01

    Full Text Available One of the main problems in the Ukrainian dimension stone sector is the distribution problem. A typical quarry exploits up to 1000–1500 m3/y of trade blocks. Thus, it is very difficult to perform a standard foreign order of 500-1000 m3. This is often due to improper exploitation technique planning and management. The aim of the study is to identify the best exploitation technique for the Ukrainian shield conditions in terms of the highest technical and economic applicability. The data were collected at several Ukrainian and Italian quarries. Performance data of dimension stone exploitation techniques was measured in order to determine which of them are the most economic and the least labour-intensive. Unit costs for the monolith explosive separation (using detonating cord are more than 3 times lower than the use of the combination of diamond wire sawing and dynamic splitting in terms of 1 m3 of trade blocks. The combination of diamond wire saw with «hydrorocksplitters» is slightly cheaper; it justifies its widespread use in Ukrainian quarries. To preserve the rock mass integrity and block surface quality all of the techniques are suitable. Among the tipping techniques the use of wheel loaders is disseminating nowadays. Hydraulic jacks are used at this stage sometimes. Block separation on trade units is often carried out by splitting with manual or hydraulic wedges. Expensive rock blocks can be also splitted by a diamond wire saw. A wheel loader can be used for block handling under short trips condition. While long trip the use of dump trucks for block and waste products transportation is required.

  14. Implications for complex cognition from the hafting of tools with compound adhesives in the Middle Stone Age, South Africa

    Science.gov (United States)

    Wadley, Lyn; Hodgskiss, Tamaryn; Grant, Michael

    2009-01-01

    Compound adhesives made from red ochre mixed with plant gum were used in the Middle Stone Age (MSA), South Africa. Replications reported here suggest that early artisans did not merely color their glues red; they deliberately effected physical transformations involving chemical changes from acidic to less acidic pH, dehydration of the adhesive near wood fires, and changes to mechanical workability and electrostatic forces. Some of the steps required for making compound adhesive seem impossible without multitasking and abstract thought. This ability suggests overlap between the cognitive abilities of modern people and people in the MSA. Our multidisciplinary analysis provides a new way to recognize complex cognition in the MSA without necessarily invoking the concept of symbolism. PMID:19433786

  15. Histopathology Predicts the Mechanism of Stone Formation

    Science.gov (United States)

    Evan, Andrew P.

    2007-04-01

    About 5% of American women and 12% of men will develop a kidney stone at some time in their life and these numbers appear to be on the rise. Despite years of scientific research into the mechanisms of stone formation and growth, limited advances have been made until recently. Randall's original observations and thoughts on the mechanisms for kidney stone formation have been validated for idiopathic calcium oxalate stone formers (ICSF) but not for most other stone forming groups. Our current studies on selected groups of human stone formers using intraoperative papillary biopsies has shown overwhelming evidence for the presence of Randall's plaque in ICSF and that stone formation and growth are exclusively linked to its availability to urinary ions and proteins. Intense investigation of the plaque-stone junction is needed if we are to understand the factors leading to the overgrowth process on exposed regions of plaque. Such information should allow the development of treatment strategies to block stone formation in ICSF patients. Patients who form brushite stones, or who form apatite stones because of distal renal tubular acidosis (dRTA), or patients with calcium oxalate stones due to obesity bypass procedures, or patients with cystinuria, get plugged inner medullary collecting ducts (IMCD) which leads to total destruction of the lining cells and focal sites of interstitial fibrosis. These stone formers have plaque but at levels equal to or below non-stone formers, which would suggest that they form stones by a different mechanism than do ICSF patients.

  16. Use of flexible ureteroscopy in the clinical practice for the treatment of renal stones: results from a large European survey conducted by the EAU Young Academic Urologists-Working Party on Endourology and Urolithiasis.

    Science.gov (United States)

    Sanguedolce, F; Liatsikos, E; Verze, P; Hruby, S; Breda, A; Beatty, J D; Knoll, T

    2014-08-01

    Treatment of renal stones using flexible ureteroscopy (fURS) is increasingly common despite the poor evidence in literature supporting its use and indications. With this study, we wanted to investigate the current use and indication of fURS for the treatment of renal stones in the clinical practice across the European countries. A survey was conducted using an emailed questionnaire consisting of 21 items; 2,894 recipients were selected via the EAU membership database. The questionnaires were collected through the SurveyMonkey system and the data were processed with the SPSS statistical package. Frequencies, cross tabs and Pearson correlation coefficients were applied as appropriate. 1,168 questionnaires were collected (response rate 40.4%). fURS was performed in 72.9% of the respondents' institutions, and 54.2% of the respondents were performing the procedure. For 95% of the users, fURS was considered first-line treatment, for stone of lower pole stone (45.9%) and <1 cm (44.2%) and 2 cm (43.8%) in size. The ureteral access sheaths were used routinely by more than 70% of the respondents. Lower pole stone repositioning technique was routinely performed by 45.9% of the surgeons. After fragmentation, 47.2% of the responders preferred to retrieve only the bigger fragments. At the end of fURS, lower volume surgeons were more likely to place routinely a double-J stent (p = 0.001). Higher volume surgeons estimated a higher durability of devices, both optical and digital ones (p < 0.001), and were more prone to consider fURS cost-effective when compared to other treatment modalities (p < 0.001). fURS is widely used for the treatment of renal stones and its use and indication can vary according to the age and surgeons' case volume. Higher volume surgeons are more prompt to extend international guidelines indications and to consider the technology cost-effective.

  17. Renal Tumor Anatomic Complexity: Clinical Implications for Urologists.

    Science.gov (United States)

    Joshi, Shreyas S; Uzzo, Robert G

    2017-05-01

    Anatomic tumor complexity can be objectively measured and reported using nephrometry. Various scoring systems have been developed in an attempt to correlate tumor complexity with intraoperative and postoperative outcomes. Nephrometry may also predict tumor biology in a noninvasive, reproducible manner. Other scoring systems can help predict surgical complexity and the likelihood of complications, independent of tumor characteristics. The accumulated data in this new field provide provocative evidence that objectifying anatomic complexity can consolidate reporting mechanisms and improve metrics of comparisons. Further prospective validation is needed to understand the full descriptive and predictive ability of the various nephrometry scores. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Impact of renal anatomy on shock wave lithotripsy outcomes for lower pole kidney stones: results of a prospective multifactorial analysis controlled by computerized tomography.

    Science.gov (United States)

    Torricelli, Fabio C M; Marchini, Giovanni S; Yamauchi, Fernando I; Danilovic, Alexandre; Vicentini, Fabio C; Srougi, Miguel; Monga, Manoj; Mazzucchi, Eduardo

    2015-06-01

    We evaluated which variables impact fragmentation and clearance of lower pole calculi after shock wave lithotripsy. We prospectively evaluated patients undergoing shock wave lithotripsy for a solitary 5 to 20 mm lower pole kidney stone between June 2012 and August 2014. Patient body mass index and abdominal waist circumference were recorded. One radiologist blinded to shock wave lithotripsy outcomes measured stone size, area and density, stone-to-skin distance, infundibular length, width and height, and infundibulopelvic angle based on baseline noncontrast computerized tomography. Fragmentation, success (defined as residual fragments less than 4 mm in asymptomatic patients) and the stone-free rate were evaluated by noncontrast computerized tomography 12 weeks postoperatively. Univariate and multivariate analysis was performed. A total of 100 patients were enrolled in the study. Mean stone size was 9.1 mm. Overall fragmentation, success and stone-free rates were 76%, 54% and 37%, respectively. On logistic regression body mass index (OR 1.27, 95% CI 1.11-1.49, p = 0.004) and stone density (OR 1.0026, 95% CI 1.0008-1.0046, p = 0.005) significantly impacted fragmentation. Stone size (OR 1.24, 95% CI 1.07-1.48, p = 0.039) and stone density (OR 1.0021, 95% CI 1.0007-1.0037, p = 0.012) impacted the success rate while stone size (OR 1.24, 95% CI 1.04-1.50, p = 0.029), stone density (OR 1.0015, 95% CI 1.0001-1.0032, p = 0.046) and infundibular length (OR 1.1035, 95% CI 1.015-1.217, p = 0.015) impacted the stone-free rate. The best outcomes were found in patients with a body mass index of 30 kg/m(2) or less, stones 10 mm or less and 900 HU or less, and an infundibular length of 25 mm or less. The coexistence of significant unfavorable variables led to a stone-free rate of less than 20%. Obese patients with higher than 10 mm density stones (greater than 900 HU) in the lower pole of the kidney with an infundibular length of greater than 25 mm should be discouraged from

  19. Emergency management of ureteral stones: Recent advances

    Directory of Open Access Journals (Sweden)

    Luis Osorio

    2008-01-01

    Full Text Available Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators′ experience, patients′ preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.

  20. Emergency management of ureteral stones: Recent advances.

    Science.gov (United States)

    Osorio, Luis; Lima, Estêvão; Autorino, Riccardo; Marcelo, Filinto

    2008-10-01

    Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators' experience, patients' preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.

  1. Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease

    DEFF Research Database (Denmark)

    Williams, James C; Borofsky, Michael S; Bledsoe, Sharon B

    2018-01-01

    PURPOSE: Mechanisms of early stone retention in the kidney are under studied and poorly understood. To date attachment via Randall's plaque is the only widely accepted theory in this regard, which is best described in idiopathic calcium oxalate stone formers. Brushite stone formers are known...... to have distinct papillary morphology relative to calcium oxalate stone formers. As such we sought to determine whether stone attachment mechanisms in such patients may be similarly unique. MATERIALS AND METHODS: Patients undergoing percutaneous and or ureteroscopic procedures for stone removal consented...... to endoscopic renal papillary examination and individual stone collection. Each removed stone was processed using micro computerized tomography to assess the 3-dimensional microstructure and the minerals contained, and search for common structural features indicative of novel mechanisms of early growth...

  2. Zonal NePhRO scoring system: a superior renal tumor complexity classification model.

    Science.gov (United States)

    Hakky, Tariq S; Baumgarten, Adam S; Allen, Bryan; Lin, Hui-Yi; Ercole, Cesar E; Sexton, Wade J; Spiess, Philippe E

    2014-02-01

    Since the advent of the first standardized renal tumor complexity system, many subsequent scoring systems have been introduced, many of which are complicated and can make it difficult to accurately measure data end points. In light of these limitations, we introduce the new zonal NePhRO scoring system. The zonal NePhRO score is based on 4 anatomical components that are assigned a score of 1, 2, or 3, and their sum is used to classify renal tumors. The zonal NePhRO scoring system is made up of the (Ne)arness to collecting system, (Ph)ysical location of the tumor in the kidney, (R)adius of the tumor, and (O)rganization of the tumor. In this retrospective study, we evaluated patients exhibiting clinical stage T1a or T1b who underwent open partial nephrectomy performed by 2 genitourinary surgeons. Each renal unit was assigned both a zonal NePhRO score and a RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior, location relative to polar lines) score, and a blinded reviewer used the same preoperative imaging study to obtain both scores. Additional data points gathered included age, clamp time, complication rate, urine leak rate, intraoperative blood loss, and pathologic tumor size. One hundred sixty-six patients underwent open partial nephrectomy. There were 37 perioperative complications quantitated using the validated Clavien-Dindo system; their occurrence was predicted by the NePhRO score on both univariate and multivariate analyses (P = .0008). Clinical stage, intraoperative blood loss, and tumor diameter were all correlated with the zonal NePhRO score on univariate analysis only. The zonal NePhRO scoring system is a simpler tool that accurately predicts the surgical complexity of a renal lesion. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Bilateral Giant Renal Angiomyolipoma in a Patient with Tuberous Sclerosis Complex: A Case Report

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    Andika Afriansyah

    2018-04-01

    Full Text Available Tuberous sclerosis complex (TSC has several renal manifestations including angiomyolipomas (AML and renal epithelial neoplasms. A bilateral giant renal AML is extremely rare. We report a case of giant bilateral AML and discuss the diagnosis and treatment of it. The 22-year-old man was admitted due to bilateral flank pain, gross hematuria, and abdominal fullness. He had history of epilepsy, mental retardation, and delayed development during childhood. He had angiofibroma on his face since 10 years ago. Abdominal CT and MRI revealed large lobulated heterogeneous mass with fatty content. Based on those findings, we diagnosed the patient with bilateral giant renal AML. We gave conservative management for the patient and planned to total nephrectomy on the left kidney if the continued bleeding occurred. AML associated with TSC occur more frequently as multiple lesions and grows to larger size than idiopathic AML. Bilateral giant AML, which is very rare, could be treated with conservative management if no significant hemorrhage occurred.

  4. Evidence of active transport of cadmium complexing dithiocarbamates into renal and hepatic cells in vivo

    International Nuclear Information System (INIS)

    Gale, G.R.; Smith, A.B.; Jones, M.M.; Singh, P.K.

    1992-01-01

    A study was made of the effects of certain inhibitors of transport systems on the actions of four cadmium (Cd) complexing N,N-disubstituted dithiocarbamates (DTCs) in mobilizing murine renal and hepatic Cd in vivo. Probenecid, the prototypical antagonist of organic anion transport in the kidney, when given 1 hr prior to each DTC, sharply suppressed the DTC-induced reduction of renal Cd but was virtually without effect on mobilization of Cd from liver. Sulfinpyrazone, which blocks tubular reabsorption of uric acid and also inhibits transport of a variety of organic acids, inhibited markedly the mobilization of both renal and hepatic Cd by DTCs. Phlorizin, an inhibitor of tubular sugar reabsorption, did not affect the Cd mobilizing actions of DTCs in any consistent fashion. We propose that the high degree of selectivity of DTCs in mobilizing renal hepatic Cd is dependent, at lest in part, upon active transport of DTCs into these tissues via the organic anion transport systems. This report presents the first evidence that compounds of the (R) 2 NCSS - class may gain access to intracellular space by an active, carrier-mediated process. (au)

  5. Impact of stone density on outcomes in percutaneous nephrolithotomy (PCNL)

    DEFF Research Database (Denmark)

    Anastasiadis, Anastasios; Onal, Bulent; Modi, Pranjal

    2013-01-01

    were assigned to a low stone density [LSD, ≤ 1000 Hounsfield units (HU)] or high stone density (HSD, > 1000 HU) group based on the radiological density of the primary renal stone. Preoperative characteristics and outcomes were compared in the two groups. Results. Retreatment for residual stones...... was more frequent in the LSD group. The overall stone-free rate achieved was higher in the HSD group (79.3% vs 74.8%, p = 0.113). By univariate regression analysis, the probability of achieving a stone-free outcome peaked at approximately 1250 HU. Below or above this density resulted in lower treatment...

  6. Is anatomic complexity associated with renal tumor growth kinetics under active surveillance?

    Science.gov (United States)

    Mehrazin, Reza; Smaldone, Marc C; Egleston, Brian; Tomaszewski, Jeffrey J; Concodora, Charles W; Ito, Timothy K; Abbosh, Philip H; Chen, David Y T; Kutikov, Alexander; Uzzo, Robert G

    2015-04-01

    Linear growth rate (LGR) is the most commonly employed trigger for definitive intervention in patients with renal masses managed with an initial period of active surveillance (AS). Using our institutional cohort, we explored the association between tumor anatomic complexity at presentation and LGR in patients managed with AS. Enhancing renal masses managed expectantly for at least 6 months were included for analysis. The association between Nephrometry Score and LGR was assessed using generalized estimating equations, adjusting for the age, Charlson score, race, sex, and initial tumor size. Overall, 346 patients (401 masses) met the inclusion criteria (18% ≥ cT1b), with a median follow-up of 37 months (range: 6-169). Of these, 44% patients showed progression to definitive intervention with a median duration of 27 months (range: 6-130). On comparing patients managed expectantly to those requiring intervention, no difference was seen in median tumor size at presentation (2.2 vs. 2.2 cm), whereas significant differences in median age (74 vs. 65 y, P anatomic tumor complexity at presentation and renal masses of LGR of clinical stage 1 under AS may afford a clinically useful cue to tailor individual patient radiographic surveillance schedules and warrants further evaluation. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. A case–control study on environmental and biological risk factors for renal calculi persisting in a coastal Union Territory, India

    Directory of Open Access Journals (Sweden)

    Prakash Mathiyalagen

    2017-01-01

    Full Text Available Background and Objectives: Renal stone disease is a common disorder of the urinary tract and also a significant problem because of incidence, recurrence, and severe consequences. The complex pathogenetic mechanisms of renal stone formation involve both biologic and environmental risk factors. The present study was performed to identify the role of these parameters among renal stone patients and normal individuals from a coastal union territory region in South India. Methods: The authors conducted a case–control study of renal stone disease among outpatient department patients more than 30 years of age using systematic random sampling procedure with 100 study participants (50 subjects for each group. A questionnaire to explore some relevant history as well as to note general examination findings was used along with a house visit to collect a sample of water. Analysis was undertaken using appropriate statistical techniques. Results: The study showed statistically significant association for renal stones with female sex, illiteracy, body mass index (BMI (>25 kg/m2, sodium (>50 mg/L, water consumption (<1.5 L/day, water source being borewell, consuming soft drink, sedentary work, and family history of renal stones. The adjusted odds ratios (ORs were significantly higher for consuming soft drink (OR: 8.19; 95% confidence interval: 1.99–33.69, sedentary work (10.01; 1.27–78.91, and water consumption < 1.5 L/day (7.73; 2.24–26.69. Interpretation and Conclusions: We conclude that in this part of India, female gender, illiteracy, high BMI, high sodium in drinking water, inadequate water consumption, borewell drinking water, soft-drink consumption, sedentary work, and family history of renal stones can lead to a significant increase in the risk of renal stone disease.

  8. Trends in urological stone disease.

    Science.gov (United States)

    Turney, Benjamin W; Reynard, John M; Noble, Jeremy G; Keoghane, Stephen R

    2012-04-01

    To summarize the changes in prevalence and treatment of upper urinary tract stone disease in the UK over the last 10 years. Data from the Hospital Episode Statistics (HES) website (http://www.hesonline.nhs.uk) were extracted, summarized and presented. The number of upper urinary tract stone hospital episodes increased by 63% to 83,050 in the 10-year period. The use of shock wave lithotripsy (SWL) for treating all upper tract stones increased from 14,491 cases in 2000-2001 to 22,402 cases in 2010 (a 55% increase) with a 69% increase in lithotripsy for renal stones. There was a 127% increase in the number of ureteroscopic stone treatments from 6,283 to 14,242 cases over the 10-year period with a 49% increase from 2007/2008 to 2009/2010. There was a decline in open surgery for upper tract stones from 278 cases in 2000/2001 to 47 cases in 2009/2010 (an 83% reduction). Treatment for stone disease has increased substantially in comparison with other urological activity. In 2009/2010, SWL was performed almost as frequently as transurethral resection of the prostate or transurethral resection of bladder tumour, ureteroscopy for stones was performed more frequently than nephrectomy, radical prostatectomy and cystectomy combined, and percutaneous nephrolithotomy was performed more frequently than cystectomy. The present study highlights the increase in prevalence and treatment of stone disease in the UK over the last 10 years. If this trend continues it has important implications for workforce planning, training, service delivery and research in the field of urolithiasis. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  9. Kidney Stones (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Kidney Stones KidsHealth / For Parents / Kidney Stones What's in ... other treatments to help remove the stones. How Kidney Stones Form It's the kidneys' job to remove ...

  10. Bladder stones after bladder augmentation are not what they seem.

    Science.gov (United States)

    Szymanski, Konrad M; Misseri, Rosalia; Whittam, Benjamin; Lingeman, James E; Amstutz, Sable; Ring, Joshua D; Kaefer, Martin; Rink, Richard C; Cain, Mark P

    2016-04-01

    Bladder and renal calculi after bladder augmentation are thought to be primarily infectious, yet few studies have reported stone composition. The primary aim was to assess bladder stone composition after augmentation, and renal stone composition in those with subsequent nephrolithiasis. The exploratory secondary aim was to screen for possible risk factors for developing infectious stones. Patients treated for bladder stones after bladder augmentation at the present institution between 1981 and 2012 were retrospectively reviewed. Data were collected on demographics, surgeries and stone composition. Patients without stone analysis were excluded. Stones containing struvite, carbonate apatite or ammonium acid ureate were classified as infectious. The following variables were analyzed for a possible association with infectious bladder stone composition: gender, history of cloacal exstrophy, ambulatory status, nephrolithiasis, recurrent urea-splitting urinary tract infections, first vs recurrent stones, timing of presentation with a calculus, history of bladder neck procedures, catheterizable channel and vesicoureteral reflux. Fisher's exact test was used for analysis. Of the 107 patients with bladder stones after bladder augmentation, 85 met inclusion criteria. Median age at augmentation was 8.0 years (follow-up 10.8 years). Forty-four patients (51.8%) recurred (14 multiple recurrences, 143 bladder stones). Renal calculi developed in 19 (22.4%) patients with a bladder stone, and 10 (52.6%) recurred (30 renal stones). Overall, 30.8% of bladder stones were non-infectious (Table). Among patients recurring after an infectious bladder stone, 30.4% recurred with a non-infectious one. Among patients recurring after a non-infectious stone, 84.6% recurred with a non-infectious one (P = 0.005). Compared with bladder stones, renal stones were more likely to be non-infectious (60.0%, P = 0.003). Of patients with recurrent renal calculi after an infectious stone, 40.0% recurred with

  11. Laparoscopic Cryoablation Of Small Renal Tumors – Does Anatomical Tumor Complexity Affect Treatment Outcome?

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjærgaard; Østraat, Øyvind; Andersen, Gratien

    risk in relation to nephron sparing surgery, but they may also be useful when planning cryoablation. Aim: The aim of the present study was to investigate whether patients with an anatomical complex tumor, represented by a high PADUA-score (≥10), carried a higher risk of residual unablated tumor...... compared to patients with a less anatomical complex tumor when treated with laparoscopic cryoablation. Material and methods: A retrospective review of Aarhus Cryoablation Register identified 120 patients with a single biopsy-verified pT1a renal tumor, treated with primary laparoscopic cryoablation between....... This relative risk of 2.9 (95%CI 1.1;7.6) was statistically significant (p=0.03). The mean follow-up time from treatment to diagnosis of treatment failure was 13 months (95%CI 8;18), which was not significantly different between the two groups. Conclusion: Patients with an anatomical complex tumor, represented...

  12. Laparoscopic Cryoablation Of Small Renal Tumors – Does Anatomical Tumor Complexity Effect Treatment Outcome?

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjærgaard; Østraat, Øyvind; Andersen, Gratien

    risk in relation to nephron sparing surgery, but they may also be useful when planning cryoablation. Aim: The aim of the present study was to investigate whether patients with an anatomical complex tumor, represented by a high PADUA-score (≥10), carried a higher risk of residual unablated tumor...... compared to patients with a less anatomical complex tumor when treated with laparoscopic cryoablation. Material and methods: A retrospective review of Aarhus Cryoablation Register identified 120 patients with a single biopsy-verified pT1a renal tumor, treated with primary laparoscopic cryoablation between....... This relative risk of 2.9 (95%CI 1.1;7.6) was statistically significant (p=0.03). The mean follow-up time from treatment to diagnosis of treatment failure was 13 months (95%CI 8;18), which was not significantly different between the two groups. Conclusion: Patients with an anatomical complex tumor, represented...

  13. Sulfate but not thiosulfate reduces calculated and measured urinary ionized calcium and supersaturation: implications for the treatment of calcium renal stones.

    Directory of Open Access Journals (Sweden)

    Allen Rodgers

    Full Text Available Urinary sulfate (SO4(2- and thiosulfate (S2O3(2- can potentially bind with calcium and decrease kidney stone risk. We modeled the effects of these species on the concentration of ionized calcium (iCa and on supersaturation (SS of calcium oxalate (CaOx and calcium phosphate (CaP, and measured their in vitro effects on iCa and the upper limit of stability (ULM of these salts.Urine data from 4 different types of stone patients were obtained from the Mayo Nephrology Clinic (Model 1. A second data set was obtained from healthy controls and hypercalciuric stone formers in the literature who had been treated with sodium thiosulfate (STS (Model 2. The Joint Expert Speciation System (JESS was used to calculate iCa and SS. In Model 1, these parameters were calculated as a function of sulfate and thiosulfate concentrations. In Model 2, data from pre- and post STS urines were analyzed. ULM and iCa were determined in human urine as a function of sulfate and thiosulfate concentrations.Calculated iCa and SS values for all calcium salts decreased with increasing sulfate concentration. Thiosulfate had no effect on these parameters. In Model 2, calculated iCa and CaOx SS increased after STS treatment, but CaP SS decreased, perhaps due to a decrease in pH after STS treatment. In confirmatory in vitro experiments supplemental sulfate, but not thiosulfate, significantly increased the calcium needed to achieve the ULM of CaP and tended to increase the oxalate needed to reach the ULM of CaOx. Sulfate also significantly decreased iCa in human urine, while thiosulfate had no effect.Increasing urinary sulfate could theoretically reduce CaOx and CaP stone risk. Although STS may reduce CaP stone risk by decreasing urinary pH, it might also paradoxically increase iCa and CaOx SS. As such, STS may not be a viable treatment option for stone disease.

  14. Doença de Crohn e cálculo renal: muito mais que coincidência? Crohn’s disease and kidney stones: much more than coincidence?

    Directory of Open Access Journals (Sweden)

    Maria Lenise Lopes Viana

    2007-09-01

    hipocitratúria e a hipomagnesiúria, que representam fatores de risco reconhecido para a formação de cálculos, devem ter participação ativa nestes resultados. O impacto dessas alterações, medido pela saturação urinária elevada de oxalato e fosfato de cálcio, representa uma das maneiras de se demonstrar como estes fatores predispõem à nucleação de cristais e, conseqüentemente, à formação de cálculos nas vias urinárias.BACKGROUND: Crohn’s disease is an inflammatory bowel disease associated with a wide variety of complications and manifestations secondary to the effects of underlie inflammatory process. In about 30% of the patients with Crohn’s disease can be found extra-intestinals symptoms. Nephrolithiasis is one of them and the appearance of kidney stones, mainly of oxalate of calcium, is more common in these patients than in general population. AIM: To evaluate urinary metabolic factors potentially involved in renal stones formation on patients with Crohn’s disease. METHODS: We evaluated 29 patients with Crohn’s disease followed in the Outpatient Bowel Inflammatory Disease Clinics of State University Hospital, Londrina, PR, Brazil, from January to December of 2004. The metabolic evaluation included measured of blood and urine substances related to renal stones formation, kidneys, ureters and bladder ultrassonography and calculation of urinary supersaturation for calcium oxalate, uric acid and calcium phosphate. RESULTS: Twenty-nine of the evaluated patients were female or 65.5% and 34.5% were males. Among the metabolic urinary studied, we identified the following potential disturbances associated with nephrolithiasis: hypocitraturia in 21 patients (72.4%, hypomagnesuria in 12 (41.4%, hyperoxaluria in 4 (13.6% and urinary volume low in 5 (17.2%. Renal stones were identified in 13 patients (44.8%. Oxalate urinary excretion was higher in patients submitted to bowel surgery and also in patients with ileum resection. The urinary supersaturation of

  15. Percutaneous management of staghorn renal calculi

    International Nuclear Information System (INIS)

    Lee, Won Jay

    1989-01-01

    During a four year period, ending May 1987, 154 cases of symptomatic staghorn calculi have been treated by percutaneous nephrolithotomy. Of these patients,86% were discharged completely stone free with the remainder having fragments less than 5 mm in greatest diameter. More than one operative procedure during the same hospitalizations was required in 24% of patients and multiple percutaneous tracts were established in excess of 73% of them. Significant complications occurred in 16% of patients and there was one death. Most complications can be generally by minimized by careful approach and manageable by interventional radiological means. The management of patients with staghorn calculi requires a comprehensive understanding of the renal anatomy, selection of appropriate percutaneous nephrostomy tract sites, and radiologic-urologic expertise needed to remove the large stone mass. The advent of extracorporeal shock wave lithotripsy will not abolish the need for nephrolithotomy, particularly complex stones such as staghorn calculi

  16. Stone coalgebras

    NARCIS (Netherlands)

    C.A. Kupke (Clemens); A. Kurz (Alexander); Y. Venema

    2003-01-01

    textabstractIn this paper we argue that the category of Stone spaces forms an interesting base category for coalgebras, in particular, if one considers the Vietoris functor as an analogue to the power set functor on the category of sets. We prove that the so-called descriptive general frames, which

  17. Contribution of stone size to chronic kidney disease in kidney stone formers.

    Science.gov (United States)

    Ahmadi, Farrokhlagha; Etemadi, Samira Motedayen; Lessan-Pezeshki, Mahbob; Mahdavi-Mazdeh, Mitra; Ayati, Mohsen; Mir, Alireza; Yazdi, Hadi Rokni

    2015-01-01

    To determine whether stone burden correlates with the degree of chronic kidney disease in kidney stone formers. A total of 97 extracorporeal shockwave lithotripsy candidates aged 18 years and older were included. Size, number and location of the kidney stones, along with cumulative stone size, defined as the sum of diameters of all stones) were determined. Estimated glomerular filtration rate was determined using the Chronic Kidney Disease Epidemiology Collaboration cystatin C/creatinine equation, and chronic kidney disease was defined as estimated glomerular filtration rate chronic kidney disease. The relationship persisted even after adjustment for age, sex, body mass index, C-reactive protein, fasting plasma glucose, thyroid stimulating hormone, presence of microalbuminuria, history of renal calculi, history of extracorporeal shockwave lithotripsy, number and location of the stones (odds ratio 1.24, 95% confidence interval 1.02-1.52). The same was not observed for individuals with a cumulative stone size ≥ 20 mm. In kidney stone formers with a cumulative stone size up to 20 mm, estimated glomerular filtration rate linearly declines with increasing cumulative stone size. Additionally, cumulative stone size is an independent predictor of chronic kidney disease in this group of patients. © 2014 The Japanese Urological Association.

  18. Metabolic Characteristics and Risks Associated with Stone Recurrence in Korean Young Adult Stone Patients.

    Science.gov (United States)

    Kang, Ho Won; Seo, Sung Pil; Kim, Won Tae; Kim, Yong-June; Yun, Seok-Joong; Kim, Wun-Jae; Lee, Sang-Cheol

    2017-08-01

    The aim of this study was to assess the metabolic characteristics and risks of stone recurrence in young adult stone patients in Korea. The medical records of 1532 patients presenting with renal or ureteric stones at our stone clinic between 1994 and 2015 were retrospectively reviewed. Patients were grouped according to age (young adult, 18-29 years; intermediate onset, 30-59 years; old age, ≥60 years) at first presentation, and measurements of clinicometabolic characteristics and risks of stone recurrence were compared. Overall, excretion of urinary stone-forming substances was highest in the intermediate onset group, followed by the young adult and old age groups. Importantly, excretion of urinary citrate was lowest in the young adult group. Kaplan-Meier analyses identified a significant difference between the three age groups in terms of stone recurrence (log rank test, p adult stone patients. Younger age (18-29 years) at first stone presentation was a significant risk factor for stone recurrence, and urinary citrate excretion was an independent risk factor affecting recurrence in this group. Metabolic evaluation and potassium citrate therapy should be considered for young adult stone patients to prevent recurrence.

  19. New non-renal congenital disorders associated with medullary sponge kidney (MSK) support the pathogenic role of GDNF and point to the diagnosis of MSK in recurrent stone formers.

    Science.gov (United States)

    Ria, Paolo; Fabris, Antonia; Dalla Gassa, Alessandra; Zaza, Gianluigi; Lupo, Antonio; Gambaro, Giovanni

    2017-08-01

    Medullary sponge kidney (MSK) is a congenital renal disorder. Its association with several developmental abnormalities in other organs hints at the likelihood of some shared step(s) in the embryogenesis of the kidney and other organs. It has been suggested that the REarranged during Transfection (RET) proto-oncogene and the Glial cell line-Derived Neurotrophic Factor (GDNF) gene are defective in patients with MSK, and both RET and GDNF are known to have a role in the development of the central nervous system, heart, and craniofacial skeleton. Among a cohort of 143 MSK patients being followed up for nephrolithiasis and chronic kidney disease at our institution, we found six with one or more associated non-renal anomalies: one patient probably has congenital hemihyperplasia and hypertrophic cardiomyopathy with adipose metaplasia and mitral valve prolapse; one has Marfan syndrome; and the other four have novel associations between MSK and nerve and skeleton abnormalities described here for the first time. The discovery of disorders involving the central nervous system, cardiovascular system and craniofacial skeleton in MSK patients supports the hypothesis of a genetic alteration on the RET-GDNF axis having a pivotal role in the pathogenesis of MSK, in a subset of patients at least. MSK seems more and more to be a systemic disease, and the identification of extrarenal developmental defects could be important in arousing the suspicion of MSK in recurrent stone formers.

  20. Endourological Evaluation and Management of Leukoplakia of the Renal Pelvis

    Directory of Open Access Journals (Sweden)

    Hidehiro Kakizaki

    1996-01-01

    Full Text Available Since August 1989, we have seen 4 patients with leukoplakia of the renal pelvis associated with a longstanding renal stone. In 2 of them, excretory or retrograde pyelography revealed multiple filling defects in the left renal pelvis as well as a renal stone, although urine cytological examination was negative. One of the other 2 patients underwent extracorporeal shock wave lithotripsy (ESWL for the renal stone, but this was not followed by the passage of stone fragments. The renal stone in the remaining patient was associated with staghorn calculi. For stone extraction as well as endoscopic evaluation of the intrapelvic lesion, percutaneous nephroscopy was performed. A small to large amount of tissue-like white debris in sheets characteristic of leukoplakia was found in the renal pelvis with stones embedded in it and was removed directly by forceps or suction and then by irrigating with saline. We propose that 1 the endourological approach should be recommended for patients with renal pelvic lesions associated with longstanding renal stones or for patients who show difficulty in passing stone fragments after ESWL and 2 this entity of leukoplakia should be kept in mind for the differential diagnosis of renal pelvic lesions associated with renal stones.

  1. A multi-reader in vitro study using porcine kidneys to determine the impact of integrated circuit detectors and iterative reconstruction on the detection accuracy, size measurement, and radiation dose for small (<4 mm) renal stones.

    Science.gov (United States)

    Wells, Michael L; Froemming, Adam T; Kawashima, Akira; Vrtiska, Terri J; Kim, Bohyun; Hartman, Robert P; Holmes, David R; Carter, Rickey E; Bartley, Adam C; Leng, Shuai; McCollough, Cynthia H; Fletcher, Joel G

    2017-08-01

    Background Detection of small renal calculi has benefitted from recent advances in computed tomography (CT) scanner design. Information regarding observer performance when using state-of-the-art CT scanners for this application is needed. Purpose To assess observer performance and the impact of radiation dose for detection and size measurement of <4 mm renal stones using CT with integrated circuit detectors and iterative reconstruction. Material and Methods Twenty-nine <4 mm calcium oxalate stones were randomly placed in 20 porcine kidneys in an anthropomorphic phantom. Four radiologists used a workstation to record each calculus detection and size. JAFROC Figure of Merit (FOM), sensitivity, false positive detections, and calculus size were calculated. Results Mean calculus size was 2.2 ± 0.7 mm. The CTDI vol values corresponding to the automatic exposure control settings of 160, 80, 40, 25, and 10 Quality Reference mAs (QRM) were 15.2, 7.9, 4.2, 2.7, and 1.3 mGy, respectively. JAFROC FOM was ≥ 0.97 at ≥ 80 QRM, ≥ 0.89 at ≥ 25 QRM, and was inferior to routine dose (160 QRM) at 10 QRM (0.72, P < 0.05). Per-calculus sensitivity remained ≥ 85% for every reader at ≥ 25 QRM. Mean total false positive detections per reader were ≤ 3 at ≥ 80 QRM, but increased substantially for two readers ( ≥ 12) at ≤ 40 QRM. Measured calculus size significantly decreased at ≤ 25 QRM ( P ≤ 0.01). Conclusion Using low dose renal CT with iterative reconstruction and ≥ 25 QRM results in high sensitivity, but false positive detections increase for some readers at very low dose levels (≤ 40 QRM). At very low doses with iterative reconstruction, measured calculus size will artifactually decrease.

  2. Urinary stone composition in Oman: with high incidence of cystinuria.

    Science.gov (United States)

    Al-Marhoon, Mohammed S; Bayoumi, Riad; Al-Farsi, Yahya; Al-Hinai, Abdullhakeem; Al-Maskary, Sultan; Venkiteswaran, Krishna; Al-Busaidi, Qassim; Mathew, Josephkunju; Rhman, Khalid; Sharif, Omar; Aquil, Shahid; Al-Hashmi, Intisar

    2015-06-01

    Urinary stones are a common problem in Oman and their composition is unknown. The aim of this study is to analyze the components of urinary stones of Omani patients and use the obtained data for future studies of etiology, treatment, and prevention. Urinary stones of 255 consecutive patients were collected at the Sultan Qaboos University Hospital. Stones were analyzed by Fourier transform infrared spectrophotometer. The biochemical, metabolic, and radiological data relating to the patients and stones were collected. The mean age was 41 years, with M:F ratio of 3.7:1. The common comorbidities associated with stone formation were hypertension; diabetes, benign prostate hyperplasia; urinary tract infection; obesity; and atrophic kidney. The common presentation was renal colic and flank pain (96%). Stones were surgically retrieved in 70% of patients. Mean stone size was 9 ± 0.5 mm (range 1.3-80). Stone formers had a BMI ≥ 25 in 56% (P = 0.006) and positive family history of stones in 3.8%. The most common stones in Oman were as follows: Calcium Oxalates 45% (114/255); Mixed calcium phosphates & calcium oxalates 22% (55/255); Uric Acid 16% (40/255); and Cystine 4% (10/255). The most common urinary stones in Oman are Calcium Oxalates. Overweight is an important risk factor associated with stone formation. The hereditary Cystine stones are three times more common in Oman than what is reported in the literature that needs further genetic studies.

  3. Determination of thermodynamic parameters for complexation of calcium and magnesium with chondroitin sulfate isomers using isothermal titration calorimetry: Implications for calcium kidney-stone research

    Science.gov (United States)

    Rodgers, Allen L.; Jackson, Graham E.

    2017-04-01

    Chondroitin sulfate (CS) occurs in human urine. It has several potential binding sites for calcium and as such may play an inhibitory role in calcium oxalate and calcium phosphate (kidney stone disease by reducing the supersaturation (SS) and crystallization of these salts. Urinary magnesium is also a role player in determining speciation in stone forming processes. This study was undertaken to determine the thermodynamic parameters for binding of the disaccharide unit of two different CS isomers with calcium and magnesium. These included the binding constant K. Experiments were performed using an isothermal titration calorimeter (ITC) at 3 different pH levels in the physiological range in human urine. Data showed that interactions between the CS isomers and calcium and magnesium occur via one binding site, thought to be sulfate, and that log K values are 1.17-1.93 and 1.77-1.80 for these two metals respectively. Binding was significantly stronger in Mg-CS than in Ca-CS complexes and was found to be dependent on pH in the latter but not in the former. Furthermore, binding in Ca-CS complexes was dependent on the location of the sulfate binding site. This was not the case in the Mg-CS complexes. Interactions were shown to be entropy driven and enthalpy unfavourable. These findings can be used in computational modeling studies to predict the effects of the calcium and magnesium CS complexes on the speciation of calcium and the SS of calcium salts in real urine samples.

  4. Disappearing renal calculus.

    Science.gov (United States)

    Cui, Helen; Thomas, Johanna; Kumar, Sunil

    2013-04-10

    We present a case of a renal calculus treated solely with antibiotics which has not been previously reported in the literature. A man with a 17 mm lower pole renal calculus and concurrent Escherichia coli urine infection was being worked up to undergo percutaneous nephrolithotomy. However, after a course of preoperative antibiotics the stone was no longer seen on retrograde pyelography or CT imaging.

  5. Greco-Roman Stone Disease

    Science.gov (United States)

    Moran, Michael E.; Ruzhansky, Katherine

    2008-09-01

    Greek and Roman thought had a profound influence upon Western medical practice. From the fall of the Greek civilization to the fall of the Roman, remarkable progress of our understanding of human anatomy and physiology occurred. Here we review the attempts of Greek and Roman thinkers to develop the first understanding of the pathophysiology of urolithiasis, its epidemiology, differential diagnosis of renal versus bladder stones, medications for both colic and prevention, the role of familial syndromes, and dietary management.

  6. Deposition of idiotype-anti-idiotype immune complexes in renal glomeruli after polyclonal B cell activation

    International Nuclear Information System (INIS)

    Goldman, M.; Rose, L.M.; Hochmann, A.; Lambert, P.H.

    1982-01-01

    We investigated the possible role of idiotypic interactions in the pathogenesis of the glomerular lesions observed in mice undergoing polyclonal B cell activation. BALB/c mice were studied for the presence of renal deposits of T15 idiotype-anti-T15 idiotype-immune complexes (IC) after injection of bacterial lipopolysaccharides (LPS). The T15 idiotype is the major idiotype of BALB/c mice anti-phosphorylcholine (PC) antibodies, which are cross-reactive with the idiotype of the TEPC-15 myeloma protein. This model was used because T15 idiotype-anti-T15 idiotype IC have been detected in the circulation of BALB/c mice after polyclonal B cell activation. First, an idiotype-specific immunofluorescence technique allowed us to detect T15 idiotype-bearing immunoglobulins in glomeruli from day 6 to day 28 after LPS injection. Second, fluorescein isothiocyanate-conjugated TEPC-15 myeloma protein was found to localize in the glomeruli after in vivo injection 18 d after LPS administration. This renal localization was shown to be idiotype-specific and could be quantified in a trace-labeling experiment. Third, kidney-deposited immunoglobulins of mice injected with LPS were eluted, radiolabeled, and analyzed by radioimmunoassay. Both T15 idiotype-bearing immunoglobulins and anti-T15 idiotype antibodies were detected in the eluates, providing further evidence for a renal deposition of T15 idiotype-anti-T15 idiotype IC. Polyclonal B cell activation is likely to result in a simultaneous triggering of many idiotypic clones and of corresponding anti-idiotypic clones represented in the B cell repertoire. This could lead to the formation of a variety of idiotype-anti-idiotype IC that could participate in the development of glomerular lesions

  7. Technetium-Iron Complex. Radiopharmaceutical for Renal Scanning and Function Studies

    Energy Technology Data Exchange (ETDEWEB)

    Aquino, J. A.; Cunningham, R. M. [Victoria General Hospital and Dalhousie Medical School, Halifax, NS (Canada)

    1969-05-15

    A preliminary report on the use of a technetium-iron complex as a radiopharmaceutical in the evaluation of kidney function as well as renal scanning is presented. The first part considers the {sup 99m}Tc iron complex as an agent to determine the kidney function. This is correlated with the conventional {sup 131}I Hippuran renogram as well as the mercury accumulative test. The second part describes the use of the {sup 99m}Tc iron complex as a renal scanning agent; again it is compared with {sup 197}Hg Neohydrin. The availability of the Anger gamma camera, along with {sup 99m}Tc and its favourable characteristics have encouraged further search for better preparations. Among these is the {sup 99m}Tc iron complex. The authors' technique of preparation is described. Although the pertechnetate ion is not very active chemically in combining with other compounds, it is readily reduced to more reactive lower valence states. Such alterations of chemical form produce changes in biologic localization of {sup 99m}Tc. After the intravenous injection of {sup 99m}Tc as pertechnetate, it is rapidly localized in the stomach, urinary bladder, thyroid, and salivary glands. Excretion during the first 24 h occurs largely through the urine. Harper et al. have shown that the {sup 99m}Tc iron complex is rapidly excreted through the urine. The initial disappearance from the plasma is so very rapid that 50% or more has usually left the blood in 3-5 min. Part of the 5'irnTc is fixed in the kidney which constitutes half of what is retained in the body. Our technique consists of obtaining the conventional {sup 131}I Hippuran renogram. This is followed by the injection of {sup 99m}Tc iron complex. The two renograms obtained, using the two agents, are correlated along with other diagnostic tests. Since the {sup 99m}Tc iron complex used for doing the renogram can be used in scanning the kidney, both kidneys are scanned using the Anger gamma camera. Comparative scans are done with the use of {sup

  8. Uncovering the real outcomes of active renal stone treatment by utilizing non-contrast computer tomography: a systematic review of the current literature.

    Science.gov (United States)

    Tokas, Theodoros; Habicher, Martin; Junker, Daniel; Herrmann, Thomas; Jessen, Jan Peter; Knoll, Thomas; Nagele, Udo

    2017-06-01

    To evaluate the stone-free rates (SFRs) and stone clearance rates (SCRs) of extracorporeal shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolitholapaxy (PCNL) according to non-contrast computer tomography (NCCT) findings. Original articles were identified from PubMed. After exclusion of ineligible papers, twenty-three studies with 2494 cases were included in the review. Six SWL, five RIRS and eight PCNL studies were selected. Additionally, four comparative articles were identified. SWL presents SFRs ranging 35-61.3 % and SCRs for residuals <4 mm being 43.2-92.9 %. RIRS studies report SFRs of 34.8-59.7 % and SCRs for residuals <4 mm ranging 48-96.7 %. Finally, PCNL presents SFRs of 20.8-100 % and SCRs for residuals <4 mm being 41.5-91.4 %. According to the comparative studies, SFRs are 17-61.3 % for SWL, 50 % for RIRS, and 95-100 % for PCNL. According to NCCT findings, it seems that PCNL provides better SFRs than ESWL and RIRS. However, further research with comparable and complete preoperative parameters and outcomes could reduce the heterogeneity of current data.

  9. Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy.

