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Afsar SI, Sarifakioglu B, Yalbuzdağ ŞA, Saraçgil Coşar SN. An unresolved relationship: the relationship between lesion severity and neurogenic bladder in patients with spinal cord injury. J Spinal Cord Med 2015; 39:93-8. [PMID: 26322550 PMCID: PMC4725797 DOI: 10.1179/2045772315y.0000000011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We aimed to investigate the relationship between the severity of the spinal lesion and urodynamic findings, bladder drainage method at discharge, and incidence of renal calculi in patients with spinal cord injury (SCI). STUDYDESIGN: Retrospective. SETTING In-patient rehabilitation unit of a tertiary research hospital. METHODS A total of 131 patients who were admitted to our clinic with a diagnosis of SCI and placed into a rehabilitation program were included in the study. The severity of the lesion was determined according to the American Spinal Injury Association Impairment Scale (AIS). We evaluated the relationship between the severity of the lesion and the detrusor hyperactivity and compliance as determined by urodynamic investigation, the bladder drainage method used at discharge, and the renal calculi rate as determined by ultrasonography. RESULTS While no difference was found between the patients with complete and incomplete injuries in terms of age, sex, disease duration, detrusor hyperactivity and compliance, the bladder drainage method was found to show a significant change according to the severity of the lesion. None of the patients were found to have hydronephrosis and the rate of renal calculi showed no statistically significant difference according to the severity of the lesion. CONCLUSIONS We concluded that urodynamic examination is required in each patient with SCI as the severity of the lesion is not sufficient to determine the bladder type, and patients with complete and incomplete injuries should be monitored with the same sensitivity in terms of complications.
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Affiliation(s)
- Sevgi Ikbali Afsar
- Department of Physical Medicine and Rehabilitation,Baskent University, Faculty of Medicine, Ankara, Turkey
| | - Banu Sarifakioglu
- Department of Physical Medicine and Rehabilitation, Namık Kemal University, School of Medicine, Tekirdağ, Turkey
| | | | - Sacide Nur Saraçgil Coşar
- Department of Physical Medicine and Rehabilitation,Baskent University, Faculty of Medicine, Ankara, Turkey
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Distinct metabolic characteristics and risk of stone recurrence in patients with multiple stones at the first-time presentation. Urology 2014; 84:274-8. [PMID: 24768010 DOI: 10.1016/j.urology.2014.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/26/2014] [Accepted: 02/20/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize the clinical and metabolic abnormalities of patients presenting with multiple stones and determine their risk of new stone formation. MATERIALS AND METHODS This retrospective case-controlled study consisted of 911 patients who had ureter stones for the first time and 107 age- and sex-matched patients without stones. The patients were classified into 2 groups: those with a single ureter stone (n = 690) and those with 1 or more additional stones somewhere in the ureter or kidney (n = 221). All patients underwent 24-hour urinary metabolic evaluation. The 240 patients (26.3%) who were followed for >12 months (median follow-up, 35.0 months) were included in recurrence analyses. Stone recurrence was defined as "new stone formation," namely, the radiographic appearance of stones that had not been present in previous examinations. RESULTS The multiple-stone group had significantly lower urinary citrate excretion than the single-stone (P = .011) and control (P = .003) groups. Compared with the single-stone group, it also had a higher incidence of hypocitraturia (P = .011) and stone recurrence (27 of 84 [32.1%] vs 29 of 156 [18.6%] patients; P = .025). Multivariate Cox regression analyses revealed that stone multiplicity (hazard ratio, 2.343; 95% confidence interval, 1.302-4.220; P = .005) was an independent predictor of recurrent stone formation. Kaplan-Meier curves showed identical results. CONCLUSION The patients with multiple stones had distinct metabolic characteristics, particularly hypocitraturia and a significantly higher risk of recurrence than patients with 1 stone. Patients with multiple stones, even if it is their first stone episode, should undergo metabolic evaluation and possibly also potassium citrate therapy to prevent future stones.
