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AlSary S, Al-Zahrani EF, Al Baalharith M. Vesical Calculi and Female Pelvic Organ Prolapse: A Case Report and Literature Review. Cureus 2023; 15:e44578. [PMID: 37790022 PMCID: PMC10545005 DOI: 10.7759/cureus.44578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
This study presents a case report and reviews the literature on the simultaneous occurrence of advanced uterovaginal prolapse and urolithiasis, aiming to provide a comprehensive analysis of the reported cases. A thorough search was conducted in PubMed and Google Scholar; the search strategy included specific keywords and terms related to both conditions aiming to identify relevant case reports describing the association between advanced uterovaginal prolapse and urolithiasis; a total of 22 case reports were found in English literature. We present a case report of a 56-year-old woman, para 4, presenting with complaints of vaginal bulge and urinary symptoms. Upon examination, a complete procidentia with superficial ulceration was observed. During the reduction of the uterus, multiple small stones were noted coming through the urethral meatus. The patient underwent a vaginal hysterectomy, and the bladder stone was successfully extracted through vaginal cystotomy without complications. Our case report highlights the association between vesical calculi and female high-grade pelvic organ prolapse. Managing bladder stones in the context of pelvic organ prolapse can be challenging and vary significantly, reflecting the individual patient characteristics and surgeon preferences. The lack of standardized guidelines for managing bladder stones in the presence of pelvic organ prolapse highlights the need for further research.
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Affiliation(s)
- Saeed AlSary
- Urogynecology and Reconstructive Pelvic Surgery, King Abdul-Aziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
- Obstetrics and Gynecology, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Eman F Al-Zahrani
- Urogynecology and Reconstructive Pelvic Surgery, King Abdul-Aziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
- Obstetrics and Gynecology, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Maha Al Baalharith
- Urogynecology and Reconstructive Pelvic Surgery, King Abdul-Aziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
- Obstetrics and Gynecology, King Abdullah International Medical Research Center, Riyadh, SAU
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2
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Maresca G, Mc Clinton S, Swami S, El‐Mokadem I, Donaldson JF. Do men with bladder stones benefit from treatment of benign prostatic obstruction? BJU Int 2022; 130:619-627. [PMID: 35482471 PMCID: PMC9790555 DOI: 10.1111/bju.15761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify whether men aged ≥40 years with bladder stones (BS) benefit from treatment of benign prostatic obstruction (BPO). PATIENTS AND METHODS A regional, retrospective study of patients undergoing BS surgery between January 2011 and December 2018 was performed using a prospectively collected database. The primary outcome was BS recurrence after successful removal. Kruskal-Wallis and chi-squared statistical tests were used. RESULTS A total of 174 patients underwent BS removal and 71 (40.8%) were excluded due to BS formation secondary to causes other than BPO. Hence, 103 men aged ≥40 years had BS successfully removed, of which 40% had a history of upper tract urolithiasis. These men were divided into three groups: those undergoing contemporaneous medical, surgical, or no BPO treatment. Age, diabetes, previous urolithiasis and previous BPO surgery were well matched between the BPO treatment groups. In all, 18 of these men (17%) had BS recurrence after 46 months follow-up. Recurrences were significantly lower following BPO surgery; one of 34 (3%) men versus five of 28 (18%) with no BPO treatment (P = 0.048) and 12 of 41 (29%) with medical BPO treatment (P = 0.003). Recurrences after medical and no BPO treatment were similar (P = 0.280). In all, 34 men (33%) had BPO complications that were similar between groups (P = 0.378). CONCLUSION This is the largest reported cohort of men, with the longest follow-up after BS removal. Most men aged ≥40 years with BS benefit from BPO surgery. However, the study findings also support a multifactorial aetiology for BS, which questions the dogma that BS are an 'absolute indication' for BPO surgery, as is stated in the Non-neurogenic Male Lower Urinary Tract Symptoms European Association of Urology Guideline. Assessment and management of all causative factors is likely to enable selection of which men will benefit from BPO surgery and to reduce BS recurrence rates.
