Ultrasonic Destruction of Kidney Stones

Kidney stones may be removed without using a surgical incision by a combination of techniques and skills recently developed in the fields of urology and radiology. Percutaneous access to the kidney is established under fluoroscopic control. A guide wire placed into the renal pelvis allows a nephroscope to be inserted and the collecting system visualized. A long hollow metal probe is advanced through the nephroscope and placed in contact with the stone. This probe conducts the ultrasonic energy. The stone absorbs the energy and breaks into fine granules, which are evacuated by suction.Twenty-three consecutively seen patients presenting with 27 upper urinary tract calculi for which removal was indicated underwent successful percutaneous ultrasonic lithotripsy. Fifteen stones were located in the renal pelvis, eight in a calix, three at the ureteropelvic junction and one in the upper ureter. One infected staghorn calculus was removed. Two complications resulted in extended hospital stays, but in no patients were surgical incisions required. Of the 23 patients, 9 had previously had a surgical lithotomy. The authors believe that most renal and upper ureteral calculi for which removal is indicated may be extracted percutaneously with the aid of the ultrasonic lithotriptor. The patients may expect a rapid convalescence with diminished pain.     

Selecting Treatment for Distal Ureteral Calculi: Shock Wave Lithotripsy versus Ureteroscopy

Shock wave lithotripsy (SWL) and ureteroscopy (URS) are both effective treatments for removal of distal ureteral calculi, associated with high success rates and limited morbidity. The American Urological Association Ureteral Stones Clinical Guidelines Panel has found both to be acceptable treatment options for patients, based on the stone-free results, morbidity, and retreatment rates for each respective therapy. However, costs and patient satisfaction or preference were not addressed, and the report was based on data derived from older endoscopic and lithotripsy technology. Each of these treatment options has valid advantages and disadvantages. Both modalities are reasonable treatment options for the majority of patients with distal ureteral calculi. Whereas SWL is less invasive, the high, immediate success rate with minimal morbidity and decreased cost makes URS a very valid competitor. The results of treating patients with larger stones favor URS.     

胆道镜结合微爆破碎石治疗复杂性胆道结石

目的:探讨微爆破碎石用于治疗复杂胆道结石的治疗体会。方法:在胆道镜直视下,分别在术中和术后对158例复杂的胆道结石患者进行微爆破碎石,然后用取石网取出碎石,泥沙状结石随液体流出或让其自行流入肠道。结果:158例患者156例取石成功。取石成功率98.73%。明显提高了胆道取石的成功率。无1例出现胆道穿孔、瘘道穿孔及胆道出血等严重并发症。结论:在胆道镜下,采用微爆破碎石术治疗复杂的胆道结石是一种安全、可靠、高效的方法,可以明显提高结石的取净率。     

胆道镜结合微爆破碎石治疗复杂性胆道结石

目的：探讨微爆破碎石用于治疗复杂胆道结石的治疗体会。方法：在胆道镜直视下,分别在术中和术后对158例复杂的胆道结石患者进行微爆破碎石,然后用取石网取出碎石,泥沙状结石随液体流出或让其自行流入肠道。结果：158例患者156例取石成功。取石成功率98.73%。明显提高了胆道取石的成功率。无1例出现胆道穿孔、瘘道穿孔及胆道出血等严重并发症。结论：在胆道镜下,采用微爆破碎石术治疗复杂的胆道结石是一种安全、可靠、高效的方法,可以明显提高结石的取净率。     

Hydrochlorothiazide, allopurinol and magnesium oxide in the treatment of recurrent calcium urolithiasis]