    Science.gov (United States)

    Simhan, Jay; Smaldone, Marc C; Tsai, Kevin J; Canter, Daniel J; Li, Tianyu; Kutikov, Alexander; Viterbo, Rosalia; Chen, David Y T; Greenberg, Richard E; Uzzo, Robert G

    2011-10-01

    The association between tumor complexity and postoperative complications after partial nephrectomy (PN) has not been well characterized. We evaluated whether increasing renal tumor complexity, quantitated by nephrometry score (NS), is associated with increased complication rates following PN using the Clavien-Dindo classification system (CCS). We queried our prospectively maintained kidney cancer database for patients undergoing PN from 2007 to 2010 for whom NS was available. All patients underwent PN. Tumors were categorized into low- (NS: 4-6), moderate- (NS: 7-9), and high-complexity (NS: 10-12) lesions. Complication rates within 30 d were graded (CCS: I-5), stratified as minor (CCS: I or 2) or major (CCS: 3-5), and compared between groups. A total of 390 patients (mean age: 58.0 ± 11.9 yr; 66.9% male) undergoing PN (44.6% open, 55.4% robotic) for low- (28%), moderate- (55.6%), and high-complexity (16.4%) tumors (mean tumor size: 3.74 ± 2.4 cm; median: 3.2 cm) from 2007 to 2010 were identified. Tumor size, estimated blood loss, and ischemia time all significantly differed (prenal tumors. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  10. Coupling-induced complexity in nephron models of renal blood flow regulation

    DEFF Research Database (Denmark)

    Laugesen, Jakob Lund; Sosnovtseva, Olga; Mosekilde, Erik

    2010-01-01

    Marsh DJ. Coupling-induced complexity in nephron models of renal blood flow regulation. Am J Physiol Regul Integr Comp Physiol 298: R997-R1006, 2010. First published February 10, 2010; doi: 10.1152/ajpregu.00714.2009.-Tubular pressure and nephron blood flow time series display two interacting...... oscillations in rats with normal blood pressure. Tubulo-glomerular feedback (TGF) senses NaCl concentration in tubular fluid at the macula densa, adjusts vascular resistance of the nephron's afferent arteriole, and generates the slower, larger-amplitude oscillations (0.02-0.04 Hz). The faster smaller...... of glomerular pressure caused by fluctuations of blood pressure. The oscillations become irregular in animals with chronic high blood pressure. TGF feedback gain is increased in hypertensive rats, leading to a stronger interaction between the two mechanisms. With a mathematical model that simulates tubular...

  11. Renal oncocytoma characterized by the defective complex I of the respiratory chain boosts the synthesis of the ROS scavenger glutathione.

    Science.gov (United States)

    Kürschner, Gerrit; Zhang, Qingzhou; Clima, Rosanna; Xiao, Yi; Busch, Jonas Felix; Kilic, Ergin; Jung, Klaus; Berndt, Nikolaus; Bulik, Sascha; Holzhütter, Hermann-Georg; Gasparre, Giuseppe; Attimonelli, Marcella; Babu, Mohan; Meierhofer, David

    2017-12-01

    Renal oncocytomas are rare benign tumors of the kidney and characterized by a deficient complex I (CI) enzyme activity of the oxidative phosphorylation (OXPHOS) system caused by mitochondrial DNA (mtDNA) mutations. Yet, little is known about the underlying molecular mechanisms and alterations of metabolic pathways in this tumor. We compared renal oncocytomas with adjacent matched normal kidney tissues on a global scale by multi-omics approaches, including whole exome sequencing (WES), proteomics, metabolomics, and metabolic pathway simulation. The abundance of proteins localized to mitochondria increased more than 2-fold, the only exception was a strong decrease in the abundance for CI subunits that revealed several pathogenic heteroplasmic mtDNA mutations by WES. We also observed renal oncocytomas to dysregulate main metabolic pathways, shunting away from gluconeogenesis and lipid metabolism. Nevertheless, the abundance of energy carrier molecules such as NAD + , NADH, NADP, ATP, and ADP were significantly higher in renal oncocytomas. Finally, a substantial 5000-fold increase of the reactive oxygen species scavenger glutathione can be regarded as a new hallmark of renal oncocytoma. Our findings demonstrate that renal oncocytomas undergo a metabolic switch to eliminate ATP consuming processes to ensure a sufficient energy supply for the tumor.

  12. Anatomically-specific intratubular and interstitial biominerals in the human renal medullo-papillary complex.

    Directory of Open Access Journals (Sweden)

    Ling Chen

    Full Text Available Limited information exists on the anatomically-specific early stage events leading to clinically detectable mineral aggregates in the renal papilla. In this study, quantitative multiscale correlative maps of structural, elemental and biochemical properties of whole medullo-papillary complexes from human kidneys were developed. Correlative maps of properties specific to the uriniferous and vascular tubules using high-resolution X-ray computed tomography, scanning and transmission electron microscopy, energy dispersive X-ray spectroscopy, and immunolocalization of noncollagenous proteins (NCPs along with their association with anatomy specific biominerals were obtained. Results illustrated that intratubular spherical aggregates primarily form at the proximal regions distant from the papillary tip while interstitial spherical and fibrillar aggregates are distally located near the papillary tip. Biominerals at the papillary tip were closely localized with 10 to 50 μm diameter vasa recta immunolocalized for CD31 inside the medullo-papillary complex. Abundant NCPs known to regulate bone mineralization were localized within nanoparticles, forming early pathologic mineralized regions of the complex. Based on the physical association between vascular and urothelial tubules, results from light and electron microscopy techniques suggested that these NCPs could be delivered from vasculature to prompt calcification of the interstitial regions or they might be synthesized from local vascular smooth muscle cells after transdifferentiation into osteoblast-like phenotypes. In addition, results provided insights into the plausible temporal events that link the anatomically specific intratubular mineral aggregates with the interstitial biomineralization processes within the functional unit of the kidney.

  13. Measuring stone volume - three-dimensional software reconstruction or an ellipsoid algebra formula?

    Science.gov (United States)

    Finch, William; Johnston, Richard; Shaida, Nadeem; Winterbottom, Andrew; Wiseman, Oliver

    2014-04-01

    To determine the optimal method for assessing stone volume, and thus stone burden, by comparing the accuracy of scalene, oblate, and prolate ellipsoid volume equations with three-dimensional (3D)-reconstructed stone volume. Kidney stone volume may be helpful in predicting treatment outcome for renal stones. While the precise measurement of stone volume by 3D reconstruction can be accomplished using modern computer tomography (CT) scanning software, this technique is not available in all hospitals or with routine acute colic scanning protocols. Therefore, maximum diameters as measured by either X-ray or CT are used in the calculation of stone volume based on a scalene ellipsoid formula, as recommended by the European Association of Urology. In all, 100 stones with both X-ray and CT (1-2-mm slices) were reviewed. Complete and partial staghorn stones were excluded. Stone volume was calculated using software designed to measure tissue density of a certain range within a specified region of interest. Correlation coefficients among all measured outcomes were compared. Stone volumes were analysed to determine the average 'shape' of the stones. The maximum stone diameter on X-ray was 3-25 mm and on CT was 3-36 mm, with a reasonable correlation (r = 0.77). Smaller stones (15 mm towards scalene ellipsoids. There was no difference in stone shape by location within the kidney. As the average shape of renal stones changes with diameter, no single equation for estimating stone volume can be recommended. As the maximum diameter increases, calculated stone volume becomes less accurate, suggesting that larger stones have more asymmetric shapes. We recommend that research looking at stone clearance rates should use 3D-reconstructed stone volumes when available, followed by prolate, oblate, or scalene ellipsoid formulas depending on the maximum stone diameter. © 2013 The Authors. BJU International © 2013 BJU International.

  14. Hyaluronan and Stone Disease

    Science.gov (United States)

    Asselman, Marino

    2008-09-01

    Kidney stones cannot be formed as long as crystals are passed in the urine. However, when crystals are retained it becomes possible for them to aggregate and form a stone. Crystals are expected to be formed not earlier than the distal tubules and collecting ducts. Studies both in vitro and in vivo demonstrate that calcium oxalate monohydrate crystals do not adhere to intact distal epithelium, but only when the epithelium is proliferating or regenerating, so that it possesses dedifferentiated cells expressing hyaluronan, osteopontin (OPN) and their mutual receptor CD44 at the apical cell membrane. The polysaccharide hyaluronan is an excellent crystal binding molecule because of its negative ionic charge. We hypothesized that the risk for crystal retention in the human kidney would be increased when tubular cells express hyaluronan at their apical cell membrane. Two different patient categories in which nephrocalcinosis frequently occurs were studied to test this hypothesis (preterm neonates and kidney transplant patients). Hyaluronan (and OPN) expression at the luminal membrane of tubular cells indeed was observed, which preceded subsequent retention of crystals in the distal tubules. Tubular nephrocalcinosis has been reported to be associated with decline of renal function and thus further studies to extend our knowledge of the mechanisms of retention and accumulation of crystals in the kidney are warranted. Ultimately, this may allow the design of new strategies for the prevention and treatment of both nephrocalcinosis and nephrolithiasis in patients.

  15. Evolution of stone management in Australia.

    Science.gov (United States)

    Lee, Ming-Chak; Bariol, Simon Virgil

    2011-11-01

    What's known on the subject? and What does the study add? There is very little contemporary data regarding stone management in Australia. This study assesses the impact of technological advances on stone management practises, and raises questions as to why there is an increasing rate of intervention for stone disease in Australia. Knowledge of management trends as demonstrated in this paper give individual surgeons a guideline for contemporary practise in this country. • To examine trends in the operative management of upper urinary tract stone disease in Australia over the past 15 years. • The Medicare Australia and Australian Institute of Health and Welfare databases were used to determine the annual number of renal colic presentations and procedural interventions undertaken for stone disease. • In Australia over the past 15 years, the annual number of procedural interventions for upper urinary tract stones has increased, primarily due to the rising number of endoscopic procedures performed. • During this period, shock wave lithotripsy numbers have remained steady whilst open and percutaneous procedures have been in decline. • The introduction of and subsequent preference for less invasive techniques has changed the management pathway of patients presenting with stone disease in Australia. • Further studies are necessary to determine whether this escalation in endoscopic procedures is due to an increase in the incidence of stone disease, earlier detection, a lower intervention threshold or a higher retreatment rate. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  16. Laparoscopic Transperitoneal Ureterolithotomy for Complex Lower Ureteral Stones:a Report of 13 Cases%经腹腔入路腹腔镜治疗复杂性输尿管下段结石13例报告

    Institute of Scientific and Technical Information of China (English)

    邵四海; 王荣江; 陈晓农; 王伟高; 钟欢; 陈煜

    2014-01-01

    Objective To study the technical points and application value of laparoscopic transperitoneal ureterolithotomy for complex lower ureteral stones. Methods Thirteen cases of complex lower ureteral stones were treated with laparoscopic transperitoneal ureterolithotomy.Firstly, the ureter was separated to find the calculi.And then the ureter was opened longitudinally and the stones were removed completely.A double J tube was inserted in the ureter and the incision was sewed by 2 -3 times of 4-0 absorbable suture.The urinary tube and the peritoneal drainage tube were retained. Results The operations of the 13 cases were successfully performed.No case was converted into open operation.The operation time was 70-180 min, with a mean of 103.9 min. The blood loss was 56.2 ml (30-210 ml).The period of drainage was 2.7 days (1-6 days).Postoperative hospitalization stay was 5.6 days (4-9 days).One patient suffered from urine leakage and was found retracted double J stents into ureter, and was cured at 6 days postoperation after the replacement of the stent under ureteroscopy.The follow-up period of 13 cases was 7 months ( 3 -12 months).Hydronephrosis became better or recovered, except 1 case was found renal atrophy. Conclusions Laparoscopic transperitoneal ureterolithotomy has advantages of minimally invasive, little postoperative discomfort, and high stone clearance rate.It should be adopted for the patients with complex lower ureteral stones instead of open surgery.%目的:探讨经腹腔入路行腹腔镜输尿管下段切开取石术治疗复杂性输尿管结石的技术要点和应用价值。方法2008年6月~2013年10月对13例复杂性输尿管下段结石行经腹腹腔镜输尿管下段切开取石术,术中切开腹膜,游离结石段输尿管,纵行切开输尿管壁取出结石,输尿管内留置双J管,4-0可吸收线缝合切口2~3针,保留尿管及腹腔引流管。结果13例手术均成功,无中转开放手术。手术时间70~180

  17. Long-term safety of left renal vein division and ligation to expedite complex abdominal aortic surgery.

    Science.gov (United States)

    Samson, Russell H; Lepore, Michael R; Showalter, David P; Nair, Deepak G; Lanoue, Julien B

    2009-09-01

    Left renal vein division and ligation (LRVDAL) is performed to facilitate complex abdominal aortic surgery. Surgeons restore continuity of the vein due to concern that ligation could cause renal compromise or hematuria. However, we report the short and long-term safety of left renal vein division and ligation. Between 1992 and 2007, we divided the left renal vein in 56 patients (40 males, 16 females) ages 57 to 84 (average 74-years-old) who were treated for aortic occlusive disease (9) or abdominal aortic aneurysm (47). Patients requiring concomitant renal artery reconstruction were excluded from this review. Suprarenal cross-clamp was used in 51 patients with temporary vessel-loop control of the renal arteries. Creatinine (Cr) and glomerular filtration rates (eGFR) were measured pre-, post-, and long-term after surgery. Outpatient records of all patients that had survived more than 12 months were also reviewed in order to evaluate the late effects on renal function or symptoms possibly related to LRVDAL. Median procedure duration was 157 (61-375) minutes. Median cross-clamp time was 16 (10-45) minutes. Median intensive care unit (ICU) and hospital length of stays were 2 (1-11) days and 7 (4-58) days, respectively. There were no deaths. There were no complications directly related to renal vein ligation. Hematuria, seen in 2 patients, was a result of traumatic insertion of a Foley catheter. Median pre-op and discharge Cr levels were 1.1 mg/dL (0.7-2.4 mg/dL) and 1.1 mg/dL (0.6-2.1 mg/dL), respectively (P 2.0 mg/dL remained unchanged post-op. Only 2 patients with a Cr of 2.0 mg/dL and both returned to normal by day 3 post-op. Thirty-six patients have been followed for more than a year (median 34.5 months, maximum 144 months) and Cr has remained stable in all but 2 patients. These 2 patients, both with a pre-op Cr of 1.5 mg/dL, subsequently developed Cr levels of 2.1 mg/dL and 2.4 mg/dL but maintained baseline Cr levels for 25 and 34 months, respectively, before

  18. Dynamic Geometric Analysis of the Renal Arteries and Aorta following Complex Endovascular Aneurysm Repair.

    Science.gov (United States)

    Ullery, Brant W; Suh, Ga-Young; Kim, John J; Lee, Jason T; Dalman, Ronald L; Cheng, Christopher P

    2017-08-01

    Aneurysm regression and target vessel patency during early and mid-term follow-up may be related to the effect of stent-graft configuration on the anatomy. We quantified geometry and remodeling of the renal arteries and aneurysm following fenestrated (F-) or snorkel/chimney (Sn-) endovascular aneurysm repair (EVAR). Twenty-nine patients (mean age, 76.8 ± 7.8 years) treated with F- or Sn-EVAR underwent computed tomography angiography at preop, postop, and follow-up. Three-dimensional geometric models of the aorta and renal arteries were constructed. Renal branch angle was defined relative to the plane orthogonal to the aorta. End-stent angle was defined as the angulation between the stent and native distal artery. Aortic volumes were computed for the whole aorta, lumen, and their difference (excluded lumen). Renal patency, reintervention, early mortality, postoperative renal impairment, and endoleak were reviewed. From preop to postop, F-renal branches angled upward, Sn-renal branches angled downward (P renals exhibited increased end-stent angulation (12 ± 15°, P renals, whereas F-renals exhibited increased end-stent angulation (5 ± 10°, P renal stent patency was 94.1% and renal impairment occurred in 2 patients (6.7%). Although F- and Sn-EVAR resulted in significant, and opposite, changes to renal branch angle, only Sn-EVAR resulted in significant end-stent angulation increase. Longitudinal geometric analysis suggests that these anatomic alterations are primarily generated early as a consequence of the procedure itself and, although persistent, they show no evidence of continued significant change during the subsequent postoperative follow-up period. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Complex malformations of the urogenital tract in a female dog: Gartner duct cyst, ipsilateral renal agenesis, and ipsilateral hydrometra.

    Science.gov (United States)

    Fujita, Atsushi; Tsuboi, Masaya; Uchida, Kazuyuki; Nishimura, Ryohei

    2016-05-01

    A 10-month-old female toy poodle was referred to the University of Tokyo Veterinary Medical Center with a urogenital anomaly found during sterilization. An exploratory laparotomy revealed a cyst adhering to the cervix and a unilateral renal agenesis. Histopathology and immunohistochemical analysis of the cyst was consistent with remnants of the Wolffian duct or a Gartner duct cyst. This is a rare case of a canine Gartner duct cyst with renal agenesis and uterine anomaly. We discuss the similarity of this case to that of humans and introduce a classification in the literature for these complex urogenital malformations for further clinical research into the precise diagnosis and appropriate surgical planning.

  20. Benign renal complex cysts: MR imaging. Kystes atypiques benins du rein: aspects IRM

    Energy Technology Data Exchange (ETDEWEB)

    Levy, P.; Helenon, O.; Melki, P.; Paraf, F.; Chauveau, D.; Chretien, Y.; Moreau, J.F. (Hopital Necker-Enfants-Malades, 75 - Paris (France))

    1994-10-01

    The aim of this study was to assess the magnetic resonance imaging (MRI) characteristics of 13 benign complex renal cysts using T1 and T2-weighted images and contrast-enhanced images. The results have been compared to CT and ultrasonographic findings in all cases and correlated with histopathologic datas in 12 cases. Five groups have been defined according to the MR features. Group 1: homogeneous low signal intensity on T1-weighted images and homogeneous high signal intensity on T2-weighted images mimicking simple cyst (n = 2); group 2: homogeneous high signal intensity on both T1 and T2-weighted images mimicking hemorrhagic cyst (n = 1); group 3: characterized by high signal intensity on T1-weighted images and fluid-iron level on T2-weighted images (n = 3); group 4: characterized by fluid-iron level on both T1 and T2-weighted images (n = 3); group 5: pseudotumoral feature: heterogeneous signal intensity and/or wall contrast enhancement (n = 3). Among the 13 indeterminate lesions on ultrasonography and CT, MRI was of diagnostic value in 8 cases, whereas the 5 remaining cases remained indeterminate on MR images. Our results suggest that MRI can be useful in the diagnosis of benign complex cyst of the kidney presenting as indeterminate cystic lesion on other modalities. (authors). 40 refs., 7 figs., 2 tabs.

  1. Kidney Stones and Ceftriaxone

    Directory of Open Access Journals (Sweden)

    Murat Dursun

    2015-01-01

    Full Text Available Metabolic causes such as hypercalciuria, urinary tract infection, and obstruction are the most common aetiologies of urolithiasis, and drugs, although important in this regard, are rarely the cause of urolithiasis. Administration of one of these drugs, ceftriaxone (CTX, has been associated with biliary pseudolithiasis in adult and paediatric patients, and rarely may cause urolithiasis. Several factors, including drug concentration and incubation time, are very important for determining the degree of CTX/calcium (Ca crystallisation in the urine. According to this data, CTX crystallisation was a dose and time-dependent reaction. It is particularly important to monitor patients on high-dose long-term CTX treatment with the urinary Ca to creatinine ratios, ultrasound sonography, and renal function testing, as these individuals may be at greater risk of large stones and renal damage. This type of screening may help prevent permanent complications in the future. This underlying review will help to educate readers on the pathophysiology and interaction between CTX and urolithiasis.

  2. Renal calculus

    CERN Document Server

    Pyrah, Leslie N

    1979-01-01

    Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long an...

  3. Bariatric Surgery and Stone Disease

    Science.gov (United States)

    Lieske, John C.; Kumar, Rajiv

    2008-09-01

    Bariatric surgery is an effective treatment strategy for patients with morbid obesity that can result in effective weight loss, resolution of diabetes mellitus and other weight related complications, and even improved mortality. However, it also appears that hyperoxaluria is common after modern bariatric surgery, perhaps occurring in up to 50% of patients after Rouxen-Y gastric bypass. Although increasing numbers of patients are being seen with calcium oxalate kidney stones after bariatric surgery, and even a few with oxalosis and renal failure, the true risk of these outcomes remains unknown. The mechanisms that contribute to this enteric hyperoxaluria are also incompletely defined, although fat malabsorption may be an important component. Since increasing numbers of these procedures are likely to be performed in the coming years, further study regarding the prevalence and mechanisms of hyperoxaluria and kidney stones after bariatric surgery is needed to devise effective methods of treatment in order to prevent such complications.

  4. Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones.

    Science.gov (United States)

    Tligui, M; El Khadime, M R; Tchala, K; Haab, F; Traxer, O; Gattegno, B; Thibault, P

    2003-05-01

    To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

  5. Calcium Oxalate Stones Are Frequently Found Attached to Randall's Plaque

    International Nuclear Information System (INIS)

    Matlaga, Brian R.; Williams, James C. Jr.; Evan, Andrew P.; Lingeman, James E.

    2007-01-01

    The exact mechanisms of the crystallization processes that occur during the formation of calcium oxalate calculi are controversial. Over six decades ago, Alexander Randall reported on a series of cadaveric renal units in which he observed calcium salt deposits on the tips of the renal papilla. Randall hypothesized that these deposits, eponymously termed Randall's plaque, would be the ideal site for stone formation, and indeed in a number of specimens he noted small stones attached to the papillae. With the recent advent of digital endoscopic imaging and micro computerized tomography (CT) technology, it is now possible to inspect the renal papilla of living, human stone formers and to study the attached stone with greater scrutiny

  6. Renal lithiasis and nutrition

    Directory of Open Access Journals (Sweden)

    Prieto Rafel M

    2006-09-01

    Full Text Available Abstract Renal lithiasis is a multifactorial disease. An important number of etiologic factors can be adequately modified trough diet, since it must be considered that the urine composition is directly related to diet. In fact, the change of inappropriate habitual diet patterns should be the main measure to prevent kidney stones. In this paper, the relation between different dietary factors (liquid intake, pH, calcium, phosphate, oxalate, citrate, phytate, urate and vitamins and each type of renal stone (calcium oxalate monohydrate papillary, calcium oxalate monohydrate unattached, calcium oxalate dihydrate, calcium oxalate dihydrate/hydroxyapatite, hydroxyapatite, struvite infectious, brushite, uric acid, calcium oxalate/uric acid and cystine is discussed.

  7. Uric acid stones increase the risk of chronic kidney disease.

    Science.gov (United States)

    Li, Ching-Chia; Chien, Tsu-Ming; Wu, Wen-Jeng; Huang, Chun-Nung; Chou, Yii-Her

    2018-02-28

    The aim of this study was to compare the clinical characteristics of uric acid stones and their potential risk for chronic kidney disease (CKD). A total of 401 patients (196 with uric acid stone and 205 without) were enrolled from our database of patients with urolithiasis. We analyzed the clinical demographic features, stone location, urine chemistries, and renal function. There was a significant difference (p uric acid group. Patients with uric acid stones had much lower pH of urine (p uric acid level (p = 0.002). Notably, those with uric acid stones had worse eGFR than those with non-uric acid stones. Multivariate analysis confirmed that age over 60 years (ORs = 9.19; 95% CI 3.5-24.3), female sex (ORs = 4.01; 95% CI 1.8-9.0), hyperuricemia (ORs = 8.47; 95% CI 1.6-43.5), and uric acid stone (OR = 2.86; 95% CI 1.2-6.7) were the independent predictors of poor prognoses in CKD. Therefore, an association exists between uric acid stones and higher prevalence of CKD. Patients with uric acid stones may need close monitoring of renal function during follow-up.

  8. Infection (urease) stones.

    Science.gov (United States)

    Griffith, D P; Osborne, C A

    1987-01-01

    Infection-induced stones in man probably form solely as a consequence of urealysis which is catalyzed by the bacterial protein urease. Urease stones composed of struvite and carbonate-apatite may form primarily, or as secondary stones or pre-existent metabolic stones. Struvite stones form and grow rapidly owing to (a) supersaturation of urine with stone forming salts, (b) 'salting out' of poorly soluble organic substances normally dissolved in urine and (c) ammonia-induced destruction of the normally protective urothelial glycosaminoglycan layer. Immature (predominantly organic) matrix stones mature into densely mineralized stones. Curative treatment is possible only by eliminating all of the stone and by eradicating all urinary and parenchymal infection. A variety of operative and pharmaceutical approaches are available. Patient treatment must be individualized inasmuch as some patients are better candidates for one type of treatment than another.

  9. Dual-layer spectral detector CT: non-inferiority assessment compared to dual-source dual-energy CT in discriminating uric acid from non-uric acid renal stones ex vivo.

    Science.gov (United States)

    Ananthakrishnan, Lakshmi; Duan, Xinhui; Xi, Yin; Lewis, Matthew A; Pearle, Margaret S; Antonelli, Jodi A; Goerne, Harold; Kolitz, Elysha M; Abbara, Suhny; Lenkinski, Robert E; Fielding, Julia R; Leyendecker, John R

    2018-04-07

    To assess the non-inferiority of dual-layer spectral detector CT (SDCT) compared to dual-source dual-energy CT (dsDECT) in discriminating uric acid (UA) from non-UA stones. Fifty-seven extracted urinary calculi were placed in a cylindrical phantom in a water bath and scanned on a SDCT scanner (IQon, Philips Healthcare) and second- and third-generation dsDECT scanners (Somatom Flash and Force, Siemens Healthcare) under matched scan parameters. For SDCT data, conventional images and virtual monoenergetic reconstructions were created. A customized 3D growing region segmentation tool was used to segment each stone on a pixel-by-pixel basis for statistical analysis. Median virtual monoenergetic ratios (VMRs) of 40/200, 62/92, and 62/100 for each stone were recorded. For dsDECT data, dual-energy ratio (DER) for each stone was recorded from vendor-specific postprocessing software (Syngo Via) using the Kidney Stones Application. The clinical reference standard of X-ray diffraction analysis was used to assess non-inferiority. Area under the receiver-operating characteristic curve (AUC) was used to assess diagnostic performance of detecting UA stones. Six pure UA, 47 pure calcium-based, 1 pure cystine, and 3 mixed struvite stones were scanned. All pure UA stones were correctly separated from non-UA stones using SDCT and dsDECT (AUC = 1). For UA stones, median VMR was 0.95-0.99 and DER 1.00-1.02. For non-UA stones, median VMR was 1.4-4.1 and DER 1.39-1.69. SDCT spectral reconstructions demonstrate similar performance to those of dsDECT in discriminating UA from non-UA stones in a phantom model.

  10. Assessment of stone composition in the management of urinary stones

    NARCIS (Netherlands)

    Kijvikai, Kittinut; de la Rosette, J. J. M.

    2011-01-01

    Several explanations have been suggested to account for the failure of extracorporeal shockwave lithotripsy (ESWL) treatment in patients with urinary stones, including large stone volume, unfavorable stone location or composition and the type of lithotriptor used. Unfavorable stone composition is

  11. Extracorporeal shock wave lithotripsy for urinary stones

    International Nuclear Information System (INIS)

    Shinn, Kyung Sub; Kim, Hyun; Byun, Jae Young; Lee, Myung Hee; Bahk, Yong Whee; Park, Yong Hyun

    1988-01-01

    Extracorporeal shock wave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary stones, and it sometimes is to necessitate endourologic techniques. ESWL with an Edap lithotripter which uses piezo-electric elements, was performed in 142 cases (130 patients) with urinary stones including 68 in calices, 30 in pelves, and 44 in ureters. Technical factors were 100 storages at 5 to 10 pulse rates/sec and 70-100% adjustable power for about 60 minutes (15-90) for renal stones, and 200 storages at 20 pulse rates/sec and 100% adjustable power for about 60 minutes for ureteral stones in a single treatment under stone localization by 5 MHz ultrasonic sector scanner. All patients were treated at Kangnam St.Mary's Hospital of Catholic University Medical College during the 5 months period from May 1, 1987. Every patient had pre-treatment chest, plain abdomen, intravenous urogram and ultrasonogram studies and post-treatment follow-up abdominal radiograms in 1 to 3 months after ESWL.The overall success rate of ESWL in 142 cases was 94.4%. Eight out of 142 cases were successful. Thus, 134 cases were analysed. Of these, 58 cases (43.3%) received one treatment, 33 cases (24.6%) two treatments, 16 cases (11.9%) three treatments and 27 cases (20.2%) more than four treatments. Renal stones were more successfully treated (98.0%) than ureteral stones (88.1%), and calyceal stones presented the highest success rate (98.5%). The stones as small as 5 to 10 mm in size were easily fragmented and the stones of round of oval shape were more easily pulverized than those of staghorn or amorphous shape. The adjunctive endourlogic techniques such as percutaneous nephrostomy, ureteral catheterization or internal ureteral stenting with a double pigtail catheter were required in 17 cases (11.9%). Complications of ESWL for urolithiasis included hematuria (84.5%), flank pain (8.5%) and fever (5.6%), which were controlled without specific treatment. ESWL using ultrasonic localization was

  12. Extracorporeal shock wave lithotripsy for urinary stones

    Energy Technology Data Exchange (ETDEWEB)

    Shinn, Kyung Sub; Kim, Hyun; Byun, Jae Young; Lee, Myung Hee; Bahk, Yong Whee; Park, Yong Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical College, Seoul (Korea, Republic of)

    1988-06-15

    Extracorporeal shock wave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary stones, and it sometimes is to necessitate endourologic techniques. ESWL with an Edap lithotripter which uses piezo-electric elements, was performed in 142 cases (130 patients) with urinary stones including 68 in calices, 30 in pelves, and 44 in ureters. Technical factors were 100 storages at 5 to 10 pulse rates/sec and 70-100% adjustable power for about 60 minutes (15-90) for renal stones, and 200 storages at 20 pulse rates/sec and 100% adjustable power for about 60 minutes for ureteral stones in a single treatment under stone localization by 5 MHz ultrasonic sector scanner. All patients were treated at Kangnam St.Mary's Hospital of Catholic University Medical College during the 5 months period from May 1, 1987. Every patient had pre-treatment chest, plain abdomen, intravenous urogram and ultrasonogram studies and post-treatment follow-up abdominal radiograms in 1 to 3 months after ESWL.The overall success rate of ESWL in 142 cases was 94.4%. Eight out of 142 cases were successful. Thus, 134 cases were analysed. Of these, 58 cases (43.3%) received one treatment, 33 cases (24.6%) two treatments, 16 cases (11.9%) three treatments and 27 cases (20.2%) more than four treatments. Renal stones were more successfully treated (98.0%) than ureteral stones (88.1%), and calyceal stones presented the highest success rate (98.5%). The stones as small as 5 to 10 mm in size were easily fragmented and the stones of round of oval shape were more easily pulverized than those of staghorn or amorphous shape. The adjunctive endourlogic techniques such as percutaneous nephrostomy, ureteral catheterization or internal ureteral stenting with a double pigtail catheter were required in 17 cases (11.9%). Complications of ESWL for urolithiasis included hematuria (84.5%), flank pain (8.5%) and fever (5.6%), which were controlled without specific treatment. ESWL using ultrasonic localization

  13. Long-term Follow-up Assessing Renal Angiomyolipoma Treatment Patterns, Morbidity, and Mortality : An Observational Study in Tuberous Sclerosis Complex Patients in the Netherlands

    NARCIS (Netherlands)

    Eijkemans, Marinus J C; van der Wal, Willem; Reijnders, Leida J; Roes, Kit C B; van Waalwijk van Doorn-Khosrovani, Sahar Barjesteh; Pelletier, Corey; Magestro, Matthew; Zonnenberg, Bernard

    2015-01-01

    BACKGROUND: Long-term data from patients with tuberous sclerosis complex (TSC)-associated renal angiomyolipoma (angiomyolipoma) are limited. STUDY DESIGN: Retrospective observational study. SETTING & PARTICIPANTS: Adult patients with TSC treated at the University Medical Center Utrecht (the

  14. Accuracy of endoscopic intraoperative assessment of urologic stone size.

    Science.gov (United States)

    Patel, Nishant; Chew, Ben; Knudsen, Bodo; Lipkin, Michael; Wenzler, David; Sur, Roger L

    2014-05-01

    Endoscopic treatment of renal calculi relies on surgeon assessment of residual stone fragment size for either basket removal or for the passage of fragments postoperatively. We therefore sought to determine the accuracy of endoscopic assessment of renal calculi size. Between January and May 2013, five board-certified endourologists participated in an ex vivo artificial endoscopic simulation. A total of 10 stones (pebbles) were measured (mm) by nonparticipating urologist (N.D.P.) with electronic calibers and placed into separate labeled opaque test tubes to prevent visualization of the stones through the side of the tube. Endourologists were blinded to the actual size of the stones. A flexible digital ureteroscope with a 200-μm core sized laser fiber in the working channel as a size reference was placed through the ureteroscope into the test tube to estimate the stone size (mm). Accuracy was determined by obtaining the correlation coefficient (r) and constructing an Altman-Bland plot. Endourologists tended to overestimate actual stone size by a margin of 0.05 mm. The Pearson correlation coefficient was r=0.924, with a p-valuestones (stones (≥4 mm), r=0.911 vs r=0.666. Altman-bland plot analysis suggests that surgeons are able to accurately estimate stone size within a range of -1.8 to +1.9 mm. This ex vivo simulation study demonstrates that endoscopic assessment is reliable when assessing stone size. On average, there was a slight tendency to overestimate stone size by 0.05 mm. Most endourologists could visually estimate stone size within 2 mm of the actual size. These findings could be generalized to state that endourologists are accurately able to intraoperatively assess residual stone fragment size to guide decision making.

  15. Can ureteral stones cause pain without causing hydronephrosis?

    Science.gov (United States)

    Song, Yan; Hernandez, Natalia; Gee, Michael S; Noble, Vicki E; Eisner, Brian H

    2016-09-01

    While computerized tomography (CT) is the gold standard for diagnosis of ureterolithiasis, ultrasound is a less costly and radiation-free alternative which is commonly used to evaluate patients with ureteral colic. The purpose of this study was to evaluate the frequency with which patients with ureteral stones and renal colic demonstrate hydronephrosis in order to better understand the evaluation of these patients. Two hundred and forty-eight consecutive patients presenting with ureteral colic and diagnosed with a single unilateral ureteral stone on CT scan in an urban tertiary care emergency department were retrospectively reviewed. Radiology reports were reviewed for stone size, diagnosis, and degree of hydronephrosis. Of the 248 patients evaluated for suspected ureteral stone, 221 (89.1 %) demonstrated any hydronephrosis, while 27 (10.9 %) did not. Hydronephrosis grade, available in 194 patients, was as follows: mild-70.6 %, moderate-27.8 %, and severe-1.5 %. Mean patient age was 47.0 years (SD 15.5), gender distribution was 35.9 % female and 64.1 % male, and mean stone axial diameter was 4.1 mm (SD 2.4). Stone location was as follows: ureteropelvic junction-4.1 %, proximal ureter-21 %, distal ureter-24.9 %, and ureterovesical junction-47.1 %. Axial stone diameter and coronal length (craniocaudal) were both significant predictors of degree of hydronephrosis (ANOVA, p hydronephrosis. In patients with ureteral stones and colic, nearly 11 % do not demonstrate any hydronephrosis and a majority (nearly 71 %) will demonstrate only mild hydronephrosis. Stone diameter appears to be related to degree of hydronephrosis, whereas age, gender, and stone location are not. The lower incidence of hydronephrosis for small stones causing renal colic may explain the lower diagnostic accuracy of ultrasound when compared to CT for detecting ureteral stones.

  16. Bosniak classification system: a prospective comparison of CT, contrast-enhanced US, and MR for categorizing complex renal cystic masses.

    Science.gov (United States)

    Graumann, Ole; Osther, Susanne Sloth; Karstoft, Jens; Hørlyck, Arne; Osther, Palle Jörn Sloth

    2016-11-01

    Background The Bosniak classification was originally based on computed tomographic (CT) findings. Magnetic resonance (MR) and contrast-enhanced ultrasonography (CEUS) imaging may demonstrate findings that are not depicted at CT, and there may not always be a clear correlation between the findings at MR and CEUS imaging and those at CT. Purpose To compare diagnostic accuracy of MR, CEUS, and CT when categorizing complex renal cystic masses according to the Bosniak classification. Material and Methods From February 2011 to June 2012, 46 complex renal cysts were prospectively evaluated by three readers. Each mass was categorized according to the Bosniak classification and CT was chosen as gold standard. Kappa was calculated for diagnostic accuracy and data was compared with pathological results. Results CT images found 27 BII, six BIIF, seven BIII, and six BIV. Forty-three cysts could be characterized by CEUS, 79% were in agreement with CT (κ = 0.86). Five BII lesions were upgraded to BIIF and four lesions were categorized lower with CEUS. Forty-one lesions were examined with MR; 78% were in agreement with CT (κ = 0.91). Three BII lesions were upgraded to BIIF and six lesions were categorized one category lower. Pathologic correlation in six lesions revealed four malignant and two benign lesions. Conclusion CEUS and MR both up- and downgraded renal cysts compared to CT, and until these non-radiation modalities have been refined and adjusted, CT should remain the gold standard of the Bosniak classification.

  17. Obesity as defined by waist circumference but not body mass index is associated with higher renal mass complexity.

    Science.gov (United States)

    Bertrand, Laura A; Thomas, Lewis J; Li, Peng; Buchta, Claire M; Boi, Shannon K; Orlandella, Rachael M; Brown, James A; Nepple, Kenneth G; Norian, Lyse A

    2017-11-01

    Obesity, typically defined as a body mass index (BMI)≥30kg/m 2 , is an established risk factor for renal cell carcinoma (RCC) but is paradoxically linked to less advanced disease at diagnosis and improved outcomes. However, BMI has inherent flaws, and alternate obesity-defining metrics that emphasize abdominal fat are available. We investigated 3 obesity-defining metrics, to better examine the associations of abdominal fat vs. generalized obesity with renal tumor stage, grade, or R.E.N.A.L. nephrometry score. In a prospective cohort of 99 subjects with renal masses undergoing resection and no evidence of metastatic disease, obesity was assessed using 3 metrics: body mass index (BMI), radiographic waist circumference (WC), and retrorenal fat (RRF) pad distance. R.E.N.A.L. nephrometry scores were calculated based on preoperative CT or MRI. Univariate and multivariate analyses were performed to identify associations between obesity metrics and nephrometry score, tumor grade, and tumor stage. In the 99 subjects, surgery was partial nephrectomy in 51 and radical nephrectomy in 48. Pathology showed benign masses in 11 and RCC in 88 (of which 20 had stage T3 disease). WC was positively correlated with nephrometry score, even after controlling for age, sex, race, and diabetes status (P = 0.02), whereas BMI and RRF were not (P = 0.13, and P = 0.57, respectively). WC in stage T2/T3 subjects was higher than in subjects with benign masses (P = 0.03). In contrast, subjects with Fuhrman grade 1 and 2 tumors had higher BMI (Pobesity measured by WC, but not BMI or RRF, is associated with increased renal mass complexity. Tumor Fuhrman grade exhibited a different trend, with both high WC and BMI associated with lower-grade tumors. Our findings indicate that WC and BMI are not interchangeable obesity metrics. Further evaluation of RCC-specific outcomes using WC vs. BMI is warranted to better understand the complex relationship between general vs. abdominal obesity and RCC

  18. Extracorporeal shockwave lithotripsy vs. percutaneous nephrolithotomy vs. flexible ureterorenoscopy for lower-pole stones

    Science.gov (United States)

    Knoll, Thomas; Buchholz, Noor; Wendt-Nordahl, Gunnar

    2012-01-01

    Objectives To review previous reports and discuss current trends in extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS). ESWL was recommended as the first-line treatment for small and intermediate-sized stones in the lower pole, while it is the standard treatment for large stones. However, the stone clearance rate after ESWL seems to be lower than that of stones in other locations. This seems to result from a lower rate of fragment passage, due to anatomical factors. Methods Reports on urinary stone disease were reviewed, assessing only publications in peer-reviewed, Medline-listed journals in the English language (publication years 1990–2011). Results Recent experience with flexible URS (fURS) for intrarenal stones showed that excellent stone-free rates can be achieved. With increasing experience and technically improved equipment, fURS has become an alternative to ESWL for small and intermediate-sized renal stones. Furthermore, several authors reported successful retrograde treatment for large renal stones, proposing fURS as an alternative to PCNL. However, the major drawbacks are long operating times and commonly, staged procedures, which is why PCNL remains the method of choice for such stones. Conclusions Considering the currents trends and evidence, the 2012 update of the European Association of Urology Guidelines on Urolithiasis has upgraded the endourological treatment of kidney stones. Individual factors such as body habitus, renal anatomy, costs and patient preference must be considered. PMID:26558046

  19. Pattern of urinary tract stone diseases in Mekelle, Ethiopia.

    Science.gov (United States)

    Alemu, Mekonnen Hagos

    2008-07-01

    To evaluate and analyze the pattern of patients with urinary stone diseases admitted to Mekelle Hospital. Between Sept 2003 to Sept 2006, 102 patients with urinary stone disease were admitted to Mekelle Hospital. In this descriptive retrospective audit, case notes were obtained from medical record office and were analyzed for age, sex, localization of the stone disease and the geographic back grounds. Seventy six (74.5%) of the patients were males and 26 (25.5%) were females. There were 102 (13.6%) cases of urinary stone disease admitted to Mekelle Hospital out of 750 total admissions for urological disease for intervention in the surgical ward during the study period. There were 76 (74.5%) males and 26 (25.5%) females and the sex ratio was (M: F: 2.9:1). Most (46.0%) of the urinary stone diseases were between 0-19 year age group both in males and females. The median age was 20 years (range from 2-74 years) and the mean was 25.4 years. Urinary bladder stones were the most common urinary tract stone diseases accounting for 47 (46.0%) followed by renal stones 29 (28.4%), ureteric 16 (15.6%) and urethral 10 (9.8%) stone disease; in that order of frequency. The geographical back ground of the patients with urinary tract stone disease in this report has shown that majorities (53.7%) were from urban and the remaining (44.2%) were from the rural areas. This study has depicted that urinary bladder stone diseases are the most common stone diseases affecting the younger age group. Since this is an institutional based study, it underestimates the magnitude and the pattern of urinary stone diseases at all level. Nevertheless, the audit provides useful information on the socio demographic variables, localization and the geographic back ground of the patients.

  20. Metabolic abnormalities associated with renal calculi in patients with horseshoe kidneys.

    Science.gov (United States)

    Raj, Ganesh V; Auge, Brian K; Assimos, Dean; Preminger, Glenn M

    2004-03-01

    Horseshoe kidneys are a complex anatomic variant of fused kidneys, with a 20% reported incidence of associated calculi. Anatomic causes such as high insertion of the ureter on the renal pelvis and obstruction of the ureteropelvic junction are thought to contribute to stone formation via impaired drainage, with urinary stasis, and an increased incidence of infection. In this multi-institutional study, we evaluated whether metabolic factors contributed to stone development in patients with horseshoe kidneys. A retrospective review of 37 patients with horseshoe kidneys was performed to determine if these patients had metabolic derangements that might have contributed to calculus formation. Stone compositions as well as 24-hour urine collections were examined. Specific data points of interest were total urine volume; urine pH; urine concentrations of calcium, sodium, uric acid, oxalate, and citrate; and number of abnormalities per patient per 24-hour urine collection. These data were compared with those of a group of 13 patients with stones in caliceal diverticula as well as 24 age-, race-, and sex-matched controls with stones in anatomically normal kidneys. Eleven (9 men and 2 women) of the 37 patients (30%) with renal calculi in horseshoe kidneys had complete metabolic evaluations available for review. All patients were noted to have at least one abnormality, with an average of 2.68 abnormalities per 24-hour urine collection (range 1-4). One patient had primary hyperparathyroidism and underwent a parathyroidectomy. Low urine volumes were noted in eight patients on at least one of the two specimens (range 350-1640 mL/day). Hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia were noted in seven, three, six, and six patients, respectively. No patients were found to have gouty diathesis or developed cystine stones. Comparative metabolic analyses of patients with renal calculi in caliceal diverticula or normal kidneys revealed a distinct profile in patients

  1. [Ultraminipercutaneous nephrolithotripsy in treating kidney stones].

    Science.gov (United States)

    Martov, A G; Dutov, S V; Andronov, A S

    2016-04-01

    Percutaneous nephrolithotripsy (PNL) is the recommended method of surgical treatment of kidney stones of size greater than 2 cm. Trends in the development of modern urology have been steadily toward less traumatic method to treat nephrolithiasis - minimally invasive PNL. The present work aimed to explore of the possibilities of one of the modern variants of minimally invasive PNL - ultra-mini-PNL in treating nephrolithiasis. The study included 60 patients (mean age 45.6+/-7.2 years) with isolated kidney calculus, up to 2.0 cm or several stones with a total size of up to 2.5 cm. All patients were found to have 77 kidney stones, six of which had a size of 10 mm, 51 had a size of 11-15 mm and 20 had a size of 16-20 mm. 45% of patients had isolated renal pelvic stones and 28.3% had stones in the renal pelvis and lower calyx. All patients underwent ultra-mini-PNL using nephroscope size 7.5 Ch and tube size 12 Fr. The average duration of surgery from the moment of the puncture of the pyelocaliceal system to installing the nephrostomy tube was 65.4 minutes. Complete clearance of stones after single-stage ultra-mini-PNL was observed in 80% of cases. Nephrostomy tube was removed on days 2-3. The average postoperative hospital stay was 5.1 days. The most common complication was postoperative exacerbation of pyelonephritis (13.3% of patients), successfully treated with conservative measures. There were no cases of postoperative bleeding, accompanied by anemia and needed a blood transfusion. Considering high effectiveness and low rate of complications of ultra-mini-PNL, it can be successfully used in treating nephrolithiasis among a wide group of patients.

