The treatment of lower pole renal calculi in 2003

The optimal treatment of patients with lower pole renal calculi is still being defined. Shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy are all currently utilized to treat patients with this condition. These methods have yielded varying degrees of success. The influence of collecting system anatomy on shock wave lithotripsy results remains controversial. Ongoing randomized, prospective trials evaluating the efficacy of all of these respective therapeutic options will, it is hoped, determine the best approaches for this patient cohort.     

The effect of shock wave lithotripsy on nitric oxide and malondialdehyde levels in plasma and urine samples

Shock wave lithotripsy (SWL) is accepted as the first treatment choice for most urinary stones, but it has adverse effects on the kidneys. The mechanisms underlying shock wave-induced renal injury have been discussed and include shear stress, thermal and cavitation effects and free radical formation. We investigated the effects of SWL on plasma and urinary nitrite, a stable metabolite of nitric oxide (NO), and malondialdehyde (MDA) concentrations. Between February and October 2004, 12 men and 8 women with renal calculi were treated using a Dornier MPL-9000 lithotriptor. The ages ranged from 22 to 45 years (average age: 33.7 years). Plasma and urinary NO and MDA levels were analysed before, immediately after, 30 and 60 min and 24 h after SWL. Plasma NO levels were higher than baseline levels immediately, and at 30, 60 min and 24 h after treatment (p = 0.016, p = 0.031, p = 0.033 and p = 0.045, respectively). Simultaneously, the mean urinary NO levels also showed significant elevation after SWL compared with baseline values, except for 24 h (p = 0.021, p = 0.023 and p = 0.048, respectively). The mean levels of plasma MDA showed statistically significant elevation immediately, and 30 and 60 min after SWL termination compared with pre-SWL values (p = 0.012, p = 0.008 and p = 0.012, respectively). Urinary MDA levels obtained immediately (p = 0.035), and 30 (p = 0.006) and 60 (p = 0.045) min after SWL were increased compared to pre-SWL values. We speculate that SWL treatment causes oxidative stress caused by renal ischemia-reperfusion (I/R) injury. Additionally, the increase of NO production may have prevented renal damage caused by vasoconstriction.     

Extracorporeal shock wave lithotripsy: the first 50 patients treated in Britain.

Fifty patients have been treated for upper tract urinary calculi by extracorporeal shock wave lithotripsy (ESWL) at the Devonshire Hospital lithotripter centre since November 1984. The average stay for an inpatient was 3 X 7 days. All patients suffered minimal postoperative discomfort and nearly all resumed normal activity within one day after discharge. Complications requiring auxiliary procedures were few. The procedure was found to be safe, cost effective, extremely well received by patients, and superior to all other methods of removing renal stones. This study confirms that treatment by ESWL is a specialised urological procedure that requires operators who are also trained in open, percutaneous, and ureteroscopic surgery and with a back up of a radiological team skilled in percutaneous renal puncture.     

Clinical comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in treating renal calculi.

STUDY OBJECTIVE: To compare extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for efficacy in treating renal calculi. DESIGN: Non-randomised multicentre cohort study with 3 month follow up and 13 month data collection period. SETTING: Lithotripter centre in London, tertiary referral hospital, and urological clinics in several secondary and tertiary care centres. PATIENTS: 933 of 1001 patients treated by lithotripsy at the lithotripter centre were compared with 195 treated by nephrolithotomy. Missing patients were due to incomplete collection of data. Age and sex distributions and characteristics of the stones were similar in the two treatment groups. Two patients died in the lithotripsy group. Three month follow up was achieved in about 84% of both groups (783/933 for lithotripsy; 163/195 for nephrolithotomy). INTERVENTIONS: The nephrolithotomy group had surgical nephrolithotomy alone. In the lithotripsy group 83% (774/933) had lithotripsy alone, 11% (103/933) had combined lithotripsy and nephrolithotomy, and 6% (56/933) had lithotripsy plus ureteroscopy. Single and combined lithotripter treatments were analysed as one group and compared with nephrolithotomy. END POINT: Presence of stones three months after treatment. MEASUREMENTS AND MAIN RESULTS: Presence of residual stones was assessed by plain radiography, ultrasonography, or intravenous urography. After adjustment for age and size and position of stone for patients with single stones the likelihood of being free of stones three months after treatment was significantly greater in the nephrolithotomy group than the lithotripsy group (odds ratio 6.6; 95% confidence interval 3.0 to 14.6) and the response was particularly pronounced with staghorn calculi (62% (8/13) v 15% (141/96) patients free of stones after nephrolithotomy and lithotripsy, respectively). OTHER FINDINGS: 19%(146/775) of patients who had had lithotripsy had to be readmitted within three months after treatment compared with 14%(23/162) who had nephrolithotomy; and 64%(94/146) of readmissions after lithotripsy were for complications compared with 30%(7/23) of readmissions after nephrolithotomy. CONCLUSIONS: Nephrolithotomy may be preferable to lithotripsy for treating renal stones and it may not be wise to invest heavily in lithotripsy facilities.     