The study aimed at presenting own experience in prevention of new urinary calculi in 18 patients with metabolically active calcium urolithiasis treated with hydrochlorothiazide in daily doses of 100 mg (group I) for 2 years, and in 6 patients with the same disease treated with magnesium oxide in daily doses 300 mg twice a day (group II) for average period of 10 months. In 9 patients a new calculus was formed during the treatment with hydrochlorothiazide, in 7 patients no recurrence was noted, and in 2 remaining patients the results were controversial (coral calculus). Therefore, patients were subdivided into group Ia (failure of hydrochlorothiazide therapy), and group Ib (no recurrence noted). Hydrochlorothiazide did not lead to the stable decrease in the saturation of the urine with calcium oxalate in group Ia whereas in group Ib (without recurrence of urolithiasis) the content of calcium oxalate in the urine was significantly lower than that in group Ia after a 2-year treatment with hydrochlorothiazide (p < 0.01) Recurrence of the disease was seen only in one patient of group II, i.e. treated with magnesium oxide. The treatment of the recurrent calcium urolithiasis is justified and efficient in those patients in whom therapy decreases the content of calcium oxalate in the urine.     

输尿管软镜治疗小儿上尿路结石的疗效及对血清炎症因子的影响

目的:探讨输尿管软镜治疗小儿上尿路结石的疗效及对血清炎症因子的影响。方法:选择2013年4月至2016年4月我院收治的上尿路结石患儿60例,通过随机数表法分为观察组(n=30)和对照组(n=30),对照组给予经皮肾镜激光碎石,观察组采用输尿管软镜取石术进行治疗。观察记录两组患者术中出血量、手术时间、住院天数及疼痛评分;比较两组患者白细胞介素-10(IL-10)、C反应蛋白(CRP)、白细胞(WBC)水平、并发症发生情况及结石的清除率。结果:观察组患者手术时间、术中出血量、住院天数以及疼痛评分均低于对照组,差异均具有统计学意义(P0.05);两组患儿术前IL-10、CRP及WBC水平无明显差异;术后两组患儿各项炎性因子均明显增加(P0.05),观察者患儿IL-10、CRP及WBC水平显著低于对照组,差异具有统计学意义(P0.05);术后,观察组患者并发症总发生率为6.67%,明显低于对照组的33.33%,差异具有统计学意义(P0.05);两组患者结石清除率无明显差异(P0.05)。结论:输尿管软镜取石术治疗上尿路结石安全有效、创伤小、并发症少,患者产生的应激反应小,值得临床推广和应用。     

Calculus artifact. A challenge in urinary cytology.

OBJECTIVE: To retrospectively review calculus artifact and compare it with instrument artifact and papillary transitional cell carcinoma (TCC). STUDY DESIGN: Voided urine specimens from patients with calculi (65), TCC (low grade, 10, high grade, 34) and history of prior instrumentation (12) were studied. RESULTS: Nineteen specimens of calculus artifact had unremarkable cytology. Forty-six specimens had abnormal single cells or papillary clusters and cell balls or a mixture of both. The papillary groups had smooth as well as irregular borders, a cytoplasmic collar and cells with occasional cytoplasmic vacuoles, slightly increased nuclear/cytoplasmic (N/C) ratio and inconspicuous nucleoli. Squamous preponderance and birefringent crystals were seen. In instrumentation artifact, papillary clusters or three-dimensional cell balls had smooth borders, cytoplasmic collars, an occasional cytoplasmic vacuole, normal N/C ratio, regular nuclear membrane and finely granular nuclear chromatin. In TCC, papillary clusters with loss of polarity and irregular borders were present in both grades but were predominant in low grade TCC. No cytoplasmic collar was noted. In high grade TCC, single cells and nuclear alterations were more pronounced, with increased N/C ratio, hyperchromasia, coarse chromatin, irregular nuclear envelopes, prominent nucleoli and rare mitosis. CONCLUSION: Calculus artifact can produce papillary clusters masquerading as papillary TCC. Unlike instrument artifact, there may be significant nuclear atypia, which could be reversible. To avoid diagnostic pitfalls, further investigation is suggested after removal of calculus.     

