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Zheng J, Zhang J, Cai J, Yao Y, Lu S, Wu Z, Cai Z, Tuerxun A, Batur J, Huang J, Kong J, Lin T. Development of a radiomics model to discriminate ammonium urate stones from uric acid stones in vivo : A remedy for the diagnostic pitfall of dual-energy computed tomography. Chin Med J (Engl) 2024; 137:1095-1104. [PMID: 37994499 PMCID: PMC11062676 DOI: 10.1097/cm9.0000000000002866] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Dual-energy computed tomography (DECT) is purported to accurately distinguish uric acid stones from non-uric acid stones. However, whether DECT can accurately discriminate ammonium urate stones from uric acid stones remains unknown. Therefore, we aimed to explore whether they can be accurately identified by DECT and to develop a radiomics model to assist in distinguishing them. METHODS This research included two steps. For the first purpose to evaluate the accuracy of DECT in the diagnosis of uric acid stones, 178 urolithiasis patients who underwent preoperative DECT between September 2016 and December 2019 were enrolled. For model construction, 93, 40, and 109 eligible urolithiasis patients treated between February 2013 and October 2022 were assigned to the training, internal validation, and external validation sets, respectively. Radiomics features were extracted from non-contrast CT images, and the least absolute shrinkage and selection operator (LASSO) algorithm was used to develop a radiomics signature. Then, a radiomics model incorporating the radiomics signature and clinical predictors was constructed. The performance of the model (discrimination, calibration, and clinical usefulness) was evaluated. RESULTS When patients with ammonium urate stones were included in the analysis, the accuracy of DECT in the diagnosis of uric acid stones was significantly decreased. Sixty-two percent of ammonium urate stones were mistakenly diagnosed as uric acid stones by DECT. A radiomics model incorporating the radiomics signature, urine pH value, and urine white blood cell count was constructed. The model achieved good calibration and discrimination {area under the receiver operating characteristic curve (AUC; 95% confidence interval [CI]), 0.944 (0.899-0.989)}, which was internally and externally validated with AUCs of 0.895 (95% CI, 0.796-0.995) and 0.870 (95% CI, 0.769-0.972), respectively. Decision curve analysis revealed the clinical usefulness of the model. CONCLUSIONS DECT cannot accurately differentiate ammonium urate stones from uric acid stones. Our proposed radiomics model can serve as a complementary diagnostic tool for distinguishing them in vivo .
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Affiliation(s)
- Junjiong Zheng
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong 510120, China
| | - Jie Zhang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong 510120, China
| | - Jinhua Cai
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
| | - Yuhui Yao
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong 510120, China
| | - Sihong Lu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong 510120, China
| | - Zhuo Wu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
| | - Zhaoxi Cai
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, China
| | - Aierken Tuerxun
- Department of Urology, The First People's Hospital of Kashgar Prefecture, Kashgar, Xinjiang 844000, China
| | - Jesur Batur
- Department of Urology, The First People's Hospital of Kashgar Prefecture, Kashgar, Xinjiang 844000, China
| | - Jian Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong 510120, China
| | - Jianqiu Kong
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong 510120, China
| | - Tianxin Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, Guangdong 510120, China
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Schrag TA, Diarra D, Veser J. Prevention, diagnosis, and treatment of urolithiasis in geriatric patients - differences, similarities and caveats in comparison to the general population. Curr Opin Urol 2024; 34:154-165. [PMID: 38445376 DOI: 10.1097/mou.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
PURPOSE OF REVIEW Purpose of the review is to address management and prevention of urolithiasis in elderly patients examining the dynamic interplay between general measures, dietary adjustments, lifestyle modifications, and targeted pharmacological and/ or surgical interventions. The goal is to provide understanding of the evolving strategies required for effective urolithiasis prevention in the geriatric population. RECENT FINDINGS Age-specific diagnostic considerations are necessary because urolithiasis in the elderly population is characterized by bigger stones, greater peri-operative risks, and heightened symptom severity. When comorbidities are present, conservative treatments - especially analgesia - provide difficulties. Surgical procedures prove to be safe and effective, with complication rates and practical application comparable to younger cohorts. Prevention approaches that include lifestyle changes and the investigation of novel pharmaceutical options such as sodium-dependent glucose co-transporter 2 (SGLT-2)-inhibitors are promising in the management of urolithiasis in the elderly population. SUMMARY Our review offers a thorough investigation of urolithiasis in the elderly population, elucidating distinct clinical manifestations, complex diagnostic issues, and treatment implications. The safety and effectiveness of ureteroscopy in older patients, as well as the possible prophylactic function of SGLT-2-I, offer crucial insights for clinicians. Subsequent studies are necessary to enhance age-specific therapies, addressing the distinct obstacles presented by urolithiasis in the elderly population within this rapidly growing demographic.
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Siener R, Stein J, Ritter M. [Prevention of recurrence of urolithiasis]. Urologie 2024; 63:387-395. [PMID: 38466398 DOI: 10.1007/s00120-024-02312-8] [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] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
Urolithiasis is one of the most frequent urological diseases. Identifying the causes of stone formation forms the basis for successful prevention of recurrence. Metabolic diagnostics and measures for prevention of recurrence are based on the assignment of the patient to a low-risk or high-risk group. Analysis of the urinary calculi is an essential prerequisite for identifying patients at risk. The general recommendations on diet and lifestyle are considered to be the basis of treatment. Depending on the type of stone and the individual biochemical risk profile of a patient, these general measures should be supplemented by targeted medical nutrition therapy and pharmacological treatment. Mixed stones can pose a challenge for the treatment and prevention of recurrence. A personalized treatment decision that takes the various components of mixed stones into account could further improve the prevention of recurrence of urolithiasis.
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Affiliation(s)
- Roswitha Siener
- Universitäres Steinzentrum, Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Johannes Stein
- Universitäres Steinzentrum, Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Manuel Ritter
- Universitäres Steinzentrum, Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Lombardo R, Tzelves L, Geraghty R, Davis NF, Neisius A, Petřík A, Gambaro G, Türk C, Somani B, Thomas K, Skolarikos A. Follow-up of urolithiasis patients after treatment: an algorithm from the EAU Urolithiasis Panel. World J Urol 2024; 42:202. [PMID: 38546854 DOI: 10.1007/s00345-024-04872-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/08/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To develop a follow-up algorithm for urinary stone patients after definitive treatment. MATERIALS AND METHODS The panel performed a systematic review on follow-up of urinary stone patients after treatment (PROSPERO: CRD42020205739). Given the lack of comparative studies we critically evaluated the literature and reached a consensus on the follow-up scheme. RESULTS A total of 76 studies were included in the analysis, including 17 RCTs. In the stone-free general population group, 71-100% of patients are stone-free at 12 months while 29-94% remain stone-free at 36 months. We propose counselling these patients on imaging versus discharge after the first year. The stone-free rate in high-risk patients not receiving targeted medical therapy is < 40% at 36 months, a fact that supports imaging, metabolic, and treatment monitoring follow-up once a year. Patients with residual fragments ≤ 4 mm have a spontaneous expulsion rate of 18-47% and a growth rate of 10-41% at 12 months, supporting annual imaging follow-up. Patients with residual fragments > 4 mm should be considered for surgical re-intervention based on the low spontaneous expulsion rate (13% at 1 year) and high risk of recurrence. Plain film KUB and/or kidney ultrasonography based on clinicians' preference and stone characteristics is the preferred imaging follow-up. Computed tomography should be considered if patient is symptomatic or intervention is planned. CONCLUSIONS Based on evidence from the systematic review we propose, for the first time, a follow-up algorithm for patients after surgical stone treatment balancing the risks of stone recurrence against the burden of radiation from imaging studies.
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Affiliation(s)
| | - Lazaros Tzelves
- National and Kapodistrian University of Athens, Chairman of the EAU Urolithiasis Guidelines, Department of Urology, Sismanogleio Hospital, Athens, Greece
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Niall F Davis
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Andreas Neisius
- Department of Urology, Hospital of the Brothers of Mercy Trier, Medical Campus University Mainz, Trier, Germany
| | - Ales Petřík
- Department of Urology, Region Hospital, Ceske Budejovice, Czech Republic
- Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
| | - Christian Türk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria
- Urologische Praxis, Vienna, Austria
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kay Thomas
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Andreas Skolarikos
- National and Kapodistrian University of Athens, Chairman of the EAU Urolithiasis Guidelines, Department of Urology, Sismanogleio Hospital, Athens, Greece.
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Mulyani GT, Pramono AB, Pangestiningsih TW. Diagnosis and treatment of urolithiasis in a Toy Poodle dog. Open Vet J 2024; 14:937-940. [PMID: 38682149 PMCID: PMC11052625 DOI: 10.5455/ovj.2024.v14.i3.23] [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] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/23/2024] [Indexed: 05/01/2024] Open
Abstract
Background Urolithiasis in dogs is a disorder of the urinary tract caused by the development of crystals. These crystals are composed of minerals such as phosphates, oxalates, urates, cystine, carbonates, and silica. It can be fatal if the diagnosis and treatment are inaccurate. This report aims to report a case of urolithiasis in a Toy Poodle dog. Case Description A 2-year-old male Toy Poodle dog weighing 4.2 kg with black hair, and having trouble urinating was presented to Prof. Soeparwi Animal Hospital, Universitas Gadjah Mada, Indonesia. The dog is examined physically and, in the laboratory, diagnosed and continued with operative therapy. The history and physical examination revealed that the dog had been experiencing hematuria, stranguria, and oliguria for 2 months, with the last few days accompanied by decreased appetite. The dog exhibited decreased skin turgor, a capillary refill time (CRT) of less than 2 seconds, signs of pain and distress during urination, and palpation of distended urinary vesicles. Ultrasound scans revealed uroliths in the urinary vesica, which were identified by an acoustic shadow. Blood tests indicated a decrease in hematocrit and erythrocytes along with an increase in leukocytes. Urolithiasis was diagnosed in the case dog based on anamnesis, physical examination, hematological examination, and ultrasonography. Subsequently, a cystotomy was performed, and uroliths located in urinary vesicles were removed. The dog received ceftriaxone injections at 15 mg/kg body weight and vitamin B-complex injections at a concentration of 10 mg/kg body weight for 5 days. Four days post-surgery, the case dog was able to successfully urinate and pass clean urine. Conclusion The Toy Poodle dog was diagnosed with silica urolithiasis in the urinary vesicles and the urolith is quite large. Cystotomy was performed to remove the urolith. Postoperative care were included the administration of antibiotics and vitamins to facilitate the healing process. The condition of the Poodle toy dog improved.
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Affiliation(s)
- Guntari Titik Mulyani
- Department of Internal Medicine, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Agung Budi Pramono
- Prof. Soeparwi Animal Hospital, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tri Wahyu Pangestiningsih
- Departement of Anatomy, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Sun X, Zhou S, Zhang Y, Ma C, Hu Y, Tian S, Wang X, Kong L, Huang Z, Liang T, Wan H, Wang P. Simultaneous Detection of Citric Acid and Oxalic Acid Based on Dual Spectrum and Biomimetic Peroxidase for Urolithiasis Screening with a Fully Automatic Urine Analyzer. Small 2024; 20:e2304941. [PMID: 37822184 DOI: 10.1002/smll.202304941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/29/2023] [Indexed: 10/13/2023]
Abstract
Urolithiasis stands as a prevalent ailment within the urinary system, with hyperoxaluria and hypocitraturia being the most frequent manifestations characterized by excessive oxalic acid (OA) and deficient citric acid (CA) levels in urine. Detecting these compounds in urine quantitatively holds paramount importance for early urolithiasis screening. Existing methodologies fall short in achieving simultaneous and on-site identification of OA and CA, posing challenges for accurate urolithiasis screening. Addressing this concern, the study successfully accomplishes the concurrent identification of OA and CA in urine through a combination of dual-spectral analysis and biomimetic peroxidase utilization. Bovine serum albumin and dithiothreitol-modified copper nanoclusters (BSA-DTT-CuNCs) are employed as biomimetic peroxidases, effectively mitigating interference and enabling the simultaneous determination of OA and CA. The quantification range spans from 0 to 12 mm for OA and 0.5 to 2.5 mm for CA, with detection limits of 0.18 and 0.11 mm, respectively. To facilitate swift and on-location urine analysis, a fully automated urine analyzer (FAUA) is introduced that streamlines the process of biomarker pretreatment and identification within urine samples. Validation with real urine samples from urolithiasis patients demonstrates the method's diagnostic precision, highlighting the dual-spectral technique and analyzer's promising role in urolithiasis screening.