  2. Experience of extracorporeal shock wave lithotripsy for kidney and upper ureteric stones by electromagnetic lithotripter

    International Nuclear Information System (INIS)

    Wazir, B.G.; Haq, M.I.H.; Faheem-ul-Haq; Nawaz, A.; Nawaz, A.; Ikramullah; Jamil, M.

    2010-01-01

    Background: Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive treatment of urinary stones which breaks them, by using externally applied, focused, high intensity acoustic pulse, into smaller pieces so that they can pass easily through ureter. Shock wave generation, focusing, coupling and stone localisation by fluoroscope or ultrasound are the basic components of ESWL. ESWL has some complications and is contraindicated in certain situations. The aim of this study was to evaluate the effectiveness and safety of ESWL in kidney and upper ureteric stones by Electromagnetic Lithotriptor. Methods: All adult patients with renal and upper ureteric stones having a diameter of up to 1 Cm were included in the study. Basic evaluation such as history, examination, ultrasound and excretory urography were performed. Electromagnetic lithotripsy was done and data were collected on a printed proforma from January 1, 2008 to March 30, 2009 in Institute of Kidney Diseases, Peshawar. Results: Out of a total of 625 patients 463 were male and 162 were female; 67.36% of patients were having renal stones, 23.84% upper ureteric and 8.8% both renal and ureteric stones. Complications noted were renal colic in 9.76%, haematuria in 3.2%, stein strasse in 2.72%, and fever in 1.12% of patients. The stone free rate was 89% and 7% of patients were having stone fragments <4 mm. ESWL failed in 4% of patients. Conclusion: ESWL is a safe and effective way of treating kidney and upper ureteric stones. (author)

  3. Detection of Asymptomatic Renal Calcifications in Astronauts Using a Novel Ultrasound Protocol

    Science.gov (United States)

    Garcia, Kathleen; Sargsyan, Ashot; Reyes, David; Locke, James

    2017-01-01

    Ultrasound (US) specifically looking for asymptomatic renal calcifications that may be renal stones is typically not done in the terrestrial setting. Standard abdominal US without a renal focus may discover incidental, mineralized renal material (MRM); however punctate solid areas of MRM is less than 3 mm are usually considered subclinical. Detecting these early calcifications before they become symptomatic renal stones is critical to prevent adverse medical and mission outcomes during spaceflight.

  4. Pancreatic Stones: Treat or Ignore?

    Directory of Open Access Journals (Sweden)

    DA Howell

    1999-01-01

    Full Text Available Painful, chronic pancreatitis is of complex etiology, but increasing clinical experience suggests that removal of pancreatic duct stones in many cases significantly improves patients’ symptoms. The development and refinement of therapeutic endoscopic retrograde choledochopancreatography have permitted improved access to the pancreatic duct, which makes the development of new techniques of stone fragmentation and fragment removal a much more successful nonsurgical intervention. A major step forward has been the understanding of the safety and efficacy of pancreatic sphincterotomy, which is necessary for the removal of these difficult stones. The recognition that extracorporeal shock wave lithotripsy can be delivered safely with good efficacy has revolutionized the nonsurgical management of pancreatic duct stones. Nevertheless, advanced and sophisticated therapeutic endoscopy is necessary to achieve clearance of the duct, which can generally be accomplished in the majority of selected patients. State-of-the-art treatments are described, and some new approaches using pancreatoscopy and electrohydrolic lithotripsy are discussed. Newly recognized long term complications are reviewed. Finally, it must be recognized that chronic pancreatitis is an ongoing disease that does not have a simple treatment or cure, and frequently represents a process of remissions and relapses requiring interventions and problem solving.

  5. Cardio-renal syndrome

    OpenAIRE

    Gnanaraj, Joseph; Radhakrishnan, Jai

    2016-01-01

    Cardio-renal syndrome is a commonly encountered problem in clinical practice. Its pathogenesis is not fully understood. The purpose of this article is to highlight the interaction between the cardiovascular system and the renal system and how their interaction results in the complex syndrome of cardio-renal dysfunction. Additionally, we outline the available therapeutic strategies to manage this complex syndrome.

  6. [A case of ammonium urate urinary stones with anorexia nervosa].

    Science.gov (United States)

    Komori, K; Arai, H; Gotoh, T; Imazu, T; Honda, M; Fujioka, H

    2000-09-01

    A 27-year-old woman had been suffering from bulimia and habitual vomiting for about 7 years and was incidentally found to have right renal stones by computed tomography. She was referred to our hospital for the treatment of these caluculi. On admission, she presented with hypokalemia, hypochloremia and metabolic alkalosis and was diagnosed with anorexia nervosa. Following successful removal by percutaneous nephrolithotripsy and extracorporeal shockwave lithotripsy the stones were found to consist of pure ammonium urate. Since the urine of an anorexia nervosa patient tends to be rich in uric acid and ammonium, anorexia nervosa seems to be associated with ammonium urate urinary stones.

  7. Kidney stones - self-care

    Science.gov (United States)

    ... self-care; Nephrolithiasis and self-care; Stones and kidney - self-care; Calcium stones and self-care; Oxalate ... provider or the hospital because you have a kidney stone. You will need to take self-care ...

  8. Relationship between renal pathology and the size of circulating immune complexes in patients with systemic lupus erythematosus

    International Nuclear Information System (INIS)

    Wener, M.H.; Mannik, M.; Schwartz, M.M.; Lewis, E.J.

    1987-01-01

    Sera from 35 patients with biopsy-proven diffuse proliferative (WHO class IV) or membranous (WHO class V) lupus nephritis were analyzed for the presence and size of circulating immune complexes. Elevations of the C1q solid-phase assay (C1qSP) for immune complexes were found in sera from all patients with diffuse proliferative nephritis, with a mean +/- 1 SEM of 166.8 +/- 42.0 micrograms/AHG-equivalents/ml serum, and in 71.4% of the patients with membranous nephritis (83.1 +/- 26.7, p = 0.06). Using the WHO criteria for subclasses of membranous lupus nephritis, we also designated renal biopsies as nonproliferative (WHO classes Va and Vb) or proliferative (WHO classes IV and Vc). Employing the latter groupings, we observed significant differences between C1qSP results of patients with nonproliferative (30.3 +/- 8.8) and proliferative (172.8 +/- 36.8, p less than 0.001) lupus nephritis. These data suggest that the presence of C1q-binding material in serum is pathophysiologically related to proliferative glomerular lesions, and that levels of C1qSP binding reflect renal lesions in SLE patients. Sucrose density gradient ultracentrifugation was performed on each serum, and gradient fractions analyzed for C1qSP-binding and total IgG, using techniques to minimize losses of immune complexes. The predominant peak of C1qSP activity sedimented with the 6.6S monomeric IgG. The 6.6S C1q-binding IgG was increased only in 1 of 10 patients with membranous lupus nephritis without proliferative changes, and was elevated in 16 of 25 patients with proliferative lesions (WHO classes IV and Vc)

  9. Efficacy and safety of totally tubeless standard percutaneous nephrolithotomy in patients with kidney stones

    Directory of Open Access Journals (Sweden)

    Cemil Aydın

    2014-09-01

    Full Text Available Objective: Percutaneous nephrolithotomy (PNL is the first- line treatment for large and complex renal calculi. In this study, we aimed to compare the efficacy and safety of the totally tubeless PNL versus the standard PNL. Methods:Between January 2012 and July 2013, 73 selected patients were treated standard or totally tubeless PNL, nephrostomy tube and ureteral stent was not placed at the end of the operation in 35 (39.7% (Group 1 of them and 38 (43.1% (Group 2 patient underwent standard PNL. Stone disintegration was performed with a pneumatic lithotripter. We retrospectively compared patient and stone characteristics, operation time, duration of hospitalization, analgesia requirements, stone-free rate, operative findings, blood loss, and perioperative complications between two groups. Results:The mean operation time, excluding the preparation course, was 38,3±15,4 minutes vs 51,2±12,9 minutes and mean fluoroscopy time was 4,5±2,4 minutes vs 4,8±2,1 minutes, respectively. No significant intraoperative complication or indication additional access or second-look PNL due to residual stones was observed. In both groups none of the patients demonstrated a urinoma, hemorrhage or residual stones in postoperative ultrasonography and plain radiograph. Blood transfusion was needed only in a patient vs two patients for group 1 and 2, respectively. There were no significant differences in preoperative patient characteristics, postoperative complications between two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with other group. Conclusion: Absence of the nephrostomy tube and ureteral stent may help in keeping the patient comfortable after the operation and reduction in the analgesia requirement and length of hospital stay. We believe totally tubeless PNL is safe and effective management option in properly selected cases.

  10. The twelve colourful stones

    International Nuclear Information System (INIS)

    Doria, R.M.

    1983-01-01

    A dynamics with twelve colourful stones is created based on the concepts of gauge and colour. It is associated different gauge fields to the same group. A group of gauge invariant Lagrangians is established. A gauge invariant mass term is introduced. The colourful stones physical insight is to be building blocks for quarks and leptons. (Author) [pt

  11. Monoanionic 99mTc-tricarbonyl-aminopolycarboxylate complexes with uncharged pendant groups: Radiosynthesis and evaluation as potential renal tubular tracers

    International Nuclear Information System (INIS)

    Lipowska, Malgorzata; Klenc, Jeffrey; Jarkas, Nashwa; Marzilli, Luigi G.; Taylor, Andrew T.

    2017-01-01

    Introduction: 99m Tc(CO) 3 -nitrilotriacetic acid, 99m Tc(CO) 3 (NTA), is a new renal tubular agent with pharmacokinetic properties comparable to those of 131 I-OIH but the clearance of 99m Tc(CO) 3 (NTA) and 131 I-OIH is still less than the clearance of PAH, the gold standard for the measurement of effective renal plasma flow. At physiological pH, dianionic 99m Tc(CO) 3 (NTA) has a mononegative inner metal-coordination sphere and a mononegative uncoordinated carboxyl group. To evaluate alternate synthetic approaches, we assessed the importance of an uncoordinated carboxyl group, long considered essential for tubular transport, by evaluating the pharmacokinetics of three analogs with the 99m Tc(CO) 3 (NTA) metal-coordination sphere but with uncharged pendant groups. Methods: 99m Tc(CO) 3 complexes with N-(2-acetamido)iminodiacetic acid (ADA), N-(2-hydroxyethyl)iminodiacetic acid (HDA) and N-(fluoroethyl)iminodiacetic acid (FEDA) were prepared using a tricarbonyl kit and isolated by HPLC. The pharmacokinetics were evaluated in Sprague–Dawley rats, with 131 I-OIH as an internal control; urine was analyzed for metabolites. Plasma protein binding and erythrocyte uptake were determined from the 10 min blood samples. Re(CO) 3 (FEDA), the analog of 99m Tc(CO) 3 (FEDA), was prepared and characterized. Results: 99m Tc(CO) 3 (ADA), 99m Tc(CO) 3 (HDA) and 99m Tc(CO) 3 (FEDA) were efficiently prepared as a single species with high radiochemical purities (>99%). These new monoanionic 99m Tc(CO) 3 tracers with uncharged dangling groups all showed rapid blood clearance and high specificity for renal excretion. Activity in the urine, as a percent of 131 I-OIH at 10 and 60 min, was 96% and 99% for ADA, 96% and 100% for HDA, and 100% and 99% for FEDA, respectively. Each new tracer was excreted unchanged in the urine. The Re(CO) 3 (FEDA) structure adds compelling evidence that such 99m Tc(CO) 3 (NTA) analogs have metal-coordination spheres identical to that of 99m Tc(CO) 3 (NTA

  12. The composition of urinary stones in central sindh

    International Nuclear Information System (INIS)

    Memon, J.M.; Naqvi, S.Q.H.

    2014-01-01

    To determine chemical analysis of urinary stones of central sindh. Study design: Prospective and randomized study. Setting: Department of Surgery and Pathology of Peoples University of Medical and Health Sciences Nawabshah. Duration of study: Three years from May 2008 to May 2011. Material and Methods: Total 106 urolith patients who underwent open stone surgery were included in the study. EDTA Titration used for determination of calcium ions and determination of oxalate, phosphate, magnesium, ammonia, uric acid and cystine stones was carried out using spectrophotometer. These patients were asked to fill out a proforma with parameters of age, sex, radiological location of stone and chemical composition of surgically recovered stones. The stone analysis findings were reviewed and compared with other reported series Results: In this study 75(70.75%) patients were male and 31 (29.25%) female. Male to female ratio was of 2.41:1. The age ranged from 1 to 70 years with the mean of 22.69 years. The peak incidence of upper urinary tract stone in 20-30 years and lower urinary tract stones in both sexes was under 10 years. Anatomical location of stone showed 48(45.29%) renal, 13(12.26%) ureteric and 45(42.45%) bladder calculi. Chemical analysis revealed 56(52.8%) calcium oxalate, 7(6.6%) calcium phosphate, 11(10.3%) ammonium urate, 18(16.9%) uric acid, 13(12.2%) Sturvite and 1(0.9%) cystine calculi. Conclusion: It was concluded that urolithiasis is predominantly male disease. No age group was spared to stone disease. Calcium oxalate, uric acid, ammonium urate and mixed calculi are the main types in our study due to poor nutritional status, poverty and inadequate health facilities. Considering that knowledge of stone composition is of utmost importance to modify the incidence of urolithiasis. (author)

  13. Everybody Must Get Stones

    Directory of Open Access Journals (Sweden)

    Timothy Darvill

    2009-09-01

    Full Text Available It is now widely recognised that monument building in the fourth and third millennia cal BC often involved transporting selected blocks of preferred stone many kilometres over difficult terrain. Some structures incorporated blocks from several different sources, brought together as an ensemble in much the same way perhaps that assemblages of flint and stone axes reflect both local and distant sources. This article explores alternative models accounting for the selection of stones, contrasting those that foreground symbolic attachments and imposed meanings with those that focus on the intrinsic qualities of particular types of stone and their source. The assemblage of different stone types that accumulated at Stonehenge, Wiltshire, over a period of more than a thousand years is used as a case study.

  14. The effect of inclined position on stone free rates in patients with lower caliceal stones during SWL session

    Directory of Open Access Journals (Sweden)

    Basri Cakiroglu

    2015-03-01

    Full Text Available Objective: To compare the outcomes of shock wave lithotripsy (SWL combined with inclined position and SWL alone in patients with lower pole calyx stones. Methods: Seven hundred forty patients who underwent SWL treatment for lower pole renal stones with a total diameter of 2 cm or less were prospectively randomized into two groups. They were comparable in terms of age, sex, and stone diameters. Patients with lower calyceal stones (4-20 mm were randomized to SWL (368 patients or SWL with simultaneous inclination (372 patients with 30o head down Trendelenburg position. Shock wave and session numbers were standardized according to stone size. Additional standardized shock waves were given to patients with stone fragments determined by kidney urinary bladder film and ultrasound at weeks 1, 4, 10. Results: The overall stone free rate (SFR was 73% (268/368 in patients with SWL alone and 81% (300/372 in SWL with inclination at the end of 12th week (p = 0.015. No significant adverse events were noted in both treatment groups. Conclusion: Simultaneous inclination of patients during SWL session increase SFR in lower caliceal stones significantly compared to SWL treatment alone.

  15. Efficacy of surgical techniques and factors affecting residual stone rate in the treatment of kidney stones.

    Science.gov (United States)

    Aydemir, Hüseyin; Budak, Salih; Kumsar, Şükrü; Köse, Osman; Sağlam, Hasan Salih; Adsan, Öztuğ

    2014-09-01

    In this study, we aimed to evaluate, the efficacy of surgical methods and the factors affecting the residual stone rate by scrutinizing retrospectively the patients who had undergone renal stone surgery. Records of 109 cases of kidney stones who had been surgically treated between January 2010, and July 2013 were reviewed. Patients were divided into three groups in terms of surgical treatment; open stone surgery, percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS). Patients' history, physical examination, biochemical and radiological images and operative and postoperative data were recorded. The patients had undergone PNL (n=74; 67.9%), RIRS (n=22;20.2%), and open renal surgery (n=13; 11.9%). The mean and median ages of the patients were 46±9, 41 (21-75) and, 42 (23-67) years, respectively. The mean stone burden was 2.6±0.7 cm(2) in the PNL, 1.4±0.1 cm(2) in the RIRS, and 3.1±0.9 cm(2) in the open surgery groups. The mean operative times were 126±24 min in the PNL group, 72±12 min in the RIRS group and 82±22 min in the open surgery group. The duration of hospitalisation was 3.1±0.2 days, 1.2±0.3 days and 3.4±1.1 days respectively. While the RIRS group did not need blood transfusion, in the PNL group blood transfusions were given in the PNL (n=18), and open surgery (n=2) groups. Residual stones were detected in the PNL (n=22), open surgery (n=2), and RIRS (n=5) groups. PNL and RIRS have been seen as safe and effective methods in our self application too. However, it should not be forgotten that as a basical method, open surgery may be needed in cases of necessity.

  16. Critical appraisal of first-generation renal tumor complexity scoring systems: Creation of a second-generation model of tumor complexity.

    Science.gov (United States)

    Tobert, Conrad M; Shoemaker, Allen; Kahnoski, Richard J; Lane, Brian R

    2015-04-01

    To investigate whether a combination of variables from each nephrometry system improves performance. There are 3 first-generation systems that quantify tumor complexity: R.E.N.A.L. nephrometry score (RNS), preoperative aspects and dimensions used for an anatomical (PADUA) classification (PC), and centrality index (CI). Although each has been subjected to validation and comparative analysis, to our knowledge, no work has been done to combine variables from each method to optimize their performance. Scores were assigned to each of 276 patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN). Individual components of all 3 systems were evaluated in multivariable logistic regression analysis of surgery type (PN vs. RN) and combined into a "second-generation model." In multivariable analysis, each scoring system was a significant predictor of PN vs. RN (Psystems, CI was most highly correlated with surgery type (area under the curve [AUC] = 0.91), followed by RNS (AUC = 0.90) and PC (AUC = 0.88). Each individual component of these scoring systems was also a predictor of surgery type (Psystem (RNS), location along the lateral rim (PC), and centrality (CI). A novel model in which these 4 variables were rescaled outperformed each first-generation system (AUC = 0.91). Optimization of first-generation models of renal tumor complexity results in a novel scoring system, which strongly predicts surgery type. This second-generation model should aid comprehension, but future work is still needed to establish the most clinically useful model. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Calcium oxalate stone and gout.

    Science.gov (United States)

    Marickar, Y M Fazil

    2009-12-01

    Gout is well known to be produced by increased uric acid level in blood. The objective of this paper is to assess the relationship between gout and calcium oxalate stone formation in the humans. 48 patients with combination of gout and calcium oxalate stone problem were included. The biochemical values of this group were compared with 38 randomly selected uric acid stone patients with gout, 43 stone patients with gout alone, 100 calcium oxalate stone patients without gout and 30 controls, making a total of 259 patients. Various biochemical parameters, namely serum calcium, phosphorus and uric acid and 24-h urine calcium, phosphorus, uric acid, oxalate, citrate and magnesium were analysed. ANOVA and Duncan's multiple-range tests were performed to assess statistical significance of the variations. The promoters of stone formation, namely serum calcium (P stone patients and gouty calcium oxalate stone patients compared to the non-gouty patients and controls. Urine oxalate (P stones patients. The inhibitor urine citrate (P stone gouty patients, followed by the gouty uric acid stone formers and gouty calcium oxalate stone patients. The high values of promoters, namely uric acid and calcium in the gouty stone patients indicate the tendency for urinary stone formation in the gouty stone patients. There is probably a correlation between gout and calcium oxalate urinary stone. We presume this mechanism is achieved through the uric acid metabolism. The findings point to the summation effect of metabolic changes in development of stone disease.

  18. A neural network - based algorithm for predicting stone - free status after ESWL therapy.

    Science.gov (United States)

    Seckiner, Ilker; Seckiner, Serap; Sen, Haluk; Bayrak, Omer; Dogan, Kazim; Erturhan, Sakip

    2017-01-01

    The prototype artificial neural network (ANN) model was developed using data from patients with renal stone, in order to predict stone-free status and to help in planning treatment with Extracorporeal Shock Wave Lithotripsy (ESWL) for kidney stones. Data were collected from the 203 patients including gender, single or multiple nature of the stone, location of the stone, infundibulopelvic angle primary or secondary nature of the stone, status of hydronephrosis, stone size after ESWL, age, size, skin to stone distance, stone density and creatinine, for eleven variables. Regression analysis and the ANN method were applied to predict treatment success using the same series of data. Subsequently, patients were divided into three groups by neural network software, in order to implement the ANN: training group (n=139), validation group (n=32), and the test group (n=32). ANN analysis demonstrated that the prediction accuracy of the stone-free rate was 99.25% in the training group, 85.48% in the validation group, and 88.70% in the test group. Successful results were obtained to predict the stone-free rate, with the help of the ANN model designed by using a series of data collected from real patients in whom ESWL was implemented to help in planning treatment for kidney stones. Copyright® by the International Brazilian Journal of Urology.

  19. Association of calcitonin receptor gene (CALCR) polymorphism with kidney stone disease in the population of West Bengal, India.

    Science.gov (United States)

    Mitra, Pubali; Guha, Manalee; Ghosh, Sudakshina; Mukherjee, Sourav; Bankura, Biswabandhu; Pal, Dilip Kumar; Maity, Biswanath; Das, Madhusudan

    2017-07-30

    Kidney Stone Disease (KSD) is a complex urologic disorder with strong genetic constituent. Earlier association studies have indicated that the genetic polymorphisms are the potential cause of stone materialization; however unfortunately, the actual genetic signature is still unknown. Therefore, present study was aimed to investigate the potential contribution of two important polymorphisms of calcitonin receptor gene (CALCR): (i) rs1801197 (Leu447Pro) and (ii) rs1042138 (3'UTR+18C>T) in renal stone formation. Accordingly, we enrolled 152 patients registered with calcium-rich stone in kidney (case) and 144 corresponding age, sex and ethnicity matched healthy individuals (controls). Epidemiological and clinical data were recorded as well as peripheral blood sample was collected from each individual. Serum creatinine and urinary calcium level was found high in patients, compared to controls. Out of two studied polymorphisms, we have not found any significant association against the rs1042138 with KSD, nonetheless, significant high frequency (p=0.001; Odds ratio=1.81; 95% CI: 1.28-2.55) of risk allele T against the rs1801197 (T>C) in patient was noted. Moreover, significant association with KSD was noted by genotypic analysis of rs1801197 (Leu447Pro) in our population. Interestingly, male patients carrying TT genotype was found to be at high risk of stone formation, while no such association was observed in female patients. Altogether, present study indicated that the rs1042138 might not be used as a useful marker for susceptibility of kidney stone formation, whereas, the rs1801197 could definitely be considered as one of the risk factors for KSD in Indian population at least in West Bengal in particular. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Direct pelvic access percutaneous nephrolithotomy in management of ectopic kidney stone: a case report and literature review.

    Science.gov (United States)

    Mehmet, Rifaioglu Murat; Rustu, Yalcinkaya Fatih; Hanefi, Bayarogullari; Mursel, Davarci; Fusun, Aydogan; Mehmet, Inci

    2013-01-01

    Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7 × 1.7 cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5 cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique.

  1. A Single Nucleotide Polymorphism (rs4236480 in TRPV5 Calcium Channel Gene Is Associated with Stone Multiplicity in Calcium Nephrolithiasis Patients

    Directory of Open Access Journals (Sweden)

    Anas Khaleel

    2015-01-01

    Full Text Available Nephrolithiasis is characterized by calcification of stones in the kidneys from an unknown cause. Animal models demonstrated the functional roles of the transient receptor potential vanilloid member 5 (TRPV5 gene in calcium renal reabsorption and hypercalciuria. Therefore, TRPV5 was suggested to be involved in calcium homeostasis. However, whether genetic polymorphisms of TRPV5 are associated with kidney stone multiplicity or recurrence is unclear. In this study, 365 Taiwanese kidney-stone patients were recruited. Both biochemical data and DNA samples were collected. Genotyping was performed by a TaqMan allelic discrimination assay. We found that a TRPV5 polymorphism (rs4236480 was observed to be associated with stone multiplicity of calcium nephrolithiasis, as the risk of stone multiplicity was higher in patients with the TT+CT genotype than in patients with the CC genotype (p=0.0271. In summary, despite the complexity of nephrolithiasis and the potential association of numerous calcium homeostatic absorption/reabsorption factors, TRPV5 plays an important role in the pathogenesis of calcium nephrolithiasis.

  2. Factors affecting lower calyceal stone clearance after Extracorporeal ...

    African Journals Online (AJOL)

    Objective: Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures to remove renal calculi from the lower calyces. The aim of this work is to study the impact of radiological, anatomical and demographic factors on stone clearance after ESWL of lower calyceal calculi. Patients and ...

  3. Understanding pathologic variants of renal cell carcinoma: distilling therapeutic opportunities from biologic complexity.

    Science.gov (United States)

    Shuch, Brian; Amin, Ali; Armstrong, Andrew J; Eble, John N; Ficarra, Vincenzo; Lopez-Beltran, Antonio; Martignoni, Guido; Rini, Brian I; Kutikov, Alexander

    2015-01-01

    Once believed to represent a uniform malignant phenotype, renal cell carcinoma (RCC) is now viewed as a diverse group of cancers that arise from the nephron. To review the pathologic characteristics, clinical behavior, molecular biology, and systemic therapy options of recognized RCC histologic subtypes. A systematic review of English-language articles was performed using the Medline and Web of Science databases. Manuscripts were selected with consensus of the coauthors and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. The major findings of the evaluated manuscripts are discussed with an emphasis on the description of the pathologic features, clinical behavior, prognosis, and therapeutic strategies. Classification schemes for kidney cancer have undergone dramatic changes over the past two decades. Improvements in these classification schemes are important, as pathologic variants differ not only in disease biology, but also in clinical behavior, prognosis, and response to systemic therapy. In the era of genomic medicine, further refinements in characterization of RCC subtypes will be critical to the progress of this burgeoning clinical space. Kidney cancer can be subdivided into related but different cancers that arise from the kidney's tubules. In this article we review current classifications for kidney cancer, discuss their characteristics, and provide an overview of each subtype's clinical behavior and treatment. We stress that each subtype harbors unique biology and thus responds differently to available treatment strategies. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  4. The calcium-binding protein complex S100A8/A9 has a crucial role in controlling macrophage-mediated renal repair following ischemia/reperfusion

    NARCIS (Netherlands)

    Dessing, Mark C.; Tammaro, Alessandra; Pulskens, Wilco P.; Teske, Gwendoline J.; Butter, Loes M.; Claessen, Nike; van Eijk, Marco; van der Poll, Tom; Vogl, Thomas; Roth, Johannes; Florquin, Sandrine; Leemans, Jaklien C.

    2015-01-01

    Upon ischemia/reperfusion (I/R)-induced injury, several damage-associated molecular patterns are expressed including the calcium-binding protein S100A8/A9 complex. S100A8/A9 can be recognized by Toll-like receptor-4 and its activation is known to deleteriously contribute to renal I/R-induced injury.

  5. Thermoluminescence of pyramid stones

    International Nuclear Information System (INIS)

    Gomaa, M.A.; Eid, A.M.

    1982-01-01

    It is the aim of the present study to investigate some thermoluminescence properties of pyramid stones. Using a few grammes of pyramid stones from Pyramids I and II, the TL glow peaks were observed at 250 and 310 0 C, respectively. The TL glow peaks of samples annealed at 600 0 C, then exposed to 60 Co γ-rays were observed at 120, 190 and 310 0 C, respectively. The accumulated dose of natural samples is estimated to be around 310 Gray (31 krad). By assuming an annual dose is 1 mGy, the estimated age of pyramid stones is 0.31 M year. (author)

  6. Thermoluminescence of pyramid stones

    Energy Technology Data Exchange (ETDEWEB)

    Gomaa, M A; Eid, A M [Atomic Energy Establishment, Cairo (Egypt)

    1982-01-01

    It is the aim of the present study to investigate some thermoluminescence properties of pyramid stones. Using a few grammes of pyramid stones from Pyramids I and II, the TL glow peaks were observed at 250 and 310/sup 0/C, respectively. The TL glow peaks of samples annealed at 600/sup 0/C, then exposed to /sup 60/Co ..gamma..-rays were observed at 120, 190 and 310/sup 0/C, respectively. The accumulated dose of natural samples is estimated to be around 310 Gray (31 krad). By assuming an annual dose is 1 mGy, the estimated age of pyramid stones is 0.31 M year.

  7. Packing of Renal Fossa: Useful Technique for Intractable Bleeding ...

    African Journals Online (AJOL)

    There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours) to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone ...

  8. Stone fragmentation by ultrasound

    Indian Academy of Sciences (India)

    Unknown

    In the present work, enhancement of the kidney stone fragmentation by using ultrasound is studied. The cavi- ... ment system like radiation pressure balance, the power is given by ... Thus the bubble size has direct relationship with its life and.

  9. Crushed Stone Operations

    Data.gov (United States)

    Department of Homeland Security — This map layer includes crushed stone operations in the United States. These data were obtained from information reported voluntarily to the USGS by the aggregate...

  10. Fire effects on flaked stone, ground stone, and other stone artifacts [Chapter 4

    Science.gov (United States)

    Krista Deal

    2012-01-01

    Lithic artifacts can be divided into two broad classes, flaked stone and ground stone, that overlap depending on the defining criteria. For this discussion, flaked stone is used to describe objects that cut, scrape, pierce, saw, hack, etch, drill, or perforate, and the debris (debitage) created when these items are manufactured. Objects made of flaked stone include...

  11. Clinical experience for radiolucent stones; A report of 27 cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyung Jee; Lee, Gil Ho [Dankook University, Seoul (Korea, Republic of)

    1997-02-01

    The cause of radiolucent filling defects in the upper urinary tract are malignant tumor, radiolucent stones, blood clots, air bubbles, congenital deformities of renal parenchyme, and various specific and non-specific infection and their sequence. So the differential diagnosis between malignancy and radiolucent stones is very important, and the exact and fast diagnosis of radiolucent stones is useful in excluding the possibility of malignancy. 27 cases with radiolucent stones were evaluated retrospectively for exact diagnosis and appropriate treatment method. Intravenous urography was done in all cases, and retrograde pyelography, ultrasonography, computed tomography and/or ureterorenoscopy were performed for diagnosis, if needed. Size of stones were measured below 10mm by transverse length in 19 cases (70.4%) with a range of 3 to 30mm. The locations of stones were pelvicalyceal system in 8 cases (29.6%) and ureter in 19 cases (70.4%). Among the diagnostic methods, computed tomography was used most frequency. ESWL with retrograde pyelography was most frequent used method of treatment, also simple hydration to small stone was effective. (author).

  12. Clinical experience for radiolucent stones; A report of 27 cases

    International Nuclear Information System (INIS)

    Kim, Hyung Jee; Lee, Gil Ho

    1997-01-01

    The cause of radiolucent filling defects in the upper urinary tract are malignant tumor, radiolucent stones, blood clots, air bubbles, congenital deformities of renal parenchyme, and various specific and non-specific infection and their sequence. So the differential diagnosis between malignancy and radiolucent stones is very important, and the exact and fast diagnosis of radiolucent stones is useful in excluding the possibility of malignancy. 27 cases with radiolucent stones were evaluated retrospectively for exact diagnosis and appropriate treatment method. Intravenous urography was done in all cases, and retrograde pyelography, ultrasonography, computed tomography and/or ureterorenoscopy were performed for diagnosis, if needed. Size of stones were measured below 10mm by transverse length in 19 cases (70.4%) with a range of 3 to 30mm. The locations of stones were pelvicalyceal system in 8 cases (29.6%) and ureter in 19 cases (70.4%). Among the diagnostic methods, computed tomography was used most frequency. ESWL with retrograde pyelography was most frequent used method of treatment, also simple hydration to small stone was effective. (author)

  13. Shock wave lithotripsy outcomes for lower pole and non-lower pole stones from a university teaching hospital: Parallel group comparison during the same time period

    Science.gov (United States)

    Geraghty, Robert; Burr, Jacob; Simmonds, Nick; Somani, Bhaskar K.

    2015-01-01

    Introduction: Shock wave lithotripsy (SWL) is a treatment option for all locations of renal and ureteric stones. We compared the results of SWL for lower pole renal stones with all other non-lower pole renal and ureteric stones during the same time period. Material and Methods: All SWL procedures were carried out as day case procedures by a mobile lithotripter from January 2012 to August 2013. The follow-up imaging was a combination of KUB X-ray or USS. Following SWL treatment, the stone free rate (SFR) was defined as ≤3 mm fragments. Results: A total of 148 patients with a mean age of 62 years underwent 201 procedures. Of the 201 procedures, 93 (46%) were for lower pole stones. The non-lower pole stones included upper pole (n = 36), mid pole (n = 40), renal pelvis (n = 10), PUJ (n = 8), mid ureter (n = 3), upper ureter (n = 5) and a combination of upper, middle and/or lower pole (n = 6). The mean stone size for lower pole stones (7.4 mm; range: 4-16 mm) was slightly smaller than non-lower pole stones (8 mm; range: 4-17 mm). The stone fragmentation was successful in 124 (62%) of patients. However, the SFR was statistically significantly better (P = 0.023) for non-lower pole stones 43 (40%) compared to lower pole stones 23 (25%). There were 9 (4%) minor complications and this was not significantly different in the two groups. Conclusions: Although SWL achieves a moderately high stone fragmentation rate with a low complication rate, the SFR is variable depending on the location of stone and the definition of SFR, with lower pole stones fairing significantly worse than stones in all other locations. PMID:25657543

  14. Relationship Between Milk Adulterated With Melamine and the Appearance of Renal Stones in a Childhood Population: A Review of the Literature of the Cases That Occurred in the People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Jasmina Bordón-González

    2014-05-01

    Full Text Available Introduction: Melamine is a chemical substance used in the production of resins. When melamine is added to milk, nitrogen concentration increases, which suggest an increase the amount of false proteins and consequently causing kidney diseases in some population subgroups. The objective of this study is to document the possible connection in between adulterated industrial milk with melamine and the appearance of kidney stones in children under 12 years old by reviewing cases occurred in the People’s Republic of China.Material and methods: A literature review was carried out on articles published on dated between 2005-2010, and an extensive analysis was made on the results found.Results: A total of 20 articles were reviewed, of which 11 met the criteria for inclusion, There were 9 cross-sectional studies, one follow-up study and a case-control study. Four studies calculated odds ratio (OR in their analysis to evaluate the relative risk of having stones in those children exposed to melamine formula. In the case-control study, children exposed to melamine formula were 5.17 times as likely to have kidney stones as children exposed to a non-melamine formula (95% confidence interval, 3.28-8.14; P<.001.Conclusions: Melamine adulteration in milk is a preventable public health issue which suggests the establishing of greater control measures and the implementation of food regulations by the food industry and Health and Food Institutions.

  15. Calcium Stone Growth in Urine from Cystic Fibrosis Patients and Healthy Controls

    Science.gov (United States)

    McSorley, Anita; Jones, Andrew M.; Webb, A. Kevin; Rao, P. Nagaraj; Kavanagh, John P.

    2007-04-01

    Cystic fibrosis patients have an increased risk of renal stone disease. There is some evidence that this may be related to a different excretory pattern of stone risk factors, but an alternative hypothesis, that the urine of cystic fibrosis patients is deficient in urinary inhibitors of crystallization and stone formation has not been tested. Here we have grown calcium stones, in vitro, in the presence of urine from healthy controls and compared this with growth in the presence of urine from cystic fibrosis patients. A stone farm was used to grow twelve calcium stones simultaneously, firstly in artificial urine for about 200 hours and then in 90% whole human urine for another 500 hours. Six of the stones received urine from healthy controls and six received urine from adult cystic fibrosis patients. There were no significant differences in stone mass at any of the key time points or in the overall growth pattern (p>0.05) between stones destined for, or treated with, urine from CF patients and the controls. Human urine greatly inhibited stone growth in vitro but there was no difference in the growth rate in urine from healthy controls and CF patients. This refutes the hypothesis that a tendency for a higher prevalence of urinary stones in CF patients is related to a deficiency in inhibitory activity.

  16. Predicting stone composition before treatment – can it really drive clinical decisions?

    Science.gov (United States)

    Bres–Niewada, Ewa; Radziszewski, Piotr

    2014-01-01

    Introduction Determination of stone composition is considered to be crucial for the choice of an optimal treatment algorithm. It is especially important for uric acid stones, which can be dissolved by oral chemolysis and for renal stones smaller than 2 cm, which can be treated with extracorporeal shockwave lithotripsy (ESWL). Material and methods This short review identifies the latest papers on radiological assessment of stone composition and presents a comprehensive evaluation of current scientific findings. Results Stone chemical composition is difficult to predict using standard CT imaging, however, attenuation index measured in Hounsfield units (HU) is related to ESWL outcome. Stone density >1000 HU can be considered predictive for ESWL failure. It seems that stone composition is meaningless in determining the outcome of ureterolithotripsy and percutaneous surgery. Alternative imaging techniques such as Dual–Energy CT or analysis of shape, density and homogeneity of stones on plain X–rays are used as promising methods of predicting stone composition and ESWL outcome. Conclusions New imaging techniques facilitate the identification of uric acid stones and ESWL–resistant stones. Therefore, they may help in selecting the best therapeutic option. PMID:25667761

  17. Management of complete staghorn stone in a developing country

    Directory of Open Access Journals (Sweden)

    Anant Kumar

    2002-01-01

    Renal failure patients had higher clearance rates with open procedures compared to PNL (80% vs 62.5% respec-tively. Moreover these patients had higher incidence of major bleeding with PNL compared to open procedures (31.3% vs 10%. Conclusions: Advantages of endourological procedures in the management of staghorn stones is offset by the need of ancillary treatments, which are expensive and which require frequent visits to the hospital. In view of high clear-ance rates, lesser treatment cost and lesser incidence of complications, open surgery still has a place in the man-agement of staghorn renal stones in patients who have economic constraints and live in remote areas where medi-cal facilities are not freely available. These advantages are also seen in the renal failure patients where complica-tions with endourologic procedures were significantly more than that with open surgery. However postoperative mor-bidity and larger scar should be discussed with the pa-tients.

  18. Monoanionic 99mTc-tricarbonyl-aminopolycarboxylate complexes with uncharged pendant groups: Radiosynthesis and evaluation as potential renal tubular tracers.

    Science.gov (United States)

    Lipowska, Malgorzata; Klenc, Jeffrey; Jarkas, Nashwa; Marzilli, Luigi G; Taylor, Andrew T

    2017-04-01

    99m Tc(CO) 3 -nitrilotriacetic acid, 99m Tc(CO) 3 (NTA), is a new renal tubular agent with pharmacokinetic properties comparable to those of 131 I-OIH but the clearance of 99m Tc(CO) 3 (NTA) and 131 I-OIH is still less than the clearance of PAH, the gold standard for the measurement of effective renal plasma flow. At physiological pH, dianionic 99m Tc(CO) 3 (NTA) has a mononegative inner metal-coordination sphere and a mononegative uncoordinated carboxyl group. To evaluate alternate synthetic approaches, we assessed the importance of an uncoordinated carboxyl group, long considered essential for tubular transport, by evaluating the pharmacokinetics of three analogs with the 99m Tc(CO) 3 (NTA) metal-coordination sphere but with uncharged pendant groups. 99m Tc(CO) 3 complexes with N-(2-acetamido)iminodiacetic acid (ADA), N-(2-hydroxyethyl)iminodiacetic acid (HDA) and N-(fluoroethyl)iminodiacetic acid (FEDA) were prepared using a tricarbonyl kit and isolated by HPLC. The pharmacokinetics were evaluated in Sprague-Dawley rats, with 131 I-OIH as an internal control; urine was analyzed for metabolites. Plasma protein binding and erythrocyte uptake were determined from the 10min blood samples. Re(CO) 3 (FEDA), the analog of 99m Tc(CO) 3 (FEDA), was prepared and characterized. 99m Tc(CO) 3 (ADA), 99m Tc(CO) 3 (HDA) and 99m Tc(CO) 3 (FEDA) were efficiently prepared as a single species with high radiochemical purities (>99%). These new monoanionic 99m Tc(CO) 3 tracers with uncharged dangling groups all showed rapid blood clearance and high specificity for renal excretion. Activity in the urine, as a percent of 131 I-OIH at 10 and 60min, was 96% and 99% for ADA, 96% and 100% for HDA, and 100% and 99% for FEDA, respectively. Each new tracer was excreted unchanged in the urine. The Re(CO) 3 (FEDA) structure adds compelling evidence that such 99m Tc(CO) 3 (NTA) analogs have metal-coordination spheres identical to that of 99m Tc(CO) 3 (NTA). New tracers lacking the negatively

  19. Microstructural characterization of stone wool fibre network

    DEFF Research Database (Denmark)

    Chapelle, Lucie; Brøndsted, Povl; Kusano, Yukihiro

    2014-01-01

    Understanding the mechanical properties of fibrous network as complex as stone wool materials requires a relevant description of their microstructure and architecture. In this study, different methods have been proposed to characterize the fibre orientation, diameter and length of fibres as well...

  20. Predictive factors of lower calyceal stone clearance after extracorporeal shockwave lithotripsy (ESWL): the impact of radiological anatomy.

    Science.gov (United States)

    Lin, Chih-Chieh; Hsu, Yen-Shen; Chen, Kuang-Kuo

    2008-10-01

    This study was carried out to determine whether or not there is a significant relationship between the radiologic anatomy of the lower calyx, as seen on preoperative intravenous urography (IVU), and the outcome of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for lower renal calyceal stones. Between June 1998 and April 2007, 112 patients with a solitary lower renal calyceal stone measuring 20 mm or less in size were enrolled in this retrospective study. Pretreatment IVU was reviewed for measuring the anatomical predictors, such as lower pole infundibular length, infundibular width (IW) and infundibulopelvic angle, while the stone location and size were determined on plain abdominal X-ray. All patients were treated with ESWL using a Siemens Lithostar Plus lithotriptor and were followed-up for the outcome of stone clearance 3 months after ESWL with plain abdominal X-ray films and ultrasonography. Three months after ESWL, only 49 (43.7%) patients were stone-free. Under multivariate analysis with logistic regression, smaller stone size (10 mm or less, p = 0.005) and greater IW (4 mm or more, p = 0.029) were significant favourable predictors for better stone clearance. In addition to the influence of stone size, lower pole anatomy, especially IW, has a significant impact on stone clearance for lower calyceal stone after ESWL.

  1. Titanocene–Gold Complexes Containing N-Heterocyclic Carbene Ligands Inhibit Growth of Prostate, Renal, and Colon Cancers in Vitro

    Science.gov (United States)

    2016-01-01

    We report on the synthesis, characterization, and stability studies of new titanocene complexes containing a methyl group and a carboxylate ligand (mba = −OC(O)-p-C6H4-S−) bound to gold(I)–N-heterocyclic carbene fragments through the thiolate group: [(η5-C5H5)2TiMe(μ-mba)Au(NHC)]. The cytotoxicities of the heterometallic compounds along with those of novel monometallic gold–N-heterocyclic carbene precursors [(NHC)Au(mbaH)] have been evaluated against renal, prostate, colon, and breast cancer cell lines. The highest activity and selectivity and a synergistic effect of the resulting heterometallic species was found for the prostate and colon cancer cell lines. The colocalization of both titanium and gold metals (1:1 ratio) in PC3 prostate cancer cells was demonstrated for the selected compound 5a, indicating the robustness of the heterometallic compound in vitro. We describe here preliminary mechanistic data involving studies on the interaction of selected mono- and bimetallic compounds with plasmid (pBR322) used as a model nucleic acid and the inhibition of thioredoxin reductase in PC3 prostate cancer cells. The heterometallic compounds, which are highly apoptotic, exhibit strong antimigratory effects on the prostate cancer cell line PC3. PMID:27182101

  2. Complex left profunda femoris vein to renal vein bypass for the management of progressive chronic iliofemoral occlusion.

    Science.gov (United States)

    Anaya-Ayala, Javier E; Adams, Matthew K; Telich-Tarriba, Jose E; Dresser, Kelly L; Ismail, Nyla; Peden, Eric K

    2013-01-01

    Chronic occlusions of the inferior vena cava (IVC) and iliofemoral veins are long-term sequelae of deep venous thrombosis (DVT) that can lead to postthrombotic syndrome (PTS). Patients may present with a wide spectrum of signs and symptoms, ranging from mild discomfort and swelling to severe venous hypertension and ulcerations. We report a 68-year-old man who had a history of left lower extremity DVT after a laminectomy and who developed PTS with nonhealing ulcers. The patient underwent a cross-pubic femorofemoral venous bypass that failed to improve his clinical status. After unsuccessful endovascular attempts for recanalization of the iliofemoral segment, a profunda femoris to IVC bypass was performed. The symptoms recurred 2 years later. Venography revealed restenosis at the caval anastomosis that did not resolve by endovascular means. A surgical revision was performed, and given the quality of the IVC, a jump bypass was created to the left renal vein. The swelling improved and the ulcers healed completely. Twenty-eight months after the complex reconstructions, he remains ulcer-free with mild edema controlled with stockings. Venous reconstructions remain a viable option for patients with symptomatic and recalcitrant nonmalignant obstruction of the large veins. Copyright © 2013 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  3. Bone Genes in the Kidney of Stone Formers

    Science.gov (United States)

    Evan, Andrew P.; Bledsoe, Sharon B.

    2008-09-01

    Intraoperative papillary biopsies from kidneys of idiopathic-calcium oxalate stone formers (ICSF) have revealed a distinct pattern of mineral deposition in the interstitium of the renal papilla. The earliest sites of these deposits, termed Randall's plaque, are found in the basement membrane of thin loops of Henle and appear to spread into the surrounding interstitium down to the papillary epithelium. Recent studies show kidney stones of ICSF patients grow attached to the renal papilla and at sites of Randall's plaque. Together these observations suggest that plaque formation may be the critical step in stone formation. In order to control plaque formation and thereby reduce future kidney stone development, the mechanism of plaque deposition must be understood. Because the renal papilla has unique anatomical features similar to bone and the fact that the interstitial deposits of ICSF patients are formed of biological apatite, this paper tests the hypothesis that sites of interstitial plaque form as a result of cell-mediated osteoblast-like activity.

