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Vaiman M, Mizrakli Y, Gavriel H. Comparative analysis of approaches to the Wharton's duct during surgery of the submandibular gland: A retrospective case-control study. Clin Otolaryngol 2024. [PMID: 38699810 DOI: 10.1111/coa.14176] [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: 08/13/2023] [Revised: 03/13/2024] [Accepted: 04/20/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION We investigated complications and recurrence rates after surgical techniques for sialolith removal with intact and resected Wharton's duct of the submandibular gland. METHODS The retrospective case-control analysis of a series analysed 271 surgical operations (2003-2022) for sialolithiasis performed at a hospital department of Otolaryngology-Head and Neck Surgery. The study compared two approaches: (1) pure endoscopic technique or pinpoint stone removal with Wharton's duct left intact and (2) transoral duct dissection or pinpoint stone removal technique, after which the duct was shortened. While choosing the surgical option, the size of the stone, the location of the stone, and the presence of multiple stones were taken into account. The rates of complications (lingual nerve paraesthesia, duct stenosis, drooling, and sialoadenitis), the incidence of foreign bodies, and the rate of recurrence during follow-up of ≥18 months were compared. RESULTS 323 sialoliths were removed from 271 patients. Of these 323 calculi, 150 were removed by the first approach and 173 by the second approach. The calculi varied in diameter from 2 to 38 mm with an average diameter of 8.2 mm. For all 271 patients, the rate of recurrence was 4.8%, but 11 recurrent cases (8.7%) appeared after the first approach surgeries and 2 cases (1.4%) after the second approach surgeries (p = .03). Other variables did not show statistically significant differences. CONCLUSIONS Surgical removal of the submandibular calculi, ending with shortening of Wharton's duct, reduces the recurrence rate for sialolithiasis but does not affect the rate of postsurgical complications.
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Affiliation(s)
- Michael Vaiman
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Mizrakli
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Davis SO, Zubair A, Anyakora C, Igbokwe MC, Haladu Z, Ajibade AF, Noah O, Agyeman C, Oisamokhai K, Enemoh O, Ikuborije P, Nwokeocha ES, Ajari O, Adejala I, Mastaki VM, Akinro O. Paediatric Renal Stone Management in Africa: A Scoping Review and Analysis of Current Practices. Cureus 2024; 16:e56819. [PMID: 38654778 PMCID: PMC11037113 DOI: 10.7759/cureus.56819] [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] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Renal stones are solid deposits formed from minerals and salts that develop within the kidneys and urinary tract. While the condition is more common among adults, children and even infants can also be affected. There is an increasing incidence of paediatric renal stones in Africa alongside multiple challenges faced in managing the condition. This scoping review aimed to provide an overview of the management modalities of paediatric renal stones in Africa. This study utilised Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A systematic search was conducted in three electronic databases: PubMed, African Journal Online (AJOL), and Google Scholar, with 1,180 articles curated. After extensive examination, 10 articles satisfied the inclusion criteria. The review found that calcium oxalate stones were the most prevalent type, accounting for 34.03% of cases, followed by whewellite stones and ammonium urate stones. The most frequent location for stones was the kidney, and the most common symptom was pain. Abdominopelvic ultrasound was the most frequently utilised investigation. Of the 886 patients managed for renal stones, 75.4% were managed surgically, 2.9% medically, and 21.7% spontaneously resolved without intervention. This review identifies opportunities for improving the management of paediatric renal stones in Africa, including the need for standardised diagnostic and treatment protocols and the development of evidence-based guidelines tailored to the African context. Overall, this scoping review provides valuable insights into the patterns and management of paediatric renal stones in Africa and highlights the need for further research to improve the management of this condition in the region.
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Affiliation(s)
| | | | | | | | | | | | - Olumide Noah
- Urology, Surgery Interest Group of Africa, Lagos, NGA
| | | | | | - Obinna Enemoh
- Urology, Surgery Interest Group of Africa, Lagos, NGA
| | | | | | | | - Isaac Adejala
- Urology, Surgery Interest Group of Africa, Lagos, NGA
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3
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Li J, Lv Y, Chen Z, Zhao J, Wang S. Citric Acid Loaded Hydrogel-Coated Stent for Dissolving Pancreatic Duct Calculi. Gels 2024; 10:125. [PMID: 38391455 PMCID: PMC10888429 DOI: 10.3390/gels10020125] [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: 12/18/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
In recent years, the incidence of chronic pancreatitis has increased significantly. Pancreatic calculi obstruct the pancreatic duct and induce abdominal pain in the patients. Pancreatic duct stenting is the major treatment option for chronic pancreatitis with calculi. In this study, a new kind of drug-eluting stent, a pancreatic stent coated by methacrylated gelatin (GelMA) hydrogel loaded with citric acid (CA), was designed for the interventional treatment of pancreatic duct calculi. The CA loading capacity reached up to 0.7 g CA/g hydrogel-coated stent. The GelMA hydrogel coating has higher mechanical strength and lower swelling performance after loading with CA. The in vitro experiments of stents exhibited good performance in CA sustained release and the calculi can be dissolved in almost 3 days. The stents also showed good blood compatibility and cell compatibility. This research has important clinical value in the treatment of chronic pancreatitis with pancreatic calculi.
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Affiliation(s)
- Jing Li
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 334 Jungong Road, Shanghai 200093, China
- Public Experiment Center, University of Shanghai for Science and Technology, No. 334 Jungong Road, Shanghai 200093, China
| | - Yanwei Lv
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai 200433, China
| | - Zheng Chen
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 334 Jungong Road, Shanghai 200093, China
| | - Jiulong Zhao
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai 200433, China
| | - Shige Wang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 334 Jungong Road, Shanghai 200093, China
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4
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Suzuki I, Mizuno T, Kambara T. Intravesical Infection Stones Caused by Magnetic Beads. Cureus 2023; 15:e47422. [PMID: 38021588 PMCID: PMC10658753 DOI: 10.7759/cureus.47422] [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] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
The presence of an intravesical foreign body is a rare condition concerning the diseases of the urinary system. Intravesical foreign bodies may cause hematuria and bladder perforation, which are difficult to diagnose and treat. There are various types of foreign bodies in the bladder; however, magnetic beads are rare. Multiple beads may be inserted into the urethra. A few small magnetic beads may be removed from the urethra, but an open removal is an option for many or large beads because of calculus adherence. This case reports the successful open removal of 57 magnetic beads with calculus adherence.
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5
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Matsubara S, Nakagawa K, Suda K, Otsuka T, Oka M, Nagoshi S. Removal of a small pancreatic stone in thin main pancreatic duct using an ultrafine balloon catheter (with video). J Hepatobiliary Pancreat Sci 2023; 30:e58-e59. [PMID: 36403226 DOI: 10.1002/jhbp.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Saburo Matsubara
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Keito Nakagawa
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kentaro Suda
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Takeshi Otsuka
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masashi Oka
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Sumiko Nagoshi
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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6
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Bokhari A, Alghamdi AAM, Khushayl AMA, Alaklabi SNA, Albarrak SKA, Aldarwish HA. Prevalence and Risk Factors of Renal Stones Among the Bisha Population, Saudi Arabia. Cureus 2023; 15:e40090. [PMID: 37425544 PMCID: PMC10328147 DOI: 10.7759/cureus.40090] [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] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND In urolithiasis, urinary calculi are formed in the urinary system. Stone development does not initially result in any symptoms, but later renal colic, flank pain, hematuria, obstruction of urine flow, and/or hydronephrosis may indicate renal stone disease. In addition to age, gender, ethnicity, and local climate, urolithiasis can be caused by several other factors. The prevalence and recurrence rate of kidney stone disease is rising globally, while few effective treatment options currently exist. METHODS Between June and October 2022, a cross-sectional study was conducted. An electronic questionnaire subdivided into three categories was used to determine the prevalence and identify the factors that increase the likelihood of developing urolithiasis among the population in Bisha. The collected data were reviewed and analyzed via IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. RESULTS A total of 1,002 participants filled out the questionnaire. The age of the participants ranged from 18 to over 60 years, with an average age of 26.1 ± 13.9 years. There were 451 female participants (45%), and 927 (92.5%) were Saudis. According to the participants' body mass index, 98 (9.8%) were underweight, 388 (38.7%) were normal weight, 300 (29.9%) were overweight, and 216 (21.6%) were obese. The total number of participants with urolithiasis was 161 (16.1%), and 420 (41.9%) had a family history of renal stones. Urolithiasis was found to be significantly associated with family history, smoking, diabetes, hypertension, hyperthyroidism, gout, and chronic kidney disease. Older age and female gender were also associated with the risk of having urolithiasis. CONCLUSION This study found urolithiasis to be highly prevalent among the Bisha population. In terms of risk factors, body mass index, smoking, and diabetes were the most significant. Based on the findings of this study, the authors recommend more public education regarding urolithiasis and its risk factors, emphasizing the importance of preventing the disease and the ways of treating urolithiasis through medical campaigns and social media.
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Affiliation(s)
- Akram Bokhari
- Department of Surgery, University of Hail College of Medicine, Hail, SAU
- Department of Urology, Miami Cancer institute, Florida, USA
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7
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Kunkel G, Sorokin I, Oster M, Van Horn C, Movahedi B, Pang-Yen F, Martins PN. Ex-vivo ureteroscopy, laser lithotripsy, and stone basketing extraction of deceased donor kidney stones during machine perfusion preservation. Artif Organs 2023. [PMID: 37026524 DOI: 10.1111/aor.14528] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 04/08/2023]
Abstract
The incidence of nephrolithiasis in kidney donors is rare. The timing and treatment of nephrolithiasis in deceased donor kidneys are not well established. While some programs have proposed ex-situ rigid or flexible ureteroscopy treatment before transplantation, we report on two cases of kidney stones in the same deceased donor that we treated by flexible ureteroscopy and laser lithotripsy performed during the storage time on a hypothermic perfusion machine. Two deceased donor kidneys were found to have multiple kidney stones discovered on preprocurement CT imaging. The right kidney had less than five 2-3 mm stones, whereas the left had five to ten 1 mm stones with a single 7 mm stone. Both organs were placed on a hypothermic perfusion machine and maintained at a temperature of 4°C. An ex-vivo flexible ureteroscopy with laser lithotripsy and basket extraction was performed while the kidneys were maintained on Lifeport* perfusion machine. The cold ischemia time was 16.9 and 23.1 h. After 12 months of observational follow-up, neither recipient had nephrolithiasis, UTI, or other urologic complications. The creatinine values now are 1.17 and 2.44 mg/dL (103.4 and 215.7 μmol/L), respectively. Ex-vivo flexible ureteroscopy with laser lithotripsy and stone removal on machine-perfused kidneys appears to be safe and offers a good option to treat graft nephrolithiasis and prevent posttransplant complications. Ureteroscopy serves as a minimally invasive treatment option with direct stone removal. Performing this while on machine perfusion minimizes the ischemic time of the kidney and resultant complications or delays in graft function.