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Affiliation(s)
- Xianyou Sun
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Shuqi Zhou
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Yanchi Zhang
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Chiyu Ma
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Yanjie Hu
- Department of Respiratory Medicine, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Shichao Tian
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Xinyi Wang
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Liubing Kong
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Zhuoru Huang
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Tao Liang
- Research Center for Quantum Sensing, Zhejiang Lab, Hangzhou, 310000, China
| | - Hao Wan
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
- State Key Laboratory of Transducer Technology, Chinese Academy of Sciences, Shanghai, 200050, China
- Binjiang Institute of Zhejiang University, Hangzhou, 310053, China
| | - Ping Wang
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, Zhejiang University, Hangzhou, 310027, China
- State Key Laboratory of Transducer Technology, Chinese Academy of Sciences, Shanghai, 200050, China
- Binjiang Institute of Zhejiang University, Hangzhou, 310053, China
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Salevitz D, Lin CY, Alcanzo B, Namjoshi A, Lee P, Monteilh C, Grimsby G. Standardization of the management of pediatric urolithiasis in the emergency department. J Pediatr Urol 2024; 20:89.e1-89.e6. [PMID: 37919215 DOI: 10.1016/j.jpurol.2023.10.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION The incidence of urolithiasis in the pediatric population is rising and medical expulsive therapy (MET) using alpha-adrenergic antagonists has been found to be effective in aiding in the passage of ureteral stones in children. A prior review of patients presenting to our quaternary children's hospital with urolithiasis found only 54 % were prescribed MET and these patients had increased rates of spontaneous stone passage. Thus, an ED urolithiasis management protocol was created to standardize evaluation and care of children with suspected urolithiasis. OBJECTIVE To compare management of children with urolithiasis presenting to the ED before and after urolithiasis management protocol implementation. METHODS This is a retrospective review of patients with urolithiasis who presented to our children's ED from 2011 to 2022. The primary outcome was rate of MET prescribing before and after pathway implementation in July 2017, thus the pre-implementation group comprises patients who presented to the ED from July 2011 to July 2017, and the post-protocol group includes those who presented from August 2017 to April 2022. Secondary outcomes included CT utilization in the ED, surgical intervention rate, proportion with spontaneous stone passage, and frequency of urology consultation. Two-sample t-test and Fisher's exact test were used to compare the outcomes of interest before and after protocol implementation. RESULTS Of 337 patients who presented to the ED after protocol implementation, 120 met inclusion criteria. When comparing outcomes before and after implementation of the protocol, there was significantly decreased use of CT scans (79 % vs 50 %, p < 0.0001) and increased prescribing of MET (54 % vs 82 %, p < 0.0001). There was a significant decrease in opioids prescribed (44 % vs 26.7 %, p = 0.0040), and an increased rate of spontaneous stone passage (34 % vs 46 %, p = 0.0483). Lastly, there was a significant reduction in the rate of surgery for stone management after the implementation of protocol (35 % vs 17 %, p = 0.0020) DISCUSSION: As the ED is the primary site of presentation for many children with urolithiasis, standardization of evaluation and management provides an opportunity to improve outcomes in this population. We found that implementation of an ED urolithiasis management protocol was associated with decreased use of CT scans, decreased opioid prescribing, increased spontaneous stone passage, and decreased rate of surgical management for children with ureteral stones. CONCLUSIONS This study demonstrates the positive impact of standardizing care for children presenting to the ED with urolithiasis.
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Affiliation(s)
| | - Chung-Yon Lin
- University of Arizona, College of Medicine, Phoenix, United States
| | - Bernice Alcanzo
- University of Arizona, College of Medicine, Phoenix, United States
| | - Abhijeet Namjoshi
- Department of Pediatrics, Phoenix Children's Hospital, United States
| | - Philip Lee
- Department of Pediatrics, Phoenix Children's Hospital, United States
| | - Cecilia Monteilh
- Department of Emergency Medicine, Phoenix Children's Hospital, United States
| | - Gwen Grimsby
- Division of Urology, Phoenix Children's Hospital, United States.
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Szymanska B, Debowski J, Malkiewicz B, Piwowar A. Assessment of interleukin 17A and 23 in the course of bladder cancer and selected benign urological diseases. J Physiol Pharmacol 2024; 75. [PMID: 38583441 DOI: 10.26402/jpp.2024.1.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/19/2024] [Indexed: 04/09/2024]
Abstract
Several cytokines have been indicated to be significantly involved in urological diseases. Interleukin 17A (IL-17A) and interleukin 23 (IL-23) have recently received attention for their involvement in inflammatory diseases and cancers. The aim of the study was to show changes in the level of pro-inflammatory interleukins IL-17A and IL-23 in patients with bladder cancer (BC) and selected urological diseases. An important cognitive aspect was to study the interdependencies between the studied interleukins and to assess their diagnostic value for such diseases. The material for the study was urine sample from patients with BC, urinary tract infection (UTI), urolithiasis, benign prostatic hyperplasia (BPH), US (urethral stricture), which was compared to the urine sample of healthy people without urological disorders. Interleukin concentrations were measured by the immunoenzymatic method. The levels of IL-17A and IL-23 in the urine of patients with BC, UTI, BPH and US were significantly higher compared to the control group. Statistically significant differences were found in the level of both interleukins compared to the control group in all diseases except urolithiasis. IL-17A and IL-23 correlated with each other in patients with all urological diseases except urolithiasis. The results of the conducted studies showed that selected urological diseases changed the levels of IL-17A and IL-23 in the urine of patients. The observations made confirmed the participation of these interleukins in the course of the urological diseases, especially in BC, and allowed to classify them as potentially useful parameters for diagnostic purposes.
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Affiliation(s)
- B Szymanska
- Department of Toxicology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland.
| | - J Debowski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Wroclaw, Poland
| | - B Malkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Wroclaw, Poland
| | - A Piwowar
- Department of Toxicology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
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Cakir H, Caglar U, Yildiz O, Meric A, Ayranci A, Ozgor F. Evaluating the performance of ChatGPT in answering questions related to urolithiasis. Int Urol Nephrol 2024; 56:17-21. [PMID: 37658948 DOI: 10.1007/s11255-023-03773-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 08/12/2023] [Accepted: 08/26/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE ChatGPT is an artificial intelligence (AI) program with natural language processing. We analyzed ChatGPT's knowledge about urolithiasis whether it can be used to inform patients about urolithiasis. METHODS Frequently asked questions (FAQs) about urolithiasis on the websites of urological associations and hospitals were analyzed. Also, strong recommendation-level information was gathered from the urolithiasis section of the European Association of Urology (EAU) 2022 Guidelines. All questions were asked in order in ChatGPT August 3rd version. All answers were evaluated separately by two specialist urologists and scored between 1 and 4, where 1: completely correct, 2: correct but inadequate, 3: a mix of correct and misleading information, and 4: completely incorrect. RESULTS Of the FAQs, 94.6% were answered completely correctly. No question was answered completely incorrectly. All questions about general, diagnosis, and ureteral stones were graded as 1. Of the 60 questions prepared according to the EAU guideline recommendations, 50 (83.3%) were evaluated as grade 1, and 8 (13.3%) and 2 (3.3%) as grade 3. All questions related to general, diagnostic, renal calculi, ureteral calculi, and metabolic evaluation received the same answer the second time they were asked. CONCLUSION Our findings demonstrated that ChatGPT accurately and satisfactorily answered more than 95% of the questions about urolithiasis. We conclude that applying ChatGPT in urology clinics under the supervision of urologists can help patients and their families to have better understanding on urolithiasis diagnosis and treatment.
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Affiliation(s)
- Hakan Cakir
- Department of Urology, Fulya Acibadem Hospital, Sisli, Istanbul, Turkey.
| | - Ufuk Caglar
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Oguzhan Yildiz
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Arda Meric
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ali Ayranci
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Faruk Ozgor
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
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Hu K, Chen X, Song X, Wu Y, Huang K, Chen P. Carbon dots and MnO 2 nanosheet nanocomposites sensing platform for sensitive detection of oxalate in urine samples of urolithiasis patients. Talanta 2024; 266:124976. [PMID: 37499363 DOI: 10.1016/j.talanta.2023.124976] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
In the human body, oxalate tends to form calcium oxalate with calcium ions, which can trigger the formation of stones in the urinary system. Therefore, oxalate in urine is usually utilized as a crucial biomarker in clinical urolithiasis diagnoses. In this work, a turn-on fluorescent nanoprobe was developed based on nitrogen-doped carbon dots (N-CDs) and MnO2 nanosheets (NSs) nanocomposites for oxalate sensing in urolithiasis patients. MnO2 NSs is a good sensing platform with high extinction coefficients and rich redox chemistry. The fluorescent N-CDs can be quenched efficiently by MnO2 NSs through the inner filter effect (IFE) to form N-CDs-MnO2 nanocomposites. The reductive oxalate could operate the decomposition of MnO2 NSs to Mn2+ resulting in the dissociation of the N-CDs-MnO2 nanocomposites and fluorescence recovery of N-CDs. Under optimal conditions, the developed sensor revealed good specificity toward oxalate with a limit of detection (LOD) of 0.69 μM. The developed sensor was successfully applied to quantify oxalate content in 47 urine samples (41 urolithiasis patients and 6 healthy persons). The results showed great consistency with clinical diagnostic reports and computed tomography images. This novel method retains several unique advantages, including affordable, rapid, and validating potential clinical application.
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Affiliation(s)
- Kelin Hu
- Key Laboratory of the Evaluation and Monitoring of Southwest Land Resources, Ministry of Education, College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China
| | - Xin Chen
- Key Laboratory of the Evaluation and Monitoring of Southwest Land Resources, Ministry of Education, College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China
| | - Xuemei Song
- Key Laboratory of the Evaluation and Monitoring of Southwest Land Resources, Ministry of Education, College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China
| | - Yiman Wu
- Key Laboratory of the Evaluation and Monitoring of Southwest Land Resources, Ministry of Education, College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China
| | - Ke Huang
- Key Laboratory of the Evaluation and Monitoring of Southwest Land Resources, Ministry of Education, College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China.
| | - Piaopiao Chen
- Department of Laboratory Medicine, Med+X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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11
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Gil A, Kushnir D, Frajewicki V. The Association of Urolithiasis with Uricosuria, Uricemia and their Combination. Isr Med Assoc J 2024; 26:18-23. [PMID: 38420637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND There are conflicting data on the significance of hyperuricemia or hyperuricosuria in urolithiasis formation and on the need for medical treatment. OBJECTIVES To assess the significance of hyperuricemia or hyperuricosuria in urolithiasis formation, particularly when hyperuricemia occurs with normal uricosuria. METHODS The electronic medical records of patients treated in Haifa and the Western Galilee district of Clalit Health Services, Israel, were retrospectively screened for diagnosis of nephrolithiasis or renal or urinary tract/bladder calculi between February 2014 and April 2019. The diagnosis was confirmed by ultrasonography or computed tomography. The study group included patients with one of these diagnoses. Patients in the control group did not have these diagnoses. The inclusion criterion for all patients was the presence of both serum and urinary uric acid levels. RESULTS The study group included 359 patients and the control group 267. After adjustment by logistic regression, we found no significant differences in the prevalence of hyperuricosuria in the study group (14.8%) compared to the control group (9.7%), odds ratio (OR) 1.54 (95% confidence interval [95%CI] 0.74-3.2, P = 0.245). No significant differences between the groups were observed for hyperuricemia prevalence (45.4% vs. 55.1%, respectively, OR 0.82, 95%CI 0.54-1.25, P = 0.355), nor among those without hyperuricosuria (OR 0.83, 95%CI 0.52-1.33, P = 0.438) and after propensity score matching (OR 0.93, 95%CI 0.66-1.3, P = 0.655). CONCLUSIONS There were no significant differences in hyperuricemia or hyperuricosuria between the two groups of patients or in hyperuricemia among participants without hyperuricosuria.