  4. Fasting and Urinary Stones

    Directory of Open Access Journals (Sweden)

    Ali Shamsa

    2013-11-01

    Full Text Available Introduction: Fasting is considered as one of the most important practices of Islam, and according to Prophet Mohammad, fasting is obligatory upon Muslims. The aim of this study is to evaluate the effects of fasting on urinary stones. Materials and Methods: Very few studies have been carried out on urinary stones and the effect of Ramadan fasting. The sources of the present study are Medline and articles presented by local and Muslim researchers. Meanwhile, since we are acquainted with three well-known researchers in the field of urology, we contacted them via email and asked for their professional opinions. Results: The results of studies about the relationship of urinary stones and their incidence in Ramadan are not alike, and are even sometimes contradictory. Some believe that increased incidence of urinary stones in Ramadan is related not to fasting, but to the rise of weather temperature in hot months, and an increase in humidity. Conclusion: Numerous biological and behavioral changes occur in people who fast in Ramadan and some researchers believe that urinary stone increases during this month.

  5. Ultrasonographic diagnosis of ureteral stones: Accuracy and factors influencing on diagnostic sensitivity

    Energy Technology Data Exchange (ETDEWEB)

    Park, Young Mi; Han, Sang Seok; Chang, Seung Kuk; Joo, Sang Hoo; Lee, Jeong Sik; Eun, Choong Ki [Pusan Paik Hospital, Inje University College of Medicine, Pusan (Korea, Republic of)

    1999-12-15

    To determine the accuracy of ultrasonographic diagnosis in patients with clinically suspected ureteral stones and to evaluate the factors influencing on the diagnostic sensitivity for the detection of ureteral stone. The patients (115 cases) with proven presence or absence of ureteral stones were included in the study. At first, both sided kidney and proximal ureters were examined on each decubitus position and then middle ureters were done if proximal ureters were visualized. On the supine view, distal ureters and UVJ were scanned through the acoustic window of the filled bladder. KUB (20 cases), IVU (62 cases), AGP (7 cases), RGP (3 cases), ESWL (9 cases), CT (9 cases), and patients' history of spontaneous passage of stones (5 cases) were included as confirmation methods. The sensitivity, specificity, and accuracy of the ultrasonographic diagnosis of ureteral stones were calculated and the factors influencing on the sensitivity on the focus of the position and size of ureteral stone, visibility of ureter, the presence or absence of renal stone and hydronephrosis were analyzed. Of 82 cases with proven ureteral stone, 72 cases were revealed on ultrasonography and there was one false positive examination among 33 cases with proven absence of ureteral stone. The overall diagnostic accuracy was 90%. The ultrasonographic detection rates of ureteral stones as correlated with their locations were 83% (24/29), 100% (11/11), 80% (16/20), and 100% (21/21) of each group of proximal, middle, distal ureter, and UVJ stones. Of 61 stones, those as correlated with their sizes, were 82% (37/45) and 94% (15/16) of each group less than 10 mm and more than 11 mm. Those as correlated with the presence or absence of ureteral visualization on ultrasonography were 92% (69/75) and 43% (3/7) of each group. Those as correlated with presence of absence of renal stones were 85% (41/48) and 91% (31/34) of each group. Those as correlated with presence or absence of hydronephrosis were 89

  6. Genetics Home Reference: renal tubular acidosis with deafness

    Science.gov (United States)

    ... adults with renal tubular acidosis with deafness have short stature, and many develop kidney stones. The metabolic acidosis ... enlarged vestibular aqueduct, can be seen with medical imaging. The vestibular aqueduct is a bony canal that ...

  7. Emergency extracorporeal shockwave lithotripsy (eSWL) as opposed to delayed SWL (dSWL) for the treatment of acute renal colic due to obstructive ureteral stone: a prospective randomized trial.

    Science.gov (United States)

    Bucci, Stefano; Umari, Paolo; Rizzo, Michele; Pavan, Nicola; Liguori, Giovanni; Barbone, Fabio; Trombetta, Carlo

    2018-05-14

    To assess the efficacy of emergency extracorporeal shockwave lithotripsy (eSWL) as first-line treatment in patients with acute colic due to obstructive ureteral stone. 74 patients were randomized to emergency SWL within 12 hours (eSWL group) and deferred SWL later than 3 days (dSWL group). Follow-up included ultrasound, KUB (Kidney-Ureter-Bladder) radiography and CT (computed tomography) scan at 24 hours, 7 days, 1 and 3 months from the treatment. When necessary, repeated SWL (re-SWL) or ureteroscopy (auxiliary-URS) was performed. Preoperative and postoperative data were compared and stone free rates (SFR) and efficiency quotients (EQ) were evaluated. Analyses were performed using SAS software. Complete data of 70 patients were collected. 36 underwent eSWL and 34 dSWL. The mean patient age was 48.7. Mean stone size was 9.8 mm (CI 95%, 8.9-10.8). 25 (35.7%) were proximal and 45 (64.3%) distal. Mean SWL energy was 19.2 kV (CI 95%, 18.5-19.9) and mean number of shocks was 2657 (CI 95%, 2513-2802). eSWL patients needs less auxiliary-URS than dSWL patients (13.9% vs 44.1%, p=0.039) and less re-SWL sessions (8.3% vs 32.4%, p=0.093). SFR at 24 hours was 52.8% and 11.8% (p<0.001) and the EQ at 3 months was 79.1% and 57.5% in the eSWL and dSWL group respectively. Patients from the dSWL group spent more time in the hospital (2.21 vs 1.36 days, p=0.046) and complication rates between the two groups were similar. eSWL is a safe procedure and delivers high SFR even within 24 hours especially for <10mm stones. It is able to reduce the number of auxiliary procedures and hospitalization.

  8. [Renal colic in pregnancy].

    Science.gov (United States)

    Negru, Irina; Pricop, C; Costăchescu, Gh

    2010-01-01

    Renal colic in pregnant women is a serious condition, mainly when is associated with fever. Our retro-prospective study analyzes 111 cases managed conservatively or with endourological procedures for renal colic--insertion of JJ stents and percutaneous nephrostomy. Clinical evolution determined the insertion of JJ stents in 60 cases and the failure of this procedure imposed percutaneous nephrostomy in 5 cases. In 56 cases urinary tract infection was associated and in 2 cases, despite all efforts, the patients deceased due to sever sepsis. The immediate drainage of the upper urinary tract for renal colic in pregnancy is the recommended treatment, especially when the pain is associated with fever. JJ stens were well tolerated, even when they were replaced after 3 months. Pregnant women with a history of UTI or stone disease should be carefully followed-up.

  9. Strides in Preservation of Malawi's Natural Stone

    Science.gov (United States)

    Kamanga, Tamara; Chisenga, Chikondi; Katonda, Vincent

    2017-04-01

    The geology of Malawi is broadly grouped into four main lithological units that is the Basement Complex, the Karoo Super group, Tertiary to Quaternary sedimentary deposits and the Chilwa Alkaline province. The basement complex rocks cover much of the country and range in age from late Precambrian to early Paleozoic. They have been affected by three major phases of deformation and metamorphism that is the Irumide, Ubendian and The Pan-African. These rocks comprise gneisses, granulites and schists with associated mafic, ultramafic, syenites and granite rocks. The Karoo System sedimentary rocks range in age from Permian to lower Jurassic and are mainly restricted to two areas in the extreme North and extreme Alkaline Province - late Jurassic to Cretaceous in age, preceded by upper Karoo Dolerite dyke swarms and basaltic lavas, have been intruded into the Basement Complex gneisses of southern Malawi. Malawi is endowed with different types of natural stone deposits most of which remain unexploited and explored. Over twenty quarry operators supply quarry stone for road and building construction in Malawi. Hundreds of artisanal workers continue to supply aggregate stones within and on the outskirts of urban areas. Ornamental stones and granitic dimension stones are also quarried, but in insignificant volumes. In Northern Malawi, there are several granite deposits including the Nyika, which is the largest single outcrop occupying approximately 260.5 km2 , Mtwalo Amazonite an opaque to translucent bluish -green variety of microcline feldspar that occurs in alkali granites and pegmatite, the Ilomba granite (sodalite) occurring in small areas within biotite; apatite, plagioclase and calcite. In the Center, there are the Dzalanyama granites, and the Sani granites. In the South, there are the Mangochi granites. Dolerite and gabbroic rocks spread across the country, treading as black granites. Malawi is also endowed with many deposits of marble. A variety of other igneous

  10. Forty-five-year follow-up on the renal function after spinal cord injury

    DEFF Research Database (Denmark)

    Elmelund, M; Oturai, P S; Toson, B

    2016-01-01

    rate (GFR) ⩽75% of expected according to age and gender) was 58%. The cumulative risk of severe renal deterioration (functional distribution outside 30-70% on renography or relative GFR⩽51%) was 29% after 45 years postinjury. Only dilatation of UUT and renal/ureter stone requiring removal significantly...... increased the risk of moderate and severe renal deterioration. CONCLUSION: Renal deterioration occurs at any time after injury, suggesting that lifelong follow-up examinations of the renal function are important, especially in patients with dilatation of UUT and/or renal/ureter stones....

  11. Anholt Rosetta Stones

    DEFF Research Database (Denmark)

    Trempe Jr., Robert B.; Buthke, Jan

    2017-01-01

    This book records and celebrates the research finding of Anholt Island by students from Studio 2B, Arkitektskolen Aarhus, These mahogany constructions are our architectural versions of a Rosetta Stone. These are constructs that record layers of information about Anholt island through virtual...... and physical techniques, where each step and mechanic imparts and inscribes knowledge beyond the 1:1. These constructs are visual keys, used to inspire and influence all decision-making processes in a design project. These architectural Rosetta Stones document and amplify quantitative information about a site...

  12. The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic

    Directory of Open Access Journals (Sweden)

    Elizabeth Waine

    2010-04-01

    Full Text Available NSAIDs provide optimal analgesia in renal colic due to the reduction in glomerular filtration and renal pelvic pressure, ureteric peristalsis and ureteric oedema. Prevention of glomerular afferent arteriolar vasodilatation renders these patients at risk of renal impairment. NSAIDs have the additional benefit of reducing the number of new colic episodes and preventing subsequent readmission to hospital. Despite recent work promoting the use of pharmacological agents to improve stone passage rates, NSAIDs do not appear to reduce the time to stone passage or increase the likelihood of stone passage in renal colic.

  13. The History of Urinary Stones: In Parallel with Civilization

    Directory of Open Access Journals (Sweden)

    Ahmet Tefekli

    2013-01-01

    Full Text Available The roots of modern science and history of urinary stone disease go back to the Ancient Egyptians and Mesopotamia. Hippocrates defined the symptoms of bladder stones. The first recorded details of “perineal lithotomy” were those of Cornelius Celsus. Ancient Arabic medicine was based mainly on classical Greco-Roman works. Interestingly, the Fourth Lateran Council in 1215 forbade physicians from performing surgical procedures, as contact with blood or body fluids was viewed as contaminating to men. With Renaissance new procedures could be tried on criminals. The first recorded suprapubic lithotomy was carried out by Pierre Franco in 1561. In 1874, Bigelow developed a lithotrite, which was introduced into the bladder under anaesthesia (called as “litholopaxy”. Young was the first to report ureteroscopy (1929. With advances in intracorporeal lithotripsy techniques, ureteroscopy became the treatment of choice for ureteric stones. In 1976, Fernstrom and Johannson established percutaneous access to remove a renal stone. However, with the introduction of the first extracorporeal shock wave machine in 1980, a dramatic change in stone management was observed. Civilization in parallel with scientific developments has brought us to a point where we try not to “cut” our patients for stone disease, as Hippocrates admonishes, but rather manage them with minimal invasive alternatives.

  14. Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision.

    Science.gov (United States)

    Nakamura, Kogenta; Tobiume, Motoi; Narushima, Masahiro; Yoshizawa, Takahiko; Nishikawa, Genya; Kato, Yoshiharu; Katsuda, Remi; Zennami, Kenji; Aoki, Shigeyuki; Yamada, Yoshiaki; Honda, Nobuaki; Sumitomo, Makoto

    2011-12-12

    The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

  15. Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL Sonolith vision

    Directory of Open Access Journals (Sweden)

    Nakamura Kogenta

    2011-12-01

    Full Text Available Abstract Background The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. Methods The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. Results At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]. Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. Conclusions ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

  16. Coronal reconstruction of unenhanced abdominal CT for correct ureteral stone size classification

    Energy Technology Data Exchange (ETDEWEB)

    Berkovitz, Nadav; Simanovsky, Natalia; Hiller, Nurith [Hadassah Mount Scopus - Hebrew University Medical Center, Department of Radiology, Jerusalem (Israel); Katz, Ran [Hadassah Mount Scopus - Hebrew University Medical Center, Department of Urology, Jerusalem (Israel); Salama, Shaden [Hadassah Mount Scopus - Hebrew University Medical Center, Department of Emergency Medicine, Jerusalem (Israel)

    2010-05-15

    To determine whether size measurement of a urinary calculus in coronal reconstruction of computed tomography (CT) differs from stone size measured in the axial plane, and whether the difference alters clinical decision making. We retrospectively reviewed unenhanced CT examinations of 150 patients admitted to the emergency room (ER) with acute renal colic. Maximal ureteral calculus size was measured on axial slices and coronal reconstructions. Clinical significance was defined as an upgrading or downgrading of stone size according to accepted thresholds of treatment: {<=}5 mm, 6-9 mm and {>=}10 mm. There were 151 stones in 150 patients (male:female 115:34, mean age 41 years). Transverse stone diameters ranged from 1 to 11 mm (mean 4 mm). On coronal images, 56 (37%) stones were upgraded in severity; 46 (30%) from below 5 mm to 6 mm or more, and ten (7%) from 6-9 mm to 10 mm or more. Transverse measurement on the axial slices enabled correct categorization of 95 stones (63%). Transverse calculus measurement on axial slices often underestimates stone size and provides incorrect clinical classification of the true maximal stone diameter. Coronal reconstruction provides additional information in patients with renal colic that may alter treatment strategy. (orig.)

  17. Coronal reconstruction of unenhanced abdominal CT for correct ureteral stone size classification

    International Nuclear Information System (INIS)

    Berkovitz, Nadav; Simanovsky, Natalia; Hiller, Nurith; Katz, Ran; Salama, Shaden

    2010-01-01

    To determine whether size measurement of a urinary calculus in coronal reconstruction of computed tomography (CT) differs from stone size measured in the axial plane, and whether the difference alters clinical decision making. We retrospectively reviewed unenhanced CT examinations of 150 patients admitted to the emergency room (ER) with acute renal colic. Maximal ureteral calculus size was measured on axial slices and coronal reconstructions. Clinical significance was defined as an upgrading or downgrading of stone size according to accepted thresholds of treatment: ≤5 mm, 6-9 mm and ≥10 mm. There were 151 stones in 150 patients (male:female 115:34, mean age 41 years). Transverse stone diameters ranged from 1 to 11 mm (mean 4 mm). On coronal images, 56 (37%) stones were upgraded in severity; 46 (30%) from below 5 mm to 6 mm or more, and ten (7%) from 6-9 mm to 10 mm or more. Transverse measurement on the axial slices enabled correct categorization of 95 stones (63%). Transverse calculus measurement on axial slices often underestimates stone size and provides incorrect clinical classification of the true maximal stone diameter. Coronal reconstruction provides additional information in patients with renal colic that may alter treatment strategy. (orig.)

  18. Healing stone ... by infection

    OpenAIRE

    Micallef, Roderick

    2014-01-01

    Roderick Micallef has a long family history within the construction industry. He coupled this passion with a fascination with science when reading for an undergraduate degree in Biology and Chemistry (University of Malta). http://www.um.edu.mt/think/healing-stone-by-infection/

  19. Modeling Stone Columns.

    Science.gov (United States)

    Castro, Jorge

    2017-07-11

    This paper reviews the main modeling techniques for stone columns, both ordinary stone columns and geosynthetic-encased stone columns. The paper tries to encompass the more recent advances and recommendations in the topic. Regarding the geometrical model, the main options are the "unit cell", longitudinal gravel trenches in plane strain conditions, cylindrical rings of gravel in axial symmetry conditions, equivalent homogeneous soil with improved properties and three-dimensional models, either a full three-dimensional model or just a three-dimensional row or slice of columns. Some guidelines for obtaining these simplified geometrical models are provided and the particular case of groups of columns under footings is also analyzed. For the latter case, there is a column critical length that is around twice the footing width for non-encased columns in a homogeneous soft soil. In the literature, the column critical length is sometimes given as a function of the column length, which leads to some disparities in its value. Here it is shown that the column critical length mainly depends on the footing dimensions. Some other features related with column modeling are also briefly presented, such as the influence of column installation. Finally, some guidance and recommendations are provided on parameter selection for the study of stone columns.

  20. Automated visual inspection for polished stone manufacture

    Science.gov (United States)

    Smith, Melvyn L.; Smith, Lyndon N.

    2003-05-01

    Increased globalisation of the ornamental stone market has lead to increased competition and more rigorous product quality requirements. As such, there are strong motivators to introduce new, more effective, inspection technologies that will help enable stone processors to reduce costs, improve quality and improve productivity. Natural stone surfaces may contain a mixture of complex two-dimensional (2D) patterns and three-dimensional (3D) features. The challenge in terms of automated inspection is to develop systems able to reliably identify 3D topographic defects, either naturally occurring or resulting from polishing, in the presence of concomitant complex 2D stochastic colour patterns. The resulting real-time analysis of the defects may be used in adaptive process control, in order to avoid the wasteful production of defective product. An innovative approach, using structured light and based upon an adaptation of the photometric stereo method, has been pioneered and developed at UWE to isolate and characterize mixed 2D and 3D surface features. The method is able to undertake tasks considered beyond the capabilities of existing surface inspection techniques. The approach has been successfully applied to real stone samples, and a selection of experimental results is presented.

  1. Stone composition and metabolic status.

    Science.gov (United States)

    Bibilash, B S; Vijay, Adarsh; Fazil Marickar, Y M

    2010-06-01

    This paper aims to study the correlation between biochemical risk factors of the stone former and the type of oxalate stone formed, namely calcium oxalate monohydrate (COM) and calcium oxalate dehydrate (COD). A retrospective study of 487 patients who had been attending the urinary stone clinic, Trivandrum during 1998-2007 was conducted. The stones retrieved from them were subjected to chemical analysis and FTIR spectrographic analysis. They were categorized into COM, COD, mixed COM+COD and others. Of 142 pure calcium oxalate stone patients, 87 were predominantly COM stone formers and 55 COD stone formers. Their metabolic status of 24 h urine and serum was assessed. The values of urine calcium, phosphorus, uric acid, magnesium, creatinine, oxalate, citric acid, sodium and potassium, serum values of calcium, phosphorus, uric acid, magnesium and creatinine and calculated values of creatinine clearance, tubular reabsorption of phosphate, calcium magnesium ratio and calcium oxalate ratio were recorded. Comparison was made between the COM stone group and the COD stone group. Patients forming COM stones had significantly higher mean values for urine calcium (P stone forming patients. All other values failed to show significant difference. Patients, with higher urine oxalate, formed COM stones. Those with low magnesium (which is an inhibitor) formed more of COD stones. Urine calcium was high in both groups without showing significant variation from the mean. In patients with high calcium-oxalate and calcium-magnesium ratios, there is higher chance of forming a COD stone than COM. Identification of the crystallization pattern of the calcium stone will help in selecting treatment modalities.

  2. [Massive residual stones after ESWL for staghorn cystine calculi were completely dissolved by oral administration of alkaline citrate: a case report].

    Science.gov (United States)

    Nagashima, Masazumi; Udagawa, Koichi; Fujinami, Kiyoshi; Murai, Tetsuo; Noguchi, Kazumi

    2007-11-01

    A 62-year-old woman was referred to our hospital for bilateral renal stones. Ultrasonography (US) and computed tomography (CT) revealed bilateral staghorn calculi and atrophic left kidney. She had extracorporeal shock-wave lithotripsy (ESWL) for right renal stone during the first 6 months. However, ESWL was not effective and the patient did not want to continue this treatment. Her stone was composed of cystine. We started oral administration of alkaline citrate. Then massive residual stones were completely dissolved during the next 32 months.

  3. Predictors of success after extracorporeal shock wave lithotripsy (ESWL) for renal calculi between 20-30 mm: a multivariate analysis model.

    Science.gov (United States)

    El-Assmy, Ahmed; El-Nahas, Ahmed R; Abo-Elghar, Mohamed E; Eraky, Ibrahim; El-Kenawy, Mahmoud R; Sheir, Khaled Z

    2006-03-23

    The first-line management of renal stones between 20-30 mm remains controversial. The Extracorporeal Shock Wave Lithotripsy (ESWL) stone-free rates for such patient groups vary widely. The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL in such controversial groups. Between January 1990 and January 2004, 594 patients with renal stones 20-30 mm in length underwent ESWL monotherapy. Stone surface area was measured for all stones. The results of treatment were evaluated after 3 months of follow-up. The stone-free rate was correlated with stone and patient characteristics using the Chi-square test; factors found to be significant were further analyzed using multivariate analysis. Repeat ESWL was needed in 56.9% of cases. Post-ESWL complications occurred in 5% of cases and post-ESWL secondary procedures were required in 5.9%. At 3-month follow-up, the overall stone-free rate was 77.2%. Using the Chi-square test, stone surface area, location, number, radiological renal picture, and congenital renal anomalies had a significant impact on the stone-free rate. Multivariate analysis excluded radiological renal picture from the logistic regression model while other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. A regression analysis model was designed to estimate the probability of stone-free status after ESWL. The sensitivity of the model was 97.4%, the specificity 90%, and the overall accuracy 95.6%. Stone surface area, location, number, and congenital renal anomalies are prognostic predictors determining stone clearance after ESWL of renal calculi of 20-30 mm. High probability of stone clearance is obtained with single stone ESWL in such controversial groups and can define patients who would need other treatment modality.

  4. Predictors for kidney stones recurrence following extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL).

    Science.gov (United States)

    Chongruksut, Wilaiwan; Lojanapiwat, Bannakij; Tawichasri, Chamaiporn; Paichitvichean, Somboon; Euathrongchit, Jantima; Ayudhya, Vorvat Choomsai Na; Patumanond, Jayanton

    2012-03-01

    Stone recurrence after extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) are common. Predictors for kidney stones vary among populations and areas. To determine predictors for kidney stones recurrence after ESWL or PCNL. A retrospective cohort study was conducted at a university hospital. The study cohort was patients aged more than 18 years, diagnosed with kidney stones, who were treated with ESWL or PCNL between 2006 and 2009. Medical files were reviewed for clinical profiles, stone characteristics, composition, type of treatment, presence of stone after treatment, stone reappearance, and related laboratory data. Predictors were determined by a multivariable poisson regression and presented as incidence rate ratios (IRRs) with 95% confidence interval. From a cohort of 252 patients, 240 who had at least one follow-up and with complete plain kidney ureters and bladder (KUB) film or intravenous pyelogram (IVP) were included in analysis. At three years, the total incidence rate of recurrence was 46 per 1,000 person-months. After a multivariable poisson regression clustering by type of stone composition, independent predictors for stone recurrence were age ESWL treatment (adjusted IRR = 2.1, 95% CI = 2.1-2.2, p < 0.001), stones located in lower calyx as compared to renal pelvis (adjusted IRR = 8.7, 95% CI = 2.9-25.9, p = 0.001), multiple stones (adjusted IRR = 5.9, 95% CI = 4.8-7.5, p < 0.001), and stone size larger than 20 mm (adjusted IRR = 1.4, 95% CI = 1.2-1.6, p < 0.001). After stone removals, patients with these predictors should closely be followed up for regular clinical evaluations.

  5. Two pelvises, one stone: A different approach for management of ...

    African Journals Online (AJOL)

    M. Elhadi

    2017-12-13

    Dec 13, 2017 ... Abstract. Duplex renal collecting systems are a common congenital abnormality. Management of renal calculi in patients with this abnormality is complex. We describe a patient with a duplex collecting system presenting with a renal calculus. Initial flexible ureteroscopy failed to reach the collecting system ...

  6. Lower Pole Calyceal Stone and Lithotripsy are Issues with Clearance Fact or Reality?

    Directory of Open Access Journals (Sweden)

    M. Hammad Ather

    2013-12-01

    Full Text Available The lower pole calyceal (LPC stone continues to be an enigma. The complex anatomy of the lower pole collecting system, along with other factors like acute pelvi calyceal angle and narrow and long infundibulum, are some of the complicating factors affecting stone clearance. There have been many studies assessing the impact of collecting system anatomy and most conclude that the complex anatomy of the lower pole collecting system does impact the overall stone-free rate.

  7. Diagnosis of obstruction and stone passage after extracorporeal shock-wave lithotripsy (ESWL)

    Energy Technology Data Exchange (ETDEWEB)

    Vorwerk, D.; Auffermann, W.; Fischer, N.

    1987-09-01

    78 patients with ureteral formations of stone fragments after ESWL therapy have been controlled by both ultrasound and plain abdominal films. Detection of renal stone fragments was possible similarly by sonography or radiographs. The plain films demonstrated well location and length of the 'Steinstrasse', which did not necessarily cause obstruction. Combination of sonography and plain abdominal film allows an easy follow-up after ESWL therapy, so i.v. urogramm is not acquired routinely.

  8. The diagnosis of obstruction and stone passage after extracorporeal shock-wave lithotripsy (ESWL)

    International Nuclear Information System (INIS)

    Vorwerk, D.; Auffermann, W.; Fischer, N.; Technische Hochschule Aachen

    1987-01-01

    78 patients with ureteral formations of stone fragments after ESWL therapy have been controlled by both ultrasound and plain abdominal films. Detection of renal stone fragments was possible similarly by sonography or radiographs. The plain films demonstrated well location and length of the 'Steinstrasse', which did not necessarily cause obstruction. Combination of sonography and plain abdominal film allows an easy follow-up after ESWL therapy, so i.v. urogramm is not acquired routinely. (orig.) [de

  9. Childhood bladder stones-an endemic disease of developing countries

    International Nuclear Information System (INIS)

    Lal, B.

    2015-01-01

    Bladder calculi are one of the commonest health problems in young children especially in rural and underprivileged areas. Methods: All children of bladder stones operated at District Headquarter Hospital Mithi from July 2009 to June 2012 were included in this cross-sectional study. Data was collected regarding age, sex, address (rural or urban), body weight, duration of breast feeding, weaning, detailed dietary history regarding milk type, volume, amount of water intake, recurrent diarrhoea, urinary tract infection (UTI), family history, and socioeconomic history. Urine analysis, complete blood count (CBC), renal function, ultra sound abdomen, X-ray kidney, ureter, and bladder (KUB) was done in all patients. All patients had cystolithotomy and were followed up till complete recovery. Results: A total of 113 children (97 males and 16 females) operated at District Headquarter Hospital Mithi Tharparker were included in study. All patients belonged to local desert areas of Tharparker. Age ranged from 18 months to 14 year (mean age 8.6 year). Most frequent symptom was difficulty in micturition in 76 (67.25%) patients, urinary retention in 18 (15.9%) and stone with pyuria and fever in 12 (10.6%) patients. Recurrent episodes of diarrhoea (more than 3 episodes per year) in 73(65%) patients, recurrent UTI in 51 (45.6%), family history of stone disease in 6 (5%) and associated rectal prolapse in 3(2.6%) patients. On x-ray KUB 111 (98%) patients had single stone in bladder, 2 (2%) had multiple stones and an associated renal and ureteric stone in 5 (4.5%). Mild anaemia (Hb 7-10 gm%) was seen in 35 (39.55%) patients, moderate anaemia (Hb 5-7 gm %) was seen in 21(24%) and severe anaemia (Hb less than 5 gm%) was seen in 14 (16%) patients. All patients had open cystolithotomy for removal of stones under general anaesthesia. Conclusion: Bladder stones are public health problem. Majority of affected patients were less than 5 years old. Low protein diet, dehydration, use of goat milk

  10. Relationship Between Ureteral Jet Flow, Visual Analogue Scale, and Ureteral Stone Size.

    Science.gov (United States)

    Ongun, Sakir; Teken, Abdurrazak; Yılmaz, Orkun; Süleyman, Sakir

    2017-06-01

    To contribute to the diagnosis and treatment of ureteral stones by investigating the relationship between the ureteral jet flow measurements of patients with ureteral stones and the size of the stones and the patients' pain scores. The sample consisted of patients who presented acute renal colic between December 2014 and 2015 and from a noncontrast computed tomography were found to have a urinary stone. The ureteral jet flow velocities were determined using Doppler ultrasonography. The patients were all assessed in terms of stone size, localization and area, anteroposterior pelvis (AP) diameter, and visual analogue scale (VAS) scores. A total of 102 patients were included in the study. As the VAS score decreased, the peak jet flow velocity on the stone side increased, whereas the flow velocity on the other side, AP diameter, and stone area were reduced (P flow velocity was reduced and the AP diameter increased significantly (P flow was not observed in 17 patients on the stone side. A statistically significant difference was found between these patients and the remaining patients in terms of all parameters (P flow velocity of ureteral jet is low and with a severe level of pain or the peak flow velocity of ureteral jet cannot be measured, there is a low possibility of spontaneous passage and a high possibility of a large stone, and therefore the treatment should be started immediately. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Comparison of ESWL and ureteroscopic holmium laser lithotripsy in management of ureteral stones.

    Science.gov (United States)

    Cui, Yon; Cao, Wenzhou; Shen, Hua; Xie, Jianjun; Adams, Tamara S; Zhang, Yuanyuan; Shao, Qiang

    2014-01-01

    There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones. To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones. Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8-15 mm) were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared. Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive. ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.

  12. Comparison of ESWL and ureteroscopic holmium laser lithotripsy in management of ureteral stones.

    Directory of Open Access Journals (Sweden)

    Yon Cui

    Full Text Available BACKGROUND: There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones. OBJECTIVE: To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones. METHODS: Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8-15 mm were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared. RESULTS: Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive. CONCLUSION: ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.

  13. [Clinical analysis of percutaneous nephrolithotomy for staghorn calculi with different stone branch number].

    Science.gov (United States)

    Qi, Shi-yong; Zhang, Zhi-hong; Zhang, Chang-wen; Liu, Ran-lu; Shi, Qi-duo; Xu, Yong

    2013-12-01

    To investigate the impact of staghorn stone branch number on outcomes of percutaneous nephrolithotomy (PNL). From January 2009 to January 2013, the 371 patients with staghorn stones who were referred to our hospital for PNL were considered for this study. All calculi were showed with CT 3-dimentional reconstruction (3-DR) imaging. The computerized database of the patients had been reviewed. Our exclusion criterion was patients with congenital renal anomalies, such as horse-shoe and ectopic kidneys. And borderline stones that branched to one major calyx only were also not included. From 3-DR images, the number of stone branching into minor renal calices was recorded. We made "3" as the branch breakdown between groups. And the patients were divided into four groups. The number of percutaneous tract, operative time, staged PNL, intra-operative blood loss, complications, stone clearance rate, and postoperative hospital day were compared. The 371 patients (386 renal units) underwent PNL successfully, included 144 single-tract PNL, 242 multi-tract PNL, 97 staged PNL. The average operative time was (100 ± 50) minutes; the average intra-operative blood loss was (83 ± 67) ml. The stone clearance rate were 61.7% (3 days) and 79.5% (3 months). The postoperative hospital stay was (6.9 ± 3.4) days. A significantly higher ratio of multi-tract (χ(2) = 212.220, P PNL (χ(2) = 49.679, P PNL for calculi with stone branch number ≥ 5. There was no statistically meaningful difference among the 4 groups based on Clavien complication system (P = 0.460). The possibility of multi-tract and staged PNL, lower rate of stone clearance and longer postoperative hospital day increase for staghorn calculi with stone branch number more than 5.

  14. The twelve colourful stones

    International Nuclear Information System (INIS)

    Doria, R.M.

    1984-01-01

    The gauge symmetry is extended. It is associated differents matter and gauge fields to the same group. A group of gauge invariant Lagrangians is established. A gauge invariant mass term is introduced. A massive Yang Mills is obtained. A dynamics with twelve colourful stones is created based on the concepts of gauge and colour. Structures identified as quarks and leptons are generated. A discussion about colour meaning is presented. (Author) [pt

  15. Anholt Rosetta Stones

    DEFF Research Database (Denmark)

    Trempe Jr., Robert B.; Buthke, Jan

    2017-01-01

    This book records and celebrates the research finding of Anholt Island by students from Studio 2B, Arkitektskolen Aarhus, These mahogany constructions are our architectural versions of a Rosetta Stone. These are constructs that record layers of information about Anholt island through virtual and ...... on Anholt Island through qualitative means. They are tools for uncovering realities previously unseen or unimagined through the manipulation of data via personal experience....

  16. Lessons from a Stone Farm

    Science.gov (United States)

    Kavanagh, John P.; Rao, P. Nagaraj

    2007-04-01

    The stone farm is a system for measuring macroscopic stone growth of 12 calcium stones simultaneously. It is based on mixed suspension, mixed product removal continuous crystallization principles and the stones are grown continuously for about 500 hours or more. The growth of the stones follows a surface area dependent pattern and the growth rate constants are very similar irrespective of whether the stating materials are fragments of human stone or pieces of marble chip. Increasing citrate from 2mM to 6mM caused a significant growth inhibition which persisted in the presence of urinary macromolecules. Phytate was a very effective inhibitor (about 50% at sub-μM concentrations) but the effective concentration was increased by an order of magnitude in the presence of urinary macromolecules. The effective concentration for inhibition in a crystallization assay was a further two orders of magnitude higher. Urinary macromolecules or almost whole urine were also strongly inhibitory although neither human serum albumin nor bovine mucin had any great effect. The relationship between the size distribution of crystals in suspension and the stone enlargement rate suggests that the primary enlargement mechanism for these in vitro stones is through aggregation. The stone farm is a powerful tool with which to study crystallization inhibitors in a new light. Some differences between inhibition of crystallization and inhibition of stone growth have emerged and we have obtained quantitative evidence on the mechanism of stone enlargement in vitro. Our findings suggest that the interface between crystals in suspension and the stone surface is the key to controlling stone enlargement.

  17. A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi.

    Science.gov (United States)

    Wiesenthal, Joshua D; Ghiculete, Daniela; Ray, A Andrew; Honey, R John D'A; Pace, Kenneth T

    2011-08-01

    Although shock wave lithotripsy is dependent on patient and stone related factors, there are few reliable algorithms predictive of its success. In this study we develop a comprehensive nomogram to predict renal and ureteral stone shock wave lithotripsy outcomes. During a 5-year period data from patients treated at our lithotripsy unit were reviewed. Analysis was restricted to patients with a solitary renal or ureteral calculus 20 mm or less. Demographic, stone, patient, treatment and 3-month followup data were collected from a prospective database. All patients were treated using the Philips Lithotron® lithotripter. A total of 422 patients (69.7% male) were analyzed. Mean stone size was 52.3±39.3 mm2 for ureteral stones and 78.9±77.3 mm2 for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single treatment success rates for ureteral and renal stones were 60.3% and 70.2%, respectively. On univariate analysis predictors of shock wave lithotripsy success, regardless of stone location, were age (p=0.01), body mass index (p=0.01), stone size (pstone density (pstone distance (pstone area and skin to stone distance were significant predictors with an AUC of 0.75. For ureteral calculi predictive factors included body mass index and stone size (AUC 0.70). Patient and stone parameters have been identified to create a nomogram that predicts shock wave lithotripsy outcomes using the Lithotron lithotripter, which can facilitate optimal treatment based decisions and provide patients with more accurate single treatment success rates for shock wave lithotripsy tailored to patient specific situations. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  18. A Giant Ureteral Stone without Underlying Anatomic or Metabolic Abnormalities: A Case Report

    Directory of Open Access Journals (Sweden)

    Selcuk Sarikaya

    2013-01-01

    Full Text Available A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux.

  19. Journey of a cystinuric patient with a long-term follow-up from a medical stone clinic: necessity to be SaFER (stone and fragments entirely removed).

    Science.gov (United States)

    Moore, Sacha L; Somani, Bhaskar K; Cook, Paul

    2018-04-25

    There is a lack of studies looking at the longitudinal follow-up of patients with cystine stones. We wanted to assess the journey of cystinuric patients through our specialist metabolic stone clinic to improve the understanding of episodes, interventions and current outcomes in this patient cohort. After ethical approval, all patients who attended our metabolic stone clinic from 1994 to 2014 with at least one cystine stone episode were included in our study. Data were retrospectively analysed for patient demographics, stone episodes or intervention, clinical parameters and patient compliance. Over a period of 21 years, 16 patients with a median age of 15.5 years underwent a mean follow-up of 8.6 years (1-21 years). The mean number of surgical interventions was 3.1 (1-8/patient), but patients who were stone free after their first treatment had lower recurrences (p = 0.91) and lower number of interventions during their follow-up (2.7/patient, compared to those who were not stone free at 4/patient). During their follow-up period, patients with stone episodes (r 2  = 0.169). It was also noted that patients who began early medical management remained stone free during follow-up compared to those who had medical management after ≥ 2 stone episodes, of whom all had a recurrent episode. Our long-term longitudinal study of cystine stone formers highlights that patients who are stone free and receive early metabolic stone screening and medical management after their initial presentation have the lowest recurrence rates and tend to preserve their renal function. Hence, prompt referral for metabolic assessment, and the stone and fragments entirely removed (SaFER) principles are key to preventing stone episodes and improving long-term function.

  20. Imaging of renal osteodystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Jevtic, V. E-mail: vladimir.jevtic@mf.uni-lj.si

    2003-05-01

    Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination.

  1. Imaging of renal osteodystrophy

    International Nuclear Information System (INIS)

    Jevtic, V.

    2003-01-01

    Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination

  2. Impact of stone branch number on outcomes of percutaneous nephrolithotomy for treatment of staghorn calculi.

    Science.gov (United States)

    Qi, Shiyong; Li, Li; Liu, Ranlu; Qiao, Baomin; Zhang, Zhihong; Xu, Yong

    2014-02-01

    To determine the impact of staghorn calculi branch number on outcomes of percutaneous nephrolithotomy (PNL). Retrospectively, we evaluated 371 patients (386 renal units) who underwent PNL for staghorn calculi. All calculi were showed with CT three-dimensional reconstruction (3DR) imaging preoperatively. From 3DR images, the number of stone branching into minor renal calices was recorded. According to the number, patients were divided into four groups. Group 1: the branch number 2-4; Group 2: the branch number 5-7; Group 3: the branch number 8-10; Group 4: the branch number >10. The number of percutaneous tract, operative time, staged PNL, intraoperative blood loss, postoperative hospital stay, complications, main stone composition, and stone clearance rate were compared. A significantly higher ratio of multitract (pPNL (pPNL for calculi with a stone branch number ≥5. There was no statistical difference in intraoperative blood loss (p=0.101) and main stone composition (p=0.546). There was no statistically meaningful difference among the four groups based on the Clavien complication system (p=0.46). With the stone branch number more than five, the possibility of multitract and staged PNL, lower rate of stone clearance, and a longer postoperative hospital stay increases for staghorn calculi.

  3. Should flexible ureteroscope be added to our armamentarium to treat stone disease?

    Directory of Open Access Journals (Sweden)

    Anand Dharaskar

    2008-01-01

    Full Text Available The field of Urology in Medicine has witnessed tremendous advancement in technology and in accordance with it. Endourology has taken a leap ahead in terms of stone management. Most of the stones could be treated with semi-rigid ureteroscopy, percutaneous nephrolithotomy (PNL and ESWL and some would need Flexible ureteroscopy. Flexible ureteroscopy has been primarily indicated to treat ESWL resistant renal stones but with changes in the technology of incorporating secondary active deflection and availability of laser fibres, its horizon for indications to treat stones is being widened. Though Flexible ureteroscopy is being used to treat stones of various sizes and locations, its cost effectiveness is debatable. Should it be used ubiquitously to treat stones amenable to PNL or ESWL is a big question we need to answer. As of now true indications of Flexible ureteroscopy are limited and there is an urgent need for a randomized trial to compare its efficacy with ESWL and PNL for renal and upper ureteric stones.

  4. Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for moderate sized kidney stones.

    Science.gov (United States)

    Deem, Samuel; Defade, Brian; Modak, Asmita; Emmett, Mary; Martinez, Fred; Davalos, Julio

    2011-10-01

    To compare the outcomes of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) for moderate sized (1-2 cm) upper and middle pole renal calculi in regards to stone clearance rate, morbidity, and quality of life. All patients diagnosed with moderate sized upper and middle pole kidney stones by computed tomography (CT) were offered enrollment. They were randomized to receive either ESWL or PNL. The SF-8 quality of life survey was administered preoperatively and at 1 week and 3 months postoperatively. Abdominal radiograph at 1 week and CT scan at 3 months were used to determine stone-free status. All complications and outcomes were recorded. PNL established a stone-free status of 95% and 85% at 1 week and 3 months, respectively, whereas ESWL established a stone-free status of 17% and 33% at 1 week and 3 months, respectively. Retreatment in ESWL was required in 67% of cases, with 0% retreatment in PNL. Stone location, stone density, and skin-to-stone distance had no impact on stone-free rates at both visits, irrespective of procedure. Patient-reported outcomes, including overall physical and mental health status, favored a better quality of life for patients who had PNL performed. PNL more often establishes stone-free status, has a more similar complication profile, and has similar reported quality of life at 3 months when compared with ESWL for moderate-sized kidney stones. PNL should be offered as a treatment option to all patients with moderate-sized kidney stones in centers with experienced endourologists. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Bilateral same-session ureterorenoscopy: A feasible approach to treat pan-urinary stone disease

    Directory of Open Access Journals (Sweden)

    Bora Özveren

    2017-12-01

    Full Text Available Objectives: To assess treatment effectiveness and safety of bilateral same-session ureterorenoscopy (BSSU for the management of stone disease involving the entire urinary system. Patients and methods: We reviewed the records of 64 patients who underwent BSSU for the treatment of bilateral ureteric and/or kidney stones. Size, number, location per side, and the total burden of stones were recorded. Data on stenting, lithotripsy, and stone retrieval, and details of hospital stay and operation times were investigated. Treatment results were assessed using intraoperative findings and postoperative imaging. The outcome was considered successful in patients who were completely stone-free or who had only residual fragments of ≤2 mm. Results: The outcome was successful in 82.8% of the patients who received BSSU (54.7% stone-free and 28.1% insignificant residual fragments. The success rate per renal unit was 89.8%. There were no adverse events in 73.4% of the patients. The most common intraoperative complication was mucosal injury (36%. The complications were Clavien–Dindo Grade I in 9.4% and Grade II in 7.8%. Grade IIIa and IIIb (9.4% complications required re-treatments. Statistical evaluation showed no association between complication grades and stone, patient, or operation features. Stone burden had no negative impact on BSSU results. The presence of impacted proximal ureteric stones was significantly related to unsuccessful outcomes. Conclusion: BSSU is safe and effective for the management of bilateral urolithiasis. BSSU can prevent recurrent surgeries, reduce overall hospital stay, and achieve a stone-free status and complication rates that are comparable to those of unilateral or staged bilateral procedures. Keywords: Ureteroscopy, Bilateral, Kidney stones, ureter stones, Flexible ureterorenoscopy, Treatment outcomes

  6. Effect of Stone Size and Composition on Ultrasonic Propulsion Ex Vivo.

    Science.gov (United States)

    Janssen, Karmon M; Brand, Timothy C; Bailey, Michael R; Cunitz, Bryan W; Harper, Jonathan D; Sorensen, Mathew D; Dunmire, Barbrina

    2018-01-01

    To evaluate in more detail the effectiveness of a new designed more efficient ultrasonic propulsion for large stones and specific stone compositions in a tissue phantom model. In the first clinical trial of noninvasive ultrasonic propulsion, urinary stones of unknown compositions and sizes up to 10 mm were successfully repositioned. The study included 8- to 12-mm stones of 4 different primary compositions (calcium oxalate monohydrate, ammonium acid urate, calcium phosphate, and struvite) and a renal calyx phantom consisting of a 12 mm × 30 mm well in a 10-cm block of tissue-mimicking material. Primary outcome was the number of times a stone was expelled over 10 attempts, with ultrasonic propulsion burst duration varying from 0.5 seconds to 5 seconds. Overall success rate at expelling stones was 95%. All calcium oxalate monohydrate and ammonium acid urate stones were expelled 100% of the time. The largest stone (12 mm) became lodged within the 12-mm phantom calyx 25% of the time regardless of the burst duration. With the 0.5-second burst, there was insufficient energy to expel the heaviest stone (0.88 g), but there was sufficient energy at the longer burst durations. With a single burst, ultrasonic propulsion successfully moved most stones at least 3 cm and, regardless of size or composition, expelled them from the calyx. Ultrasonic propulsion is limited to the stones smaller than the calyceal space, and for each burst duration, related to maximum stone mass. Published by Elsevier Inc.

  7. Expression and clinical value of the soluble major histocompatibility complex class I-related chain A molecule in the serum of patients with renal tumors.