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Affiliation(s)
- Gianluca Maresca
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - Samuel Mc Clinton
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - Satchi Swami
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - Ismail El‐Mokadem
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - James F. Donaldson
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
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3
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Kasabwala K, Borofsky M, Grove S, Lenherr SM, Myers JB, Stoffel JT, Welk B, Elliott SP. Association of stone surgery with patient-reported complications after spinal cord injury. Neurourol Urodyn 2022; 41:820-829. [PMID: 35114016 DOI: 10.1002/nau.24887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Abstract
AIMS To determine if a history of urinary stone surgery in individuals with spinal cord injury (SCI) is associated with an increased incidence of SCI-related complications and lower quality of life (QOL). METHODS The Neurogenic Bladder Research Group (NBRG) registry is a multicenter, prospective, observational study which measures QOL after acquired SCI. Over 1.5 years, 1479 participants were enrolled and grouped according to history of stone surgery. We evaluated SCI-related complications, QOL, and associations between patient factors and prior stone surgery using multivariable regression. RESULTS Participants were a median of 11 years post-SCI and 189 (12.8%) reported prior bladder or kidney stone surgery; 95.8% of these occurred after the SCI. Median time between SCI and first stone was 5.6 years (IQR: 1.8-12.8). Hospitalizations were higher for those with prior stone surgery, with common reasons including UTIs, blood clots, pressure ulcers, and pneumonia (p < 0.001). During the year of observation, the incidence of stone surgery was 17% in those with a prior history of stone surgery and 2% per year in those without prior stone surgery (p < 0.001). Controlling for covariates, bladder management strategy, age, BMI, and years since SCI were associated with history of stone surgery. CONCLUSIONS People with SCI and a history of surgical stone disease are at high risk for episodes of recurrent stones and increased hospitalizations, particularly those with kidney stones and indwelling catheter use. Identification of high-risk patients may guide tailored surveillance for complications and stone prevention strategies.
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Affiliation(s)
- Khushabu Kasabwala
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shawn Grove
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara M Lenherr
- Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Blayne Welk
- Department of Surgery (Urology), Western University, London, Ontario, Canada
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
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4
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Gong ZC, Wu ZL, Wen YA, Zou JP, Wang X, Leng X, Bleyer AJ, Deng C, Feloney MP, Zhang Y, Zhao SC. Sexual Dysfunction in Patients With Urinary Bladder Stones but no Bladder Outlet Obstruction. Front Med (Lausanne) 2021; 8:704360. [PMID: 34604254 PMCID: PMC8482996 DOI: 10.3389/fmed.2021.704360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/10/2021] [Indexed: 12/22/2022] Open
Abstract
Objective: To explore the correlates of sexual dysfunction and lower urinary tract symptoms (LUTS) in male patients with urinary bladder stones and to determine the effect of stone extraction on recovery of sexual function. Materials and Methods: A total of 87 male patients with primary bladder stones were studied from January 2015 to May 2016. All patients underwent pneumatic lithotripsy for bladder stones. Sexual dysfunction was assessed based on sexual function assessment scales. The relationship of bladder stones with sexual dysfunction or LUTS was assessed using a two-sample t-test. Postoperative improvement of sexual function was assessed by repeated measures Analysis of Variance (ANOVA). Results: Forty-one patients had primary bladder stones and 46 had secondary stones from the kidneys. Eighty-three of 87 patients (95%) had sexual dysfunction; 79 patients (91%) had both sexual dysfunction and LUTS. There was a significant association between bladder stones and sexual dysfunction, between sexual dysfunction and LUTS, and between bladder stone and LUTS (p < 0.05). There was no significant association between the course of illness, size and number of bladder stones, or urinary tract infection with sexual function (p > 0.05). In addition, among 83 patients with both bladder stone and sexual dysfunction, 61 patients (73%) had benign prostatic hyperplasia (BPH) and 22 patients (27%) had no BPH. On postoperative evaluation at 3 months, sexual dysfunction scores were significantly improved in 77 patients (88.5%) Conclusion: Patients with bladder stones have a high incidence of sexual dysfunction, particularly those with co-existing LUTS and BPH. About 1/3 patients without BPH had sexual dysfunction and surgical removal of bladder stones significantly improved sexual function and LUTS.
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Affiliation(s)
- Zhi-Cheng Gong
- Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Urology, Xiang'an Hospital of Xiamen University, Xiamen, China
| | - Zhi-Liang Wu
- Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Urology, Dongfeng Zhongshan People's Hospital, Zhongshan, China
| | - Yao-An Wen
- Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jie-Peng Zou
- Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xisheng Wang
- Department of Urology, Shenzhen Longhua New District Central Hospital, Shenzhen, China
| | - Xiaoyan Leng
- Public Health Sciences, Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Anthony J Bleyer
- Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Chunhua Deng
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Michael P Feloney
- Department of Urology, School of Medicine, Creighton University, Omaha, NE, United States
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Shan-Chao Zhao
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Department of Urology, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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5
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Ahn MB. Extrathyroidal Manifestations of Persistent Sporadic Non-Autoimmune Hyperthyroidism in a 6-Year-Old Boy: A Case Report. Life (Basel) 2021; 11:713. [PMID: 34357084 DOI: 10.3390/life11070713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/17/2022] Open
Abstract
Thyroid-stimulating hormone receptor (TSHR) belongs in a subfamily of the G protein-coupled receptors. Thyroid-stimulating hormone receptor gene (TSHR), a gene encoding TSHR, is a major controller of thyroid cell metabolism, and its gain of function mutation leads to non-autoimmune hyperthyroidism (NAH), a condition of a prolonged state of hyperthyroidism. Diverse human diseases, and genetic, constitutional, or environmental factors contribute to the phenotypic variations of TSHR mutations; however, the underlying mechanisms leading to various extrathyroidal manifestations across ages are poorly understood. In 2018, the first Korean case of persistent sporadic NAH due to missense mutation of TSHR was reported, and this report highlights the extrathyroidal manifestations of NAH. Further investigation is warranted to clarify the roles of functional mutations of TSHR by investigating the correlation between G protein-dependent signaling properties and clinical phenotypes associated with persistent hyperthyroidism in order to develop novel therapies that could be provided for numerous conditions caused by NAH.