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Affiliation(s)
- Amnon Gil
- Department of Nephrology and Hypertension, Carmel Medical Center, Haifa, Israel, Department of Nephrology and Hypertension, Lin Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daniel Kushnir
- Department of Nephrology and Hypertension, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Victor Frajewicki
- Department of Nephrology and Hypertension, Carmel Medical Center, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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12
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Yoo MJ, Pelletier J, Koyfman A, Long B. High risk and low prevalence diseases: Infected urolithiasis. Am J Emerg Med 2024; 75:137-142. [PMID: 37950981 DOI: 10.1016/j.ajem.2023.10.049] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023] Open
Abstract
INTRODUCTION Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of infected urolithiasis, including presentation, diagnosis, and management in the emergency department based on current evidence. DISCUSSION Although urolithiasis is common and the vast majority can be treated conservatively, the presence of a concomitant urinary tract infection significantly increases the risk of morbidity, to include sepsis and mortality. Identification of infected urolithiasis can be challenging as patients may have symptoms similar to uncomplicated urolithiasis and/or pyelonephritis. However, clinicians should consider infected urolithiasis in toxic-appearing patients with fever, chills, dysuria, and costovertebral angle tenderness, especially in those with a history of recurrent urinary tract infections. Positive urine leukocyte esterase, nitrites, and pyuria in conjunction with an elevated white blood cell count may be helpful to identify infected urolithiasis. Patients should be resuscitated with fluids and broad-spectrum antibiotics. Additionally, computed tomography and early urology consultation are recommended to facilitate definitive care. CONCLUSIONS An understanding of infected urolithiasis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Michael J Yoo
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT, Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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13
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Leow EH, Chong SL, Tan ES, Koh AL, Cham BWM, Yap CJY, Ng YH. Adenine phosphoribosyl transferase (APRT) deficiency and a novel sequence variant in APRT with phenotypic diversity and a literature review. Nephrology (Carlton) 2023; 28:649-654. [PMID: 37619970 DOI: 10.1111/nep.14232] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Adenine phosphoribosyl transferase (APRT) deficiency is an autosomal recessive disorder and a rare cause of urolithiasis due to mutations in APRT (OMIM #102600). APRT deficiency results in increased urinary excretion of 2,8-dihydroxyadenine (DHA) which can cause urolithiasis and kidney failure. However, with prompt diagnosis, patients with APRT deficiency can be treated with xanthine oxidoreductase inhibitors which decrease urinary DHA excretion and improve outcomes. We report a pair of siblings, an 11-year-old brother and his 14-year-old sister with compound heterozygous variants c.270del (p.Lys91Serfs*46) and c.484_486del (p.Leu162del) in APRT with variable clinical presentation of APRT deficiency. The brother presented at 17 months of age with urolithiasis and severe acute kidney injury. His elder sister remained well and asymptomatic with normal kidney function and did not develop renal calculi. Brownish disk or sphere-like crystals with both concentric and radial markings were reported on urine microscopy in the sister on screening. The sister's diagnosis was confirmed with further laboratory evidence of absent red cell lysate APRT activity with corresponding elevated levels of urinary DHA. In conclusion, we identified a novel mutation in the APRT gene in a pair of siblings with greater phenotypic severity in the male.
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Affiliation(s)
- Esther Huimin Leow
- Nephrology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Siew Le Chong
- Nephrology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ee Shien Tan
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ai Ling Koh
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Breana Wen Min Cham
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Celeste Jia Ying Yap
- Nephrology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yong Hong Ng
- Nephrology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
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14
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Meria P, Raynal G, Denis E, Plassais C, Cornet P, Gil-Jardiné C, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones. Prog Urol 2023; 33:791-811. [PMID: 37918980 DOI: 10.1016/j.purol.2023.08.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.
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Affiliation(s)
- P Meria
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France
| | - G Raynal
- Clinique Métivet, department of urology, Saint-Maur-des-Fossés, France
| | - E Denis
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France
| | - P Cornet
- Department of General Medicine, Sorbonne University, SFMG, Paris, France
| | - C Gil-Jardiné
- Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, SFR-SIGU, Bordeaux, France; Inserm U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University, ISPED, Bordeaux, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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15
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Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Specific cases - chronic kidney disease, bilateral stones, and solitary kidney. Prog Urol 2023; 33:875-882. [PMID: 37918987 DOI: 10.1016/j.purol.2023.08.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Chronic kidney disease, diabetes and hypertension are risk factors of kidney function impairment. The relative risk of kidney failure is 1.52 in patients with urinary stone disease. The various techniques used to remove upper urinary tract stones generally do not alter kidney function in patients with normal kidney function and may sometimes improve kidney function or slow its deterioration in patients with kidney disease. Compared to the asynchronous treatment of bilateral renal and ureteral stones, concomitant treatment is associated with higher risk of anuria and the need of additional interventions, in the absence of postoperative stenting. For the treatment of solitary kidney stones, the absence of postoperative stenting increases the risk of postoperative anuria. Moreover, the multiplication of percutaneous nephrolithotomy access tracts increases the risk of bleeding and that of kidney function impairment. METHODOLOGY: These recommendations were developed according to two methods: the Clinical Practice Recommendations (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and their adaptability to the French context.
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Affiliation(s)
- P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris-Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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16
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Lemoine S, Dahan P, Haymann JP, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Medical management - from diagnosis to treatment. Prog Urol 2023; 33:911-953. [PMID: 37918992 DOI: 10.1016/j.purol.2023.08.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The morphological-compositional analysis of urinary stones allows distinguishing schematically several situations: dietary, digestive, metabolic/hormonal, infectious and genetic problems. Blood and urine testing are recommended in the first instance to identify risk factors of urinary stone disease in order to avoid recurrence or progression. The other objective is to detect a potential underlying pathology associated with high risk of urinary stone disease (e.g. primary hyperparathyroidism, primary or enteric hyperoxaluria, cystinuria, distal renal tubular acidosis) that may require specific management. Lifestyle-diet measures are the basis of the management of all stone types, but pharmacological treatments may be required. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU 2022] and their adaptability to the French context.
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Affiliation(s)
- S Lemoine
- Hospices Civils de Lyon, SFNDT, SP, Lyon, France
| | - P Dahan
- Nephrology Department, Clinique Saint-Exupéry, SFNDT, Toulouse, France
| | - J P Haymann
- Inserm, UMRS 1155 UPMC, Tenon Hospital, SP, Paris, France; Service d'Explorations Fonctionnelles Multidisciplinaires, Tenon Hospital, Paris, France
| | - P Meria
- Service d'Urologie, Hôpital Saint Louis, AP-HP-Centre Université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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17
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von Bargen MF, Glienke M, Wilhelm K, Neubauer J, Weiß J, Kotter E, Mager R, Jorg T, Mildenberger P, Pinto Dos Santos P, Gratzke C, Schoenthaler M. [Report template from the German Society of Urology and the German Radiological Society for standardized, structured reporting of native computed tomography scans in the diagnosis of urinary stones]. Urologie 2023; 62:1169-1176. [PMID: 37755575 DOI: 10.1007/s00120-023-02199-x] [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] [Accepted: 08/24/2023] [Indexed: 09/28/2023]
Abstract
Standardized structured radiological reporting (SSRB) has been promoted in recent years. The aims of SSRB include that reports be complete, clear, understandable, and stringent. Repetitions or superfluous content should be avoided. In addition, there are advantages in the presentation of chronological sequences, tracking and correlations with structured findings from other disciplines and also the use of artificial intelligence (AI)-based methods. The development of the presented template for SSRB of native computed tomography for urinary stones followed the "process for the creation of quality-assured and consensus-based report templates as well as subsequent continuous quality control and updating" proposed by the German Radiological Society (DRG). This includes several stages of drafts, consensus meetings and further developments. The final version was published on the DRG website ( www.befundung.drg.de ). The template will be checked annually by the steering group and adjusted as necessary. The template contains 6 organ domains (e.g., right kidney) for which entries can be made for a total of 21 different items, mostly with selection windows. If "no evidence of stones" is selected for an organ in the first query, the query automatically jumps to the next organ, so that the processing can be processed very quickly despite the potentially high total number of individual queries for all organs. The German, European, and North American Radiological Societies perceive the establishment of a standardized structured diagnosis of tomographic imaging methods not only in oncological radiology as one of the current central tasks. With the present template for the description of computed tomographic findings for urinary stone diagnostics, we are presenting the first version of a urological template. Further templates for urological diseases are to follow.
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Affiliation(s)
- M F von Bargen
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
| | - M Glienke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - K Wilhelm
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - J Neubauer
- Medizinische Fakultät, Klinik für Radiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Weiß
- Medizinische Fakultät, Klinik für Radiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - E Kotter
- Medizinische Fakultät, Klinik für Radiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - R Mager
- Klinik für Urologie, Universitätsklinikum Mainz, Mainz, Deutschland
| | - T Jorg
- Klinik für Radiologie, Universitätsklinikum Mainz, Mainz, Deutschland
| | - P Mildenberger
- Klinik für Radiologie, Universitätsklinikum Mainz, Mainz, Deutschland
| | | | - C Gratzke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
| | - M Schoenthaler
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland
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18
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Almeras C, Estrade V, Meria P. 2022 Recommendations of the AFU Lithiasis Committee: Endoscopic description of renal papillae and stones. Prog Urol 2023; 33:766-781. [PMID: 37918978 DOI: 10.1016/j.purol.2023.08.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Endoscopic observation is performed during treatments by flexible ureteroscopy to differentiate in situ between renal papillary abnormalities and stones based on their concordance with Daudon's morphological/composition descriptions adapted to endoscopy. These intraoperative visual analyses are now an integral part of the urinary stone disease diagnostic approach in addition to the morphological/structural and spectrophotometric analysis that remains the reference exam, but that loses information on the stone component representativeness due to the development of in situ laser lithotripsy. These are the first practical recommendations on the endoscopic description of renal papillae and stones. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations (CPR) and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Affiliation(s)
- C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
| | - V Estrade
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - P Meria
- Service d'urologie, Hôpital Saint-Louis, AP-HP-Centre université Paris cité, Paris, France
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19
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Daudon M, Haymann JP, Estrade V, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Epidemiology, stone analysis and composition. Prog Urol 2023; 33:737-765. [PMID: 37918977 DOI: 10.1016/j.purol.2023.08.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The incidence of urinary lithiasis is rising steadily in industrialized countries, and its prevalence in the general population of France is estimated at 10%. Renal colic accounts for 1-2% of emergency department consultations. At a time when the new LASER stone fragmentation techniques available to urologists will lead to ever finer in situ pulverization of stones, the exact identification of the compounds that form the stone is essential for etiological diagnosis. Constitutional analysis by infrared spectrophotometry or X-ray diffraction is therefore recommended, to be complemented by morphological typing of the calculi. METHODOLOGY: These recommendations have been drawn up using two methods: the Recommendation for Clinical Practice (RPC) method and the ADAPTE method, depending on whether or not the issue was considered in the EAU recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU 2022] and their adaptability to the French context.
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Affiliation(s)
- M Daudon
- CRISTAL Laboratory, Tenon Hospital, SFBC, Paris, France; Inserm, UMRS 1155 UPMC, Tenon Hospital, Paris, France
| | - J-P Haymann
- Inserm, UMRS 1155 UPMC, Tenon Hospital, Paris, France; Service d'Explorations Fonctionnelles Multidisciplinaires, Tenon Hospital, SP, Paris, France
| | - V Estrade
- Department of Urology, CHU Pellegrin, Bordeaux, France
| | - P Meria
- Service d'Urologie, Hôpital Saint-Louis, AP-HP-Centre Université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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20
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Schönthaler M, Miernik A. [Imaging for urolithiasis]. Urologie 2023; 62:1144-1152. [PMID: 37702750 DOI: 10.1007/s00120-023-02193-3] [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] [Accepted: 08/16/2023] [Indexed: 09/14/2023]
Abstract
The substantial reduction of radiation exposure using (ultra-)low dose programs in native computed tomographic imaging has led to considerable changes in imaging diagnostics and treatment planning in urolithiasis in recent years. In addition, especially in Germany, ultrasound diagnostics is highly available in terms of equipment and with increasing expertise. This can largely replace the previous radiation-associated procedures in emergency and follow-up diagnostics, but also in intraoperative imaging, e.g., in percutaneous stone therapy (intraoperative fluoroscopy). This is reflected in the international guidelines, which recommend these two modalities as first-line diagnostics in all areas mentioned. Continuous technical development enables ever higher resolution imaging and thus improved diagnostics with high sensitivity and specificity. This also enables reliable imaging of particularly vulnerable patient groups, such as children or pregnant women. In addition, methods from the field of artificial intelligence (AI; machine learning, deep learning) are increasingly being used for automated stone detection and stone characterization including its composition. Furthermore, AI models can provide prognosis models as well as individually tailored treatment, follow-up, and prophyaxis. This will enable further personalization of diagnostics and therapy in the field of urolithiasis.
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Affiliation(s)
- Martin Schönthaler
- Universitätsklinikum Freiburg, Freiburg, Deutschland.
- Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
| | - A Miernik
- Universitätsklinikum Freiburg, Freiburg, Deutschland
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21
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Kim HJ, Oh SH. Comprehensive prediction of urolithiasis based on clinical factors, blood chemistry and urinalysis: UROLITHIASIS score. Sci Rep 2023; 13:14885. [PMID: 37689768 PMCID: PMC10492849 DOI: 10.1038/s41598-023-42208-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023] Open
Abstract
Comprehensive prediction of urolithiasis using available factors obtained in the emergency department may aid in patient-centered diagnostic imaging decisions. This retrospective study analyzed the clinical factors, blood chemistry and urine parameters of patients who underwent nonenhanced urinary computed tomography for suspected urolithiasis. A scoring system was developed from a logistic regression model and was tested using the area under the curve (AUC). The prevalence of urolithiasis and important possible causes in the three risk subgroups were determined. Finally, the scoring model was validated. In the derivation cohort (n = 673), 566 patients were diagnosed with urolithiasis. Age > 35 years, history of urolithiasis, pain duration < 8 h, nausea/vomiting, costovertebral angle tenderness, serum creatinine ≥ 0.92 mg/dL, erythrocytes ≥ 10/high power field, no leukocytes ≤ + , and any crystalluria were retained in the final multivariable model and became part of the score. This scoring model demonstrated good discrimination (AUC 0.808 [95% CI, 0.776-0.837]). In the validation cohort (n = 336), the performance was similar (AUC 0.803 [95% CI, 0.756-0.844]), surpassing that of the STONE score (AUC 0.654 [95% CI, 0.601-0.705], P < 0.001). This scoring model successfully stratified patients according to the probability of urolithiasis. Further validation in various settings is needed.
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Affiliation(s)
- Hyo Joon Kim
- Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06509, Republic of Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06509, Republic of Korea.
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Avramenko N, Bachurin G, Kolomoets Y, Nikiforov O. REPRESENTATION OF KIDNEY DAMAGE AT THE MOLECULAR LEVEL IN PATIENTS WITH UROLITHIASIS BASED ON THE STUDY OF ENZYMATIC TEST INDICATORS. Georgian Med News 2023:191-197. [PMID: 37805897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
The aim of the work is to improve the results of early diagnosis of acute infectious kidney diseases at the molecular level in urolithiasis (urinary stone disease) through the study of enzymatic test indicators. Enzymatic tests (NGAL, IL-1β, β2-microglobulin) were investigated at the molecular level using the IFA method in the urine of patients with urolithiasis. Comparative and prognostic significance of the conducted treatment was established between the groups of patients, and an algorithm was developed based on the results of kidney damage predictors. It was found that the indicators of general laboratory analysis in patients with urolithiasis within the first 24-48 hours do not reliably indicate the absence of an infectious-inflammatory process in the kidneys and the development of renal failure. It was determined that an increase in the inflammation predictor indicators in more than 50% of patients indicates the development of infectious-inflammatory complications within the first 12-24 hours before the occurrence of general laboratory and clinical changes. The assessment of the effectiveness of conservative therapy in groups IA and II revealed that complications of the inflammatory process in the kidneys were observed five times more frequently in group II (comparison) than in group IA. The use of enzymatic tests as markers for early kidney damage allows for the classification of two main groups of patients: those requiring conservative treatment and those requiring urgent surgical intervention. This significantly reduces the frequency of inflammatory, purulent-septic complications and improves the treatment outcomes for patients with upper urinary tract obstruction in urolithiasis.
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Affiliation(s)
- N Avramenko
- 1Head of the Department of Obstetrics, Gynecology and Reproductive Medicine of the Educational and Scientific Institute of Postgraduate Education, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine
| | - G Bachurin
- 2Department of Urology, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine
| | - Yu Kolomoets
- 3Department of Urology, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine
| | - O Nikiforov
- 4Department of Obstetrics, Gynecology and Reproductive Medicine of the Educational and Scientific Institute of Postgraduate Education, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine
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23
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Mbouché LO, Mbassi AA, Nkolo JCE, Avebe JA, Kamga J, Fouda PJ, Angwafo III F. [Epidemiology and diagnosis of urinary lithiasis: a cross-sectional study in a Cameroonian based population]. Pan Afr Med J 2023; 45:61. [PMID: 37637399 PMCID: PMC10460109 DOI: 10.11604/pamj.2023.45.61.38677] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/02/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction urinary stone is a multifactorial disease characterized by the presence of concretions in the urinary tract. The diagnosis of urinary lithiasis is based on clinical and imaging findings. The objective of this study was to determine the profile of patients suffering from urolithiasis in the city of Yaounde. Methods this was a descriptive observational cross-sectional study with retrospective data collection. Patients with an age > 15 years and patients diagnosed with lithiasis confirmed by medical imaging were included in our study. The variables studied were sociodemographic, clinical and paraclinical. Results a total of 120 patients were included in our study. The mean age was 40.46±12.62 years with extremes from 19 to 74 years. Male gender was predominant at 60.8% (n=73). Renal colic was the circumstance found in 67.5% (n=81). Physical examination was normal in 55.8% (n=67). Insufficient hydration was found in 45% (n=61) of cases. Abdominal scanner was the most performed examination in our study in 50.7% (n=61). The median stone density was 731 Hounsfield units [346; 1183.5]. The stones were predominantly located in the upper tract. The left renal topography was predominant in 35% (n=42) of cases. Urine culture revealed Escherichia Coli at 60% (n=15). Blood calcium, phosphorus and uricemia were requested in 15.8% (n=19), 0.8% (n=1) and 12.5% (n=15) of cases, respectively. The results were normal. In the absence of a laboratory specialized in biochemical analysis of calculi, a minority of patients (n=3) benefited from spectrophotometry. Conclusion urinary lithiasis is a disease of men in their forties. Renal colic is the main revealing sign. The diagnosis is revealed by the abdominal scanner in half of the cases. Metabolic assessment and constitutional analysis of the calculus are still very rarely requested.
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Affiliation(s)
- Landry Oriole Mbouché
- Service de Chirurgie et Spécialités, Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé, Yaoundé, Cameroun
- Département de Chirurgie et Spécialités, Faculté de Médecine et des Sciences Biomédicales de l´Université de Yaoundé I, Yaoundé, Cameroun
| | - Achille Aurèle Mbassi
- Service d´Urologie, Hôpital Central de Yaoundé, Yaoundé, Cameroun
- Département de Chirurgie, Institut Supérieur de Technologie Médicale de Yaoundé, Yaoundé, Cameroun
| | | | - Josepha Abe Avebe
- Département de Chirurgie, Institut Supérieur de Technologie Médicale de Yaoundé, Yaoundé, Cameroun
| | - Justin Kamga
- Service de Chirurgie, Hôpital Général de Yaoundé, Yaoundé, Cameroun
| | - Pierre Joseph Fouda
- Département de Chirurgie et Spécialités, Faculté de Médecine et des Sciences Biomédicales de l´Université de Yaoundé I, Yaoundé, Cameroun
- Service d´Urologie, Hôpital Central de Yaoundé, Yaoundé, Cameroun
| | - Fru Angwafo III
- Département de Chirurgie et Spécialités, Faculté de Médecine et des Sciences Biomédicales de l´Université de Yaoundé I, Yaoundé, Cameroun
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Woo S, Lee CA, Lee JW, Moon J, Cho YS, Nah S, Han S. Predictors for Distinguishing Renal Infarction From Urolithiasis in the Emergency Department: A Randomly Matched Retrospective Case-Control Study. J Emerg Med 2023; 64:31-39. [PMID: 36641258 DOI: 10.1016/j.jemermed.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Emergency department (ED) clinicians may misdiagnose renal infarction (RI) as urolithiasis because RI is a rare disease with presenting symptoms similar to the symptoms of urolithiasis. However, earlier diagnosis of RI can improve patient prognosis. OBJECTIVES We investigated potential predictors for distinguishing RI from urolithiasis based on clinical findings and laboratory results. METHODS This randomly matched retrospective case-control study included patients who had been diagnosed with acute RI or acute urolithiasis between January 2016 and March 2020. Patients were excluded if they were aged under 18 years, had a history of trauma, or had incomplete medical records. Using a matching ratio of 1:4, RI patients were randomly matched to urolithiasis patients. Multivariable logistic regression was performed to identify factors that could distinguish RI from urolithiasis. RESULTS In total, 48 patients were included in the RI group and 192 patients were included in the urolithiasis group. Multivariable logistic regression showed that age ≥ 65 years (odds ratio [OR] 6.155; p = 0.022), atrial fibrillation (OR 18.472; p = 0.045), current smoking (OR 17.070; p = 0.001), costovertebral angle tenderness (OR 0.179; p = 0.037), aspartate aminotransferase level ≥ 27.5 U/L (OR 6.932; p = 0.009), sodium level ≥ 138.5 mEq/L (OR 0.079; p = 0.004), and hematuria (OR 0.042; p = 0.001) were significant predictors that could distinguish RI from urolithiasis. Based on these results, a nomogram was constructed. CONCLUSION Age ≥ 65 years, atrial fibrillation, current smoking, absence of costovertebral angle tenderness, aspartate aminotransferase level ≥ 27.5 U/L, sodium level < 138.5 mEq/L, and absence of hematuria were predictors that can distinguish between RI and urolithiasis.
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Affiliation(s)
- Seungho Woo
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Choung Ah Lee
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Jae Wook Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jieun Moon
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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25
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Siener R, Strohmaier WL, Neisius A. [Urolithiasis-Therapy and recurrence prevention taking into account gender-specific aspects]. Urologie 2022; 61:1076-1082. [PMID: 36018380 DOI: 10.1007/s00120-022-01912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
The prevalence of urolithiasis is steadily increasing worldwide in both genders. Diet and lifestyle, such as the rising prevalence of obesity and other metabolic syndrome traits, are considered key factors in this trend. Gender differences as a result of interventional therapy for urolithiasis have not been observed. However, iatrogenic injury to the male urethra is considered the most common reason for urethral strictures after endourologic (stone) therapy. In contrast, sepsis, as the major cause of urinary stone-related mortality, is more frequently reported in women after ureterorenoscopy and percutaneous nephrolithotomy. There are also differences in the frequency of various types of stones between men and women. Calcium oxalate and uric acid stones are more commonly observed in men, while carbonate apatite and struvite are diagnosed more often in women. Urinary stone analysis is therefore paramount for successful recurrence prevention. Diagnosis is based on the assignment of patients to the low-risk or high-risk group. The medical nutrition and pharmacological measures for the therapy of the respective type of stone are based on the risk factors in 24 h urine samples. A personalized approach that accounts for gender differences could further improve treatment, and recurrence prevention decisions for urinary stones.
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Affiliation(s)
- Roswitha Siener
- Universitäres Steinzentrum, Klinik und Poliklinik für Urologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Walter L Strohmaier
- Medical School Regiomed, Regiomed-Klinikum Coburg, Coburg, Deutschland
- School of Medicine, University of Split, Academic Hospital of the University of Split, Split, Kroatien
| | - Andreas Neisius
- Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
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26
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Karagöz MA, Güven S, Tefik T, Gökçe Mİ, Kiremit MC, Atar FA, İbiş MA, Yitgin Y, Böyük A, Verep S, Sarıca K. Attitudes of urologists on metabolic evaluation for urolithiasis: outcomes of a global survey from 57 countries. Urolithiasis 2022; 50:711-720. [PMID: 36169664 DOI: 10.1007/s00240-022-01362-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022]
Abstract
Although stone disease is an important health problem with high incidence and recurrence rates, it is a preventable disease. Attitudes and practices of urologists regarding the prevention of recurrence continue to be a subject of debate. In this context, an online survey study was conducted involving 305 urologists from 57 different countries. The first 7 questions collected demographic data about the urologists and the remaining 23 questions were about the recurrence and metabolic evaluation, medical treatment, and follow-up of urinary stone disease. Most urologists (85.2%) thought that metabolic examination was important. Approximately one-third of the participants (34.1%) performed 24-hour urine analysis and stone analysis was ordered by 87.5% of the urologists. Metabolic analysis was performed for all patients by 14.7% of the participants. For pediatric patients this rate was 68.5%, and for adults with recurrence the rate was 81.6%. Reasons cited by the urologists for not performing metabolic analysis included not feeling confident doing so (18.3%), having limited facilities in their hospital (26.5%), having an excessive daily workload (31.8%), patient-related factors (27.5%), and referring patients to other departments for metabolic evaluation (20.9%). Although majority of the responding urologists do consider the metabolic analysis as vital important, they seemed not to be willing to perform these tests with the same degree of enthusiasm in their daily practice. Our results show that urologists need support in performing and interpreting 24-hour urine analysis, improving their knowledge levels, and communicating with patients. Urology residency training should focus more on the prevention of urinary stone recurrence in addition to the surgical training.