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3
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Ren Z, Pan C, Jiang L, Wu C, Liu Y, Zhong Z, Ran L, Ren F, Chen X, Wang Y, Zhu Y, Huang K. Oxalate-degrading capacities of lactic acid bacteria in canine feces. Vet Microbiol 2011; 152:368-73. [PMID: 21641129 DOI: 10.1016/j.vetmic.2011.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 05/02/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
Abstract
In this study, lactic acid bacteria in canine feces were isolated and identified, and their oxalate-degrading capacities were evaluated. The oxalate-degrading capacities were determined for 24 of 47 (51.06%) lactic acid bacteria isolates. Of these, 8 isolates [Leuconostoc mesenteroides (RL75), Lactococcus garvieae (CD2), Lactococcus subsp. lactis (CS21), Enterococcus faecium (CL71 and CL72), and Enterococcus faecalis (CD14, CS62, and CD12)] degraded more than 5% of the oxalate present, while the others degraded less than 5% of the oxalate in vitro. Isolates that degraded more than 5% of the oxalate present were selected for further examination. The oxalate-degrading capacities of individual isolates, a mixture of Enterococcus, a mixture of Lactococcus, and a mixture of the eight isolates were evaluated in media containing different concentrations of glucose (sufficient, insufficient, or no glucose). In comparison with the control medium, all of the individual isolates and mixtures of isolates could degrade oxalate in all three groups (P<0.05). In most cases, the isolates growing in medium with 20 g/L of glucose had higher oxalate-degrading capacities than those growing in medium with 2.5 g/L of glucose or no glucose. The mixture of all isolates showed higher oxalate-degrading capacity than the individual isolates and other mixtures. The oxalate-degrading capacities of the isolates were isolate dependent.
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Affiliation(s)
- Zhihua Ren
- Institute of Nutritional and Metabolic Disorders in Domestic Animals and Fowls, Nanjing Agricultural University, Nanjing 210095, China
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Farooq Qadri SJ, Khan N, Khan M. Retroperitoneal laparoscopic ureterolithotomy--a single centre 10 year experience. Int J Surg 2010; 9:160-4. [PMID: 21059419 DOI: 10.1016/j.ijsu.2010.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 09/23/2010] [Accepted: 10/22/2010] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The management of ureteric stones has standardized with the introduction of ureteroscopy (URS), shock wave lithotripsy(SWL) and HO:YAG laser. But still one may need to use laparoscopic ureterolithotomy for failed URS/SWL cases or as a primary procedure for large impacted stones. At centers which do not have access to expensive equipment needed in URS and SWL, laparoscopic ureterolithotomy may be used as a primary procedure. The aim of this article is to share our 10 year long experience and the lessons learnt from performing retroperitoneal laparoscopic ureterolithotomy (RLU) which we believe is the better route than transperitoneal one. METHODS From January 2000 to January 2010, 820 cases of ureteric stones were managed at our centre. RLU was performed for 126 cases. Most common indication for RLU was as a primary procedure for large impacted upper or mid ureteric stones 86(68.25%) followed by failed URS in 28(22.23%) and failed SWL in 12(9.52%) cases. RESULTS With a mean operative time of 88(45-120) min RLU was successful in 123(97.6%) cases. There was no major intra or postoperative complication. Most common complication of the procedure was the inadvertent peritoneotomy 15(11.9%). Mean hospital stay was 2.8(2-13) days and there were 3(2.38%) cases of prolonged urinary drainage which were managed conservatively. CONCLUSION RLU is a very effective minimally invasive modality of treating ureteral calculi. Unlike URS this procedure can give 100% stone clearance in one session. Its role in advanced urological centers is primarily as a salvage procedure for failed URS/SWL but in developing nations which usually do not have access to URS and SWL RLU can be used as a primary procedure for managing upper and mid ureteric stones with excellent results and with minimal resources.