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Affiliation(s)
- Gregory Kunkel
- Department of Urology, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Igor Sorokin
- Department of Urology, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Michela Oster
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Christine Van Horn
- Department of Urology, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Babak Movahedi
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Fan Pang-Yen
- Division of Transplant Nephrology, Department of Medicine, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
| | - Paulo N Martins
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts Memorial Hospital, University of Massachusetts, Worcester, Massachusetts, USA
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8
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Zeng S, Xu Z, Li Y, Liu Q. Application of percutaneous nephrolithotomy combined with da Vinci Xi robot in complicated upper urinary tract repair surgery: A case report. Int J Med Robot 2023; 19:e2488. [PMID: 36479803 DOI: 10.1002/rcs.2488] [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: 09/19/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Duplex kidney and ureter is a congenital malformation. Few patients present with hydronephrosis caused by obstruction of the ureteropelvic junction of the duplex kidney, but lower kidney calculi caused by a duplex kidney abnormality is rare. This study reports a case of a duplex kidney and ureter complicated by multiple calculi in the duplex lower kidney. Percutaneous nephrolithotomy combined with a da Vinci robot-assisted laparoscopic upper urinary tract reconstruction was performed. The lower ureter was resected, and the lower kidney was preserved. One year after the surgery, a follow-up examination reported satisfactory renal function without hydronephrosis or calculi.
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Affiliation(s)
- Sheng Zeng
- School of Medicine, Nankai University, Tianjin, China.,Department of Urology, Tianjin First Central Hospital, Tianjin, China
| | - Zhikao Xu
- Department of Urology, Tianjin First Central Hospital, Tianjin, China.,First Center Clinical College, Tianjin Medical University, Tianjin, China
| | - Yaowen Li
- Department of Urology, Tianjin First Central Hospital, Tianjin, China.,First Center Clinical College, Tianjin Medical University, Tianjin, China
| | - Qian Liu
- School of Medicine, Nankai University, Tianjin, China.,Department of Urology, Tianjin First Central Hospital, Tianjin, China.,First Center Clinical College, Tianjin Medical University, Tianjin, China
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9
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Reid G. Perspective: microbial interventions in the urinary tract. Microbiome Res Rep 2023; 2:3. [PMID: 38045610 PMCID: PMC10688806 DOI: 10.20517/mrr.2022.17] [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] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/30/2023] [Accepted: 02/14/2023] [Indexed: 12/05/2023]
Abstract
Despite multiple advances in medicine, the management of urinary tract infections (UTIs) in women has remained stalled for decades. To prevent the development of symptomatic recurrences, low-dose antibiotics are the mainstay, while alternative approaches have been attempted with limited success. The use of probiotics was first considered forty years ago, and while some promising studies have been published, additional evidence in larger patient groups is needed to recommend specific strains as a primary preventive regimen. Overall, the role of beneficial microbes in reducing the risk of UTI and other urological diseases, such as urolithiasis, remains a target for researchers. The aim of this perspective is to offer a viewpoint on the status of this approach and recommendations for how to develop novel probiotic therapies.
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Affiliation(s)
- Gregor Reid
- Canadian R&D Centre for Human Microbiome and Probiotics, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
- Departments of Microbiology and Immunology, and Surgery, Western University, London, Ontario N6A 3K7, Canada
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10
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Abstract
In the past two decades, major breakthroughs that improve our understanding of the pathophysiology and therapy of kidney stones (KS) have been lacking. The disease continues to be challenging for patients, physicians, and healthcare systems alike. In this context, epidemiological studies are striving to elucidate the worldwide changes in the patterns and the burden of the disease and identify modifiable risk factors that contribute to the development of kidney stones. Our expanding knowledge of the epidemiology of kidney stones is of paramount importance and largely upgrades the modern management of the disease. In this paper, we review the variables affecting prevalence and incidence, including age, gender, race, ethnicity, occupation, climate, geography, systemic diseases, diabetes, vascular disease, chronic kidney disease, and dietary risk factors relevant to kidney stones.
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Affiliation(s)
- Kyriaki Stamatelou
- “MESOGEIOS” Nephrology Center, Haidari and Nephros.eu Private Clinic, 11527 Athens, Greece
| | - David S. Goldfarb
- Nephrology Division, NYU Langone Health and NYU Grossman School of Medicine, NY Nephrology Section, NY Harbor VA Healthcare System, New York, NY 10016, USA
- Correspondence: ; Tel.: +1-212-686-7500 (ext. 3877); Fax: +1-212-951-6842
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11
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Hall MK, Thiel J, Dunmire B, Samson PC, Kessler R, Sunaryo P, Sweet RM, Metzler IS, Chang HC, Gunn M, Dighe M, Anderson L, Popchoi C, Managuli R, Cunitz BW, Burke BH, Ding L, Gutierrez B, Liu Z, Sorensen MD, Wessells H, Bailey MR, Harper JD. First Series Using Ultrasonic Propulsion and Burst Wave Lithotripsy to Treat Ureteral Stones. J Urol 2022; 208:1075-82. [PMID: 36205340 DOI: 10.1097/JU.0000000000002864] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE Our goal was to test transcutaneous focused ultrasound in the form of ultrasonic propulsion and burst wave lithotripsy to reposition ureteral stones and facilitate passage in awake subjects. MATERIALS AND METHODS Adult subjects with a diagnosed proximal or distal ureteral stone were prospectively recruited. Ultrasonic propulsion alone or with burst wave lithotripsy was administered by a handheld transducer to awake, unanesthetized subjects. Efficacy outcomes included stone motion, stone passage, and pain relief. Safety outcome was the reporting of associated anticipated or adverse events. RESULTS Twenty-nine subjects received either ultrasonic propulsion alone (n = 16) or with burst wave lithotripsy bursts (n = 13), and stone motion was observed in 19 (66%). The stone passed in 18 (86%) of the 21 distal ureteral stone cases with at least 2 weeks follow-up in an average of 3.9±4.9 days post-procedure. Fragmentation was observed in 7 of the burst wave lithotripsy cases. All subjects tolerated the procedure with average pain scores (0-10) dropping from 2.1±2.3 to 1.6±2.0 (P = .03). Anticipated events were limited to hematuria on initial urination post-procedure and mild pain. In total, 7 subjects had associated discomfort with only 2.2% (18 of 820) propulsion bursts. CONCLUSIONS This study supports the efficacy and safety of using ultrasonic propulsion and burst wave lithotripsy in awake subjects to reposition and break ureteral stones to relieve pain and facilitate passage.
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12
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Akatsuka J, Suzuki K, Ikuma S, Yanagi M, Endo Y, Takeda H, Toyama Y, Dohi T, Kimura G, Kondo Y. Vesicocutaneous fistula due to vesical diverticulitis with stones: A case report and literature review. IJU Case Rep 2022; 6:46-50. [PMID: 36605677 PMCID: PMC9807334 DOI: 10.1002/iju5.12546] [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: 08/08/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction We encountered an extremely rare case of a vesicocutaneous fistula due to vesical diverticulitis with stones. Case presentation A 78-year-old male patient presented to our department with complaints of suppurative discharge in the suprapubic area. Computed tomography revealed an enlarged prostate, a vesical diverticulum with stones located on the ventral side, and an aberrant connection between the anterior bladder wall and the external surface of the skin. The patient was diagnosed with a vesicocutaneous fistula due to vesical diverticulitis and was successfully treated with a multidisciplinary approach including vesical diverticulectomy with stone removal and nonviable tissue debridement. The patient continues to receive regular outpatient follow-ups with urinary catheter changes. Conclusion Vesicocutaneous fistulas due to vesical diverticulitis with stones are extremely rare. We should be aware that a vesical diverticulum with stones located on the ventral side might pose a high-risk factor for the formation of a vesicocutaneous fistula in elderly patients.
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Affiliation(s)
- Jun Akatsuka
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Kyota Suzuki
- Department of UrologyNippon Medical SchoolTokyoJapan
| | | | - Masato Yanagi
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Yuki Endo
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Hayato Takeda
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Yuka Toyama
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Teruyuki Dohi
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
| | - Go Kimura
- Department of UrologyNippon Medical SchoolTokyoJapan
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13
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McGeorge S, Loh B, Shibu R, Dobeli K, Brown NJ, Esler R, Hacking C, Purvey M, Roberts MJ. Plain x-ray misses many ureteric calculi: Time to challenge the old dogma? BJUI Compass 2022; 4:59-61. [PMID: 36569499 PMCID: PMC9766866 DOI: 10.1002/bco2.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Stephen McGeorge
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Brendon Loh
- Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Ryan Shibu
- Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Karen Dobeli
- Department of Medical ImagingRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Nathan J. Brown
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Rachel Esler
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Craig Hacking
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Department of Medical ImagingRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Megan Purvey
- Emergency and Trauma CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Matthew J. Roberts
- Department of UrologyRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchBrisbaneQueenslandAustralia
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14
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Dias VL, Battaglene SC, Cobcroft JM, Goemann K, Nowak BF. Urinary calculi in larvae of striped trumpeter, Latris lineata. J Fish Dis 2022; 45:1281-1287. [PMID: 35638101 DOI: 10.1111/jfd.13660] [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] [Received: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Urinary calculi are observed in some cultured marine fish larvae and may negatively impact larval health and survival. This study assessed urinary calculi in striped trumpeter Latris lineata larvae from hatching to 28 days post-hatching (dph). The prevalence of urinary calculi was variable over time and ranged from 15% to 50%, whereas the average size of calculi increased with larval age. Urinary calculi were semi-translucent, light cream to white colour with irregular morphology and a uniform internal structure. The calculi resulted in pressure atrophy causing a distended epithelium of the urinary bladder of fish with calculi. The calculi were predominantly formed of calcium hydrogen phosphate (CaHPO4 ). Routine assessment of the prevalence of urinary calculi in marine fish larvae is recommended, along with other parameters, to monitor larval quality and inform hatchery management actions.