Kidney Stones

The prevalence of kidney stones has steadily risen during this century; passage of a calculus and a positive family history increase the probability of recurrence. Findings from recent studies on the cause of renal calculi have stressed crystallization and crystal aggregation of stone minerals from supersaturated urine, rather than excessive organic matrix. Absence of normal urine inhibitors of calcium salts is also stressed. Formation of calcium oxalate stones is the major problem. Therapy with decreased calcium and oxalate intake, thiazides, phosphate salts and allopurinol in various combinations has substantially decreased the prevalence of recurrent stones. The rationale for the use of allopurinol is that uric acid salts enhance the tendency for calcium oxalate to crystallize from supersaturated urine. The hypercalciuria seen in 30 percent to 40 percent of patients with oxalate stones is usually caused by intestinal hyperabsorption of calcium. Although patients with uric acid calculi constitute only a small fraction of those in whom stones form, they represent a group in whom good medical therapy, based on sound physiologic principles, has proved extremely successful. Renal tubular syndromes lead to nephrocalcinosis and lithiasis through hypercalciuria, alkaline urine and hypocitraturia, the latter an inhibitor of calcium salt precipitation. Recent advances in surgical techniques are discussed, including the rationale for removing staghorn calculi. The ileal ureter and coagulum pyelolithotomy deserve special emphasis.     

Itô versus Stratonovich calculus in random population growth

The context is the general stochastic differential equation (SDE) model dN/dt=N(g(N)+sigmaepsilon(t)) for population growth in a randomly fluctuating environment. Here, N=N(t) is the population size at time t, g(N) is the 'average' per capita growth rate (we work with a general almost arbitrary function g), and sigmaepsilon(t) is the effect of environmental fluctuations (sigma>0, epsilon(t) standard white noise). There are two main stochastic calculus used to interpret the SDE, It? calculus and Stratonovich calculus. They yield different solutions and even qualitatively different predictions (on extinction, for example). So, there is a controversy on which calculus one should use. We will resolve the controversy and show that the real issue is merely semantic. It is due to the informal interpretation of g(x) as being an (unspecified) 'average' per capita growth rate (when population size is x). The implicit assumption usually made in the literature is that the 'average' growth rate is the same for both calculi, when indeed this rate should be defined in terms of the observed process. We prove that, when using It? calculus, g(N) is indeed the arithmetic average growth rate R(a)(x) and, when using Stratonovich calculus, g(N) is indeed the geometric average growth rate R(g)(x). Writing the solutions of the SDE in terms of a well-defined average, R(a)(x) or R(g)(x), instead of an undefined 'average' g(x), we prove that the two calculi yield exactly the same solution. The apparent difference was due to the semantic confusion of taking the informal term 'average growth rate' as meaning the same average.     

肠道与泌尿系统的微生物对肾结石发病机制影响的研究进展

肾结石是成人泌尿系统的常见疾病。它会影响肾脏的生理机能,还会导致尿路感染从而对人体健康造成一定危害。肾结石周围存在一个多元化的微生物群落,而肠道微生物和泌尿系统微生物的变化可能引起肾结石的发生与发展。其中双歧杆菌(Bifidobacterium)、乳酸杆菌(Lactobacillus)和肠杆菌科(Enterobacteriaceae)与肾结石发生较为密切。本篇综述着重介绍了肠道微生物与泌尿系统微生物在肾结石形成过程中的关联性,同时也对肾-肠轴概念,肠道微生物从短链脂肪酸产生、草酸盐变化和炎症发生对肾结石的影响,以及肾结石的预防与治疗等方面做出了介绍。     

Population growth in random environments

This paper reviews some recent advances in single population stochastic differential equation growth models. They are a natural way to model population growth in a randomly varying environment. The question of which calculus, Itô or Stratonovich, is preferable is addressed. The two calculi coincide when the noise term is linear, if we take into account the differences in the interpretation of the parameters. This clarifies, among other things, the controversy on the theory of niche limiting similarity proposed by May and MacArthur. The effects of correlations in the environmental fluctuations and statistical methods for estimating parameters and for prediction based on a single population trajectory are mentioned. Applications to fisheries, wildlife management and particularly to environmental impact assessment are now becoming possible and are proposed in this paper.     

