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Watanabe T, Komeya M, Odaka H, Kiuchi H, Saigusa Y, Makiyama K, Matsuzaki J. Ureteral stone volume and female gender predicts perioperative complications after complete ipsilateral upper urinary tract stone removal using flexible ureterorenoscopy. Int Urol Nephrol 2024; 56:1611-1616. [PMID: 38123734 DOI: 10.1007/s11255-023-03899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To identify the risk factors for perioperative complications to prevent perioperative complications after complete ipsilateral upper urinary stone removal using flexible ureterorenoscopy. MATERIALS AND METHODS We retrospectively examined 111 patients who underwent flexible ureterorenoscopy for ipsilateral renal stones with a diameter ≥ 5 mm at the same time as ureterorenoscopy for ureteric stones. The flexible ureterorenoscopy procedures were performed following the fragmentation technique. Patients who experienced (complication group) and did not experience (non-complication group) perioperative complications were compared. The complication group included 33 patients with Clavien-Dindo classification scores of I, II, III, or IV and/or those with a body temperature of > 37.5 ℃ during hospitalization. RESULTS The overall stone volume, stone-free rate and procedure duration were 1.71 mL, 96.4% and 77 min, respectively. The rate of perioperative complications was 29.7% (grade 1, 2 and 3 was 23.4%, 5.4% and 0.9%, respectively). Severe complications (Clavien-Dindo grade 4) were not observed. Multivariable analysis revealed that ureteral stone volume and female patients were independent predictors of perioperative complications after flexible ureterorenoscopy (p = 0.015 and 0.017, respectively). CONCLUSIONS This study showed that ureteral stone volume and female gender have the possibility to increase perioperative complications. These preliminary data help to select for patients who are at low risk of complications. Therefore, in these selected patients, complete ipsilateral upper urinary tract stone removal using flexible ureterorenoscopy may reduce the recurrence of urolithiasis without increasing perioperative complications.
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Affiliation(s)
- Takahiko Watanabe
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Mitsuru Komeya
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan.
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Hisakazu Odaka
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Hirokazu Kiuchi
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
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Da Silva Ferreira D, Bhattu AS, Adam A. Miniaturizing the approach to upper tract renal calculi: Is smaller always better? A narrative review. Curr Urol 2023; 17:280-285. [PMID: 37994342 PMCID: PMC10662827 DOI: 10.1097/cu9.0000000000000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/14/2023] [Indexed: 11/24/2023] Open
Abstract
Newer modalities for treating upper tract urinary stones focus on maintaining and improving outcomes, reducing complications, and optimizing patient care. This narrative review aims to outline novel miniaturized endourological innovations for managing upper tract calculi.
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Affiliation(s)
| | - Amit Satish Bhattu
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ahmed Adam
- Division of Urology, University of the Witwatersrand, Johannesburg, South Africa
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Carmen Tong CM, Ellison JS, Tasian GE. Pediatric Stone Disease: Current Trends and Future Directions. Urol Clin North Am 2023; 50:465-475. [PMID: 37385708 DOI: 10.1016/j.ucl.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Pediatric nephrolithiasis is less common in children than in adults but the incidence has been rising rapidly, and it is now a public health and economic burden in the United States. There are challenges unique to children that should be taken into consideration when evaluating and managing pediatric stone disease. In this review, we present the current research on risk factors, emerging new technologies for treatment of stones and recent investigations on prevention of stones in this population.
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Affiliation(s)
- Ching Man Carmen Tong
- Department of Pediatric Urology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 318, Birmingham, AL 35233, USA.
| | - Jonathan S Ellison
- Department of Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin and Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Fujii M, Shime N, Kawabata Y. Use of a laryngeal tube for sialolithotomy in a pediatric patient with left vocal cord paralysis: a case report. JA Clin Rep 2023; 9:36. [PMID: 37329485 DOI: 10.1186/s40981-023-00629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND The laryngeal tube (LT), a closed esophageal supraglottic device comprising pharyngeal and esophageal cuffs, is used for emergency airway management. However, it is not often used in intraoperative airway management. CASE PRESENTATION A 9-year-old boy was scheduled for a sialolithotomy for sialolithiasis. He had a history of surgery for tetralogy of Fallot and had undergone vocal cord fusion for postoperative left-sided vocal cord paralysis. Following a strong request by the mother to avoid tracheal intubation to reduce the risk of bilateral vocal cord paralysis, management without intubation was initially considered in the preoperative anesthesia plan. Airway management was planned using an LT in case of ventilation failure due to positional abnormalities. Although some leakage was observed during intraoral surgery, it was quickly resolved by adjusting the position of the LT outside the sterile surgical field. CONCLUSIONS The LT may be a viable option in cases where tracheal intubation is not preferred.
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Affiliation(s)
- Masashi Fujii
- Department of Anaesthesia, Nagahama Red Cross Hospital, 14-7 Miyamae, Nagahama, Shiga, 526-8585, Japan.
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasuyo Kawabata
- Department of Anaesthesia, Nagahama Red Cross Hospital, 14-7 Miyamae, Nagahama, Shiga, 526-8585, Japan
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Zhao Y, Zheng D, Zhang L, Xie X, Liu D, Yu G. Recovery of gland function after endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton's duct. Int J Oral Maxillofac Surg 2023; 52:553-559. [PMID: 36210232 DOI: 10.1016/j.ijom.2022.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 04/09/2023]
Abstract
The aim of this study was to evaluate the gland function of patients following endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton's duct. The study cohort comprised 115 patients who had undergone successful endoscopy-assisted lithotomy for hilo-parenchymal stones (mean diameter 7.7 mm). Gland function was evaluated at a mean 12 months after surgery using ultrasonography, sialography, and/or sialometry. Postoperative ultrasonography of 51 affected glands revealed a regular gland size in 58.8%, normal parenchyma density in 51.0%, and ductal ectasia in 80.4%. Postoperative sialograms of 109 affected glands were scored as type I (approximately normal) in 13 cases, type II (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and no contrast retention) in 64, type III (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and mild contrast retention) in 23, and type IV (poor shape of the main duct with evident contrast retention) in nine cases. The existence of ductal ectasia corresponded well to larger stone cases (P = 0.002). In the postoperative sialometry of 35 patients with unilateral stones, differences between the two sides were insignificant (P > 0.05). For patients with hilo-parenchymal submandibular gland stones, endoscopy-assisted surgery and extended postoperative follow-up help preserve the gland with good function.
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Affiliation(s)
- Y Zhao
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, PR China; Department of Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, Shandong, PR China
| | - D Zheng
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - L Zhang
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - X Xie
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - D Liu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, PR China.
| | - G Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
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Zhan CS, Zhang C, Wang JZ, Fan S, Zhao L, Shu HM, Hao ZY. Stone attenuation on computer tomography helps surgeons make decisions between miniaturized percutaneous nephrolithotomy or retrograde intrarenal surgery for lower pole stones: a retrospective study. Urolithiasis 2023; 51:77. [PMID: 37093335 DOI: 10.1007/s00240-023-01442-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/30/2023] [Indexed: 04/25/2023]
Abstract
A retrospective study was performed on 200 patients who underwent miniaturized percutaneous nephrolithotomy (mini-PCNL) or retrograde intrarenal surgery (RIRS) for 10-20 mm sized lower pole renal calculi to investigate the relationship between computed tomography (CT) attenuation of calculi and surgical outcomes. CT was used to examine the location, size, and CT attenuation values of the calculi. Additionally, the operation time, hospital stay, hemoglobin (Hb) reduction, stone-free rate (SFR), and complication rate were also meticulously documented and subjected to comparative analysis. Complications were assessed using the Clavien-Dindo grading system. We observed no significant differences in hospitalization data and follow-up outcomes, except for a longer hospital stay and higher Hb drops in patients receiving mini-PCNL. Statistical analysis revealed an association between CT attenuation and operation time. Compared with mini-PCNL, RIRS could reduce bleeding, hospital stay, surgery time, and complications for 10-20 mm sized lower pole kidney stones with CT values < 1000 HU. RIRS resulted in longer operation time and lower stone-free rates despite shorter hospital stays and less bleeding than mini-PCNL for stones with CT values > 1000 HU. Therefore, selecting an appropriate surgical method based on CT attenuation might improve outcomes. For patients with stone attenuation values < 1000 HU, RIRS is the recommended option. When stone attenuation values > 1000 HU, the surgical method should be chosen based on the patient's individual situation.
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Affiliation(s)
- Chang-Sheng Zhan
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Jian-Zhong Wang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Song Fan
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Lei Zhao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Hong-Min Shu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zong-Yao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Institute of Urology, Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.
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Benabdallah W, Othmane MB, Bouassida K, Hmida W, Jaidane M. Crossed-fused renal ectopia with renal calculi and its management, a case report. Int J Surg Case Rep 2023; 106:108218. [PMID: 37084557 PMCID: PMC10154733 DOI: 10.1016/j.ijscr.2023.108218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Crossed fused renal ectopia is a rare congenital anomaly characterized by both kidneys being fused together on one side of the spine. Herein, we present an atypical subtype of this disease. To our best knowledge, in the current literature, there is few cases reported with superior crossed fused renal ectopia of the right kidney. CASE PRESENTATION A 40-year-old man with diabetes type 1 presented to our hospital with diabetic ketoacidosis and abdominal pain initially taken care of in an endocrinology department then transferred to our urology department after discovery on the CT scan of a staghorn calculus in the solitary right kidney is later discovered during the therapeutic management that it is a superior CFRE. CLINICAL DISCUSSION Unilateral fused renal superior ectopia is extremely rare and the management of urinary calculi in this disease is technically challenging for urologists. The choice of treatment for urinary calculi in cases of crossed renal ectopia should be made depending on the size and position of the urinary calculi and the patient's anatomy. CONCLUSION Before proceeding to surgery, a preoperative assessment with contrast computed tomography is necessary to explore a solitary kidney with calculi so as not to miss the diagnosis of crossed fused renal ectopia because the management of renal stone in this rare malformation is complicated.
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Affiliation(s)
| | | | | | - Wissem Hmida
- Urology Department, Sahloul Hospital, Sousse, Tunisia
| | - Mehdi Jaidane
- Urology Department, Sahloul Hospital, Sousse, Tunisia.
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Woźniak MM, Mitek-Palusińska J. Imaging urolithiasis: complications and interventions in children. Pediatr Radiol 2023; 53:706-713. [PMID: 36576514 PMCID: PMC10027801 DOI: 10.1007/s00247-022-05558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/26/2022] [Accepted: 11/30/2022] [Indexed: 12/29/2022]
Abstract
Urolithiasis affects people in all age groups, but over the last decades there has been an increasing incidence in children. Typical symptoms include abdominal or flank pain with haematuria; in acute cases dysuria, fever or vomiting also occur. Ultrasound is considered the modality of choice in paediatric urolithiasis because it can be used to identify most clinically relevant stones. Complementary imaging modalities such as conventional radiographs or non-contrast computed tomography should be limited to specific clinical situations. Management of kidney stones includes dietary, pharmacological and urological interventions, depending on stone size, location or type, and the child's condition. With a very high incidence of underlying metabolic abnormalities and significant recurrence rates in paediatric urolithiasis, thorough metabolic evaluation and follow-up examination studies are of utmost importance.
