[Obesity as one of the risk factors for urolithiasis]

BACKGROUND

It is well known that many diseases may be associated with obesity resulting from an energy-rich diet, and that a westernized diet may increase the incidence of urinary stone formation. To evaluate degree of obesity, we investigated body mass index (BMI) in patients with calcium containing upper urinary stones and examined their blood with regard to lipid metabolism.

METHODS

Between July 1994 and December 1995, we analyzed 332 fresh renal-stone formers (253 males and 79 females) who visited 7 hospitals located in Ehime prefecture. As a control, 949 residents older than 20 years (387 males and 562 females) of the same prefecture were also examined by the annual Ehime prefecture office report of 1994. Body mass index as degree of obesity, stone-recurrence, blood test and other complicated diseases were examined.

RESULTS

In male stone formers the rate of obesity was significantly higher than that of control males (p < 0.001). The differences were seen only in their twenties and fifties. Furthermore, among male stone formers the rate of obesity was significantly higher in recurrent stone formers than in single stone formers (p < 0.05). On the other hand, in female, there was no significant difference in the rate of obesity between stone formers and controls. No difference was seen between recurrent stone formers and single stone formers. In the blood test, there was no differences in the level of calcium, phosphate and uric acid between stone formers and controls. The level of cholesterol and triglyceride in male were significantly higher in controls (p < 0.01) and there was no difference in the level of high density lipoprotein (HDL) between stone formers and controls. Among the stone formers, 48 males (20.0%) and 17 females (21.5%) had other diseases. The rate of complicated diseases was similar to that of controls and no specific diseases in the stone formers were identified.

CONCLUSION

Our report suggested that obesity in male should be considered as a risk factor for calcium containing stone formation.

[Extracorporeal shock wave lithotripsy in a patient with hemophilia A. A case report]

We treated a 25-year-old hemophilia A patient (FVIII:C activity 2%) with left ureteral stone by means of extracorporeal shock wave lithotripsy under replacement therapy of concentrated Factor VIII material. The patient was attacked by sudden onset of left renal colic with gross hematuria on the 12th postoperative day. Renal ultrasonography and computed tomography demonstrated subcapsular bleeding of the left kidney. In spite of usual antihemophiliac replacement therapy, bleeding was extended from the retroperitoneal space to intraperitoneal and intrapleural space because potent Factor VIII inhibitors (14 Bethesda Unit) was produced. After embolization of the left renal artery, double filtration plasmapheresis and bypassing therapy using prothrombin complex concentrate were performed effectively to save the patient's life.

The organic matrix of urinary uric acid crystals

We have demonstrated that urinary uric acid crystals contain an organic matrix within the crystalline boundaries, morphologically similar to that of uric acid stones. Among several glycosaminoglycans in urine, heparan sulfate was almost exclusively identified in this matrix, as in that of uric acid stones. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) showed that several proteins in urine were incorporated in this matrix on a selective basis; two of which were albumin and Tamm-Horsfall mucoprotein. An affinity of uric acid or urate for selective urinary macromolecules in a liquid phase was supposed to be the origin of this matrix. But the proteins in the uric acid stone matrix were not separated by SDS-PAGE. Therefore we could not conclude whether the organic matrix of urinary uric acid crystals is similar to that of uric acid stones.

[A case of vesical malacoplakia]

A 44-year-old woman was admitted to our hospital, complaining of terminal hematuria. On cystoscopy four yellow and soft nodular masses were observed in the bladder, one of which had central ulceration. TUR was performed for these masses. Histological examination revealed that they were vesical malacoplakia. The masses consisted of aggregates of macrophages with abundant cytoplasma in which typical Michaelis-Gutmann bodies were demonstrated by light and electron microscopies.

[Experience with transabdominal and scrotal ultrasonographic examination in urology]

To evaluate its diagnostic availability in urology, transabdominal and scrotal ultrasonographic examination was made on 87 patients who had been admitted to our hospital for space occupying lesions. In retroperitoneal lesions, adrenal tumors and renal tumors greater than 2.5 cm could be detected by this examination. In pelvic lesions, bladder tumors greater than 0.5 cm were demonstrated and prostatic carcinoma with heterogeneous echotexture and irregular margin was discriminated from BPH. Not only could fluid-filled scrotal lesions larger than 1.0 cm be distinguished from solid mass lesions, but the intrascrotal anatomy could also be demonstrated in detail. Because of its safety, flexibility, and accuracy in detecting space occupying lesions, this examination could be a useful screening test in urology. Representative cases we experienced are presented.