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Affiliation(s)
- Mehmet Ali Karagöz
- Department of Urology, Health Sciences University, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey.
| | - Selçuk Güven
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Tzevat Tefik
- Department of Urology, İstanbul University İstanbul School of Medicine, Istanbul, Turkey
| | - Mehmet İlker Gökçe
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Feyzi Arda Atar
- Department of Urology, Başakşehir Çam Ve Sakura City Hospital, Istanbul, Turkey
| | - Muhammed Arif İbiş
- Department of Urology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Yasin Yitgin
- Depatment of Urology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Abubekir Böyük
- Department of Urology, Medivita İncirli Hospital, Istanbul, Turkey
| | - Samed Verep
- Department of Urology, Van Training and Research Hospital, Van, Turkey
| | - Kemal Sarıca
- Department of Urology, Biruni University Medical School, Medicana Bahçelievler Hospital, Istanbul, Turkey
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27
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Edell AS, Vella DG, Sheen JC, Carotenuto SE, McKee T, Bergman PJ. Retrospective analysis of risk factors, clinical features, and prognostic indicators for urolithiasis in guinea pigs: 158 cases (2009-2019). J Am Vet Med Assoc 2022; 260:S95-S100. [PMID: 35333752 DOI: 10.2460/javma.21.09.0421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate risk factors, clinical features, and prognostic indicators in guinea pigs with urolithiasis. ANIMALS 158 guinea pigs with urolithiasis. PROCEDURES Medical records of an exotics animal specialty service were searched, identifying guinea pigs with urolithiasis. Signalment, clinical data, and outcomes were recorded. Variables of interest were analyzed for statistical associations with outcome. RESULTS Overall, 54.4% (86/158) of animals survived to discharge. Median survival time was 177 days. Females (53.2%; 84/158) were more common than males (46.8%; 74/158). Males were presented younger (mean age, 3.64 years) than females (4.41 years). In 81 of 154 (52.5%) cases, animals were presented with primary urinary concerns, while 73 (47.5%) presented for nonurinary primary concerns. Females more commonly presented with distal urinary tract urolithiasis (63/84; 75%) but fared better overall with a longer median survival time (1,149 days) than males (59 days). Surgical intervention was not a risk factor for nonsurvival; however, increased age (> 4.1 years), male sex, anorexia, weight loss, and lower rectal temperature (< 37.2 °C) on presentation were associated with nonsurvival. Reoccurrence was noted in 13.9% (22/158) of cases, at an average of 284 days. CLINICAL RELEVANCE Urolithiasis should always be considered a differential diagnosis for any unwell guinea pig. In particular, distal urinary tract urolithiasis should be considered in females. A poorer prognosis was associated with older, male guinea pigs, and those displaying anorexia, weight loss, and hypothermia. The need for surgical intervention should not confer a poorer outcome. Further studies are needed to determine specific risk factors and identify possible preventative measures.
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Affiliation(s)
- Analisa S Edell
- VCA Valley Animal Hospital and Emergency Center, Tucson, AZ
- Wildlife Safari, Winston, OR
| | - David G Vella
- Sydney Exotics and Rabbits Vets, Artarmon, NSW, Australia
| | - Joanne C Sheen
- Sydney Exotics and Rabbits Vets, Artarmon, NSW, Australia
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28
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Lin Y, Xu Z, Ding X, Chen L, Dai K. Development and validation of a clinical diagnostic model for pregnant women with renal colic in the emergency department in China: a protocol for a retrospective cohort study. BMJ Open 2022; 12:e056510. [PMID: 35501078 PMCID: PMC9062803 DOI: 10.1136/bmjopen-2021-056510] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Urolithiasis affects many people throughout their lives. Among the maternal population, although the morbidity of acute urolithiasis in pregnant women is unremarkable, it is the leading cause of hospitalisation during pregnancy. There is no effective clinical diagnostic tool to help doctors diagnose diseases. Our primary aim was to develop and validate a clinical prediction model based on statistical methods to predict the probability of having disease in pregnant women who visited the emergency department because of urolithiasis-induced colic. METHODS AND ANALYSIS We will use multivariate logistic regression analysis to build a multivariate regression linear model. A receiver operating characteristic curve plot and calibration plot will be used to measure the discrimination value and calibration value of the model, respectively. We will also use least absolute shrinkage and selection operator regression analysis combined with logistic regression analysis to select predictors and construct the multivariate regression model. The model will be simplified to an application that has been reported before, and users will only need to enter their clinical parameters so that risk probability is automatically derived. ETHICS AND DISSEMINATION The review and approval documents of the clinical research ethics committee have been received from the ethics committee of our hospital (The Third Affiliated Hospital of Wenzhou Medical University). We will disseminate research findings through presentations at scientific conferences and publication in peer-reviewed journals.
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Affiliation(s)
- YuZhan Lin
- Department of Clinical Laboratory, Ruian People's Hospital, Ruian, China
| | - ZhiKai Xu
- Department of Ultrasound Imaging, Ruian People's Hospital, Ruian, China
| | - XiangCui Ding
- Gynecology Department, Ruian People's Hospital, Ruian, China
| | - Lei Chen
- Department of Clinical Laboratory, Ruian People's Hospital, Ruian, China
| | - KangWei Dai
- Department of Clinical Laboratory, Ruian People's Hospital, Ruian, China
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29
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Mejia S, McOnie RC, Nelligan KL, Fubini SL. Small ruminant urinary obstruction: decision trees for treatment. J Am Vet Med Assoc 2022; 260:S64-S71. [PMID: 35442905 DOI: 10.2460/javma.22.02.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Urolithiasis is the most common cause of urinary tract disease in small ruminants and has significant economic and production impacts worldwide. Urolithiasis is multifactorial in origin and generally begins with the formation of cystoliths followed by urethral obstruction. The condition is most common in males. Clinical signs are variable depending on the severity of the obstruction. Uroliths can be calcium, struvite, or silicate based; however, struvite and amorphous magnesium calcium phosphate are the most common urolith types observed in small ruminants. Although urethral process (vermiform appendage) amputation is widely considered the first line of treatment, reobstruction is common within the first 36 hours. Surgical interventions such as temporary tube cystostomy, perineal urethrostomy (PU), modified proximal perineal urethrostomy, vesico-preputial anastomosis (VPA), and urinary bladder marsupialization (BM) are reported to carry an improved prognosis for long-term survival. PU carries a lower proportion of long-term success (> 12-month survival time) when compared with VPA and BM. Stoma stricture and urine scald are the most commonly observed surgical complications. Currently, the literature provides minimal direction for clinician decision-making in managing these cases while accounting for patient history, client financial ability, composition of calculi, and potential treatment complications. Small ruminant urinary obstructions are challenging and complicated conditions to treat, due to their multifactorial etiology, ruminant urogenital anatomy, and the variety of imperfect treatment options available. The purpose of this article this article is to provide veterinary practitioners with decision trees to guide management and treatment of urolithiasis in small ruminants.
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Yusof MR, Fairuz MS, Lee FY, Arvind VJ, Fahmy O, Lee CK, Saiful Azli MZ, Arunasalam AP, Khairul-Asri MG. [The tale of two stones in an obstructed partial duplex kidney: case presentation]. Urologiia 2022:78-80. [PMID: 35274865] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Duplex renal systems is a common anomalies. Incidence rate of 0.8% in healthy adult population and 2-4% in patients investigated for urinary tract symptoms. Urolithiasis management for patients with anomalies is complex and require proper imaging and planning. We have a patient with a partial duplex collecting system presented with a right renal calculus in a non-functioning lower moiety and multiple distal ureteric calculi. Preoperative planning done and surgery performed with good outcome without any early and late complications.
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Affiliation(s)
- M R Yusof
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - M S Fairuz
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - F Y Lee
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - V J Arvind
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - O Fahmy
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - C K Lee
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - M Z Saiful Azli
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - A P Arunasalam
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - M G Khairul-Asri
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
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31
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Saenz-Medina J, Muñoz M, Rodriguez C, Sanchez A, Contreras C, Carballido-Rodríguez J, Prieto D. Endothelial Dysfunction: An Intermediate Clinical Feature between Urolithiasis and Cardiovascular Diseases. Int J Mol Sci 2022; 23:ijms23020912. [PMID: 35055099 PMCID: PMC8778796 DOI: 10.3390/ijms23020912] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/08/2023] Open
Abstract
UNLABELLED An epidemiological relationship between urolithiasis and cardiovascular diseases has extensively been reported. Endothelial dysfunction is an early pathogenic event in cardiovascular diseases and has been associated with oxidative stress and low chronic inflammation in hypertension, coronary heart disease, stroke or the vascular complications of diabetes and obesity. The aim of this study is to summarize the current knowledge about the pathogenic mechanisms of urolithiasis in relation to the development of endothelial dysfunction and cardiovascular morbidities. METHODS A non-systematic review has been performed mixing the terms "urolithiasis", "kidney stone" or "nephrolithiasis" with "cardiovascular disease", "myocardial infarction", "stroke", or "endothelial dysfunction". RESULTS Patients with nephrolithiasis develop a higher incidence of cardiovascular disease with a relative risk estimated between 1.20 and 1.24 and also develop a higher vascular disease risk scores. Analyses of subgroups have rendered inconclusive results regarding gender or age. Endothelial dysfunction has also been strongly associated with urolithiasis in clinical studies, although no systemic serum markers of endothelial dysfunction, inflammation or oxidative stress could be clearly related. Analysis of urine composition of lithiasic patients also detected a higher expression of proteins related to cardiovascular disease. Experimental models of hyperoxaluria have also found elevation of serum endothelial dysfunction markers. CONCLUSIONS Endothelial dysfunction has been strongly associated with urolithiasis and based on the experimental evidence, should be considered as an intermediate and changeable feature between urolithiasis and cardiovascular diseases. Oxidative stress, a key pathogenic factor in the development of endothelial dysfunction has been also pointed out as an important factor of lithogenesis. Special attention must be paid to cardiovascular morbidities associated with urolithiasis in order to take advantage of pleiotropic effects of statins, angiotensin receptor blockers and allopurinol.
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Affiliation(s)
- Javier Saenz-Medina
- Department of Urology, Puerta de Hierro-Majadahonda University Hospital, 28222 Majadahonda, Spain
- Department of Medical Specialities and Public Health, Faculty of Health Sciences, King Juan Carlos University, 28933 Móstoles, Spain
- Correspondence:
| | - Mercedes Muñoz
- Department of Physiology, Pharmacy Faculty, Complutense University, 28040 Madrid, Spain; (M.M.); (C.R.); (A.S.); (C.C.); (D.P.)
| | - Claudia Rodriguez
- Department of Physiology, Pharmacy Faculty, Complutense University, 28040 Madrid, Spain; (M.M.); (C.R.); (A.S.); (C.C.); (D.P.)
| | - Ana Sanchez
- Department of Physiology, Pharmacy Faculty, Complutense University, 28040 Madrid, Spain; (M.M.); (C.R.); (A.S.); (C.C.); (D.P.)
| | - Cristina Contreras
- Department of Physiology, Pharmacy Faculty, Complutense University, 28040 Madrid, Spain; (M.M.); (C.R.); (A.S.); (C.C.); (D.P.)
| | - Joaquín Carballido-Rodríguez
- Department of Urology, Puerta de Hierro-Majadahonda University Hospital, Autonoma University, 08193 Bellaterra, Spain;
| | - Dolores Prieto
- Department of Physiology, Pharmacy Faculty, Complutense University, 28040 Madrid, Spain; (M.M.); (C.R.); (A.S.); (C.C.); (D.P.)