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6
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Maltagliati M, Sampogna G, Secco S, Galfano A, Montanari E, Micali S, Rocco B, Spinelli M. Case report of life-threatening complications following cystectomy in a woman with neurogenic lower urinary tract dysfunction treated with indwelling bladder catheter for about 30 years. Acta Biomed 2021; 92:e2021086. [PMID: 33944853 PMCID: PMC8142763 DOI: 10.23750/abm.v92is1.8615] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/21/2019] [Indexed: 11/23/2022]
Abstract
Patients with neurogenic lower urinary tract dysfunction (NLUTD), specially with indwelling bladder catheter (iBC), have an increased risk of developing bladder stones, incomplete bladder emptying, recurrent urinary tract infections, sepsis, urethral trauma and bladder cancer. We present the case of a patient with a large bladder stone in iatrogenic NLUTD treated with iBC for about 30 years, who underwent a cystectomy followed by several life-threatening complications.
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Affiliation(s)
- Matteo Maltagliati
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
| | - Gianluca Sampogna
- Urology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Silvia Secco
- Urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Antonio Galfano
- Urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Salvatore Micali
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
| | - Bernardo Rocco
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
| | - Michele Spinelli
- Neuro-urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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7
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Alshayyah RWA, Yu Y, Lv H, Liu W, Yang B. Bipolar transurethral enucleation of the prostate combined with open cystolithotomy in the treatment of large and giant prostate with bladder stones: Case series. Urologia 2021; 89:195-202. [PMID: 33784912 DOI: 10.1177/03915603211001686] [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] [Indexed: 11/15/2022]
Abstract
The surgical management of large or giant prostate still has challenges to urologists, especially if combined with bladder stones, and the traditional techniques by open prostatectomy and cystolithotomy have significant morbidity rates. The endoscopic procedure might not be feasible to treat both conditions in a single procedure, despite advances in surgical techniques and instrumentation, we present a one-session procedure by a combined endoscopic and open approach for treating benign prostatic hyperplasia (BPH) larger than 100 g combined with bladder stones in the elderly patient with other comorbidities. Between May 2017 and January 2020, bipolar transurethral plasma kinetic enucleation of the prostate (TUEP) followed by open cystolithotomy was performed to six patients at our institution, three of them combined with a big bladder stone(s). All the patients have other chronic chest and heart diseases; we retrospectively collected the data. All the patients diagnosed as BPH of big size or giant prostate over 100 g, with bladder stone, and all the patients treated with the same procedure. We founded that the combination methods showed a significant effect in terms of surgery time, patient outcomes and recovery, hospital discharge. The mean age of patients was 78.16 ± 4.2 (73-84) years, and the mean prostate-specific antigen (PSA) value was 16.27 ± 10.01 (8.32-32.17) ng/mL. The mean size of the prostate measured by MRI/US was 266.16 ± 89.1 (169-405) mL. The mean total operation time was 70.5 ± 10.9 (60-90) min, while the mean enucleation time was 28.38 ± 6.61 (23-40) min. The mean intraoperative blood loss was 193.33 ± 19.66 (170-220) mL. The mean resected prostate weight was 217.166 ± 94.67 (117-365) g. The mean post-operative hospital stay was 2.6 ± 0.81 (2-4) days. One patient was readmitted 2 months later due to urinary tract infection, and one patient complains of urine incontinence who spontaneously subsided in 4 months after surgery, other that no severe postoperative complications observed, a significant reduction of serum PSA and IPSS recorded at 3 months, postoperatively. Although simple open prostatectomy remains the reference standard for the treatment. Of excessively large or giant prostatic hyperplasia, the combination procedure not only facilitates the management of selected cases of hyperplasia but further imparts significant benefits to patients and surgeons alike. This treatment plan is safe, time-consuming, and could revolutionize future treatment approaches to giant prostate.