输尿管单发结石患者体外冲击波碎石术的冲击波频率研究及碎石效果的影响因素探讨

摘要 目的：探讨输尿管单发结石患者体外冲击波碎石术（ESWL）的最佳冲击波频率,并分析碎石效果的影响因素。方法：选取2020年4月~2022年4月期间来空军第九八六医院接受治疗的输尿管单发结石患者148例作为研究对象,按照不同治疗频率将患者分为低频组（48例,频率为60~70次/min）、中频组（51例,频率为80~90次/min）和高频组（49例,频率为100~120次/min）,观察三组患者的碎石结局、肾功能指标以及并发症发生情况。统计三组患者的碎石结局,按照碎石结局的不同分为成功组和失败组。收集所有患者的一般资料,采用多因素Logistic回归分析输尿管单发结石患者碎石效果的影响因素。结果：三组碎石成功率组间对比无统计学差异（P>0.05）。三组术后1 d、术后14 d尿素氮（BUN）、血肌酐（Scr）均升高后下降（P<0.05）。高频组、中频组术后1 d BUN、Scr均高于低频组,且高频组高于中频组（P<0.05）。高频组、中频组的并发症总发生率高于低频组（P<0.05）。单因素分析显示,输尿管单发结石患者ESWL术后碎石失败与病程、结石位置、结石直径、肾绞痛、结石嵌顿、服用坦索罗辛有关（P<0.05）。多因素Logistic回归分析显示,病程偏长、结石位置中下段、结石直径偏大、结石嵌顿、未服用坦索罗辛是碎石失败的危险因素（P＜0.05）。结论：低、中、高三种频率下的ESWL用于输尿管单发结石患者,均有较好的碎石效果。但随着频率的增加,患者一过性肾功能损伤增大,且并发症发生风险也相应增加。此外,病程偏长、结石位置中下段、结石直径偏大、结石嵌顿、未服用坦索罗辛是碎石失败的危险因素,可考虑结合上述因素进行综合评估选择最佳治疗方式。     

应用管路封堵器处理输尿管上段结石的随机对照研究

目的:研究辅助使用管路封堵器后,采用输尿管镜下碎石术处理输尿管上段结石的效果及安全性。方法:选取自2012年6月至2013年2月需输尿管镜处理输尿管上段结石的病例198例,随机分为应用管路封堵器组98例和对照组100例。封堵器组术中输尿管镜发现结石后,封堵器组患者使用英诺伟IVX-SC10型管路封堵器超越结石远端封堵结石,再予钬激光碎石,对照组术中输尿管镜发现结石后,直接予钬激光碎石,术后留置双J管2至4周。记录并随访患者输尿管镜术后结石清除率及肾脏出血相关并发症。结果:管路封堵器组碎石成功率95.9%(94/98),对照组碎石成功率81.0%(81/100),两组有统计学差异(P=0.0011)。碎石成功后管路封堵器组出现3例(3.2%)肾脏破裂出血,而对照组无肾脏破裂出血,两组无统计学差异(P=0.1048)。结论:辅助应用管路封堵器能提高输尿管镜对于输尿管上段结石的碎石成功率;其使用并没有增加术后肾脏出血并发症的发生。     

Nifedipine, verapamil and diltiazem block shock-wave-induced rises in cytosolic calcium in MDCK cells

Nifedipine and verapamil have been shown previously to protect against renal function alterations induced by shock wave lithotripsy (SWL) in humans and rats; however, the mechanism is unclear. This study was aimed to examine whether these drugs could protect cultured kidney cells following shock wave exposure (SWE). The effect of nifedipine, verapamil and diltiazem on Madin Darby canine kidney (MDCK) cells following SWE was examined by determining the release of glutamate oxalactate transferase (GOT) and lactate dehydrogenase (LDH) in cell suspensions; and also cytosolic Ca2+ concentration ([Ca2+]i). Immediately after SWE, there was a transient release of GOT and LDH (16% and 4 fold, respectively). In contrast, [Ca2+]i measured within 1-6 hr after SWE gradually increased by 15-156%. The Ca2+ entry blockers (1 or 10 microM) failed to inhibit the enzyme release; however, they abolished the progressive rises in [Ca2+]i. The Ca2+ entry blockers may protect the cells from damage of SWE via maintaining a low resting [Ca2+]i.     