    Science.gov (United States)

    Zhao, Y-K; Jia, C-M; Yuan, G-J; Liu, W; Qiu, Y; Zhu, Q-G

    2015-06-29

    We investigated the expression and clinical value of the soluble major histocompatibility complex class I-related chain A (sMICA) molecule in the serum of patients with renal tumors. Sixty patients diagnosed with renal tumors were enrolled in the experimental group, whereas 20 healthy volunteers served as the control group. The sMICA levels were measured via enzyme-linked immunosorbent assay, and the results were analyzed in combination with data from pathol-ogy examination. The experimental group had a statistically significant higher sMICA level (P < 0.05) than the control group. The sMICA level was higher in patients with malignant tumors than in those with be-nign tumors. We also observed a positive relationship among different tumor-node-metastasis (TNM) pathological stages with more advanced diseases exhibiting higher sMICA levels. As a tumor-associated antigen, MICA has a close relationship with renal tumorigenesis and immune es-cape. Our results indicated that sMICA levels were related to tumor pathol-ogy, TNM stage, and metastasis. Therefore, sMICA might be a potential marker for tumor characteristics, prognosis, and recurrence prediction.

  8. Comparison of the significance of the RENAL, PADUA, and C-index nephrometric scales for the prediction of the complexity of laparoscopic nephrectomy

    Directory of Open Access Journals (Sweden)

    Yu. G. Alyaev

    2018-01-01

    Full Text Available Objective: to compare the predictive value of RENAL, PADUA, C-index nephrometry score systems according to projection of complexity  of operative measure in terms of warm ischaemic time, extent of blood loss and rate of postoperative complications.Materials and methods. Information for the research was collected from 314 patients with localized kidney cancer, who had laparoscopic partial nephrectomy from January 2012 to May 2017. In 210 (66.8 % cases, in addition to the routine examinations, 3D modelling and operative measure planning were carried out. The average tumor volume of the patients was equal to 62.5 ± 33.5 mm3. All patients before  the operation were estimated the complexity of operative measure on the nephrometry score systems: PADUA, RENAL, C-index. The average sum of balls according to scale RENAL – 7.56 ± 1.12, on scale PADUA – 7.98 ± 1.55, on scale C-index – 2.76 ± 1.14. Then in retrospect by the method of logistic regression analysis was determined predictive value of RENAL, PADUA, C-index nephrometry score systems for prediction of warm ischaemic time, duration of operative measure, extent of intraoperative blood loss and possibility of rate of postoperative complications.Results. In 265 (84.4 cases transperitoneal approach was perfomed and in 49 (15.6 % cases it was retroperitoneal approach. The average time of laparoscopic partial nephrectomy is 140.15 ± 55.8 min, the average time of ischaemic warm is 13.35 ± 7,65 min. The average extent of blood loss during the laparoscopic partial nephrectomy is 291.95 ± 196.5 ml. Intraoperative complications were found in 8 (2.54 % cases. Postoperative complications were estimated according to the Clavien–Dindo classification of surgical complications and were found in 31  (9.9 % cases, among them 12 (3.8 % patients had surgical complications. The index of the RENAL nephrometry scoring system had the highest predictive value in the multivariant analysis for warm ischaemic

  9. The economics of stone disease.

    Science.gov (United States)

    Canvasser, Noah E; Alken, Peter; Lipkin, Michael; Nakada, Stephen Y; Sodha, Hiren S; Tepeler, Abdulkadir; Lotan, Yair

    2017-09-01

    The rising prevalence of kidney stone disease is associated with significant costs to healthcare systems worldwide. This is in part due to direct procedural and medical management costs, as well as indirect costs to health systems, patients, and families. A number of manuscripts evaulating the economics of stone disease have been published since the 2008s International Consultation on Stone Disease. These highlight costs associated with stone disease, including acute management, surgical management, and medical management. This work hopes to highlight optimization in care by reducing inefficient treatments and maximizing cost-efficient preventative strategies.

  10. Villamayor stone (Golden Stone) as a Global Heritage Stone Resource from Salamanca (NW of Spain)

    Science.gov (United States)

    Garcia-Talegon, Jacinta; Iñigo, Adolfo; Vicente-Tavera, Santiago

    2013-04-01

    Villamayor stone is an arkosic stone of Middle Eocene age and belongs to the Cabrerizos Sandstone Formation that comprising braided fluvial systems and paleosoils at the top of each stratigraphic sequence. The sandstone is known by several names: i) the Villamayor Stone because the quarries are located in Villamayor de Armuña village that are situated at 7 km to the North from Salamanca city; ii) the Golden Stone due to its patina that produced a ochreous/golden color on the façades of monuments of Salamanca (World Heritage City,1988) built in this Natural stone (one of the silicated rocks utilised). We present in this work, the Villamayor Stone to be candidate as Global Heritage Stone Resource. The Villamayor Stone were quarrying for the construction and ornamentation of Romanesque religious monuments as the Old Cathedral and San Julian church; Gothic (Spanish plateresc style) as the New Cathedral, San Esteban church and the sculpted façade of the Salamanca University, one of the oldest University in Europe (it had established in 1250); and this stone was one of the type of one of the most sumptuous Baroque monuments is the Main Square of the its galleries and arcades (1729). Also, this stone was used in building palaces, walls and reconstruction of Roman bridge. Currently, Villamayor Stone is being quarried by small and family companies, without a modernized processing, for cladding of the façades of the new buildings until that the construction sector was burst (in 2008 the international economic crisis). However, Villamayor Stone is the main stone material used in the city of Salamanca for the restoration of monuments and, even in small quantities when compared with just before the economic crisis, it would be of great importance for future generations protect their quarries and the craft of masonry. Villamayor Stone has several varieties from channels facies to floodplains facies, in this work the selected varieties are: i) the fine-grained stone

  11. Obstructive uropathy and acute renal failure due to ureteral calculus in renal graft: a case report.

    Science.gov (United States)

    Lusenti, T; Fiorini, F; Barozzi, L

    2009-09-01

    Obstructive uropathy caused by kidney stones is quite rare in transplant kidneys. The authors report the case of a patient, previously gastrectomized for gastric carcinoma. He underwent renal transplantation using uretero-ureterostomy, and presented an episode of acute renal failure 7 years after surgery. Ultrasound (US) examination showed no sign of rejection but allowed detection of moderate hydronephrosis in the transplant kidney. Subsequent computed tomography (CT) revealed a kidney stone in the middle ureter at the crossing of the iliac vessels. The patient therefore urgently underwent percutaneous nephrostomy of the graft and recovered diuresis and renal function. The patient was transferred to the Transplant Center where he underwent ureterotomy with removal of the stone and subsequent ureteropyelostomy. Also transureteral resection of the prostate (TURP) was performed due to urinary retention of prostatic origin. Histological examination showed prostate carcinoma, Gleason stage 3, which was treated conservatively using radiotherapy without suspension of the administered low dose of immunotherapy. Calculosis is one of the least common causes of obstructive uropathy in transplant kidneys. In the described case, US examination performed after onset of renal insufficiency led to subsequent radiological investigation and resulting interventional procedures (nephrostomy and surgical removal of the stone) with complete recovery of pre-existing renal function.

  12. A study on the industrialization of building stones and industrial stone crafts - Study on the causes of stone contaminations

    Energy Technology Data Exchange (ETDEWEB)

    Hyun, Jeon Ki; Lee, Han Yeang [Korea Institute of Geology Mining and Materials, Taejon (Korea, Republic of)

    1996-12-01

    Causes of building stone contamination are acid rains in polluted areas, iron bearing minerals in stone itself, salts, sealants, cutting and grinding processes in stone factory and steel compounds structures such as stone anchors, bolts, rain culvert and guide frames. Contaminations on the building stone surface of Sejong culture center can be found around floor stones, stair stones, parterre stones, pillar stones and other outdoor stone panels. The parterre stones are contaminated by white tarnishes and rust flows are occurred on the surface of pillar stones and outdoor stone panels around entrance. Black tarnishes are cumulated on the pillar stones and other outdoor decorated stone panels and change the original granite color. Causes of building stone contaminations from Sejong culture center are wet method to attach stone panels, rust from steel compounds structures and air pollutants. Cement and mortar used from wet method react with sulfur dioxides in polluted air and from fine calcite crystals (white tarnish). Rusts from steel compounds structures such as rainwater culvert and steel guide frames can move to the stone surface by rain and leave rust flows on it. Pollutants (tar compounds, carbons, dusts, etc.) in air are cumulated with humidity on the stone surface and change color from white granite color to dusty dark color. Historical stone sculptures such as man and animal shaped stone crafts, tombstones, square stone tables in front of a tomb and guide and circumference stones around tomb in Royal Tombs (Donggu rung, Yung rung, Seoou rung and Hunin rung) distributed in Kyunggi province are contaminated by various moss and air pollutants and its original colors are deeply changed. (author). 21 refs., 11 tabs., 22 figs.

  13. Weathering and weathering rates of natural stone

    Science.gov (United States)

    Winkler, Erhard M.

    1987-06-01

    Physical and chemical weathering were studied as separate processes in the past. Recent research, however, shows that most processes are physicochemical in nature. The rates at which calcite and silica weather by dissolution are dependent on the regional and local climatic environment. The weathering of silicate rocks leaves discolored margins and rinds, a function of the rocks' permeability and of the climatic parameters. Salt action, the greatest disruptive factor, is complex and not yet fully understood in all its phases, but some of the causes of disruption are crystallization pressure, hydration pressure, and hygroscopic attraction of excess moisture. The decay of marble is complex, an interaction between disolution, crack-corrosion, and expansion-contraction cycies triggered by the release of residual stresses. Thin spalls of granites commonly found near the street level of buildings are generally caused by a combination of stress relief and salt action. To study and determine weathering rates of a variety of commercial stones, the National Bureau of Standards erected a Stone Exposure Test Wall in 1948. Of the many types of stone represented, only a few fossiliferous limestones permit a valid measurement of surface reduction in a polluted urban environment.

  14. Application of spectroscopic techniques for the analysis of kidney stones: a pilot study

    Science.gov (United States)

    Shameem, K. M., Muhammed; Chawla, Arun; Bankapur, Aseefhali; Unnikrishnan, V. K.; Santhosh, C.

    2016-03-01

    Identification and characterization of kidney stone remains one of the important analytical tasks in the medical field. Kidney stone is a common health complication throughout the world, which may cause severe pain, obstruction and infection of urinary tract, and can lead to complete renal damage. It commonly occurs in both sexes regardless of age. Kidney stones have different composition, although each stones have a major single characteristic component. A complete understanding of a sample properties and their function can only be feasible by utilizing elemental and molecular information simultaneously. Two laser based analytical techniques; Laser Induced Breakdown spectroscopy (LIBS) and Raman spectroscopy have been used to study different types of kidney stones from different patients. LIBS and Raman spectroscopy are highly complementary spectroscopic techniques, which provide elemental and molecular information of a sample. Q-switched Nd:YAG laser at 355 nm laser having energy 17mJ per pulse at 10 Hz repetition rate was used for getting LIBS spectra. Raman measurements were carried out using a home assembled micro-Raman spectrometer. Using the recorded Raman spectra of kidney stones, we were able to differentiate different kinds of kidney stones. LIBS spectra of the same stones are showing the evidence of C, Ca, H, and O and also suggest the presence of certain pigments.

  15. Flexible ureterorenoscopy for lower pole stones: influence of the collecting system's anatomy.

    Science.gov (United States)

    Jessen, Jan Peter; Honeck, Patrick; Knoll, Thomas; Wendt-Nordahl, Gunnar

    2014-02-01

    The impact of renal anatomy on the success rate of flexible ureterorenoscopy (fURS) for lower pole stones is less clear than it is on shock wave lithotripsy, for which it is a recognized influence factor. We analyzed safety and efficiency of fURS using modern endoscopes for lower pole stones dependent on the collecting system's configuration. We retrospectively evaluated a consecutive sample of 111 fURS for lower pole stones at our tertiary care center between January 2010 and September 2012 from our prospectively kept database. All procedures were performed with modern flexible ureterorenoscopes, nitinol baskets, holmium laser lithotripsy, and ureteral access sheaths whenever needed. The infundibular length (IL) and width (IW) and infundibulopelvic angle (IPA) were measured and the data were stratified for stone-free status and complications classified by the Clavien-Dindo scale. Univariate and multifactorial statistical analyses were performed. Correlation of operation time (OR-time) with anatomical parameters was conducted. Ninety-eight (88.3%) of the 111 patients were stone free after a single fURS. On multifactorial analysis, the stone size and IL had significant influence on the stone-free rate (SFR) (panatomy. fURS is a safe and efficient treatment option for lower pole kidney stones. A long infundibulum and a very acute IPA (anatomy.

  16. Recumbent Stone Circles

    Science.gov (United States)

    Ruggles, Clive L. N.

    During the 1970s and early 1980s, British archaeoastronomers were striving to bridge the interpretative gulf between the "megalithic observatories" of Alexander Thom and an archaeological mainstream that, generally speaking, was hostile to any mention of astronomy in relation to the megalithic monuments of Neolithic and Early Bronze Age Britain. The Scottish recumbent stone circles (RSCs) came to represent an example where sounder methodology could overcome many of the data selection issues that had beset earlier studies and, with due restraint, produce credible interpretations. Systematic studies of their orientations consistently concluded that the RSCs had a strong lunar connection, and it was widely envisaged that they were the setting for ceremonies associated with the appearance of the moon over the recumbent stone. Other evidence such as the presence of white quartz and the spatial distribution of cupmarks appeared to back up this conclusion. New archaeological investigations since 1999 have challenged and modified these conclusions, confirming in particular that the circles were built to enclose cairns rather than to demarcate open spaces. Yet the restricted pattern of orientations of these structures could only have been achieved by reference to the basic diurnal motions of the skies, and orientation in relation to simple observations of the midsummer moon remains the most likely reading of the alignment evidence taken as a whole. On the other hand, a consideration of the broader context, which includes the nearby Clava cairns, highlights instead the symbolic importance of the sun.

  17. Endoscopic Stone Measurement During Ureteroscopy.

    Science.gov (United States)

    Ludwig, Wesley W; Lim, Sunghwan; Stoianovici, Dan; Matlaga, Brian R

    2018-01-01

    Currently, stone size cannot be accurately measured while performing flexible ureteroscopy (URS). We developed novel software for ureteroscopic, stone size measurement, and then evaluated its performance. A novel application capable of measuring stone fragment size, based on the known distance of the basket tip in the ureteroscope's visual field, was designed and calibrated in a laboratory setting. Complete URS procedures were recorded and 30 stone fragments were extracted and measured using digital calipers. The novel software program was applied to the recorded URS footage to obtain ureteroscope-derived stone size measurements. These ureteroscope-derived measurements were then compared with the actual-measured fragment size. The median longitudinal and transversal errors were 0.14 mm (95% confidence interval [CI] 0.1, 0.18) and 0.09 mm (95% CI 0.02, 0.15), respectively. The overall software accuracy and precision were 0.17 and 0.15 mm, respectively. The longitudinal and transversal measurements obtained by the software and digital calipers were highly correlated (r = 0.97 and 0.93). Neither stone size nor stone type was correlated with error measurements. This novel method and software reliably measured stone fragment size during URS. The software ultimately has the potential to make URS safer and more efficient.

  18. Grasping the Formless in Stones

    DEFF Research Database (Denmark)

    Aktor, Mikael

    2017-01-01

    and the repertoire of used forms. The chapter demonstrates that neither anthropomorphic perceptions nor the agency of the stone material alone make up the ritual aesthetics in which the stones are involved. Rather, applying concepts from landscape phenomenology and cognitive theories including the role of material...

  19. Impact of Hydronephrosis on Treatment Outcome of Solitary Proximal Ureteral Stone After Extracorporeal Shock Wave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Hsi-Lin Hsiao

    2008-10-01

    Full Text Available The purpose of this study was to investigate the impact of hydronephrosis on the treatment outcome of patients with a solitary proximal ureteral stone after extracorporeal shock wave lithotripsy (ESWL. A total of 182 consecutive patients who underwent ESWL for a solitary proximal ureteral stone of between 5 and 20 mm in size in our institution were included in this study. The degree of hydronephrosis was defined by renal ultrasonography. Patient data, stone size, shock wave numbers and shock wave energy were also recorded. Treatment outcome was evaluated 3 months after the first session of ESWL. In multivariate analysis, only the maximal stone length (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03–0.91; p = 0.04 and the degree of hydronephrosis (OR, 0.40; 95% CI, 0.16–0.98; p = 0.045 were significant predicting factors for stone-free status 3 months after ESWL. For stones ≤ 10 mm, the stone-free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydro-nephrosis. For stones > 10 mm, the stone-free rate decreased further, from 65.2% in patients with mild hydronephrosis to 33.3% in those with moderate to severe hydronephrosis. In summary, patients with a solitary proximal ureteral stone and a stone > 10 mm, the treatment outcome after ESWL was not good if moderate to severe hydronephrosis was noted on ultrasonography. Alternative treatments, such as ureteroscopic lithotripsy, may be appropriate as initial treatment or after failure of one session of ESWL.

  20. Prevalence of Coronal Pulp Stones and Its Relation with Systemic Disorders in Northern Indian Central Punjabi Population

    Science.gov (United States)

    Bains, Sandeep Kumar; Bhatia, Archana; Singh, Harkanwal Preet; Biswal, Swati Swagatika; Kanth, Shashi; Nalla, Srinivas

    2014-01-01

    Aim. To estimate the prevalence of coronal pulp stones in the molar teeth of dental outpatients of Sunam, Sangrur district, Punjab, India, to report any association between occurrence of pulp stones with age, gender, dental arch, side, and dental status and to find out correlation between pulp stones with dental and systemic diseases. Materials and Methods. 500 routine dental outpatients within age group of 18–67 years were involved in the study. Molar bitewing of left and right side of each patient was taken with XCP bitewing instrument and size 2 film. The presence or absence of pulp stones was recorded. Chi-square analysis was used to record the prevalence of pulp stones and to compare it with demographic and systemic factors. Results. Overall prevalence of pulp stones was 41.8%. Pulp stones were significantly higher in maxilla (11.59%) than mandible (6.54%), left side than right side, and first molar than other molars. Higher numbers of pulp stones were recorded in patients with cardiovascular disease (38.89%) than with cholelithiasis and renal lithiasis. Conclusion. Pulp stones were higher in maxillary arch than mandibular arch and in females than males. Cardiovascular patients had higher number of pulp stones than other groups. PMID:24944821

  1. The Effect of Tamsulosin in the Medical Treatment of Distal Ureteral Stones

    Science.gov (United States)

    Alizadeh, M.; Magsudi, M.

    2014-01-01

    Introduction: Renal stones are common disorders that affect approximately 5% to 10% of the population and the incidence of renal stones is rising. Treatment of ureteral stones is an important part of urologists and minimally invasive procedures such as ESWL and ureteroscopy effectiveness has been proven in various studies. However, these methods are not completely safe and are expensive and can be complicated. Purpose of this study is to evaluate the effectiveness of tamsulosin in the medical treatment of distal ureteral stones. Patients and methods: A total of 96 patients with distal ureteral stones or UVj are randomly divided into two study group (50 patients) and control group (46 patients). Patients in the control group allowed to freely consuming fluids (hydration) and indomethacin 100 mg PRN. Study group in addition to indomethacin and daily analgesic 0.4 mg tamsulosin was administered. All subjects in terms of analgesic dose, duration of expulsion and expulsion were studied. Results: Spontaneous expulsion of stone was occurred in 62.5% (30 patients out of 46) of control group patients and 82% (41 patients out of 50) that there was no significant difference (P>0.05). Average time to fix the stone in control group 4.7±8.03 days (range 2 to 28 days) and in the study group, 3.7±5.70 days (range 1 to 23 days) is significantly different (P>0.05). The average amount of analgesic consumption in the control group was 2.3±4.31and in the study group was 1.48±2.15 that showed significant differences (Ptamsulosin to conservative treatment of distal ureteral stones in the distal ureteral stone expulsion showed no significant difference between the two groups, but the reduction in the duration of expulsion, reduce pain and reduce the need for analgesic has been beneficial. PMID:25363178

  2. Bath Stone - a Possible Global Heritage Stone from England

    Science.gov (United States)

    Marker, Brian

    2014-05-01

    The Middle Jurassic strata of England have several horizons of oolitic and bioclastic limestones that provide high quality dimension stone. One of the most important is found in and near the City of Bath. The Great Oolite Group (Upper Bathonian) contains the Combe Down and Bath Oolites, consisting of current bedded oolites and shelly oolites, that have been used extensively as freestones for construction nearby, for prestigious buildings through much of southern England and more widely. The stone has been used to some extent since Roman times when the city, then known as Aquae Sulis, was an important hot spa. The stone was used to a limited extent through medieval times but from the early 18th century onwards was exploited on a large scale through surface quarrying and underground mining. The City was extensively redeveloped in the 18th to early 19th century, mostly using Bath Stone, when the spas made it a fashionable resort. Buildings from that period include architectural "gems" such as the Royal Crescent and Pulteney Bridge, as well as the renovated Roman Baths. Many buildings were designed by some of the foremost British architects of the time. The consistent use of this stone gives the City an architectural integrity throughout. These features led to the designation of the City as a World Heritage Site. It is a requirement in current City planning policy documents that Bath Stone should be used for new building to preserve the appearance of the City. More widely the stone was used in major houses (e.g. Buckingham Palace and Apsley House in London; King's Pavilion in Brighton); civic buildings (e.g. Bristol Guildhall; Dartmouth Naval College in Devon); churches and cathedrals (e.g. Truro Cathedral in Cornwall); and engineered structures (e.g. the large Dundas Aqueduct on the Kennet and Avon Canal). More widely, Bath Stone has been used in Union Station in Washington DC; Toronto Bible College and the Town Hall at Cape Town, South Africa. Extraction declined in

  3. The Complexities of Interpreting Reversible Elevated Serum Creatinine Levels in Drug Development: Does a Correlation with Inhibition of Renal Transporters Exist?

    Science.gov (United States)

    Chu, Xiaoyan; Bleasby, Kelly; Chan, Grace Hoyee; Nunes, Irene; Evers, Raymond

    2016-09-01

    In humans, creatinine is formed by a multistep process in liver and muscle and eliminated via the kidney by a combination of glomerular filtration and active transport. Based on current evidence, creatinine can be taken up into renal proximal tubule cells by the basolaterally localized organic cation transporter 2 (OCT2) and the organic anion transporter 2, and effluxed into the urine by the apically localized multidrug and toxin extrusion protein 1 (MATE1) and MATE2K. Drug-induced elevation of serum creatinine (SCr) and/or reduced creatinine renal clearance is routinely used as a marker for acute kidney injury. Interpretation of elevated SCr can be complex, because such increases can be reversible and explained by inhibition of renal transporters involved in active secretion of creatinine or other secondary factors, such as diet and disease state. Distinction between these possibilities is important from a drug development perspective, as increases in SCr can result in the termination of otherwise efficacious drug candidates. In this review, we discuss the challenges associated with using creatinine as a marker for kidney damage. Furthermore, to evaluate whether reversible changes in SCr can be predicted prospectively based on in vitro transporter inhibition data, an in-depth in vitro-in vivo correlation (IVIVC) analysis was conducted for 16 drugs with in-house and literature in vitro transporter inhibition data for OCT2, MATE1, and MATE2K, as well as total and unbound maximum plasma concentration (Cmax and Cmax,u) data measured in the clinic. Copyright © 2016 by The American Society for Pharmacology and Experimental Therapeutics.

  4. Stone cladding engineering

    CERN Document Server

    Sousa Camposinhos, Rui de

    2014-01-01

    This volume presents new methodologies for the design of dimension stone based on the concepts of structural design while preserving the excellence of stonemasonry practice in façade engineering. Straightforward formulae are provided for computing action on cladding, with special emphasis on the effect of seismic forces, including an extensive general methodology applied to non-structural elements. Based on the Load and Resistance Factor Design Format (LRDF), minimum slab thickness formulae are presented that take into consideration stress concentrations analysis based on the Finite Element Method (FEM) for the most commonly used modern anchorage systems. Calculation examples allow designers to solve several anchorage engineering problems in a detailed and objective manner, underlining the key parameters. The design of the anchorage metal parts, either in stainless steel or aluminum, is also presented.

  5. Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination

    Directory of Open Access Journals (Sweden)

    Jiun-Hung Geng

    2015-01-01

    Full Text Available Urolithiasis is a common disease of the urinary system. Extracorporeal shockwave lithotripsy (SWL has become one of the standard treatments for renal and ureteral stones; however, the success rates range widely and failure of stone disintegration may cause additional outlay, alternative procedures, and even complications. We used the data available from noncontrast abdominal computed tomography (NCCT to evaluate the impact of stone parameters and abdominal fat distribution on calculus-free rates following SWL. We retrospectively reviewed 328 patients who had urinary stones and had undergone SWL from August 2012 to August 2013. All of them received pre-SWL NCCT; 1 month after SWL, radiography was arranged to evaluate the condition of the fragments. These patients were classified into stone-free group and residual stone group. Unenhanced computed tomography variables, including stone attenuation, abdominal fat area, and skin-to-stone distance (SSD were analyzed. In all, 197 (60% were classified as stone-free and 132 (40% as having residual stone. The mean ages were 49.35 ± 13.22 years and 55.32 ± 13.52 years, respectively. On univariate analysis, age, stone size, stone surface area, stone attenuation, SSD, total fat area (TFA, abdominal circumference, serum creatinine, and the severity of hydronephrosis revealed statistical significance between these two groups. From multivariate logistic regression analysis, the independent parameters impacting SWL outcomes were stone size, stone attenuation, TFA, and serum creatinine. [Adjusted odds ratios and (95% confidence intervals: 9.49 (3.72–24.20, 2.25 (1.22–4.14, 2.20 (1.10–4.40, and 2.89 (1.35–6.21 respectively, all p < 0.05]. In the present study, stone size, stone attenuation, TFA and serum creatinine were four independent predictors for stone-free rates after SWL. These findings suggest that pretreatment NCCT may predict the outcomes after SWL. Consequently, we can use these

  6. Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination.

    Science.gov (United States)

    Geng, Jiun-Hung; Tu, Hung-Pin; Shih, Paul Ming-Chen; Shen, Jung-Tsung; Jang, Mei-Yu; Wu, Wen-Jen; Li, Ching-Chia; Chou, Yii-Her; Juan, Yung-Shun

    2015-01-01

    Urolithiasis is a common disease of the urinary system. Extracorporeal shockwave lithotripsy (SWL) has become one of the standard treatments for renal and ureteral stones; however, the success rates range widely and failure of stone disintegration may cause additional outlay, alternative procedures, and even complications. We used the data available from noncontrast abdominal computed tomography (NCCT) to evaluate the impact of stone parameters and abdominal fat distribution on calculus-free rates following SWL. We retrospectively reviewed 328 patients who had urinary stones and had undergone SWL from August 2012 to August 2013. All of them received pre-SWL NCCT; 1 month after SWL, radiography was arranged to evaluate the condition of the fragments. These patients were classified into stone-free group and residual stone group. Unenhanced computed tomography variables, including stone attenuation, abdominal fat area, and skin-to-stone distance (SSD) were analyzed. In all, 197 (60%) were classified as stone-free and 132 (40%) as having residual stone. The mean ages were 49.35 ± 13.22 years and 55.32 ± 13.52 years, respectively. On univariate analysis, age, stone size, stone surface area, stone attenuation, SSD, total fat area (TFA), abdominal circumference, serum creatinine, and the severity of hydronephrosis revealed statistical significance between these two groups. From multivariate logistic regression analysis, the independent parameters impacting SWL outcomes were stone size, stone attenuation, TFA, and serum creatinine. [Adjusted odds ratios and (95% confidence intervals): 9.49 (3.72-24.20), 2.25 (1.22-4.14), 2.20 (1.10-4.40), and 2.89 (1.35-6.21) respectively, all p < 0.05]. In the present study, stone size, stone attenuation, TFA and serum creatinine were four independent predictors for stone-free rates after SWL. These findings suggest that pretreatment NCCT may predict the outcomes after SWL. Consequently, we can use these predictors for selecting

  7. The bioreceptivity of building stone

    Science.gov (United States)

    Mauko Pranjić, Alenka; Mulec, Janez; Muck, Tadeja; Hladnik, Aleš; Mladenovič, Ana

    2015-04-01

    Bioreceptivity is an intrinsic property of stone, and is defined as the ability of a material to be colonized by living organisms. The fouling and staining of building stone material due to the activity of microorganisms presents a serious problem in modern as well as historical buildings, not only due to the aesthetic impact but also due to the deterioration of the material. Biological colonisation on stone materials is influenced by a number of factors, e.g. the intrinsic properties of the stone (porosity, roughness, permeability, mineral composition), environmental parameters (e.g. solar radiation, temperature, water regime, climate, etc.), and specific microclimatic parameters (e.g. orientation, exposure to shadow, permanent capillary humidity, etc.). In order to assess the bioreceptivity of building stones, use is often made of artificial colonisation experiments compromising the inoculation of stones with a single species or a few isolated strains under laboratory conditions. In the present work the authors present the development of a method for the determination of bioreceptivity, as well as a study of the bioreceptivity of selected natural stone versus the latter's intrinsic properties. Field examples of biodeterioration are also presented. The study was supported by the Slovenian Research Agency (L1-5453).

  8. The glue-clot technique: a new technique description for small calyceal stone fragments removal

    NARCIS (Netherlands)

    Cloutier, J.; Cordeiro, E. R.; Kamphuis, G. M.; Villa, L.; Letendre, J.; de la Rosette, J. J.; Traxer, Olivier

    2014-01-01

    During the last 20 years, the technology advancement of small flexible ureterorenoscopes has dramatically changed the management of renal calculi. Retrograde intrarenal surgery (RIRS) has currently a high impact on active stone treatment, and it is increasingly used worldwide. Nevertheless, kidney

  9. Weathering of stone-built heritage: A lens through which to read the Anthropocene

    OpenAIRE

    Gómez-Heras, Miguel; McCabe, Stephen

    2015-01-01

    This paper discusses how the study of stone-built heritage decay is relevant in the context of the Anthropocene by raising the complex two-way interplay between stone and society. Natural and built stone heritage is an asset that is vulnerable to present and future climate change. Especially in the context of built heritage, stone can also be conceptualized as a “large scale laboratory” in which the evolution of weathering, and thus past exposure conditions, can be studied (analogous to physi...

  10. Gypsum accumulation on carbonate stone

    Science.gov (United States)

    McGee, E.S.; Mossotti, V.G.

    1992-01-01

    The accumulation of gypsum on carbonate stone has been investigated through exposure of fresh samples of limestone and marble at monitored sites, through examination of alteration crusts from old buildings and through laboratory experiments. Several factors contribute to gypsum accumulation on carbonate stone. Marble or limestone that is sheltered from direct washing by rain in an urban environment with elevated pollution levels is likely to accumulate a gypsum crust. Crust development may be enhanced if the stone is porous or has an irregular surface area. Gypsum crusts are a surficial alteration feature; gypsum crystals form at the pore opening-air interface, where evaporation is greatest.

  11. Renal Osteodystrophy

    Directory of Open Access Journals (Sweden)

    Aynur Metin Terzibaşoğlu

    2004-12-01

    Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

  12. Complexities of implementing Stepping Stones and Creating ...

    African Journals Online (AJOL)

    assessing' their effectiveness towards understanding processes around how such interventions are implemented. Implementation Science is focused on understanding potential challenges of translating interventions from highly controlled conditions ...

  13. Ultrastructure of the renal juxtaglomerular complex and peripolar cells in the axolotl (Ambystoma mexicanum) and toad (Bufo marinus).

    Science.gov (United States)

    Hanner, R H; Ryan, G B

    1980-01-01

    Renal juxtaglomerular regions were examined in the axolotl (Ambystoma mexicanum and toad (Bufo marinus). Prominent granulated peripolar epithelial cells were found surrounding the origin of the glomerular tuft in the axolotl. These cells resembled the peripolar cells recently discovered in mammalian species. They contained multiple electron-dense cytoplasmic granules, some of which showed a paracrystalline substructure and signs of exocytoxic activity. Such cells were difficult to find and smaller in the toad. In contrast, granulated juxtaglomerular arteriolar myoephithelial cells were much more readily found and larger in the toad than in the axolotl. No consistent differences were noted in juxtaglomerular cells or their granules in response to changes in environmental chloride concentration. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 PMID:7410189

  14. Quality Assessment of Urinary Stone Analysis

    DEFF Research Database (Denmark)

    Siener, Roswitha; Buchholz, Noor; Daudon, Michel

    2016-01-01

    After stone removal, accurate analysis of urinary stone composition is the most crucial laboratory diagnostic procedure for the treatment and recurrence prevention in the stone-forming patient. The most common techniques for routine analysis of stones are infrared spectroscopy, X-ray diffraction......, fulfilled the quality requirements. According to the current standard, chemical analysis is considered to be insufficient for stone analysis, whereas infrared spectroscopy or X-ray diffraction is mandatory. However, the poor results of infrared spectroscopy highlight the importance of equipment, reference...... spectra and qualification of the staff for an accurate analysis of stone composition. Regular quality control is essential in carrying out routine stone analysis....

  15. Outcomes of percutaneous nephrolithotomy versus open stone surgery for patients with staghorn calculi

    Directory of Open Access Journals (Sweden)

    Friedrich Bo-Yuan Zhang

    2017-06-01

    Conclusion: Both OSS and PNL are viable options for the management of staghorn stones. Considering the lower postoperative complication rate and need for auxiliary treatment, we suggest that OSS is more suitable for staghorn stones with large burdens. OSS should still be considered as a valid treatment for patients with complex staghorn calculi, although PNL is a less invasive treatment option in most cases.

  16. The challenge of cystine and struvite stone formers: clinical, metabolic and surgical assessment

    Science.gov (United States)

    Yamaçake, Kleiton G. R.; Marchini, Giovanni S.; Reis, Sabrina; Danilovic, Alexandre; Vicentini, Fábio C.; Torricelli, Fábio C. M.; Srougi, Miguel; Mazzucchi, Eduardo

    2016-01-01

    ABSTRACT Purpose: To compare the clinical, metabolic, and calculi characteristics of cystine and struvite stone patients after percutaneous nephrolithotripsy (PCNL). Material and Methods: Between January/2006-July/2013, 11 cystine stone patients were treated in our clinic. Of those, 3 were excluded due to incomplete follow-up. Eight cystine stone patients (2 with bilateral disease; 10 renal units-RU) were considered for further analysis. A cohort of 8 struvite stone formers (10RU) was matched having the same age, gender, body mass index (BMI) and Guys stone score. Analyzed parameters comprised demographic data, serum/urinary metabolic evaluation and surgical outcomes. Results: Both groups had 6 female patients. Groups were similar in regards to age, gender, BMI, stone burden, and serum creatinine (p=NS). All patients had PCNL as the first surgical treatment modality. Stone free rate (SFR) after the first PCNL tended to be lower (0%) in the cystine compared to the struvite group (40%)(p=0.08). Final SFR after secondary procedures increased to 70% in cystine and 80% in struvite patients (p=1.0); mean number of procedures to achieve stone free status was higher in the first group (3.57 vs. 2.0;p=0.028). Hypocitraturia was found in all patients, but struvite cases presented with lower mean urinary citrate levels (p=0.016). Other common abnormalities were elevated urinary pH (cystine 75% and struvite 62.5%;p=1.0) and low urinary volume (62.5%,37.5%;p=0.63). Conclusion: Multiple interventions and suboptimal stone free rates are trait of the significant stone burden of struvite and cystine patients. Underlying metabolic abnormalities characterized by increased urinary pH, hypocitraturia and low urinary volume are often encountered in both populations. PMID:27622279

  17. Synthesis, bioevaluation and gamma scintigraphy of 99mTc-N-2-(furylmethyl iminodiacetic acid) complex as a new renal radiopharmaceutical

    International Nuclear Information System (INIS)

    Sanad, M.H.; Talaat, H.M.; Ibrahim, A.A.

    2018-01-01

    A ligand of N-2-(furylmethyl iminodiacetic acid) (FMIDA) has been easily labeled by a tetradentate chelating agent of [ 99m Tc]. Factors like a stannous chloride solution as a reducing agent (100 μg), substrate amount (100 μg), pH (7), in vitro stability (8 h) and temperature (37 °C) have been systematically studied to optimize high radiochemical yield (98.0%). The radiochemical conversion was calculated on thin-layer chromatography, paper electrophoresis, and high performance liquid chromatography. Biodistribution study showed that this complex was removed from the kidneys and bladder path way during 1 h post injection. Therefore, [ 99m Tc]FMIDA may be used as renal function radiotracer. (author)

  18. [Horseshoe kidney, stone disease and prostate cancer: a case presentation].

    Science.gov (United States)

    Hermida Pérez, J A; Bermejo Hernández, A; Hernández Guerra, J S; Sobenes Gutierrez, R J

    2013-01-01

    The horseshoe kidney is the most common congenital renal fusion anomalies. It occurs in 0.25% of the population, or 1 in every 400 people. It is more frequent in males (ratio 2:1). The most observed complication of horseshoe kidney is stone disease, although there may be others such as, abdominal pain, urinary infections, haematuria, hydronephrosis, trauma and tumours (most commonly associated with hypernephroma and Wilms tumour). We describe a case of a male patient with horseshoe kidney, stone disease and adenocarcinoma of the prostate. One carrier of this condition who suffered a transitional cell carcinoma of the prostate was found in a review of the literature. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  19. Renal venogram

    Science.gov (United States)

    ... be black. Other structures will be shades of gray. Veins are not normally seen in an x- ... Venogram - kidney; Renal vein thrombosis - venogram Images Kidney anatomy Kidney - blood and urine flow Renal veins References ...

  20. “Die Another Day”: A Qualitative Analysis of Hmong Experiences with Kidney Stones

    Directory of Open Access Journals (Sweden)

    Kathleen A. Culhane-Pera

    2007-01-01

    Full Text Available Background: A chart review at a urological office revealed that Hmong patients present with higher rates of kidney stones, uric acid stones, and complications from kidney stones than non-Hmong patients. In order to ultimately redress this health disparity, a conferenceof Hmong and non-Hmong health care providers decided that we needed to first understand the pertinent social, cultural, economic, and biological factors contributing to the disparity. This research project sought to elicit Hmong patients and family members’explanatory models, decision-making processes, and experiences with the health care system.Methods: We conducted in–depth interviews with 10 Hmong kidney stone patients, 11 family members of 9 patients, and 4 traditional healers. All 10 patients had received urological interventions, including ureteroscopy (8, percutaneous lithotomy (5 and nephrectomy (2. Some patients had postponed medical assistance (6 and had refusedprocedures (4. We qualitatively analyzed the transcribed and translated interviews with an Excel spread sheet and N6 computer software. Results were discussed with patients and a community advisory council.Results: Hmong concepts of kidney function and explanatory models of kidney stones are a blend of traditional and biomedical concepts. Kidney stones are understood as acute health problems caused by hard substances in water and food that stick to the kidney, which weak kidneys cannot excrete. Kidney stone sufferers do not know they have stones until they pass a stone or they see stones on X-rays, as pain or hematuria are non-specific symptoms. They prefer medications, including herbal medicines, to invasive urologicalprocedures. In making decisions about urological interventions, Hmong patients balance fear of disease (pain and renal failure with fear of doctors (complications from interventions and anesthesia. While patients have variable balance points to accept interventions, the basic philosophy of

  1. Contemporary Management of Renal Transplant Recipients With De Novo Urolithiasis: A Single Institution Experience and Review of the Literature.

    Science.gov (United States)

    Harraz, Ahmed M; Zahran, Mohamed H; Kamal, Ahmed I; El-Hefnawy, Ahmed S; Osman, Yasser; Soliman, Shady A; Kamal, Mohamed M; Ali-El-Dein, Beder; Shokeir, Ahmed A

    2017-06-01

    We report on the long-term follow-up of managing allograft stones at a single tertiary referral institution and review the relevant literature. A retrospective analysis of renal allograft recipient charts was performed to identify patients who developed allograft lithiasis between 1974 and 2009. Patient and stone characteristics, diagnoses, treatments, and outcomes were described. Sixteen patients developed 22 stones after a median follow-up of 170 months (range, 51-351 mo). The mean (standard deviation) and median diameter of the stones were 13.8 (8.5) mm and 11 mm. Among these, 3 stones were treated conservatively, 3 by shock-wave lithotripsy, and 7 by cystolitholapaxy. Seven patients underwent percutaneous treatment in the form of percutaneous nephrostomy tube fixation and spontaneous passage of stone (1 stone), shock-wave lithotripsy (1 stone), antegrade stenting (1 stone), and percutaneous nephrolithotomy (6 stones). All patients were stone free after treatment, except for 2 patients whose stones were stable and peripheral on long-term follow-up. Allograft lithiasis requires a multimodal treatment tailored according to stone and graft characteristics. Protocols regarding spontaneous passage can be adopted if there is no harm to the graft and the patient is compliant. Careful attention to the anatomy during percutaneous nephrostomy tube placement is mandatory to avoid intestinal loop injury. A more attentive follow-up is required for early stone management.

  2. Shielding features of quarry stone

    International Nuclear Information System (INIS)

    Hernandez V, C.; Contreras S, H.; Hernandez A, L.; Baltazar R, A.; Escareno J, E.; Mares E, C. A.; Vega C, H. R.

    2010-10-01

    Quarry stone lineal attenuation coefficient for gamma-rays has been obtained. In Zacatecas, quarry stone is widely utilized as a decorative item in buildings, however its shielding features against gamma-rays unknown. The aim of this work is to determine the shielding properties of quarry stone against γ-rays using Monte Carlo calculations where a detailed model of a good geometry experimental setup was carried out. In the calculations 10 pieces 10 X 10 cm 2 of different thickness were utilized to evaluate the photons transmission as the quarry stone thickness is increased. It was noticed that transmitted photons decay away as the shield thickness is increased, these results were fitted to an exponential function were the linear attenuation coefficient was estimated. Also, using XCOM code the linear attenuation coefficient from several keV up to 100 MeV was estimated. From the comparison between Monte Carlo results and XCOM calculations a good agreement was found. For 0.662 MeV γ-rays the attenuation coefficient of quarry stone, whose density is 2.413 g-cm -3 , is 0.1798 cm -1 , this mean a X 1/2 = 3.9 cm, X 1/4 = 7.7 cm, X 1/10 = 12.8 cm, and X 1/100 = 25.6 cm. Having the information of quarry stone performance as shielding give the chance to use this material to shield X and γ-ray facilities. (Author)

  3. Timelines of the “free-particle” and “fixed-particle” models of stone-formation: theoretical and experimental investigations

    NARCIS (Netherlands)

    Kok, D.J.; W.P.A. Boellaard (Willem); Y. Ridwan (Yanto); Levchenko, V.A.

    2017-01-01

    textabstractTwo major theories on renal stone formation will be reviewed, the “free-particle” and “fixed-particle” mechanisms. These theories combine data on intrinsic factors (inborn metabolic errors), extrinsic factors (diet), renal cell responses and the physico-chemistry and biochemistry of

  4. Calculating the number of shock waves, expulsion time, and optimum stone parameters based on noncontrast computerized tomography characteristics.

    Science.gov (United States)

    Foda, Khaled; Abdeldaeim, Hussein; Youssif, Mohamed; Assem, Akram

    2013-11-01

    To define the parameters that accompanied a successful extracorporeal shock wave lithotripsy (ESWL), namely the number of shock waves (SWs), expulsion time (ET), mean stone density (MSD), and the skin-to-stone distance (SSD). A total of 368 patients diagnosed with renal calculi using noncontrast computerized tomography had their MSD, diameter, and SSD recorded. All patients were treated using a Siemens lithotripter. ESWL success meant a stone-free status or presence of residual fragments 934 HUs and SSD >99 mm. The required number of SWs and the expected ET can be anticipated. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Effect of size and site on the outcome of extracorporeal shock wave lithotripsy of proximal urinary stones in children.

    Science.gov (United States)

    Habib, Enmar I; Morsi, Hany A; Elsheemy, Mohammed S; Aboulela, Waseem; Eissa, Mohamed A

    2013-06-01

    To determine the effect of location and size of stones on the outcome of extracorporeal shock wave lithotripsy (ESWL) in children. In 2008-2010, 150 children (median age 6.6 years) with radio-opaque ureteric and renal stones measuring ≤4 cm were treated. Exclusion criteria were coagulation disorders, pyelonephritis, distal obstruction, non-functioning kidney and hypertension. ESWL was performed under general anesthesia. Follow up period was 5-22 months. 186 stones were treated: 76 calyceal, 92 pelvic and 18 proximal ureteral. Mean stone size was 1.3 cm. A total of 312 sessions were performed (mean per stone = 1.67 sessions). The mean number of shock waves per session was 2423.68. Overall stone-free rate was 89.24%. Having a calyceal location did not significantly affect the stone-free rate (p = 0.133). The failure rate was significantly higher (66.7%) in stones >3 cm in size (p auxillary ureteroscopy and 4 uretrolithotomy for treatment of steinstrasse. ESWL is a safe and effective method for treatment of stones up to 2 cm in children. Rate of auxillary procedures increases in stones >2 cm in size. About 80% of failures were associated with stone size >1.35 cm while 52.3% of completely cleared stones were associated with size <1.35 cm. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  6. Purbeck Stone - A possible Global Heritage Stone from England

    Science.gov (United States)

    Marker, Brian

    2014-05-01

    By definition, a Global Heritage Stone Resource (GHSR) should have international significance. The Purbeck Group of uppermost Jurassic to lowermost Cretaceous age (Tithonian- Berriasian) outcrops mainly in the Purbeck area of Dorset, England. It was deposited in shallow freshwater to brackish lagoons with occasional marine incursions. Limestones, mainly biosparites, occur at 6 main levels. Differences in bed thickness, jointing and hardness make it suitable for a variety of purposes including dimension stone, monumental and ornamental stone, roofing tiles, paving, flooring and rockery stone. Near the top of the sequence is a dark gastropod biosparite, traditionally called Purbeck Marble, easily carved, which has been extensively used for decorative interior work in churches and cathedrals particularly for fonts, tombs, flooring and facings on columns for example in the medieval cathedrals of Salisbury, Exeter, Durham, York and Wells and Worcester and Westminster Abbey. The stone was extracted at least from Roman times (1st century AD) through the medieval period. Quarrying expanded from about 1700 reaching a peak in the late 18th and 19th centuries. Stone was transported first by sea but later by rail for wider use. Used in many local buildings, it gives an important element of local character. Many of the villages are designated conservation areas with a requirement for repair, maintenance and new building using local stone. Initially the stone was taken from quarries but was later mined. The number of operating companies declined from 15 to 5 over the past 40 years, with 10 active small quarries. Outputs are from few hundred tonnes to a few thousand tonnes per annum or about 9 to 12 years of permitted reserves but the Planning Authority intends to make sufficient provision for production at recent levels for their development plan period. The extraction sites are in an Area of Outstanding Natural Beauty and close to Jurassic Coast World Heritage Site. This might

  7. Regional differences in constituents of gall stones.

    Science.gov (United States)

    Ashok, M; Nageshwar Reddy, D; Jayanthi, V; Kalkura, S N; Vijayan, V; Gokulakrishnan, S; Nair, K G M

    2005-01-01

    The pathogenesis of pigment and mixed gall stone formation remains elusive. The elemental constituents of gall stones from southern states of Tamil Nadu, Kerala and Karnataka have been characterized. Our aim was to determine the elemental concentration of representative samples of pigment, mixed and cholesterol gall stones from Andhra Pradesh using proton-induced X-ray emission (PIXE) using a 3 MV horizontal pelletron accelerator. Pigment gall stones had significantly high concentrations of copper, iron and lead; chromium was absent. Except for iron all these elements were significantly low in cholesterol gall stones and intermediate levels were seen in mixed gall stones. Highest concentrations of chromium was seen in cholesterol and titanium in mixed gall stones respectively; latter similar to other southern states. Arsenic was distinctly absent in cholesterol and mixed gall stones. The study has identified differences in elemental components of the gall stones from Andhra Pradesh.