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López JM, Mainez JA, Mora Christian J, Gil J, Garganta R. Usefulness and acceptability of a Smart pH meter and mobile medical App as a monitoring tool in patients with urolithiasis: short-term prospective study. ARCH ESP UROL 2022; 75:60-68. [PMID: 35173078] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ORIGINAL ARTICLE Usefulness and Acceptability of a Smart pH Meter and Mobile Medical App as a Monitoring Tool in Patients with Urolithiasis: Short-term Prospective Study. OBJECTIVE An accurate strategy for regularly measuring urine pH is the use of portable electronic pH meters. This study evaluated the usefulness and acceptability of the smart Lit-Control® pH Meter connected with a companion mobile medical application (myLit-Control(R) App) used by patients with urolithiasis for home monitoring of urine pH. We also examined adherence and compliance rates, and users´ satisfaction levels. MATERIALS AND METHODS: This was a multicenter, prospective study conducted in 10 centers from Spain. Adult patients with a history of urolithiasis were recruited and instructed to carry out a pH measurement with the pH meter three times per day for two weeks. User tasks included turning on the device, registration and on boarding processes in the App, sync the device and the App, and data dumping. At the end of the trial, we evaluated the level of adherence and usage compliance. Participants' perceptions about the usefulness, acceptability, and satisfaction with the device/App were collected through the Computer System Usability Questionnaire (CSUQ) and subjective surveys. RESULTS: Participants were 27 men and 10 women. The mean age of participants was 48.7 (SD = 10.4) years, ranging from 25 to 66. The predominant type of stone was calcium oxalate. The mean pH of all readings was 5.83 (SD = 0.41). Seventy-three (73%) patients met the "good adherence" criterion (not being more than 2 days without recording any pH value). The compliance (actual vs. theoretical readings) was 87.6%. Participants rated the usability of the App 5.4 and above (on a 7-point scale) in all the items of CSUQ. Satisfaction was high, as indicated by the mean score of 6.0 in item 16. In the subjective questionnaire (0 to 3 scale), nearly all mean values were above 2. Patients scored their probability to recommend the App with an average of 8.2 on a 0 to 10 scale. CONCLUSION The new smart Lit-Control® pH Meter and the accompanying medical App were deemed useful and acceptable by urolithiasis patients as a portable tool for urine pH monitoring at home. The usage compliance rates were high and the satisfaction with the products was good.
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Affiliation(s)
| | | | - Jorge Mora Christian
- Unidad de Litiasis y Endourología, Urología Clínica, Clínica IMQ Zorrotzaurre, Bilbao, Spain
| | - Jesús Gil
- Servicio de Urología, Hospital General Universitario de Elche, Alicante, Spain
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Çaltik Yilmaz A, Ünal N, Çelebi Tayfur A, Büyükkaragöz B. How important urolithiasis is under 2 years of age? Urolithiasis 2021; 50:159-165. [PMID: 34842953 DOI: 10.1007/s00240-021-01295-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Abstract
Urolithiasis (UL) is a common health problem in the world and the observed incidence of this disease is increasing in the infantile period. The study included cases of UL diagnosed before the age of two who had a comprehensive analysis for possible etiologic variables and were followed for a minimum of 6 months. Of the 60 patients included in the study, 37 were male, and the male/female ratio was 1.6. The average age at diagnosis is 8.5 ± 4.5 months. Of the cases diagnosed 41 (68.3%) were before than 1 year of age. The average time for follow-up is 28.9 ± 22.6 months. There was a family history of stone disease in 41 (68.3%) cases. Twenty-four (40%) patients were treated for dehydration at least once before stone disease was identified. The number of patients presenting with symptoms is 43 (71.7%). Restlessness was noted as the main symptom. In 17 (28.3%) patients, stone disease was found incidentally. Metabolic causes (n: 19, 31.6%) were determined to be the most common underlying cause, followed by UTI-related causes (n: 12, 20%). During the follow-up, 57 (64%) of the stones spontaneously disappeared. The size of 16 (18%) stones reduced, while the size of eleven remained same (13%). Following their absence, nine (15%) of the stones reappeared. The essential strategy is to identify high-risk groups, to closely monitor them, and to take preventative interventions against modifiable conditions such as dehydration if possible.
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Affiliation(s)
| | - Necla Ünal
- Department of Pediatrics, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
| | - Aslı Çelebi Tayfur
- Department of Pediatric Nephrology, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
| | - Bahar Büyükkaragöz
- Department of Pediatric Nephrology, Ankara Gazi University, Ankara, Turkey
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Lebedev GS, Shaderkin IA, Gazimiev MA, Rudenko VI, I DV, Alfimov AE, Vladzimirsky AV, Gazimiev AM. [The methodology of remote monitoring of patients with urinary stone disease: development and primary approbation]. Urologiia 2021:26-34. [PMID: 34743428] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Urolithiasis is a clinically and socially significant disease that requires long-term follow-up in order to prevent stone recurrence. Currently, telemedicine consultations in the "patient-doctor" format are actively used in urology, however, the methodology, technological base and assessment of the efficiency of remote monitoring of the patient's health status are virtually not developed. AIM To provide basics for the methodology of remote monitoring of patients with urolithiasis for detailed comprehensive examination and comprehensive metaphylaxis of recurrent stone formation. MATERIALS AND METHODS A comprehensive clinical examination was carried out on the basis of the Institute of Urology and Human Reproductive Health, the National Medical Research Center on Urology and the Institute of Digital Medicine of FGAOU VO I.M. Sechenov First Moscow State Medical University during the period from 1st February to 1st December 2020. A total of 30 patients with urolithiasis were included in the study. Remote monitoring of health status was carried out using a portable analyzer "ETTA AMP-01" on dipstick. Data transmission was performed through a mobile application, which is part of the "NetHealth" information system (www.nethealth.ru). The values and frequency of urine tests performed by the patient independently, as well as patient satisfaction and adherence to the monitoring technology were evaluated. Analytical, clinical, sociological and statistical research methods were used. RESULTS By systematizing published data and our own clinical experience, we have developed a model for remote monitoring of the health status of patients with urinary stone disease, which included a system of indications and contraindications, a program and an order of the monitoring, as well as a basic technological solution (medical devices and a hardware-software complex). In this study, median duration of remote monitoring was 168 days. According to the questionnaire, general positive assessment and desire to continue telemonitoring was seen in 100.0% of cases, while 86.7% of patients positively evaluated the technical accessibility and reliability of the system and 93.3% considered the quality and availability of medical care as high. CONCLUSION A methodology for remote monitoring of patients with urolithiasis has been developed with the aim of preventing recurrent stone formation. There was a high adherence of patients to remote monitoring with a tendency to decrease in values after 4 and 6 months. During these periods, it is necessary to carry out routine consultations by the physician who appointed remote monitoring in order to continue the follow-up program. There was a high satisfaction of patients with remote monitoring, and they pointed out the quality and availability of urological care owing to telemedicine technologies.
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Affiliation(s)
- G S Lebedev
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- GBUZ Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health, Moscow, Russia
| | - I A Shaderkin
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- GBUZ Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health, Moscow, Russia
| | - M A Gazimiev
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- GBUZ Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health, Moscow, Russia
| | - V I Rudenko
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- GBUZ Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health, Moscow, Russia
| | - Dyakonov V I
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- GBUZ Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health, Moscow, Russia
| | - A E Alfimov
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- GBUZ Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health, Moscow, Russia
| | - A V Vladzimirsky
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- GBUZ Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health, Moscow, Russia
| | - A M Gazimiev
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- GBUZ Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health, Moscow, Russia
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Castro Henríquez E. [Metabolic Stone assessment: Underused tool and how to implement it on daily practice.]. ARCH ESP UROL 2021; 74:823-834. [PMID: 34726618] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Nephrolithiasis is a highly prevalent disease presenting itself mostly at a working age, which leads to a great economic burden on health system. Kidney Stone disease should be viewed as a systemic disorder,associated with or predictive of hypertension, insulin resistance, chronic kidney disease and cardiovasculardamage. According to current guidelines and evidence,a full screening of risk factors for kidney stones and for cardiovascular damage should be recommended in all cases of kidney stone disease, yet it is rarely performed, and a real-world clinical practice is lacking. The aim of this narrative literature is to serve as guidance for a patient-tailored dietary suggestion after a clinical and biochemistry evaluation, with limited resources, and still offer a rational management of kidney stone patients. Meta-analysis, systematic review, experimental studies, case-control plus high-impact factor journals PubMed and EMBASE, on the topic were included. Search criteria included metabolic profile, metabolic work-up, kidney stone, urolithiasis between 2010 and 2020.
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Sergeeva L, Strogonova T, Kolomoets Y, Bachurin G. [DISCRIMINANT ANALYSIS AS A SUPPORTING METHOD OF DECISION-MAKING IN MEDICAL INVESTIGATIONS ON THE EXAMPLE OF THE ENZYME IMMUNOASSAY IN PATIENTS WITH UROLITHIASIS]. Georgian Med News 2021:147-153. [PMID: 34511462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose of this article is to study the possibilities of discriminant analysis as a statistical decision support tool in medical research, using the example of the problem of choosing a tactics for treating patients with urolithiasis. based on the results of enzyme-linked immunosorbent assay. Discriminant analysis was carried out on an array of clinical and laboratory data of 70 patients with urolithiasis, of which two groups were formed: Group I included 36 patients who underwent conservative therapy; Group II consisted of 34 patients who underwent surgery. In the discriminant model, 11 indicators of general clinical examination of blood and urine, biochemical methods of blood testing and indicators of enzyme immunoassay were selected. The analysis of the constructed discriminant model made it possible to combine indicators of different nature into a single picture and solve the following tasks: find a combination of inflammation predictors and general analysis indicators in order to distinguish a group of patients requiring surgery from a group of conservative treatment; select the most informative indicators. Discriminant analysis showed the statistical significance of using the threshold values for the level of β2-microglobulin and NGAL-lipocalin. According to the discriminant model, a change in the level of β2-microglobulin is associated with changes in ESR parameters and the gender of patients (Wilks' Lambda: 0.51, approx. F (4.65)=15.47, p <0.01), and lipocalin values - with indicators of ESR, interleukin and the patient's age (Wilks' Lambda: 0.5; F (4.65)=15.87; p <0.01). Also, according to the used model, in the early diagnosis of Urolithiasis, the level of β2-microglobulin is a more informative sign than the level of lipocalin. Thus, the combinations of parameters of general, biochemical blood analysis and indicators of enzyme-linked immunosorbent assay of urine, found using discriminant analysis, which characterize the work of the body's defense subsystems in an acute state of the urolithiasis, may be useful in making a doctor's decision on the choice of treatment tactics.
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Affiliation(s)
- L Sergeeva
- Zaporizhzhya State Medical University, Ukraine
| | | | | | - G Bachurin
- Zaporizhzhya State Medical University, Ukraine
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Jafari GA, Fotouhi Ardakani R, Akhavan Sepahi M, Nowroozi J, Soltanpour MS. Development of an Innovative Method by Optimizing qPCR Technique for Isolating and Determining Oxalobacter Formigenes Microbial Load in the Stool of Patients with Urolithiasis. Iran J Kidney Dis 2021; 15:190-198. [PMID: 33994378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Oxalobacter formigenes, as a gram-negative anaerobic bacterium, metabolizes oxalate in the intestine by the enzymes oxalyl-CoA decarboxylase (OXC) and formyl-CoA transferase (FRC). Therefore, not only the presence of the bacterium but also microbial load may affect intestinal absorption and urinary exertion. We evaluated the relationship between Oxalobacter formigenes load and the formation of calcium oxalate urolithiasis using quantitative molecular methods. METHODS By clinical manifestation and stone analysis, we selected the urine and stool specimens of 73 patients with calcium oxalate urolithiasis. First, the gene regions of the two genes FRC and OXC in Oxalobacter formigenes were selected utilizing bioinformatics and specific primers designed for these regions. Following DNA extraction from stool specimens by specific primers of each gene, PCR was carried out and positive samples were sequenced. Then, qPCR was applied to determine the effective load of Oxalobacter. Also, biochemical tests were performed to measure the excretion rate of oxalate in urine specimens. RESULTS In addition to oxalobacter identification by PCR, the load of bacteria was quantitatively assessed using qPCR by specific primers for both FRC and OXC gene regions. A significant negative relationship had found between the formation of calcium oxalate urolithiasis and the presence of Oxalobacter formigenes in patients with kidney stone disease. The mean excretion of oxalate and citrate in urolithiasis cases were 22.93 and 552.106 mg/24h, respectively. CONCLUSION The presence of Oxalobacter formigenes can highly inhibit the generation of calcium oxalate urolithiasis. Furthermore, molecular techniques are more effective than other methods such as culture for the isolation of this bacterium.
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Affiliation(s)
| | | | - Mohsen Akhavan Sepahi
- Department of Pediatric Nephrology, School of Medicine, Qom University of Medical Sciences, Qom, Iran.