体外冲击波碎石焦点附近声压分布的时域有限差分法数值解析

泌尿系统结石症是一种多发病。体外冲击波碎石(Extracorporealshockwavelithotropisy,ESWL)法是应用人体外发射的高强度脉冲超声波在人体内的焦点附近形成的冲击波破碎结石,被破碎的结石碎片随尿液排出体外的治疗泌尿系统结石症方法。由于这种治疗方法具有非创伤等优点而被广泛地应用于泌尿系统结石症的治疗。但是,ESWL治疗过程中有时会引发尿血、肾血肿等并发症,影响其治疗效果的主要因素之一为ESWL焦点附近形成的声压分布。在这里,利用作者等以前提出的时域有限差分(finitedifferencetimedomain,FDTD)超声波非线性传播的仿真方法,数值仿真ESWL超声波非线性传播过程,研究ESWL焦点附近声压的分布、焦点区域(焦区)的大小形状、高强度超声波形成的实际焦点位置。     

Hemorrhagic fever with renal syndrome: clinical aspects

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral fever which typically progresses through five stages: an acute grippe, followed by hemorrhage and shock, acute renal insufficiency from tubulo-interstitial nephritis, and recovery. Death from circulatory or renal failure occurs in 5%-15% of cases. In mild or abortive forms of the disease, associated with viral strains enzootic in Scandinavia the illness is milder. Hemorrhage and shock occur with lower frequency and the fatality rate is less than 1%. Pathologic examination of HFRS cases from Asia discloses generalized congestion, hyperemia, and hemorrhage, with scattered foci of necrosis in numerous organs. Congestion and hemorrhage are most evident in the kidney medulla. Widespread microscopic evidence of capillary and vascular dysfunction is found, with endothelial cell swelling, perivascular edema, diapadesis of erythrocytes and mononuclear cell infiltration. Hemorrhage and inflammation in the renal interstitium and tubular epithelial degeneration characterize the kidney pathology. Limited data indicate pathogenic roles for cell destruction from viral infection as well as immune mediated mechanisms. No specific therapy is available.     

Optimizing Shock Wave Lithotripsy: A Comprehensive Review

Shock wave lithotripsy is a commonly used procedure for eradicating upper urinary tract stones in patients who require treatment. A number of methods have been proposed to improve the results of this procedure, including proper patient selection, modifications in technique, adjunctive therapy to facilitate elimination of fragments, and changes in lithotripter design. This article assesses the utility of these measures through an analysis of contemporary literature.Key Words: Shock wave lithotripsy, Upper urinary tract stones, ComminutionShock wave lithotripsy (SWL) is commonly utilized to treat patients with upper urinary tract stones. It is now clear that proper patient selection, modifications in treatment technique, and employment of adjunctive measures can be utilized to optimize SWL results. In addition, certain future changes in lithotripter design may prove to be beneficial. Herein, we review methods to improve SWL results.     

Kidney stones and lithotripters: critical analysis of the introduction of extracorporeal shock wave lithotripsy into Canada.

It is possible for a nonpharmaceutical medical innovation to enter the mainstream of the health care system without its efficacy and effectiveness having first been established by means of a randomized controlled trial (RCT). The result of this omission may be the discreditation and abandonment of the technology or procedure but not before precious resources that could have been better used elsewhere in the health care system are absorbed. A possible example of such a misallocation of resources is the introduction into Canada of extracorporeal shock wave lithotripsy (ESWL) for the treatment of urolithiasis. We review the development and diffusion of ESWL and recommend ways in which the deficiencies in regulating the introduction of new medical technologies can be corrected.     

Massive and recurrent hernias; use of dermal grafts in carrying out repair

Nonpenetrating abdominal injuries are commonly seen in a general hospital. High speed traffic accidents are responsible for the majority of these injuries. The mortality rate is high. Deaths were from associated injuries, failure to recognize abdominal trauma, hemorrhage and from acute renal insufficiency. Careful observation of every severely injured person, vigorous treatment of hemorrhagic shock with whole blood, and prompt surgical intervention when indicated will improve the mortality figures.     