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Kaya M, Boleken ME, Soran M, Kanmaz T, Yücesan S. Acute renal failure due to bilateral uric acid lithiasis in infants. ACTA ACUST UNITED AC 2007; 35:119-22. [PMID: 17396250 DOI: 10.1007/s00240-007-0088-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 03/09/2007] [Indexed: 10/23/2022]
Abstract
Acute renal failure (ARF) is one of the complications of urolithiasis, but the role of medical treatment to relieve urinary obstruction in children with ARF is uncertain. We report on infants with acute obstructive uric acid lithiasis. We describe presentation features as well as diagnosis methods and medical treatment in five infants who were admitted to our institution with ARF due to uric acid lithiasis. The medical treatments for all patients were fluid liberalization, urine alkalinization, and oral allopurinol. Two children underwent urinary diversion. Within 8 h, urine output improved in all patients, and the stones passed spontaneously. All obstructed kidneys were relieved with medical treatment, and no renal sequel remained. So this series has showed a role of medical therapy in acute obstructive uric acid lithiasis.
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Affiliation(s)
- Mete Kaya
- Department of Pediatric Surgery, Harran University School of Medicine, Sanliurfa, Turkey.
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Lim JH, Kim MK, Kim YG. The Stone Risk Factors for Stone Patients with Hypertension. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.9.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ju Hyun Lim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Myung Ki Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Gon Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
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Cha JS, Jeon SB, Kim MK, Jeong YB, Kim YG. Metabolic Stone Risk Factors Associated with Papillary Calcification on Unenhanced Spiral Computed Tomography. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.5.507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jai Seong Cha
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Sang Bong Jeon
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Myung Ki Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Young Beom Jeong
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Young Gon Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
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Dal Moro F, Mancini M, Tavolini IM, De Marco V, Bassi P. Cellular and molecular gateways to urolithiasis: a new insight. Urol Int 2005; 74:193-7. [PMID: 15812202 DOI: 10.1159/000083547] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Accepted: 05/12/2004] [Indexed: 11/19/2022]
Abstract
Urolithiasis is a relevant clinical problem in everyday practice with a subsequent burden for the health system. Urolithiasis is classically explained as the derangement in the process of biomineralization involving the equilibrium between promoters and inhibitors of crystallization: a deficit of one or several inhibitors or an excess of one or several promoters plays a pivotal role in the stone formation. The revolutionary introduction of the molecular biology in medicine has given a new insight in urolithiasis too. Genetic factors have also been postulated to play an important role. A review of the current knowledge on urolithiasis based upon a molecular and genetic approach is reported.
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Affiliation(s)
- Fabrizio Dal Moro
- Department of Urology, Padova Medical School, University of Padova, Padova, Italy
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Erbagci A, Erbagci AB, Yilmaz M, Yagci F, Tarakcioglu M, Yurtseven C, Koyluoglu O, Sarica K. Pediatric urolithiasis--evaluation of risk factors in 95 children. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2004; 37:129-33. [PMID: 12745721 DOI: 10.1080/00365590310008866] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Pediatric urolithiasis is a rarely encountered pathology, except in endemic areas such as Turkey. As a recurrent pathology which may reveal functional as well and morphologic changes in the urinary tract, metabolic and environmental factors, in addition to urogenital abnormalities, should be evaluated thoroughly in each patient. In this prospective study, the patient and family histories of 95 children with stone disease were evaluated, together with serum and urine risk factors. MATERIAL AND METHODS Between 1996 and 2001, 95 children (25 females, 70 males; mean age 7.3 years; age range 0.6-15 years) referred to our department with urolithiasis were evaluated. All patients were investigated with respect to stone localization, associated abnormalities, urinary tract infection (UTI), positive family history and serum and urine risk factors. In addition to standard risk factors (hypocitraturia, hypercalciuria, hyperoxaluria, hyperuricosuria, hypomagnesuria), diet and 24-h urine volume were also assessed in all children. Children with cystinuria were excluded from the study. RESULTS Stone size ranged from 0.3 to 3.3 cm, with an average value of 2.0 cm. The localization of the stones was classified as unilateral single stone in 37 patients, multiple unilateral stones in six and bilateral multiple stones in 27. Hypocitraturia was the commonest risk factor detected in our patients. A positive family history was present in 51 cases (54%). In addition, UTI was present in 59 cases (62%) and 67 cases had a previous history of recurrent UTI. Associated urogenital abnormality was detected in nine cases (9.4%). There were significant correlations between stone size and urinary citrate excretion (p < 0.05) and between the presence of UTI and urinary phosphate excretion (r = 0.59, p = 0.047). Treatments used were open surgery in seven (7.3%) cases, extracorporeal shock-wave lithotripsy in 39 (41%) and endoscopic surgery in 20 (21%). Following these procedures, 39 (41%) patients were completely stone-free, 11 (11%) had residual stones (<5 mm in diameter) and 12 (14.8%) passed the stone(s) spontaneously. During follow-up, regrowth was seen in four (4.2%) patients and stone recurrence was noted in a further four (4.2%). CONCLUSIONS In addition to stone removal, treatment of pediatric urolithiasis requires a thorough metabolic and environmental evaluation of all patients on an individual basis. Obstructive pathologies have to be corrected immediately and apparent metabolic abnormalities should also be treated. Children with a positive family history should be followed carefully with respect to stone recurrence. Urine volume increases in parallel with body mass index and medical therapeutic agents which increase urine citrate levels should be encouraged.
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Affiliation(s)
- Ahmet Erbagci
- Department of Biochemistry, Medical School, University of Gaziantep, TR-27070 Kolejtepe, Gaziantep, Turkey.
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Kwak C, Kim HK, Kim EC, Choi MS, Kim HH. Urinary oxalate levels and the enteric bacterium Oxalobacter formigenes in patients with calcium oxalate urolithiasis. Eur Urol 2004; 44:475-81. [PMID: 14499684 DOI: 10.1016/s0302-2838(03)00318-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We performed a prospective study to evaluate the intestinal colonization of Oxalobacter formigenes and its relationship with urinary oxalate levels in patients with calcium oxalate stone disease. METHODS One hundred and three patients with calcium oxalate urolithiasis, ranging in age from 21 to 73 years (mean age, 47 years) who were followed from August 2000 to September 2001 participated in this study. Fresh stool and 24-hour urine samples were collected. Genus specific oligonucleotide sequences corresponding to the homologous regions residing in the oxc gene were designed. In order to quantify O. formigenes in clinical specimens, a quantitative-PCR-based assay system utilizing a competitive DNA template as an internal standard was developed. Urine volume, pH, creatinine, oxalate, calcium, magnesium, phosphate, citrate and uric acid were measured. RESULTS Intestinal Oxalobacteria were detected in 45.6% (n=47) of calcium oxalate stone patients by PCR. In stone formers who tested negative for Oxalobacteria, the average urinary oxalate level was 0.36 mmol/day, and this compared to 0.29 mmol/day for those patients that tested positive for Oxalobacteria (p<0.05). Mean colony forming units per gram of stool of all patients was 1.1 x 10(7) (0-4.1 x 10(8)), and the level of 24 hours urine oxalate significantly decreased with increasing level of colony forming units of O. formigenes (r=-0.356, p=0.021). CONCLUSION Our results support the concept that O. formigenes is important in maintaining oxalate homeostasis and that its absence from the gut may be the risk of calcium oxalate urolithiasis.