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Affiliation(s)
- Rami Walid Abdullah Alshayyah
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yang Yu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Hang Lv
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Wengtong Liu
- Department of Urology, the Third Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Bo Yang
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
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8
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Persico F, Saita A, Peschechera R, Diana P, Lughezzani G, Guazzoni GF, Casale P. New super-pulse thulium laser for the treatment of benign prostatic hyperplasia and bladder stones: our first experience. Cent European J Urol 2021; 74:139. [PMID: 33976930 PMCID: PMC8097646 DOI: 10.5173/ceju.2021.330.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Francesco Persico
- Humanitas Clinical and Research Center - IRCCS, Department of Urology, Rozzano, Milan, Italy.,University of Naples Federico II, Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Naples, Italy
| | - Alberto Saita
- Humanitas Clinical and Research Center - IRCCS, Department of Urology, Rozzano, Milan, Italy
| | - Roberto Peschechera
- Humanitas Clinical and Research Center - IRCCS, Department of Urology, Rozzano, Milan, Italy
| | - Pietro Diana
- Humanitas Clinical and Research Center - IRCCS, Department of Urology, Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Humanitas Clinical and Research Center - IRCCS, Department of Urology, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Giorgio Ferruccio Guazzoni
- Humanitas Clinical and Research Center - IRCCS, Department of Urology, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Paolo Casale
- Humanitas Clinical and Research Center - IRCCS, Department of Urology, Rozzano, Milan, Italy
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9
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Khusid JA, Sadiq AS, Gupta M, Atallah WM. Management of a Massive Bladder Stone Burden in an Elderly Comorbid Woman via a Transurethral Approach. J Endourol Case Rep 2021; 6:509-511. [PMID: 33457715 DOI: 10.1089/cren.2020.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Here we present the case of a 78-year-old medically comorbid woman with an extremely large bladder stone burden treated by cystolithalopaxy performed using a Swiss LithoClast® Trilogy Lithotripter (Boston Scientific, Marlborough, MA, USA) through a nephroscope traversing a transurethral Amplatz sheath.
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Affiliation(s)
- Johnathan A Khusid
- Department of Urology, Ichan School of Medicine at Mount Sinai, New York, New York, USA
| | - Areeba S Sadiq
- Department of Urology, Ichan School of Medicine at Mount Sinai, New York, New York, USA
| | - Mantu Gupta
- Department of Urology, Ichan School of Medicine at Mount Sinai, New York, New York, USA
| | - William M Atallah
- Department of Urology, Ichan School of Medicine at Mount Sinai, New York, New York, USA
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10
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Hughes T, Ho HC, Pietropaolo A, Somani BK. Guideline of guidelines for kidney and bladder stones. Turk J Urol 2020; 46:S104-S112. [PMID: 33052834 PMCID: PMC7731951 DOI: 10.5152/tud.2020.20315] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/25/2020] [Indexed: 11/22/2022]
Abstract
Urological organizations publish detailed evidence-based guidelines to support the urologists in the management of urolithiasis. Our objective was to provide clear guidance on the management of urolithiasis, compare the American Urological Association (AUA) and European Association of Urologists (EAU) guidelines, and present an algorithm for different clinical scenarios. The latest AUA and EAU guidelines on urolithiasis were evaluated for the level of evidence and grade of recommendation. All recommendations on management of urolithiasis (surgical and medical management) were reviewed and included. Both the organizations provide guidance for initial patient assessment, imaging requirements, and therapeutic options, including surgical intervention and medical therapy. In addition, these guidelines provide advice for managing specific patient groups, including pediatric patients and pregnant patients. Although there is a general concordance between both the groups, differences exist particularly for recommended modality of surgical intervention depending on stone location and size. Although both the guidelines were broadly similar, we also highlighted the variations in the level of evidence and grade of recommendation. Although these guidelines provide a valuable evidence-based framework to support the management of urinary tract stones, their implementation must be tailored to individual patient needs and available resources.