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Kanashiro A, Angerri O. [Urinary pH relevance on urolithiasis management.]. ARCH ESP UROL 2021; 74:102-111. [PMID: 33459626] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Urinary pH is a factor that influences in urinary lithogenesis. It can condition the heterogeneous nucleation of calcium oxalate and the crystallization or dissolution of other substances such as uricacid, cystine and phosphates. Its exact and precise measurement is a tool to guide the treatment and prevention. The most accurate way to measure the pH is to use a glass electrode and a pH-meter, but this device is used in hospital's environment and is not portable. Test strips are not adequate for proper measurement. Recently, a portable and electronic device for measuring urinary pH has shown greater precision and accuracy in the measurement of urinary pH, with good acceptance by patients. METHOD We carried out a bibliographic search inPUBMED and EMBASE using the terms "URINARY pH", "Lithiasis", "Uro-Lihitiasis", "Urinary Stone", "Urinary pH measurement", in order to compile articles, books, abstracts and the most relevant clinical guides in English and Spanish on this topic. RESULTS We select a total of 66 articles, 3 books, an abstract of a study unpublished presented at the American urology congress and the European Guidelines on urolithiasis on the effect of pH on the formation and prevention of urolithiasis. Four articles deal specifically with the effect of urinary pH on urolithiasis, 5 articles deal with a new portable electronic device for measuring urinary pH, 5 articles dealt with the measurement of urinary pH with test strips and 1 article dealt with the modification of urinary pH to reduce fouling of double J catheters, 2 articles deal about the urinary acidification with oral methionine. The selected abstract deals with the new portable device for measuring urinary pH in cystinuric patients. The 3 selected books have specific sections where the role of urinary pH in urolithiasis is discussed. Finally, in the European Urology Guidelines, the control of urinary pH is emphasized in the sections of prevention of urolithiasis formation, treatment of uric lithiasis, infectious/non-infectious phosphocalcic and cystine. CONCLUSIONS Urinary pH is a recognized factor in the scientific-urological community for the study, monitoring, treatment and prevention of lithiasic patients. Urinary pH measurement is a very useful tool, but test strips are not suitable for pH measurement and medical decision making. Currently, several studies have evaluated a new device to achieve the measurement of urinary pH effectively and easily by the patient, keeping urinary pH innon-lithogenic ranges with the association of medical and non-medical treatments, and good acceptability from the patients.
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Affiliation(s)
| | - Oriol Angerri
- Servicio de Urología. Fundació Puigvert. Barcelona. España
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Tzelves L, Mourmouris P, Skolarikos A. Comparison of current guidelines on medical management of stone disease. ARCH ESP UROL 2021; 74:171-182. [PMID: 33459633] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective of this study isto present the content of existing Guidelines on medical management of urinary stone disease. MATERIALS AND METHODS A search for current Guidelines from national and international urological Associations was performed in Societe International d'Urologie and American Urological Association websites, along with a search in Pubmed/MEDLINE until 30/06/2020. Two authors performed an independent search and data extraction regarding medical management of acute renal colic, medical expulsive treatment, dietary modifications and pharmaceutical interventions for prevention of stone disease recurrence. Quality of Guidelines was assessed by the two reviewers using the AGREE II instrument. RESULTS Literature search revealed 82 Associations, while eight of them provide recommendations/Guidelines on medical management of stone disease. Non-steroidalanti-inflammatory drugs or paracetamol are the most common 1st line treatment proposed for acute pain management, with opiates following next. Use of a-blockers is also indicated by most Guidelines for facilitating expulsion of distal ureteral stones 5-10 mm, after shockwave or laser lithotripsy or for alleviating stent-related symptoms. Adequate fluid in take, normal dietary calcium consumption and sodium restriction with varying daily limits, are universal dietary modifications from urological Associations on prevention of stone disease. Thiazidesand alkaline citrates are proposed usually for calciumoxalate stone formers with differences in grading of the recommendations, while urinary alkalization with allopurinol or febuxostat as a second line treatment is acommon treatment algorithm for urate stones, but with differences in target urine pH. European and American Urological Association Guidelines, along with National Institute for Health and Care Excellence recommendations were the most highly rated based on AGREE II. CONCLUSIONS Despite methodological heterogeneity and subjective rating of recommendations, an acceptable degree of consensus was noted on Guidelines regarding medical management of stone disease.
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Affiliation(s)
- Lazaros Tzelves
- Second Department of Urology. National and Kapodistrian University of Athens. Sismanogleio General Hospital. Athens. Greece
| | - Panagiotis Mourmouris
- Second Department of Urology. National and Kapodistrian University of Athens. Sismanogleio General Hospital. Athens. Greece
| | - Andreas Skolarikos
- Second Department of Urology. National and Kapodistrian University of Athens. Sismanogleio General Hospital. Athens. Greece
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Blasl-Kling F, Dold SK, Klein JT, Wakileh GA, Humke U, Ebert AK. Guideline-adherence in the treatment of symptomatic urolithiasis in children and adolescents in southwestern Germany. BMC Urol 2020; 20:76. [PMID: 32590972 PMCID: PMC7320579 DOI: 10.1186/s12894-020-00643-0] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 1% of urolithiasis cases in Germany affect children. Interdisciplinary groups have agreed on national and international guidelines for children to recommend appropriate treatment pathways. The aim of this retrospective and preliminary study is to analyze whether adherence to current guidelines for pediatric stone disease in southwestern Germany is feasible. METHODS During 2014 to 2017 24 children and adolescents (nine female, 15 male, median age 9.7 years), were treated for symptomatic urolithiasis in our institutions. We retrospectively collected clinical and operative courses. Clinical pathways were compared to previous guideline recommendations of the EAU 2014 and the German S2k guideline 2015. RESULTS 17 of the 24 patients were treated according to guideline recommendations (71%). Non-adherency was based on parental decisions in two and technical/medical considerations in five cases. In 11 children (45.8%) secondary or adjunctive treatments were necessary, in three of the seven non-adherently treated (43%) and in eight of the 17 adherently treated children (47%). CONCLUSION Our daily treatment approach seems to comply well with current pediatric stone guidelines. Nevertheless, guideline-non-adherent decision making emphasizes their strength and limitations, as specific clinical situations in children may require an individual treatment plan, as non-predictable conditions may occur.
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Affiliation(s)
- Felix Blasl-Kling
- Department of Urology, Katharinenhospital, Kriegsbergstr. 60, 70174 Stuttgart, Germany
| | - Simone Katrin Dold
- Department of Pediatrics and Adolescent Medicine, Medical University Ulm, Eytthstr. 24, 89075 Ulm, Germany
| | - Jan-Thorsten Klein
- Department of Urology and Paediatric Urology, Medical University Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Gamal Anton Wakileh
- Department of Urology and Paediatric Urology, Medical University Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Ulrich Humke
- Department of Urology, Katharinenhospital, Kriegsbergstr. 60, 70174 Stuttgart, Germany
| | - Anne-Karoline Ebert
- Department of Urology and Paediatric Urology, Medical University Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Cepeda M, Budía A, Pérez-Fentes D, Cansino R, Galán JA, Angerri O, Torrecilla C. [Strategies and recommendations for urolithiasis treatment and follow-up in COVID-19 pandemia.]. ARCH ESP UROL 2020; 73:438-446. [PMID: 32538815] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The health crisis caused by COVID-19 pandemic has led to a restructuring of urological activity in order not to delay priority situations. An important part to prioritize within Urologyis Urolithiasis. The objective of this article is to establish strategies and recommendations for the treatment and follow-up in COVID-19 pandemic in phases I, II and III, based on available scientific evidence and the consensus of a group of experts in these pathologies. MATERIAL AND METHODS: The document is based on the evidence available in the literature so far on SARSCoV-2 and the experience of the authors in the management of COVID-19 in their institutions. A narrative review of the literature was conducted, and a modified nominal group technique was used due to the extraordinary restrictions of assembly and mobility during the pandemic. RESULTS: Recommendations are made regarding the epidemiological evaluation of patients before surgery ,the management of positive patients, the epidemiological measures for healthcare personnel, the management of renal colic, the type of anesthesia, endourological surgery, shockwave lithotripsy, hospitalization, clinicalt ests, out-patient service and priorities on the surgical waiting list. CONCLUSION: Treatment of Urolithiasis in COVID-19 pandemic calls for prioritization of patients, maximum efficiency in treatments, adequate protection of healthcare personnel, and the implementation of telemedicine as a measure to reduce patient attendance to the hospital.
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Affiliation(s)
- Marcos Cepeda
- Servicio de Urología. Hospital Universitario Río Hortega. Valladolid. España
| | - Alberto Budía
- Servicio de Urología. Hospital Universitario La Fe. Valencia. España
| | - Daniel Pérez-Fentes
- Servicio de Urología. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela. España
| | - Ramón Cansino
- Servicio de Urología. Hospital Universitario La Paz. Madrid. España
| | | | - Oriol Angerri
- Servicio de Urología. Fundació Puigvert. Barcelona. España
| | - Carlos Torrecilla
- Servicio de Urología. Hospital Universitario de Bellvitge. Barcelona. España
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Lee EH, Kim SH, Shin JH, Park SB, Chi BH, Hwang JH. Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study. BMJ Open 2019; 9:e030438. [PMID: 31685503 PMCID: PMC6858199 DOI: 10.1136/bmjopen-2019-030438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Obstruction release from urolithiasis can be delayed with a lack of suggested time for preventing the deterioration of renal function. The objective of this study was to investigate the effect of obstruction duration, concomitant acute kidney injury (AKI) or acute pyelonephritis (APN) during the obstruction on the prognosis of renal function. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS 1607 patients from a urolithiasis-related obstructive uropathy cohort, between January 2005 and December 2015. OUTCOME MEASURES Estimated glomerular filtration rate (eGFR) decrease ≥30% and/or end-stage renal disease (ESRD), and eGFR decrease ≥50% and/or ESRD, according to obstruction duration, AKI and APN accompanied by obstructive uropathy. RESULTS When the prognosis was divided by obstruction duration quartile, the longer the obstruction duration the higher the probability of eGFR reduction >50% (p=0.02). In patients with concomitant APN or severe AKI during hospitalisation with obstructive uropathy, an eGFR decrease of >30% and >50% occurred more frequently, compared with others (p<0.001). When we adjusted for sex, age, hypertension, diabetes mellitus, APN, AKI grades and obstruction release >7 days for multivariate analysis, we found that concomitant APN (HR 3.495, 95% CI 1.942 to 6.289, p<0.001), concomitant AKI (HR 3.284, 95% CI 1.354 to 7.965, p=0.009 for AKI stage II; HR 6.425, 95% CI 2.599 to 15.881, p<0.001 for AKI stage III) and an obstruction duration >7 days (HR 1.854, 95% CI 1.095 to 3.140, p=0.001) were independently associated with an eGFR decrease >50%. Tree analysis also showed that AKI grade 3, APN and an obstruction duration >7 days were the most important factors affecting renal outcome. CONCLUSIONS In patients with urolithiasis-related obstructive uropathy, concomitant APN was strongly associated with deterioration of renal function after obstruction release. The elapsed time to release the obstruction also affected renal function.
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Affiliation(s)
- Eung Hyun Lee
- Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Su-Hyun Kim
- Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jung-Ho Shin
- Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Sung Bin Park
- Radiology, Chung-Ang University Hospital, Seoul, Korea
| | | | - Jin Ho Hwang
- Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
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Runolfsdottir HL, Palsson R, Thorsteinsdottir UA, Indridason OS, Agustsdottir IMS, Oddsdottir GS, Thorsteinsdottir M, Edvardsson VO. Urinary 2,8-dihydroxyadenine excretion in patients with adenine phosphoribosyltransferase deficiency, carriers and healthy control subjects. Mol Genet Metab 2019; 128:144-150. [PMID: 31378568 PMCID: PMC6864267 DOI: 10.1016/j.ymgme.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive disorder of adenine metabolism that results in excessive urinary excretion of the poorly soluble 2,8-dihydroxyadenine (DHA), leading to kidney stones and chronic kidney disease. The purpose of this study was to assess urinary DHA excretion in patients with APRT deficiency, heterozygotes and healthy controls, using a recently developed ultra-performance liquid chromatography - tandem mass spectrometry (UPLC-MS/MS) assay. METHODS Patients enrolled in the APRT Deficiency Registry and Biobank of the Rare Kidney Stone Consortium (http://www.rarekidneystones.org/) who had provided 24-h and first-morning void urine samples for DHA measurement were eligible for the study. Heterozygotes and healthy individuals served as controls. Wilcoxon-Mann-Whitney test was used to compare 24-h urinary DHA excretion between groups. Associations were examined using Spearman's correlation coefficient (rs). RESULTS The median (range) 24-h urinary DHA excretion was 138 (64-292) mg/24 h and the DHA-to-creatinine (DHA/Cr) ratio in the first-morning void samples was 13 (4-37) mg/mmol in APRT deficiency patients who were not receiving xanthine oxidoreductase inhibitor therapy. The 24-h DHA excretion was highly correlated with the DHA/Cr ratio in first-morning void urine samples (rs = 0.84, p < .001). DHA was detected in all urine samples from untreated patients but not in any specimens from heterozygotes and healthy controls. CONCLUSIONS High urinary DHA excretion was observed in patients with APRT deficiency, while urine DHA was undetectable in heterozygotes and healthy controls. Our results suggest that the UPLC-MS/MS assay can be used for diagnosis of APRT deficiency.