  8. Stone Soup Partnership: A Grassroots Model of Community Service.

    Science.gov (United States)

    Kittredge, Robert E.

    1997-01-01

    Stone Soup Partnership is a collaboration between California State University at Fresno and its surrounding community to address serious problems in a high-crime, impoverished apartment complex near the university. The program involves students in service learning for university credit, and has expanded from a single summer youth program to a…

  9. Renal perfusion scintiscan

    Science.gov (United States)

    ... Radionuclide renal perfusion scan; Perfusion scintiscan - renal; Scintiscan - renal perfusion Images Kidney anatomy Kidney - blood and urine flow Intravenous pyelogram References Rottenberg G, Andi AC. Renal ...

  10. Current approach for urinary system stone disease in pregnant women

    Directory of Open Access Journals (Sweden)

    Orcun Celik

    2016-01-01

    Full Text Available Urinary system stones can be classified according to size, location, X-ray characteristics, aetiology of formation, composition, and risk of recurrence. Especially urolithiasis during pregnancy is a diagnostic and therapeutic challenge. In most cases, it becomes symptomatic in the second or third trimester. Diagnostic options in pregnant women are limited due to the possible teratogenic, carcinogenic, and mutagenic risk of foetal radiation exposure. Clinical management of a pregnant urolithiasis patient is complex and demands close collaboration between patient, obstetrician and urologist. We would like to review current diagnosis and treatment modalities of stone disease of pregnant woman.

  11. Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review.

    Science.gov (United States)

    Scotland, Kymora B; Rudnick, Benjamin; Healy, Kelly A; Hubosky, Scott G; Bagley, Demetrius H

    2018-06-06

    Advances in flexible ureteroscope design and accessory instrumentation have allowed for more challenging cases to be treated ureteroscopically. Here, we evaluate our experience with ureteroscopy (URS) for the management of large renal calculi (≥2 cm) and provide a concise review of recent reports. A retrospective review was undertaken of all URS cases between 2004 and 2014 performed by the endourologic team at a single academic tertiary care institution. We identified patients with at least one stone ≥2 cm managed with retrograde URS. Stone size was defined as the largest linear diameter of the index stone. Small diameter flexible ureteroscopes were used primarily with holmium laser. Patient demographics, intraoperative data, and postoperative outcomes were evaluated. We evaluated 167 consecutive patients who underwent URS for large renal stones ≥2 cm. The initial reason for choosing URS included patient preference (29.5%), failure of other therapies (8.2%), anatomic considerations/body habitus (30.3%), and comorbidities (28.8%). Mean patient age was 55.5 years (22-84). The mean stone size was 2.75 cm with mean number of procedures per patient of 1.65 (1-6). The single session stone-free rate was 57.1%, two-stage procedure stone-free rate was 90.2% and three-stage stone-free rate was 94.0%. Access sheaths were used in 47% of patients. An association was identified between stone size and patient outcomes; smaller stones correlated with decreased number of procedures. Postoperative complications were minor. Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate.

  12. Percutaneous nephrolithotomy in semisupine position: a modified approach for renal calculus.

    Science.gov (United States)

    Xu, Ke-Wei; Huang, Jian; Guo, Zheng-Hui; Lin, Tian-Xin; Zhang, Cai-Xai; Liu, Hao; Chun, Jian; Yao, You-Sheng; Han, Jin-Li; Huang, Hai

    2011-12-01

    Conventional percutaneous nephrolithotomy (PCNL) is usually performed in a prone position, which compresses the thorax and results in difficulty in rescue during operation. When PCNL is performed in a supine position, the flank renal puncture area is limited, so it is difficult to treat disseminated and complex renal calculi. Herein, we introduce a modified semisupine position for performing PCNL, which has numerous benefits as well as safe and effective. Between May 2002 and May 2009, a total of 452 patients with renal calculi were treated with semisupine PCNL. The patient was placed in 45° semisupine position during the procedure, with the affected flank arched as much as possible. In this series, no one converted to open surgery. The average operating time was (115.2 ± 44.5) min. Single tract PCNL was performed for 80.97% of the cases, two tracts 13.94%, three tracts 4.65%, and four tracts 0.44%. The upper, middle, and lower calix tracts accounted for 12.1, 63.0, and 24.9%, of procedures, respectively. Stone-free rate was 85.7% overall, 92.2% for single calculus (83/90), and 72.9% for staghorn calculi (78/107). Major postoperative complications occurred in 3.3% of the cases. This study demonstrated PCNL in a semisupine position is an effective alternative for treating renal calculi, which combines the advantages of PCNL in a prone position, and PCNL in a supine position. The semisupine position allows easier irrigation of stone fragments, is more comfortable for the patient, and facilitates monitoring of anesthesia.

  13. A stone mould from Klinovac

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    Bulatović Aleksandar

    2002-01-01

    Full Text Available A two-piece stone mould that reached the National Museum at Vranje in 1966 had been recovered from a depth of about one meter at the site known as Tri Kruške (Three Pear-trees, the village of Klinovac. The site is situated on a river terrace on the right bank of the Krševica River some 15 kilometers south of Vranje. The mould was carved out of metamorphic rock from the class of schist, more exactly, of greenschist (with chlorite and mica as its constituent minerals that is widespread in the area, which geologically belongs to the upper (Vlasina complex of the Serbian-Macedonian mass. The mould was intended for casting four kinds of bronze weapons: three chisels and a winged axe. More sensitive as dating evidence, the winged axe (Ärmchenbeil may be broadly dated to the last three centuries of the second millennium BC. The type is geographically related with the Aegean, while its northernmost findspot so far is Pobit Kamak in northern Bulgaria. The chisels cast in this mould do not have direct analogies, although many hoards of similar tools have been registered in Croatia, Romania and Central Europe. Apparently the mould was made by a local workshop and from the locally available raw material. The possible activity of local workshops in the above mentioned period has already been presumed by scholars, and the Klinovac mould constitutes yet another corroboration of the hypothesis. Nevertheless its Aegean origin should not be ruled out completely, because cultural contacts between the Late Bronze Age population inhabiting the region and their southern neighbours seem quite certain, as evidenced by Mycenaean pottery discovered on the site of Resulja at Lučani near Bujanovac.

  14. Spiral CT in kidney: assumption of renal function by objective evaluation of renal cortical enhancement

    International Nuclear Information System (INIS)

    Choi, Bo Yoon; Lee, Jong Seok; Lee, Joon Woo; Myung, Jae Sung; Sim, Jung Suk; Seong, Chang Kyu; Kim, Seung Hyup; Choi, Guk Myeong; Chi, Seong Whi

    2000-01-01

    To correlate the degree of renal cortical enhancement, objectively evaluated by means of spiral CT with the serum level of creatinine, and to determine the extent to which this degree of enhancement may be used to detect renal parenchymal disease. Eighty patients (M:F = 50:30; age + 25-19, (mean 53) years) with available serum level of creatinine who underwent spiral CT between September and October 1999 were included in this study. In fifty patients the findings suggested hepatic or biliary diseases such as hepatoma, biliary cancer, or stone, while in thirty, renal diseases such as cyst, hematoma, or stone appeared to be present. Spiral CT imaging of the cortical phase was obtained at 30-40 seconds after the injection of 120 ml of non-ionic media at a rate of 3 ml/sec. The degree of renal cortical enhancement was calculated by dividing the CT attenuation number of renal cortex at the level of the renal hilum by the CT attenuation number of aorta at the same level. The degree of renal cortical enhancement was compared with the serum level of creatinine, and the degree of renal cortical enhancement in renal parenchymal disease with that of the normal group. Among eighty patients there were five with renal parenchymal disease and 75 with normal renal function. The ratio of the CT attenuation number of renal cortex to that of aorta at the level of the renal hilum ranged between 0.49 and 0.99 (mean, 0.79; standard deviation, 0.15). while the serum level of creatinine ranged between 0.6 and 3.2 mg/dl. There was significant correlation (coefficient of -0.346) and a statistically significant probability of 0.002 between the ratio of the CT attenuation numbers and the serum level of creatinine. There was a significant difference (statistically significant probability of less than 0.01) between those with renal parenchymal disease and the normal group. The use of spiral CT to measure the degree of renal cortical enhancement provides not only an effective index for

  15. Canada's National Building Stone: Tyndall Stone from Manitoba

    Science.gov (United States)

    Pratt, Brian R.; Young, Graham A.; Dobrzanski, Edward P.

    2016-04-01

    Tyndall Stone is a distinctively mottled and highly fossiliferous dolomitic limestone that belongs to the Selkirk Member of the Red River Formation, of Late Ordovician (Katian) age. It has been quarried at Garson, Manitoba, 37 km northeast of Winnipeg, since 1895, although other quarries in the area go back to 1832. Tyndall Stone, so named because it was shipped by rail from nearby Tyndall, is currently produced by Gillis Quarries Limited. It has various uses as a dimension stone. Large slabs, most often cut parallel to bedding, face the exterior or interior of many important buildings such as the Parliament Buildings and the Canadian Museum of Civilization in the Ottawa area, the Empress Hotel in Victoria, and the provincial legislatures in Winnipeg and Regina, as well as many commercial buildings especially in the Canadian prairies. At the quarries, the stone is cut vertically, using eight foot (2.44 m) diameter saws mounted on one hundred foot (30.5 m) tracks, then split into 6-8 tonne blocks that are moved using front-end loaders. Gillis Quarries operates a large finishing plant with an area of about 4000 m2. Stone is processed along advanced cutting lines that feature eight primary saws and six gantry saw stations, allowing it to be made into a variety of sizes, shapes, and finishes. The Selkirk Member is 43 m thick and the stone is extracted from a 6-8 m thick interval within the lower part. The upper beds tend to be more buff-coloured than the grey lower beds due to weathering by groundwater. The stone is massive, but extracted blocks are less than ~1m thick due to splitting along stylolites. Consisting of bioturbated wackestone to packstone, the Tyndall Stone was deposited in a shallow-marine environment within the photic zone, in the central part of the vast equatorial epicontinental sea that covered much of Laurentia. Scattered thin, bioclastic grainstone lenses record brief, low-energy storm events. The distinctive mottles are formed by dolomitized

  16. Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy.

    Science.gov (United States)

    Ozgor, Faruk; Kucuktopcu, Onur; Sarılar, Omer; Toptas, Mehmet; Simsek, Abdulmuttalip; Gurbuz, Zafer Gokhan; Akbulut, Mehmet Fatih; Muslumanoglu, Ahmet Yaser; Binbay, Murat

    2015-11-01

    In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62%) compared to the other groups (77.10% in Group 2 and 75.61% in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success.

  17. Indoor external dose rates due to decorative sheet stone

    Energy Technology Data Exchange (ETDEWEB)

    Lu, C.H.; Sheu, R.D.; Jiang, S.H. [Dept. of Engineering and System Science, National Tsing Hua Univ., Hsinchu (Taiwan)

    2002-03-01

    The specific activities in decorative sheet stone made of granite or marble were measured, whereby the absolute peak efficiency of the HPGe detectors employed in the measurements for the sheet-stone sample was determined using the semi-empirical method. The spatial distribution for the indoor external dose rates due to the radionuclides present in the decorative sheet stone used to clad the floor and the four walls of a standard room was calculated using a three-dimensional point kernel computer code. It was found that the spatial distribution for the indoor dose rates was complex and non-uniform, which represents a difference in relation to the results of earlier studies. (orig.)

  18. Indoor external dose rates due to decorative sheet stone

    International Nuclear Information System (INIS)

    Lu, C.H.; Sheu, R.D.; Jiang, S.H.

    2002-01-01

    The specific activities in decorative sheet stone made of granite or marble were measured, whereby the absolute peak efficiency of the HPGe detectors employed in the measurements for the sheet-stone sample was determined using the semi-empirical method. The spatial distribution for the indoor external dose rates due to the radionuclides present in the decorative sheet stone used to clad the floor and the four walls of a standard room was calculated using a three-dimensional point kernel computer code. It was found that the spatial distribution for the indoor dose rates was complex and non-uniform, which represents a difference in relation to the results of earlier studies. (orig.)

  19. Leiomyosarcoma of the renal vein

    Directory of Open Access Journals (Sweden)

    Lemos Gustavo C.

    2003-01-01

    Full Text Available Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We presented a case of renal vein leiomyosarcoma detected in a routine study. The primary treatment was complete surgical removal of the mass. In cases where surgical removal is not possible the prognosis is poor, with high rates of local recurrence and distant spread.

  20. Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic

    Directory of Open Access Journals (Sweden)

    Megan M. Leo

    2017-05-01

    Full Text Available Introduction: Supporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP ultrasound to computed tomography (CT detection of hydronephrosis severity in patients with suspected renal colic. We calculated test characteristics of hydronephrosis on EP-performed ultrasound for detecting ureteral stones or ureteral stone size >5mm. We then analyzed the association of hydronephrosis on EP-performed ultrasound, stone size >5mm, and proximal stone location with 30-day events. Methods: This was a prospective observational study of ED patients with suspected renal colic undergoing CT. Subjects had an EP-performed ultrasound evaluating for the severity of hydronephrosis. A chart review and follow-up phone call was performed. Results: We enrolled 302 subjects who had an EP-performed ultrasound. CT and EP ultrasound results were comparable in detecting severity of hydronephrosis ( x 2=51.7, p5mm less likely (NPV 89%; LR− 0.39. Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03. Conclusion: Using an ultrasound-first approach to detect hydronephrosis may help physicians identify patients with renal colic. The lack of hydronephrosis on ultrasound makes the presence of a larger ureteral stone less likely. Stone size >5mm may be a useful predictor of 30-day events.

  1. Family history and biochemical diagnosis in 1948 kidney stone formers

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    Francisco R. Spivacow

    2016-12-01

    Full Text Available Introduction: The presence of family history of nephrolithiasis is associated with an increased risk of renal lithiasis. Different epidemiological studies have shown a family component in the incidence of it, which is independent of dietary and environmental factors. The role of heredity is evident in monogenic diseases such as cystinuria, Dent’s disease or primary hyperoxaluria, while a polygenic inheritance has been proposed to explain the tendency to form calcium oxalate stones. Objective: Our objective was to evaluate the family history of patients with renal lithiasis and the correlation of family history with its corresponding biochemical alteration, considering only those with a single metabolic alteration. Methods: a prospective and retrospective observational and analytical study that included 1948 adults over 17 years of age and a normal control group of 165 individuals, all evaluated according to an ambulatory protocol to obtain a biochemical diagnosis. They were asked about their family history of nephrolithiasis and classified into five groups according to the degree of kinship and the number of people affected in the family. Results: a positive family history of nephrolithiasis was found in 27.4% of renal stone formers, predominantly in women, compared to 15.2% of normal controls. The family history of nephrolithiasis was observed especially in 31.4% of patients with hypomagnesuria and in 29.6% of hypercalciuric patients. The rest of the biochemical alterations had a positive family history between 28.6% in hyperoxaluria and 21.9% in hypocitraturia. The highest percentage of family history of nephrolithiasis was found in cystinuria (75% although there were few patients with this diagnosis. Conclusions: the inheritance has a clear impact on urolithiasis independently of the present biochemical alteration. Family history of nephrolithiasis of the first and second degree was observed between 21 and 32% of patients with renal

  2. Combined use of flexible ureteroscopic lithotripsy with micro-percutaneous nephrolithotomy in pediatric multiple kidney stones.

    Science.gov (United States)

    Li, Jun; Wang, Wenying; Du, Yuan; Tian, Ye

    2018-03-28

    We investigated the clinical value of treating pediatric multiple kidney stones with extensive distribution using flexible ureteroscopic lithotripsy (FUL) combined with micro-percutaneous nephrolithotomy (micro-PNL). In total, 21 pediatric patients with multiple renal calculi between May 2016 and June 2017 received FUL combined with micro-PNL. The group included 13 boys and eight girls; the patients' mean age was 3.8 years (range 1-8 years). The maximum stone diameter ranged from 1.0 to 1.5 cm. FUL was first performed in the lithotomy position to fragment stones that were located in the renal pelvis, and upper and mid-renal calyx. Patients were then moved to a prone position, and micro-PNL was performed to treat lower pole stones that could not be reached by the flexible ureteroscope during FUL. Percutaneous renal access to the lower calyx was achieved using a 4.8F "all-seeing needle" with ultrasound guidance, and stone fragmentation was performed with a 200-μm holmium laser at different settings to disintegrate 1- to 2-mm fragments. All 21 pediatric patients with multiple kidney stones underwent combined FUL and micro-PNL. The stone free rate (SFR) was 85.7% (18/21). The mean surgical time was 45 min (range 30-70 min). The mean volume of irrigation fluid used was 480 mL (range 300-1200 mL). The mean surgical time for FUL and micro-PNL was 31 min and 14 min, respectively, and the mean volume of fluid used for FUL and micro-PNL was 360 mL and 120 mL, respectively. According to the modified Clavien classification, grade 1 and 2 postoperative complications occurred in five and one patients, respectively. The mean decrease in the level of hemoglobin was 0.4 g/dL (0-0.7 g/dL), and no patients required a transfusion. The average hospital stay was 3 days (range 2-5 days). Combined FUL and micro-PNL is a safe, effective, and minimally invasive operation to remove multiple renal calculi with extensive distribution in children in selected cases. Copyright © 2018

  3. Nephrolithiasis-induced end stage renal disease

    Directory of Open Access Journals (Sweden)

    M Ounissi

    2010-03-01

    Full Text Available M Ounissi¹, T Gargueh², M Mahfoudhi¹, K Boubaker¹, H Hedri¹, R Goucha¹, E Abderrahim¹, F Ben Hamida¹, T Ben Abdallah¹, F El Younsi¹, H Ben Maiz³, A Kheder¹1Internal Medicine Department, 2Pediatric Department, 3Laboratory of Kidney Diseases, Charles Nicolle Hospital, Tunis, TunisiaIntroduction: Nephrolithiasis still remains a too frequent and underappreciated cause of end stage renal disease (ESRD.Methods and patients: Of the entire cohort of 7128 consecutive patients who started maintenance dialysis in our nephrology department between January 1992 and December 2006, a total of 45 patients (26 women, 19 men had renal stone disease as the cause of ESRD. The type of nephrolithiasis was determined in 45 cases and etiology in 42. The treatment and evolution of stone disease and patient’s survival were studied.Results: The overall proportion of nephrolithiasis related ESRD was 0.63%. The mean age was 48.4 years. Infection stones (struvite accounted for 40%, calcium stones, 26.67% (primary hyperparathyroidism:15.56%; familial hypercalciuria: 4.44%, unknown etiology: 6.66%, primary hyperoxaluria type 1, 17.78% and uric acid lithiasis in 15.56% of cases. The mean delay of the evolution of the stone renal disease to chronic renal failure was 85.8 months. The feminine gender, obesity and elevated alkaline phosphatases >128 IU/L were significantly correlated with fast evolution of ESRD. The median evolution to ESRD was 12 months. The normal body mass index (BMI, medical treatment of stone and primary hyperoxaluria type 1 were correlated with fast evolution to ESRD. All patients were treated by hemodialysis during a mean evolution of 60 months. Sixteen patients died. The patient's survival rate at 1, 3 and 5 years was 97.6, 92.8 and 69% respectively. Hypocalcemia, cardiopathy and normal calcium-phosphate product were significantly correlated with lower survival rate.Conclusion: Severe forms of nephrolithiasis remain an underestimated cause of

  4. Laparoscopic transperitoneal ureterolithotomy for large ureteric stones

    Directory of Open Access Journals (Sweden)

    Ahmed Al-Sayyad

    2012-01-01

    Conclusion: Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones.

  5. Kidney Stones in Children and Teens

    Science.gov (United States)

    ... Issues Listen Español Text Size Email Print Share Kidney Stones in Children and Teens Page Content Article ... teen girls having the highest incidence. Types of Kidney Stones There are many different types of kidney ...

  6. RENAL CRYOABLATION

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    A. V. Govorov

    2012-01-01

    Full Text Available Renal cryoablation is an alternative minimally-invasive method of treatment for localized renal cell carcinoma. The main advantages of this methodology include visualization of the tumor and the forming of "ice ball" in real time, fewer complications compared with other methods of treatment of renal cell carcinoma, as well as the possibility of conducting cryotherapy in patients with concomitant pathology. Compared with other ablative technologies cryoablation has a low rate of repeat sessions and good intermediate oncological results. The studies of long-term oncological and functional results of renal cryoablation are presently under way.

  7. Predictors of Success after Extracorporeal Shock Wave Lithotripsy (ESWL for Renal Calculi Between 20—30 mm: A Multivariate Analysis Model

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    Ahmed El-Assmy

    2006-01-01

    Full Text Available The first-line management of renal stones between 20—30 mm remains controversial. The Extracorporeal Shock Wave Lithotripsy (ESWL stone-free rates for such patient groups vary widely. The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL in such controversial groups. Between January 1990 and January 2004, 594 patients with renal stones 20—30 mm in length underwent ESWL monotherapy. Stone surface area was measured for all stones. The results of treatment were evaluated after 3 months of follow-up. The stone-free rate was correlated with stone and patient characteristics using the Chi-square test; factors found to be significant were further analyzed using multivariate analysis.Repeat ESWL was needed in 56.9% of cases. Post-ESWL complications occurred in 5% of cases and post-ESWL secondary procedures were required in 5.9%. At 3-month follow-up, the overall stone-free rate was 77.2%. Using the Chi-square test, stone surface area, location, number, radiological renal picture, and congenital renal anomalies had a significant impact on the stone-free rate. Multivariate analysis excluded radiological renal picture from the logistic regression model while other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. A regression analysis model was designed to estimate the probability of stone-free status after ESWL. The sensitivity of the model was 97.4%, the specificity 90%, and the overall accuracy 95.6%.Stone surface area, location, number, and congenital renal anomalies are prognostic predictors determining stone clearance after ESWL of renal calculi of 20—30 mm. High probability of stone clearance is obtained with single stone ≤400 mm2 located in renal pelvis with no congenital anomalies. Our regression model can predict the probability of the success of ESWL in such controversial groups and can define patients who

  8. Ultrastructural Analysis of Urinary Stones by Microfocus Computed Tomography and Comparison with Chemical Analysis

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    Tolga Karakan

    2016-06-01

    Full Text Available Objective: To investigate the ultra-structure of urinary system stones using micro-focus computed tomography (MCT, which makes non-destructive analysis and to compare with wet chemical analysis. Methods: This study was carried out at the Ankara Train­ing and Research hospital. Renal stones, removed from 30 patients during percutaneous nephrolithotomy (PNL surgery, were included in the study. The stones were blindly evaluated by the specialists with MCT and chemi­cal analysis. Results: The comparison of the stone components be­tween chemical analysis and MCT, showed that the rate of consistence was very low (p0.05. It was also seen that there was no significant relation between its 3D structure being heterogeneous or homogenous. Conclusion: The stone analysis with MCT is a time con­suming and costly method. This method is useful to un­derstand the mechanisms of stone formation and an im­portant guide to develop the future treatment modalities.

  9. Stone stability under non-uniform flow

    NARCIS (Netherlands)

    Hoan, N.T.

    2008-01-01

    Despite the fact that many studies on the stability of stones in bed protections under flowing water have been conducted, our knowledge is still far from advanced and reliable. Issues like how to quantify the hydraulic loads exerted on the stones on a bed and the associated stability of the stones

  10. [Laparoscopic management of complex lithiasis in horseshoe kidneys].

    Science.gov (United States)

    Valdivia-Uria, J G; Abril Baquero, G; Monzón Alebesque, F; López López, J A; Lanchares Santamaría, E

    1994-05-01

    Based on the fact that the results obtained with extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are uncertain in cases of complex lithiasis in horseshoe kidney, and counting on a wide laparoscopic experience as the most suitable solution in these cases, the authors present their initial experience in two cases of double lithiasis in right hemikidney. Approach was done through transperitoneal laparoscopy, after placement of a stent catheter and under the support of a radiological C-arc. After removal of the stones, the renal pelvis was closed with loose 4 zero reabsorbable suture with kots done intracorporeally. The post-operative had no complications with the exception of a transient leak of urine (5 days) that cause no further complications or subsequent sequelae. Monitoring at 6 months showed absence of residual lithiasis and good morphology and renal function of the sides operated.

  11. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era

    OpenAIRE

    Zhang, Wei-jie; Xu, Gui-fang; Huang, Qin; Luo, Kun-lun; Dong, Zhi-tao; Li, Jie-ming; Wu, Guo-zhong; Guan, Wen-xian

    2015-01-01

    Background: Laparoscopic common bile duct exploration (LCBDE) for stone can be carried out by either laparoscopic transcystic stone extraction (LTSE) or laparoscopic choledochotomy (LC). It remains unknown as to which approach is optimal for management of gallbladder stone with common bile duct stones (CBDS) in Chinese patients. Methods: From May 2000 to February 2009, we prospective treated 346 consecutive patients with gallbladder stones and CBDS with laparoscopic cholecystectomy and LCBDE....

  12. The ground stones from Sphinx

    Czech Academy of Sciences Publication Activity Database

    Řídký, Jaroslav

    2017-01-01

    Roč. 2017, č. 21 (2017), s. 39-42 ISSN 1369-5770 Grant - others:GA ČR(CZ) GA17-03207S Institutional support: RVO:67985912 Keywords : Sudan * Mesolithic * ground stones Subject RIV: AC - Archeology, Anthropology, Ethnology OBOR OECD: Archaeology

  13. Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants.

    Science.gov (United States)

    Younesi Rostami, Mehdi; Taghipour-Gorgikolai, Mehrdad; Sharifian, Rayka

    2012-01-01

    Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6 mm to 22 mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13 mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13 mm.

  14. Renal cancer.

    NARCIS (Netherlands)

    Corgna, E.; Betti, M.; Gatta, G.; Roila, F.; Mulder, P.H.M. de

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  15. Renal cancer

    NARCIS (Netherlands)

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.

    2007-01-01

    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  16. Computer tomography urography assisted real-time ultrasound-guided percutaneous nephrolithotomy on renal calculus.

    Science.gov (United States)

    Fang, You-Qiang; Wu, Jie-Ying; Li, Teng-Cheng; Zheng, Hao-Feng; Liang, Guan-Can; Chen, Yan-Xiong; Hong, Xiao-Bin; Cai, Wei-Zhong; Zang, Zhi-Jun; Di, Jin-Ming

    2017-06-01

    This study aimed to assess the role of pre-designed route on computer tomography urography (CTU) in the ultrasound-guided percutaneous nephrolithotomy (PCNL) for renal calculus.From August 2013 to May 2016, a total of 100 patients diagnosed with complex renal calculus in our hospital were randomly divided into CTU group and control group (without CTU assistance). CTU was used to design a rational route for puncturing in CTU group. Ultrasound was used in both groups to establish a working trace in the operation areas. Patients' perioperative parameters and postoperative complications were recorded.All operations were successfully performed, without transferring to open surgery. Time of channel establishment in CTU group (6.5 ± 4.3 minutes) was shorter than the control group (10.0 ± 6.7 minutes) (P = .002). In addition, there was shorter operation time, lower rates of blood transfusion, secondary operation, and less establishing channels. The incidence of postoperative complications including residual stones, sepsis, severe hemorrhage, and perirenal hematoma was lower in CTU group than in control group.Pre-designing puncture route on CTU images would improve the puncturing accuracy, lessen establishing channels as well as improve the security in the ultrasound-guided PCNL for complex renal calculus, but at the cost of increased radiation exposure.

  17. Do stone size and impaction influence therapeutic approach to proximal ureteral stones?

    Directory of Open Access Journals (Sweden)

    Radulović Slobodan

    2009-01-01

    Full Text Available Background/Aim. Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. Methods. A total of 123 patients with proximal ureteral stones were investigated in this prospective study performed in a 10- month period. The patients were divided into the group I - 86 patients treated with extracorporeal shock wave lithotripsy (ESWL and the group II - 37 patients treated with 'Swiss' Lithoclast. In the group I, 49 stones (57% were classified as impacted, while 20 stones (23.3% were larger than 100 mm2. In the group II, 26 stones (70.3% were impacted, and 11 stones (29.7% were larger than 100 mm2. Stones were defined as impacted by the radiographic, echosonographic as well as endoscopic findings in the group II of patients. Stone size was presented in mm2. Chemical composition of stones were almost the same in both groups of the patients. Results. Generally, there was no statistically significant difference in the treatment success between the groups. However, stones larger than 100 mm2 were statistically more successfully treated endoscopically, while there was no statistical difference in the treatment success of impacted stones between these two groups. Conclusion. ESWL can by considered as primary first therapeutic approach in treatment of all proximal ureteral stones except for stones larger than 100 mm2 that should primarily be treated endoscopically.

  18. Rhenium(V) oxo complexes relevant to technetium renal imaging agents derived from mercaptoacetylglycylglycylaminobenzoic acid isomers. Structural and molecular mechanics studies

    International Nuclear Information System (INIS)

    Hansen, L.; Taylor, A. Jr; Marzilli, L.G.; Cini, R.

    1992-01-01

    The synthesis and characterization of three rhenium(V) oxo complexes derived from isomers of mercaptoacetylglycylglycylaminobenzoic acid (MAG 2 -ABAH 5 ) are reported. The isomers were synthesized from o-, m- and p-aminobenzoic acid and differed in the position of the terminal carboxyl group. The anions of 8-10, [ReO(MAG 2 -*ABAH)] - (* = para (8), meta (9), ortho (10)), contained the tetraanionic form of the ligands with the carboxyl group protonated. Compounds 8,9, and 10 were synthesized by exchange reactions of ReOCl 3 (Me 2 SO)(Ph 3 P) under moderate conditions and were isolated as [Ph 4 P] + , [Bu 4 N] + , and [Ph 4 P] + salts, respectively. The structures of 8 and 10 were determined by X-ray diffraction methods; except for the location of the carboxyl group, the structures are similar. The coordination geometry is pseudo square pyramidal, with nitrogen and sulfur donor atoms forming a square base and the oxo ligand at the apex. The orientation of the carboxyl group in 10 is anti to the Re double-bond O group. Since the carboxyl groups are protonated in 8 and 10 and in other relevant structures from this class of radiopharmaceuticals including [Ph 4 As][TcO(MAG 3 H)] (MAG 3 H = tetraanionic form of mercaptoacetyltriglycine), the authors developed molecular mechanics parameters that allowed them to calculate the structures of 8, 10, and [TcO(MAG 3 H)] - . They then extended the calculations to all three isomeric complexes in their deprotonated forms and to [TcO(MAG 3 )] 2- in order to approximate their solution phase structures. They conclude that the [TcO(MAG 3 )] 2- species is conformationally flexible, and they have made an initial assessment of structures vs renal clearance

  19. Stones used in Milan architecture

    Directory of Open Access Journals (Sweden)

    Folli, Luisa

    2008-06-01

    Full Text Available The city of Milan lies in a plain with clayey soil well suited to brick-making, but no stone deposits. An ample supply of stone is available, however, in the surrounding hills and mountains, which are connected to the city via both natural and artificial waterways. The types of stone used since Roman times include: granite, marble and gneiss from Ossola Valley; dolomite from Lake Maggiore; detrital limestone from Ceresio Valley; sandstone from the Brianza Hills; black limestone and marble from Lake Como; and conglomerate and sandstone from the Adda River basin. Traditionally, the chief uses have been dimension stone (all stones, column shafts (granite, slabs (marble, moulding (dolomite, limestone and ornamental (marble, dolomite, limestone.La ciudad de Milán se encuentra en una llanura de suelo arcilloso adecuado para la fabricación de ladrillos pero en la cual no hay yacimientos de rocas. No obstante, en las colinas y montañas circundantes, que están comunicadas con la ciudad mediante vías navegables naturales y artificiales, sí existe una abundante cantidad de piedra. Entre los tipos de piedra utilizados desde la época de los romanos se encuentran granitos, mármoles y gneises del valle de Ossola, dolomías del lago Mayor, calizas detríticas del valle de Ceresio (Lugano, areniscas de las colinas de la Brianza, calizas negras y mármoles del lago Como y conglomerados y areniscas de la cuenca del río Adda. Tradicionalmente, los principales usos han sido la piedra de fábrica (todas ellas, fustes de columnas (granito, losas (mármol, molduras (dolomía, caliza y ornamental (mármol, dolomía, caliza.

  20. Long-distance stone transport and pigment use in the earliest Middle Stone Age

    Science.gov (United States)

    Brooks, Alison S.; Yellen, John E.; Potts, Richard; Behrensmeyer, Anna K.; Deino, Alan L.; Leslie, David E.; Ambrose, Stanley H.; Ferguson, Jeffrey R.; d’Errico, Francesco; Zipkin, Andrew M.; Whittaker, Scott; Post, Jeffrey; Veatch, Elizabeth G.; Foecke, Kimberly; Clark, Jennifer B.

    2018-04-01

    Previous research suggests that the complex symbolic, technological, and socioeconomic behaviors that typify Homo sapiens had roots in the middle Pleistocene methods. Hominins at these sites made prepared cores and points, exploited iron-rich rocks to obtain red pigment, and procured stone tool materials from ≥25- to 50-kilometer distances. Associated fauna suggests a broad resource strategy that included large and small prey. These practices imply notable changes in how individuals and groups related to the landscape and to one another and provide documentation relevant to human social and cognitive evolution.

  1. Rare calcium oxalate monohydrate calculus attached to the wall of the renal pelvis.

    Science.gov (United States)

    Grases, Felix; Costa-Bauza, Antonia; Prieto, Rafael M; Saus, Carlos; Servera, Antonio; García-Miralles, Reyes; Benejam, Joan

    2011-04-01

    Most renal calculi can be classified using well-established criteria in a manner that reflects both composition and fine structure under specific pathophysiological conditions. However, when a large patient population is considered, rare renal calculi invariably appear, some of which have never been classified; careful study is required to establish stone etiology in such cases. The patient in the present case report formed two types of calculi. One was attached on the wall of the renal pelvis near the ureter and part of the calculus was embedded inside pelvic renal tissue. The calculus developed on an ossified calcification located in the pelvis tissue. Current knowledge on the development of calcification in soft tissues suggests a pre-existing injury as an inducer of its development. A mechanism of calculus formation is proposed. The second stone was a typical jack-stone calculus. © 2011 The Japanese Urological Association.

  2. Tc-99m mercaptoacetylglycine to evaluate renal damage after ESWL

    International Nuclear Information System (INIS)

    Schaub, T.; Witsch, U.; El Damanhoury, H.; Naegele-Woehrle, B.; Hahn, K.

    1990-01-01

    This paper evaluates renal damage after extracorporeal shock wave lithotripsy (ESWL) with a new Tc-99m renal imaging compound. Tc-99m mercaptoacetylglycine-3 (MAG3) sequential scintigraphy was performed on 113 patients. A gamma camera was used, and the studies were done within 2 days before and after ESWL for renal stones. Relative renal function and clearance were calculated. Seventy (62%) of the 113 patients had abnormal findings after ESWL that were not present before the treatment. In 56 patients (50%) intra- or perirenal lesions were seen on sequential scintigraphy. Forty-six patients (41%) had a decrease of the relative renal function of at least 3% without an increase of total renal function

  3. Management of ureteric stone in pediatric patients

    Directory of Open Access Journals (Sweden)

    Eugene Minevich

    2010-01-01

    Full Text Available The management of ureteral stones in children is becoming more similar to that in adults. A number of factors must be taken into account when selecting one′s choice of therapy for ureteral stone in children such as the size of the stone, its location, its composition, and urinary tract anatomy. Endoscopic lithotripsy in children has gradually become a major technique for the treatment of ureteral stones. The stone-free rate following urteroscopic lithotripsy for ureteral stones has been reported in as high as 98.5-100%. The safety and efficacy of Holmium:YAG laser lithotripsy make it the intracorporeal lithotriptor of choice. Given its minimally invasive features, extracorporeal shock wave lithotripsy (ESWL has become a primary mode of treatment for the pediatric patients with reno-ureteral stones. Stone-free rates have been reported from 59% to 91% although some patients will require more than one treatment session for stone clearance. It appears that the first-line of therapy in the child with distal and mid-ureteral stones should be ureteroscopic lithotripsy. While ESWL is still widely considered the first-line therapy for proximal ureteral calculi, there is an increasing body of evidence that shows that endoscopic or ESWL are equally safe and efficacious in those clinical scenarios. Familiarity with the full spectrum of endourological techniques facilitates a minimally invasive approach to pediatric ureteral stones.

  4. Renal function study assessed by 99mTc-DMSA renal scintigraphy before and after PNL

    International Nuclear Information System (INIS)

    Sakurai, Masaki; Hioki, Takuichi; Okuno, Toshiyuki; Sugimura, Yoshiki; Yamakawa, Kensuke; Yanagawa, Makoto; Tajima, Kazuhiro; Tochigi, Hiromi; Kawamura, Juichi

    1990-01-01

    99m Tc-DMSA renal scintigraphy was carried out in 54 patients with unilateral renal stones before and after PNL. Four to 8 weeks after PNL the DMSA renal uptake significantly decreased to 17.2±6.0% from 18.2±6.7% before PNL. DMSA renal uptake did not change in the contralateral side. Since in some patients changes in the DMSA renal uptake of 5-7% were observed after PNL not only in the PNL side but also in the contralateral side, the renal function was assessed by the formula: DMSA renal uptake in the PNL side/DMSA renal uptake in the contralateral side, and the change of this ratio was evaluated in 44 patients, in whom the renal DMSA uptake in the PNL side was less than two times that in the contralateral side. The DMSA renal uptake ratio decreased to 95.6±8.7% from the base line 4-8 weeks after PNL. This change was statistically significant. Some functional risks such as massive bleeding with PNL, the fever after PNL and the number of nephrostomy tract did not affect the decrease in the renal function. In 29 patients in whom renal function was reevaluated one year after PNL, the DMSA renal uptake ratio significantly decreased to 94.2±9.6% from the base line 4-8 weeks after PNL. But the ratio significantly improved to 99.6±11.6% about one year after PNL. In two patients with a cold area on the renal image, the renal function of the operated side still remained at about 80% levels from the base line even one year after PNL. It is concluded that although renal function slightly decreased 4-8 weeks after PNL, it is expected to improve within one year after PNL. But in the case with a cold area on the renal image, the complete functional recovery would not be expected. 99m Tc-DMSA renal scintigraphy is a useful adjunct to evaluate the renal function before and after PNL. (author)

  5. Artificial porous stone from of ornamental rock waste adaptable for civil construction and heritage restoration

    International Nuclear Information System (INIS)

    Durán Suárez, J.A.; García Casco, A.

    2017-01-01

    The technique of volumetric reintegration in severely deteriorated stone materials is of major importance for the restoration of architectural heritage. In using mortars for restoration it is important to control aspects such as the colour and textural similarity in relation to the adjacent stone, minor or equal strength and equal or greater porosity/permeability with respect to the original stone. This latter aspect is of particular complexity because the percentage distribution of pore-size ranges should not differ from that of the original stone material. The invention patent (with numbers of publication ES2187245 A1 and B1 16. 06. 2004), owned by the University of Granada, allows the production of excellent porous stones for decorative work in construction and mortar for restoration of stone materials with controlled porosity. Both materials consist of ornamental rock waste, so that a particular recycling purpose is given to this type of material which is difficult to reuse. In this paper we present the manufacturing process of these artificial stones and porous mortars with decorative and restorative purposes, from the controlled mixture of aggregates of ornamental rocks, organic and inorganic binders and generators of porosity. Once the curing and hardening has been done it is worth noting that one of the most important aspects of the product is the generation of a complex connected porous system as a result of the incorporation of crushed expanded polystyrene, which is activated after hardening through the application of organic solvents. [es

  6. Context: The strategic management Rosetta Stone

    Directory of Open Access Journals (Sweden)

    R. V. Weeks

    2007-12-01

    Full Text Available Purpose: The purpose of this paper is to analyse context as a means for interpreting and making sense of evolving strategic management theory and practice. Problem investigated: Traditional strategic management theory based on rational deductive methodologies assumes contextual predictability, yet contemporary conditions tend to contradict this assumption. In response, alternative theories and practices for dealing with complex contexts have emerged (Brews & Purohit, 2006; Grant, 2003; Kurt & Snowden, 2003and Stacey, 1995. Methodology: A literature study was undertaken to determine the nature of emergent strategic management theory and practice, in response to contextual complexity and how it differs from traditional practice (Mintzberg, 1994 and Weeks &Lessing, 1993. Findings: An important conclusion drawn from the study is that context acts as a determinant for making sense of the evolution of strategic management theory and practice. While traditional strategic management practice still assumes relevance in contexts of linear causality, it breaks down in complex contexts. Emergent strategic management theory, based on complex adaptive systems, is increasingly assuming relevance. Notably, many institutions are still attempting to make use of scenario planning in an attempt to deal with contextual complexity, a practice not supported by leading researchers(Stacey, 1995 and Kurt & Snowden, 2003. Value of the research: The insights gained from the study assume relevance, in view of the contextual complexity confronting modern-day institutions. The findings suggest that emergent strategy based on complex adaptive system theory needs to be considered as a means for dealing with increasing environmental turbulence. Conclusion: It is concluded that context serves as the Rosetta stone for making sense of strategic management theory and practice. In view of the research findings, as reflected in the literature, it would seem that the use of complex

  7. Lower pole stones: prone PCNL versus supine PCNL in the International Cooperation in Endourology (ICE) group experience.

    Science.gov (United States)

    Sanguedolce, Francesco; Breda, Alberto; Millan, Felix; Brehmer, Marianne; Knoll, Thomas; Liatsikos, Evangelos; Osther, Palle; Traxer, Olivier; Scoffone, Cesare

    2013-12-01

    To assess efficacy and safety of prone- and supine percutaneous nephrolithotomy (PCNL) for the treatment of lower pole kidney stones. Data from patients affected by lower pole kidney stones and treated with PCNL between December 2005 and August 2010 were collected retrospectively by seven referral centres. Variables analysed included patient demographics, clinical and surgical characteristics, stone-free rates (SFR) and complications. Statistical analysis was conducted to compare the differences for SFRs and complication rates between prone- and supine PCNL. One hundred seventeen patients underwent PCNL (mean stone size: 19.5 mm) for stones harboured only in the lower renal pole (single stone: 53.6%; multiple stones: 46.4%). A higher proportion of patients with ASA score ≥ 3 and harbouring multiple lower pole stones were treated with supine PCNL (5.8 vs. 23.1%; p = 0.0001, and 25 vs. 81.5%; p = 0.0001, respectively, for prone- and supine PCNL). One-month SFR was 88.9%; an auxiliary procedure was needed in 6 patients; the 3-month SFR was 90.2%. There were 9 post-operative major complications (7.7%). No differences were observed in terms of 1- and 3-month SFRs (90.4 vs. 87.7%; p = 0.64; 92.3 vs. 89.2%; p = 0.4) and complication rates (7.6 vs. 7.7%; p = 0.83) when comparing prone- versus supine PCNL, respectively. The results confirm the high success rate and relatively low morbidity of modern PCNL for lower pole stones, regardless the position used. Supine PCNL was more frequently offered in case of patients at higher ASA score and in case of multiple lower pole stones.

  8. Rhabdoid and Undifferentiated Phenotype in Renal Cell Carcinoma: Analysis of 32 Cases Indicating a Distinctive Common Pathway of Dedifferentiation Frequently Associated With SWI/SNF Complex Deficiency.