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Affiliation(s)
- Magdalena Maria Woźniak
- Department of Pediatric Radiology, Medical University of Lublin, Al. Racławickie 1, 20-059, Lublin, Poland.
| | - Joanna Mitek-Palusińska
- Department of Pediatric Radiology, Medical University of Lublin, Al. Racławickie 1, 20-059, Lublin, Poland
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Ramesmayer C, Lusuardi L, Griessner H, Gruber R, Oberhammer L. Robotic partial cystectomy with excision of mesh after inguinal hernia repair: a case report. BMC Urol 2023; 23:27. [PMID: 36855070 PMCID: PMC9976512 DOI: 10.1186/s12894-023-01197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Mesh erosion into the bladder after hernioplasty is sparsely reported in literature and may be underestimated in clinical practice. We report a case of a patient who was referred to our department due to recurrent urinary tract infections caused by a bladder stone due to mesh migration after inguinal hernia repair 22 years ago. CASE PRESENTATION A 67-year-old male patient was referred from the outpatient urologist for transurethral resection of the prostate in September 2021 due to recurrent urinary tract infections caused by benign prostatic enlargement and bladder stone formation. During the operation, parts of the stone were smashed and the prostate was resected. Additionally, a mesh eroding from the bladder roof was detected masqueraded by the stone. A computed tomography scan, which was performed afterwards, revealed a 20 × 25 mm mesh migration into the bladder after inguinal hernia repair on the left with concomitant stone adhesion to the mesh. After revealing patient history, an inguinal hernia repair with mesh implantation was done 22 years ago. A robotic assisted partial cystectomy and mesh excision was performed. The patient recovered well. CONCLUSION Mesh erosion into the urinary bladder after hernia repair can occur up to two decades after the primary operation. Although it is rarely reported, it can be a possible cause for recurrent urinary tract infections and therefore a mentionable complication after inguinal hernia operation. Robotic-assisted laparoscopic partial cystectomy with complete excision of the mesh is an option for definitive treatment.
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Affiliation(s)
- Christian Ramesmayer
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Lukas Lusuardi
- grid.21604.310000 0004 0523 5263Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Hubert Griessner
- grid.21604.310000 0004 0523 5263Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Ricarda Gruber
- Department of Urology and Andrology, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Lukas Oberhammer
- grid.21604.310000 0004 0523 5263Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
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Ito K, Okano N, Takuma K, Iwasaki S, Watanabe K, Kimura Y, Yamada Y, Yoshimoto K, Hara S, Kishimoto Y, Matsuda T, Igarashi Y. Are Newer Extracorporeal Shock Wave Lithotripsy Models Truly Improving Pancreatolithiasis Lithotripsy Performance? A Japanese Single-Center Study Using Endoscopic Adjunctive Treatment. Gut Liver 2022:gnl220204. [PMID: 36510774 PMCID: PMC10352058 DOI: 10.5009/gnl220204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/25/2022] [Accepted: 10/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. Methods We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. Results For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. Conclusions The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.
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Affiliation(s)
- Ken Ito
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Naoki Okano
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Kensuke Takuma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Susumu Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Koji Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Yusuke Kimura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Yuto Yamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Kensuke Yoshimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Seiichi Hara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Yui Kishimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
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Li H, Jelley CR, Forster L, Arad J, Mudhar GS, Bardgett HP, Stewart AB, Forster JA. Ultra-low-dose CTKUB: the new standard of follow-up of ureteric calculi not visible on plain radiograph? Int Urol Nephrol 2022. [PMID: 35129775 DOI: 10.1007/s11255-022-03134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE With sensitivities over 95%, non-contrast computer tomography of kidney, ureter and bladder (CTKUB) is the investigation of choice in renal colic to diagnose or exclude ureteric calculi. CTKUB delivers an average effective radiation dose of 5.4 millisievert (mSv) and is used to follow-up calculi not visible on plain X-ray, whereas plain radiography has a radiation exposure of 0.7 mSv and is used to follow-up radio-opaque calculi. We assessed the effectiveness of using ultra-low-dose CTKUB (ULDCTKUB) for the follow-up of ureteric calculi not visible on plain radiograph of the kidneys, ureter and bladder (KUB), as an emerging option to reduce radiation exposure compared to standard dose CTKUB. METHODS Between 2013 and 2016 we retrospectively analysed 86 patients who underwent ULDCTKUB for CTKUB-confirmed ureteric calculi that were not visible on plain radiography. Patients were identified from our Radiology Management System with additional information from electronic patient records. RESULTS 98% of ULDCTKUBs were of diagnostic quality; two patients required further cross-sectional imaging. 67% of patients had passed their calculi after the initial diagnostic CTKUB. In the remaining 33% who had persistent calculi on ULDCTKUB, 20% required surgical intervention and 13% required no intervention. The mean ULDCTKUB effective radiation dose was six times lower than conventional CTKUB (0.8 vs 5.4 mSv). 67% of patients had a radiation dose equivalent to X-ray KUB (< 1 mSv). CONCLUSION ULDCTKUB is a reliable and safe follow-up investigation of ureteric calculi and has absorbed radiation doses similar to plain radiography and lower than annual background radiation. We advocate ULDCTKUB as the primary imaging modality in the follow-up of ureteric calculi not visible on plain radiograph.
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Xu XJ, Zhang J, Li M, Hou JQ. Clinical study on the minimally invasive percutaneous nephrolithotomy treatment of upper urinary calculi. World J Clin Cases 2022; 10:1198-1205. [PMID: 35211553 PMCID: PMC8855199 DOI: 10.12998/wjcc.v10.i4.1198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/02/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Upper urinary tract stones are very common in my country, with an incidence of 1% to 5% in the North and an even higher incidence of 5% to 10% in the south. The incidence rate in the south is higher than that in the north, mainly due to the water quality, climate and eating habits of the region. From the perspective of sex, incidence is more likely in males than females. In the high-incidence population, young adults are most prone to stones. Men in the age range of 25 to 40 years are more likely to have stones.
AIM To observe the therapeutic effect of minimally invasive percutaneous nephrolithotomy (mPCNL) on upper urinary tract stones and its influence on the renal function of patients.
METHODS Patients with upper urinary tract stones who were treated in our hospital from February 2017 to March 2018 were selected as research subjects and were divided into the PCNL group and the mPCNL group according to the random number table method. The general conditions of the two groups of patients were observed during the perioperative period, and the differences in stone clearance, pain, renal function indicators and complication rates were compared between the two groups to determine which were statistically significant (P < 0.05).
RESULTS The operation time of the mPCNL group was longer than that of the PCNL group (t = -34.392, P < 0.001), and the intraoperative blood loss of the mPCNL group was more than that of the PCNL group (t = 34.090, P < 0.001). There was no difference in renal function indices between the two groups of patients before treatment, and there was no difference in the levels of serum creatinine, β2 microglobulin or retinol binding protein in the mPCNL group after treatment. The visual analog scale score of patients in the mPCNL group was lower than that of the PCNL group (t = 12.191, P < 0.001), and there was no significant difference in the stone clearance rate between the two groups (χ2 value = 1.013, P = 0.314). There was no significant difference in the incidence of urine extravasation, dyspnea and peripheral organ damage between the two groups (χ2 value = 1.053, P = 0.305). At 1 mo after treatment and 3 mo after treatment, the quality of life of the mPCNL group was lower than that of the PCNL group, and the Qmax level of the mPCNL group was higher than that of the PCNL group.
CONCLUSION mPCNL has a good therapeutic effect on upper urinary tract stones, with a high stone clearance rate without causing kidney damage or increasing the incidence of complications, and thus has good application value.
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Affiliation(s)
- Xiao-Jian Xu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jun Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Miao Li
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jian-Quan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Oh CK, Kim JY. Primary squamous cell carcinoma of the kidney parenchyma with ascending colon invasion: A case report and literature review. Int J Surg Case Rep 2022; 91:106762. [PMID: 35033898 PMCID: PMC8762047 DOI: 10.1016/j.ijscr.2022.106762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Primary squamous cell carcinoma (SCC) of the kidney parenchyma is extremely rare, with only seven cases reported to date. Herein, we present a case of primary with colon invasion. PRESENTATION OF CASE A 61-year-old man presented right flank pain for 5 months. Computed tomography (CT) showed multiple renal stones and a necrotic mass in the lower pole of the right kidney, which was suspicious for ascending colon invasion. There was no history of radiation or occupational exposure to chemicals. Radical nephrectomy, right hemicolectomy, and lymph node dissection were performed. The kidneys showed a solid mass with multiple renal stones. The tumor comprised nests of atypical squamous cells and keratin pearls; however, the renal pelvis was normal. 18-Fluorodeoxyglucose-positron emission tomography/CT failed to demonstrate other primary site. Therefore, the patient was diagnosed as primary SCC of the kidney. The patient did not receive adjuvant therapy and was alive during follow-up for 6 months after surgery. DISCUSSION SCC of the urinary tract is considered to be the result of squamous metaplasia of the urothelium, which may potentially progress to SCC. Squamous metaplasia may be caused by chronic irritation. However, the mechanism of SCC remains unclear. Although the prognosis of SCC is similar to that of urothelial carcinoma when compared stage for stage, SCC tends to be diagnosed at a more advanced stage. CONCLUSION This is a rare case of kidney SCC with adjacent organ invasion. Additional studies are required to further our understanding of this rare tumor and improve diagnosis and treatment.
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Affiliation(s)
- Cheol Kyu Oh
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Joo Yeon Kim
- Department of Pathology, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea.
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Pais JS, Rocha MB, Muglia VF, Chahud F, Molina CAF, Ruellas HR, Tucci SJ. Xanthogranulomatous pyelonephritis: Case series - Clinical, radiologic, therapeutic, and histological aspects. Urol Ann 2022; 14:383-388. [PMID: 36505992 PMCID: PMC9731190 DOI: 10.4103/ua.ua_180_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/31/2022] [Accepted: 05/10/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Xanthogranulomatous pyelonephritis (XGP) is a chronic and severe infection of the kidney. We aimed to review the main clinical, imaging, and histological findings and to assess predictors of surgical complications or hospitalization >10 days (no deaths reported). Materials and Methods We retrospectively searched all patients with XGP treated at our institution from 2005 to 2019, with 57 patients enrolled. Clinical data were retrieved by a single reader, computed tomographic (CT) examinations by two radiologists, and histopathological specimens by an experienced pathologist. Results The patients' mean age was 44.3 ± 16.2 years and 41 (71.9%) were female. The most common symptoms were flank/lumbar pain (89.5%), fever (43.9%), and recurrent urinary tract infection (43.9%). The mean time until the presumptive diagnosis was 365.1 days and the median hospitalization period was 11 days. Blood tests showed anemia (78.9%), leukocytosis (43.6%) with left shift (21.6%). Urinalysis showed hematuria (75.6%), bacteriuria (40.9%), and leukocytes (93.2%). Urine cultures showed Escherichia coli in 14.8%, Proteus mirabilis in 7.4%, while 59.3% were negative. Of 40 patients with CT examinations, 38 (95%) presented with hydronephrosis and perinephric inflammatory changes (PIC) and 22 (55%) with Bear Paw sign. PIC was the only independent predictor at multivariate analysis for surgical complications. For prolonged hospitalization, fever and PIC were independent predictors at univariate, but only fever at multivariate analysis. Conclusions XGP is a worrisome condition, with unclear pathophysiological mechanisms. Fever and PIC at CT examinations were predictors of poor outcomes.