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Affiliation(s)
| | - Hui Ching Ho
- University Hospital Southampton, Southampton, UK
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11
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Byrne MHV, Dragos L, Winterbottom A, Saeb-Parsy K, Wiseman OJ. Percutaneous Cystolitholapaxy Using the LithoClast Trilogy for Multiple Bladder Stones. J Endourol Case Rep 2020; 6:118-120. [PMID: 33102704 DOI: 10.1089/cren.2019.0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Multiple large bladder calculi are traditionally managed through open cystolithotomy or transurethrally in patients who have an open bladder neck. Open procedures are technically challenging in patients who may have had multiple previous open surgeries, and may be associated with significant morbidity in patients with a high comorbid burden. Therefore, a percutaneous approach to such stones has been used especially when there is a closed bladder neck, and has been shown to be effective. There are a number of available devices for breaking stones in these approaches, the newest of which is the LithoClast Trilogy™ (EMS, Nyon, Switzerland) device, a probe that provides ultrasonic and mechanical calculi fragmentation and suction in a single instrument. Case Presentation: We describe the first reported case of percutaneous cystolitholapaxy using the LithoClast Trilogy device in a 41-year-old woman with spina bifida, and multiple large bladder calculi with a history of ileocystoplasty and Mitrofanoff formation, and a bladder neck closure for neuropathic bladder. The calculi measured 31 and 25 mm, and had a volume of 19.6 and 7.9 cm3 and average HU of 408 and 462, respectively. The calculi were composed of 37% calcium phosphate and 63% magnesium ammonium phosphate. Conclusion: We demonstrate that this approach can be used as a viable alternative to open surgery, which is of particular importance for complex patients who have undergone multiple previous open operations, and who may have a high comorbid burden.
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Affiliation(s)
- Matthew H V Byrne
- Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Laurian Dragos
- Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Andrew Winterbottom
- Department of Interventional Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Kasra Saeb-Parsy
- Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Oliver J Wiseman
- Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
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12
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Abstract
Prostatic calculi are commonly seen in older men as their incidence increases with age. They are associated with prostate hypertrophy, chronic inflammation of the gland, prostate cancer, and rarely with other pathological conditions such as granulomatous diseases. Although typical small in size, they can seldom become giant and replace the entire prostate gland with only few cases reported in literature. We present one such rare case of a young male who presented to the emergency department with clinical manifestations of sepsis and no relevant past medical history. The patient was ultimately treated with open simple retropubic prostatectomy as a surgical stone extraction method.
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13
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Esposito C, Autorino G, Masieri L, Castagnetti M, Del Conte F, Coppola V, Cerulo M, Crocetto F, Escolino M. Minimally Invasive Management of Bladder Stones in Children. Front Pediatr 2020; 8:618756. [PMID: 33575232 PMCID: PMC7870782 DOI: 10.3389/fped.2020.618756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Bladder stones (BS) are rare in children. Minimally invasive surgery (MIS) seems to be nowadays the procedure of choice to treat pediatric patients with BS. This study aimed to analyze retrospectively our experience with percutaneous cystolithotomy, endourological treatment with Holmium laser and robotic cystolithotomy in children with BS. Methods: We retrospectively analyzed the data of 13 children (eight boys and five girls) with BS who were treated at our centers between July 2013 and July 2020. The patients received three different MIS procedures for stones removal: five underwent robotic cystolithotomy, five underwent endourological treatment and three received percutaneous cystolithotomy (PCCL). We preferentially adopted endourological approach for stones <10 mm, percutaneous approach between 2014 and 2016 and robotic approach since 2016 for larger stones. Results: Mean patients' age at the time of diagnosis was 13 years (range 5-18). Ten/13 patients (76.9%) had primary BS and 3/13 patients (23.1%) had secondary BS. Mean stone size was 18.8 mm (range 7-50). In all cases the stones were removed successfully. One Clavien II post-operative complication occurred following PCCL (33.3%). All the procedures were completed without conversions. Operative time ranged between 40 and 90 min (mean 66) with no significant difference between the three methods (p = 0.8). Indwelling bladder catheter duration was significantly longer after PCCL (mean 72 h) compared with robotic and endourological approaches (mean 15.6 h) (p = 0.001). Hospitalization was significantly longer after PCCL (mean 7.6 days) compared with the other two approaches (mean 4.7 days) (p = 0.001). The endourological approach was the most cost-effective method compared with the other two approaches (p = 0.001). Conclusions: Minimally invasive management of bladder stones in children was safe and effective. Endourological management was the most cost-effective method, allowing a shorter hospital stay compared with the other procedures but it was mainly indicated for smaller stones with a diameter < 10 mm. Based upon our preliminary results, robotic surgery seemed to be a feasible treatment option for BS larger than 15-20 mm. It allowed to remove the big stones without crushing them with a safe and easy closure of the bladder wall thanks to the easy suturing provided by the Robot technology.