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Affiliation(s)
- Cheol Kwak
- Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, 28 Yongon Dong, Jongno Ku, Seoul 110-744, Republic of Korea
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Kwak C, Jeong BC, Kim HK, Kim EC, Chox MS, Kim HH. Molecular epidemiology of fecal Oxalobacter formigenes in healthy adults living in Seoul, Korea. J Endourol 2003; 17:239-43. [PMID: 12816588 DOI: 10.1089/089277903765444384] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Oxalobacter formigenes is a member of the intestinal flora that degrades oxalate. This bacterium maintains an important symbiotic relation with its hosts by regulating oxalic acid absorption in the intestine as well as oxalic acid concentrations in plasma. We tried to define the prevalence of fecal O. formigenes positivity in healthy adults. MATERIALS AND METHODS Whole-bacterial DNA was isolated directly from fresh stool samples obtained from 233 healthy adults known to be free of urolithiasis. Genus-specific oligonucleotide sequences corresponding to homologous regions residing in the oxc gene that encodes oxalyl-coenzyme A decarboxylase were designed. A PCR-based assay was done on the stool samples. RESULTS A PCR product of 416 bp encoding the oxc gene was detected in 197 of the 233 stool samples (76.8%). Adjusted to the Seoul population census 1995, the calibrated fecal O. formigenes-positive rate was estimated to be 76.7%: 79.2% in men and 74.2% in women, with no significance difference according to age or sex. CONCLUSION These results suggest that O. formigenes inhabits the intestine of three fourths of the normal Korean populations. These data provide a base for further studies to uncover the relation between O. formigenes and urolithiasis.
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Affiliation(s)
- Cheol Kwak
- Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Rizvi SAH, Naqvi SAA, Hussain Z, Hashmi A, Hussain M, Zafar MN, Mehdi H, Khalid R. The management of stone disease. BJU Int 2002; 89 Suppl 1:62-8. [PMID: 11876736 DOI: 10.1046/j.1465-5101.2001.134.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S A H Rizvi
- Sindh Institute of Urology and Transplantation (SIUT), Dow Medical College, Karachi 74200, Pakistan.
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Campieri C, Campieri M, Bertuzzi V, Swennen E, Matteuzzi D, Stefoni S, Pirovano F, Centi C, Ulisse S, Famularo G, De Simone C. Reduction of oxaluria after an oral course of lactic acid bacteria at high concentration. Kidney Int 2001; 60:1097-105. [PMID: 11532105 DOI: 10.1046/j.1523-1755.2001.0600031097.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hyperoxaluria is a major risk factor for renal stones, and in most cases, it appears to be sustained by increased dietary load or increased intestinal absorption. Previous studies have shown that components of the endogenous digestive microflora, in particular Oxalobacter formigenes, utilize oxalate in the gut, thus limiting its absorption. We tested the hypothesis of whether oxaluria can be reduced by means of reducing intestinal absorption through feeding a mixture of freeze-dried lactic acid bacteria. METHODS Six patients with idiopathic calcium-oxalate urolithiasis and mild hyperoxaluria (>40 mg/24 h) received daily a mixture containing 8 x 10(11) freeze-dried lactic acid bacteria (L. acidophilus, L. plantarum, L. brevis, S. thermophilus, B. infantis) for four weeks. The 24-hour urinary excretion of oxalate was determined at the end of the study period and then one month after ending the treatment. The ability of bacteria to degrade oxalate and grow in oxalate-containing media, and the gene expression of Ox1T, an enzyme that catalyzes the transmembrane exchange of oxalate, also were investigated. RESULTS The treatment resulted in a great reduction of the 24-hour excretion of oxalate in all six patients enrolled. Mean levels +/- SD were 33.5 +/- 15.9 mg/24 h at the end of the study period and 28.3 +/- 14.6 mg/24 h one month after treatment was interrupted compared with baseline values of 55.5 +/- 19.6 mg/24 h (P < 0.05). The treatment was associated with a strong reduction of the fecal excretion of oxalate in the two patients tested. Two bacterial strains among those used for the treatment (L. acidophilus and S. thermophilus) proved in vitro to degrade oxalate effectively, but their growth was somewhat inhibited by oxalate. One strain (B. infantis) showed a quite good degrading activity and grew rapidly in the oxalate-containing medium. L. plantarum and L. brevis showed a modest ability to degrade oxalate even though they grew significantly in oxalate-containing medium. No strain expressed the Ox1T gene. CONCLUSIONS The urinary excretion of oxalate, a major risk factor for renal stone formation and growth in patients with idiopathic calcium-oxalate urolithiasis, can be greatly reduced with treatment using a high concentration of freeze-dried lactic acid bacteria. We postulate that the biological manipulation of the endogenous digestive microflora can be a novel approach for the prevention of urinary stone formation.