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Affiliation(s)
- João Sakuray Pais
- Department of Surgery and Anatomy, Division of Urology, Ribeirão Preto Medical School, University of São Paulo, Brazil,Address for correspondence: Dr. João Sakuray Pais, Rui Barbosa Street, 882-Apartment 41, Ribeirão Preto, São Paulo, Brazil. E-mail:
| | - Mirelle Barbosa Rocha
- Department of Medical Images, Hematology and Clinical Oncology, Division of Radiology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Valdair Francisco Muglia
- Department of Medical Images, Hematology and Clinical Oncology, Division of Radiology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology and Legal Medicine, Division of Pathology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Heitor Ramos Ruellas
- Department of Medical Images, Hematology and Clinical Oncology, Division of Radiology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Silvio Junior Tucci
- Department of Surgery and Anatomy, Division of Urology, Ribeirão Preto Medical School, University of São Paulo, Brazil
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15
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Omar M, Dorrah M, Khalifa A, El Sherif E, Sayedahmed K, Ghazwani Y, Noureldin YA. Randomized comparison of 4.5/6 Fr versus 6/7.5 Fr ureteroscopes for laser lithotripsy of lower/middle ureteral calculi: towards optimization of efficacy and safety of semirigid ureteroscopy. World J Urol 2022; 40:3075-81. [PMID: 36208314 DOI: 10.1007/s00345-022-04173-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND PURPOSE To compare 4.5/6 Fr versus 6/7.5 Fr semirigid ureteroscopes in terms of safety and efficacy in adult non-obese patients with middle or lower ureteric stones. MATERIALS AND METHODS A total of 198 patients with middle/lower ureteric stone and a BMI ≤ 30 kg/m2 were recruited. Patients were randomized according to the size of ureteroscope into two groups: group 1 where a 4.5/6 Fr semi-rigid ureteroscope was used, and group 2 where a 6/7.5 Fr semi-rigid ureteroscope was used. Patient's demographic, stone characteristics, intraoperative and postoperative outcomes including stone-free rate (SFR) and complications were compared. RESULTS Preoperative characteristics in terms of age, sex, BMI, and stone location, side, size, and HU were comparable between both groups (p values > 0.05). The overall SFR was significantly higher in group 1 (0.004). Balloon dilatation was not required in all patients of group-1 compared with 33% of group-2 (p = 0.0001). The JJ stent was required in 10% of group-1 compared with 30% of group-2 (p = 0.0004). Failure to reach the stone due to tight ureter occurred in 8% of group 2 (p = 0.003), respectively. Traxer's grade 1 ureteral injury occurred in 2% of group-1 versus 14% of group-2 (p = 0.001). Consequently, hematuria was significantly lower in group-1 (1% vs. 8%; p = 0.01), respectively. The hospital stay < 9 h was significantly higher in group 1 (p = 0.0001). CONCLUSIONS The 4.5/6 Fr semi-rigid Ureteroscope was associated with significantly higher SFR and shorter hospital stay, with lower ureteral injury, fewer double-J stenting, and without the need for intraoperative balloon dilatation for the ureter.
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16
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Familiari M, Ferrario F, Giordano L, Santo DD, Indelicato P, Battista RA, Bussi M. Management of obstructive pathology of the salivary glands in elderly patients: a preliminary study. J Laryngol Otol 2021;:1-4. [PMID: 34839847 DOI: 10.1017/S0022215121003881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Obstructive pathology is a benign condition of the salivary glands that can affect elderly and co-morbid people. Sialoendoscopy is a minimally invasive surgical procedure with a success rate comparable to standard sialoadenectomy and has the advantage that it can be performed under local anaesthesia. METHODS This study aimed to assess sialoendoscopy benefits in elderly patients unfit for general anaesthesia. A group of elderly patients (aged 65 years or more) undergoing sialoendoscopy under local anaesthesia were evaluated. Age, co-morbidities, surgical time, hospital stay, and complication and recurrence rates were assessed. RESULTS Nineteen sialoendoscopies were performed in 18 elderly patients with a mean age of 69.7 ± 5.6 years, with some of them suffering from multiple co-morbidities. Surgery was successful in 16 patients, while surgery was unsuccessful in 2 patients because of intraglandular stones. The average surgical duration was 54.5 ± 30.1 minutes, and all patients were discharged 2-3 hours after surgery. No post-operative complications were found and only one patient had recurrence during follow up. CONCLUSION Sialoendoscopy under local anaesthesia is a safe and effective procedure in elderly patients who are more prone to complications.
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17
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Griggs-Demmin A, Patel S, Faisal F, Saoud C, Salimian K, Cohen A. Acquired male urethral diverticulum complicated by calculi: A case report. Urol Case Rep 2021; 39:101837. [PMID: 34603966 DOI: 10.1016/j.eucr.2021.101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 12/05/2022] Open
Abstract
We present the case of a 38-year-old male with a past presumed history of traumatic genitourinary injury. Twenty-one years later, he presented with dysuria, urinary frequency, and urinary urgency and was found to have membranous stricture as well as a urethral diverticulum filled with calculi. For this rare case, we elected surgical management via urethroplasty and a urethral diverticulectomy. We present his clinical course and brief review of the diagnosis and management of male urethral diverticula.
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18
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Alshoabi SA, Alhamodi DS, Alhammadi MA, Alshamrani AF. Etiology of Hydronephrosis in adults and children: Ultrasonographic Assessment in 233 patients. Pak J Med Sci 2021; 37:1326-1330. [PMID: 34475906 PMCID: PMC8377938 DOI: 10.12669/pjms.37.5.3951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: Hydronephrosis (HN) is dilatation of the collecting system of the kidney due to obstruction of urine outflow. This study intended firstly, to investigate the efficacy of ultrasound (US) imaging to determine the cause of HN, and secondly, to list the causes of HN. Methods: In this retrospective study, 233 patients with HN were scanned to determine the cause of the HN in the period from 1st January 2016 to 31st October 2017. Categorical results were written as frequencies and percentages. Results: Out of 233, 91.41% were adults and 8.58% were children (P<0.001), 66.10% were male and 33.90% were female (P<0.001). In 55.36%, HN was in the right kidney and 44.64% was in the left (P=0.116). Exactly 58% of patients were suffering from grade-2, 21.5% grade-3, 11.6% grade-1, and 8.2% grade-4 HN. US imaging can determine the cause of HN in 70.4% of patients. Kidney or ureteric calculi were the cause of HN in 54.1% of cases, reflux was in 7.3%, and pelviureteric junction (PUJ) stenosis was in 3.9%. In cases of calculi induced HN, 25.3% of the calculi were in the vesicoureteric (VUJ) junction, 21.5% were in the renal pelvis, 6.4% were in the PUJ or upper ureter, and only 0.9% were in the middle ureter. Conclusion: Ultrasound imaging can determine the cause of HN in more than two thirds of patients. Calculi are the most common cause of HN even in children and are most common in the VUJ junction.
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Affiliation(s)
- Sultan Abdulwadoud Alshoabi
- Sultan Abdulwadoud Alshoabi, Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia
| | - Dahhan Saleh Alhamodi
- Dahhan Saleh Alhamodi, Unit of Ultrasound Imaging, Department of Radiology, Amran Hospital, Amran, Republic of Yemen
| | - Mohammed Ali Alhammadi
- Mohammed Ali Alhammadi, Department of Radiology and Medical Imaging, Prince Mohamad bin Abdulaziz Hospital, National Guard, Almadinah Almunawarah, Kingdom of Saudi Arabia
| | - Abdullah Fahad Alshamrani
- Abdullah Fahad Alshamrani, Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawarah, Kingdom of Saudi Arabia
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Symeonidis EN, Toutziaris C, Katsimantas A, Dimitriadis G. Incidental Detection of Preputial Calculus in a Patient with Partial Phimosis: Is it as Rare as We Believed? Acta Med Litu 2021; 28:195-198. [PMID: 34393645 PMCID: PMC8311848 DOI: 10.15388/amed.2021.28.1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/22/2022] Open
Abstract
Summary. Background: Preputial stone disease is the rarest type of urolithiasis. Adult males with severe phimosis and poor hygiene are mainly affected. Case Presentation: A 90-year-old male sought treatment for steadily worsening urinary frequency, intermittency, incontinence, and pain at the tip of his penis of 3-days duration. Clinical examination revealed a palpable distended urinary bladder, a partial phimosis and a round, hard on palpation, and partly ulcerative lesion at the tip of the foreskin. A single, 1 cm in maximum diameter stone, was incidentally discovered beneath the prepuce and subsequently removed from the preputial sac. The patient refused further treatment with circumcision, and opted for conservative therapy of benign prostate hyperplasia. Conclusion: Personal hygiene remains the cornerstone in the prevention of the preputial calculi formation, while circumcision represents the mainstay of treatment for definite stone removal and elimination of the precipitating causes.
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Affiliation(s)
- Evangelos N Symeonidis
- 1 Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | - Chrysovalantis Toutziaris
- 1 Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | | | - Georgios Dimitriadis
- 1 Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G. Gennimatas" General Hospital, Thessaloniki, Greece
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20
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Alam R, Matlaga BR, Alam A, Winoker JS. Contemporary considerations in the management and treatment of lower pole stones. Int Braz J Urol 2021; 47:957-968. [PMID: 33861542 PMCID: PMC8321457 DOI: 10.1590/s1677-5538.ibju.2021.0010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 12/23/2022] Open
Abstract
The presence of lower pole stones poses a unique challenge due to the anatomical considerations involved in their management and treatment. Considerable research has been performed to determine the optimal strategy when faced with this highly relevant clinical scenario. Standard options for management include observation, shock wave lithotripsy, retrograde intrarenal surgery, or percutaneous nephrolithotomy. Indeed, each approach confers a distinct set of risks and benefits, which must be placed into the context of patient preference and expected outcomes. The current state of practice reflects a combination of lessons learned from managing calculi not only in the lower pole, but also from other locations within the kidney as well.
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Affiliation(s)
- Ridwan Alam
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Brian R Matlaga
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ayman Alam
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jared S Winoker
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
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21
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Martínez B, Peña-Espinoza B, Valdez-Ortiz R, Escalante-Sosa R, Flores-Tapia JP, Menjivar M. High prevalence of hypocitraturia in stone formers from the Maya region of Yucatan, Mexico. Arch Med Res 2021:S0188-4409(21)00121-1. [PMID: 34243991 DOI: 10.1016/j.arcmed.2021.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/26/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Urinary Stone Disease (USD) arises from an interaction of genetic and environmental factors. Urinary metabolic abnormalities are well described as risk factors. In Mexico, the Maya region holds the highest prevalence of USD. Treatment of these abnormalities lowers the risk of recurrences. AIM Assess the underlying metabolic abnormalities of patients with USD to provide a rationale to lead further prevention strategies. METHODS Clinical and demographical data from patients coming to the Stone Clinic were prospectively collected along with a 24 h urinary panel to identify metabolic abnormalities. All participants signed consent and the study was approved by the hospital's institutional review board. RESULTS A total of 126 patients were included, with a mean age of 47.2 ± 13 years, 75.4% were female. A positive family history of stones was observed in 40 and 87.3% were overweight/obese. The frequency of hypocitraturia, hypercalciuria, hypomagnesuria, hyperoxaluria, and hyperuricosuria was 91.3, 68.5, 42.1, 36.5, and 26.6%, respectively. Median urinary citrate was 79.5 (37.5-160) mg/24 h and was inversely correlated to glycemia. Urine Calcium/Creatinine index was correlated with Hounsfield units (HU) (p = 0.01). Oxalate was correlated with HU and stone burden. Interestingly, dietary distribution of macro- and micronutrients were similar between groups. Patients with a single kidney had lower citrate and higher urinary calcium. CONCLUSIONS Interestingly, a shortage of inhibitors such as citrate and magnesium are highly prevalent in patients with USD from the Maya region and seems to be influenced by other metabolic conditions as malnutrition next to the genetic component.
