Search

Introduction: Renal calculi is a prevalent disease and has some causes described. The drug calculi origin are rare, accounting for around 1% to 2% of cases. The crystals of sulfadiazine are formed in 20% to 45% of cases, but between 0.4% and 4.5% are associated with renal failure. We present a case report and a review of the literature on diagnosis and treatment of this entity, given its rarity and specificity. Case Report: A 48-year-old male, diabetic, during treatment for acute toxoplasmosis with sulfadiazine initiated renal colic associated with renal failure. The hypothesis of drug calculation was considered, because during the diagnostic investigation of toxoplasmosis, imaging studies were performed and presented without renal calculi. Initially he was treated conservatively with hyperhydration and alpha-blocker, but since he did not present improvement in the exams, he underwent ureterolithotripsy and double j stent. Conclusion: We present a report of urinary lithiasis of pharmacological origin associated with renal insufficiency and a review of the literature.

Purpose: To evaluate the efficacy and safety of increasing the energy dose in treating urinary lithiasis with extracorporeal lithotripsy through an expanded number of Shock Waves Per Session (SWPS). Materials and Methods: a randomized, prospective, and comparative study was performed with patients with renal or ureteral lithiasis from 2011 to 2014. Two groups were studied: Group A (n=136), treated with 3500 SWPS, and Group B (n=171), subjected to an expanded treatment with 7000 SWPS. Patients were considered stone free when there was no lithiasis or it were less or equal to 4mm after treatment. Variables related to the patient, stones, treatment, and complications were collected. Results: The global SFR was 75.0% and 87.7% in Groups A and B, respectively (p=0.004). In renal location, the SFR was higher in Group B (74.1% vs 90.7%, p=0.003) regardless of the size. In the ureteral location, there were differences in the pelvic only (73.7% vs 95.2%). There were no differences in either the complication rate (27.2% vs 25.7%, p=0.77), or the severity between the two groups. The variable number of SWPS was seen to be an independent predictor of the resolution of lithiasis, having the probability of resolving lithiasis 2.62 (CI 95%=1.40-4.89) times greater when applying 7000 SWPS. Conclusion: In our study, increasing the energy dose applied through an expanded number of SWPS has been shown to be more effective than standard regimens with a similar safety profile. However, more clinical studies on different types of lithotripters are required to confirm these results.

Intracorporeal lithotripsy is becoming the most commonly used surgical method of stone treatment in Urology. The five major types of intracorporeal lithotripters are ultrasonic, ballistic, and combination lithotripters as well as laser and electrohydraulic lithotripters. The advantages and disadvantages of choosing each of these treatment modalities are reviewed. Extensive review of literature was performed to identify the types of intracorporeal lithotripters. An investigation was undertaken of the early development of each modality of intracorporeal lithotripsy and/or the mechanism of action. Challenges of each technique were identified and presented. Finally, a determination was made of how these lithotripters compare on the basis of effectiveness of action and cost based on information provided in primary literature as well as previous reviews of these modalities. Contemporary lithotripters have found widespread use in the management of urinary lithiasis. Holmium laser lithotripsy has become one of the most commonly used tools for intracorporeal lithotripsy. There is a wide variety of intracorporeal lithotripters which can be chosen based on the characteristics of each modality and the requirements of the urologist.

There are several special situations in which urinary lithiasis presents management challenges to the urologist. An in-depth knowledge of the pathophysiology, unique anatomy, and treatment options is crucial in order to maintain good health in these patients. In this review, we summarize the current literature on the management of the following scenarios: bladder stones, stones in bowel disease, during pregnancy, in association with renal anomalies, with skeletal deformities, in urinary diversions, and in children.

