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Tang W, Yang D, Wu T, Liang G. Delayed bilateral spontaneous renal rupture after surgery for unilateral upper ureteral calculi: a case report. Front Med (Lausanne) 2023; 10:1173386. [PMID: 37869167 PMCID: PMC10587595 DOI: 10.3389/fmed.2023.1173386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Spontaneous renal rupture is a rare clinical condition characterized by spontaneous bleeding in the renal subcapsular and perinephric spaces in patients without a history of trauma. It occurs mainly in pathologic kidneys and after some renal surgeries. We report a 40-year-old male patient admitted with a diagnosis of gallstones with cholecystitis due to fever and abdominal pain after unilateral ureteral calculi. The patient developed delayed right renal rupture hemorrhage during treatment, controlled after selective arterial embolization (SAE). Still, the patient developed spontaneous left renal rupture due to a systemic inflammatory response. Finally, the patient's life was saved after several selective embolizations of the renal artery. We retrospectively analyzed this case to improve our understanding of the disease.
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Affiliation(s)
| | | | - Tao Wu
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Muacevic A, Adler JR, Aljedani R, Alsaleh MH, Atyia N, Alsedrah A, Albardi M. The Role of Radiological Imaging in the Diagnosis and Treatment of Urolithiasis: A Narrative Review. Cureus 2022; 14:e33041. [PMID: 36589703 PMCID: PMC9795962 DOI: 10.7759/cureus.33041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
The incidence and prevalence of urolithiasis have been increasing worldwide for the last several decades. This increase could be attributed to many factors, including missed cases of small stones, a sedentary lifestyle, a high BMI, a lack of physical activity, and poor dietary intake. In addition, the increased incidence of co-morbidities such as diabetes, dyslipidemia, infections, and multiple urinary tract surgeries could contribute significantly to the formation of urolithiasis. Radiology has a major role in diagnosing a variety of these stone types and can be used in planning management approaches, either as guidance or as a direct therapeutic method for stones. Because of the availability, safety, cost, and effectiveness of radiological imaging nowadays, urolithiasis is rarely missed; furthermore, the availability of radiological treatment options decreases the need for surgical intervention for urolithiasis, which minimizes hospital stay and surgical-related complications. This review aims to scope and analyze the role of radiological imaging modalities in reaching a diagnosis and planning treatment options for urolithiasis in different circumstances. Information was gathered from relevant peer-reviewed publications in PubMed and thereafter refined and summarized to provide a comprehensive review. The selected indexing terms included "radiological imaging modality," "treatment of urolithiasis," and "diagnosis of urolithiasis," among others.
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Culpan M, Acar HC, Akalin K, Cakici MC, Tufekci B, Gunduz N, Dogan MB, Yildirim A, Atis G. Are the current nomograms sufficient to predict shockwave lithotripsy outcomes? Actas Urol Esp 2022; 46:473-480. [PMID: 35803872 DOI: 10.1016/j.acuroe.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/11/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES To investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones. PATIENTS AND METHODS Medical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC). RESULTS A total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350-6.612; p = 0.007), middle calyx (OR:3.036; 95%Cl: 1.472-6.258; p = 0.003), and lower calyx (OR:2.131; 95%Cl: 1.182-3.839; p = 0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140-2.425; p = 0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098-1.217; p < 0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001-1.002; p < 0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively. CONCLUSIONS Stone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, "Kim JK nomogram", "Triple D score" and "S3HoCKwave score" can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.
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Affiliation(s)
- M Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - H C Acar
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - K Akalin
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - M C Cakici
- Department of Urology, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - B Tufekci
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - N Gunduz
- Department of Radiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - M B Dogan
- Department of Radiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - A Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - G Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Alić J, Heljić J, Hadžiosmanović O, Kulovac B, Lepara Z, Spahović H, Bajramović S, Aganović D. The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option? Cureus 2022; 14:e28671. [PMID: 36196280 PMCID: PMC9525100 DOI: 10.7759/cureus.28671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/05/2022] Open
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Lessons learned after the disruption caused by COVID-19 in the management of urolithiasis: An example of adaptation in a high-volume center. ACTAS UROLÓGICAS ESPAÑOLAS (ENGLISH EDITION) 2022; 47:149-158. [PMID: 36334974 PMCID: PMC9351306 DOI: 10.1016/j.acuroe.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/22/2021] [Accepted: 02/07/2022] [Indexed: 12/03/2022]
Abstract
Background The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management. Methods In this retrospective study, we comparatively evaluated urgent and elective procedures due to urolithiasis during the early eight months of the COVID-19 pandemic (March 1, 2020, to October 31, 2020) compared to the same period a year before, and between waves. The student’s t-test, chi-square test, Mann–Whitney U test and Fisher’s exact test were used to compare the patients’ characteristics and outcomes between the two periods and waves. Results Five hundred and thirty procedures were included. The overall numbers of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in first wave was detected, and a growth in the number of urgent procedures after the first wave was noted, owing to the delay in urolithiasis treatment and diagnosis. Conclusion The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care.