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Yılmaz N, Yüksel S, Altıntaş F, Koçyiğit A. Nephrolithiasis during the first 6 months of life in exclusively breastfed infants. Pediatr Nephrol 2021; 36:1227-1231. [PMID: 33150500 DOI: 10.1007/s00467-020-04815-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We investigated etiology and prognosis of infantile nephrolithiasis, including whether lithogenic and anti-lithogenic content of breast milk affects its formation. METHODS Thirty infants with nephrolithiasis and 30 healthy infants exclusively breastfed for the first 6 months of life were included in this prospective cohort case-control study. At entry, age, sex, and timing of birth of patients and controls were recorded. All patients were diagnosed and followed up periodically using ultrasonography. All infants received oral vitamin D (400 units/day). Lithogenic (calcium, oxalate, uric acid, phosphate) and anti-lithogenic (citrate, magnesium) components of maternal milk, serum calcium, phosphate, magnesium, 25-hydroxy vitamin D and parathormone, as well as spot urine calcium, uric acid, cystine, oxalate, magnesium, citrate/creatinine ratio, and calcium/citrate ratio were compared. RESULTS Mean follow-up period was 56.1 ± 6.8 months. There was no difference concerning lithogenic and anti-lithogenic content of breast milk. Serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D levels (49.1 ± 19 vs. 26.7 ± 4 ng/ml, p < 0.001) were significantly higher and parathormone level significantly lower in patients. Random urine calcium/creatinine and calcium/citrate ratios were significantly higher in patient group (0.63 ± 0.40 vs. 0.42 ± 0.10 and 0.62 ± 0.12 vs. 0.41 ± 0.25 mg/mg, respectively, p < 0.01). Three patients were lost to follow-up after the first year. At last follow-up, calculi disappeared in 25/27 remaining patients without interventions or therapy. CONCLUSIONS Breast milk does not have an etiologic effect in infantile nephrolithiasis. Higher serum vitamin D levels may have roles in development of lower levels of PTH and higher levels of serum and urine calcium, leading to stone formation. The prognosis for infantile stones is excellent. Graphical abstract.
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Affiliation(s)
- Neslihan Yılmaz
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Mavi Bina 1 Kat, Kinikli, 20070, Denizli, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Mavi Bina 1 Kat, Kinikli, 20070, Denizli, Turkey.
| | - Fatih Altıntaş
- Department of Physiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ali Koçyiğit
- Department of Radiology, Istinye University, Liv Hospital, Istanbul, Turkey
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23
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He Y, Feng YG, He J, Liang B, Jiang MD, Liu J, Kang YM, Ma LP, Zhang Q, Peng QJ, Yang T, Liu Y, Luo L, Zhang M. Effects of irrigation fluid temperature during flexible ureteroscopic holmium laser lithotripsy on postoperative fever and shivering: a randomized controlled trial. BMC Urol 2021; 21:72. [PMID: 33906652 PMCID: PMC8077842 DOI: 10.1186/s12894-021-00841-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/20/2021] [Indexed: 02/08/2023] Open
Abstract
Background Flexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postoperative complications include shivering, fever and infection. To investigate the effects of irrigation fluid temperature on postoperative complications. Methods This randomized controlled trial included 120 consecutive patients undergoing flexible ureteroscopic holmium laser lithotripsy at the Urology Department, Suining Central Hospital, Sichuan, China between January 2017 and July 2019. Patients were randomized 1:1:1 into three groups (17 °C, 27 °C or 37 °C). Primary outcome was fever incidence (body temperature > 37.5 °C) within 48 h after surgery. Secondary outcomes included shivering incidence during recovery from anesthesia, white blood cell count (WBC), serum procalcitonin (PCT) and incidence of suspected infection (temperature > 38.5 °C and PCT > 0.5 µg/L). Results There were 108 patients, (17 °C group, n = 36; 27 °C group, n = 35; 37 °C group, n = 37), received flexible ureteroscopic holmium laser lithotripsy and analyzed. Age, gender distribution, body mass index, ASA grade, stone burden, preoperative creatinine, preoperative core temperature and irrigation fluid volume did not differ significantly between groups. 17 °C, 27 °C and 37 °C groups exhibited significant differences in the incidences of postoperative fever (38.9% vs. 17.1% vs. 13.5%) and shivering (22.2% vs. 5.7% vs. 2.7%) (p < 0.05 for all pairwise comparisons). There was no significant difference of WBC, PCT and incidence of suspected infection in 37 °C or 27 °C group compared with 17 °C group. One case each of flash pulmonary edema and bleeding occurred in 37 °C group. Conclusion Warming the irrigation fluid can reduce the incidence of postoperative fever and shivering, but further studies are needed to determine the optimal temperature. Trial registration The trial was registered at the Chinese Clinical Trials Registry and allocated as ChiCTR2000031683. The trial was registered on 07/04/2020 and this was a retrospective registration.
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Affiliation(s)
- Yue He
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China. .,Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, People's Republic of China.
| | - You-Gang Feng
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Jun He
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Bo Liang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Ming-Dong Jiang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Jun Liu
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Yong-Ming Kang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Li-Ping Ma
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Qin Zhang
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Qi-Jia Peng
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Tao Yang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Yao Liu
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Li Luo
- Department of Anesthesiology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Min Zhang
- Department of Anesthesiology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
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Abstract
Purpose: High intra-renal pressures during flexible ureteroscopy have been associated with adverse renal tissue changes as well as pyelovenous backflow. Our objective was to investigate the effect of various intra-renal pressures on histologic changes and fluid extravasation during simulated ureteroscopy. Materials and Methods: Twenty-four juvenile pig kidneys with intact ureters were cannulated with an Olympus flexible ureteroscope with and without a ureteral access sheath and subjected to India ink-infused saline irrigation for 30 minutes at constant pressures ranging from sphygmomanometer settings of 50mm, 100mm and 200mmHg. Renal tissue samples were collected, processed and stained, and were evaluated by a blinded pathologist for depth of ink penetration into renal parenchyma as a percentage of total parenchymal thickness from urothelium to renal capsule. Results: The mean percentage of tissue penetration for kidneys with ink present in the cortical tubules at sphygmomanometer pressure settings of 50, 100, and 200mm Hg without a ureteral access sheath was 33.1, 31.0 and 99.3%, respectively and with ureteral access sheath was 0, 0 and 18.8%, respectively. Overall, kidneys with an access sheath demonstrated a smaller mean tissue penetration among all pressure compared to kidneys without a sheath (6.3% vs. 54.5%, p=0.0354). Of kidneys with sheath placement, 11% demonstrated any ink compared to 56% of kidneys without sheath placement. Conclusions: Pressurized endoscopic irrigation leads to significant extravasation of fluid into the renal parenchyma. Higher intra-renal pressures were associated with increased penetration of irrigant during ureteroscopy in an ex-vivo porcine model.
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Affiliation(s)
- Christopher Loftus
- Department of Urology, University of Washington Medical Center, Seattle, WA, United States
| | | | - Manoj Monga
- Glickman Urological and Kidney Institute Cleveland Clinic Foundation - Urology, Cleveland, Ohio, United States
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Chaudhary K, Devana SK, Tyagi S, Sharma AP. A huge ureteric stone in a functionally, metabolically and anatomically normal kidney: an alliance of rarity. Ann R Coll Surg Engl 2021; 103:e206-e207. [PMID: 33851874 DOI: 10.1308/rcsann.2020.7110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Urinary stones are a common health problem, necessitating frequent outpatient visits and hospital admissions. Ureteric stones demand special attention, given their propensity for upstream hydroureteronephrosis and loss of renal function. They are usually predisposed by diverse anatomical, functional or metabolic abnormalities of the urinary tract and have an early symptomatic presentation. We report an exceptional clinical presentation of a huge ureteric stone yet functional renal moiety with no obvious anatomical or metabolic predilection for urolithiasis, and its minimally invasive management in a young woman. We emphasise that swift salvaging of the renal function is of utmost importance in these cases. Open exploration can be avoided in favour of laparoscopic ureterolithotomy with better cosmesis and early recovery.
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Affiliation(s)
- K Chaudhary
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Devana
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Tyagi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A P Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kim EM, Lee SH, Oh SH, Kim GT, Choi YS, Hwang EH. Ultrasound-guided sialo-irrigation for the treatment of chronic sialodochitis with sialolithiasis. Oral Radiol 2021; 37:345-351. [PMID: 33394278 DOI: 10.1007/s11282-020-00495-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
Sialolithiasis is one of the most common causes of salivary duct obstruction. In the last 20 years, minimally invasive procedures like sialendoscopy, extracorporeal lithotripsy, and basket snaring are increasingly being used for the treatment of salivary gland duct stones. Sialo-irrigation of the salivary gland is an effective procedure for treating inflammation and providing symptomatic relief. This procedure can be employed for the treatment of sialolithiasis using the back pressure of instilled saline. Sialo-irrigation under ultrasound (US) guidance allows for dynamic studies showing real-time images during diagnostic or surgical procedure and can be used for the removal of sialoliths. In addition, it can also be used to remove primitive sialoliths and microliths by washing out the ductal system, which prevents the recurrence of sialoliths. The aim of this study was to propose a minimally invasive technique for sialolithiasis using US-guided sialo-irrigation.