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Affiliation(s)
- Hrafnhildur L Runolfsdottir
- Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Runolfur Palsson
- Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Unnur A Thorsteinsdottir
- Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Olafur S Indridason
- Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Inger M Sch Agustsdottir
- Children's Medical Center, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - G Steinunn Oddsdottir
- Department of Clinical Biochemistry, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Margret Thorsteinsdottir
- Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland; ArcticMass, Reykjavik, Iceland
| | - Vidar O Edvardsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Children's Medical Center, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
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Ramos D, Reis S, Cordinhã C, Carmo C, Gomes C, Correia AJ. [Distal Renal Tubular Acidosis: Clinical Variability in the Same Family]. ACTA MEDICA PORT 2019; 32:542-545. [PMID: 31445535 DOI: 10.20344/amp.10758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/21/2018] [Indexed: 11/20/2022]
Abstract
Primary distal renal tubular acidosis is a genetic disorder characterized by the inability in acidification of urine. Symptoms are usually non-specific and highly variable. We described six cases in a family with four generations affected. The first case was diagnosed in a 3-year-old child presenting with hematuria and urolithiasis. Later, his sister, sons and two nephews were studied. Although asymptomatic, they all had nephrocalcinosis and hyperchloremic metabolic acidosis with normal anionic gap, except one case with normal arterial blood gas test but with nephrocalcinosis and inability of urinary acidification. At follow-up, they all maintained nephrocalcinosis, the index case had acute renal damage and developed hypertension, but none developed chronic renal disease. The diagnosis of autosomal dominant distal renal tubular acidosis is generally made later and patients tend to present with milder disease. But the condition may manifest early and have a variable phenotypic severity spectrum. Carrying out screening through assessment of family history enables an earlier diagnosis while also allowing treatment to start sooner.
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Affiliation(s)
- Daniela Ramos
- Serviço de Pediatria Médica. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Sofia Reis
- Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu. Portugal
| | - Carolina Cordinhã
- Unidade de Nefrologia Pediátrica. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Carmen Carmo
- Unidade de Nefrologia Pediátrica. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Clara Gomes
- Unidade de Nefrologia Pediátrica. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - António Jorge Correia
- Unidade de Nefrologia Pediátrica. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Prieto RM, Rodriguez A, Sanchis P, Morey M, Fiol M, Grases F, Castañer O, Martínez-González MA, Salas-Salvadó J, Romaguera D. Association of Adherence to The Mediterranean Diet with Urinary Factors Favoring Renal Lithiasis: Cross-Sectional Study of Overweight Individuals with Metabolic Syndrome. Nutrients 2019; 11:nu11081708. [PMID: 31344950 PMCID: PMC6723981 DOI: 10.3390/nu11081708] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 07/21/2019] [Accepted: 07/21/2019] [Indexed: 11/16/2022] Open
Abstract
Our purpose was to study the relationship of adherence to the Mediterranean diet (MedDiet) with urinary factors that favor the formation of renal calcium and uric acid stones in overweight and obese participants who had metabolic syndrome. This cross-sectional study examined 267 participants. A well-known MedDiet score (range 0–9) was calculated for each patient, and patients were then categorized has having low (≤3), medium (4–5), or high (≥6) adherence to the MedDiet. Baseline characteristics and urinary parameters were also analyzed. High calcium salt urinary crystallization risk (CaUCR) and high uric acid urinary crystallization risk (UrUCR) were calculated from urinary parameters using pre-defined criteria. More than half of patients with MedDiet scores ≤3 had high UrUCR (55.4%) and high CaUCR (53.8%). In contrast, fewer patients with high adherence (≥6) to the MedDiet had high UrUCR (41.2%) and high CaUCR (29.4%). Relative to those with low adherence, individuals with high adherence had a prevalence ratio (PR) of 0.77 for a high UrUCR (95% CI: 0.46–1.12; p for trend: 0.069) and a PR of 0.51 for a high CaUCR (95% CI: 0.26–0.87; p for trend: 0.012) after adjusting for age, sex, body mass index, type 2 diabetes, and total energy intake. Our findings indicate that greater adherence to the MedDiet was associated with a reduced CaUCR and a reduced UrUCR. This suggests that adequate dietary management using the MedDiet patterns may prevent or reduce the incidence and recurrence of calcium salt and uric acid renal stones.
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Affiliation(s)
- Rafael M Prieto
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa). University of the Balearic Islands, 07122 Palma de Mallorca, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain.
| | - Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa). University of the Balearic Islands, 07122 Palma de Mallorca, Spain
| | - Pilar Sanchis
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa). University of the Balearic Islands, 07122 Palma de Mallorca, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Margalida Morey
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Miquel Fiol
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa). University of the Balearic Islands, 07122 Palma de Mallorca, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Olga Castañer
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain
| | - Miguel A Martínez-González
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, 31009 Pamplona, Spain
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, 43204 Reus, Spain
- Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Rovira i Virgili University, 43003 Tarragona, Spain
| | - Dora Romaguera
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
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Hajji M, Ben Fatma L, Kaaroud H, Abdelmoula J, Zouaghi MK, Ben Abdallah T. Management of urolithiasis in living kidney donors. Tunis Med 2019; 97:140-144. [PMID: 31535706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Kidney donors with asymptomatic stones were previously excluded from the kidney donation list because of a potential increased morbidity risk for both the recipient and the donor. Currently, recent studies tend to consider these risks as overestimated. AIM The aim of this study was to analyze our experience in the management of urolithiasis in potential donors. METHODS We conducted a retrospective analysis during the period (2008-2015). We included donors with urilithiasis or a family history of urolithiasis whom had urinary biochemical analysis of urolithiasis. We identified the exact location, size, and anatomy of the kidney bearing the stone were identified. RESULTS Among 252 potentially proposed living kidney donors (LKD) in two renal transplantation centers, we noted urinary lithiasis in 8 patients (3.17%). The mean age was 40,12±20 years old with a sex-ratio M/F at 0,3. We noted urinary lithiasis on radiographs in one case, on echographs in one case and on computerized tomography kidney angiography in 5 cases. All are not obese and without any medical history. In one case, there was no lithiasis detected but chemical urinary analysis was performed because of family renal stone history. We performed a 24-hours urine test, and examined PH, calcium and oxalate. The urine analysis, showed acidic pH and hypercalciuria in all cases associated to weddelite in 3 cases, hyperoxaluria in all cases. In one case, we noted vitamin D deficiency related hyperparathyroidism. Renal transplantation has been achieved in two cases. After a mean follow up of 11,25 months [range :27-84], no urological complications were noted. CONCLUSION Urinary lithiasis may occur in proposed living kidney donors and may not contraindicate this donation.
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Abstract
OBJECTIVE Recent international guidelines suggest renal imaging to detect occult urolithiasis in all patients with asymptomatic primary hyperparathyroidism (PHPT), but data regarding their prevalence and associated risk factors are limited. We evaluated the prevalence and risk factors for occult urolithiasis. METHODS Cross-sectional analysis of 96 asymptomatic PHPT patients from a university hospital in the United States with and without occult nephrolithiasis. RESULTS Occult urolithiasis was identified in 21% of patients. Stone formers had 47% higher 24-hour urinary calcium excretion (p = 0.002). Although available in only a subset of patients (n = 28), activated vitamin D [1,25(OH)2D] was 29% higher (p = 0.02) in stone formers. There was no difference in demographics, BMI, calcium or vitamin D intake, other biochemistries, renal function, BMD, or fractures. Receiver operating characteristic curves indicated that urinary calcium excretion and 1,25(OH)2D had an area under the curve of 0.724 (p = 0.003) and 0.750 (p = 0.04), respectively. A urinary calcium threshold of >211mg/day provided a sensitivity of 84.2% and a specificity of 55.3% while a 1,25(OH)2D threshold of >91pg/mL provided a sensitivity and specificity of 62.5% and 90.0% respectively for the presence of stones. CONCLUSION Occult urolithiasis is present in about one-fifth of patients with asymptomatic PHPT and is associated with higher urinary calcium and 1,25(OH)2D. Given that most patients will not have occult urolithiasis, targeted imaging in those most likely to have occult stones rather than screening all asymptomatic PHPT patients may be useful. The higher sensitivity of urinary calcium versus 1,25(OH)2D suggests screening those with higher urinary calcium may be an appropriate approach.
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Affiliation(s)
- Yu-Kwang Donovan Tay
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
- Department of Medicine, Sengkang Health, Singapore
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore
| | - Minghao Liu
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
| | - Leonardo Bandeira
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
| | - Mariana Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
| | - James A. Lee
- Department of Endocrine Surgery, Columbia University, New York, USA
| | - Shonni J. Silverberg
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
| | - Marcella D. Walker
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
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Kulchavenya EV, Kholtobin DP, Brizhatyuk EV. [Nephrotuberculosis and urolithiasis]. Urologiia 2018:48-52. [PMID: 29634134] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Urolithiasis and nephrotuberculosis, due to the similarity of the radiographic patterns, share the same differential diagnosis list. The study aimed to analyze the incidence of co-occurrence of nephrotuberculosis and urolithiasis and to determine the impact of urolithiasis on the clinical course of renal tuberculosis. MATERIAL AND METHODS This open cohort retrospective study comprised 843 patients with renal tuberculosis and 245 patients with urolithiasis. 1088 medical records were analyzed to identify cases with co-occurrence of these two diseases and determine the clinical presentation of renal tuberculosis, urolithiasis, and the comorbid state. Also, patients with pulmonary tuberculosis (44), urogenital tuberculosis (17), and chronic nonspecific pyelonephritis (12) were tested for serum concentration of total calcium and phosphorus. RESULTS Of 843 patients with renal tuberculosis, 39 (4.6%), had concomitant nephrolithiasis. The combination of urolithiasis with nephrotuberculosis manifested by more severe symptoms; these patients had a more than two-fold risk of tuberculosis recurrence. Except for the incidence of renal colic and dysuria, the clinical manifestations of urolithiasis and nephrotuberculosis did not differ statistically significantly. Prolonged infectious and inflammatory process in the kidneys resulted in an increase in the excretion of oxalates, which was more pronounced in patients with nonspecific pyelonephritis (p<0.05). A three-month course of antituberculosis chemotherapy resulted in a 36.2% increase in the excretion of oxalates in patients with urotuberculosis (p<0.05). Excretion of uric acid also significantly increased after a three-month intake of antituberculosis drugs. CONCLUSION In our study, the incidence of concomitant urolithiasis and urogenital tuberculosis was low (4.6%), but comorbidity significantly complicated the clinical course of the disease and worsened the prognosis of nephrotuberculosis. Antituberculosis polychemotherapy increases the risk for formation of urinary stones. Prevention of urolithiasis in patients with urogenital tuberculosis warrants further investigation.
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Affiliation(s)
- E V Kulchavenya
- Tuberculosis Research Institute of Minzdrav of Russia
- Novosibirsk State Medical University of Minzdrav of Russia, Novosibirsk, Russia
| | - D P Kholtobin
- Tuberculosis Research Institute of Minzdrav of Russia
- Novosibirsk State Medical University of Minzdrav of Russia, Novosibirsk, Russia
| | - E V Brizhatyuk
- Tuberculosis Research Institute of Minzdrav of Russia
- Novosibirsk State Medical University of Minzdrav of Russia, Novosibirsk, Russia
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Abstract
Clinical suspicion of urolithiasis should be evaluated with low-dose computed tomography as the first-line imaging modality for nonpregnant, adult patients. A period of observation may be appropriate for ureteral stones less than 10 mm, and medical expulsive therapy may be beneficial for facilitating passage of distal ureteral stones. Regardless of stone type, patients should adhere to a low-sodium diet and attempt to achieve a urine volume of more than 2.5 L daily. Individuals with calcium stones should maintain a normal calcium diet, and if stones persist, citrate therapy or thiazide diuretics in the setting of hypercalciuria may be indicated.
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Affiliation(s)
- Wesley W Ludwig
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Marburg 134, Baltimore, MD 21287, USA.
| | - Brian R Matlaga
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Marburg 134, Baltimore, MD 21287, USA
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Walker MA. Struvite urolithiasis with eosinophilic polypoid cystitis in a shih tzu dog. Can Vet J 2018; 59:181-183. [PMID: 29386681 PMCID: PMC5764206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 7-year-old female spayed shih tzu dog was presented with hematuria of 4 weeks' duration. Radiographs revealed 1 cystic calculus. A polypoid mass was found incidentally during cystotomy and was removed by partial cystectomy. Histopathology revealed eosinophilic polypoid cystitis and urolith analysis reported struvite. A urinary tract infection was treated.
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