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Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Giuseppe Autorino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Lorenzo Masieri
- Pediatric Urology Unit, Meyer Children Hospital, Florence, Italy
| | | | - Fulvia Del Conte
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Vincenzo Coppola
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Felice Crocetto
- Urology Unit, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
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14
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Dhondup T, Kittanamongkolchai W, Vaughan LE, Mehta RA, Chhina JK, Enders FT, Hickson LJ, Lieske JC, Rule AD. Risk of ESRD and Mortality in Kidney and Bladder Stone Formers. Am J Kidney Dis 2018; 72:790-797. [PMID: 30146423 DOI: 10.1053/j.ajkd.2018.06.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 06/11/2018] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVES Kidney stones have been associated with increased risk for end-stage renal disease (ESRD). However, it is unclear whether there is also an increased risk for mortality and if these risks are uniform across clinically distinct categories of stone formers. STUDY DESIGN Historical matched-cohort study. SETTING & PARTICIPANTS Stone formers in Olmsted County, MN, between 1984 and 2012 identified using International Classification of Diseases, Ninth Revision codes. Age- and sex-matched individuals who had no codes for stones were the comparison group. PREDICTOR Stone formers were placed into 5 mutually exclusive categories after review of medical charts: incident symptomatic kidney, recurrent symptomatic kidney, asymptomatic kidney, bladder only, and miscoded (no stone). OUTCOMES ESRD, mortality, cardiovascular mortality, and cancer mortality. ANALYTICAL APPROACH Cox proportional hazards models with adjustment for baseline comorbid conditions. RESULTS Overall, 65 of 6,984 (0.93%) stone formers and 102 of 28,044 (0.36%) non-stone formers developed ESRD over a mean follow-up of 12.0 years. After adjusting for baseline hypertension, diabetes mellitus, dyslipidemia, gout, obesity, and chronic kidney disease, risk for ESRD was higher in recurrent symptomatic kidney (HR, 2.34; 95% CI, 1.08-5.07), asymptomatic kidney (HR, 3.94; 95% CI, 1.65-9.43), and miscoded (HR, 6.18; 95% CI, 2.25-16.93) stone formers, but not in incident symptomatic kidney or bladder stone formers. The adjusted risk for all-cause mortality was higher in asymptomatic kidney (HR, 1.40; 95% CI, 1.18-1.67) and bladder (HR, 1.37; 95% CI, 1.12-1.69) stone formers. Chart review of asymptomatic and miscoded stone formers suggested increased risk for adverse outcomes related to diagnoses including urinary tract infection, cancer, and musculoskeletal or gastrointestinal pain. CONCLUSIONS The higher risk for ESRD in recurrent symptomatic compared with incident symptomatic kidney stone formers suggests that stone events are associated with kidney injury. The clinical indication for imaging in asymptomatic stone formers, the correct diagnosis in miscoded stone formers, and the cause of a bladder outlet obstruction in bladder stone formers may explain the higher risk for ESRD or death in these groups.
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Affiliation(s)
- Tsering Dhondup
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Lisa E Vaughan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Ramila A Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jasdeep K Chhina
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Felicity T Enders
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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15
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Abstract
OBJECTIVE To assess detailed familial risks for medically diagnosed urolithiasis (UL, urinary tract stone disease) based on nationwide hospital and population records. PATIENTS/SUBJECTS AND METHODS Subjects were identified from the Swedish Multigeneration Register in which there were 211 718 patients with UL. Standardised incidence ratios (SIRs) were calculated by comparison to individuals without a family history of UL. RESULTS The highest familial SIRs were invariably found for the same (concordant) type of UL: 2.18 for kidney, 2.20 for ureter, and 1.93 for bladder. SIRs increased from 1.84, when one parent was affected, to 3.54 when both parents were affected, which was a multiplicative interaction. The SIR was 1.79 when one sibling was affected but it increased to 24.91 when two siblings were affected. Such excessive risks (5.2% of familial cases) are probably explained by high-penetrant genes. A low SIR of 1.29 between spouses suggested a minor contribution by shared environmental factors on the familial risk. CONCLUSIONS The results point to underlying genetic causes for the observed familial clustering and establish the genetic landscape of UL. Family histories should be taken in UL diagnostics and prevention could follow guidelines recommended for recurrent UL.
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Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Otto Hemminki
- Department of Urology, Helsinki University Hospital, Helsinki, Finland.,Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
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16
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Abstract
As the population ages the prevalence of long-term urinary catheters, especially in the elderly, is going to increase. Urinary catheters are usually placed to manage urinary retention or incontinence that cannot be managed any other way. There is significant morbidity associated with an indwelling catheter. The commonest problems are catheter blockages, infection and bladder stones. These will occur with a similar incidence with either a suprapubic or a urethral catheter. Urethral complications such as strictures, scrotal infection and erosion are less common with suprapubic catheterization (SPC). However the benefit of having a SPC needs to be balanced against the risks involved in inserting the catheter suprapubically. Patient reported symptoms show that a SPC is more comfortable and better tolerated than a urethral catheter. However there needs to be more research into developing better catheters that reduce the frequency of urinary infections and blockages and hence catheter morbidity.