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Affiliation(s)
- Eun Mi Kim
- Department of Oral and Maxillofacial Radiology, Graduate School, Kyung Hee University, Kyungheedae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Sung Hyun Lee
- Department of Oral and Maxillofacial Radiology, Graduate School, Kyung Hee University, Kyungheedae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Song Hee Oh
- Department of Oral and Maxillofacial Radiology, Graduate School, Kyung Hee University, Kyungheedae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Gyu-Tae Kim
- Department of Oral and Maxillofacial Radiology, Graduate School, Kyung Hee University, Kyungheedae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Yong-Suk Choi
- Department of Oral and Maxillofacial Radiology, Graduate School, Kyung Hee University, Kyungheedae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Eui-Hwan Hwang
- Department of Oral and Maxillofacial Radiology, Graduate School, Kyung Hee University, Kyungheedae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea
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Barghouthy Y, Corrales M, Doizi S, Somani BK, Traxer O. Tea and coffee consumption and pathophysiology related to kidney stone formation: a systematic review. World J Urol 2021; 39:2417-26. [PMID: 33052484 DOI: 10.1007/s00345-020-03466-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To explore the mechanisms behind the potential protective effect of coffee and tea consumption, regarding urinary stone formation, previously demonstrated in large epidemiological studies. METHODS A systematic review was performed using the Medline, Cochrane library (CENTRAL) and Scopus databases, in concordance with the PRISMA statement. English, French and Spanish language studies, regarding the consumption of caffeinated and decaffeinated coffee and tea, and the relationship to urinary stone formation were reviewed. Meta-analyses, systematic reviews, case reports and letters, unpublished studies, posters and comments abstracts were excluded. RESULTS As per the inclusion criteria, 13 studies were included in the final review. The major findings show that caffeine increases urinary excretion of calcium, sodium and magnesium, in addition to a diuretic action with consumption > 300-360 mg (approximately four cups of coffee). Together with other components of coffee, this beverage might have potential protective effects against the formation of urinary stones. Tea exerts many protective effects against stone formation, through the accompanying water intake, the action of caffeine and the effects of components with antioxidant properties. CONCLUSION Caffeine has a hypercalciuric effect, balanced partially by a diuretic effect which appears after consumption of large quantities of caffeine. The current available literature supports in general, a potentially protective role for tea against stone formation, mainly for green tea. Additional standardization in this field of research, through specification of tea and coffee types studied, and their respective compositions, is needed for further clarification of the relation between coffee, tea and urinary stones.
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Saghir SM, Mashiana HS, Mohan BP, Dhindsa BS, Dhaliwal A, Chandan S, Bhogal N, Bhat I, Singh S, Adler DG. Efficacy of pancreatoscopy for pancreatic duct stones: A systematic review and meta-analysis. World J Gastroenterol 2020; 26:5207-5219. [PMID: 32982119 PMCID: PMC7495039 DOI: 10.3748/wjg.v26.i34.5207] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients. Per oral pancreatoscopy (POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct calculi (PDC) in chronic pancreatitis. POP uses two techniques: Electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL). Data on the safety and efficacy are limited for this procedure. We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP. The secondary aim was to assess pooled rates of technical success, clinical success for the two individual techniques, and adverse event rates.
AIM To perform a systematic review and meta-analysis of POP, EHL and LL for management of PDC in chronic pancreatitis.
METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Cochrane, Google Scholar and Web of Science databases (from 1999 to October 2019) to identify studies with patient age greater than 17 and any gender that reported on outcomes of POP, EHL and LL. The primary outcome assessed involved the pooled technical success and clinical success rate of POP. The secondary outcome included the pooled technical success and clinical success rate for EHL and LL. We also assessed the pooled rate of adverse events for POP, EHL and LL including a subgroup analysis for the rate of adverse event subtypes for POP: Hemorrhage, post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), perforation, abdominal pain, fever and infections. Technical success was defined as the rate of clearing pancreatic duct stones and clinical success as the improvement in pain. Random-effects model was used for analysis. Heterogeneity between study-specific estimates was calculated using the Cochran Q statistical test and I2 statistics. Publication bias was ascertained, qualitatively by visual inspection of funnel plot and quantitatively by the Egger test.
RESULTS A total of 16 studies including 383 patients met the inclusion criteria. The technical success rate of POP was 76.4% (95%CI: 65.9-84.5; I2 = 64%) and clinical success rate was 76.8% (95%CI: 65.2-85.4; I2 = 66%). The technical success rate of EHL was 70.3% (95%CI: 57.8-80.3; I2 = 36%) and clinical success rate of EHL was 66.5% (95%CI: 55.2-76.2; I2 = 19%). The technical success rate of LL was 89.3% (95%CI: 70.5-96.7; I2 = 70%) and clinical success rate of LL was 88.2% (95%CI: 66.4-96.6; I2 = 77%). The incidence of pooled adverse events for POP was 14.9% (95%CI: 9.2-23.2; I2 = 49%), for EHL was 11.2% (95%CI: 5.9-20.3; I2 = 15%) and for LL was 13.1% (95%CI: 6.3-25.4; I2 = 31%). Subgroup analysis of adverse events showed rates of PEP at 7% (95%CI: 3.5-13.6; I2 = 38%), fever at 3.7% (95%CI: 2-6.9; I2 = 0), abdominal pain at 4.7% (95%CI: 2.7-7.8; I2 = 0), perforation at 4.3% (95%CI: 2.1-8.4; I2 = 0), hemorrhage at 3.4% (95%CI: 1.7-6.6; I2 = 0) and no mortality. There was evidence of publication bias based on funnel plot analysis and Egger’s test.
CONCLUSION Our study highlights the high technical and clinical success rates for POP, EHL and LL. POP-guided lithotripsy could be a viable option for management of chronic pancreatitis with PDC.
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Affiliation(s)
- Syed M Saghir
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Harmeet S Mashiana
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, United States
| | - Banreet S Dhindsa
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Neil Bhogal
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Ishfaq Bhat
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, United States
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Amaresh M, Hegde P, Chawla A, de la Rosette JJMCH, Laguna MP, Kriplani A. Safety and efficacy of superior calyceal access versus inferior calyceal access for pelvic and/or lower calyceal renal calculi- a prospective observational comparative study. World J Urol 2020; 39:2155-2161. [PMID: 32865690 PMCID: PMC8216999 DOI: 10.1007/s00345-020-03409-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To compare efficacy and safety between superior calyceal access and inferior calyceal access for pelvic and/or lower calyceal renal stones. Methods Consecutive patients presenting with Pelvic and/or inferior calyceal renal calculi were allocated to the superior calyceal access (group 1) or inferior calyceal access (group 2) treatment arm. Allocation of treatment access was based on the surgeon’s preference. Variables studied included stone free rate, operating time, intraoperative and postoperative complications. Statistical analysis was executed using SPSS, Version 16.0. The statistical significance was evaluated at 5% level of significance (p value < 0.05). Results Between July 2018 and February 2019, 63 patients were included in each group. The percutaneous inserted guidewire entered the ureter in 92% in group1 and 74.6% in group 2 (p = 0.034). Stone fragments migrated to the middle calyx in 3.2% in group1 and 9.5% in group 2 (p = 0.033). A second puncture was required in one patient in group 1 and in 5 patients in group 2 (p = 0.04). The operative duration (minutes) was 13.46 ± 1.09 in the group 1 while 16.58 ± 1.44 in the group 2 (p = 0.002). Thoracic complications (hydropneumothorax) occurred to 2 patients in superior calyceal access group managed with intercostal tube drainage (p = 0.243).Post operatively blood transfusion was required in two patients in group 2 (p = 0.169). Angioembolization was done in one patient among the inferior calyceal access approach (p = 0.683). Complete stone clearance assessed at 3 months was 96.8% in group 1 and 85.7% in group 2 (p = 0.046). Conclusions Superior calyceal access is a safe and most efficacious in terms of achieving complete stone clearance rate with reduced operative time, minimal blood loss, less need for a second puncture and auxiliary procedures at minimal complications. Study registration Clinical trials registry – INDIA; CTRI/2018/07/014,687.
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Affiliation(s)
- M Amaresh
- Department of Urology, Kasturba Medical College, Manipal, Karnataka, India
| | - P Hegde
- Department of Urology, Kasturba Medical College, Manipal, Karnataka, India
| | - A Chawla
- Department of Urology, Kasturba Medical College, Manipal, Karnataka, India.
| | | | - M P Laguna
- Department of Urology, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - A Kriplani
- Department of Urology, Kasturba Medical College, Manipal, Karnataka, India
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Browne C, Redmond E, Kelly T, Rogers E, O'Malley P, Nusrat N, Jaffry S, Durkan G, Walsh K, Dowling C, D'Arcy FT. Strategies to maximise patient comfort during extracorporeal shockwave lithotripsy - A randomised controlled trial. Surgeon 2020; 19:207-211. [PMID: 32771299 DOI: 10.1016/j.surge.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE OF STUDY We aim to assess if distraction techniques improve patient comfort tolerability of SWL. METHODS We carried out a prospective randomised controlled trial of SWL-naïve patients attending for treatment. Patients were randomised into three groups and offered oral analgesia as standard of care. Group 1 (n = 19) received stress balls to squeeze during treatment. Group 2 (n = 19) listened to music during treatment. Group 3 (n = 17) received standard of care only. All patients completed a validated health anxiety inventory score prior to treatment. All patients completed a validated pain questionnaire and visual analogue scale (VAS) after treatment. Primary outcomes were completion of SWL treatment and pain score results. RESULTS 55 patients attending for SWL were randomised. There was no difference in stone size or position, presence of a stent, height or weight between the groups. VAS scores were lower in controls compared to Group 1 (1.93 vs 3.69, p = 0.08). On subgroup analysis of non-anxious patients, pain questionnaire scores were lower in controls compared to Group 1 (2.58 vs 4.77, p = 0.06). VAS scores were lower in patients who received optional analgesia alone than in patients who received stress balls alone (1.92 vs 4.07, p = 0.05). Across all subgroups, pain scores were lower in the control group compared to the distraction groups, but did not achieve significance. CONCLUSIONS In conclusion, distraction techniques should not replace standard of care for analgesia during SWL. This study was registered with clinicaltrials.gov (identifier NCT03379922).
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Affiliation(s)
- Clíodhna Browne
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland.
| | - Elaine Redmond
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Therese Kelly
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Eamonn Rogers
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Patrick O'Malley
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Nadeem Nusrat
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Syed Jaffry
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Garrett Durkan
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Kilian Walsh
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Catherine Dowling
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
| | - Frank T D'Arcy
- Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland
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Pan SB, Wu CL, Hou H, Zhou DC, Cui X, He L, Gu J, Wang L, Yu ZF, Dong GY, Xie SX, Xiong QR, Geng XP. [Open hepatectomy versus laparoscopic in the treatment of primary left-sided hepatolithiasis: a propensity, long-term follow-up analysis at a single center]. Zhonghua Wai Ke Za Zhi 2020; 58:530-538. [PMID: 32610424 DOI: 10.3760/cma.j.cn112139-20191114-00561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To compare short-term and long-term efficacy after laparoscopic left hepatectomy(LLR) to open left hepatectomy(OLH) for primary left-sided hepatolithiasis. Methods: Clinical data of 187 patients with left-sided hepatolithiasis and underwent laparoscopically or open left-sided hepatectomy from October 2014 to October 2019 at the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed in this propensity score matching (PSM) study and were matched in terms of age, sex, body mass index, liver function, ASA score, comorbidities, history of biliary surgery, and smoking history on the ratio of 1∶1.There were 47 cases in each group and the mean age were (54.7±12.3)years old(range:34 to 75 years old) and (53.2±12.6) years old (range: 34 to 75 years old) in open and laparoscopically group respectively. The data of operation time, intraoperative blood loss, postoperative hospital-stay, complication rate, biliary fistula rate, stone clearance rate, and stone recurrence rate were compared. The quantitative data were compared using t-test or rank-sum test. Count data were analyzed with χ(2) test or Fisher test. Results: No significant difference was observed in the clinical characteristics of included 94 patients in this study(all P>0.05).The length of the postoperative hospital-stay after OLH was significantly higher than that in the LLH group((10.8±3.1) days vs.(8.5±2.2)days, t=4.085, P=0.000). LLR significantly decreased the incidence of postoperative biliary fistula compared with the OLH (6.3% vs.21.2%, χ(2)=4.374, P=0.036) and the rates of postoperative complications in the OLH group was significantly higher than that in the LLH group (48.9% vs.27.6%, χ(2)=4.502, P=0.034). Moreover, the stone recurrence rates in the LLH group was significantly lower than that after OLR (4.2% vs. 17.0%, χ(2)=4.029, P=0.045). OLH (95% CI: 1.55 to 10.75, P=0.004) and postoperative complications (95% CI: 1.29 to 9.52, P=0.013) were independent risk factors for prolonged hospital stay. OLH (95% CI: 1.428 to 44.080, P=0.018) and residual stones (95% CI: 1.580 to 62.379, P=0.014) were independent risk factors for the occurrence of postoperative biliary fistula. Biliary fistula (95% CI: 1.078 to 24.517, P=0.040) was an independent risk factor for the recurrence of stones. Conclusion: Compared with OLH, LLH is safe and effective for the treatment of the primary left-sided hepatolithiasis with the clinical benefits of shorter hospital stay, fewer morbidity and biliary fistula occurrence, and lower stone recurrence rates.
