Percutaneous caliceal irrigation during extracorporeal shock wave lithotripsy for lower pole renal calculi

A percutaneous nephrostomy tube coiled in the lower pole calix was used to irrigate stone fragments during extracorporeal shock wave lithotripsy in a small series of patients. This procedure is suggested as a possible means of improving lithotripsy results for larger, lower pole stones.

Percutaneous nephrolithotomy directly through an angiomyolipoma

We present a patient with tuberous sclerosis and bilateral angiomyolipomas with a right partial staghorn calculi in which the calculi was managed with a percutaneous nephrolithotomy. Despite the inherent risk of hemorrhage with a percutaneous approach compounded by the fact that this was done directly through a tumor, we were able to render the patient stone free with no intraoperative bleeding, complications, or the need for postoperative blood transfusion. To our knowledge, this is the first reported case of percutaneous nephrolithotomy directly through a renal angiomyolipoma.

[Instrumental chemolysis of cystine calculi]

ESWL and PCN have modified the urinary stones therapy. Nevertheless these therapeutic procedures are not much effective in cystine stone because of its protein structure and frequent recurrences; these procedures need to be combined to achieve the best results. In cystine stones the lithochemolysis, performed following recent technique has shown excellent results, without complications and easy to apply.

Acetazolamide-induced nephrocalcinosis

Nephrocalcinosis has been reported in patients treated with acetazolamide and other agents, such as furosemide or bicarbonate. We present a case of nephrocalcinosis induced solely by acetazolamide and diagnosed radiographically. Possible mechanisms of pathogenesis are reviewed.

Immobilization, a risk factor for urinary tract stones in children. A case report

Immobilization causes bone dissolution leading to hypercalcemia and hypercalciuria in children. We report the case of a 10-year-old boy who developed 2 stones in the pelvis off his left healthy kidney after only 8 days of immobilization. He was on bedrest after pyeloplasty done for a ureteropelvic junction obstruction on the right side. Compared to references in literature our patient showed stone formation very early during the course of immobilization. Temporary hypercalciuria and stone formation are well documented because of underlying kidney disease. The risk factors of immobilization-induced hypercalciuria and hypercalcemia are discussed together with possible treatment and prophylaxis of this pathology.

Bolus-enhanced renal spiral CT: technique, diagnostic value and drawbacks

In addition to pre- and postcontrast renal CT scans, early bolus-enhanced spiral scans during demarcation of the corticomedullary junction were acquired in 85 patients. The diagnostic value and drawbacks of the three imaging series in the evaluation of renal disease were assessed. Renal calcifications and calculus disease detected at precontrast scans (18%) were obscured after contrast administration and excretion in most cases. In the detection of renal lesions bolus-enhanced spiral CT and delayed postcontrast scans had an identical diagnostic yield (94%). Bolus-enhanced spiral CT was superior in the assessment of lesion vascularity and vascular anatomy as well as opacification of renal arteries (95%) and veins (85%). Delayed postcontrast scans were indispensable to delineate medullary or parapelvic cysts as well as anatomic abnormalities or tumors of the renal pelvis (17% of all lesions). Routine renal CT of the kidneys should consist of precontrast images and delayed postcontrast spiral scans. Bolus-enhanced spiral scans are advised to assess lesion vascularity of renal veins.

Mechanisms of differing stone fragility in extracorporeal shockwave lithotripsy

Clinical experience with extracorporeal shockwave lithotripsy (SWL) has demonstrated significant variations in stone fragility. To understand the physical mechanisms of the differences, we quantitatively determined shockwave-stone interaction under clinically relevant SWL conditions for six stone compositions: calcium oxalate monohydrate (COM), struvite (MAPH), calcium apatite (CA), uric acid (UA), brushite, and cystine. We also characterized the acoustic and mechanical properties of the stones using ultrasound and microindentation techniques. Our results show that renal calculi have distinctly different acoustic and mechanical properties. Higher wave speed, Young's modulus, and fracture toughness were measured from COM and cystine stones, whereas lower values of the corresponding properties were found in CA and MAPH, and the values for brushite and UA stones were in between. Computer modeling of shockwave propagation revealed that under the same shockwave intensity, larger deformation was induced in CA and MAPH stones than in COM and cystine stones. In addition, multiple reflected tensile waves were predicted for stones with concentric layer structure, indicating their susceptibility to shockwave fragmentation. These findings elucidate the mechanisms of the differences in stone fragility observed clinically. Their implications to SWL are discussed.