Uric Acid nephrolithiasis: recent progress and future directions

The prevalence of urolithiasis has been increasing for the past few decades in industrialized nations. Uric acid calculi account for a significant percentage of urinary stones. Certain risk factors may be involved in the pathogenesis of uric acid nephrolithiasis, including hyperuricosuria, low urinary volume, and persistently low urinary pH. Patients with medical conditions that promote profound hyperuricosuria are at high risk of developing uric acid calculi. These conditions include chronic diarrheal states; myeloproliferative disorders; insulin resistance, including diabetes mellitus; and monogenic metabolic disorders, such as Lesch-Nyhan syndrome. Computed tomography can provide a definitive diagnosis. Except in cases in which there is severe obstruction, progressive azotemia, serious infection, or unremitting pain, the initial treatment of patients with uric acid nephrolithiasis should be medical dissolution therapy because this approach is successful in the majority of cases. A thorough review of the epidemiology and pathophysiology of uric acid nephrolithiasis is crucial for the diagnosis, treatment, and prevention of stones in patients with this condition.     

SOME ASPECTS OF THE MANAGEMENT OF BILATERAL CALCULUS DISEASE OF THE KIDNEY

In the diagnosis of bilateral calculus disease of the kidneys, it is important to differentiate between cystine, uric acid, calcium oxalate and phosphate renal lithiasis. Methods for distinguishing one from another are described.Dietary therapy is the method of choice for cystine and uric acid lithiasis.In calcium and phosphate urolithiasis, dietary therapy is a very useful adjunct. It must be regulated by careful studies of its effect on urinary calcium precipitability, a new test for which is described based upon the demonstration of the existence of two forms of calcium in the urine.Irrigation therapy for calcium phosphate and phosphate lithiasis is briefly discussed.Surgical therapy for large renal phosphatic calculi is discussed to show how considerations of renal counterbalance and urinary calcium, magnesium and phosphate excretion through damaged kidney substances influence the surgical plan in each case.     

孤立肾多发结石患者超声引导微创经皮肾穿刺取石术治疗的效果分析

目的:分析孤立肾多发结石患者超声引导微创经皮肾穿刺取石术治疗的效果。方法:64例孤立肾多发结石患者随机均分为试验组和对照组。其中对照组患者均采用常规开放式取石术治疗,试验组患者则在超声引导下实施微创经皮肾穿刺取石术治疗。比较两组患者的手术时间和术中出血量以及术后取净率等临床资料。结果:两组患者的手术时间并无明显差异(t=1.942,P0.05)且试验组患者的术后取净率和术后两个月排净率均显著高于对照组患者(t=4.731,P0.05,t=4.288,P0.05);对照组患者的并发症发生率显著高于试验组患者(t=4.333,P0.05);试验组患者的术中出血量显著低于对照组(t=3.762,P0.01)。两组患者术前术后以及术后2个月的血肌酐水平比较均无明显差异(均P0.05),并且两组患者血肌酐水平组间比较亦无明显差异(均P0.05)。结论:超声引导下对孤立肾多发结石患者实施微创经皮肾穿刺取石术治疗具有较高的安全性和临床疗效。     

三镜联合手术方案治疗胆道结石患者的临床疗效及预后情况分析

目的:研究三镜联合手术方案治疗肝外胆道结石患者的临床疗效及预后情况分析。方法:选择从1999年5月至2014年5月在我院接受治疗的肝外胆道结石患者300例进行回顾性分析。所有患者均接受三镜联合手术方案治疗,290例患者成功接受手术,其中先行经内镜十二指肠乳头造影/切开术(ERCP/EST),然后行腹腔镜胆囊切除术(LC)(先ERCP/EST后LC组)103例,先行LC,然后行ERCP/EST(先LC后ERCP/EST组)73例,同时行LC和ERCP/EST(LC与ERCP/EST同时组)114例。分析患者整体手术情况,对比各组手术相关指标、结石取出情况及并发症。结果:300例患者中,10例因结石过大、缩窄乳头炎、出血及怀疑胆囊癌因素中转开腹。三组手术时间、术中出血量、住院时间与住院费用指标相比,差异均无统计学意义(均P0.05),成功取出结石率及并发症发生率三组相比,差异均无统计学意义(均P0.05)。结论:通过不同手术顺序的三镜联合手术方案治疗肝外胆道结石,临床疗效及患者的预后情况均较好,值得在临床推广应用。     