    Science.gov (United States)

    Agaimy, Abbas; Cheng, Liang; Egevad, Lars; Feyerabend, Bernd; Hes, Ondřej; Keck, Bastian; Pizzolitto, Stefano; Sioletic, Stefano; Wullich, Bernd; Hartmann, Arndt

    2017-02-01

    Undifferentiated (anaplastic) and rhabdoid cell features are increasingly recognized as adverse prognostic findings in renal cell carcinoma (RCC), but their molecular pathogenesis has not been studied sufficiently. Recent studies identified alterations in the Switch Sucrose nonfermentable (SWI/SNF) chromatin remodeling complex as molecular mechanisms underlying dedifferentiation and rhabdoid features in carcinomas of different organs. We herein have analyzed 32 undifferentiated RCCs having in common an undifferentiated (anaplastic) phenotype, prominent rhabdoid features, or both, irrespective of the presence or absence of conventional RCC component. Cases were stained with 6 SWI/SNF pathway members (SMARCB1, SMARCA2, SMARCA4, ARID1A, SMARCC1, and SMARCC2) in addition to conventional RCC markers. Patients were 20 males and 12 females aged 32 to 85 years (mean, 59). A total of 22/27 patients with known stage presented with ≥pT3. A differentiated component varying from microscopic to major component was detected in 20/32 cases (16 clear cell and 2 cases each chromophobe and papillary RCC). The undifferentiated component varied from rhabdoid dyscohesive cells to large epithelioid to small monotonous anaplastic cells. Variable loss of at least 1 SWI/SNF complex subunit was noted in the undifferentiated/rhabdoid component of 21/32 cases (65%) compared with intact or reduced expression in the differentiated component. A total of 15/17 patients (88%) with follow-up died of metastatic disease (mostly within 1 y). Only 2 patients were disease free at last follow-up (1 and 6 y). No difference in survival, age distribution, or sex was observed between the SWI/SNF-deficient and the SWI/SNF-intact group. This is the first study exploring the role of SWI/SNF deficiency as a potential mechanism underlying undifferentiated and rhabdoid phenotype in RCC. Our results highlight the association between the aggressive rhabdoid phenotype and the SWI/SNF complex deficiency, consistent

  9. Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic.

    Science.gov (United States)

    Leo, Megan M; Langlois, Breanne K; Pare, Joseph R; Mitchell, Patricia; Linden, Judith; Nelson, Kerrie P; Amanti, Cristopher; Carmody, Kristin A

    2017-06-01

    Supporting an "ultrasound-first" approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with suspected renal colic. We calculated test characteristics of hydronephrosis on EP-performed ultrasound for detecting ureteral stones or ureteral stone size >5mm. We then analyzed the association of hydronephrosis on EP-performed ultrasound, stone size >5mm, and proximal stone location with 30-day events. This was a prospective observational study of ED patients with suspected renal colic undergoing CT. Subjects had an EP-performed ultrasound evaluating for the severity of hydronephrosis. A chart review and follow-up phone call was performed. We enrolled 302 subjects who had an EP-performed ultrasound. CT and EP ultrasound results were comparable in detecting severity of hydronephrosis ( x 2 =51.7, pHydronephrosis on EP-performed ultrasound was predictive of a ureteral stone on CT (PPV 88%; LR+ 2.91), but lack of hydronephrosis did not rule it out (NPV 65%). Lack of hydronephrosis on EP-performed ultrasound makes larger stone size >5mm less likely (NPV 89%; LR- 0.39). Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03). Using an ultrasound-first approach to detect hydronephrosis may help physicians identify patients with renal colic. The lack of hydronephrosis on ultrasound makes the presence of a larger ureteral stone less likely. Stone size >5mm may be a useful predictor of 30-day events.

  10. Biochemical and dietary factors of uric acid stone formation.

    Science.gov (United States)

    Trinchieri, Alberto; Montanari, Emanuele

    2018-04-01

    The aim of this study was to compare the clinical characteristics of "pure" uric acid renal stone formers (UA-RSFs) with that of mixed uric acid/calcium oxalate stone formers (UC-RSFs) and to identify which urinary and dietary risk factors predispose to their formation. A total of 136 UA-RSFs and 115 UC-RSFs were extracted from our database of renal stone formers. A control group of 60 subjects without history of renal stones was considered for comparison. Data from serum chemistries, 24-h urine collections and 24-h dietary recalls were considered. UA-RSFs had a significantly (p = 0.001) higher body mass index (26.3 ± 3.6 kg/m 2 ) than UC-RSFs, whereas body mass index of UA-RSFs was higher but not significantly than in controls (24.6 ± 4.7) (p = 0.108). The mean urinary pH was significantly lower in UA-RSFs (5.57 ± 0.58) and UC-RSFs (5.71 ± 0.56) compared with controls (5.83 ± 0.29) (p = 0.007). No difference of daily urinary uric acid excretion was observed in the three groups (p = 0.902). Daily urinary calcium excretion was significantly (p = 0.018) higher in UC-RSFs (224 ± 149 mg/day) than UA-RSFs (179 ± 115) whereas no significant difference was observed with controls (181 ± 89). UA-RSFs tend to have a lower uric acid fractional excretion (0.083 ± 0.045% vs 0.107+/-0.165; p = 0.120) and had significantly higher serum uric acid (5.33 ± 1.66 vs 4.78 ± 1.44 mg/dl; p = 0.007) than UC-RSFs. The mean energy, carbohydrate and vitamin C intakes were higher in UA-SFs (1987 ± 683 kcal, 272 ± 91 g, 112 ± 72 mg) and UC-SFs (1836 ± 74 kcal, 265 ± 117, 140 ± 118) with respect to controls (1474 ± 601, 188 ± 84, 76 ± 53) (p = 0.000). UA-RSFs should be differentiated from UC-RSFs as they present lower urinary pH, lower uric acid fractional excretion and higher serum uric acid. On the contrary, patients with UC-RSFs show urinary risk factors

  11. Smad signaling pathway in pathogenesis of kidney injury induced by calcium oxalate stone in rats

    Directory of Open Access Journals (Sweden)

    Fan Zhang

    2016-10-01

    Full Text Available Objective: To investigate the involvement of Smad signaling pathway in the pathogenesis of kidney injury induced by calcium oxalate stone in rats to provide a reference for clinical treatment. Methods: Clean SD rats were randomly divided into 3 group, namely the control group, model group and pirfenidone group. Ethylene glycol + αhydroxy vitamin D3 was used as a stone-inducing agent to replicate the renal calcium oxalate stone model. Rats in the pirfenidone group were treated with pirfenidone intragastric administration. The serum Cr, BUN and 24-hour oxalate and calcium in renal tissues were assayed. The expressions of Bax/ Bcl2 protein, Caspase3 protein, TGFβ, Smad1, Smad2 and Smad3 proteins were detected by the fluorescent quantitation PCR method. Results: Compared with the rats of the control group, the results showed that the levels of serum BUN, Cr and 24-hour oxalate in rats of the model group were increased greatly, Bax and Caspase3 mRNA also increased while the level of Bcl2 decreased significantly, and the expressions of TGFβ, Smad1, Smad2 and Smad3 proteins increased distinctly as well (P<0.01. These abnormal parameters could be normalized effectively by pirfenidone. Conclusions: Activated TGFβ/Smad signaling pathway is involved in the pathogenesis of kidney injury induced by calcium oxalate stone in rats.

  12. Role of ultrasonography in percutaneous renal access in patients with renal anatomic abnormalities.

    Science.gov (United States)

    Penbegul, Necmettin; Hatipoglu, Namik Kemal; Bodakci, Mehmet Nuri; Atar, Murat; Bozkurt, Yasar; Sancaktutar, Ahmet Ali; Tepeler, Abdulkadir

    2013-05-01

    To present our experience regarding the feasibility, safety, and efficacy of ultrasound (US)-guided percutaneous nephrolithotomy in anatomically abnormal kidneys. We performed US-guided percutaneous nephrolithotomy in 15 patients with anatomically abnormal kidneys and renal calculi. Of the 15 patients, 5 had horseshoe kidneys, 5 had rotation anomalies, 2 had kyphoscoliosis, and 3 had scoliosis. The stone size, number of access tracts, operative time, hospitalization duration, rate of stone clearance, and complication rate were recorded. Percutaneous access was achieved with US guidance in the operating room by the urologist. Successful renal access was obtained by the surgeon using US guidance in all patients, and a single access was obtained in all cases. Of the 15 patients, 8 were females, and 7 were males; 8 patients had solitary stones, and 7 had multiple calculi. The renal calculi were on the right in 7 patients and on the left in 8. Three patients had previously undergone unsuccessful shock wave lithotripsy. Complete stone clearance was achieved in 13 patients. The mean operative time was 54.2 minutes. No patient required a blood transfusion because of bleeding. Urinary tract infections occurred in 2 patients, who were treated with antibiotics. A double-J catheter was not inserted in any patient; however, a ureteral catheter was used in 3 patients for 1 day. None of the patients had any major complications during the postoperative period. The stone-free rate was 87%, and 2 patients had clinically insignificant residual fragments. Our results have demonstrated that US-guided percutaneous nephrolithotomy can be performed feasibly, safely, and effectively in anatomically abnormal kidneys. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Renal scan

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003790.htm Renal scan To use the sharing features on this ... anaphylaxis . Alternative Names Renogram; Kidney scan Images Kidney anatomy Kidney - blood and urine flow References Chernecky CC, ...

  14. Flow and edge scour in current adjacent to stone covers

    DEFF Research Database (Denmark)

    Petersen, Thor U.; Sumer, B. Mutlu; Bøgelund, Jon

    2015-01-01

    This paper presents the results of an experimental investigation on edge scour adjacent to a stone cover laid on a sandy bed. The three-dimensional flow over the edge of the stone layer has been investigated by the use of particle image velocimetry. The flow measurements show a significant amount...... of turbulence in the primary flow near the junction between the stone layer and the sand bed and the formation of complex secondary-flow structures. The results show that the flow and the edge scour process in a steady current are governed by the size of the roughness elements and to some extent the side slope...... of the berm. The edge scour is caused by the combined action of the primary flow and the secondary flow. The primary flow stirs up the sediment and puts it into suspension, and the secondary flow carries it away from the junction between the stone layer and the sand bed, resulting in a scour hole forming...

  15. Renal Hemangiopericytoma

    Directory of Open Access Journals (Sweden)

    İbrahim Halil Bozkurt

    2015-03-01

    Full Text Available Hemangiopericytoma is an uncommon perivascular tumor originating from pericytes in the pelvis, head and tneck, and the meninges; extremely rarely in the urinary system. We report a case of incidentally detected renal mass in which radiologic evaluation was suggestive of renal cell carcinoma. First, we performed partial nephrectomy, and then, radical nephrectomy because of positive surgical margins and the pathological examination of the surgical specimen that revealed a hemangiopericytoma. No additional treatment was administered.

  16. The R.I.R.S. scoring system: An innovative scoring system for predicting stone-free rate following retrograde intrarenal surgery.

    Science.gov (United States)

    Xiao, Yinglong; Li, Deng; Chen, Lei; Xu, Yaoting; Zhang, Dingguo; Shao, Yi; Lu, Jun

    2017-11-21

    To establish and internally validate an innovative R.I.R.S. scoring system that allows urologists to preoperatively estimate the stone-free rate (SFR) after retrograde intrarenal surgery (RIRS). This study included 382 eligible samples from a total 573 patients who underwent RIRS from January 2014 to December 2016. Four reproducible factors in the R.I.R.S. scoring system, including renal stone density, inferior pole stone, renal infundibular length and stone burden, were measured based on preoperative computed tomography of urography to evaluate the possibility of stone clearance after RIRS. The median cumulative diameter of the stones was 14 mm, and the interquartile range was 10 to 21. The SFR on postoperative day 1 in the present cohort was 61.5% (235 of 382), and the final SFR after 1 month was 73.6% (281 of 382). We established an innovative scoring system to evaluate SFR after RIRS using four preoperative characteristics. The range of the R.I.R.S. scoring system was 4 to 10. The overall score showed a great significance of stone-free status (p R.I.R.S. scoring system was 0.904. The R.I.R.S. scoring system is associated with SFR after RIRS. This innovative scoring system can preoperatively assess treatment success after intrarenal surgery and can be used for preoperative surgical arrangement and comparisons of outcomes among different centers and within a center over time.

  17. A huge bladder calculus causing acute renal failure.

    Science.gov (United States)

    Komeya, Mitsuru; Sahoda, Tamami; Sugiura, Shinpei; Sawada, Takuto; Kitami, Kazuo

    2013-02-01

    A 81-year-old male was referred to our emergency outpatient unit due to acute renal failure. The level of serum creatinine was 276 μmol/l. A CT scan showed bilateral hydronephroureter, large bladder stone (7 cm × 6 cm × 6 cm) and bladder wall thickness. He was diagnosed as post renal failure due to bilateral hydronephroureter. Large bladder stone is thought to be the cause of bilateral hydronephroureter and renal failure. To improve renal failure, we performed open cystolithotomy and urethral catheterization. Three days after the surgery, the level of serum creatinine decreased to 224 μmol/l. He was discharged from our hospital with uneventful course. Bladder calculus is thought to be a rare cause of renal failure. We summarize the characteristics of bladder calculus causing renal failure. We should keep that long-term pyuria and urinary symptom, and repeated urinary tract infection can cause huge bladder calculus and renal failure in mind.

  18. COMORBIDITY OF KIDNEY STONES AND PYCHIATRIC DISEASE

    OpenAIRE

    Bilić, Vedran; Marčinko, Darko

    2010-01-01

    This paper describes a patient who is suffering from PTSD with elements of hypochondria, panic attacks and episodes of 0depression in comorbidity with kidney stones. Kidney stones provoked egzacerbation of psychiatric symptoms. Kidney stones and frustration about them have taken part of provoking factor, the last drop, which led to regression of otherwise precarious, but compensated patient’s mental functioning which resulted in development of psychiatric symptoms.

  19. Changes of renal blood flow after ESWL: assessment by ASL MR imaging, contrast enhanced MR imaging, and renal resistive index.

    Science.gov (United States)

    Abd Ellah, Mohamed; Kremser, Christian; Pallwein, Leo; Aigner, Friedrich; Schocke, Michael; Peschel, Reinhard; Pedross, Florian; Pinggera, Germar-Michael; Wolf, Christian; Alsharkawy, Mostafa A M; Jaschke, Werner; Frauscher, Ferdinand

    2010-10-01

    The annual incidence of stone formation is increased in the industrialised world. Extracorporeal shockwave lithotripsy is a non-invasive effective treatment of upper urinary tract stones. This study is aimed to evaluate changes of renal blood flow in patients undergoing extracorporeal shock wave lithotripsy (ESWL) by arterial spin labeling (ASL) MR imaging, contrast enhanced dynamic MR imaging, and renal resistive index (RI). Thirteen patients with nephrolithiasis were examined using MR imaging and Doppler ultrasound 12h before and 12h after ESWL. ASL sequence was done for both kidneys and followed by contrast enhanced MR imaging. In addition RI Doppler ultrasound measurements were performed. A significant increase in RI (pESWL causes changes in RI and ASL MR imaging, which seem to reflect changes in renal blood flow. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  20. Building stones can be of geoheritage significance

    Science.gov (United States)

    Brocx, Margaret; Semeniuk, Vic

    2017-04-01

    Building stones have generally been assigned values according to their cultural, aesthetic, and rarity significance, amongst other criteria, but they also may have geoheritage significance. This is akin to the geoheritage significance ascribed to minerals and fossils housed as ex situ specimens in museums. We proffer the notion that building stones can be of geoheritage value particularly where they comprise permanent buildings, they illustrate significant windows into the history of the Earth, and they can be visited as an ex situ museum locality (e.g., the "Blue Granite" of Iceland) for education as part of building-stone tours. For some rocks the quarries that supplied the building stone are no longer in existence and hence the building stones provide the only record of that type of material; for other rocks, the building stone may illustrate features in the lithology no longer present in the quarry itself (e.g., rare and large xenoliths). Building stones are particularly significant as they are often polished and manifest structures, fabrics, and textures not evident in outcrop. We illustrate here examples of building stone of geoheritage significance using Australian and International examples. Australian designated stones could include the "Sydney Sandstone" or "Victorian Bluestone". For international examples, there is the famous "Carrara Marble" in Italy and the widely known "Portland Limestone" from southern England, the latter having been utilized for St Pauls Cathedral in London and the UN building in New York City.

  1. Success in treating renal calculi with single-access, single-event percutaneous nephrolithotomy: is a routine "second look" necessary?

    Science.gov (United States)

    Davol, Patrick E; Wood, Craig; Fulmer, Brant

    2006-05-01

    Percutaneous nephrolithotomy (PCNL) is an effective procedure for the treatment of large renal calculi. An important consideration for patients undergoing PCNL is the management of any residual stone burden, which may include "second-look" nephroscopy. The utility of this practice is unproven, and we present our data on a series of patients in which second-look procedures were not performed. We retrospectively reviewed the records of 43 consecutive patients undergoing a total of 45 procedures by a single surgeon at a tertiary-care center. Patients were considered stone free if no calculi were evident by either plain film or noncontrast CT scan. Statistical analysis was used to look for correlations between radiographic stone clearance and various patient and stone characteristics. Of these procedures, 15% had immediate postoperative evidence of residual fragments. At a mean follow-up of 8 months, 32.5% had residual or recurrent stone. There were statistically significant correlations between both patient age and stone size and the risk of recurrent or residual stone. In our study, PCNL was effective for the single-stage treatment of large renal calculi. Aggressive stone clearance obviated the need for routine second-look nephroscopy. Factors leading to an increased risk of residual or recurrent calculi included the presence of a staghorn calculus and younger patient age. The excellent stone-free rates achieved suggest that routine second-look nephroscopy may not be necessary for the majority of patients undergoing PCNL.

  2. 77 FR 27245 - Big Stone National Wildlife Refuge, Big Stone and Lac Qui Parle Counties, MN

    Science.gov (United States)

    2012-05-09

    ... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R3-R-2012-N069; FXRS1265030000S3-123-FF03R06000] Big Stone National Wildlife Refuge, Big Stone and Lac Qui Parle Counties, MN AGENCY: Fish and... plan (CCP) and environmental assessment (EA) for Big Stone National Wildlife Refuge (Refuge, NWR) for...

  3. Mini-percutaneous nephrolithotomy for stones in anomalous-kidneys: a prospective study.

    Science.gov (United States)

    Khadgi, Sanjay; Shrestha, Babu; Ibrahim, Hamdy; Shrestha, Sunil; ElSheemy, Mohammed S; Al-Kandari, Ahmed M

    2017-08-01

    To evaluate safety and efficacy of minipercutaneous nephrolithotomy (Mini-PNL) in management of stones in different types of renal anomalies. Patients with stones ≥2 cm or SWL-resistant stones in anomalous-kidneys treated by Mini-PNL between March 2010 and September 2012 were included prospectively. Mini-PNL was done under regional anesthesia in prone position with fluoroscopic guidance through 18 Fr sheath using semirigid ureteroscope (8.5/11.5 Fr) and pneumatic lithotripter. All patients were followed-up for 2-3 years. Stone-free rate was defined as absence of residual fragments ≥2 mm. Student-T, Mann-Whitney, Chi square (χ 2 ), Fisher-exact, one way ANOVA or Kruskal-Wallis test were used for analysis. Mini-PNL was performed for 59 patients (20 horseshoe, 15 malrotated, 7 polycystic, 13 duplex and 4 ectopic pelvic-kidneys). Mean age was 40.18 ± 12.75 (14-78) years. Mean stone burden was 31.72 ± 21.43 (7.85-141.3) mm 2 . Two tracts were required in 7 (11.9 %) patients. Tubeless Mini-PNL with double-J insertion was performed in all patients except two. Operative time was 50.17 ± 18.73 (15-105) min. Hemoglobin loss was 0.44 ± 0.30 (0-1.4) g/dL. Complications were reported in 15 (25.4 %) patients. No pleural injury, sepsis, perinephric-collection or renal-pelvis perforation were reported. Stone-free rate was 89.8 % (converted to open-surgery in one patient, second-look PNL in two patients, auxiliary SWL in three patients). Stone-free rate improved to 98.3 % after retreatment and auxiliary SWL. Site of puncture was mostly upper calyceal in horseshoe-kidney (80 %), mid calyceal in polycystic-kidney (85.7 %) and lower calyceal in duplex-kidney (46.2 %). Punctures were also significantly infracostal in horseshoe-kidney (100 %) and supracostal in both duplex (53.8 %) and malrotated-kidneys (66.7 %). Mini-PNL is safe for management of stones in anomalous-kidney with SFR comparable to standard-PNL but with less complications.

  4. A Lion of a Stone

    Science.gov (United States)

    2004-01-01

    This approximate true-color image of the rock called 'Lion Stone' was acquired by the Mars Exploration Rover Opportunity's panoramic camera on sol 104 (May 9, 2004). The rock stands about 10 centimeters tall (about 4 inches) and is about 30 centimeters long (12 inches). Plans for the coming sols include investigating the rock with the spectrometers on the rover's instrument arm. This image was generated using the camera's L2 (750-nanometer), L5 (530-nanometer) and L6 (480-nanometer) filters.

  5. Do You Have Symptoms of a Kidney Stone?

    Science.gov (United States)

    ... Or, the stone will be removed with treatment. Dogs, Cats, and Kidney Stones Humans aren't the only ones affected by kidney and bladder stones. Dogs, cats, and other animals can also have kidney ...

  6. Is the gravity effect of radiographic anatomic features enough to justify stone clearance or fragments retention following extracorporeal shock wave lithotripsy (SWL).

    Science.gov (United States)

    Mustafa, Mahmoud

    2012-08-01

    We determined whether the gravity effect of radiographic anatomic features on the preoperative urography (IVP) are enough to predict fragments clearance after shock wave lithotripsy (SWL). A Total of 282 patients with mean age 45.8 ± 13.2 years (189 male, 93 female), who underwent SWL due to renal calculi between October 2005 and August 2009 were enrolled. The mean calculi load was 155.72 ± 127.66 mm². The patients were stratified into three groups: patients with pelvis calculi (group 1); patients with upper or middle pole calculi (group 2) and patients with lower pole calculi (group 3). Three angles on the pretreatment IVP were measured: the inner angle between the axis of the lower pole infundibular and ureteropelvic axis (angle I); the inner angle between the lower pole infundibular axis and main axis of pelvis-ureteropelvic (UP) junction point (angle II) and the inner angle between the lower pole infundibular axis and perpendicular line (angle III). Multivariate analysis was used to define the significant predictors of stone clearance. The overall success rate was 85.81%. All angles, sessions number, shock waves number and stone burden were significant predictors of success in patients in group 1. However, in group 2 only angle II and in group 3 angles I and II had significant effect on stone clearance. Radiographic anatomic features have significant role in determining the stone-free rate following satisfactory fragmentation of renal stones with SWL. The measurement of infundibulopelvic angle in different manner helps to predict the stone-free status in patients with renal calculi located not only in lower pole, but also in renal pelvis and upper or middle pole. Gravity effect is not enough to justify the significant influence of the radiographic anatomic features on the stone clearance and fragments retention after SWL.

  7. Laparoscopic and open stone surgery

    NARCIS (Netherlands)

    Hruza, Marcel; Zuazu, Jorge Rioja; Goezen, Ali Serdar; de La Rosette, Jean J. M. C. H.; Rassweiler, Jens J.

    2010-01-01

    INTRODUCTION: Due to the increasing spread and technical enhancement of endourological methods, open surgery for renal and ureteral calculi almost disappeared. MATERIALS AND METHODS: Based on an actual review of literature, we describe indications, technique and clinical importance of the open and

  8. Percutaneous suprapubic stone extraction for posterior urethral stones in children: efficacy and safety.

    Science.gov (United States)

    Safwat, Ahmed S; Hameed, Diaa A; Elgammal, Mohamed A; Abdelsalam, Yasser M; Abolyosr, Ahmad

    2013-08-01

    To evaluate the safety and efficacy of percutaneous suprapubic stone extraction (PSPSE) for pediatric posterior urethral stones. Between July 2007 and June 2010, 54 boys presenting with acute urinary retention due to posterior urethral stones underwent PSPSE. Patients were a mean age of 66.4 months (range, 8-180 months). The stone size was 0.7-1.9 cm. Patients were placed under general anesthesia, and a 7F urethroscope was used to pushback the stone to the bladder. A 3-mm suprapubic puncture with a scalpel was performed, followed by insertion of a straight narrow hemostat through the puncture aided with cystoscopic guidance. The stone was grasped with the hemostat in its narrowest diameter and was extracted percutaneously or crushed if friable. The suprapubic puncture was closed with a single 4-0 Vicryl (Ethicon) suture. Intact stone retrieval was achieved in 45 patients, and the stone was crushed into minute fragments in 9 patients. Intraperitoneal extravasation developed in 1 patient that required open surgical intervention. Mean operative time was 22 minutes. Patients were monitored for up to 17 months, with complete resolution of symptoms and stone clearance. PSPSE provides a minimally invasive approach for the extraction of urethral and bladder stones in the pediatric population. The use of a straight hemostat for suprapubic stone extraction or crushing is a good alternative to suprapubic tract dilation, with minimal morbidity. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. A Boy with a Large Bladder Stone

    Directory of Open Access Journals (Sweden)

    Kuo-Shen Chow

    2008-08-01

    Full Text Available Despite the frequent association of urinary tract infection with vesicoureteral reflux and urinary calculi, since vesicouretal reflux is induced by bladder stones, the coexistence of vesicoureteral reflux and bladder stones is rare. Because of its occurrence in children belonging to poor socioeconomic groups, it is believed to be a deficiency disorder. Most cases of bladder stones occur between the ages of 2 and 5 years. Common clinical presentations of bladder stones include urinary dribbling and enuresis, frequency of micturition, pain during micturition, pelvic pain and hematuria. We report the occurrence of a large bladder stone in a boy, who experienced intermittent lower abdominal pain and urinary incontinence, both during the day and at night. He had been diagnosed with enuresis and treated in pediatric clinics for 1 year. Delayed diagnosis resulted in bladder stone formation. The stone was larger than 2.5 cm and open vesicolithotomy was therefore selected as the best and safest treatment choice. His symptoms disappeared after surgery. Thorough metabolic and environmental evaluations of such cases are required on an individual basis. Bladder stones should be considered as a possible diagnosis in children presenting with urinary incontinence.

  10. Sculpture: Stone Shapes, Art: 6683.08.

    Science.gov (United States)

    Dubocq, Edward R.

    This elective course for grades 7-12 was created with a three fold purpose: 1) to create in the student an awareness of the effect of sculptural forms on his environment; 2) to introduce the student to an appreciation of stone sculpture; and 3) to further enhance the artistic abilities of the student through sculpting in stone. Course content…

  11. Stone Formation in the Infected Pediatric Enterocystoplasty

    NARCIS (Netherlands)

    R.B. Mathoera (Rejiv)

    2003-01-01

    markdownabstract__Abstract__ Proteus mirabilis is one of the most frequent bacterial agents that can induce infection stone formation by urease production. In recent years the influence of Proteus mirabilis on stone formation in enterocystoplasties has been primarily related to the presence of

  12. Effect of stone coverage on soil erosion

    Science.gov (United States)

    Jomaa, S.; Barry, D. A.; Heng, B. P.; Brovelli, A.; Sander, G. C.; Parlange, J.

    2010-12-01

    Soil surface coverage has a significant impact on water infiltration, runoff and soil erosion yields. In particular, surface stones protect the soils from raindrop detachment, they retard the overland flow therefore decreasing its sediment transport capacity, and they prevent surface sealing. Several physical and environmental factors control to what extent stones on the soil surface modify the erosion rates and the related hydrological response. Among the most important factors are the moisture content of the topsoil, stone size, emplacement, coverage density and soil texture. Owing to the different inter-related processes, there is ambiguity concerning the quantitative effect of stones, and process-based understanding is limited. Experiments were performed (i) to quantify how stone features affect sediment yields, (ii) to understand the local effect of isolated surface stones, that is, the changes of the soil particle size distribution in the vicinity of a stone and (iii) to determine how stones attenuate the development of surface sealing and in turn how this affects the local infiltration rate. A series of experiments using the EPFL 6-m × 2-m erosion flume were conducted at different rainfall intensities (28 and 74 mm h-1) and stone coverage (20 and 40%). The total sediment concentration, the concentration of the individual size classes and the flow discharge were measured. In order to analyze the measurements, the Hairsine and Rose (HR) erosion model was adapted to account for the shielding effect of the stone cover. This was done by suitably adjusting the parameters based on the area not covered by stones. It was found that the modified HR model predictions agreed well with the measured sediment concentrations especially for the long time behavior. Changes in the bulk density of the topsoil due to raindrop-induced compaction with and without stone protection revealed that the stones protect the upper soil surface against the structural seals resulting in

  13. Instrumental neutron activation analysis of kidney stones

    International Nuclear Information System (INIS)

    Sarmani, S.; Kuan, L.L.; Bakar, M.A.A.

    1990-01-01

    Kidney stone samples of the types calcium oxalate, uric acid, and xanthine were analyzed for their elemental contents by neutron activation analysis to study both the elemental correlation and influence of element on stone precipitation processes. Elements, such as Al, Au, Br, Ca, Cl, Co, Cr, Fe,H, I, K, Mg, Na, Sb, Se, Sr, and Zn, were determined quantitatively. Calcium oxalate stones contained higher concentration of all the elements analyzed compared to uric acid or xanthine stones. The concentrations of Cl, Fe, K, Na, Sr, and Zn were relatively higher than Au, Co, Cr, and Sb. A positive correlation exists between Ca and Zn, whereas a negative correlation exists between Sr and Ca. Zinc may play an important role in the formation of calcium oxalate stone

  14. Extracorporeal Shockwave Lithotripsy of Primary Intrahepatic Stones

    Science.gov (United States)

    Kim, Myung Hwan; Lee, Sung Koo; Min, Young Il; Lee, Mun Gyu; Sung, Kyu Bo; Cho, Kyung Sik; Lee, Sung Gyu; Min, Pyung Chul

    1992-01-01

    Extracorporeal shockwave lithothripsy (ESWL) was performed in intrahepatic stone patients (n = 18) by Dornier MPL 9,000 with ultrasound guidance. The patients had T-tube (n = 9) or percutaneous transhepatic biliary drainge tube (n = 9). Average treatment session was four and shock-wave numbers were in the range of 3,064 to 12,000 (average 6,288 shocks). Intrahepatic stones were removed completely in 16 patients over a 3 month period by ESWL and combined stone extraction maneuver such as cholangioscopic or interventional radiologic method. Extracorporeal shockwave lithothripsy was very helpful in facilitating extraction of stones in unfavorable locations or located above the severe stricture. In summary, extracorporeal Shockwave lithotripsy, followed by percutaneous stone extraction, will provide an improvement in the success rate and duration of treatment required for complete removal of primary hepatolithiasis. PMID:1477027

  15. Clinical experience with EDAP LT-01+ extracorporeal shock wave lithotripsy for radiolucent stones; a report of 27 cases

    International Nuclear Information System (INIS)

    Rim, Hee Kwan; Kim, Ho Sung; Rim, Joung Sik

    1994-01-01

    Between February 1990 and February 1993, Radiolucent stones of 27 renal units in 22 patients were treated by extracorporeal shock wave lithotripsy (ESWL) using the EDAP LT-01+. Intravenous urography was done in all patients for the diagnosis of radiolucent stones. Retrograde pyelography, ultrasonography and/or computed tomography was done, if needed. The locations of stones were kidney in 11(40.7 %), upper ureter in 8(29.6 %), lower ureter in 6(22.2 %), bladder in 1(3.7 %), ureteropelvic junction in 1(3.7 %). The average stone size was 10.9mm with a range of 5 to 32mm in maximum diameter. The average numbers of treatment were 2.7 sessions and average storage required was 34.8 in one session. The average treatment time was 40.4 minutes. All the patients showed complete removal of all calculous materials. Of 17 urinary stones analysed by chemical method, 8(47.1 %) were composed of uric acid, 5(29.4 %) of uric acid and calcium, 3 of phosphate and 1 of carbonate and phosphate. Therefore, we conclude that ESWL with EDAP LT-01+ lithotriptor is considered to be an effective noninvasive procedure for treatment of radiolucent stones. (Author)

  16. Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone.

    Science.gov (United States)

    el-Nahas, Ahmed R; Eraky, Ibrahim; Shokeir, Ahmed A; Shoma, Ahmed M; el-Assmy, Ahmed M; el-Tabey, Nasr A; Soliman, Shady; Elshal, Ahmed M; el-Kappany, Hamdy A; el-Kenawy, Mahmoud R

    2012-06-01

    To determine factors affecting the stone-free rate and complications of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones. The computerized database of patients who underwent PNL for treatment of staghorn stones between January 2003 and January 2011 was reviewed. All perioperative complications were recorded and classified according to modified Clavien classification system. The stone-free rate was evaluated with low-dose noncontrast computed tomography (CT). Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free and complication rates. The study included 241 patients (125 male and 116 female) with a mean age of 48.7 ±14.3 years. All patients underwent 251 PNL (10 patients had bilateral stones). The stone-free rate of PNL monotherapy was 56% (142 procedures). At 3 months, the stone-free rate increased to 73% (183 kidneys) after shock wave lithotripsy. Independent risk factors for residual stones were complete staghorn stone and presence of secondary calyceal stones (relative risks were 2.2 and 3.1, respectively). The complication rate was 27% (68 PNL). Independent risk factors for development of complications were performance of the procedure by urologists other than experienced endourologist and positive preoperative urine culture (relative risks were 2.2 and 2.1, respectively). Factors affecting the incidence of residual stones after PNL are complete staghorn stones and the presence of secondary calyceal stones. Complications are significantly high if PNL is not performed by an experienced endourologist or if preoperative urine culture is positive. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Endovascular Exclusion of Renal Artery Aneurysm

    International Nuclear Information System (INIS)

    Andersen, Poul Erik; Rohr, Nils

    2005-01-01

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90 o , but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable

  18. Renal tissue damage induced by focused shock waves

    Science.gov (United States)

    Ioritani, N.; Kuwahara, M.; Kambe, K.; Taguchi, K.; Saitoh, T.; Shirai, S.; Orikasa, S.; Takayama, K.; Lush, P. A.

    1990-07-01

    Biological evidence of renal arterial wall damage induced by the microjet due to shock wave-cavitation bubble interaction was demonstrated in living dog kidneys. We also intended to clarify the mechanism of renal tissue damage and the effects of different conditions of shock wave exposure (peak pressure of focused area, number of shots, exposure rate) on the renal tissue damage in comparison to stone disintegration. Disruption of arterial wall was the most remarkable histological change in the focused area of the kidneys. This lesion appeared as if the wall had been punctured by a needle. Large hematoma formation in the renal parenchym, and interstitial hemorrhage seemed to be the results of the arterial lesion. This arterial disorder also led to ischemic necrosis of the tubules surrounding the hematoma. Micro-angiographic examination of extracted kidneys also proved such arterial puncture lesions and ischemic lesions. The number of shots required for model stone disintegration was not inversely proportional to peak pressure. It decreased markedly when peak pressure was above 700 bar. Similarly thenumber of shots for hematoma formation was not inversely proportional to peak pressure, however, this decreased markedly above 500 bar. These results suggested that a hematoma could be formed under a lower peak pressure than that required for stone disintegration.

  19. Perspectives on hypertension outcomes after single-stage clearance of a complete staghorn renal calculus

    Directory of Open Access Journals (Sweden)

    Ranjit Chaudhary

    2017-01-01

    Full Text Available A 55-year-old male presented, in June 2013, with left flank pain. Investigations revealed a complete staghorn stone. He had undergone two sittings of extracorporeal shock wave lithotripsy (ESWL in 2008 for left renal stone. One year subsequent to this, he was diagnosed with hypertension and diabetes. The management of complete staghorn stones in a single sitting is a difficult proposition. Percutaneous nephrolithotomy (PCNL is the gold standard to manage such stones. The patient was subjected to PCNL, and complete clearance was achieved in one sitting. On one-year follow-up, there was a significant reduction in blood pressure (BP and better glycemic control. Although there are several reports where hypertension has been reported after multiple sittings of ESWL, whether ESWL contributed to the genesis of hypertension and diabetes in this patient or it was simply incidental, cannot be stated with certainty. There was a significant reduction in the BP after complete stone removal, but there is uncertainty over the effect of total clearance of renal stones on hypertension, and we need to await the results of more controlled trials studying this phenomenon. A better glycemic control was perhaps achieved secondary to the eradication of recurrent urinary tract infections due to complete stone clearance.

  20. Optimum nutrition for kidney stone disease.

    Science.gov (United States)

    Heilberg, Ita P; Goldfarb, David S

    2013-03-01

    We summarize the data regarding the associations of individual dietary components with kidney stones and the effects on 24-hour urinary profiles. The therapeutic recommendations for stone prevention that result from these studies are applied where possible to stones of specific composition. Idiopathic calcium oxalate stone-formers are advised to reduce ingestion of animal protein, oxalate, and sodium while maintaining intake of 800 to 1200 mg of calcium and increasing consumption of citrate and potassium. There are few data regarding dietary therapy of calcium phosphate stones. Whether the inhibitory effect of citrate sufficiently counteracts increasing urine pH to justify more intake of potassium and citrate is not clear. Reduction of sodium intake to decrease urinary calcium excretion would also be expected to decrease calcium phosphate stone recurrence. Conversely, the most important urine variable in the causation of uric acid stones is low urine pH, linked to insulin resistance as a component of obesity and the metabolic syndrome. The mainstay of therapy is weight loss and urinary alkalinization provided by a more vegetarian diet. Reduction in animal protein intake will reduce purine ingestion and uric acid excretion. For cystine stones, restriction of animal protein is associated with reduction in intake of the cystine precursor methionine as well as cystine. Reduction of urine sodium results in less urine cystine. Ingestion of vegetables high in organic anion content, such as citrate and malate, should be associated with higher urine pH and fewer stones because the amino acid cystine is soluble in more alkaline urine. Because of their infectious origin, diet has no definitive role for struvite stones except for avoiding urinary alkalinization, which may worsen their development. Published by Elsevier Inc.

  1. A Drosophila genetic model of nephrolithiasis: transcriptional changes in response to diet induced stone formation.

    Science.gov (United States)

    Chung, Vera Y; Turney, Benjamin W

    2017-11-28

    Urolithiasis is a significant healthcare issue but the pathophysiology of stone disease remains poorly understood. Drosophila Malpighian tubules were known to share similar physiological function to human renal tubules. We have used Drosophila as a genetic model to study the transcriptional response to stone formation secondary to dietary manipulation. Wild-type male flies were raised on standard medium supplemented with lithogenic agents: control, sodium oxalate (NaOx) and ethylene glycol (EG). At 2 weeks, Malpighian tubules were dissected under polarized microscope to visualize crystals. The parallel group was dissected for RNA extraction and subsequent next-generation RNA sequencing. Crystal formation was visualized in 20%(±2.2) of flies on control diet, 73%(±3.6) on NaOx diet and 84%(±2.2) on EG diet. Differentially expressed genes were identified in flies fed with NaOx and EG diet comparing with the control group. Fifty-eight genes were differentially expressed (FDR <0.05, p < 0.05) in NaOx diet and 20 genes in EG diet. The molecular function of differentially expressed genes were assessed. Among these, Nervana 3, Eaat1 (Excitatory amino acid transporter 1), CG7912, CG5404, CG3036 worked as ion transmembrane transporters, which were possibly involved in stone pathogenesis. We have shown that by dietary modification, stone formation can be manipulated and visualized in Drosophila Malpighian tubules. This genetic model could be potentially used to identify the candidate genes that influence stone risk hence providing more insight to the pathogenesis of human stone disease.

  2. Ultra-mini-percutaneous nephrolithotomy: A minimally-invasive option for percutaneous stone removal

    Directory of Open Access Journals (Sweden)

    Madhu Sudan Agrawal

    2016-01-01

    Full Text Available Introduction: Percutaneous nephrolithotomy (PCNL has witnessed rapid advancements, the latest being ultra-mini-percutaneous nephrolithotomy (UMP, which makes the use of 11-13F sheaths as compared to 24-30F sizes used in conventional PCNL. This miniaturization aims to reduce morbidity and improve patient outcomes. We evaluated the safety and efficacy of UMP and report our ourtcomes. Patients and Methods: A total of 120 patients underwent UMP from July 2012 to March 2014. These patients had a single unilateral renal stone measuring between 8 and 20 mm. All patients underwent UMP using a 3F nephroscope, 7.5F inner sheath, and 11F or 13F outer metallic cannula, which served as the Amplatz sheath. Stone fragmentation and clearance were achieved with holmium laser. No nephrostomy or stent was used routinely. Results: Complete stone fragmentation was achieved in 114 out of 120 patients (95% using UMP; whereas the remaining 6 were converted into mini-PCNL using a 12.5F nephroscope and 15F Amplatz sheath. The mean operative time was 39.7 ± 15.4 min, and the mean postoperative hospital stay was 22.3 ± 2.2 h. Postoperatively, 6 (5% patients had residual fragments measuring ≤4 mm. At the 2 weeks follow-up, the stone-free status was >99% (119/120. There were no significant postoperative complications. Conclusion: This study shows UMP to be an effective and safe procedure for managing stones up to 20 mm. This procedure offers an attractive alternative to shock wave lithotripsy and retrograde intrarenal surgery for managing small stones.

  3. Shock Wave Lithotripsy in Ureteral Stones: Evaluation of Patient and Stone Related Predictive Factors

    Directory of Open Access Journals (Sweden)

    Ozgur Yazici

    2015-08-01

    Full Text Available ABSTRACTPurpose:To evaluate the patient and stone related factors which may influence the final outcome of SWL in the management of ureteral stones.Materials and Methods:Between October 2011 and October 2013, a total of 204 adult patients undergoing SWL for single ureteral stone sizing 5 to 15 mm were included into the study program. The impact of both patient (age, sex, BMI, and stone related factors (laterality, location, longest diameter and density as CT HU along with BUN and lastly SSD (skin to stone distance on fragmentation were analysed by univariate and multivariate analyses. Results: Stone free rates for proximal and distal ureteral stones were 68.8% and 72.7%, respectively with no statistically significant difference between two groups (p=0.7. According to univariate and multivariate analyses, while higher BMI (mean: 26.8 and 28.1, p=0.048 and stone density values (mean: 702 HU and 930 HU, p<0.0001 were detected as statistically significant independent predictors of treatment failure for proximal ureteral stones, the only statistically significant predicting parameter for the success rates of SWL in distal ureteral stones was the higher SSD value (median: 114 and 90, p=0.012.Conclusions:Our findings have clearly shown that while higher BMI and increased stone attenuation values detected by NCCT were significant factors influencing the final outcome of SWL treatment in proximal ureteral stones; opposite to the literature, high SSD was the only independent predictor of success for the SWL treatment of distal ureteral stones.

  4. Mourning in Bits and Stone

    DEFF Research Database (Denmark)

    Sabra, Jakob Borrits

    We mourn our dead, publicly and privately, online and offline. Cemeteries, web memorials and social network sites make up parts of todays intricately weaved and interrelated network of death, grief and memorialization practices [1]–[5]. Whether cut in stone or made of bits, graves, cemeteries......, memorials, monuments, websites and social networking services (SNS) all are alterable, controllable and adaptive. They represent a certain rationale contrary to the emotive state of mourning (e.g. gravesites function as both spaces of internment and places of spiritual and emotional recollection). Following...... and memorialization by discussing the publicly and privately digital and social death from a spatial, temporal, physical and digital angle. Further the paper will reflect on how to encompass shifting trends and technologies in ‘traditional’ spaces of mourning and remembrance....

  5. In bits, bytes and stone

    DEFF Research Database (Denmark)

    Sabra, Jakob Borrits; Andersen, Hans Jørgen

    The digital spheres of Information and Communication Technologies (ICT) and Social Network Services (SNS) are influencing 21st. century death. Today the dying and the bereaved attend mourning and remembrance both online and offline. Combined, the cemeteries, web memorials and social network sites...... designs'. Urns, coffins, graves, cemeteries, memorials, monuments, websites, applications and software services, whether cut in stone or made of bits, are all influenced by discourses of publics, economics, power, technology and culture. Designers, programmers, stakeholders and potential end-users often...... the respondents and interviewees are engaged with a prototype design that encompasses digitally enhanced experiences and interactions regarding mourning, memory and remembrance. The design is situated in a traditional public place of death, the Almen Cemetery of Aalborg in Denmark....

  6. Pitfalls in urinary stone identification using CT attenuation values: Are we getting the same information on different scanner models?

    Energy Technology Data Exchange (ETDEWEB)

    Grosjean, Romain, E-mail: r.grosjean@chu-nancy.fr [IADI Laboratory, INSERM-U947, Nancy-University, Allée du Morvan, 54500 Vandoeuvre-les-Nancy (France); Daudon, Michel, E-mail: michel.daudon@tnn.aphp.fr [IADI Laboratory, INSERM-U947, Nancy-University, Allée du Morvan, 54500 Vandoeuvre-les-Nancy (France); Chammas, Mario F., E-mail: mariochammas@usp.br [University of Sao Paulo – Division of Urology, Av. Dr. Enéas de Carvalho Aguiar, 255, 7" o Andar – s. 7123, São Paulo (Brazil); Claudon, Michel, E-mail: m.claudon@chu-nancy.fr [IADI Laboratory, INSERM-U947, Nancy-University, Allée du Morvan, 54500 Vandoeuvre-les-Nancy (France); Eschwege, Pascal, E-mail: peschwege@yahoo.com [Department of Urology, Brabois Hospital, University Hospital of Nancy, Allée du Morvan, 54511 Vandoeuvre-les-Nancy (France); Felblinger, Jacques, E-mail: j.felblinger@chu-nancy.fr [IADI Laboratory, INSERM-U947, Nancy-University, Allée du Morvan, 54500 Vandoeuvre-les-Nancy (France); Hubert, Jacques, E-mail: j.hubert@chu-nancy.fr [Department of Urology, Brabois Hospital, University Hospital of Nancy, Allée du Morvan, 54511 Vandoeuvre-les-Nancy (France)

    2013-08-15

    Introduction: Evaluate the capability of different Computed Tomography scanners to determine urinary stone compositions based on CT attenuation values and to evaluate potential differences between each model. Methods: 241 human urinary stones were obtained and their biochemical composition determined. Four different CT scanners (Siemens, Philips, GEMS and Toshiba) were evaluated. Mean CT-attenuation values and the standard deviation were recorded separately and compared with a t-paired test. Results: For all tested CT scanners, when the classification of the various types of stones was arranged according to the mean CT-attenuation values and to the confidence interval, large overlappings between stone types were highlighted. The t-paired test showed that most stone types could not be identified. Some types of stones presented mean CT attenuation values significantly different from one CT scanner to another. At 80 kV, the mean CT attenuation values obtained with the Toshiba Aquilion were significantly different from those obtained with the Siemens Sensation. On the other hand, mean values obtained with the Philips Brilliance were all significantly equal to those obtained with the Siemens Sensation and with the Toshiba Aquilion. At 120 kV mean CT attenuation values of uric acid, cystine and struvite stones obtained with the Philips model are significantly different from those obtained with the Siemens and the Toshiba but equal to those obtained with the GE 64. Conclusions: According to our study, there is a great variability when different brands and models of scanners are compared directly. Furthermore, the CT scan analysis and HU evaluation appears to gather insufficient information in order to characterize and identify the composition of renal stones.