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Medina AA, García IL, Alcaraz MM, Curtis DL, Terradillos SA, Palacios MH, Ruiz GD, Funez FA, Revilla FJB. [Lessons learned about the disruption caused by COVID-19 in the management of urolithiasis: An example of adaptation in a high-volume centre]. Actas Urol Esp 2022; 47:149-158. [PMID: 35756714 PMCID: PMC9212612 DOI: 10.1016/j.acuro.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/07/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management. METHODS In this retrospective study we comparatively evaluated urgent and elective procedures due to urolithiasis during the early eight months of the COVID-19 pandemic (March 1, 2020 to October 31, 2020) compared to the same period a year before, and between waves. The student's t-test, chi-square test, Mann-Whitney U test and Fisher's exact test were used to compare the patients' characteristics and outcomes between the two periods and waves. RESULTS 530 procedures were included. The overall number of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in 1st wave was detected. A growth in the number of urgent procedures after the 1st wave was noted, owing to the delay in urolithiasis treatment and diagnosis. CONCLUSION The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care.
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Affiliation(s)
- Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). University of Alcalá, Spain
| | - Inés Laso García
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). University of Alcalá, Spain
| | - Marina Mata Alcaraz
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). University of Alcalá, Spain
| | - David López Curtis
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). University of Alcalá, Spain
| | - Silvia Arribas Terradillos
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). University of Alcalá, Spain
| | - Manuel Hevia Palacios
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). University of Alcalá, Spain
| | - Gemma Duque Ruiz
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). University of Alcalá, Spain
| | - Fernando Arias Funez
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). University of Alcalá, Spain
| | - Francisco Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). University of Alcalá, Spain
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Culpan M, Acar HC, Akalin K, Cakici MC, Tufekci B, Gunduz N, Dogan MB, Yildirim A, Atis G. ¿Son suficientes los nomogramas actuales para predecir los resultados de la litotricia por ondas de choque? Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wagenius M, Oddason K, Utter M, Popiolek M, Forsvall A, Lundström KJ, Linder A. Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study. Scand J Urol 2022; 56:237-243. [DOI: 10.1080/21681805.2022.2055137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Magnus Wagenius
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Karl Oddason
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Maria Utter
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Marcin Popiolek
- Department or Urology, Örebro University Hospital, Örebro, Sweden
| | - Andreas Forsvall
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Karl-Johan Lundström
- Institution of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Adam Linder
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
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Milišić E, Alić J, Zvizdić Z, Lepara O, Jonuzi A, Milišić L, Fajkić A. Urinary neutrophil gelatinase-associated lipocalin level as a biomarker of acute kidney injury following extracorporeal shock wave lithotripsy. Cent European J Urol 2022; 74:579-587. [PMID: 35083080 PMCID: PMC8771142 DOI: 10.5173/ceju.2021.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/27/2021] [Accepted: 10/10/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Although extracorporeal shock wave lithotripsy (ESWL) is minimally invasive and highly efficient for the management of kidney stones, adverse effects have been described. Available indicators of renal function exhibit insufficient sensitivity in acute renal injury (AKI). We aimed to evaluate the severity of the kidney tissue response to ESWL injury by measuring the urinary neutrophil gelatinase-associated lipocalin (uNGAL), which can indicate AKI in its early phase. Material and methods The prospective, controlled study included 62 patients with nephrolithiasis undergoing single ESWL treatment. uNGAL level was measured before the procedure, and 6 h and 12 h after. Results The median uNGAL level increased by 126.0%, 6 h after ESWL (p <0.001). The growth rate continued and 12 h after was higher by 583.7%, compared to the pre-treatment level (p <0.001). The median value of estimated glomerular filtration rate (eGFR) dropped by 15.3% 12 h after the treatment (p <0.001). It increased by 5.0% in the period 7 days to 3 months after (p <0.001) and after 3 months it was lower by 10.1% compared to pre-ESWL values (p <0.001). uNGAL level after 12 h was significantly negatively associated with eGFR, 12 h, 7 days and 3 months after the ESWL. The sensitivity of uNGAL 12 h after ESWL was 60.6%; its specificity was 75.0%, with a positive predictive value of 74.0% and negative predictive value of 61.7%. Conclusions uNGAL appears to be a useful biomarker for the assessment and prediction of AKI. It was noticed that uNGAL had the highest predictive value 12 h after the ESWL treatment.