Branched Renal Calculi

Surgical operation on 30 kidneys was carried out for branched renal calculi, with no operative mortality. Of 23 kidneys in which conservative surgical procedures were used, 83 percent are now stone-free. When all stones were successfully removed, cultures of urine were sterile in 80 percent of cases, but when fragments remained, no patient was infection-free. It was found that impaired renal function need not be a contraindication to surgical operation, and indeed that in five of seven patients with impaired renal function, serum creatinine levels either remained stable or improved. We believe that surgical removal is the most conservative management of branched renal calculi.     

Physical, X-ray diffraction and scanning electron microscopic studies of uroliths

Identification of chemical constituents of calculus is important in the diagnosis and management of urolithiasis. The compositional variability of uroliths has different etiologies and requires various modes of treatment and prophylaxis. In the present study, we report the chemical compositional analyses of calculi recovered from buck and bullock by X-ray diffraction (XRD) and energy dispersive X-ray (EDX) techniques and ultra-structure examination by scanning electron microscopy (SEM). XRD and EDX investigations conclusively established the chemical compositions of urinary calculi under investigation. The calculus from buck (sample I) had calcium oxalate monohydrate, a dominant salt phase and magnesium compound in significant amount. The calculus from bullock (sample II) had magnesium ammonium phosphate phase, with significant amount of calcium in apatite form and K+ ions. SEM study at higher magnification (X 1000) showed bipyramidal crystals in external zones of urolith (sample I). The struvite apatite calculus showed that basic unit of structure was lamination and the laminitis appeared to be made up of fine granules and high porosity. The bio-mineralization process of calculus formation was also studied, with a view to take preventive and therapeutic measures for amelioration of urinary stone diseases in animals and humans.     

Struvite calculus in the vagina of a bottlenose dolphin (Tursiops truncatus)

On 27 January 2000, a struvite calculus was observed in the vagina during necropsy of a 138-cm-long female bottlenose dolphin (Tursiops truncatus) collected from the Stono River, South Carolina (USA). Vaginal calculi have been reported in other species of cetaceans but not in bottlenose dolphins. Urinary tract infection might have been an underlying cause of the calculus. While urinary tract inflammation was not detected by light microscopic evaluation of sections of the urinary tract, it is conceivable that sufficient time had lapsed following voiding of the calculus through the urethra for urinary tract infection to have resolved. To further define the prevalence and significance of urolithiasis, prosectors of dead stranded marine mammals are encouraged to closely observe their urinary and genital tracts for calculi and to submit them for quantitative analysis.     

Chronic Sodium Benzoate Therapy in Children with Inborn Errors of Urea Synthesis: Effect on Carnitine Metabolism and Ammonia Nitrogen Removal

Sodium benzoate (SB) therapy is known to increase ammonia (NH₃) nitrogen elimination via conjugation with glycine and excretion as urinary hippurate. In 16 children with inborn errors of urea synthesis we studied two issues: (1) the effect of chronic SB administration upon carnitine metabolism and (2) the efficacy of chronic SB therapy as measured by the molar ratio of hippurate excretion to SB intake. Measurements were performed during elective hospitalizations when the patients were in stable metabolic condition. We found that chronic SB therapy is not associated with a constant level of hippurate elimination and that interindividual and intraindividual variability may result in irregular removal of NH₃nitrogen. This variability may be due to various factors including the formation of small quantities of benzoylcarnitine, which was detected in the plasma of three of four patients receiving SB and carnitine therapy and in one of two patients on SB therapy without carnitine supplementation. The ratios of acyl to free carnitine were elevated in both plasma and urine in patients not receiving carnitine supplementation, but were normal in patients receiving supplementation.