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Affiliation(s)
- C Campieri
- Department of Nephrology, S. Orsola University Hospital, Bologna, Italy
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Lifshitz DA, Shalhav AL, Lingeman JE, Evan AP. Metabolic evaluation of stone disease patients: a practical approach. J Endourol 1999; 13:669-78. [PMID: 10608520 DOI: 10.1089/end.1999.13.669] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the last three decades, minimally invasive techniques have progressed significantly, replacing traditional open surgery as the mainstay of stone disease surgical treatment. The challenge for the next millennium remains medical prevention of calcium urolithiasis, a field where less dramatic progress has been achieved during the same period of time. The purpose of this article is to provide the practicing urologist with current practical guidelines for the assessment and management of calcium urolithiasis patients. The recommendations are based on the latest available information regarding the pathogenesis, medical treatment options, and decision-making rationale when managing these challenging patients. Every urolithiasis patient should undergo a basic evaluation, which is considered the minimal essential diagnostic work-up, in order to rule out obvious, treatable systemic causes of urinary stone disease. All patients should be advised about conservative nonspecific preventive measures. High-risk stone patients should have a more extensive metabolic evaluation based on two 24-hour urine samples. Treatment protocols for each patient are tailored individually according to the metabolic evaluation findings.
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Affiliation(s)
- D A Lifshitz
- Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana, USA
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16
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Sidhu H, Hoppe B, Hesse A, Tenbrock K, Brömme S, Rietschel E, Peck AB. Absence of Oxalobacter formigenes in cystic fibrosis patients: a risk factor for hyperoxaluria. Lancet 1998; 352:1026-9. [PMID: 9759746 DOI: 10.1016/s0140-6736(98)03038-4] [Citation(s) in RCA: 188] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with cystic fibrosis have an increased risk of hyperoxaluria, and of subsequent nephrocalcinosis and calcium-oxalate urolithiasis. Oxalate homoeostasis is controlled, in part, by the intestinal bacterium, Oxalobacter formigenes. The loss of this bacterium from the gut flora is associated with an increased risk of hyperoxaluria and calcium-oxalate urolithiasis. We investigated whether the absence of O. formigenes and the presence of hyperoxaluria are correlated in cystic fibrosis (CF) patients. METHODS Stool specimens from 43 patients with CF aged 3-9 years and from 21 similarly aged healthy volunteers were examined for O. formigenes by culture and DNA analysis. At the same time, 24 h urine samples were collected and analysed for oxalate and other factors that promote or inhibit stone formation. FINDINGS 15 (71%) of 21 healthy volunteers but only seven (16%) of 43 CF patients were colonised with O. formigenes. Detection of O. formigenes in six of these seven patients required DNA-based identification, suggesting low numbers of colony-forming units, and the CF patient with normal numbers of O. formigenes was the only one of the 43 patients who had not been treated with antibiotics. All seven CF patients colonised with O. formigenes had normal urinary oxalate levels, but 19 (53%) of 36 patients not colonised with O. formigenes were hyperoxaluric, with the most severe hyperoxaluria occurring in young patients. INTERPRETATION Absence of O. formigenes from the intestinal tract of CF patients appears to lead to increased absorption of oxalate, thereby increasing the risk of hyperoxaluria and its complications (eg, nephrocalcinosis, urolithiasis). Prolonged widespread use of antibiotics, and alterations of the gastrointestinal tract that occur in CF, may induce a permanent decolonisation in CF patients.