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Affiliation(s)
- Sharon F English
- Department of Urology, Christchurch Hospital, Christchurch, New Zealand
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17
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Abstract
Alexandrian surgeon Ammonius Lithotomos, was the first to introduce lithoclastic cystotomy during the 3rd century BC in order to relieve a bladder's stone blockage. He had used a metallic hook or crotchet to remove the stone, which was named at the era "thrombus" of the urinary tract.
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18
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Glybochko PV, Alyaev YG, Pshikhachev AM, Sorokin NI, Dymov AM. [Choosing treatment for patients with bladder cancer combined with prostatic hyperplasia]. Urologiia 2016:92-96. [PMID: 28248027] [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: 06/06/2023]
Abstract
AIM To define treatment selection criteria for patients with bladder cancer combined with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Between 2006 and 2015, 1148 patients were treated for bladder cancer and 3368 patients for BPH. Among them, 258 (22.5%) patients had both bladder cancer and BPH. 113 (11.6%) patients had indications for surgical treatment of both diseases. In this group, 18 (13.5%) patients also had bladder stones. Only 2 (1.6%) patients had tumor invading the muscle wall, while the remaining patients had non-muscle invasive bladder cancer. RESULTS In 18% of patients the surgery was done in two stages, the first for bladder cancer and the second for BPH. The remaining 82% of patients underwent simultaneous surgery. Bladder cancer recurred in 34.4% of patients. DISCUSSION Comparative evaluation of the results of transurethral resection of the bladder and prostate showed a greater number of intraoperative complications in patients who underwent staged surgery. In our opinion, it may be attributed to the lack of adequate visualization and access to the tumor, located near the opening of the ureter, to the intravesical prostate growth or large median lobe of the prostate. Bladder tumors greater than 3 cm, the multiple lesions and the low tumor differentiation were associated with a higher risk of bladder cancer recurrence, but recurrence rates of simultaneous and staged surgeries were not significantly different. The treatment of patients with bladder cancer in combination with BPH and bladder stones depended on the prostate volume, the number and size of stones. To reduce the risk of complications, in cases with assumed operating time more than 2 hours, it is advisable to split the treatment into two stages with BPH surgery on the second stage.
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Affiliation(s)
- P V Glybochko
- Department of Urology, I.M. Sechenov First MSMU, Research Institute of Uronephrology and Human Reproductive Health
| | - Yu G Alyaev
- Department of Urology, I.M. Sechenov First MSMU, Research Institute of Uronephrology and Human Reproductive Health
| | - A M Pshikhachev
- Department of Urology, I.M. Sechenov First MSMU, Research Institute of Uronephrology and Human Reproductive Health
| | - N I Sorokin
- Department of Urology, I.M. Sechenov First MSMU, Research Institute of Uronephrology and Human Reproductive Health
| | - A M Dymov
- Department of Urology, I.M. Sechenov First MSMU, Research Institute of Uronephrology and Human Reproductive Health
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19
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Conze T, Wehrend A, Exner C, Kaminiarz A. Therapy of calcium oxalate urolithiasis in a rhesus macaque (Macaca mulatta). J Med Primatol 2016; 45:195-7. [PMID: 27283130 DOI: 10.1111/jmp.12221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2016] [Indexed: 11/27/2022]
Abstract
A rhesus macaque (Macaca mulatta) was presented for anuria. Examination revealed calcium oxalate concrements in the bladder. A cystotomy was performed, and a therapy with alfuzosin was conducted. Over 1 year after the treatment, the rhesus macaque had not shown any more signs of stranguria. This is the first case reporting the successful treatment of urolithiasis in a rhesus macaque.
