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McGeorge S, Loh B, Shibu R, Dobeli K, Brown NJ, Esler R, Hacking C, Purvey M, Roberts MJ. Plain x-ray misses many ureteric calculi: Time to challenge the old dogma? BJUI COMPASS 2022; 4:59-61. [PMID: 36569499 PMCID: PMC9766866 DOI: 10.1002/bco2.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Stephen McGeorge
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Brendon Loh
- Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Ryan Shibu
- Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Karen Dobeli
- Department of Medical ImagingRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Nathan J. Brown
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Rachel Esler
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Craig Hacking
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Department of Medical ImagingRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Megan Purvey
- Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Matthew J. Roberts
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchBrisbaneQueenslandAustralia
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Wei X, Qin Y, Wang X, Qian J, Niu S, Tu S, Yao J. Giant bladder stone: A case report. Exp Ther Med 2022; 24:535. [PMID: 35837049 PMCID: PMC9257951 DOI: 10.3892/etm.2022.11462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/15/2022] [Indexed: 11/20/2022] Open
Abstract
Giant bladder stones are rare in younger patients. Herein, we report a case of acute renal failure in a 31-year-old male with a giant bladder stone. The patient presented with lower urinary tract symptoms and urinary retention with milky-white urine. An emergency suprapubic cystotomy was performed and an 11-cm oval, solid stone was removed. Post-operative creatinine levels progressively decreased to normal and the patient exhibited smooth urination and good recovery at follow-up. A comprehensive physical examination and thorough investigation of the patient's medical history are required during clinical evaluation, diagnosis and treatment, thus preventing misdiagnoses and ensuring prompt treatment.
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Affiliation(s)
- Xiaoyi Wei
- Department of Urology, Hexi University Affiliated Zhangye People's Hospital, Zhangye, Gansu 734000, P.R. China
| | - Yujie Qin
- Endoscopy Center, Hexi University Affiliated Zhangye People's Hospital, Zhangye, Gansu 734000, P.R. China
| | - Xinghu Wang
- Department of General Surgery, Gaotai Silk Road Ciren Hospital, Zhangye, Gansu 734000, P.R. China
| | - Jun Qian
- Institute of Urology, Hexi University, Zhangye, Gansu 734000, P.R. China
| | - Shijie Niu
- Department of Urology, Hexi University Affiliated Zhangye People's Hospital, Zhangye, Gansu 734000, P.R. China
| | - Song Tu
- Department of Urology, Hexi University Affiliated Zhangye People's Hospital, Zhangye, Gansu 734000, P.R. China
| | - Jiaxi Yao
- Department of Urology, Hexi University Affiliated Zhangye People's Hospital, Zhangye, Gansu 734000, P.R. China
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Mazzon G, Choong S, Pavan N, Zeng G, Wu W, Durutovic O, Pirozzi M, Zhong J, Bada M, Celia A. Introducing Trifecta for percutaneous nephrolithotomies: a proposal for standard reporting outcomes after treatment for renal stones. Minerva Urol Nephrol 2021; 74:351-359. [PMID: 33769014 DOI: 10.23736/s2724-6051.21.04046-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In literature, the reports of outcomes after percutaneous nephrolithotomies are rather heterogeneous. This may influence studies comparison, it may also render difficult to evaluate surgical adequacy, peri-operative morbidity and patient's quality of life between studies. For this reason, we propose to introduce PNL-Trifecta as composite measure to standardize data reporting outcomes after percutaneous nephrolithotomies. METHODS We performed a prospective multicentric study on consecutive patients undergone PNL to treat renal stones between 2018 and 2020. Successful PNL-trifecta was considered achieved when procedures obtained the three following results: no residual fragments > 2mm at unenhanced CT scan at 3 months post-op, no complications (defined as Clavien-Dindo Score 0) and operation carried out without placing a nephrostomy tube (tubeless or totally tubeless). We compared results of standard versus mini-PNL and between stones of different complexity (evaluated with Guy's Stone Score and S.T.O.N.E. nephrolithometry Score). Univariate analysis was utilized to identify other factors influencing achievement of PNL-Trifecta. RESULTS 245 patients fulfilled inclusion/exclusion criteria and have been enrolled in the study (median age: 56, IQR 48-57). The overall PNL-Trifecta achievement rate was 22.85% (28.66% in the mini-PNL group and 13.68% in the standard-PNL group, p=0.010). The stone free rate, CD 0 rate and tubeless/totally tubeless rate in the mini-PNL group were 60.66%, 89.33% and 51.33% respectively. In the standard-PNL group they were 44.21%, 40.00% and 15.78% respectively. At the univariate analysis, differences between Guy's Stone Score groups in achieving PNL-Trifecta were significant (p=0.001). Also, the level of upper puncture (p=0.010) and utilization of device with active suction (p=0.002) showed statistically significant differences. Furthermore, the length of stay in the patient's group achieving Trifecta was 2.28 versus a mean length of stay of 4.64 days in the group of patients not achieving Trifecta (p=0.046). CONCLUSIONS We present Trifecta for PNLs as a potential tool to evaluate quality of percutaneous nephrolithotomies and to provide an instrument for an adequate standard data reporting. It can represent a valid way to assess and monitor surgeon's learning curves. It will require further external validation and studies to evaluate its correlation with mid- and long-term results and patient's health related quality of life outcomes.