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Affiliation(s)
- S B Pan
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - C L Wu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - H Hou
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - D C Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - X Cui
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - L He
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - J Gu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - L Wang
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Z F Yu
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - G Y Dong
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - S X Xie
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Q R Xiong
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - X P Geng
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
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Lima A, Reeves T, Geraghty R, Pietropaolo A, Whitehurst L, Somani BK. Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period. World J Urol 2020; 38:1329-1333. [PMID: 31342247 PMCID: PMC7190582 DOI: 10.1007/s00345-019-02878-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period. METHODS The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications. RESULTS During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2-89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19). CONCLUSION The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.
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Affiliation(s)
- Ashleigh Lima
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Thomas Reeves
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Robert Geraghty
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Lily Whitehurst
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
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Abstract
INTRODUCTION Since the seminal works by Singh and Blandy in the 1970s, the management of staghorn stones has almost exclusively involved surgical intervention. In contrast, a more recent study found that conservative management was not as unsafe as previously believed. The present review sought to examine the available literature to understand the implications of a conservative strategy. METHODS A systematic search of the literature was carried out using MEDLINE®, Embase™ and the Cochrane Central Register of Controlled Trials. All papers looking at management of staghorn calculi were reviewed and studies with a conservative management arm were identified. Outcomes of interest were recurrent or severe urinary tract infections, progressive renal deterioration, dialysis requirements, morbidity and disease specific mortality. Owing to the lack of relevant data, a descriptive review was carried out. RESULTS Our literature search yielded 10 suitable studies involving a total of 304 patients with staghorn stones managed conservatively. Progressive renal deterioration occurred in 0-100% of cases (mean 27.5%) with a higher rate among bilateral staghorn sufferers (44% vs 9%). Dialysis was required in 9% of patients (20% bilateral, 6% unilateral). The mean rate of severe infection was 8.7% and recurrent urinary tract infections occurred in as high as 50% of cases (80% bilateral, 41% unilateral). Disease specific mortality ranged from 0% to 67% (mean 20.5%). CONCLUSIONS It appears that conservative management of staghorn calculi is not as unsafe as previously thought and selection of patients with unilateral asymptomatic stones with minimal infection should be considered.
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Affiliation(s)
| | - T Amer
- NHS Greater Glasgow and Clyde, UK
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Yadav P, Madhavan K, Syal S, Farooq A, Srivastava A, Ansari MS. Technique, complications, and outcomes of pediatric urolithiasis management at a tertiary care hospital: evolving paradigms over the last 15 years. J Pediatr Urol 2019; 15:665.e1-7. [PMID: 31648889 DOI: 10.1016/j.jpurol.2019.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite technological advancements, there is lack of consensus for the standard treatment modalities for pediatric urolithiasis. OBJECTIVE The primary objective was to review the management of pediatric urolithiasis over the last 15 years in terms of technical modifications, surgical outcomes, and complications. The secondary objective was to compare the efficacy and outcomes of standard percutaneous nephrolithotomy (PCNL) and mini-PCNL for renal and upper ureteric calculi. STUDY DESIGN Medical records of all patients aged <18 years who presented to the authors' tertiary care hospital in northern India between August 2003 and December 2018 were reviewed retrospectively. Before 2010, all PCNLs performed were standard PCNL, whereas after 2010, most PCNLs performed were mini-PCNL. Thus, the patients were divided into two groups: group A (patients up to 2010) and group B (patients after 2010). These were compared for the type of treatment, success rate, and complications. The outcomes of surgical management of lower ureteric and vesical calculi were also reviewed. RESULTS During this period, there were 580 children with urolithiasis (677 stone sites). There were 265 patients (321 stone sites) in group A and 315 patients (356 stone sites) in group B. The median age was seven years (range: 3-18 years). The most common location of calculus was the collecting system of the kidney (n = 398, 58.8%). A total of 175 stone sites (25.8%) were located in the ureter. Urinary bladder calculi were seen in 43 (6.4%) patients. Multiple stones were seen in 61 sites (9.0%). A total of 115 patients in group A underwent standard PCNL, whereas in group B, nine patients underwent standard PCNL and 129 underwent mini-PCNL. Group B had a significantly higher stone clearance rate for mini-PCNL (P < 0.001). Minor complications (grades 1 and 2) accounted for a majority of overall complications in both groups (87.5% in group A and 94.9% in group B). DISCUSSION Mini-PCNL is an excellent option for renal calculi in children as it offers dual advantages of improved stone clearance and reduced major complications such as bleeding. Ureteroscopic lithotripsy has been established as the standard for small lower ureteric calculi. CONCLUSION For renal and upper ureteric calculi, mini-PCNL has evolved as standard technique with a high stone-free rate and minimum complications compared with standard PCNL. Extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy (URSL)/retrograde intrarenal surgery are acceptable alternatives for smaller stone burden. For lower ureteric and vesical calculi, retrograde approaches such as cystolithotripsy and URSL have now become the standard of care.
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Danil K, Dennison S, Wurster E, Garner MM, Lulich J, St Leger J. Renal and vaginal calculi in a free-ranging long-beaked common dolphin Delphinus capensis. Dis Aquat Organ 2019; 136:265-271. [PMID: 31724559 DOI: 10.3354/dao03414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bilateral nephrolithiasis with a concurrent vaginal calculus was identified in a stranded free-ranging long-beaked common dolphin Delphinus capensis. Necropsy and radiologic examinations of the sexually mature D. capensis revealed multiple small irregularly round nephroliths and a 6.4 × 4.1 × 9.2 cm vaginal calculus weighing 182 g. Nephroliths numbered 68 and 71 in the left and right kidneys, respectively, and ranged from 1.7 to 6.9 mm in diameter. Nephroliths were composed of 100% ammonium urate, which has been found in captive dolphin populations. However, the vaginolith consisted of struvite and calcium carbonate suggesting an alternate etiology. The composition of the vaginolith suggests that bacterial vaginitis could have served as the predisposing condition. Renal lesions included chronic tubulointerstitial nephritis with tubular degeneration and loss, likely secondary to the nephroliths. The pathogenesis of ammonium urate nephrolithiasis in managed care is suspected to be linked to diet and age but in this case may be due to metabolic disruption. However, if environmental changes cause a shift in prey species, the risk of nephrolithiasis in free-ranging cetaceans could increase. Careful surveillance for nephroliths in free-ranging populations should be considered by researchers.
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Affiliation(s)
- Kerri Danil
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
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Xu LL, Hu ZG, Yang DX, Zou SB, Wang K. [Surgical outcome evaluation and prediction analysis of laparoscopic left sided hepatectomy for hepatolithiasis]. Zhonghua Wai Ke Za Zhi 2019; 57:527-33. [PMID: 31269616 DOI: 10.3760/cma.j.issn.0529-5815.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the risk factors of long-term treatment outcomes and establish predicting model for laparoscopic left hepatectomy in hepatolithiasis. Methods: Clinical data of 108 patients with hepatolithiasis who underwent laparoscopic left sided hepatectomy and with complete follow-up data were retrospectively collected from June 2011 to June 2016 at the Second Affiliated Hospital of Nanchang University. Twenty-six males and 82 females were enrolled. The age was (52.4±11.7) years (range:20-80 years) , and the median follow-up time was 36 months (range: 24-83 months) . Patients were randomly divided into training group (79 cases) and validation group (29 cases) with a ratio of about 3∶1. Twenty-five preoperative and intraoperative clinical factors were selected for potential factors that might affect long-term outcomes, and quality of life was used as an surrogate evaluation index. Univariate analysis and multivariate logistic regression analysis were used to investigate the potential risk factors, and to construct and validate the predictive nomogram for surgical outcomes. Results: Among 108 patients, 10 patients (9.3%) had residual stones, 8 patients (7.4%) had recurrent stones, 12 patients (11.1%) had recurrent cholangitis and 3 patients (2.8%) died. Univariate analysis showed that history of hepatobiliary surgery, gender, activation of partial thromboplastin time, alkaline phosphatase, use of choledochoscopy, postoperative stone residual, serum creatinine, postoperative biliary drainage and operation time were risk factors that may affect long-term outcomes (all P<0.15) . Multivariate analysis showed that the history of previous hepatobiliary surgery (OR=2.305, 95% CI: 0.383-4.227, P=0.019) , postoperative biliary drainage (OR=2.043, 95% CI: 0.182-4.209, P=0.048) , operation time ≥262.5 minutes (OR=1.971, 95% CI: 0.154-4.023, P=0.045) were independent risk factor affecting long-term outcomes. Based on the above factors, the predictive nomogram model was constructed. Internal and external validations showed good discrimination (area under the curve of receiver operating curve>0.7) and calibration (Hosmer-Lemeshow test: P>0.05) performance, which indicated that the prediction effect was favorable. Conclusions: History of previous hepatobiliary surgery, postoperative biliary drainage and operation time ≥262.5 minutes are independent risk factors for long-term outcome. The predictive nomogram model based on risk factors relates to surgical outcomes presented good clinical predictive effects, which might contribute to the prediction of the long-term outcomes of laparoscopic left sided hepatectomy for hepatolithiasis.
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Anract J, Baures M, Barry Delongchamps N, Capiod T. Microcalcifications, calcium-sensing receptor, and cancer. Cell Calcium 2019; 82:102051. [PMID: 31276858 DOI: 10.1016/j.ceca.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/20/2022]
Abstract
Calcium stones and calculi are observed in numerous human tissues. They are the result of deposition of calcium salts and are due to high local calcium concentrations. Prostatic calculi are usually classified as endogenous or extrinsic stones. Endogenous stones are commonly caused by obstruction of the prostatic ducts around an enlarged prostate resulting from benign prostatic hyperplasia or from chronic inflammation. The latter occurs mainly around the urethra and is generally caused by reflux of urine into the prostate. Calcium concentrations higher than in the plasma at sites of infection may induce the chemotactic response that eventually leads to recruitment of inflammatory cells. The calcium sensing receptor (CaSR) may be crucial for this recruitment as its expression and activity are increased by cytokines such as IL-6 and high extracellular calcium concentrations, respectively. The links between calcium calculi, inflammation, calcium supplementation, and CaSR functions in prostate cancer patients will be discussed in this review.