Background: The incidence of urinary lithiasis has been increasing in recent decades at all ages, including the elderly. In parallel, the world population is aging and there is a paucity of data on treatment of urinary stones in very elderly people. Our main objective was to evaluate the effects of extracorporeal shockwave lithotripsy (ESWL) in patients older than 75 years, and the characteristics of this population. Complications and mortality rates after this procedure in octogenarians were also described. Methods: We retrospectively evaluated very elderly patients who underwent ESWL at our institution from 1998 to 2015, through chart review, telephone interviews, and consultation with the municipal mortality information program. Measured outcomes included demographic and clinical data, ESWL characteristics and complications, interval between ESWL and death, and cause of death. Results: Demographic and treatment characteristics were similar between very elderly and younger patients who underwent ESWL during the same period. No severe complications occurred among older patients. Octogenarians treated in our cohort had a significant life expectancy when ESWL procedures were performed. Even though 38.9% of the patients passed away during the studied period, mortality occurred on average 4.38 years after the ESWL session. Conclusions: In conclusion, ESWL has been used by urologists as a first-line treatment for uncomplicated urinary calculi in very elderly patients. Despite changes associated with aging, and the high prevalence of comorbidities, this procedure seems to be safe and well tolerated in elderly people.

Introduction: Urinary lithiasis involves a major source of morbidity and economic costs. The aim of this study was to evaluate the adherence to the European Association of Urology Guidelines on Urolithiasis with regard to treatment among Spanish urologists. Methods: A total of 723 patients were included in a prospective study between May 1, 2014, and July 31, 2014. The study involved 8 hospitals responsible of urolithiasis in a geographical area of Spain (Comunidad Valenciana) with approximately 4,500,000 inhabitants. Data were collected about the demographic characteristics of the patients, the characteristics of the stones, and the indicated treatment, in order to analyze the adherence to the clinical guidelines. A 90% threshold was used in concordance with the indications in the guidelines. Results: Adherence to guidelines was poor in chemolysis, distal and ureteral calculi, and >2 cm renal calculi. Adherence was high in Conclusions: In our study, the overall adherence to the clinical guidelines regarding the therapeutic indication for urinary lithiasis has been low. In the case of both renal and ureteral stones, the adherence in small lithiasis has been greater, compared with larger ones. In our survey, a trend has been observed in favor of endoscopic procedures even in large lithiasis.

Purpose: To assess the influence of holmium laser cystolitholapaxy (HLC) concomitantly with holmium laser prostate enucleation (HoLEP) on patients with benign prostatic hyperplasia (BPH) p...

Calyceal diverticulum is acystic cavity in the renal parenchyma, communicating with the collecting system via an infundibulum. In more than 40% of cases it is associated with a stone and in most cases appears as milk of calcium forming a fluid level or multiple small stones. We here report the case of an 82-year old patient with no previous history, presenting with mild and intermittent right flank pain lasting for 8 years. Clinical examination was normal. The patient first underwent X-ray of urinary tree without preparation showing a density of calcium projecting into the upper pole of the right kidney (A). The patient then underwent uroscanner showing giant stone measuring 28mm within a caliciel diverticulum of the upper pole directly communicating with the renal pelvis (B). No associated urinary tract infection or haematuria were detected. Given patient's age and that he was paucisymptomatic and uninfected, therapeutic abstention and monitoring were indicated. In accordance with the recommendations of the experts, only symptomatic intradiverticular stones must be treated. First, extracorporeal shockwave lithotripsy (ESWL) allows improvement to the symptoms in 1 patient out of 2 and no stone fragmentation in 1 patient out of 4. In second intention, flexible uretero-renoscopy should be performed. Percutaneous nephrolithotomy can be performed if the stone is located in the lower pole (rare). Finally, in case of failure, laparoscopic treatment or open surgery may be proposed.

Le diverticule caliciel correspond a une cavite kystique dans le parenchyme renal, communiquant avec le systeme collecteur via un infundibulum. Il s'y associe dans plus de 40% des cas un calcul et prend le plus souvent un aspect de niveau hydrique de tonalite calcique, ou de multiples calculs de petite taille. Nous rapportons ici le cas d'un patient de 82 ans, sans antecedents personnels, souffrant de douleurs legeres et intermittentes au flanc droit depuis 8 ans. L'examen clinique etait normal. Le patient a d'abord beneficie d'une radiographie de type arbre urinaire sans preparation montrant une image de tonalite calcique se projetant dans le pole superieur du rein droit (A). Le patient a ensuite beneficie d'un uroscanner montrant un calcul geant de 28mm dans un diverticule caliciel du pole superieur communiquant directement avec le pelvis renal (B). Il n'y avait pas d'infection urinaire associee, ni d'hematurie. Etant donne que le patient etait pauci-symptomatique, non infecte et compte tenu de son âge, nous avons decide l'abstention therapeutique et la surveillance. Conformement aux recommandations des experts, seuls les calculs intra-diverticulaires symptomatiques doivent etre traites. En premier lieu, la LEC permet une amelioration de la symptomatologie chez 1 patient sur 2 et un resultat sans fragment chez 1 patient sur 4. En deuxieme intention, une uretero-renoscopie souple a tout son interet. En cas de localisation inferieure de la pierre, ce qui est rare, une NLPC peut etre proposee. Enfin, en cas d'echec, un traitement par laparoscopie ou chirurgie ouverte peut etre propose.