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Affiliation(s)
- H Sidhu
- Division of Oxalate Research, Ixion Biotechnology, Alachua, FL, USA
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Marengo SR, Resnick MI, Yang L, Chung JY. Differential expression of urinary inter-alpha-trypsin inhibitor trimers and dimers in normal compared to active calcium oxalate stone forming men. J Urol 1998; 159:1444-50. [PMID: 9554330 DOI: 10.1097/00005392-199805000-00005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE We determine if the immunoreactive profile of urinary inter-alpha-trypsin inhibitor can be used to distinguish between normal individuals and individuals with calcium oxalate stone disease. MATERIALS AND METHODS Urinary proteins were dialyzed against water (15 kDa. molecular weight cutoff), lyophilized and resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (6% acrylamide, reducing conditions) followed by Western blot. Inter-alpha-trypsin immunoreactive proteins were detected by enhanced chemiluminescence. Stone formation was confirmed to be active radiologically or passed as stone or gravel within 12 months of the sample. Stone composition was confirmed crystallographically. Normal individuals had no personal or familial history of urolithiasis and matched stone forming patients regarding race (white) and age (23 to 71 years old). Urine from a total of 101 individuals was analyzed. RESULTS The intact inter-alpha-trypsin trimer (approximately 220 to 240 kDa.) and heavy chain (HC) 2-bikunin/HC1-bikunin dimers (approximately 115 to 130 kDa.) were detected more often in stone forming men (23 of 26 [89%] and 26 of 26 [100%], respectively) than in normal individuals (6 of 26 [23%] and 5 of 26 [19%], respectively, p < 0.0001). In those normal individuals who expressed inter-alpha-trypsin trimer and HC-bikunins the relative intensities were 5.3+/-1.4% and 16.3+/-17.1% of the stone forming controls, respectively. The identity of high molecular weight-inter-alpha-trypsin immunoreactive bands was confirmed using antibodies against the individual subunits (HC1, HC2, HC3, bikunin). In contrast to men high molecular weight-inter-alpha-trypsin's were readily detected in normal and stone forming women with equal frequency (inter-alpha-trypsin-trimer p=0.1337, HC-bikunins p=0.2836): inter-alpha-trypsin-trimer 17 of 18 [94%] and 9 of 13 [77%]; HC-bikunins 17 of 18 [94%] and 10 of 13 [85%]). Inter-alpha-trypsin-trimer and HC-bikunins, respectively, were detected in 2 and 5 of 10 patients with chronic renal disease. Expression was not related to hematuria or proteinuria. CONCLUSIONS Immunoreactive profiles of urinary proteins may be able to be developed into a useful diagnostic tool to identify active stone formation, although a separate panel may be required for men and women. It is possible that these differences may provide clues as to why the incidence of stone disease is higher in men than women.
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Affiliation(s)
- S R Marengo
- James and Eilleen Dicke Research Laboratory, Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Helical computed tomography of urinary tract stones: Accuracy and diagnostic value of stone size and density measurements. Emerg Radiol 1997. [DOI: 10.1007/bf01461737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
We compared quantitative urinary cystine values in stone-forming family members and unaffected relatives based on an index stone-forming patient. A family pedigree of 39 members was identified. Quantitative urinalyses and serum biochemical profiles were collected with the subjects on similar diets over 72 hours. Detailed medical histories were obtained. Three family members are stone-forming cystinuric patients with a mean urinary cystine excretion of 496 mg/g of creatinine per day. Six persons without a history of stones (mean age 50) had a mean urinary cystine excretion of 364 mg/g of creatinine per day. Thirty-four family members had elevated urinary cystine concentrations (mean 151 mg/g of creatinine per day), and only two family members had normal urinary cystine excretion. Fifteen subjects with elevated urinary cystine values (> 150 mg/g of creatinine per day) had no history of urinary stones despite a mean age of 44 years. Urinary electrolytes and volumes were similar in the stone-forming and non-stone-forming groups. Thirty-nine per cent of the persons from this family pedigree had elevated quantitative urinary cystine concentrations and no history of urinary stones despite a mean age of 44 years. Acalculous cystinuria is an elevated urinary cystine concentration without evidence of urinary stone disease. Despite abnormal urinary cystine excretion, acalculous cystinuria does not necessarily culminate in clinical urinary stone disease.