  7. Pitfalls in urinary stone identification using CT attenuation values: Are we getting the same information on different scanner models?

    International Nuclear Information System (INIS)

    Grosjean, Romain; Daudon, Michel; o Andar – s. 7123, São Paulo (Brazil))" data-affiliation=" (University of Sao Paulo – Division of Urology, Av. Dr. Enéas de Carvalho Aguiar, 255, 7o Andar – s. 7123, São Paulo (Brazil))" >Chammas, Mario F.; Claudon, Michel; Eschwege, Pascal; Felblinger, Jacques; Hubert, Jacques

    2013-01-01

    Introduction: Evaluate the capability of different Computed Tomography scanners to determine urinary stone compositions based on CT attenuation values and to evaluate potential differences between each model. Methods: 241 human urinary stones were obtained and their biochemical composition determined. Four different CT scanners (Siemens, Philips, GEMS and Toshiba) were evaluated. Mean CT-attenuation values and the standard deviation were recorded separately and compared with a t-paired test. Results: For all tested CT scanners, when the classification of the various types of stones was arranged according to the mean CT-attenuation values and to the confidence interval, large overlappings between stone types were highlighted. The t-paired test showed that most stone types could not be identified. Some types of stones presented mean CT attenuation values significantly different from one CT scanner to another. At 80 kV, the mean CT attenuation values obtained with the Toshiba Aquilion were significantly different from those obtained with the Siemens Sensation. On the other hand, mean values obtained with the Philips Brilliance were all significantly equal to those obtained with the Siemens Sensation and with the Toshiba Aquilion. At 120 kV mean CT attenuation values of uric acid, cystine and struvite stones obtained with the Philips model are significantly different from those obtained with the Siemens and the Toshiba but equal to those obtained with the GE 64. Conclusions: According to our study, there is a great variability when different brands and models of scanners are compared directly. Furthermore, the CT scan analysis and HU evaluation appears to gather insufficient information in order to characterize and identify the composition of renal stones

  8. Main Nutritional Lithogenic Factors in Diets of Polish Patients with Kidney Stones

    Directory of Open Access Journals (Sweden)

    Barbara Pyszczuk

    2017-10-01

    Full Text Available Background. Nutrition is one of the most important determinants of kidney stone formation. This study was designed to evaluate lithogenic factors in diet of patients with renal calculi. Materials and me­thods. 40 stone-formers without metabolic disorders stimulating stone formation (e.g. hyperparatyroidism, primary hyperoxaluria were invited to the study. Antropometric measurements of nutritional status (BMI, WHR, analysis of body composition (BIA, quality and quantitative analysis of patients’ eating habits ­(3-day food records were conducted. Results. Half of patients were overweight or obese. Their diets contained high amounts of protein, fat, phosphorus, vitamin C and low amounts of fluid, calcium, magnesium, potassium, vitamin B6. Protein consumption was positively correlated with uric acid intake in diets (r = 0.78, and body weight with dietary fat intake (r = 0.58 and uric acid intake (r = 0.55. Conclusions. Complete treatment of nephrolithiasis should include nutritional therapy. No change in customary diets of patients with renal calculi can stimulate lithogenesis process.

  9. Anti-miss-shot control device for selective stone disintegration in extracorporeal shock wave lithotripsy

    Science.gov (United States)

    Kuwahara, M.; Ioritani, N.; Kambe, K.; Orikasa, S.; Takayama, K.

    1991-06-01

    A new device to prevent erroneously focused shock waves to the renal parenchyma during extracorporeal shock wave lithotripsy (ESWL) has been developed; an anti-miss-shot control device (AMCD) and experiments have been conducted to evaluate its effectiveness. For shock wave generation and stone localization, piezoceramic elements (PSE) and ultrasound localization, respectively were used. After stone localization, probing ultrasounds (PU) were emmitted from the PSE towards the focal region and the reflected sound levels (RSL) were monitored by the PSE which also functioned as a microphone. A direct hit by the PU to the stone or a miss was judged from the RSL, i.e. a high RSL indicates a direct hit and a low RSL indicates a miss. Shock waves were generated only when the RSL exceeded the level which indicated a direct hit. The experimental results showed that the injury to the renal parenchyma was decreased by using the AMCD. Clinical application of the AMCD is expected to increase the safety of ESWL.

  10. Bacterial bio-mediated calcite precipitation for monumental stones conservation: methods of evaluation.

    Science.gov (United States)

    Tiano, P; Biagiotti, L; Mastromei, G

    1999-05-01

    The weathering of monumental stones is a complex process inserted in the more general 'matter transformation cycle' operated by physical, chemical and biological factors. The consequence of these combined actions is a loss of cohesion with dwindling and scaling of stone material and the induction of a progressive mineral matrix dissolution. In the case of calcareous stones, calcite leaching increases the material porosity and decreases its mechanical features with a general weakening of the superficial structural strength. Attempts to stop, or at least to slow down, deterioration of monumental stones has been made by conservative treatments with both inorganic or organic products. More recent studies show a new approach to hinder these phenomena by inducing a bio-mediated precipitation of calcite directly inside the stone porosity. This can be achieved either through the application of organic matrix macromolecules extracted from sea shells or of living bacteria. The effectiveness of the treatment using calcinogenic bacteria has been evaluated with laboratory tests specifically developed to evaluate the parameters such as : porosity, superficial strength and chromatic changes, influenced by the treatment itself. The results obtained seem to indicate that this type of treatment might not be suitable for monumental stone conservation.

  11. Research of environmentally-friendly utilization methods of the crushed stone waste on granite quarries

    Directory of Open Access Journals (Sweden)

    Levytskyi V.G.

    2017-12-01

    Full Text Available The analysis of activity of stone-mining enterprises shows the low competitiveness of crushed stone products Upgrading the quality of crushed stone and production of the European standard fractions requires to use of new technologies and equipment. The main waste of crushed stone pits is сrushed granite waste, which high percent of an exit is caused by outdated equipment and incorrectly selected technological parameters of the crushing process. Crushed-granite waste is stored in dumps which occupy large areas and negatively effect on production area ecology. In November 2017, the Government of Ukraine accepted the National Waste Management Strategy until 2030, the main aim of it is develop a strategy of the mineral raw materials balanced use and international standards introduction at the national level. Therefore, the problem of complex utilization and recycling of waste from stone-mining enterprises with receiving a qualitative secondary product is relevant. The publication presents the сrushed granite waste volumes by crushed stone pit, its properties and main directions of utilization. The ecological influence of waste dumps, in particular granite dust, on the environment and human, the strategy of using non-waste technologies and ecological features of сrushed granite waste secondary processing are considered

  12. The Initial Appearance of Ashlar Stone in Cyprus. éssues of Provenance and Use

    Science.gov (United States)

    Philokyprou, M.

    In Cyprus stone was the primary building material, either as rubble or in a dressed form (called ashlar), since the Neolithic period. Initially stone was used only as rubble but later during the Late Brone Age ashlar stone appeared for the first time on the island. The aim of this paper is the presentation of the results of a systematic research regarding the different types and uses of ashlar stone and the techniques followed during the Late Bronze Age in Cyprus in comparison with other Mediterranean areas. The macroscopic and microscopic examination of selected samples showed that sedimentary rocks of various geological formations were used as ashlars. One, two or even three different types of stones were transported from the quarries nearest to the settlements. Some characteristic methods of stone dressing, such as finishing only the visible faces and creating drafted margins around the face of the ashlar blocks, are to be found not only in Late Bronze Age settlements but also in more recent examples from the last two centuries. The choice of ashlar and the methods of construction can be related to social, religious and political factors and were not only based on aesthetic criteria and practical issues. Thus, the most impressive structural solutions were followed in the construction of temples and public buildings, whereas more simple methods can be observed in residential complexes.

  13. The Renal Allograft Donor with Isolated Microhematuria

    Directory of Open Access Journals (Sweden)

    Karkar Ayman

    2006-01-01

    Full Text Available Recently, there has been extensive debate about extending the criteria for accepting living donors to include the presence of mild renal abnormalities such as isolated microhematuria. Hematuria defined as the detection of greater than five red blood cells per high power field can be associated with abnormalities throughout the urinary tract. Detection of casts or dysmorphic red blood cells in the urine sediment with or without proteinuria could indicate underlying intrinsic renal disease. Anatomic causes, such as stones and tumors, should be excluded; cystoscopy may be indicated to exclude bladder pathology. Obviously, urinary tract infection, uncontrolled hypertension and latent diabetes mellitus must be excluded. Microscopic hematuria could be associated with mesangial IgA deposits; as 10% of first-degree relatives of patients with IgA glomerulonephritis suffer from microhematuria and/or proteinuria that may require consideration of renal biopsy. Microhematuria could also be associated with other known hereditary renal diseases such as C3 deposits disease, IgM nephropathy, autosomal dominant polycystic kidney disease, Alport′s syndrome or thin basement membrane disease. In conclusion, careful assessment of isolated microhematuria, in the context of living kidney donation, is mandatory as results may reveal occult renal disease that may contraindicate kidney donation.

  14. Renal candidiasis

    International Nuclear Information System (INIS)

    Khanna, S.; Malik, N.; Khandelwal, N.

    1990-01-01

    Most fungal infections of the urinary tract are caused by Candida albicans, a yeast-like saprophytic fungus which may become apathogen under various conditions which lower the host resistance. The use of computed tomography in the diagnosis of renal fungus balls is the subject of this communication with emphasis on the radiologists role in the recognition of this entity. (H.W.). 6 refs.; 2 figs

  15. Efficacy of extra corporal shock wave lithotripsy (ESWL) in upper and lower urinary tract calculi with reference to stone site, size shape and radio density according to age rule (abstract)

    International Nuclear Information System (INIS)

    Khan, S.A.; Akhlaq, M.; Ahmed, N.

    1998-01-01

    50 patients having renal ureteral and vesical stones 5-20 mm and having age range 1 years with mean of 30.5 were studied. 70% (35/50) were male and 30% (15/50) female with 2.33:1 ratio 1,1,2,32,10,4 patients were of 0-2, 2-12, 12-18, 18-40, 40-55 and above 55 years age group respectively. Stone site, size, shape and radio density were seen by X-ray plain abdomen, IVU and ultrasound. At 4 months ESWL treatment was considered successful if the patients were stone free or had residual fragments 4 mm or less. Over all success rate was 64% in renal stones it was 62.7% (25/40), in ureteral 62.5% (5/8) and in vesical stone 100% (2/2). 5-10 mm, 11-15 mm and 16-20 mm stones had success rate of 76% (19/25), 61.1% (11/18) and 28.8% (2/7) respectively. Equi bone density, low density, high density and radiolucent stones had success rate of 57.1% (16/28), 92.85% (13/14). 16.6% (1/6) and 100% (2/2). Shape of stones is mere reflection of stone size. In conclusion, the liberal use of ESWL for every type of stone in terms of radio density equal to or less than bone and size up to 20 mm were amenable to ESWL monotherapy. Upper urinary tract stone 96% (48/50) and 18-40 years age group is the commonest. (author)

  16. ASSESSING PATHOLOGIES ON VILLAMAYOR STONE (SALAMANCA, SPAIN BY TERRESTRIAL LASER SCANNER INTENSITY DATA

    Directory of Open Access Journals (Sweden)

    J. García-Talegón

    2015-02-01

    Full Text Available This paper deals with the assessing of pathologies in façades using a variety of intensity data provided by different terrestrial laser scanner. In particular, a complex building built in the Villamayor Stone that is to be candidate as a Global Heritage Stone Resource has been chosen as study case. The Villamayor Stone were quarrying for the construction and ornamentation of monuments in Salamanca, declared World Heritage City by UNESCO in 1988. The objective of this paper is to assess the pathologies of Villamayor Stone and compare the results obtained through the laser techniques with the classical techniques of mapped pathologies (i.e. visual inspection. For that intensity data coming from laser scanners will be used as non-destructive techniques applied to the façades and several retired plaques (after of building restoration of Villamayor Stone with pathologies (fissures, scales, loss of matter, humidity/biological colonization carried to the laboratory. Subsequently it will perform different comparisons between the accuracy reached with the different sensors and a high precision model setup on laboratory which performs as “ground truth”. In particular, the following objectives will be pursued: i accuracy assessment of the results obtained in in situ and laboratory; ii an automation or semi-automation of the detection of pathologies in Villamayor Stone; iii discriminate the different types of Villamayor Stone used in the façades in function of the radiometric response; iv establish a methodology for detection and assessing of pathologies based on laser scanner intensity data applied to monuments and modern buildings built in Villamayor Stone.

  17. Renal hemangioma

    Directory of Open Access Journals (Sweden)

    Theodorico F. da Costa Neto

    2004-06-01

    Full Text Available INTRODUCTION: Renal hemangioma is a relatively rare benign tumor, seldom diagnosed as a cause of hematuria. CASE REPORT: A female 40-year old patient presented with continuous gross hematuria, anemia and episodic right lumbar pain, with onset about 3 months previously. The patient underwent multiple blood transfusions during her hospital stay and extensive imaging propedeutics was performed. Semi-rigid ureterorenoscopy evidenced a bleeding focus in the upper calix of the right kidney, with endoscopic treatment being unfeasible. The patient underwent right upper pole nephrectomy and presented a favorable outcome. Histopathological analysis of the surgical specimen showed that it was a renal hemangioma. COMMENTS: Imaging methods usually employed for diagnostic investigation of hematuria do not have good sensitivity for renal hemangioma. However, they are important to exclude the most frequent differential diagnoses. The ureterorenoscopy is the diagnostic method of choice and endoscopic treatment can be feasible when the lesion is accessible and electrocautery or laser are available. We emphasize the open surgical treatment as a therapeutic option upon failure of less invasive methods.

  18. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.

    2006-01-01

    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile

  19. Radiopharmaceuticals for renal studies

    International Nuclear Information System (INIS)

    Verdera, Silvia

    1994-01-01

    Between the diagnostic techniques using radiopharmaceuticals in nuclear medicine it find renal studies.A brief description about renal glomerular filtration(GFR) and reliability renal plasma flux (ERPF),renal blood flux measurement agents (RBF),renal scintillation agents and radiation dose estimates by organ physiology was given in this study.tabs

  20. Pattern of family history in stone patients.

    Science.gov (United States)

    Marickar, Y M Fazil; Salim, Abiya; Vijay, Adarsh

    2009-12-01

    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

  1. Ramadan fasting and patients with renal diseases: A mini review of the literature.

    Science.gov (United States)

    Emami-Naini, Afsoon; Roomizadeh, Peyman; Baradaran, Azar; Abedini, Amin; Abtahi, Mohammad

    2013-08-01

    Fasting during the month of Ramadan is one of the five pillars of Islam. During this month, adult Muslims are obligated to refrain from eating and drinking from dawn to dusk. Although based on Islamic principles patients are exempted from fasting, each year, many Muslim patients express their willingness to observe the fast in Ramadan month to respect the cultural customs. There are concerns about the impact of fluid restriction and dehydration during Ramadan fasting for patients with renal diseases. In this study, we reviewed the PubMed, Google Scholar, EBSCO, SCIRUS, Embase, and DOAJ data sources to identify the published studies on the impact of Ramadan fasting on patients with renal diseases. Our review on published reports on renal transplant recipients revealed no injurious effect of Ramadan fasting for the renal graft function. Nearly all studies on this topic suggest that Ramadan fasting is safe when the function of the renal graft is acceptable and stable. Regarding the impact of Ramadan fasting on patients with chronic kidney disease, there is concern about the role of renal hypoperfusion in developing tubular cell injury. Finally, there is controversy between studies about the risk of dehydration in Ramadan in developing renal stones. There are uncertainties about the change in the incidence of renal colic in Ramadan month compared with the other periods of the year. Despite such discrepancies, nearly all studies are in agreement on consuming adequate amounts of water from dusk to dawn to reduce the risk of renal stone formation.

  2. Renal sonographic findings of type I glycogen storage disease in infancy and early childhood

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Chun-Chen; Lin, Shuan-Pei [Mackay Memorial Hospital, Department of Pediatrics, Taipei (Taiwan); Tsai, Jeng-Daw; Lee, Hung-Chang [Mackay Memorial Hospital, Department of Pediatrics, Taipei (Taiwan); Taipei Medical University, Department of Pediatrics, Taipei (Taiwan)

    2005-08-01

    Type I glycogen storage disease (GSD-I) is an inherited disorder affecting glycogenolysis and gluconeogenesis. The characteristic manifestations are hepatomegaly, hypoglycemia, hyperlacticacidemia, hyperuricemia, and hyperlipidemia. Renal disease is regarded as a long-term complication and is reported mainly in older patients. We report the renal manifestations and renal ultrasonographic findings of GSD-I in infancy and early childhood in order to assess the role of renal sonography in the diagnosis of GSD-I. We retrospectively reviewed our hospital's database for patients with GSD-I from January 1993 to September 2004. The records of five patients were reviewed for this study. These five patients were diagnosed when they were younger than 3 years old. Data extracted from the charts included the initial extrarenal and renal manifestations, laboratory data, and imaging studies. We analyzed the indications for, and results of, renal sonography. In addition to the clinical presentations and laboratory abnormalities, all five children had nephromegaly and increased echogenicity on ultrasonography on their first visit, although only a minor degree of tubular dysfunction was noted clinically. Three of these five patients had nephrocalcinosis or renal stones or both. Hyperechoic large kidneys, nephrocalcinosis, and renal stones are common in GSD-I. They can be present in early infancy. Abnormalities on renal sonography might suggest GSD-I in a patient with suspected inborn errors of metabolism. (orig.)

  3. Stability of Reshaping Breakwaters with Special Reference to Stone Durability

    DEFF Research Database (Denmark)

    Frigaard, Peter; Hald, Tue; Burcharth, H. F.

    1996-01-01

    inherently cause some breakage and abrasion of the individual stones and thereby also reduced stability. In order to avoid excessive abrasion a high stone quality is demanded or larger stones must be applied when constructed. To allow the designer to account for abrasion and armour stone breakage due...

  4. Factors affecting lower calyceal stone clearance after Extracorporeal ...

    African Journals Online (AJOL)

    shanker

    have been identified [1,3]. These include stone characteristics, the type of lithotripter used, LPC anatomy and body habitus. For iso- lated LPC stones, the pelvicalyceal angle, infundibulum length and width are considered important determinants for stone clearance. The impact of body habitus on stone clearance has so far ...

  5. Retrograde intrarenal stone surgery for extracorporeal shock-wave lithotripsy-resistant kidney stones

    DEFF Research Database (Denmark)

    Jung, Helene; Nørby, Bettina; Osther, Palle Jörn

    2006-01-01

    OBJECTIVE: The newer flexible ureteroscopes, 150-200-microm holmium YAG laser fibres and superflexible Dormia baskets have made it possible to reach and treat stones in all parts of the kidney. The object of this evaluation was to study the outcome of retrograde intrarenal stone surgery (RIRS......) for extracorporeal shock-wave lithotripsy (ESWL)-resistant kidney stones. MATERIAL AND METHODS: A total of 38 consecutive patients (18 males, 20 females) participated in the study. All patients had undergone ESWL prior to RIRS without success. In all cases the stones could be reached with the endoscope. Calculi...... ranged in size from 3 to 20 mm (mean 9 mm). In 32 cases the stones were fragmented using a holmium YAG laser and in six the stones could be extracted using zero-tip Dormia baskets without fragmentation. Sixteen patients had lower calyceal calculi and eight had an abnormal anatomy of the upper urinary...

  6. Evaluation of post-ESWL renal sequelae using quantitative radionuclide studies

    International Nuclear Information System (INIS)

    Moustafa, H.; Elhaddad, SH.; Ziada, G.; El-Tawil, A.; Hegazi, A.; Fawzy, K.

    1995-01-01

    45 adult patients with single, unilateral renal stones without back pressure change attended to Cairo University Hospital during 1990 and 1991 were treated with ESWl. All cases were subjected to radionuclide renal studies using 131 I-OIH and 99 mTc-DTPA done pre-, immediate post- and 3 months post-ESWL. No significant changes of total renal ERPF and GFR could be detected. Treated kidneys GFR, GFR%, ERPE and T max showed no significant changes after ESWL except for a transient significant improvement of their T 1/2 (P 3500 shocks caused the reverse (P 55000 caused deterioration of their GFR that persisted up to 3 months (P<0.03). Conclusion: ESWL therapy is safe method for treatment of renal stones with no significant functional changes. 6 tabs

  7. Introduction. Leave no stone unturned: Perspectives on ground stone artefact research

    OpenAIRE

    Danny Rosenberg; Yorke Rowan; Tatjana Gluhak

    2016-01-01

    Ground stone tools served in many physical and social contexts through millennia, reflecting a wide variety of functions. Although ground stone tool studies were neglected for much of early archaeology, the last few decades witnessed a notable international uptick in the way archaeologists confront this multifaceted topic. Today, with the advance of archaeology as a discipline, research into ground stone artefacts is moving into a new phase that integrates high resolution documentation with n...

  8. A variant in a Cis-regulatory element enhances claudin-14 expression and is associated with pediatric-onset hypercalciuria and kidney stones

    DEFF Research Database (Denmark)

    Ure, Megan E; Heydari, Emma; Pan, Wanling

    2017-01-01

    The greatest risk factor for kidney stones is hypercalciuria, the etiology of which is largely unknown. A recent genome-wide association study (GWAS) linked hypercalciuria and kidney stones to a claudin-14 (CLDN14) risk haplotype. However, the underlying molecular mechanism was not delineated....... Recently, renal CLDN14 expression was found to increase in response to increased plasma calcium, thereby inducing calciuria. We hypothesized therefore that some children with hypercalciuria and kidney stones harbor a CLDN14 variant that inappropriately increases gene expression. To test this hypothesis, we...... sequenced the CLDN14 risk haplotype in a cohort of children with idiopathic hypercalciuria and kidney stones. An intronic single nucleotide polymorphism (SNP) was more frequent in affected children. Dual luciferase and cell based assays demonstrated increased reporter or CLDN14 expression when...

  9. Renal function and acute heart failure outcome.

    Science.gov (United States)

    Llauger, Lluís; Jacob, Javier; Miró, Òscar

    2018-06-05

    The interaction between acute heart failure (AHF) and renal dysfunction is complex. Several studies have evaluated the prognostic value of this syndrome. The aim of this systematic review, which includes non-selected samples, was to investigate the impact of different renal function variables on the AHF prognosis. The categories included in the studies reviewed included: creatinine, blood urea nitrogen (BUN), the BUN/creatinine quotient, chronic kidney disease, the formula to estimate the glomerular filtration rate, criteria of acute renal injury and new biomarkers of renal damage such as neutrophil gelatinase-associated lipocalin (NGAL and cystatin c). The basal alterations of the renal function, as well as the acute alterations, transient or not, are related to a worse prognosis in AHF, it is therefore necessary to always have baseline, acute and evolutive renal function parameters. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  10. Etiology, diagnosis and treatment of renal colic during pregnancy.

    Science.gov (United States)

    Grasso, Angelica Anna Chiara; Cozzi, Gabriele

    2014-01-01

    To assess the incidence and causes of renal stones in pregnant women, investigate the reliability and accuracy of diagnostic investigations and to consider the various therapeutic options available. A review of the literature was conducted, searching for relevant papers on the physiology of urinary apparatus changes during pregnancy, as well as the etiology, diagnosis and management of renal colic in pregnant women. Standards of care in renal colic during pregnancy include accurate diagnosis primarily with ultrasound, or MRI if necessary, conservative therapy and careful surgical approach for urinary drainage in the first place or ureterorenoscopy when needed. Renal colic during pregnancy is potentially troublesome and likely to lead to serious adverse effects on both mother and fetus. A multi-disciplinary approach is needed, which includes experts in the fields of Urology, Obstetrics, Radiology and Anesthesiology, to ensure the optimal care of this delicate cohort of patients.

  11. Safety of ESWL in elderly: evaluation of independent predictors and comorbidity on stone-free rate and complications.

    Science.gov (United States)

    Polat, Fazli; Yeşil, Süleyman; Ak, Esat; Farahvash, Amirali; Karaoğlan, Ustünol; Biri, Hasan; Bozkirli, Ibrahim

    2012-07-01

    Urinary stone disease affects people of all ages. With its satisfactory efficacy ranges in all age groups and lack of side-effects, extracorporeal shock wave lithotripsy (ESWL) has become the preferred treatment modality for uncomplicated renal and proximal calculi ≤ 20 mm. In the present study, we aimed to assess the safety and efficacy of the ESWL treatment in elderly patients. A retrospective study was carried out on patients aged over 65 years who underwent shock wave lithotripsy at our Department from 2009 to 2011, with a Siemens Lithostar electromagnetic shockwave lithotripter. A total of 231 patients (157 males, 74 females) out of 1694 (13.6%) were studied. The patients were divided into two groups (group 1 = 65-70; group 2 >70). The effect of age and other possible predicting factors (sex, stone localization and stone size) were investigated. Concomitant diseases and related complications were also evaluated. An overall stone-free rate (SFR) of 82.2% was found. The influence of sex on SFR was non-significant. There was no significant difference when comparing SFR between the age groups. When patients were divided into those with renal and ureteral stones, the SFR were 94.4% and 67.6% (P 10 mm were 80% and 84.4%, respectively. Comorbidity was present in 148 patients. Complications were noted in 56 of 231 patients. Of 56 patients, 43 had minor complications and 13 major complications. ESWL seems to be an effective first-line treatment choice for urinary stones in elderly patients with careful patient selection and personalized preparation. © 2011 Japan Geriatrics Society.

  12. Compositions of stone and stone surface materials of historical monuments from Vidzeme and Zemgale

    International Nuclear Information System (INIS)

    Actins, A.; Spricis, A.; Zekunde, A.; Nemerova, A.

    2004-01-01

    By means of x-ray analysis composition of stone and stone surface materials of historical monuments from Vidzeme and Zemgale was investigated. Corrosion products of tuffa materials were identified on surfaces of some investigated monuments. Similarity of composition of products of stone corrosion for monuments from Latvia and Poland was recognised. Content of heavy metals at stone materials of historical monuments and at the surface layers of these monuments was investigated by means of atomic absorption and potentiometric stripping methods. Reasons of formation of compounds and pollution of investigated samples were discussed. (full text)

  13. IGCP 637 Heritage Stone Designation: A UNESCO and IUGS project on natural stones

    Science.gov (United States)

    Pereira, Dolores; Cooper, Barry; Schouenborg, Björn; Marker, Brian; Kramar, Sabina

    2017-04-01

    IGCP 637 was approved in 2015 to facilitate establishment of a new international geological standard for building and ornamental stones. Formal international recognition of those natural stone types that have achieved widespread utilization in human culture is now underway and the term "Global Heritage Stone Resource" (GHSR) has been proposed for this designation. Stones that have been used in heritage construction, sculptural masterpieces, as well as in utilitarian (yet culturally important) applications are obvious GHSR candidates. In co-ordination with these aims the project has an associated role to promote the adoption and use of the GHSR designation. Consequently an interim list of potential GHSRs is maintained and a register of GHSR approved stones is being created. IGCP 637 also enhances the capacity of the International Union of Geological Sciences (IUGS) in the realm of dimension stone and geological standards as it is the first IUGS involvement in this subject. As a consequence, the largest known international grouping of dimension stone professionals has been established. Within IGCP 637 a web page has been created at www.globalheritagestone.com, including information on the Working Group and also specific information on the evolution of the project. Several researchers were funded to attend the Heritage Stone working group activities, including researchers from Algeria, Malawi, India, Italy and Russia. We also have produced many publications, both as individual papers and special issues in journals included in the Journal Citation Reports. Monographs are being prepared at present. Hopefully, IGCP 637 will help to widen the circle of researchers interested in natural stones as part of our geoheritage. Heritage Stone references: articles and special issues - Pereira, D. and Marker, B. (2016) The value of original natural stone in the context of architectural heritage. Geosciences, 6, 13. - Heritage Stone 1. Ed. Pereira and Pratt. (2016). Geoscience

  14. Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Wang, Ralph C; Smith-Bindman, Rebecca; Whitaker, Evans; Neilson, Jersey; Allen, Isabel Elaine; Stoller, Marshall L; Fahimi, Jahan

    2017-03-01

    Tamsulosin is recommended for patients receiving a diagnosis of a ureteral stone less than 10 mm who do not require immediate urologic intervention. Because of conflicting results from recent meta-analyses and large randomized controlled trials, the efficacy of tamsulosin is unclear. We perform a systematic review and meta-analysis to investigate the effect of tamsulosin on stone passage in patients receiving a diagnosis of ureteral stone. MEDLINE, EMBASE, and CENTRAL databases were searched without language restriction through November 2015 for studies assessing the efficacy of tamsulosin and using a double-blind, randomized, controlled trial design. Meta-analysis was conducted with a random-effects model and subgroup analyses were conducted to determine sources of heterogeneity. Eight randomized controlled trials (N=1,384) contained sufficient information for inclusion. The pooled risk of stone passage in the tamsulosin arm was 85% versus 66% in the placebo arm, but substantial heterogeneity existed across trials (I 2 =80.2%; Ptamsulosin (risk difference=22%; 95% confidence interval 12% to 33%; number needed to treat=5). The meta-analysis of the small stone subgroup (Tamsulosin significantly improves stone passage in patients with larger stones, whereas the effect of tamsulosin is diminished in those with smaller stones, who are likely to pass their stone regardless of treatment. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  15. Success of electromagnetic shock wave lithotripter as monotherapy in large renal calculi—Our experience

    OpenAIRE

    K.S. Meitei; S Gupta; A.K. Singh

    2013-01-01

    Objectives: To evaluate the success of shock wave lithotripsy (SWL) as monotherapy for solitary renal stones larger than 2 cm without ureteral stenting. Hence, if our study result demonstrates acceptable success and safety, we can recommend ESWL as a treatment option for patients with large renal calculi. Subjects and methods: This is a prospective study conducted in the Department of Urology, Regional Institute of Medical Sciences, Imphal, India, from January 2011 to December 2012. A tota...

  16. Sclerotherapy for a simple renal cyst causing hydronephrosis: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Ji Hun; Park, Sang Woo; Chang, Il Soo; Hwang, Jin Ho; Jung, Sung Il [Dept. Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2017-05-15

    A simple renal cyst usually remains asymptomatic and requires no invasive treatment. Occasionally, however, some cysts may cause pain, hematuria, hypertension, or obstruction of the collecting system. We describe a case of a 50-year-old man who presented with hydronephrosis caused by an ipsilateral simple renal cyst without any stone or significant mass in the urinary system. The patient was eventually treated successfully with sclerotherapy.

  17. Production and characterization of composite stone

    International Nuclear Information System (INIS)

    Leirose, G.D.; Lameiras, F.S.

    2012-01-01

    Composite stone is a product similar to natural granite or marble, produced with particles of these materials. This material is used like natural stone as lining. The fabrication of artificial stones using residues of banded iron formations is a promising alternative to its actual destination (storage in dam). This research aims the characterization of composite stone to prove the efficacy of this kind of processing. It was used first, natural quartz as a raw material. The patterns of the samples were confirmed by IR spectra and XRD patterns, ensuring the reproducibility of processing applied. Moreover, this material is homogeneous, with low porosity and high flexural strength, confirmed by its structural characterization. Thus, it can be affirmed that the process chosen is suitable, enabling the application of this methodology to the use of waste. (author)

  18. Robust Detection of Stepping-Stone Attacks

    National Research Council Canada - National Science Library

    He, Ting; Tong, Lang

    2006-01-01

    The detection of encrypted stepping-stone attack is considered. Besides encryption and padding, the attacker is capable of inserting chaff packets and perturbing packet timing and transmission order...

  19. Portugues Marbles as Stone Heritage

    Science.gov (United States)

    Lopes, Luis; Martins, Ruben

    2013-04-01

    The main objective of this paper is to present and justify the reasons for the worldwide recognition of Portuguese Marbles as Stone Heritage. These marbles are also known as "Estremoz Marble" since was the first county were exploited. In the Estremoz Anticline marbles occupy an intermediate stratigraphic position being part of a volcano-sedimentary sequence of Cambrian age. The anticlinal structure has a Precambrian core and the younger rocks aged Devonian Period. This sequence has deformed by the Variscan Orogeny, which performed twice with different intensities both in ductile and brittle tension fields. The early Alpine Cycle also acts in the region and cause more fracturing of the marble. Practically in all the quarries is possible to perceive the spatial-temporal continuity of the deformation where one can describe a complete Wilson Cycle. Together all these geological features imprint the marbles beautiful aesthetic patterns that can be highlighted when used as dimension stone. Nowadays most of the quarries are placed in the counties of Borba and mainly in Vila Viçosa. This last city claims for itself the "Capital of the Marble" title and named the marble as "White Gold". In fact, according to the historical record, the marbles were quarried in Portuguese Alentejo's Province since the fourth century BC. Locally these geological materials are available easily accessible. Exhibit physical properties that allow the fabrication of structural and decorative elements and so were used since humans settled in the region and developed a structured Society. In the Roman period, the pieces of art made with Estremoz Marbles were exported abroad and today are represented in Museums and Archaeological Sites throughout Europe and North Africa countries. The Portuguese Marbles and Limestones, transformed into altars, stairways, columns, statues and pieces of wall cladding, were carried as ballast in the holds of ships. At the destination the Portuguese People had built

  20. Bariatric Surgery and Urinary Stone Disease

    Directory of Open Access Journals (Sweden)

    Cevahir Ozer

    2016-07-01

    Full Text Available Obesity is a major public health problem and has been suggested to play a role in the etiology of urinary tract stone disease. Furthermore, the increasingly widespread use of surgery in the treatment of obesity also is related with urinary stone disease. In daily practice, patients to whom obesity surgery has been planned or who have undergone obesity surgery are seen more frequently. This review aims to highlight the urological evaluation and management of this patient group.

  1. [Pharmacotherapy for preventing calcium containing stone formation].

    Science.gov (United States)

    Nagata, Masao; Takayama, Tatsuya; Mugiya, Souichi; Ohzono, Seiichiro

    2011-10-01

    Many urinary tract stones consist of calcium, and has high relapse rate. Accordingly, it is very important to prevent calcium-containing stone formation. This paper describes about effects and mechanisms for Xanthine oxidase inhibitor, citrate formulation, magnesium formulation, thiazides, vitamin B(6), extract of Quercus salicina Blume and chorei-to (medical herb) . Recent new drugs and the elucidation of new metabolic pathways may lead to the development of prevention of urolithiasis.

  2. Bilateral renal artery variation

    OpenAIRE

    Üçerler, Hülya; Üzüm, Yusuf; İkiz, Z. Aslı Aktan

    2014-01-01

    Each kidney is supplied by a single renal artery, although renal artery variations are common. Variations of the renal arteryhave become important with the increasing number of renal transplantations. Numerous studies describe variations in renalartery anatomy. Especially the left renal artery is among the most critical arterial variations, because it is the referred side forresecting the donor kidney. During routine dissection in a formalin fixed male cadaver, we have found a bilateral renal...

  3. Renal tuberculosis

    Directory of Open Access Journals (Sweden)

    Džamić Zoran

    2016-01-01

    Full Text Available Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if

  4. Famous Stone Patients and Their Disease

    Science.gov (United States)

    Moran, Michael E.

    2007-04-01

    The fact that stone patients have endured much throughout the ages and that prior to our current era, when the ultimate horror, "being cut for the stone" was the only alternative to the repeated episodes of colic, should be recalled from time to time. Urolithiasis has affected humanity throughout the ages and has been indiscriminate to those lives it touched. A full accounting of those who have suffered and recorded their agonies is beyond the scope of this investigation; however, even a partial accounting is valuable for present day physicians who care for those with stone disease. For the present work, the historical accounts of stone disease literature were scrutinized for individual sufferers who could be cross-referenced from other sources as legitimately afflicted by stones. Only those patients that could be documented and were (or are) well known were included, because the internet is now a verdant repository of thousands of "not so well knowns." Reliable historical data was found for a variety of persons from the pre-Christian era to the present, including those remembered as philosophers and scientists, physicians, clergy, leaders and rulers, entertainers, athletes and fictitious/Hollywood-type individuals. Verified accounts of famous stone formers were chosen for this paper, and are presented in chronological order. The list of urolithiasis sufferers presented here is undoubtedly incomplete, but it is not through lack of trying that they are missing. Most often, the suffering do so silently, and that is always allowed.

  5. Female stone disease: the changing trend.

    Science.gov (United States)

    Marickar, Y M Fazil; Vijay, Adarsh

    2009-12-01

    This paper has attempted to assess the changes noted in the trends in the incidence and biochemical pattern of female urolithiasis patients during the period 1971-2008. A prospective descriptive clinical study was done on 8,590 stone patients belonging to both sexes treated at the urinary stone clinic. The incidence of stone disease among the two sexes was plotted. The various metabolic parameters including 24-h urine volume, urine calcium, phosphorus, uric acid, oxalate, magnesium, creatinine and citrate, serum creatinine, calcium, phosphorus, uric acid and magnesium and calculated parameter calcium:magnesium ratio were studied. The possible causes for the change in incidence of stone disease in the female sex were elucidated. Of the patients studied, 12.7% (1,091) were females. There was a definite increase in the incidence of female urolithiasis over the past 37 years (P stone genesis, together with the increased excretion of calcium and oxalate may have contributed to the increasing incidence of stone disease in females. This might be due to changes in living standards and dietary habits.

  6. Renal denervation

    DEFF Research Database (Denmark)

    Olsen, Lene Kjær; Kamper, Anne-Lise; Svendsen, Jesper Hastrup

    2015-01-01

    PURPOSE OF REVIEW: Renal denervation (RDN) has, within recent years, been suggested as a novel treatment option for patients with resistant hypertension. This review summarizes the current knowledge on this procedure as well as limitations and questions that remain to be answered. RECENT FINDINGS...... selection, anatomical and physiological effects of RDN as well as possible beneficial effects on other diseases with increased sympathetic activity. The long awaited Symplicity HTN-3 (2014) results illustrated that the RDN group and the sham-group had similar reductions in BP. SUMMARY: Initial studies...

  7. Renal papillary necrosis

    Science.gov (United States)

    ... asking your provider. Alternative Names Necrosis - renal papillae; Renal medullary necrosis Images Kidney anatomy Kidney - blood and urine flow References Bushinsky DA, Monk RD. Nephrolithiasis and nephrocalcinosis. ...

  8. Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

    Science.gov (United States)

    Lim, Ki Hong; Jung, Jin-Hee; Kwon, Jae Hyun; Lee, Yong Seok; Bae, Jungbum; Cho, Min Chul; Lee, Kwang Soo

    2015-01-01

    Purpose The objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones. Materials and Methods A total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL. Results Mean stone size in the LD group was significantly smaller than that in the HD group (7.5±1.4 mm compared with 9.9±2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (pESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL. Conclusions Our data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure. PMID:25598937

  9. Introductory Overview of Stone Heritages in Japan

    Science.gov (United States)

    Kato, Hirokazu; Oikawa, Teruki; Fujita, Masayo; Yokoyama, Shunji

    2013-04-01

    As one contribution to 'Global Heritage Stone Resources' (GHSR), some stone heritages in Japan, which are nominated in the interim list, are briefly introduced. The geology of Japanese Islands where are the one of the most active areas in the history of the Earth, is very complicated. Therefore Japanese Islands consist of various kinds of minerals and rocks. Some of them were used to make stone implements and accessories. Japanese people also used to the best possible advantage to built tombstone, gate, pavement ,and the basement and wall of the large building such as temples, shrines, castles and modern buildings. 1. Stone Heritages of Pre-historical age: In the late Pleistocene and the early Holocene, ancient Japanese used obsidian cooled rapidly from rhyolitic magma.to make small implements and accessories. For example, Shirataki, Hokkaido (north island) is the largest place producing obsidian in Japan where Paleolithic people made arrowhead, knives and so on. Another example, Jade yielded in Itoigawa City, Japan Sea coast of central Japan, was made in the metamorphic rock about five hundred million years ago. Itoigawa area is only one place where jade is abundantly produced in Japan. Ancient people had been already collected and processed to ornaments although it is very hard and traded in wide area more than several thousand years ago. 2. Stone Heritages of Historical age: 2.1 Archaeological remains: In the Kofun (old mound) period (250 to 538 AD), stone burial chambers were used for old mounds to preserve against the putrefaction and to protect from the theft. For example, Ishibutai Kofun ("ishi" means "stone" and "butai" means "stage") in Nara old capital city, southwest Japan, is the largest known megalithic structure made of granite in Japan. 2.2 Stone walls of some typical castles Stones used is because of not only the rich reserves of rocks but also restriction of transportation. Osaka (second biggest city) castle, are composed of Cretaceous granite

  10. Granodiorite - one of the most significant Slovenian natural stones

    Science.gov (United States)

    Kramar, Sabina; Trajanova, Mirka; Rogan-Šmuc, Nastja; Gutman, Maja; Bedjanič, Mojca; Mladenovič, Ana

    2015-04-01

    The paper provides a description of the petrographic and mechanical characteristics of granodiorite from the Pohorje Mountains (NE Slovenia) and of its use as a natural stone. This stone, which is a calc-alkaline igneous rock of Miocene age (18.7 Ma), is characterised by its grey colour and by its thick white aplite-pegmatite veins. It mainly consists of plagioclase, quartz, and K-feldspar, which are light coloured constituents, with biotite and a small amount of hornblende as dark coloured minerals. Some other minerals are found in traces, among which pyrite is considered to be the most problematic. However, due to the presence of a small amount of arsenic, the pyrite is quite stable and not prone to alteration. In Slovenia currently two quarries are located in granodiorite, both protected as valuable natural geological features; an active quarry at Cezlak which is the largest quarry in magmatic rocks in Slovenia and the abandoned quarry in Josipdol. Granodiorite is considered the highest quality natural stone in Slovenia. It is characterised by high density, low water absorption, and low open porosity, so that it exhibits high frost and salt resistance, as well as a high compressive strength and an extremely high flexural strength, which is due to its pronounced oriented structure. It is widely recognized throughout Slovenia by its durability and its decorative white veins, and is currently the most frequently used natural stone in Slovenia. It is mainly used as paving and cladding material for residential buildings, churches, and other structures, as well as for squares, thus giving a special character to many of Slovenia's largest towns and cities. Several important buildings are decorated by means of this stone, such as the Slovenian Parliament, the Republic Square business complex, the Maximarket department store, and the Faculty of Law of the University of Ljubljana, all of which are located in Ljubljana, some of them having been declared as cultural

  11. Use of the probability of stone formation (PSF) score to assess stone forming risk and treatment response in a cohort of Brazilian stone formers

    OpenAIRE

    Turney, Benjamin; Robertson, William; Wiseman, Oliver; Amaro, Carmen Regina P. R.; Leitão, Victor A.; Silva, Isabela Leme da; Amaro, João Luiz

    2014-01-01

    Introduction: The aim was to confirm that PSF (probability of stone formation) changed appropriately following medical therapy on recurrent stone formers.Materials and Methods: Data were collected on 26 Brazilian stone-formers. A baseline 24-hour urine collection was performed prior to treatment. Details of the medical treatment initiated for stone-disease were recorded. A PSF calculation was performed on the 24 hour urine sample using the 7 urinary parameters required: voided volume, oxalate...

  12. Kidney stone erosion by micro scale hydrodynamic cavitation and consequent kidney stone treatment.

    Science.gov (United States)

    Perk, Osman Yavuz; Şeşen, Muhsincan; Gozuacik, Devrim; Koşar, Ali

    2012-09-01

    The objective of this study is to reveal the potential of micro scale hydrodynamic bubbly cavitation for the use of kidney stone treatment. Hydrodynamically generated cavitating bubbles were targeted to the surfaces of 18 kidney stone samples made of calcium oxalate, and their destructive effects were exploited in order to remove kidney stones in in vitro experiments. Phosphate buffered saline (PBS) solution was used as the working fluid under bubbly cavitating conditions in a 0.75 cm long micro probe of 147 μm inner diameter at 9790 kPa pressure. The surface of calcium oxalate type kidney stones were exposed to bubbly cavitation at room temperature for 5 to 30 min. The eroded kidney stones were visually analyzed with a high speed CCD camera and using SEM (scanning electron microscopy) techniques. The experiments showed that at a cavitation number of 0.017, hydrodynamic bubbly cavitation device could successfully erode stones with an erosion rate of 0.31 mg/min. It was also observed that the targeted application of the erosion with micro scale hydrodynamic cavitation may even cause the fracture of the kidney stones within a short time of 30 min. The proposed treatment method has proven to be an efficient instrument for destroying kidney stones.

  13. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era.

    Science.gov (United States)

    Zhang, Wei-jie; Xu, Gui-fang; Huang, Qin; Luo, Kun-lun; Dong, Zhi-tao; Li, Jie-ming; Wu, Guo-zhong; Guan, Wen-xian

    2015-01-26

    Laparoscopic common bile duct exploration (LCBDE) for stone can be carried out by either laparoscopic transcystic