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Affiliation(s)
- Valera L Dias
- Department of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - Stephen C Battaglene
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, Australia
| | - Jennifer M Cobcroft
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, Australia
| | - Karsten Goemann
- Central Science Laboratory, University of Tasmania, Hobart, Australia
| | - Barbara F Nowak
- Institute for Marine and Antarctic Studies, University of Tasmania, Launceston, Australia
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15
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Sharma O, Mallik D, Ranjan S, Sherwani P, Kumar N, Basu S. Enterolith Causing Small Bowel Obstruction: Report of a Case and Review of Literature. Clin Exp Gastroenterol 2022; 15:101-104. [PMID: 35859713 PMCID: PMC9292452 DOI: 10.2147/ceg.s369640] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/07/2022] [Indexed: 12/05/2022] Open
Abstract
Enterolithiasis, also known as gastro-intestinal concretions, is an uncommon medical disorder that arises from intestinal stasis. Enteroliths are commonly caused by tuberculosis-related constriction and arise from intestinal diverticula. Small bowel obstruction caused by an enterolith is extremely uncommon and might be difficult to diagnose. The mortality rate of uncomplicated enterolithiasis is relatively low, but it rises to 3% in patients who have background comorbid illness, have significant bowel obstruction, and are diagnosed late. We present a rare case of an uncomplicated partial intestinal obstruction caused by an enterolith in an elderly male patient with small bowel diverticular disease who was treated nonoperatively and did not develop further symptoms in the six-month follow-up and discuss the difficulty in diagnosis and its management.
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Affiliation(s)
- Oshin Sharma
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Dhiraj Mallik
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sukrati Ranjan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Sherwani
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Navin Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Somprakas Basu
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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16
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Ignatova NI, Elagin VV, Ivanova TS, Kharitonova TM, Antonyan AE, Streltsova OS. Evaluation of the potential pathogenicity of microorganisms associated with urinary calculi. Klin Lab Diagn 2022; 67:369-373. [PMID: 35749603 DOI: 10.51620/0869-2084-2022-67-6-369-373] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Due to the prevalence of postoperative complications in the treatment of urolithiasis, the study of the contamination of urinary calculi and the potential pathogenicity of isolated bacteria is of great importance in laboratory diagnostic practice. It has been shown that uropathogenic bacteria are found in the composition of urinary stones in 65±7.1% of cases, mainly representatives of the Enterobacteriaceae and Staphylococcaceae families. Bacteria of the generas Escherichia, Enterococcus, Staphylococcus were most frequently detected. The analysis of biofilm activity and antibiotic resistance in 50 uropathogenic strains was carried out. It was shown that all the studied strains were resistant to at least two tested drugs, and the average value of the multiple resistance index was 0.51. When cultured on nutrient agar with Congo red, it was shown that more than half of the tested strains have high biofilm activity and about 80% potential for biofilm formation. The greatest biofilm activity was observed in bacteria of the generas Escherichia, Klebsiella, Enterobacter, Staphylococcus.
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Affiliation(s)
- N I Ignatova
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian
| | - V V Elagin
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian
| | - T S Ivanova
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian
| | - T M Kharitonova
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian
| | - A E Antonyan
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian
| | - O S Streltsova
- Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian
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17
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Qu J, Xu K. Case report of rescue of a patient with COVID-19 and shock after holmium laser lithotripsy. Int J Urol Nurs 2022; 16:IJUN12319. [PMID: 35600258 PMCID: PMC9111667 DOI: 10.1111/ijun.12319] [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: 08/27/2021] [Revised: 01/14/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
Lithotripsy is the primary form of treatment for ureteral calculus. According to clinical data, ureteroscopic lithotripsy (URSL) is characterized by better efficacy, a lower risk of complications, and a quicker postoperative recovery, when compared with open surgery. However, elderly patients often have a variety of chronic diseases that can directly or indirectly influence intraoperative care and postoperative recovery. It is important that medical staff closely observe changes in the postoperative condition of patients and provide them with the best quality care. In order to control the progression of disease and reduce mortality rates, it is very important to promptly eliminate the cause of shock, supplement blood volume, and correct cardiovascular disorders. During the pandemic caused by coronavirus disease 2019 (COVID-19), there has been a significant focus on management, predominantly operating rooms but also intensive care units (ICUs), to ensure that hospitals can provide prompt and effective diagnosis and treatment for every patient with COVID-19 and also prevent the spread of the virus and guarantee the safety of medical staff. During surgery on patients suspected of having COVID-19, it is important that specific personnel take control of the designated work and implement three strict levels of protection to prevent the transmission of the virus by air, droplets, and personal contact. Attention should be paid to the transfer of patients, the protection of medical staff, the management and control of negative pressure operation rooms, and postoperative treatment, thereby ensuring the safety of patients and medical staff. In this case report, we describe the nursing experience of rescuing a patient with COVID-19 who developed septic shock following flexible ureteroscopic holmium laser lithotripsy. The causes of septic shock were subsequently examined to inform a new protective strategy for rescuing patients with COVID-19 in the operating room and ICU, and to prevent and control cross-infection with the virus during surgery.
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Affiliation(s)
- Jiachun Qu
- Department of Anesthesiology and SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Kui Xu
- Department of Anesthesiology and SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
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18
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Saito T, Nakai Y, Mizuno S, Isayama H, Sasahira N, Kanai S, Noguchi K, Sato T, Ishigaki K, Hakuta R, Saito K, Hamada T, Takahara N, Kogure H, Koike K. Long-term outcome of endotherapy for pancreatic stones by using a dedicated pancreatic basket catheter. J Gastroenterol Hepatol 2021; 36:2424-2431. [PMID: 33675102 DOI: 10.1111/jgh.15481] [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: 12/04/2020] [Revised: 01/28/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Although endotherapy for pancreatic stones is less invasive compared with surgical interventions, its recurrence rate is high and residual pancreatic stones can be a cause of recurrence. We previously reported usefulness of a novel basket catheter with nitinol fine reticular structure for pancreatic stone retraction. In this retrospective study, we aimed to evaluate the long-term outcomes of endotherapy for pancreatic stones with and without the use of this dedicated basket catheter. METHODS We retrospectively compared patients with symptomatic pancreatic stones who underwent the initial endotherapy between 2008 and 2019. The primary outcome was the symptomatic recurrence after complete stone clearance. Secondary outcomes were the rate of complete stone clearance, complications, risk factors for recurrences, and the treatment cost. RESULTS A total of 101 patients who underwent endotherapy for pancreatic stones were analyzed: 41 patients by using the dedicated basket catheter and 60 patients by only the conventional devices. The complete stone clearance was achieved in 87.8% in the dedicated basket group and 88.3% in the conventional device group. Symptomatic recurrence was observed in 16.7% of the dedicated basket group and 47.2% of the conventional device group (P < 0.01). In the multivariate analysis, the use of the dedicated basket catheter was significantly associated with the reduced risk of symptomatic recurrence (hazard ratio, 0.40; 95% confidence interval, 0.15-0.92, P = 0.031). The complication rate and the cost were comparable between the two groups. CONCLUSION The use of this dedicated pancreatic basket catheter significantly reduced symptomatic recurrence after complete pancreatic stone removal.
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Affiliation(s)
- Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Suguru Mizuno
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Naoki Sasahira
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation of Cancer Research, Tokyo, Japan
| | - Sachiko Kanai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kensaku Noguchi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazunaga Ishigaki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryunosuke Hakuta
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kei Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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19
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Bar-Yaakov N, Hertzberg H, Marom R, Jikia J, Mano R, Beri A, Yossepowitch O, Sofer M. Introducing in clinical practice a new laser suction handpiece for percutaneous nephrolithotomy. Urologia 2021; 89:570-574. [PMID: 34256620 PMCID: PMC9551316 DOI: 10.1177/03915603211031874] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: To assess a novel combined laser suction handpiece (LSH) for performing PCNL
in a clinical setting. Methods: The study comprised 40 consecutive PCNLs performed between May 2019 and
February 2020. The first 20 procedures (Group A) were performed with
conventional ultrasonic or pneumatic devices and the other 20 (Group B) were
performed with the use of the new LSH. All patients were treated by tubeless
supine PCNL. The groups were compared for demographics, clinical data,
operative time, lithotrite effectiveness, stone clearance rate (SCR), and
outcome. Results: Groups A and B were similar in age, and in stone size, complexity, and
density (Hounsfield units) (p < 0.05). The average
operative time was 99 and 78 min, SCR 143 and 200 mm3/min,
hospital stay 1.6 and 1.1 days, and stone-free rate 90% and 95%,
respectively. Despite a trend toward better results with the new LSH, none
of these comparisons reached statistical significance. Ineffective
lithotripsy with the initial device (ultrasonic) requiring conversion to
another modality (ballistic) occurred in six (30%) procedures in Group A,
while all procedures were effectively accomplished with the LSH in Group B
(p = 0.02). There were two complications in Group A and
none in Group B (p > 0.05). Conclusions: The LSH is as effective and safe as the traditional lithotrites for
performing PCNLs. This new tool completes the capabilities of the holmium
laser high-power machines, enabling them to serve as the sole platform for
all endourological treatments.
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Affiliation(s)
- Noam Bar-Yaakov
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Hertzberg
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Marom
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jemal Jikia
- Endourology Unit, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Mano
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Beri
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mario Sofer
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Endourology Unit, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Ru N, Qian YY, Zhu JH, Chen H, Zou WB, Hu LH, Pan J, Guo JY, Li ZS, Liao Z. Post-ESWL and post-ERCP pancreatitis in patients with chronic pancreatitis: Do they share the same risks? J Hepatobiliary Pancreat Sci 2021; 28:778-787. [PMID: 34242478 DOI: 10.1002/jhbp.1013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/13/2021] [Accepted: 06/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endoscopic intervention combined with extracorporeal shock wave lithotripsy (ESWL) is recommended as the first line therapy for large pancreatic stones, yet both can cause adverse events. The aim of the study was to identify the risk factors for post-procedural pancreatitis. METHODS Consecutive patients with chronic pancreatitis and pancreatic stones treated with both ESWL and subsequent endoscopic retrograde cholangiopancreatography (ERCP) from October 2016 to December 2019 were prospectively enrolled. Multivariate logistic analyses were performed to detect risk factors for post-ESWL and post-ERCP pancreatitis (PEP). RESULTS A total of 714 patients (507 males, 45.60 ± 12.52 years) were included in this study. A total of 80 patients (11.2%) developed post-ESWL pancreatitis,while 33 patients (4.6%) suffered from PEP. Steatorrhea (P = .018), multiple stones (P = .043), and stones located at the head combined with the body or tail of the pancreas (P = .015) were identified as independent protective factors for post-ESWL pancreatitis. The history of acute exacerbations (P = .013), post-ESWL pancreatitis (P < .001) and stricture dilation during ERCP (P = .002) were identified as risk factors for PEP. CONCLUSIONS More attention should be paid to patients with post-ESWL pancreatitis, as well as a history of acute exacerbations and stricture dilation during ERCP to prevent PEP. (ClincialTrials.gov number, NCT04619511).