Spontaneous retroperitoneal hemorrhage caused by segmental arterial mediolysis

Spontaneous retroperitoneal hemorrhage is a rare clinical entity; signs and symptoms include pain, hematuria, and shock. Spontaneous retroperitoneal hemorrhage can be caused by tumors, such as renal cell carcinoma and angiomyolipoma; polyarteritis nodosa; and nephritis. The least common cause is segmental arterial mediolysis. Although computed tomography is used for the diagnosis of spontaneous retroperitoneal hemorrhage, it can miss segmental arterial mediolysis as the cause of the hemorrhage. The diagnosis of segmental arterial mediolysis as a cause of spontaneous retroperitoneal hemorrhage requires angiography, with pathologic confirmation for a definitive diagnosis.     

爆炸波对生物膜微观创伤的分子动力学分析

爆炸冲击波作用到人体胸部时，肺部会出现肺出血及肺水肿等症状，这是人体爆炸创伤的主要原因，深入研究很有必要。为了更好地理解爆炸创伤的机理，应研究冲击波与微观组织作用的力学过程，但具有一定的难度，本文先从基本的生物膜做起。本文运用分子动力学研究了冲击波对DPPC膜造成的损伤，通过停止活塞来控制冲击波的冲量，观察了冲击过程中膜的恢复情况。观察了不同冲量下冲击波经过膜后磷脂分子及其周围水分子分布，发现随着冲量增大，膜越来越无序混乱，褶皱更严重，疏水区水分子越来越多。将膜冲击过程划为三个阶段，分别为冲击阶段、恢复阶段和后效阶段。发现当冲量大于153 mPa s时，在冲击过程中没有观察到膜的损伤恢复。     

Extracorporeal shockwave lithotripsy: urine cytology findings

Objectives:  To describe the urine cytology findings before and after stone therapy with extracorporeal shock wave lithotripsy (ESWL) and discuss its importance.
Methods:  The study consisted of 100 patients with a urinary tract stone (79 renal pelvic stones and 21 upper ureteric stones), 74 were male and 26 were female. The ages ranged 30–55 years. The average duration of symptoms was 3–8 years. The size of the stones varied from case to case ranging from 10.2 to 40 mm. Urine samples were obtained on three consecutive days before and after lithotripsy. The smears were stained by the Papanicolaou method.
Results:  The smears before lithotripsy revealed a few red blood cells, inflammatory cells, epithelial cells and crystals (calcium oxalate, uric acid and triple phosphate). Atypical malignant looking cells and epithelial cell clusters were not noticed. After lithotripsy, the urine samples were examined at different periods, 24 hours, 2 weeks, 1 month, 2 months and 3 months. The smears revealed papillary clusters in all 100 patients within 24 hours and were always associated with inflammation. Atypical malignant looking cells appeared later, within 1–2 months in 21 patients, and were associated with inflammation (19 patients), RBC, crystals and papillary clusters. Most of the papillary clusters and atypical malignant looking cells disappeared before 3 months.
Conclusion:  The epithelial cell clusters and atypical cells were seen in urine smears after ESWL. Without knowing the previous history these findings can be confused with urothelial neoplasms.     

The effects of extracorporeal shock wave lithotripsy on antioxidant enzymes in erythrocytes

The effects of extracorporeal shock wave lithotripsy (ESWL) on patients undergoing ESWL for renal stone treatment have been studied using activities of glucose-6-phosphate dehydrogenase (G6PDH), superoxide dismutase (SOD) and catalase (CAT), and levels of malondialdehyde (MDA) in the erythrocyte haemolysate. The study included 23 patients (eight women, 15 men with an age range of 23-57 years). Blood samples were taken 5 min before ESWL, in addition to 1 h and 5 days after termination of treatment. Enzyme activities and MDA levels in erythrocytes were measured spectrophotometrically. When compared with the values obtained before ESWL, erythrocyte G6PDH (p = 0.015), SOD (p = 0.036) and CAT (p = 0.01) activities were found to be significantly reduced at the first hour after ESWL. On the fifth day after ESWL, erythrocyte enzyme activities were normalized to the values obtained before ESWL. Although there was a significant difference between values before and 1 h after ESWL (p = 0.003), no difference was detected between 1 h after ESWL and 5 days after ESWL (p > 0.05) in terms of MDA values. The findings of the present study revealed that erythrocyte lipid peroxidation might be induced and antioxidative defence mechanism may be transiently impaired by ESWL.     