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Affiliation(s)
- Julien Anract
- INSERM Unit 1151, Institut Necker Enfants Malades (INEM), Université Paris Descartes, Paris 75014, France; Urology Department, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris 75014, France
| | - Manon Baures
- INSERM Unit 1151, Institut Necker Enfants Malades (INEM), Université Paris Descartes, Paris 75014, France
| | - Nicolas Barry Delongchamps
- INSERM Unit 1151, Institut Necker Enfants Malades (INEM), Université Paris Descartes, Paris 75014, France; Urology Department, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris 75014, France
| | - Thierry Capiod
- INSERM Unit 1151, Institut Necker Enfants Malades (INEM), Université Paris Descartes, Paris 75014, France.
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Roberson NP, Dillman JR, Reddy PO, DeFoor W, Trout AT. Ultrasound versus computed tomography for the detection of ureteral calculi in the pediatric population: a clinical effectiveness study. Abdom Radiol (NY) 2019; 44:1858-1866. [PMID: 30756146 DOI: 10.1007/s00261-019-01927-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the diagnostic performance of ultrasound for diagnosing ureteral calculi in children using a clinical effectiveness approach. METHODS Billing records and imaging reports were used to identify children (≤ 18 years old) evaluated for suspected urolithiasis using ultrasound between March 2012 and March 2017. Patients without unenhanced CT within 24 h (reference standard) were excluded. Imaging (ultrasound and CT) reports were reviewed for presence, number, size, and location of calculi. Diagnostic performance of ultrasound (versus CT) was calculated on an individual ureter basis both by direct calculus visualization as well as direct visualization combined with suspected presence of ureteral stone based on indirect ultrasound findings. RESULTS 41 ureteral calculi were present in 38 of 69 (55.1%) patients. Mean patient age was 14.7 ± 3.6 years, and 35 of 69 (51%) patients were boys. Based on direct calculus visualization, ultrasound had a sensitivity of 12.8% (95% CI 5.6-26.7%), specificity of 100% (95% CI 96.3-100%), positive predictive value (PPV) of 100% (95% CI 56.6-100%), and negative predictive value (NPV) of 74.4% (95% CI 66.4-81.1%). When ultrasound examinations reported as suspicious for ureteral calculi based on indirect findings also were considered positive, ultrasound had a sensitivity of 41.0% (95% CI 27.1-56.6%), specificity of 95.0% (95% CI 88.7-97.8%), PPV of 76.2% (95% CI 54.9-89.4%), and NPV of 80.3% (95% CI 72.2-86.5%). CONCLUSIONS In clinical practice, ultrasound has low sensitivity for directly visualizing ureteral calculi subsequently identified by CT, although sensitivity improves when considering suspicious examinations as positive.
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Affiliation(s)
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Pramod O Reddy
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William DeFoor
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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O'Neill AGM, Osman SO, Jain S, Hounsell AR, O'Sullivan JM. Observed high incidence of prostatic calculi with the potential to act as natural fiducials for prostate image guided radiotherapy. Tech Innov Patient Support Radiat Oncol 2019; 9:35-40. [PMID: 32095594 DOI: 10.1016/j.tipsro.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/23/2022] Open
Abstract
Prostatic calculi are a frequent radiological finding and may aid prostate IGRT. Incidence of prostatic calculi in a population of radiotherapy patients is reported. Significant proportion of patients have calculi detectable on radiotherapy images. Prostatic calculi may reduce the need for surgically implanted markers.
Purpose This study aims to quantify the incidence and distribution of prostatic calculi in a population of prostate radiotherapy patients and assess their potential role in prostate image guided radiotherapy (IGRT). Methods & materials A retrospective analysis of trans-rectal ultrasound (TRUS), computed tomography (CT) planning and treatment verification cone beam CT (CBCT) scans from radical prostate radiotherapy patients (external beam and brachytherapy) between 2012 and 2014 was undertaken by a single experienced observer. An internationally validated schema from the Prostate Imaging Reporting and Data system (PIRADS) was used to map the location of calculi. The association of calculi with patient and disease characteristics was explored. Data was analysed using SPSS (IBM version 22.0) using descriptive statistical methods and logistic binary regression analysis. Results 389 scan sets from 254 patients were included in the analysis. The overall incidence of calculi was 85% (n = 218) of which 79% (n = 201) were intra-prostatic calculi. The mean number of intra-prostatic calculi was 2 (range 1–10) and the mean size of calculi was 3.7 mm (range 0.5–15 mm). Calculi were most frequently observed in the posterior of the mid-gland (PI-RADs 3p, 9p) and posterior of the apex (PI-RADs 5p, 11p). 99% (n = 135) of CT planning scans with a corresponding CBCT had calculi in the same PIRADs location and all calculi were visible at the last fraction. There was no statistically significant association of calculi and N stage, M stage or Gleason score. Conclusions A significant proportion of prostate radiotherapy patients have prostatic calculi detectable on pre radiotherapy imaging. Calculi observed on CT were also detectable on CBCT in 99% of cases and remain visible at the end of treatment. These findings add to the growing evidence base supporting the potential of calculi as an alternative to fiducial markers to aid prostate IGRT.
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Choudhary A, Basu S, Sharma R, Gupta R, Das RK, Dey RK. A novel triple oral regime provides effective analgesia during extracorporeal shockwave lithotripsy for renal stones. Urol Ann 2019; 11:66-71. [PMID: 30787574 PMCID: PMC6362787 DOI: 10.4103/ua.ua_15_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context: Analgesia during extracorporeal shockwave lithotripsy for renal stone is an essential component. It not only makes the procedure comfortable but also increases the stone-free rate. Aims: The aim of this study was to evaluate the efficacy of triple oral analgesic agents on stone fragmentation and pain relief in comparison to injectable analgesic agents. Settings and Design: This prospective randomized study included 68 patients of renal calculi of size 5–15 mm. Subjects and Methods: Group A had 32 patients, who received injection pentazocine and injection diclofenac, 45 min before the procedure. Group B consisted of 28 patients, who received a combination of oral acetaminophen, 325 mg, oral diclofenac 50 mg, and oral tramadol 37.5 mg, 45 min prior. Procedural findings, pain score visual analog scale (VAS), fragmentation rate, and outcome were recorded. Statistical Analysis Used: Independent t-test and Pearson's correlation test. Results: A total of 60 patients were analyzed. The mean age was 40.2 ± 11.8 years. Both groups were comparable in body mass index, stone size, number, and density. Group A required more shocks than Group B (4274 vs. 3693, P = 0.043). A lower energy level of shocks (kV) was tolerated in Group A (2.5 vs. 3.2, P = 0.002). Group A required more sittings than Group B (2.3 vs. 1.9, P = 0.037). VAS score was significantly less in Group B (2.9 vs. 4.9, P = 0.0001). The overall fragmentation rate was similar among groups (81.2% vs. 89.3%); hence, the successful outcome was (59.4% vs. 75.0%, P = 0.274). The occurrence of adverse events was also equivalent in both groups (P = 0.199). Conclusions: Triple oral regime provides better analgesic effect and quicker stone-free rate than injectable agents but with similar final outcome.
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Affiliation(s)
- Arpan Choudhary
- Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Supriya Basu
- Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Rakesh Sharma
- Department of Urology, Apex Hospital, Jaipur, Rajasthan, India
| | - Rupesh Gupta
- Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Ranjit Kumar Das
- Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Ranjan Kumar Dey
- Department of Urology, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
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Abstract
PURPOSE To investigate the detectability of renal stones in corticomedullary and nephrographic phases on contrast-enhanced computed tomography (CT). METHODS All consecutive patients between January 2012 and February 2016 undergoing CT of the kidneys according to our department's standard four-phase protocol and having at least one stone in the NC-phase (NCP) were included. Fifty patients with altogether 136 stones were eligible. Two radiologists in consensus evaluated the NCP from each examination and documented the number, location, and size of stones. Three abdominal radiologists blinded to the findings of the NCP reviewed independently the corticomedullary and nephrographic phases on two different occasions. They reported the number and location of stones in each kidney. For the inter-observer agreement the intra-class correlation coefficient (ICC) was estimated. The detection rate of renal stones was calculated for the three radiologists and compared between the two contrast-enhanced phases and the results were analyzed with concern to the size of the stones. RESULTS The ICC was 0.86. There was no statistically significant difference between corticomedullary and nephrographic phases (p = 0.94). The detection rate for stones measuring 3-5 mm was 82-88% and 98% for stones ≥ 6 mm. CONCLUSION The detectability of renal stones ≥ 6 mm on contrast-enhanced CT is extremely high. This means that stones with a higher risk of not passing spontaneously can be safely diagnosed.
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Affiliation(s)
- Alice Odenrick
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden.
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
| | - Nikolaos Kartalis
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Nikolaos Voulgarakis
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Fabian Morsbach
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Louiza Loizou
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
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Tyson M, Grimes N, McAuley L, Hennessy D, Pahuja A, Young M. Renal and Ureteric Stone Composition: A five year retrospective study for Northern Ireland. Ulster Med J 2019; 88:21-4. [PMID: 30675074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The study aimed to present the types of renal and ureteric stones (calculi) present in the population of Northern Ireland. The data may help in future planning treatment of stone services, patient education and prevention. METHODS Consecutive retrospective renal and ureteric stones analysed over 5.75 years (January 2008 - September 2013) in Northern Ireland. Exclusions included patients < 16 years, and calculi listed as bladder stone. RESULTS Total of 1618 stones analysed. Male to female calculi ratio 1.93: 1. Age range 16 - 94 years (52.2 mean), most common age for stone analysis 31-60 years. From 2008 to 2012 the number of stones analysed increased by 132.9%. Calcium was demonstrated in 94.5% (1529) of stones, of which 2.5% (40) pure calcium oxalate. Calcium oxalate and phosphate 72.9% (1182) of all stones, male to female ratio 2.4:1. Stones containing uric acid 9.6% (156), with uric acid male to female ratio 4.83:1. Struvite 13.7% (222), male to female ratio 1:1.6. Pure cystine 1.1% (18) of stones, male to female ratio 1:1.3. CONCLUSION There is a high proportion (94.4%) of stones containing calcium oxalate in Northern Ireland; these patients should be aiming to produce 2L of urine a day to aid prevention. Most common age for stone analysis (31-60) is in keeping with most common age for presentation. The steep increase in calculi analysis of 132.9% must be met with personalised stone treatment and prevention strategies.
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Shields LBE, Peppas DS, Rosenberg E. Renal Calculus in Floating-Harbor Syndrome: A Case Report. J Pediatr Health Care 2019; 33:97-101. [PMID: 30205917 DOI: 10.1016/j.pedhc.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 11/24/2022]
Abstract
Floating-Harbor syndrome is a rare condition marked by short stature and delayed bone age, characteristic facial features, and speech impairment. Floating-Harbor syndrome commonly results from a sporadic genetic mutation. Renal abnormalities have rarely been encountered. We report the first patient with Floating-Harbor syndrome who spontaneously passed a renal calculus consisting of calcium oxalate monohydrate and calcium oxalate dihydrate. A renal ultrasound showed echotexture within the renal pyramids, hydronephrosis, and a cyst. Pediatric nurse practitioners should be alert to the unique features associated with Floating-Harbor syndrome and be prepared to monitor and treat the renal abnormalities that may accompany this uncommon condition.