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Affiliation(s)
- Nan Ru
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Yang-Yang Qian
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Jia-Hui Zhu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Hui Chen
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Wen-Bin Zou
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Jun Pan
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Ji-Yao Guo
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.,National Clinical Research Center for Digestive Diseases, Shanghai, China.,Shanghai Institute of Pancreatic Diseases, Shanghai, China
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21
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Jiang Y, Zhang J, Kang N, Niu Y, Li Z, Yu C, Zhang J. Current Trends in Percutaneous Nephrolithotomy in China: A Spot Survey. Risk Manag Healthc Policy 2021; 14:2507-2515. [PMID: 34163270 PMCID: PMC8216069 DOI: 10.2147/rmhp.s301484] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/02/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To describe trends in the procedure of percutaneous nephrolithotomy (PCNL) in China to identify training needs. METHODS A spot survey with 36 questions, which revealed demographic data, patterns of PCNL practice, and opinions regarding specific clinical cases, was administered to Chinese urologists during the 17th National Urological Urolithiasis Symposium held in Dandong in 2018. RESULTS Out of 400 participants, 221 responses to the survey were received. PCNL was performed by 80.5% of the participants, and 70.2% of them were senior clinicians. It was found that 91% used the prone decubitus in training programs and 27.6% the modified supine, and 46.6% were apprenticeship trained for PCNL, while 5.6% trained during their residency. The prone position was the preferred decubitus, even for obese patients. All of the urologists established their own access, 93.7% used ultrasonography guidance alone, 70.7% used ultrasonic and/or pneumatic lithotripters, and 29.2% used laser. When exiting the kidney, 73.8% placed a nephrostomy tube whereas 26.2% used the tubeless technique. For postoperative follow-up, 51.3% used computed tomography (CT) or ultrasonography plus kidney-ureter-bladder (KUB) to monitor the results of procedures, while 45% used KUB alone. Colonic injury was reported by 8.9%. Average hospital stays of >3 days were reported for 81.2% of procedures. CONCLUSION Chinese urologists obtain their own access during PCNL, with ultrasonic guidance in most cases, and almost a half of them are apprenticeship trained. They prefer the prone position, use fascial dilators, and place a nephrostomy tube when exiting the kidney. Most urologists follow the official management guidelines in special cases. Skilled use of urological ultrasound examination, flexible nephroscopy, postoperative CT, tubeless procedures in selected patients, and urology residency training are recommended for PCNL practice.
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Affiliation(s)
- Yuguang Jiang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
| | - Jiqing Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
| | - Ning Kang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
| | - Yinong Niu
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
| | - Zhiwen Li
- Institute of Reproductive and Child Health, Peking University, School of Public Health, Peking University, Beijing, 100191, The People’s Republic of China
| | - Changlian Yu
- Department of Urology, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, 014010, The People’s Republic of China
| | - Junhui Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, The People’s Republic of China
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22
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Toole KP, Frank C, Jarvis MK, Pluckebaum S, Wiles B. Ureterolithiasis in Adolescents: A Case Report. J Pediatr Health Care 2021; 35:327-331. [PMID: 33674161 DOI: 10.1016/j.pedhc.2021.01.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
A 13-year-old patient presented to the emergency department with a history of abdominal pain and right flank pain. Two days before, she was evaluated at her pediatrician's office and was diagnosed with acute gastroenteritis and sent home. In the emergency department, the patient was diagnosed with ureterolithiasis after a physical examination, laboratory work, and imaging findings. She was treated successfully with conservative medical management. Symptomatic presentation of ureterolithiasis can include abdominal pain, flank pain, hematuria, dysuria, urgency, nausea, and vomiting. Nurse practitioners need to recognize nonspecific symptoms of ureterolithiasis for accurate diagnosis and treatment. Risk factors, signs and symptoms, prevention, and treatment options for ureterolithiasis are discussed.
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23
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Boamah MO, Brakohiapa EKK, Choi S, Blankson PK, Parkins GE. A rare case of multiple minor salivary gland sialoliths in the masseteric region. Clin Case Rep 2021; 9:e04038. [PMID: 34094553 PMCID: PMC8145269 DOI: 10.1002/ccr3.4038] [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: 01/15/2021] [Accepted: 02/21/2021] [Indexed: 11/06/2022] Open
Abstract
We report a case of a 59-year-old woman who presented with swelling of the right cheek. CT Scan showed three calculi located anteromedial to the masseter, and well isolated from other major salivary glands. Calculi were surgically removed with standard intraoral incision and exploration.
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Affiliation(s)
- Matthew Owusu Boamah
- Oral and Maxillofacial Surgery UnitKorle‐Bu Teaching HospitalAccraGhana
- Department of Oral and Maxillofacial SurgeryDental SchoolUniversity of GhanaAccraGhana
| | | | - Shaun Choi
- Oral and Maxillofacial Surgery UnitKorle‐Bu Teaching HospitalAccraGhana
| | - Paa Kwesi Blankson
- Oral and Maxillofacial Surgery UnitKorle‐Bu Teaching HospitalAccraGhana
- Department of Oral and Maxillofacial SurgeryDental SchoolUniversity of GhanaAccraGhana
| | - Grace E. Parkins
- Oral and Maxillofacial Surgery UnitKorle‐Bu Teaching HospitalAccraGhana
- Department of Oral and Maxillofacial SurgeryDental SchoolUniversity of GhanaAccraGhana
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24
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Kim YW, Lee SM, Choi HC, Won JH, Na JB, Cho JM, Choi DS, Park MJ, Shin HS, Kim JE, Park SE, Shim JJ. Percutaneous removal of common bile duct stones using a modified balloon technique. Medicine (Baltimore) 2021; 100:e24486. [PMID: 33832061 PMCID: PMC8036119 DOI: 10.1097/md.0000000000024486] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/29/2020] [Indexed: 01/05/2023] Open
Abstract
To evaluate the effectiveness of percutaneous removal of common bile duct (CBD) stones using a modified balloon technique (balloon catheter sphincteroplasty and expulsion of the stones using half-captured balloons within the sheath) in patients difficult to treat with endoscopy.Fifty patients underwent a modified balloon technique (balloon group), and 53 patients underwent CBD stone removal by the basket method (stone basket group) between 2016 and 2019. We compared the balloon and stone basket groups to evaluate the effectiveness of the modified balloon technique. Outcome variables such as demographics, technical success rates, procedural details, and complications were analyzed. Statistical analysis was performed using Student t test, Fisher exact test, or the χ2 test.The technical success rate in the balloon group was 66% (33/50) in 1 session, 32% (16/50) in 2 sessions, and 2% (1/50) in 3 sessions. That of the stone basket group was 45% (24/53) in 1 session, 38% (20/53) in 2 sessions, and 17% (9/53) in 3 sessions.The total procedure time was significantly shorter in the balloon group (29.5 ± 15.1 minutes) than in the stone basket group (41.7 ± 20.2 minutes) (P < .01), whereas the number of stones was higher in the balloon group than in the stone basket group (P = .03). Maximal stone size, balloon size, pancreatitis, and hospitalization stay did not show statistical differences between the 2 groups. Most complications (9 patients, balloon group; 8 patients, stone basket group) were mild and transient. Major complications occurred in one patient in the stone basket group, who experienced hemobilia due to arterial injury caused by percutaneous transhepatic biliary drainage, which was treated by endovascular embolization without mortality.The modified balloon technique is an effective and safe treatment method for CBD stone removal in patients presenting difficulties in the endoscopic approach.
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Affiliation(s)
- Yang Won Kim
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Sang Min Lee
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Jung Ho Won
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Jae Boem Na
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Jae Min Cho
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Mi Jung Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Hwa Seon Shin
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Ji Eun Kim
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeonsang National University Changwon Hospital, Changwon
| | - Jong Joon Shim
- Department of Radiology, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Wang X, Zhang B, Zhu Y, Ge H. Abdominal aortic rupture after extracorporeal shockwave lithotripsy: A rare case report and literature review. J Int Med Res 2021; 48:300060520931608. [PMID: 32538691 PMCID: PMC7297492 DOI: 10.1177/0300060520931608] [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] [Indexed: 11/18/2022] Open
Abstract
Extracorporeal shockwave lithotripsy (ESWL) is a common and effective treatment method for most renal and upper ureteral calculi. Aortic rupture after ESWL is an extremely rare complication. Seven cases of aortic rupture have been reported to date, and only one case involved the rupture of a calcified abdominal aorta. We herein describe a Chinese patient who was hospitalized for rupture of the abdominal aorta 5 days after ESWL for right ureteral calculi. The patient was transferred to the Department of Vascular Surgery and underwent emergency endovascular aortic repair. The patient’s recovery was unremarkable. One week after the operation, enhanced computed tomography showed that the size of the hematoma around the periaortic area was constant, and repeat enhanced computed tomography 1 month later showed that the hematoma had been significantly absorbed. ESWL may cause rupture of a heavily calcified abdominal aorta. We suggest that all patients with atherosclerosis being considered for ESWL should be evaluated by imaging examinations both preoperatively and during follow-up.
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Affiliation(s)
- Xin Wang
- Department of Vascular Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Bowen Zhang
- Department of Vascular Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yunfeng Zhu
- Department of Vascular Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Hongwei Ge
- Department of Vascular Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Harper JD, Metzler I, Hall MK, Chen TT, Maxwell AD, Cunitz BW, Dunmire B, Thiel J, Williams JC, Bailey MR, Sorensen MD. First In-Human Burst Wave Lithotripsy for Kidney Stone Comminution: Initial Two Case Studies. J Endourol 2021; 35:506-511. [PMID: 32940089 PMCID: PMC8080914 DOI: 10.1089/end.2020.0725] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: To test the effectiveness (Participant A) and tolerability (Participant B) of urinary stone comminution in the first-in-human trial of a new technology, burst-wave lithotripsy (BWL). Materials and Methods: An investigational BWL and ultrasonic propulsion system was used to target a 7-mm kidney stone in the operating room before ureteroscopy (Participant A). The same system was used to target a 7.5 mm ureterovesical junction stone in clinic without anesthesia (Participant B). Results: For Participant A, a ureteroscope inserted after 9 minutes of BWL observed fragmentation of the stone to <2 mm fragments. Participant B tolerated the procedure without pain from BWL, required no anesthesia, and passed the stone on day 15. Conclusions: The first-in-human tests of BWL pulses were successful in that a renal stone was comminuted in <10 minutes, and BWL was also tolerated by an awake subject for a distal ureteral stone. Clinical Trial NCT03873259 and NCT02028559.