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Affiliation(s)
- M L Stoller
- Department of Urology, University of California School of Medicine, San Francisco, USA
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Abstract
The evaluation of urolithiases, in terms of calculus detection and evaluation of the morphology and function of the kidneys, continues to be refined with advances in imaging technology. The most significant recent advance is use of helical or spiral CT scan for the accurate delineation of renal and ureteral calculi in the acute setting. This may provide an accurate, rapid, and cost-effective method of patient evaluation. The alternative approach is to use plain abdominal radiography to detect renal or ureteral calculi. Noncontrast-enhanced helical or spiral CT scanning has its greatest impact in patients with negative abdominal radiographs or in those patients with suspected urinary colic in whom renal but not ureteral calculi are seen. A supplemental intravenous urogram can be used, as appropriate, to evaluate renal function and degree of obstruction on both the involved and uninvolved side. Combined abdominal radiography and sonography may be used for calculus detection and demonstration of obstruction. Sonography is an operator-dependent technique requiring expertise, experience, and adequate imaging equipment for satisfactory results. Physiologic study of renal blood flow and urinary dynamics using Doppler techniques are possible, though considered to be in the realm of clinical investigation at this time. Sonography has a valuable role in the serial evaluation of chronic stone formers with a history of recurrent urinary infections related to obstruction or reflux. Radiography, fluoroscopy, and sonography are the imaging, methods used in ESWL treatment in preprocedure and postprocedure.
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Affiliation(s)
- F P Begun
- Department of Urology, Medical College of Wisconsin, Milwaukee, USA
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Benizri E, Wodey J, Amiel J, Toubol J. Comparison of 2 pulsed lasers for lithotripsy of ureteral calculi: report on 154 patients. J Urol 1993; 150:1803-5. [PMID: 8230509 DOI: 10.1016/s0022-5347(17)35900-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Extracorporeal lithotripsy does not always provide satisfactory results for the treatment of ureteral stones. Such cases appear to be excellent indications for endocorporeal lithotripsy based on an association of ureteroscopy and laser. To compare the performances of 2 pulsed lasers, the pulsed dye laser (Candela) and solid Q switched laser (HMT), for the treatment of these calculi 161 ureteral stones were treated successively from November 1990 to March 1992 by a combination of ureteroscopy and laser. Endocorporeal lithotripsy was performed in 102 cases with the Candela laser, in 47 with the HMT laser and in 7 with both lasers. With a stable success rate greater than 90%, both lasers demonstrated equivalent performances regardless of the location of the stone along the ureter. However, while stone fragmentation was more rapid with the Candela laser, the HMT laser appeared to be more effective for dark stones (monohydrate calcium oxidate).
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Affiliation(s)
- E Benizri
- Service d'Urologie, Hôpital Pasteur, Nice, France
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Kennedy AP, Brocklehurst JC, Robinson JM, Faragher EB. Assessment of the use of bladder washouts/instillations in patients with long-term indwelling catheters. BRITISH JOURNAL OF UROLOGY 1992; 70:610-5. [PMID: 1486386 DOI: 10.1111/j.1464-410x.1992.tb15829.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A randomised cross-over study of 3 bladder washout treatments--saline, Suby G and Solution R--was conducted on 25 elderly females with long-term catheters in order to examine crystal formation and catheter encrustation. With 2 exceptions, all patients produced crystals; only 14 completed the study. While a significant reduction in struvite crystals was found in the returned acidic washout fluid, there was no significant reduction of crystals in the neutral (saline) washout following any of the 3-week periods of treatment. Uric acid crystals appeared with Suby G and Solution R and these solutions were associated with higher red cell deposits in the urine. There was no significant difference in catheter encrustation between the various washouts.
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Affiliation(s)
- A P Kennedy
- Department of Geriatric Medicine, University of Manchester
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