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WOS: 000314292500002 PubMed ID: 23299862 Although the management of urinary stones in obese patients is a challenge and the impact of the patient-related parameter has been well studied in adults: No study has evaluated the possible impact of obesity in terms of body mass index related SWL success in pediatric population. In this present study, we aimed to evaluate the safety and efficiency of SWL in obese children in a comparative manner with the cases in normal BMI value limits. A total of 66 children (45 boys and 21 girls, M/F:2.1) with renal calculi were treated with SWL. Depending on the BMI values, the children were divided into two groups as; Group 1 (n:50) children with normal BMI values (mean: 16.1) and Group 2 (n:16) obese children with higher BMI values (mean: 20.3). The success rates, complications, and need for auxiliary procedures after SWL were evaluated between two groups of patients in a comparative manner. While majority of the cases were treated under general anesthesia (n:61), a limited number of cases were treated under neurolept anesthesia with PiezoLith 3000 (Richard Wolf GmbH) lithotripter. Evaluation of efficiency was based on radiological examinations using abdominal radiography, ultrasonography, or CT scan when needed. Both the mean age and mean stone size values were similar in both groups. While the mean age was 62 months (24-148) in Group 1, this value was 68 months (24-137) in Group 2. Again mean stone size was 10.26 mm(5-25 mm) in Group 1 and 10.12 mm (6-20 mm) in Group 2. The mean number of SWL sessions and the number of SW's applied were similar in both groups (2.06 vs. 2.0 and 1975 vs. 1835, respectively). Evaluation of success rates after 3-months again did not show any statistically significant difference with respect to stone-free rates in both groups (47/50-94 %, 16/16-100 %, respectively). However, 3 children in Group 1 did show residual fragments (a parts per thousand currency sign3 mm) which were followed closely with regular visits without any problem. In another 3 cases, again fragments migrated to involved ureter after lithotripsy and these fragments were successfully treated in situ with further SWL. With respect to auxiliary procedures, there was no specific procedure has been done in Group 2, but 3 cases did undergo further SWL for ureteral stones in Group 1. Stone location did not affect the final outcome of the procedure in a significant manner in both groups. Lastly, no serious complication could be demonstrated in both groups either during or after SWL procedures. In the light of the successful treatment outcomes with limited need for auxiliary procedures in both groups, we may say that obesity might not be a disadvantage for SWL in children with renal stones.

Purpose: The pathogenesis of urolithiasis is mainly explained with metabolic disorders. However metabolic disorders alone are not sufficient to explain this pathology. In the present study the anatomical differences in the lower calyceal stone formers were examined on both the stone forming and contralateral normal side. The objective was to assess the effect of lower pole renal anatomy on the lower calyceal stone formation. Materials and Methods: Between July 1999 and July 2004 39 patients with non-obstructed solitary lower pole stones were studied. Mean age was 47.02 years. The anatomic factors were determined on intravenous urograms (IVU). The renal length and width and the number of major and minor calices were noted. Lower pole infundibular calyceal length (ICL) and width (IW), lower infundibular length-to-width ratio were measured. The infundibulo-ureteropelvic angle (IUPA) was measured by two methods using the angle between infundibular and ureteral axes (IUPA-1), and between infundibular and ureteropelvic axes (IUPA-2). We examined a new parameter: Renal longitudinal axis-infundibulum angle (RIA) for renal stone formation. RIA was determined between two axes, including the axis connecting the central point of the pelvis opposite the margins of inferior and superior renal sinus to midpoint of renal axis and the longitudinal renal axis (Figure 2). The data of the stone forming and non-stone forming contralateral side were compared. Statistical analysis was performed by paired-t-test. Results: The IUPA-1 of the stone forming side was more acute than the non-stone forming side, in 77% of cases. The UIPA-2 of the stone forming side was more acute than the non-stone forming side, in 72% of cases. The differences with both methods between the stone forming and contralateral normal side were statistically significant (p

Open surgical measures may be undertaken in the treatment of some complex calculi and manoeuvres such as extended pyelolithotomy or nephrolithotomy may be necessary. In an attempt to improve surgical results with less morbidity and maximum ease, we used the Swiss Lithoclast to disintegrate large stones presenting as hard cases. Five patients with renal pelvic stones associated with calyceal stones in two and two further cases with staghorn stones were treated surgically using the pneumatic lithotriptor probe with less dissection and without nephrotomy. Only one of the patients with staghorn stones had residual fragments which were then treated with ESWL. We believe that when open surgical treatment is considered in hard cases, especially in those with small renal pelvises, the best results may be achieved with minimum surgical intervention if it is combined with pneumatic lithotripsy.

A concise account of formation mechanisms of attached (papillary) and unattached renal stones is presented. Urinary conditions prevailing at least during the stone forming period are indicated. Ten main categories of renal stones, covering over 95% of all conceivable calculi, are distinguished based on their composition and structure. Aetiologic factors leading to stone formation of every category are specified and general outlines of recommended treatment procedures indicated.

We report an unusual case of 40-year-old adult man who presented as a case of urolithiasis but was found to be harboring an incidental renal cell adenocarcinoma. He underwent an uneventful radical nephrectomy. The literature regarding incidental renal cancer and it's association with urolithiasis has been reviewed and discussed.