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Affiliation(s)
- Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ian Metzler
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michael Kennedy Hall
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tony T. Chen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Adam D. Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Bryan W. Cunitz
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Barbrina Dunmire
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Jeff Thiel
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - James C. Williams
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael R. Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - Mathew D. Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
- Division of Urology, VA Puget Sound Health Care System, Seattle, Washington, USA
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Patel RM, Jiang P, Karani R, Phillips T, Arada RB, Xie L, Said H, Tapiero S, Landman J, Farzaneh T, Venkatesh R, Clayman RV. Analysis of Ureteral Diameter and Peristalsis in Response to Irrigant Fluid Temperature Changes in an In Vivo Porcine Model. J Endourol 2021; 35:1236-1243. [PMID: 33380276 DOI: 10.1089/end.2020.0849] [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] [Indexed: 11/12/2022] Open
Abstract
Objective: It has been previously reported that warming irrigation fluid higher than body temperature may decrease ureteral spasm and thereby facilitate ureteroscopic access to the proximal ureter. Our objective was to examine the effects on ureteral peristalsis and ureteral diameter if the irrigant was warmed to just under the biological threshold for injury. Materials and Methods: Two female adult Yorkshire pigs were studied in this pilot study. In the first pig, a dilute mixture of contrast and irrigation fluid at 37°C and then at 43°C was instilled for 30 minutes into each renal pelvis through a ureteral catheter at 40 mm Hg. Retrograde pyelogram images were captured for each trial and the caliber of the ureter was measured using Vitrea® software. In the second pig, a lumbotomy was performed, and a magnetic sensor was placed on the extraluminal surface of the ureter to monitor ureteral peristalsis while repeating the aforedescribed regimen. Thirty minutes after the first regimen, the force exerted during placement of a 16F ureteral access sheath (UAS) was recorded at both temperatures using the University of California, Irvine Ureteral Force Sensor. Results: There was no statistically significant difference in ureteral caliber along the length of the ureter at 43°C (p = 0.87, p = 0.32, p = 0.66 for proximal, middle, and distal ureter, respectively). Indeed, there was an increase in peristalsis from baseline with fluid irrigation at 37°C and at 43°C (59% and 65%, respectively). There was no significant difference in the force exerted for UAS placement at either temperature. On histologic analysis, there were no significant changes in ureteral histology or luminal diameter. Conclusions: In a porcine model, warming irrigation fluid to just under the biological threshold for injury did not increase ureteral caliber, decrease ureteral peristalsis, or facilitate UAS placement. As such, during ureteroscopy, we continue to warm our irrigation fluid just to body temperature.
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Affiliation(s)
- Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Pengbo Jiang
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Rajiv Karani
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Tarik Phillips
- Department of Urology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Raphael B Arada
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Lillian Xie
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Hyder Said
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Shlomi Tapiero
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ted Farzaneh
- Department of Pathology, University of California, Irvine, Orange, California, USA
| | | | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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Wiesmayr M, Meyer D, König F, Engeler D, Schmid HP, Müllhaupt G. First Report of a Symptomatic Calculus of the Ampulla of the Ductus Deferens. J Endourol Case Rep 2021; 6:253-255. [PMID: 33457647 DOI: 10.1089/cren.2020.0024] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Similar to other secretory organs, the male spermatic ducts may develop calculi. However, this condition is described as rare in literature and usually affects the seminal vesicles. As far as we know, no cases of calculi in the ampulla of the ductus deferens have been published so far. Patients with seminal vesicle calculi usually complain of hematospermia, painful ejaculation, perineal or testicular discomfort or pain, and often experience significant impairment of quality of life. Case Presentation: We present a case of a 39-year-old patient who presented himself in an external urologic practice with recurrent hematospermia and painful ejaculation. According to the diagnosis of a seminal vesicle calculus of 1 cm in length on the right side, the patient underwent a transurethral vesiculo- and ampulloscopy with a semirigid ureteroscope whereby the stone could be located in the ampulla of the ductus deferens and removed in toto. Conclusion: Lithiasis should be kept in mind when examining patients with hematospermia and ejaculation pain. Transurethral ampulloscopy is an efficient, safe, and minimally invasive method for stone removal from the ampulla of the ductus deferens.
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Affiliation(s)
- Magdalena Wiesmayr
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Daniel Meyer
- Doctor's Office for Urology, Urologie Appenzellerland, Herisau, Switzerland
| | - Frederik König
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Daniel Engeler
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Gautier Müllhaupt
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Murugan B, Das S, Aslam M M. Phimosis Presenting With Preputial Calculus: A Case Report on an Uncommon Presentation of a Common Condition. Cureus 2021; 13:e12475. [PMID: 33564497 PMCID: PMC7860983 DOI: 10.7759/cureus.12475] [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] [Indexed: 11/06/2022] Open
Abstract
Preputial calculus is a rare clinical entity in the realm of urolithiasis. It is usually seen in elderly people with poor hygiene. Experts postulate the formation to be driven by nidus deposition, accumulation of inorganic salts, and transmigration of stones along the urogenital system. An X-ray of the pelvis can confirm the diagnosis and surgical intervention can assuage the symptoms. In this case report, we describe an elderly male who presented with a hard penile swelling with a prior history of phimosis for a decade. He underwent an X-ray of the pelvis which helped diagnose a case of preputial calculus. We performed an emergency dorsal slit for the prompt removal of the calculus with follow up debridement. In conclusion, a clinical rarity such as this needs apt diagnosis and surgical mediation to treat it. Follow-up should be considered in the elderly given the possibility of malignant transformation in the future.
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Affiliation(s)
- Bala Murugan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Snehasis Das
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Mohammed Aslam M
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Canela VH, Bledsoe SB, Lingeman JE, Gerber G, Worcester EM, El‐Achkar TM, Williams JC. Demineralization and sectioning of human kidney stones: A molecular investigation revealing the spatial heterogeneity of the stone matrix. Physiol Rep 2021; 9:e14658. [PMID: 33403824 PMCID: PMC7786195 DOI: 10.14814/phy2.14658] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
The molecular mechanisms by which kidney stones grow are largely unknown. Organic molecules from the urine combine with mineral crystals to form stones, but analysis of the stone matrix has revealed over a thousand different proteins, with no clues as to which are important for stone growth. Molecules that are present in every layer of a stone would be candidates for having an essential function, and thus the analysis of the stone matrix at a microscopic level is necessary. For this purpose, kidney stones were demineralized, sectioned, stained, and imaged by microscopy, using micro CT for precise orientation. Histological staining demonstrated heterogeneity in the density of adjacent layers within stones. Additional results also showed brilliant and unique autofluorescence patterns in decalcified nephroliths, indicating heterogeneous organic composition in adjacent layers. Regions of calcium oxalate (CaOx) stones were dissected using laser microdissection (LMD) for protein analysis. LMD of broad regions of demineralized CaOx stone sections yielded the same proteins as those found in different specimens of pulverized CaOx stones. These innovative methodologies will allow spatial mapping of protein composition within the heterogeneous stone matrix. Proteins that consistently coincide spatially with mineral deposition would be candidates for molecules essential for stone growth. This kind of analysis will be required to assess which of the thousand proteins in the stone matrix may be fundamental for stone growth.
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Affiliation(s)
- Victor Hugo Canela
- Department of Anatomy, Cell Biology & PhysiologyIndiana University School of MedicineIndianapolisINUSA
| | - Sharon B. Bledsoe
- Department of Anatomy, Cell Biology & PhysiologyIndiana University School of MedicineIndianapolisINUSA
| | - James E. Lingeman
- Department of UrologyIndiana University School of MedicineIndianapolisINUSA
| | - Glenn Gerber
- Section of NephrologyDepartment of MedicineUniversity of ChicagoChicagoILUSA
| | - Elaine M. Worcester
- Section of NephrologyDepartment of MedicineUniversity of ChicagoChicagoILUSA
| | - Tarek M. El‐Achkar
- Department of Anatomy, Cell Biology & PhysiologyIndiana University School of MedicineIndianapolisINUSA
- Division of NephrologyDepartment of MedicineIndiana University and Roudebush Indianapolis Veterans Affairs Medical CenterIndianapolisINUSA
| | - James C. Williams
- Department of Anatomy, Cell Biology & PhysiologyIndiana University School of MedicineIndianapolisINUSA
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Abstract
Seminal Vesicle (SV) calculi are a rare pathology. Clinical presentation usually consists of nonspecific perineal pain and haematospermia. Adjuncts to aid diagnosis include US, MRI, and Vesiculography. This rare condition can be treated conservatively, however, surgical options are becoming more advanced with Vesiculoscopy now being the gold standard. Here, we present a case of a SV calculi treated conservatively.
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Affiliation(s)
| | - Adam Jones
- Department of Urology, Hereford County Hospital, Hereford, UK
| | - Yih Chyn Phan
- Department of Urology, Hereford County Hospital, Hereford, UK
| | - Wasim Mahmalji
- Department of Urology, Hereford County Hospital, Hereford, UK
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Chung JH, Baek M, Park SS, Han DH. The Feasibility of Pop-Dusting Using High-Power Laser (2 J × 50 Hz) in Retrograde Intrarenal Surgery for Renal Stones: Retrospective Single-Center Experience. J Endourol 2020; 35:279-284. [PMID: 33081518 DOI: 10.1089/end.2020.0585] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: Recently, retrograde intrarenal surgery (RIRS) using laser lithotripsy has become popular. However, the optimal laser energy setting for pop-dusting has not been established. In this study, we report our experiences of RIRS using the high-power (up to 100 W) pop-dusting (HPPD) technique. Methods: This study retrospectively assessed 82 cases with RIRS using HPPD. Patients who underwent abdominal CT or mercaptoacetyltriglycine (MAG3) diuretic renal scan at 3 months postoperatively were included in this study. Patient and stone characteristics and perioperative and postoperative outcomes were evaluated. Results: The average number of renal stones was 3.67 ± 4.11, and the average length of the largest stones was 13.30 ± 6.41 mm. The mean Hounsfield units was 959.99 ± 384.73. The operation time was 58.10 ± 26.67 minutes. The mean HPPD time was 11.93 ± 9.48 minutes, with settings of 1.97 ± 0.25 J and 48.78 ± 3.29 Hz. The stone-free rate was 89%. The mean hospital stay was 1.68 ± 1.29 days. Pelvicaliceal and ureter injuries were observed in 9.8% and 32.9% of the study population, respectively. However, there was no transfusion, subcapsular hematoma, persistent urinary leakage, ureteral or infundibular stricture, or renal functional deterioration. There was transient postoperative fever in 12.2% of the study population. Conclusions: HPPD could be performed safely during RIRS for renal stones without significant complications such as collecting system injury or bleeding. High-power laser mode (up to 100 W) can be a safe and effective choice for pop-dusting during RIRS, especially for large and hard stones.