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Kang N, Guan X, Song L, Zhang X, Zhang J. Simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy. Int Braz J Urol 2018; 44:958-964. [PMID: 30088721 PMCID: PMC6237515 DOI: 10.1590/s1677-5538.ibju.2018.0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/30/2018] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess the safety, feasibility, and efficacy of simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy in selected patients. Patients and Methods: We retrospectively reviewed 11 consecutive cases of parapelvic renal cysts with concomitant calculi treated by flexible ureterorenoscopy and laser lithotripsy (FURSL). Marsupialization was performed subsequently with holmium: YAG laser in our institution. Fragmentation was used to manage renal stones and a novel four-step cyst localization strategy was applied in each case for marsupialization. Results: There were no intraoperative complications. Two cases of cystitis were reported postoperatively. The mean operative times of FURSL and marsupialization were 23.6 ± 3.9 minutes and 29.1 ± 9.7 minutes, respectively. During marsupialization, seven patients underwent the first two steps of the new strategy, two patients underwent three steps and two patients underwent all four steps. The mean reduction in hemoglobin level was 4.7 ± 1.7 g / L (range 3-8 g / L). The mean length of hospital stay was 1.2 ± 0.4 days. During a mean follow-up duration of 18 months, all cases remained stone-free and there was no stone recurrence. Parapelvic cysts became undetectable in eight cases and decreased in size by at least half in three cases. Conclusion: With appropriate patient selection, FURSL and marsupialization with a four-step cyst localization strategy is feasible, safe, and effective in treating parapelvic renal cysts with concomitant calculi.
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Affiliation(s)
- Ning Kang
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
| | - Xing Guan
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
| | - Liming Song
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
| | - Xiaodong Zhang
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
| | - Junhui Zhang
- Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
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Affiliation(s)
- Osamah Hasan
- Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL, USA
| | - Alexandria Ellis
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Ryan Powers
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Patricia Vidal
- Division of Urology, Cook County Health and Hospitals System, Chicago, IL, USA
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Greed L, Willis F, Johnstone L, Teo S, Belostotsky R, Frishberg Y, Pitt J. Metabolite diagnosis of primary hyperoxaluria type 3. Pediatr Nephrol 2018; 33:1443-1446. [PMID: 29705963 DOI: 10.1007/s00467-018-3967-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Primary hyperoxaluria type 3 (PH3) is a recently described cause of childhood renal calculi. It results from mutations in the HOGA1 gene and most cases have been diagnosed after clinical ascertainment, exclusion of other genetic hyperoxalurias and mutation testing. Metabolite testing has not been widely applied but holds promise for the rapid screening and diagnosis of patients who are not specifically suspected to have PH3. CASE-DIAGNOSIS/TREATMENT Two cases presented with renal calculi. Urine metabolite testing by tandem mass spectrometry was performed as part of the routine diagnostic work-up for this condition. Both had significantly increased levels of the PH3 urine marker 4-hydroxyglutamate and related metabolites. The diagnosis of PH3 was confirmed by the finding of bi-allelic damaging HOGA1 mutations. CONCLUSIONS Urine screening by tandem mass spectrometry is a rapid, high-throughput test that can detect PH3 cases that may otherwise not be diagnosed.
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Affiliation(s)
- Lawrence Greed
- Department of Clinical Biochemistry, Princess Margaret Hospital for Children, Perth, Australia
| | - Frank Willis
- Department of Nephrology, Princess Margaret Hospital for Children, Perth, Australia
| | - Lilian Johnstone
- Department of Nephrology, Monash Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Sharon Teo
- Department of Nephrology, Monash Children's Hospital, Melbourne, Australia
| | - Ruth Belostotsky
- Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yaacov Frishberg
- Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - James Pitt
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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Prattley S, Voss J, Cheung S, Geraghty R, Jones P, Somani BK. Ureteroscopy and stone treatment in the elderly (≥70 years): prospective outcomes over 5- years with a review of literature. Int Braz J Urol 2018. [PMID: 29522293 PMCID: PMC6092651 DOI: 10.1590/s1677-5538.ibju.2017.0516] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: To assess outcomes of ureteroscopy for treatment of stone disease in the elderly. Ureteroscopy (URS) is an increasingly popular treatment modality for urolithiasis and its applications are ever expanding with the development of newer technologies. Its feasibility and outcomes within the elderly population to our knowledge remain under-reported. Materials and Methods: We examined the patient demographics and surgical outcomes from our prospective database for patients ≥70 years who underwent URS for urolithiasis, in a 5-year period between March 2012 and December 2016. Results: A total of 110 consecutive patients underwent 121 procedures (1.1 procedure/patient) with a mean age of 77.2 years (range: 70-91 years). Stone location was in the kidney/ pelviureteric junction (PUJ) in 29%, ureter in 37% and in multiple locations in 34%. The initial and final stone free rate (SFR) was 88% and 97% respectively. While 73% were done as true day case procedures, 89% patients were discharged within 24 hours. Eleven patients (9%) underwent complications of which 10 were Clavien I/II including acute urinary retention, urinary tract infection, stent symptoms and pneumonia. One patient underwent Clavien IV complication where they needed intensive care unit admission for urosepsis but fully recovered and were discharged home subsequently. Conclusion: Ureteroscopy is a safe and effective method of managing urolithiasis in elderly patients. Although most patients are discharged within 24-hours, consideration needs to be made for patients where social circumstances can impact their discharge planning.
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Affiliation(s)
- Sarah Prattley
- University Hospital Southampton, NHS Trust, United Kingdom, UK
| | - James Voss
- University Hospital Southampton, NHS Trust, United Kingdom, UK
| | | | - Robert Geraghty
- University Hospital Southampton, NHS Trust, United Kingdom, UK
| | - Patrick Jones
- University Hospital Southampton, NHS Trust, United Kingdom, UK
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Abstract
An 8-y-old lactating Holstein cow was presented to the herd veterinarian with a history of acute ataxia, and because of poor prognosis, the animal was euthanized and submitted for postmortem examination. A lumbar vertebra was incompletely fractured and had an adjacent subdural hematoma. The pancreas had a hard texture with exaggerated nodular appearance, and on cut surface, the pancreatic ducts appeared fibrotic and contained scores of round-to-faceted pancreatoliths of 0.5-2.0 mm diameter. These calculi extended from the major ducts to the pancreatic duct, sphincter, and into the duodenal lumen. Microscopically, the pancreas had severe acinar atrophy and dissecting glandular fibrosis. The major pancreatic ducts were ulcerated with fibrosis and inflammation. In humans, chronic pancreatitis has been linked to osteoporosis and increased risk of bone fractures. Manual evaluation of ribs at the time of autopsy did not reveal abnormalities in bone pliability or fragility in our cow.
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Affiliation(s)
- Alfonso López
- Departments of Pathology and Microbiology (Lopez), Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada.,Health Management (McKenna), Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Shawn McKenna
- Departments of Pathology and Microbiology (Lopez), Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada.,Health Management (McKenna), Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada
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Ozgor F, Sahan M, Yanaral F, Savun M, Sarilar O. Flexible ureterorenoscopy is associated with less stone recurrence rates over Shockwave lithotripsy in the management of 10-20 millimeter lower pole renal stone: medium follow-up results. Int Braz J Urol 2018; 44:314-322. [PMID: 29412548 PMCID: PMC6050557 DOI: 10.1590/s1677-5538.ibju.2017.0483] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose To identify the role of shock wave lithotripsy (SWL) and flexible ureterorenoscopy (f-URS) on the stone recurrence, in the management of 10-20 millimeter lower pole stone (LPS) with medium follow-up outcomes. Materials and Methods The patients’ charts which were treated with SWL or f-URS for LPS between January 2011 and September 2013 were analyzed, retrospectively. Patients who had a solitary 10-20mm LPS were enrolled into the study. In both procedures, patient was accepted as stone free, if complete stone clearance was achieved in the 3rd month abdominal computed tomography. Only patients with a stone free status were evaluated in follow ups. Results The stone-free rate was 77.9% (88/113 patients) for the SWL group and 89% (114/128 patients) for the f-URS group (p=0.029). Stone recurrence was detected in 28 (35.4%) patients in SWL group and in 17 (17.2%) patients in f-URS group (p=0.009). Stone types and 24 hour urine sample results were similar between groups (p=0.123 vs p=0.197, respectively). Multivariate regression analysis revealed that f-URS procedure and absence of abnormality in 24 hour urine analysis significantly decreased stone recurrence in medium term follow-up (p=0.001 and p<0.001, respectively). Conclusions Our study showed for the first time, that patients which underwent f-URS for LPS, faced less stone recurrence, independent from diet regimen and metabolic evaluation in medium term follow-up. Additionally, presence of abnormality in 24 hour urine analysis increase the stone recurrence risk in follow-ups.
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Affiliation(s)
- Faruk Ozgor
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Murat Sahan
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Fatih Yanaral
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Metin Savun
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Omer Sarilar
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
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Batagello CA, Vicentini FC, Marchini GS, Torricelli FCM, Srougi M, Nahas WC, Mazzucchi E. Current trends of percutaneous nephrolithotomy in a developing country. Int Braz J Urol 2018; 44:304-313. [PMID: 29244269 PMCID: PMC6050544 DOI: 10.1590/s1677-5538.ibju.2017.0292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022] Open
Abstract
Introduction To present the current practice patterns on percutaneous nephrolithotomy (PCNL) in a developing country. Materials and Methods A survey was offered to Brazilian urologists during the II International Endourology Symposium held in Sao Paulo, in 2015. The first seven questions were related to demographic data while the 20 remaining were directed to urologists who performed PCNL. Results From 250 participants, 100 replied to the survey, 81% performed PCNL and 60.4% of performers had been in practice for less than 15 years. Eighty-one percent were trained in the prone position and 64% in supine. PCNL was learned during the residency in 66.7% and 2.5% had fellowship training. Prone position was the preferred decubitus for simple or complex calculi, though for obese patients there was no difference. Younger surgeons prefer supine while older surgeons prefer prone. The access was obtained by the surgeon in all cases, 96.3% use fluoroscopy and 3.7% prefer ultrasonography. Forty-seven percent use ultrasonic lithotripters and 4.1% laser. For kidney drainage, 71.6% place a nephrostomy tube. Double J stent is left in 77%. The postoperative image method was CT for 50%. Colonic injury was reported by 25%, predominantly in the senior group without statistically difference between positions. Conclusions From a selected group of urologists, we observe that Brazilian urologists usually gain their own access for PCNL guided by fluoroscopy. They predominantly prefer the prone position, use fascial dilators, ultrasonic lithotripters and place a nephrostomy tube when exiting the kidney. Fellowship programs, ultrasonography, flexible nephoscopy and tubeless procedures could be encouraged.
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Affiliation(s)
- Carlos A Batagello
- Divisão de Urologia, Grupo de Endourologia Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Divisão de Urologia, Grupo de Endourologia Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Divisão de Urologia, Grupo de Endourologia Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio Cesar Miranda Torricelli
- Divisão de Urologia, Grupo de Endourologia Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Grupo de Endourologia Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Willian Carlos Nahas
- Divisão de Urologia, Grupo de Endourologia Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Divisão de Urologia, Grupo de Endourologia Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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