Supracostal superior calyceal access has been shown to be the most suitable approach for staghorn calculi, calculi in the upper ureter, and complex inferior calyceal calculi. It is a good choice for direct access for most of the intrarenal collecting system and upper ureter. The aim of this retrospective study was to evaluate a single center data regarding the safety and efficacy of this approach for percutaneous renal stone surgery.A total of 597 renal units (597 cases) were treated with percutaneous nephrolithotomy from the March of 2000 to March of 2005. Supracostal approach was selected in 123 cases and infracostal approach in remaining 474 cases. The indications of supracostal approach in our cases were staghorn and complex inferior calyceal stones, and stones in the upper calyx or the upper ureter. All punctures were made by the urologist under C-arm fluoroscopic guidance in the prone position. The interspace between 11th and 12th rib was used in 116 patients (94%) and 10th-11th interspace in 7 cases (6%). The operative time, success rate, hospital stay, and complications were evaluated.The complete and relative success rates were 89.4 and 10.6%, respectively. The total complication rate was 13%. The success rate in the 10th-11th rib access and 11th-12th interrib access was 77 and 90%, respectively. Complete success rate was 100% in stone sizes less than 2 cm in diameter of upper ureteral and renal pelvic areas, and 77.4% of staghorn calculi. The total complication rate was 13% (16 cases), in which the most common of it was perioperative bleeding (5.7%; 7 cases).The supracostal approach was found to be effective as well as safe, with acceptable complications. It gives high stone clearance rates with acceptable morbidity rates and should be attempted in selected cases. The rate of pulmonary complications is higher with the supracostal approach. If the supracostal approach is indicated, it should be used with caution.

The surface structure of a xanthine stone from a patient with hereditary xanthinuria was examined using scanning electron microscopy. This revealed that the xanthine stone was composed of at least two very different structures. One was a spherical protrusion with craters and a fine granular surface and the other consisted of a granular growth of plate-like crystals.

Our objective was to investigate the effects of previous open nephrolithotomy on technical features, outcomes, and morbidities of subsequent percutaneous nephrolithotomy (PCNL).One hundred and sixty patients underwent PCNL between December 2004 and September 2006. The patients were divided into those who had previous open nephrolithotomy on the same kidney (group 1: 55 patients) and those who had no previous open surgery (group 2: 105 patients). Technical features encountered during operation and outcomes were compared between groups.There were no significant differences between groups with respect to mean age (group 1: 42.6 +/- 10 years vs. group 2: 45.5 +/- 9.6 years), body mass index (24.8 +/- 2.11 vs. 24.6 +/- 2.14), and stone burden (385.6 +/- 140.6 mm(2 )vs. 401.05 +/- 142 mm(2)). In group 1, 28 and 27 stones were located in the right and left kidney, respectively, whereas the location was 51 and 54 for the right and left kidney, respectively, in group 2. When the groups were compared, the mean operative time was significantly longer (155 +/- 30 min vs. 137 +/- 30 min) in group 1. But there was no significant difference with respect to requirement for secondary intervention (11% vs. 10%). Sepsis developed in two patients in group 1 and one patient in group 2. One patient in group 1 died due to septic shock. Ten (18.2%) patients in group 1 and 13 (12.4%) patients in group 2 required blood transfusion.When PCNL is performed after previous open nephrolithotomy, the operative time lengthens. But there is no difference with respect to success rate and morbidities.

To prospectively determine the precise stone composition (quantitative analysis) by using infrared spectroscopy in patients with urinary stone disease presenting to our clinic. To determine an ideal method for stone analysis suitable for use in a clinical setting. After routine and a detailed metabolic workup of all patients of urolithiasis, stone samples of 50 patients of urolithiasis satisfying the entry criteria were subjected to the Fourier transform infrared spectroscopic analysis after adequate sample homogenization at a single testing center. Calcium oxalate monohydrate and dihydrate stone mixture was most commonly encountered in 35 (71%) followed by calcium phosphate, carbonate apatite, magnesium ammonium hexahydrate and xanthine stones. Fourier transform infrared spectroscopy allows an accurate, reliable quantitative method of stone analysis. It also helps in maintaining a computerized large reference library. Knowledge of precise stone composition may allow the institution of appropriate prophylactic therapy despite the absence of any detectable metabolic abnormalities. This may prevent and or delay stone recurrence.

A milk of calcium cyst mimicking renal stone in a 51-year-old man was presented to remind the possibility of milk of calcium when a well-defined round density was observed on the renal shadow of the plain abdomen film and the importance of graphics or CT scans taken in different positions to see the changes in the calcium gravidation to prevent unnecessary surgical interventions due to misdiagnosis.

In order to investigate the effect of electromagnetic shock waves on proximal tubular renal function, we measured the urine levels of the lysosomal enzyme N-acetyl-beta-glucosaminidase (NAG) prior to, 1 hour, 1 day, and 1 week after extracorporeal electromagnetic lithotripsy (ESWL) in 50 patients with urinary stone disease. Mean NAG level which was 5.18+0.09 U/l prior to ESWL increased to 5.29+0.09 U/l in the first hour and to 10.7+0.19 U/l on the first day after ESWL (p

From 1964 to 1970 at the Surgical Clinic No. I in Zabrze, 126 kidney pole operations were performed for lithiasis. In a period of 6 to 74 months, 25% of recurrent staghorn calculi and 7.7% of recurrent calyx lithiasis were detected, a total average of 16% of renal stone recurrences. The high percentage of cases with systolic hypertension following kidney pole excision is still an inexplicable phenomenon.

The authors advocate the use of the U-nephrostomy as the routine measure in operative treatment of infected renal stones.

In the course of a disinterment of an ancient Avar burial place at Szekkutas-Kapolna near Hodmezővasarhely, Hungary, the archaeologist conducting the excavations, Miss Katalin B. Nagy, noticed a lithoid body of oval shape in the pelvis of a skeleton. The find was identified on morphological and chemo-analytical grounds as a bladder stone. In view of its rarity and its palaeopathological interest, it is described in detail. It is also expected to draw the attention of archaeologists to the possibility of similar findings. A brief review of the pertinent literature is given.