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Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Soo Park
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Driggers EA. "A clue in a labyrinth:" The medico-chemistry of the stone in the life of Edward Darrell Smith. J Med Biogr 2020; 28:232-245. [PMID: 30179063 DOI: 10.1177/0967772018786706] [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: 06/08/2023]
Abstract
This article will argue that Edward Darrell Smith engaged in chemical analysis in order to broaden his understanding of the body, particularly stones, in a humoral framework. At the time, Antoine Lavoisier's chemical innovations were exciting the medical world, and Lavoisier himself was pursuing medical questions in his chemical research. Medical students from Philadelphia to Charleston were writing dissertations on the different types of stones and concretions found in the body. Smith practiced medicine in a world in which the remedy for the stone was compelling and a long awaited discovery. By examining Edward Darrell Smith's biography, we can get a vista into this world.
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Affiliation(s)
- Edward A Driggers
- Department of History, Tennessee Technological University, Cookeville, TN, USA
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Bernstein AP, Schulster M, Chao B, Silva MV. Bilateral Open Ureteroceles with Concomitant Bladder Calculi in an Adult Male. J Endourol Case Rep 2020; 6:103-106. [PMID: 33102700 DOI: 10.1089/cren.2019.0142] [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: 10/25/2022] Open
Abstract
Background: Bilateral ureteroceles in adult males are a rare occurrence, made even more so with simultaneous presence of bladder calculi. Management strategies for such patients are not well documented in the literature. We present a rare case of bilateral open ureteroceles with large concomitant bladder calculi to contribute to the paucity of literature on management of such patients. Case Presentation: We present the case of a 35-year-old man whose gross hematuria work-up demonstrated right-sided hydroureteronephrosis in the setting of bilateral ureteroceles and multiple large bladder calculi up to 3.8 cm. Conclusion: Bilateral orthotopic single-system ureteroceles in an adult male are a rare finding especially when intraoperatively found to be open secondary to traumatic effects of large calculi. Ultrasonic and pneumatic lithotripsy is a safe, appropriate, and effective option for bilateral ureteroceles contributing to a large bladder stone burden. Our report contributes to the growing body of literature on orthotopic bilateral single-system ureteroceles in the adult population with concomitant significant stone burden.
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Affiliation(s)
- Ari P Bernstein
- Department of Urology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Schulster
- Department of Urology, NYU Langone Medical Center, New York, New York, USA
| | - Brian Chao
- Department of Urology, NYU Langone Medical Center, New York, New York, USA
| | - Mark V Silva
- Department of Urology, NYU Langone Medical Center, New York, New York, USA
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Abstract
RATIONALE The indwelling ureteral stents is a common procedure in routine urological practice. The double-J (D-J) stent is the most common type of stents used and is indicated mainly for short-term urinary drainage and prevention of obstruction and infection. However, prolonged indwelling stents may result in disastrous complications, such as hematuria, infection, encrustation, and stone formation. In this context, the persistence of stent in situ might play a key role as a nidus in deposition of urinary sediment, then forming calculus. Although the encrustation may become more serious as time goes on, large bladder stones are relatively rare. However, the serious encrustation and giant stone may complicate or exacerbate the conditions in turn. PATIENT CONCERNS A 45-year-old female patient who underwent right ureteral stent placement after open ureterolithotomy 6 years ago complained of dysuria, urinary frequency, and urgency over 2 months. DIAGNOSIS The kidney ureter bladder (KUB) x-ray showed the presence of a giant stone in the bladder and an entire D-J stent. The computed tomography (CT) urography scans revealed normal left kidney, right hydronephrosis, and an encrusted D-J stent with the significant stone, diameter 4.2 cm with a CT value of 1211.0 ± 221.6 HU, on the vesical coil. On the basis of these auxiliary examinations, the case was diagnosed as cystolith and prolonged-indwelling stents. INTERVENTIONS Pneumatic ballistic lithotripsy was used for crushing the bladder calculi followed by the successful extraction of intact D-J ureteral stent. OUTCOMES No residual stone was detected on postoperative KUB x-ray and CT urography scans. Patient recovered well and was discharged 10 days after surgery. Semi-annual ultrasound examination was suggested to monitor the effect of therapy. LESSONS This case reminds us that it is crucial to take various measures to avoid the forgotten ureteral stent and its unfortunate late complication.
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Affiliation(s)
- Fuxun Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Jianhong Yu
- Department of Urology, the Affiliated Hospital of Gansu Medical College, Pingliang, Gansu, China
| | - Qianlong Wang
- Department of Urology, the Affiliated Hospital of Gansu Medical College, Pingliang, Gansu, China
| | - Yiping Lu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan
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Abstract
Background and objective Urolithiasis is defined as the presence of calculi in the urinary tract. Multiple studies have shown that urinary tract stones are one of the most common incidental findings in medical imaging. These stones are potentially dangerous and can cause severe impairment to renal function if they remain undiagnosed for a long time. The objective of this study was to determine the prevalence of incidentally detected urolithiasis in patients undergoing abdominopelvic CT scans. Materials and methods A retrospective cross-sectional study was conducted, which involved 721 patients selected by consecutive non-randomized sampling. The study population included patients who underwent an abdominopelvic CT scan in the radiology department of a tertiary care hospital in Pakistan. Patients aged below 10 years and those above 90 years were excluded from the study. Patients undergoing kidney, ureter, and bladder (KUB) scan for urolithiasis-associated symptoms and those with already known urolithiasis were also excluded. The data were recorded in a predesigned pro forma and analyzed with SPSS Statistics version 20.00 (IBM, Armonk, NY). Results A total of 721 patients underwent an abdominopelvic CT scan during the six months from July to December in the radiology department of the hospital. Out of these, 336 (46.6%) were males, and 385 (53.4%) were females. Incidental stones were found in 20 of these patients. Among these 20 stone formers, 11 were males, and nine were females. Out of them, six had stones in the right kidney, eight in the left kidney, and four patients had bilateral stones. The remaining two patients had stones in their ureters. In most cases, stones were found in lower poles as compared to the mid pole and upper pole of the kidneys. Conclusion The prevalence of incidentally detected urolithiasis was found to be 2.8% in this study. Its frequency was much higher in males (3.27%) compared to females (2.33%). Most of the stones were found in the kidneys whereas no stone was detected in the urinary bladder.
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Affiliation(s)
- Sajeel Saeed
- Surgery, Rawalpindi Medical University, Rawalpindi, PAK
| | - Ansar Ullah
- Surgery, Rawalpindi Medical University, Rawalpindi, PAK
| | - Jawad Ahmad
- Surgery, Rawalpindi Medical University, Rawalpindi, PAK
| | - Sidra Hamid
- Physiology, Rawalpindi Medical University, Rawalpindi, PAK
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Al-Terki A, Alkabbani M, Alenezi TA, Al-Shaiji TF, Al-Mousawi S, El-Nahas AR. Emergency vs elective ureteroscopy for a single ureteric stone. Arab J Urol 2020; 19:137-140. [PMID: 34104487 PMCID: PMC8158266 DOI: 10.1080/2090598x.2020.1813004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To compare emergency with elective ureteroscopy (URS) for the treatment of a single ureteric stone. Patients and methods The files of adult patients with a single ureteric stone were retrospectively reviewed. Patients with fever or turbid urine on passage of the guidewire beside the stone underwent ureteric stenting or nephrostomy drainage. Patients who underwent URS were included and divided into two groups: the emergency (EM) Group, those who presented with persistent renal colic and underwent emergency URS within 24 h; and the elective (EL) Group, who underwent elective URS after ≥14 days of diagnosis. Patients with ureteric stents were excluded. The technique for URS was the same in both groups. Safety was defined as absence of complications. Efficacy was defined as the stone-free rate after a single URS session. Results From March 2015 to September 2018, 179 patients (107 in the EM Group and 72 in the EL Group) were included. There were significantly more hydronephrosis and smaller stones in the EM Group (P = 0.002 and P = 0.001, respectively). Laser disintegration was needed in more patients in the EL Group (83% vs 68%, P = 0.023). Post-URS ureteric stents were inserted in more patients in the EM Group (91% vs 72%, P = 0.001). Complications were comparable for both groups (4.2% for EL and 5.6% for EM, P = 0.665). Stone-free rates were also comparable (93% in the EL Group and 96% in the EM Group, P = 0.336). Conclusions Emergency URS can be as safe and effective as elective URS for the treatment of a single ureteric stone if it is performed in patients without fever or turbid urine. Abbreviations: EL Group: elective group; EM Group: emergency group; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; MET: medical expulsive therapy; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: ureteroscopy
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Affiliation(s)
| | | | | | | | | | - Ahmed R El-Nahas
- Urology Unit, Al-Amiri Hospital, Kuwait City, Kuwait.,Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Lysenko AV, Razumova AY, Yaremenko AI, Mirzakhmedov RR. [Augmented reality in the treatment of sialolithiasis]. Stomatologiia (Mosk) 2020; 99:64-66. [PMID: 32692522 DOI: 10.17116/stomat20209904164] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In a clinical case we report on the primary application of modern methods of visualization using augmented reality in the treatment of patients with sialolithiasis for the localization of salivary stone in the parenchyma of the parotid salivary gland. Impression was taken and individual splint with radiopaque marker and a cutout for a probe was made. The splint was used for spiral CT of the head and neck. In surgical intervention under endotracheal anesthesia with intubation through the nose, the splint was placed in the mouth with a tap and a surgeon visualized the projection of the stone on the skin using glasses. The method allows to visualize salivary stone at all stages of surgery, regardless of the type of access or hydrotreatment. However, this technique does not make it possible to estimate the depth of the stone, as well as if the salivary stone is not fixed in the duct there is a risk of changing its position. In this regard, the use of augmented reality has a promising direction and requires further research.
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Affiliation(s)
- A V Lysenko
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
| | - A Ya Razumova
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
| | - A I Yaremenko
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
| | - R R Mirzakhmedov
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
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Ye Z, Mi Q, Luo D, Li Z, Luo J. A case report of primary upper urinary tract signet-ring cell carcinoma and literature review. BMC Urol 2020; 20:75. [PMID: 32590974 PMCID: PMC7318531 DOI: 10.1186/s12894-020-00645-y] [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: 11/10/2019] [Accepted: 06/18/2020] [Indexed: 01/22/2023] Open
Abstract
Background Upper tract urothelial carcinoma with pure non-urothelial histology is an exception but variants are present in ~ 25% of cases. Primary upper urinary tract signet -ring cell carcinoma is extremely rare. Case presentation We report the case of a 65-year-old male diagnosed primary upper urinary tract signet-ring cell carcinoma while underwent percutaneous nephrolithotomy. Radical nephroureterectomy and adjuvant chemotherapy were performed sequentially. The patient is now recovering well with a regular follow-up for more than 1 year. Conclusions The upper urinary tract malignancy often appears as a high grade, high stage tumor and has a uniformly poor prognosis, but a timely multimodal management can bring a good outcome.