[Imposing "calcium milk" lithiasis in giant hydronephrosis]

The authors report a quite unusual case of "milk of calcium renal Stone" in unilateral giant Hydronephrosis. Radiographic, sonographic, intravenous urographic and TC aspects are described and prominence il given to morphostructural information obtained through digital image techniques of pyeloureteral zone junction and of "milk of calcium renal Stone". The authors discuss the pathogenesis of the renal Stone type and emphasize the convenience of investigative acts to clear up the ethio-pathogenetic role of pyeloureteral infections.

[Extracorporeal shock-wave lithotripsy in horseshoe kidney]

Presentation of our experience in the use of extracorporeal shock wave lithotripsy (ESWL) for the treatment of lithiasis that occurred in 34 renal units from 28 patients with horseshoe kidneys. All patients but one were placed in supine decubitus with the calculus positioned in F2. A total of 47 sessions were performed for 34 treatments apart from 3 ureteroscopies for ureteral voiding. The results of the follow-up is absence of lithiasis in 13 renal units, debris of less than 3 mm in six, non-removable debris in 13 cases and relapse in two.

[Matrix lithiasis. Apropos a case of staghorn lithiasis]

Presentation of one case of soft lithiasis in a child which was treated by pyelolithectomy with good results and which has not relapsed after a 20-year follow-up. A commented revision is made of related literature.

ESWL for stone in a retrocaval ureter: a case report

A male patient with retrocaval ureter and right renal calculus is reported. Stone treatment by ESWL was successful and the patient became stone free after 10 weeks.

[Piezo-electric extracorporeal lithotripsy of non-coralliform kidney calculi with a maximal measurement of greater than or equal to 25 mm. Apropos of 25 cases]

From June 1991 to April 1993, 25 non-staghorn renal stones with a maximal diameter greater than or equal to 25 mm were treated by piezoelectric extracorporeal lithotripsy (EDAP LT 01). The complete success rate was 56% after 1 (16%), 2 (12%), 3 (16%) or 4 sessions (12%). 14 double J ureteric stents were implanted (56% of cases) and 4 complications were observed (2 cases of acute pyelonephritis and 2 cases of ureteric silting). These results were inferior to those obtained with percutaneous surgery, but help to define the potential indications of extracorporeal shock-wave lithotripsy. This treatment modality can therefore be applied to large friable weddellite or even struvite stones, particularly when the anatomical conditions are unfavourable for percutaneous surgery.

Sodium thiosulphate in the treatment of renal tubular acidosis I with nephrocalcinosis

Nephrocalcinosis is a common feature in renal tubular acidosis I (RTA-I) and contributes to renal insufficiency. We describe a patient, 37 years old, with RTA-I, mild renal failure and extended nephrocalcinosis. His disease was diagnosed in age 28 and patient is under treatment with sodium bicarbonate, potassium gluconate and sodium thiosulphate for 9 years. By this treatment nephrocalcinosis and renal function have not been worsened and patient is without clinical symptoms.

Urolithiasis with congenital upper tract anomalies: a 4-year experience with extracorporeal shock wave lithotripsy

Calculus formation is a natural sequela of anatomic anomalies of the upper urinary tract, and endourologic and open surgery can be difficult in these cases. Since July 1988, 81 patients with urolithiasis and renoureteral anomalies were treated with SWL on the Siemens Lithostar. Retrograde ureteropyelography and double-J stenting was done in 75 and 73 patients, respectively. All patients had satisfactory fragmentation, although 48% needed more than one session. The 6-month stone-free rate was 90%. Follow-up of 3 to 44 months in 32 patients revealed urinary infection in 1 patient and asymptomatic residual calculi in 3. SWL may be considered safe and successful for noninvasive management of calculus disease in patients with upper tract anomalies.

Serial renal sonographic evaluation of patients with Lesch-Nyhan syndrome

The objective of this study was to review sequential renal sonograms of patients with Lesch-Nyhan syndrome obtained over several years to determine different sonographic patterns, the alterations in the patterns occurring over time and the relationship to management. Additional objectives were to evaluate the size of the kidneys, and to correlate the metabolic constituents of calculi with the therapeutic regimens and with the renal sonographic patterns. Serial sonograms of six patients with Lesch-Nyhan syndrome were reviewed for periods varying between 2 and 7 years with a mean of 4 years. The ages of the patients at the conclusion of the study were between 10 and 22 years. Three patterns of abnormal echogenicity were found; a punctate increase in echogenicity in the renal medullary pyramids, a diffuse increase in medullary pyramid echogenicity, and a pattern of increased echogenicity in the collecting system. These patterns were progressive but did not alternate on sequential scans, regardless of increasing or constant therapy. Analysis of calculi suggested patients were precipitating various metabolites concurrently; the incidence of metabolites appeared to be unrelated to therapy. Those patients with shadowing opacities, whether in the renal medulla or collecting system, were more likely to develop renal colic. Renal dimensions were small with renal function remaining normal.