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Affiliation(s)
- Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy -
| | - Simon Choong
- Institute of Urology, University College Hospital of London, London, UK
| | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | - Guohua Zeng
- Department of Urology, minimally invasive Centre, the first affiliated hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenqi Wu
- Department of Urology, minimally invasive Centre, the first affiliated hospital of Guangzhou Medical University, Guangzhou, China
| | - Otas Durutovic
- Department of Urology, University of Belgrade, Belgrade, Serbia
| | - Marco Pirozzi
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Jiehui Zhong
- Department of Urology, minimally invasive Centre, the first affiliated hospital of Guangzhou Medical University, Guangzhou, China
| | - Maida Bada
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
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Gadelmoula M, Moeen AM, Elderwy A, Abdel-Kader MS, Elqady A, Aboul-Ella HA, Osman E. Can stone composition be predicted by plain X-ray and/or non-contrast CT? A study validated by X-ray diffraction analysis. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The stone composition has a great influence on the outcome of its treatment. There are several tests to predict the composition of stones preoperatively and stone analysis postoperatively. Herein, we want to evaluate if the stone composition could be predicted from plain X-ray KUB (PKUB) and/or non-contrast CT (NCCT) validated by in vitro X-ray powder diffraction analysis (XRD).
Methods
Between April 2014 and March 2016, 100 cases with urinary tract stones were included in the study. The radio-opacity of the stones in PKUB, stone density by NCCT, and after stone extraction, XRD were performed. Statistical analysis for the results was performed using Chi-square and Fisher exact tests for categorical variables and Mann–Whitney U and Kruskal–Wallis H for the nonparametric variables. The receiver operating characteristic curve was constructed to determine the best cutoff value.
Results
This study included 74 males and 26 females with a median age of 32 years (range 2–70). Regarding the radio-opacity by PKUB, there were 30 stones dense opaque, 44 opaque, 21 faint opaque, and 5 radiolucent. XRD revealed 97 mixed and 3 pure stones. The calcium oxalate monohydrate (COM) stone composition could be predicted in dense opaque stone by PKUB in 75.9% and urate composition in the radiolucent stone by 40%. The cutoff value of HU density by NCCT to the dense opaque stones in the PKUB was > 1020 and for radiolucent stones was < 590.
Conclusion
Stone radio-opacity by PKUB and its attenuation value by NCCT could successfully predict its calcium oxalate monohydrate, struvite, and urate composition. However, the chemical stone analysis is still required as most stones are mixed.
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ÖZDEMİR A, ŞAHAN MH. Radiologic features of symptomatic cholelithiasis: a current perspective. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.795078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Talso M, Emiliani E, Froio S, Gallioli A, Forzenigo L, Pradere B, Traxer O, Somani BK, Montanari E. Low-dose CT scan in stone detection for stone treatment follow-up: is there a relation between stone composition and radiation delivery? Study on a porcine-kidney model. MINERVA UROL NEFROL 2018; 71:63-71. [PMID: 30547905 DOI: 10.23736/s0393-2249.18.03265-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Non-contrast CT scan (NCCT) is becoming the standard imaging modality in urinary stone disease. Radiation dose remains an issue, especially for those patients who may need to undergo several CT scans for this indication during their lifetime. Low-dose and ultra-low-dose protocols exist, but there is limited data on the relationship between the minimum radiation dose capable of detecting stone fragments and stone composition. METHODS Seven different kinds of human kidney stone were selected. Fragments of 1, 2, 4 and 7 mm were obtained for each stone. Four fragments of the same material were placed in a porcine kidney. A CT scan was then used to scan the kidney at decreasing dosages of 140, 70, 30, 15 and 7mAs. The scans were repeated for each type of stone. Images were reviewed by two radiologists independently with the intent of identifying the stone composition and providing information on its position, dimensions and Hounsfield units (HU). RESULTS All types of stone were visible at all settings. Only the 1-mm uric-acid fragment was not detected by both radiologists at 7 and 15 mAs. Dose Length product (DLP) decreased with the reduction in mAs. In terms of HU a statistically significant difference was observed between calcium-based and non-calcium-based stones. Stone dimensions and HU were not affected by the reductions in mAs. CONCLUSIONS Ultra-low-dose CT has a good detection rate for all kinds of stone, even when the fragment size is small. Only small uric acid fragments need higher energy settings in order to be detected. When the stone composition is known after surgery for urolithiasis, the most appropriate CT scan setting could be suggested by the urologist during their follow-up.
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Affiliation(s)
- Michele Talso
- Urology Department, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy - .,Urology Department, ASST Vimercate Hospital, Vimercate, Monza Brianza, Italy -
| | - Estenan Emiliani
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Sara Froio
- Intensive Care Unit, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea Gallioli
- Urology Department, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Laura Forzenigo
- Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Benjamin Pradere
- Urology Department, Tenon Hospital, Sorbonne University, Paris, France
| | - Olivier Traxer
- Urology Department, Tenon Hospital, Sorbonne University, Paris, France
| | - Bhaskar K Somani
- Urology Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - Emanuele Montanari
- Urology Department, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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