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Affiliation(s)
- Zhaohua Ye
- Department of Urology, Dongguan People's Hospital, Dongguan, 523000, China
| | - Qiwu Mi
- Department of Urology, Dongguan People's Hospital, Dongguan, 523000, China.
| | - Daosheng Luo
- Department of Urology, Dongguan People's Hospital, Dongguan, 523000, China
| | - Zhixiong Li
- Department of Urology, Dongguan People's Hospital, Dongguan, 523000, China
| | - Jiexin Luo
- Department of Urology, Dongguan People's Hospital, Dongguan, 523000, China
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Eisner BH, Goldfarb DS, Baum MA, Langman CB, Curhan GC, Preminger GM, Lieske JC, Pareek G, Thomas K, Zisman AL, Papagiannopoulos D, Sur RL. Evaluation and Medical Management of Patients with Cystine Nephrolithiasis: A Consensus Statement. J Endourol 2020; 34:1103-1110. [PMID: 32066273 DOI: 10.1089/end.2019.0703] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Cystinuria is a genetic disorder with both autosomal recessive and incompletely dominant inheritance. The disorder disrupts cystine and other dibasic amino acid transport in proximal tubules of the kidney, resulting in recurrent kidney stone formation. Currently, there are no consensus guidelines on evaluation and management of this disease. This article represents the consensus of the author panel and will provide clinicians with a stepwise framework for evaluation and clinical management of patients with cystinuria based on evidence in the existing literature. Materials and Methods: A search of MEDLINE®/PubMed® and Cochrane databases was performed using the following key words: "cystine nephrolithiasis," "cystinuria," "penicillamine, cystine," and "tiopronin, cystine." In total, as of May 2018, these searches yielded 2335 articles, which were then evaluated for their relevance to the topic of evaluation and management of cystinuria. Evidence was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: Twenty-five articles on the topic of cystinuria or cystine nephrolithiasis were deemed suitable for inclusion in this study. The literature supports a logical evaluation process and step-wise treatment approach beginning with conservative measures: fluid intake and dietary modification. If stone formation recurs, proceed to pharmacotherapeutic options by first alkalinizing the urine and then using cystine-binding thiol drugs. Conclusions: The proposed clinical pathways provide a framework for efficient evaluation and treatment of patients with cystinuria, which should improve overall outcomes of this rare, but highly recurrent, form of nephrolithiasis.
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Affiliation(s)
- Brian H Eisner
- Deparment of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David S Goldfarb
- NYU Langone Health, New York, New York, USA.,NYU School of Medicine, New York, New York, USA
| | - Michelle A Baum
- Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Craig B Langman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Gary C Curhan
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - John C Lieske
- Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, USA
| | - Gyan Pareek
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kay Thomas
- Stone Unit, Guy's and St Thomas' NHS Foundation Trust, London, and King's College, London, United Kingdom
| | - Anna L Zisman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | - Roger L Sur
- UC San Diego Health, San Diego, California, USA
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Abstract
Certain drugs can cause kidney stones but as far as we are aware, ceftazidime-related urinary calculi have not been previously reported. We report here a case of an 8-year-old boy who developed hydronephrosis secondary to urinary calculi after receiving ceftazidime 2.0 g by intravenous infusion daily for two weeks. Previously, his left kidney showed no signs of disease. A retrograde double J ureteral stent was inserted, ceftazidime terminated, fluids increased and urine alkalised. On day 25, the patient showed no signs of kidney stones or hydronephrosis. Clinicians should be aware of the possibility of ceftazidime-related urinary calculi particularly if patients are receiving long-term treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Dan Du
- Dan Du, Department of Urology, Second People’s Hospital of Yichang, Second people’s Hospital of China Three Gorges University, 21 Xiling One Road, Yichang, 443000, Hubei Province, China.
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Ma S, Taher A, Zhu B, Durkan AM. Post-renal transplant urolithiasis in children: an increasingly diagnosed complication: a retrospective cohort study. Arch Dis Child 2020; 105:69-73. [PMID: 31243010 DOI: 10.1136/archdischild-2019-317203] [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: 03/10/2019] [Revised: 06/03/2019] [Accepted: 06/16/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Urolithiasis in renal transplant (RTx) recipients is a potential cause of allograft loss if obstruction is untreated. It is not clear if paediatric transplant recipients are following the global trend for increased prevalence of urolithiasis over time. DESIGN/SETTING/PATIENTS A retrospective chart review was undertaken to evaluate the frequency, risk factors and characteristics of post-RTx urolithiasis over two decades (1995-2016), in a tertiary Australian paediatric hospital. RESULTS Stones were diagnosed in 8 of 142 (5.6%) recipients, 6 of whom were transplanted in the latter decade. All patients were male, with a median age 4.9 years and median weight 11.8 kg. Presentation was with haematuria (n=4), pain (n=2), dysuria (n=2), stone passage (n=1) and asymptomatic (n=1). Time to presentation was bimodal; three stones were identified in the initial 3 months post RTx and the remainder after 31-53 months. Two stones were in association with retained suture material and two patients had recurrent urinary tract infections. The average stone size was 8.4 mm. Five stones were analysed; all contained calcium oxalate, three were mixed, including one with uric acid. Five (83.3%) children had hypercalciuria but none had hypercalcaemia. Cystolithotripsy was the the most common treatment (n=5), in combination with citrate supplementation. No graft was lost due to stones. CONCLUSIONS Calculi occur with increasing frequency after renal transplantation. Clinicians need a high index of suspicion as symptoms may be atypical in this population. The cause for the increased frequency of stones in transplant recipients is not clear but is in keeping with the increase seen in the general paediatric population.
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Affiliation(s)
- Sophia Ma
- Nephrology, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Amir Taher
- Nephrology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Benjamin Zhu
- Nephrology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Anne Maria Durkan
- Nephrology, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Paediatrics, University of Sydney, Sydney, New South Wales, Australia
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Yang H, Wang Y, Gao J, Wang P, Jiang X, Tian D, Hu H. Laparoscopic treatment of a huge seminal vesicle calculus: A case report and review of literature. Exp Ther Med 2019; 18:4799-4803. [PMID: 31798705 PMCID: PMC6880402 DOI: 10.3892/etm.2019.8160] [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: 01/25/2019] [Accepted: 09/10/2019] [Indexed: 11/20/2022] Open
Abstract
A 67-year-old male patient had a history of repeated urinary tract infections for numerous years. X-ray examination revealed a large calcific density in the pelvic cavity, with a diameter of 10.4 cm and a CT value of ~792.9 HU. On MRI of the pelvis, the lesion displayed with extremely low signals. The inside of the stone had a concentric ring shape with a slightly higher signal and the patient was diagnosed with a large left seminal vesicle calculus. Laparoscopic surgery was selected to treat the stone. The patient recovered rapidly and the symptoms, including urgency, urinary frequency, as well as lower abdominal and perineal pain, were obviously improved. The present case study reports on the largest seminal vesicle calculus reported in the current English literature in addition to a brief literature review. Cases of seminal vesicle calculi (SVC) are rare. The present study reports on a case of SVC, which is the largest reported in current English literature, to the best of our knowledge.
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Affiliation(s)
- Han Yang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Yinlei Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Jie Gao
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Ping Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Xingkang Jiang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Dawei Tian
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Hailong Hu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
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Abstract
RATIONALE Crossed renal ectopia (CRE) is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital and bone malformations. To the best of our knowledge, only 35 cases of crossed renal ectopia involving calculi and 30 cases of CRE associated with renal carcinoma have been reported to date. PATIENT CONCERNS Here, we present 2 cases of crossed renal ectopia. A 59-year-old woman with diabetes presented to our hospital with abdominal pain. The second patient was a 24-year-old woman who complained with abdominal pain with a duration of 1 day. DIAGNOSES On the basis of abdominal ultrasonography, we suspected a solitary kidney both in the two patients. Combined with retrograde pyelography and 3D computed tomography, case 1 was diagnosed as an S-shaped right-to-left crossed-fused ectopic kidney with many stones in the left (normal) renal pelvis and case 2 was confirmed to have lump right-to-left crossed-fused renal ectopia with two 3-mm stones in the renal pelvis of the 2 kidneys. INTERVENTIONS Case 1 underwent percutaneous nephrolithotomy while case 2 refused to undergo surgery and underwent conservative treatment for pain relief. OUTCOMES Two patients have been followed up and have no stones recurrence. LESSONS Crossed fused renal ectopia is easily misdiagnosed as a solitary kidney. CRE is so rare that the recognition of the disease needs to be improved and effective treatment should be taken timely. According to the two cases and literature review, minimally invasive surgery has become increasingly common to treat CRE with stones and carcinoma.
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Miao C, Liang C, Wang Y, Song Z, Xu A, Liu B, Li J, Song N, Wang Z. The management and composition of symptomatic seminal vesicle calculi: aetiological analysis and current research. BJU Int 2019; 125:314-321. [PMID: 30924591 DOI: 10.1111/bju.14758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report our experience in the diagnosis, minimally invasive treatment, and composition of seminal vesicle calculi (SVC). PATIENTS AND METHODS In the present study, we evaluated 20 patients who were admitted to our hospital from January 2013 to January 2018. All the patients were diagnosed with intractable haematospermia and SVC. The diagnosis was further confirmed by seminal vesiculoscopy. SVC were removed by basket extraction; with larger SVC fragmented by holmium laser before extraction. Scanning electron microscopy, X-ray diffraction, and infrared spectroscopy were used to determine the SVC composition. RESULTS All operations were completed successfully without surgical complications. SVC were mostly composed of hydroxyapatite and protein, suggesting that they were produced by infections. CONCLUSIONS Seminal vesiculoscopy is a simple, minimally invasive technique that can be used for diagnostic confirmation and treatment of seminal vesiculitis with SVC. This study improves our understanding of SVC and provides a theoretical basis for the prevention of postoperative recurrence of SVC.