Early acute rejection of renal homografts: a characteristic clinical syndrome

Seven of 74 patients with early functioning cadaveric renal homografts developed acute oliguric renal failure after the second but before the ninth day post-transplantation. The syndrome characteristically begins with an abrupt and simultaneous decrease in creatinine clearance, urine volume and urine sodium concentration. After a variable period and despite a reduction in immunosuppressive therapy, a diuretic phase ensues and renal function is restored. Complications associated with the syndrome include groin hematoma, pulmonary edema and renal rupture with shock. Renal rupture does not require nephrectomy: if the hemorrhage is controlled, the transplanted organ will resume function. Angiographic studies show normal nephrograms, stretched arterial vasculature and filling defects in the veins. Percutaneous renal biopsy shows interstitial edema and hemorrhage, venous congestion and tubular necrosis. Evidence is presented to support the hypothesis that this is a form of rejection occurring as the result of injury to the renal venous system.     

The modulus of toughness of urinary calculi

To improve the efficacy of extracorporeal shock wave lithotripsy (ESWL) treatment, it is desirable to identify the physical properties of urinary calculi could offer direct correlation with their fragilities during ESWL and thus could be used to guide treatment procedures for more effective stone fragmentation. Thirty stone specimens removed surgically were compressed by an axial testing system to measure the compressive strength and trace the stress-strain curve. Image analysis software SigmaScan (Jandel Co.) was used to calculate the area under the stress-strain curve, the modulus of toughness, for each stone. The values of compressive strength measured were similar to those reported by other researchers. The modulus of toughness of urinary calculi correlates with clinical representation of the stone fragility during ESWL. The modulus of toughness could be an index to evaluate the physical property of urinary calculi that could be used to guide treatment procedures for more effective stone fragmentation.     

彩色多普勒超声引导下经皮肾镜取石术（PCNL）治疗复杂性肾结石的临床分析

目的：总结彩色多普勒超声引导下经皮肾镜取石术（percutaneousnephrolithotomy,PCNL）治疗的复杂性肾结石的经验及其安全性、有效性以及常见并发症。方法：回顾性分析我院2011年7月-2012年8月采用彩色多普勒引导下经皮肾镜治疗复杂性肾结石患者56例的临床资料。结果：所有患者均I期建立经皮肾通道,平均手术时间（107．5±27．5）分钟,24例行EMS气压弹道联合超声碎石（1001．0±27．9）分钟,20例行钬激光联合超声碎石（119．4±23．6）分钟,10例行单纯超声碎石（108．2±30．2）分钟,EMS气压弹道联合超声碎石组的手术时间少于钬激光碎石组,差异有统计学意义（P〈0．05,单纯超声碎石组与另外两组比较无统计学意义P〉0．05）。术前肾功能损伤患者术后随访,肾功能明显改善。结石完全清除率91％,结石部分残留率9％。术中均无严重出血,无周边脏器损伤。术后出现迟发出血5例,反复发热4例,均经对症治疗后缓解。结论：彩色多普勒超声引导除了具有普通超声引导的优势外,还可有效避开肾实质大血管损伤,减少术中及术后出血风险。彩色多普勒超声引导下经皮肾镜碎石取石术是一种治疗复杂性肾结石安全、有效的方法。     

Effects of Shock Waves on Oxidative Stress, Antioxidant Enzyme and Element Levels in Kidney of Rats

The aim of this study was to investigate the effect of extracorporeal shock wave lithotripsy (ESWL) on kidney oxidative stress and trace element levels of adult rats. Twelve male Wistar albino rats were divided equally into two groups. First group was used as control. The right-side kidneys of animals in second group were treated with 2,000 18-kV shock waves under anesthesia. Localization of the right kidney was achieved following contrast medium injection through a tail vein under flouroscopy control. The animals were sacrificed 72?h after the ESWL treatment, and the kidneys were taken. Malondialdehyde level was higher in the ESWL group than in the control. Reduced glutathione levels, superoxide dismutase, and glutathione peroxidase activities were lower in the ESWL group than those of the control. Fe, Cu, Pb, Mn, Cd, and Ni levels were lower in the ESWL group than in the control, although Mg level was higher in the ESWL group than in the control. In conclusion, the result of the present study indicated that ESWL treatment produced oxidative stress in the kidney and caused impairments on the antioxidant and trace element levels in the kidneys of rats.