La douleur ressentie au cours d'une séance de lithotritie extracorporelle (LEC) est le facteur limitant le plus important de cette technique. Le but de notre travail était de comparer l'efficacité des différents types d'analgésiques utilisés pour le contrôle de la douleur pendant les séances de LEC. Nous avons mené une étude prospective colligeant 300 patients présentant une lithiase urinaire justifiant un traitement par LEC. Les patients ont été répartis de façon randomisée en trois groupes: le groupe I, incluant 100 patients ayant reçu 2cc de sérum physiologique en IM (intra musculaire) (placebo), le groupe II regroupant 100 patients ayant reçu 100mg de kétoprofène en IM tandis que le groupe III colligeant 100 patients ayant eu une application locale d'une crème contenant la lidocaïne et la prilocaïne. L'échelle visuelle analogique (EVA) a servi à évaluer la douleur à 10 minutes et à la fin de la séance. L'EVA moyenne à 10 minutes et à la fin de la LEC étaient respectivement de 3,7 et 4,91. Aucune différence significative n'a été trouvée entre les trois groupes concernant: les données épidémiologiques (âge, sexe, IMC, antécédents pathologies) et les caractéristiques du calcul (côté, taille, localisation, présence ou non de sonde double J). L'interruption précoce de la séance de LEC a été notée chez 11 patients du groupe I, avec une différence significative par rapport aux autres groupes (p=0,003). L'EVA à 10 minutes et à la fin de séance de LEC, était statistiquement plus élevée dans le groupe I par rapport aux groupes II et III (p < 0,001). Aussi, la LEC était nettement plus efficace dans les groupes (II et III) comparativement au groupe I (p

Supplemental Digital Content is available in the text, Background: The undergraduate teaching of urology is not uniform in the various European medical schools and even absent in some of them, despite the widespread adoption of the Bologna process, which advocates a standardization and harmonization of medical education. Our aim was to evaluate the perception of junior doctors about the undergraduate teaching of Urology and the exposure to the specialty of Urology in undergraduate education in Portuguese medical schools. Methods: A questionnaire was emailed to all physicians who first enrolled in the Board of Portuguese Doctors in 2017 and 2018. The questionnaire consisted of several questions about specialty exposure, pathology, and basic urological procedures. A database for statistical analysis was created. Results: One hundred and eighty-six answers were considered valid. Although almost all participant physicians attribute considerable importance to Urology specialty, most find their exposure to urological pathology and basic urological procedures to be inappropriate in medical school. Urinary lithiasis and lower urinary tract symptoms are the subjects on which doctors feel most prepared after graduating. Interestingly, 63.4% of doctors consider that the education they had in college was preponderant in choosing their specialty. Conclusions: The teaching of Urology in Portuguese Medical Schools is considered by junior doctors as inadequate, not reflecting the importance of this specialty in the clinical practice. These results are like those found in other countries. A reflection and consequent change of the teaching paradigm is necessary, namely at the practical teaching level.

Urinary lithiasis in transplanted kidney is a relatively uncommon complication. However, it may lead to a significant morbidity and loss of renal function. The report presents the case of a 32-year-old male renal-transplant recipient, with a stone in renal pelvis who was treated successfully by tubeless percutaneous nephrolithotomy (PCNL). The patient is currently stone free with no complication. This article also reviews in brief the treatment of this rare complication. Reviewing the literature showed, it could be noticed that PCNL is a safe and feasible procedure for treating nephrolithiasis in a transplanted kidney.