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Affiliation(s)
- Chenkui Miao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Liang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yamin Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen Song
- Department of Urology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Aiming Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bianjiang Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Sun Y, Tang C, Bai YJ, Li N, Yang L, Wei Q, Wei X, Shen H. Urethral diverticular with broadly squamous metaplasia in a patient with urethral diverticular calculi: A case report. Medicine (Baltimore) 2019; 98:e16923. [PMID: 31441877 PMCID: PMC6716745 DOI: 10.1097/md.0000000000016923] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE There are already several reports concerning the occurrence of urethral diverticulum (UD) in female patients, but only rarely has a article describing UD combined with UD calculi or squamous carcinoma been published. Moreover, a case with squamous carcinoma and UD calculi at the same time has never been reported, making this the first case report about this condition. PATIENT CONCERNS A 43-year-old woman presented to the gynaecology department with a complaint of a hard mass beneath the anterior vaginal wall. DIAGNOSES Transvaginal ultrasound (TVU) revealed a UD. INTERVENTIONS We performed a standard urethral diverticular excision. Intraoperatively, we identified and removed a stone from the diverticulum. The intraoperative finding of a stone challenged the diagnosis of UD, with subsequent histological examination of biopsy tissue from the mass demonstrating broadly squamous metaplasia. OUTCOMES The broadly squamous metaplasia predominantly originated from the stone, and the stone was entirely removed. No complications occurred during the whole follow-up period. Moreover, after the 12-month follow-up, there was no diverticular recurrence or carcinoma metastasis. LESSONS UD calculi may be considered a risk factor for female urethra squamous metaplasia, which with the potential of squamous carcinoma, so patients will be advised to treat this condition immediately.
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Affiliation(s)
- Yi Sun
- Department of Urology, West China Hospital, Sichuan University, No. 37 Guoxue, Xiang, Chengdu
| | - Cai Tang
- West China School of public health and West China Fourth Hospital, Sichuan University, Sichuan
| | - Yun-jin Bai
- Department of Urology, West China Hospital, Sichuan University, No. 37 Guoxue, Xiang, Chengdu
| | - Na Li
- Department of Pediatrics, Chengdu Tianfu New District People's Hospital, Chengdu, China
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, No. 37 Guoxue, Xiang, Chengdu
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, No. 37 Guoxue, Xiang, Chengdu
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Abstract
Objectives: The aim of this study was to investigate frequencies of kidney stone constituents in a Norwegian population and examine trends over time by comparing with an earlier study of this population. Materials and methods: Upper urinary tract calculi consecutively collected from patients who underwent stone surgery at Akershus University Hospital from July 2014 to December 2017, in total 1252 calculi, were analysed by infrared spectroscopy. The results were compared with a study of 500 calculi collected from June 1975 to September 1980 at the same hospital. Results: The male:female ratio was 1.83:1. Single-component stones constituted 39%, 35% were binary, and 25% ternary. Main stone component frequencies were oxalate 71.3%, calcium oxalate monohydrate 53.7% with higher occurrence in males, calcium oxalate dihydrate 17.6%, carbonate apatite 10.8% and struvite 5.7%, both with higher occurrence in females, uric acid 8.9% with a non-significant male predominance, brushite 1.6% and cystine about 1%. Over four decades the frequency of UA stones increased by 4.6-times, whereas struvite and pure carbonate apatite stones decreased and no change was observed for brushite stones. Conclusion: Frequencies of kidney stone types in this Norwegian population are mainly in accordance with other studies, except a large increase in UA stones over four decades, partly caused by a particularly low frequency of UA stones in the old study, a decreased carbonate apatite frequency over four decades, and an unaltered brushite frequency. Also, in contrast to other studies, a relatively small and non-significant male UA stone predominance was found.
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Affiliation(s)
- Gunnhild Kravdal
- a Multidisciplinary Laboratory Medicine and Medical Biochemistry , Akershus University Hospital HF , Lørenskog , Norway
| | - Dan Helgø
- b Department of Urology , Akershus University Hospital HF , Lørenskog , Norway
| | - Morten K Moe
- a Multidisciplinary Laboratory Medicine and Medical Biochemistry , Akershus University Hospital HF , Lørenskog , Norway
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Loftus CJ, Hinck B, Makovey I, Sivalingam S, Monga M. Mini Versus Standard Percutaneous Nephrolithotomy: The Impact of Sheath Size on Intrarenal Pelvic Pressure and Infectious Complications in a Porcine Model. J Endourol 2019; 32:350-353. [PMID: 29385812 DOI: 10.1089/end.2017.0602] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 01/23/2023] Open
Abstract
OBJECTIVE To determine how sheath and endoscope size affect intrarenal pelvic pressures and risk of postoperative infectious complications comparing "Mini" vs "Standard" percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS Uropathogenic Escherichia coli were grown and 109 of them were instilled into the porcine renal pelvis through retrograde access for 1 hour. Percutaneous access utilized a 14/16F 20 cm ureteral access sheath for the Mini arm and a 30F sheath for the Standard arm. Nephroscopy was simulated utilizing either an 8/9.8F semirigid ureteroscope or 26F nephroscope for 1 hour while intrarenal pelvic pressure was continuously monitored. Blood and tissue cultures of kidney, liver, and spleen biopsies were plated and incubated and positive cultures were confirmed with polymerase chain reaction. RESULTS Intrapelvic pressures were higher in the Mini group, 18.76 ± 5.82 mm Hg vs 13.56 ± 5.82 mm Hg (p < 0.0001). Time spent above 30 mm Hg was greater in the Mini arm, 117.0 seconds vs 66.1 seconds (p = 0.0452). All pigs had positive kidney tissue cultures whereas spleen cultures were positive in 100% and 60% of pigs in the Mini and Standard arms, respectively (p = 0.0253); 90% and 30% had positive liver tissue culture in the Mini and Standard arms, respectively (p = 0.0062). Blood cultures were positive in 30% of pigs in the Mini arm compared with none in the Standard arm (p = 0.0603). CONCLUSION Mini-PCNL was associated with higher intrarenal pressures and higher risk of end organ bacterial seeding in the setting of an infected collecting system. This suggests a higher potential for infectious complications in a clinical setting.
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Affiliation(s)
- Christopher J Loftus
- 1 Department of Urology, University of Washington Medical Center , Seattle, Washington
| | - Bryan Hinck
- 2 Glickman Urological and Kidney Institute , Cleveland Clinic Cleveland, Ohio
| | - Iryna Makovey
- 2 Glickman Urological and Kidney Institute , Cleveland Clinic Cleveland, Ohio
| | - Sri Sivalingam
- 2 Glickman Urological and Kidney Institute , Cleveland Clinic Cleveland, Ohio
| | - Manoj Monga
- 2 Glickman Urological and Kidney Institute , Cleveland Clinic Cleveland, Ohio
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49
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Reesink DJ, Scheltema JMW, Barendrecht MM, Boeken Kruger AE, Jansonius A, Wiltink J, van der Windt F. Extracorporeal shock wave lithotripsy under intravenous sedation for treatment of urolithiasis. Scand J Urol 2018; 52:453-458. [PMID: 30451054 DOI: 10.1080/21681805.2018.1524398] [Citation(s) in RCA: 2] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND In contrast to treatment with oral or intramuscular analgesics, extracorporeal shock wave lithotripsy (E.S.W.L.) can be performed with patients under sedation too. Besides the advantage of increased shock energy, patients tend to have more constant breathing excursions and are more idle during treatment, potentially increasing the stone-free ratio (S.F.R.) after treatment. METHODS This study presents the results of 310 patients who underwent 400 E.S.W.L. procedures under sedation, with a stationary lithotripter. RESULTS After one procedure, the S.F.R. was 54.8% (170/310). A second treatment was successful in 42.1% (32/76), a third treatment in 21.4% (3/14). Therefore, 66.1% (205/310) of patients eventually became stone-free. Kidney stones were successfully treated in 65.4% (161/246), ureteral stones in 68.8% (44/64) of cases. Patients with stones ≤15 mm were successfully treated in 67.4% (194/288), patients with stones >15 mm in 50% (11/22) of cases. Considering each procedure individually, 45.3% (181/400) of procedures were successful after 3 weeks. Extending follow-up to 3 months is important, since 26.7% of stones (24/90) eventually still disappeared, increasing S.F.R. to 51.3% after one procedure. Complications occurred after 5.5% E.S.W.L.-procedures. CONCLUSIONS E.S.W.L. is a well-tolerated, non-invasive procedure that produces reasonable stone clearance of both upper and lower urinary tract calculi. Performing the procedure whilst patients are intravenously sedated results in an acceptable S.F.R. Strong selection based on unfavourable factors could increase the chance on successful treatment and spare patients a pointless procedure. However, considering E.S.W.L.'s elegant nature, sometimes a more tolerant approach seems justifiable.
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Affiliation(s)
- Daan J Reesink
- a Urology Department , Tergooi Hospital Hilversum/Blaricum , Blaricum , The Netherlands
| | - J M W Scheltema
- a Urology Department , Tergooi Hospital Hilversum/Blaricum , Blaricum , The Netherlands
| | - M M Barendrecht
- a Urology Department , Tergooi Hospital Hilversum/Blaricum , Blaricum , The Netherlands
| | - A E Boeken Kruger
- a Urology Department , Tergooi Hospital Hilversum/Blaricum , Blaricum , The Netherlands
| | - A Jansonius
- a Urology Department , Tergooi Hospital Hilversum/Blaricum , Blaricum , The Netherlands
| | - J Wiltink
- a Urology Department , Tergooi Hospital Hilversum/Blaricum , Blaricum , The Netherlands
| | - F van der Windt
- a Urology Department , Tergooi Hospital Hilversum/Blaricum , Blaricum , The Netherlands
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50
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Abstract
Crystalluria can involve the kidney and lower urinary tract, can produce acute and chronic effects, and occurs in all mammalian species. Most commonly urinary crystals contain calcium. Numerous other endogenous and exogenous substances can produce crystalluria. Crystals are identified in kidneys of many species, up to 100% in certain rat strains. More severe renal disease (acute tubular necrosis and chronic renal disease) can be secondary to crystal accumulation, such as observed with melamine-cyanuric acid in cats and dogs. Aggregation of crystals leads to calculi that act as urothelial abrasives with consequent regenerative proliferation. Accumulation in the kidney pelvis or bladder can lead to partial or complete obstruction and hydronephrosis. Long-term presence of urinary tract calculi in rodents leads to increased risk of urothelial tumors, but not in humans. Crystals in the lower urinary tract can act as irritants in rodents, but not in humans. It is critical that specific procedures are followed to optimize the presence of crystals in urine for diagnosis, including not fasting the animals. Numerous factors have been identified which can enhance or inhibit crystal formation. Extrapolation from animals for the threshold toxicity of crystals/calculi is appropriate but is not relevant for cancer risk assessment.
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Affiliation(s)
- Samuel M Cohen
- 1 Havlik-Wall Professor of Oncology, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
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