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Affiliation(s)
- Theresa Conze
- Faculty of Veterinary Medicine, Clinic for Obstetrics, Gynecology and Andrology of Large and Small Animals with Ambulatory Service, Justus-Liebig-University Giessen, Giessen, Germany
| | - Axel Wehrend
- Faculty of Veterinary Medicine, Clinic for Obstetrics, Gynecology and Andrology of Large and Small Animals with Ambulatory Service, Justus-Liebig-University Giessen, Giessen, Germany
| | - Cornelia Exner
- Department of Animal Physiology, Philipps University Marburg, Marburg, Germany
| | - André Kaminiarz
- Department of Neurophysics, Philipps University Marburg, Marburg, Germany
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20
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Schaffer JN, Norsworthy AN, Sun TT, Pearson MM. Proteus mirabilis fimbriae- and urease-dependent clusters assemble in an extracellular niche to initiate bladder stone formation. Proc Natl Acad Sci U S A 2016; 113:4494-9. [PMID: 27044107 DOI: 10.1073/pnas.1601720113] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The catheter-associated uropathogenProteus mirabilisfrequently causes urinary stones, but little has been known about the initial stages of bladder colonization and stone formation. We found thatP. mirabilisrapidly invades the bladder urothelium, but generally fails to establish an intracellular niche. Instead, it forms extracellular clusters in the bladder lumen, which form foci of mineral deposition consistent with development of urinary stones. These clusters elicit a robust neutrophil response, and we present evidence of neutrophil extracellular trap generation during experimental urinary tract infection. We identified two virulence factors required for cluster development: urease, which is required for urolithiasis, and mannose-resistantProteus-like fimbriae. The extracellular cluster formation byP. mirabilisstands in direct contrast to uropathogenicEscherichia coli, which readily formed intracellular bacterial communities but not luminal clusters or urinary stones. We propose that extracellular clusters are a key mechanism ofP. mirabilissurvival and virulence in the bladder.
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21
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Ercil H, Altunkol A, Alma E, Goren MR, Sener NC, Kuyucu F, Karakoyunlu AN, Vuruskan E, Ortoglu F, Gurbuz ZG. Comparison of Ho:Yag laser and pneumatic lithotripsy combined with transurethral prostatectomy in high burden bladder stones with benign prostatic hyperplasia. Asian J Surg 2016; 39:238-42. [PMID: 25937584 DOI: 10.1016/j.asjsur.2015.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To compare the efficacy and reliability of Ho:YAG laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in the treatment of bladder stones in patients with benign prostatic hyperplasia and stones ≥ 20 mm who were transurethrally treated in the same surgical session. METHODS We studied the data of patients with benign prostatic hyperplasia and ≥20 mm bladder stones who were treated with transurethral resection of the prostate and cystolithotripsy in the same session, obtained between January 2010 and February 2014 from three urology clinics. All patients underwent bipolar plasmakinetic (PK) transurethral resection of the prostate. For treatment of the bladder stone, either HLL or PL was applied. A total of 62 patients were divided into two groups: PK-PL (Group 1, n = 29) and PK-HLL (Group 2, n = 33). The data of both groups were analyzed for stone dimensions, stone fragmentation time, total operating time, hospitalization duration, prostate dimensions, success rates, and complications. RESULTS Group 1 included 29 patients with a mean age of 70 ± 7.6 (range, 57-85) years, whereas Group 2 included 33 patients with a mean age of 67.5 ± 10.5 (range, 45-84) years. In Group 1, five patients had mucosa injury, one patient had residual stone, and one patient had bladder perforation. In Group 2, three patients had mucosa injury, three patients had postoperative fever, and one patient had residual stone. Total operation time and stone fragmentation time were significantly lower in Group 2 (p < 0.05). The remaining analyzed data were similar (p > 0.05). CONCLUSION PK-HLL using a single shaft without the need for repeated access has the advantages of shorter fragmentation and operation time.
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22
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Abstract
BACKGROUND Bladder calculi are the second most common urological complication in those with spinal cord injury (SCI). Detection and removal of bladder stones are important to prevent possible complications. OBJECTIVE To determine the accuracy of bladder stone detection based on catheter encrustation in asymptomatic individuals with SCI. DESIGN Prospective cohort study. METHODS Cystoscopy findings in persons with SCI who were noted to have catheter encrustation at the time of catheter removal for their scheduled cystoscopy were used in this prospective study. Indwelling catheters were examined for encrustation at the time of removal as they were being prepared for cystoscopy. Cystoscopy was performed, and the presence or absence of bladder stones was noted. MAIN OUTCOME MEASURES Presence or absence of bladder stones detected with cystoscopy in those with precystoscopy catheter encrustation. RESULTS Forty-nine individuals with indwelling catheters were evaluated. Overall, 17/49 (35%) individuals in this study had bladder stones. Catheter encrustation was noted in 13 patients. Of these 13 patients, 11 also had bladder stones. In other words, a positive result for catheter encrustation had a positive result for bladder stones 85% of the time. Thirty-six individuals had no catheter encrustation. Of these, 6 (16%) were found to have bladder stones. CONCLUSIONS Encrustation of a catheter is highly predictive of the presence of bladder stones. This suggests that cystoscopy should be scheduled in a person undergoing a catheter change if catheter encrustation is noted.
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Affiliation(s)
- Mark A Linsenmeyer
- Kessler Institute for Rehabilitation, Department of Urology, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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