Resumen Hematuria es la presencia de sangre en la orina. Su diagnostico debe realizarse mediante sedimento urinario (microscopio) y se define como la presencia de mas de 3 hematies por campo. El uso de la tira de orina permite detectar hematies en la orina con una alta sensibilidad y especificidad. Desde el punto de vista urologico, las causas mas frecuentes son la hipertrofia prostatica benigna, la infeccion urinaria y la litiasis urinaria.

The management of urolithiasis is not governed by a rigid code for all the patients. The clinical approach must be adapted to some physiological and pathological conditions which include, but are not limited to, pregnancy, early childhood, and post-renal transplantation status. The etiology of urinary stones in these fragile patients are sometimes different from that of the general population, the symptoms may be misleading, and the diagnostic and therapeutic means should be restricted to the least harmful possible.

This chapter will review the diagnostic methods that are required to demonstrate the existence of a urinary stone, followed by the investigations needed to detect the eventual cause(s) of stone formation. Finally a brief account will be given on the studies performed to evaluate the aftermath of the urinary stone disease.

Introduction: Empirical information provided by health care professionals acting in the first line of care report a constant increase in the number of civil construction workers that present painful acute conditions, in most cases associated with the existence of urinary tract calculi. Aims: Evaluating the prevalence of urinary lithiasis in civil construction workers, as a means to identify indicators for the management of health and personnel. Methods: Observational study based on directed questionnaire. Results: From the 94 participants, 18 (19%) were lithiasic, mostly due to overweight and reduced fluid intake. Conclusion: The observed prevalence appeared to be two times greater than that of the general population. Thus, prevention for such condition gains relevance, in order to avoid discomfort for the worker, and also reduce costs due to absenteeism, improving productivity, benefiting the workers by performance and creating the perspective of an improved quality of life.

Objective To demonstrate that urinary lithiasis have a specific susceptibility to fracture through extracorporeal shock wave lithotripsy (ESWL), which is common for all calculi with the same composition and which can be estimated before treatment using CT or plain X-ray. Material and method We present an in vitro, prospective, randomized, blind and multi-center study involving 308 urinary calculi. 193 of these met the inclusion criteria: whole calculi composed purely of calcium oxalate monohydrate (COM), uric acid (UA) or carbonate apatite (CA), or a mix of oxalate (COMix) and of a size greater than 0.5 cm. The samples were broken using lithotripsy until reaching a pre-established level of comminution. The variables employed were energy dose (Edose) per cm 3 of lithiasis and Edose adjusted to lithiasic surface (EdAJ) per cm 3 . Results COM was the hardest, requiring an Edose of 119,624 mJ/cm 3 and an EdAJ of 36,983 mJ/cm 3 , followed by COMix (75,501/36,983), CA (22,734/21,186) and UA (22,580/6837) ( p r = 0.434/ r = 0.420) and EdAJ ( r = 0.599/ r = 0.545) ( p 3 ( r = 0.478/ r = 0.539) y EdAJ/cm 3 ( r = 0.745/ r = 0.758) ( p Conclusions In our in vitro research lithiasis require, due to the specific nature of their composition, a given amount of energy in order to be broken by ESWL, which is inherent to all those sharing the same composition, and can be predicted using CT or plain X-ray.

The insertion of a double-j catheter in patients with urinary lithiasis is currently important because it reduces the chances of obstructive complications such as hydronephrosis and renal functional loss. The following case aims to show the patient evolution which presented the complete migration of the catheter to the renal pelvis and how it could complicate its prognosis. Placing a dual-catheter for treatment of lithiasis is a routine procedure in urology services but is not beyond complications during the process. Even with exhaustive complementary imaging exams, we must maintain a constant evaluation of the patient.

Resume La lithotritie extracorporelle (LEC) est un traitement de la lithiase urinaire par fragmentation grâce aux ondes de choc. Le principe de la LEC sera decrit ainsi que la fabrication, la diffusion et la focalisation des ondes de choc. Les moyens de reperage des calculs, les modes d’anesthesie ainsi que le deroulement d’une seance seront rappeles avec les contre-indications et le prerequis avant une seance. Les parametres influencant l’efficacite de la LEC seront ensuite exposes. Enfin, les complications, les resultats et les indications de la lEC seront passes en revue.