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Affiliation(s)
- Emir Milišić
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Jasmin Alić
- Clinic of Urology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Zlatan Zvizdić
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Orhan Lepara
- Department of Human Physiology, University of Sarajevo School of Medicine, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Lejla Milišić
- Clinic of Radiology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Almir Fajkić
- Department of Pathophysiology, University of Sarajevo School of Medicine, Sarajevo, Bosnia and Herzegovina
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Sarica K, Ferhat M, Ohara R, Parmar S. Importance of precise imaging for stone identification during shockwave lithotripsy: a critical evaluation of "OptiVision" as a post-processing radiography imaging modality. Urolithiasis 2021; 50:87-93. [PMID: 34528109 DOI: 10.1007/s00240-021-01284-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/29/2021] [Indexed: 11/26/2022]
Abstract
To evaluate the efficacy of a unique imaging software "OptiVision" on the confidence of stone identification using X-ray imaging during shockwave lithotripsy. A total of 57 patients with solitary radio-opaque kidney stones sized < 15 mm were included and evaluated with appropriate radiological imaging and laboratory studies before undergoing shockwave lithotripsy (SWL). The size of the stones was measured on KUB and CT images using maximal stone diameters. All patients were evaluated with radiography on the Dornier Delta III immediately before SWL and at the end of the SWL session with fluoroscopy, a snapshot image, and the OptiVision modality (applied over the acquired snapshot image without additional radiation exposure) for precise identification of the stone. All images obtained with these three different imaging modalities (fluoroscopy, snapshot, and OptiVision) were comparatively evaluated for confidence levels in stone identification using a five-point Likert scale (1 = poor diagnostic confidence, 5 = excellent diagnostic confidence). These confidence levels were also used to differentiate between stones and bony structures using these same imaging modalities. Results were evaluated for statistical significance regarding their impact on the precise identification of renal stones. A total of 57 patients with solitary stones were evaluated using flouroscopy, snapshot, and OptiVision images before and after SWL to ascertain the efficacy of these 3 imaging modalities on the precise identification of the calculi. Stone sizes ranged from 4 to 15 mm, with a mean of 8.30 mm in the longest dimension. Evaluation of the findings demonstrated that while the pre- and post-SWL confidence of fluoroscopic stone identification was from 29.51 to 31.15%, the values using snapshot ranged from 31.15 to 39.34%. Pre- and post-SWL confidence of stone identification with OptiVision post-processing imaging was approximately 89%. In the majority of cases (n = 43), the use of OptiVision image processing enabled urologists to identify the stone with a higher level of confidence rating than the use of both fluoroscopy (n = 0) and snapshot (n = 0) image processing tools. While a rating level of 4 or higher was given in 89% of images obtained by OptiVision during the pre- and post-SWL phase, this value was only 37% (4 or more points) using fluoroscopy and Snapshot image processing techniques. For all the radiography image processing tools, the distribution of the Likert score differed significantly among the OptiVision, fluoroscopy, and snapshot imaging modalities (p < 0.001). Precise and reliable identification of stone(s) located in the kidney is essential in delivering shock waves to the desired focal point and achieving higher stone-free rates. Our findings demonstrated that using the specially designed imaging modality OptiVision was significantly helpful in identifying and localizing stones with high-quality images before SWL for effective stone disintegration during this procedure.
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Affiliation(s)
- Kemal Sarica
- Department of Urology, Biruni University, Medical School, Bahcelievler Medicana Hospital, Istanbul, Turkey
| | - Mehmet Ferhat
- Urology Clinic, Medicana Bahcelievler Hospital, Istanbul, Turkey.
| | - Rei Ohara
- Department of Urology, Musashino Yohwakai Hospital, Tokyo, Japan
| | - Sameer Parmar
- Global Clinical Application Manager, Dornier MedTech, Wessling, Germany
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