Resume L’ureterorenoscopie souple couplee a la photovaporisation LASER (URSS-L) pour le traitement des calculs du rein est un outil moderne dont la place est en cours d’evaluation. Methodes Sa place en premiere intention a ete etudiee en France en 2010 au sein du Comite lithiase de l’association francaise d’urologie (CLAFU). Une enquete de pratique aupres de 27 experts a concerne les criteres decisionnels suivants : facteurs de comorbidite du patient, nature supposee du calcul, anatomie de l’appareil urinaire du patient. Cette enquete a ete proposee pour un calcul de taille inferieure ou egale a 20 mm, pour un calcul de taille superieure a 20 mm et pour les calculs multiples du rein. Resultats Quatorze experts ont repondu. Les criteres retenus en faveur de l’URSS-L en premiere intention etaient : l’obesite morbide (IMC > 30), un traitement anticoagulant ou antiagregant plaquettaire, les calculs durs (UH > 1000, calculs de cystine), les calculs intradiverticulaires, les calculs caliciels inferieurs, l’echec d’un premier traitement, ou le souhait du patient. Conclusion Selon les experts interroges l’URS-SL etait un traitement de premiere intention valide quelle que soit la taille du calcul et le nombre de calculs du rein, dans les cas ou la LEC et la NLPC etaient contre-indiques ou lorsque leurs resultats previsibles etaient moins bons (calculs durs/obesite morbide/calcul caliciel inferieur), lorsque la localisation du calcul etait difficile d’acces (calcul intradiverticulaire). C’etait aussi le traitement de choix lors de l’echec d’un premier traitement (LEC/NLPC).

Introduction Bladder stones constitute around 5% of bladder stones in the developed countries. Holmium laser lithotripsy has revolutionised the treatment of urinary lithiasis. Aim The aim of this study was to report the outcome of transurethral cystolithotripsy with Holmium Laser under Local Anaesthesia (LA) as a day care procedure in patients with bladder stones. Materials and methods Patients with bladder stone greater than 1.5cm attending urology Outpatient Department underwent transurethral cystolithotripsy with Holmium Laser under LA as day care procedure. The results were analysed on aspects of peri-operative pain, completion of procedure, stone clearance, hospital stay, complications and patient compliance. Results A total of 85 patients with bladder stone ≥1.5cm underwent transurethral cystolithotripsy LA. The mean age of the patient was 52±7 years. There were 80 males. The mean size of stone was 3±1.2cm. Mean operation time was 40±10 minutes. Complete stone clearance was achieved in all the patients. None of the patients required hospital stay following the procedure. Conclusion Transurethral holmium laser lithotripsy is an effective and safe procedure for large bladder stones. This procedure can be easily performed as a day care procedure.

Background Outpatient surgery is critical to improve health care costs. The aim of the study was to prospectively evaluate the results of outpatient treatment of upper tract urinary stones by rigid or flexible ureteroscopy in a routine care setting. Methods A database was created at the creation of the outpatient surgery department. 87 patients underwent 100 ureteroscopic procedures for urinary lithiasis from June 2013 to March 2015. Results Most of our patients were male with 53 men (sex ratio M/F 1.13), with a mean age of 52.9 ± 15 years old (23.4–82.4). 44 % of ureteroscopies performed were flexible ureteroscopies, 31 % rigid ureteroscopies and 25 % associated rigid and flexible ureteroscopies. The average stone load was 10.1 ± 5.7 mm (2–30) The mean operating time was 58.3 ± 21.1 min (20–150). 82.9 % of patients had a single urinary stone and 17.1 % (n = 14) had 2 or more. 114 stones were treated, 57,1 % intrarenal. There were 6 (6 %) postoperative complications: three Clavien stage 2 infections; three Clavien stage 3b complications (two renal colics requiring ureteral stenting 48 h after discharge and 1 symptomatic perirenal urinoma 48 h after discharge). There was one intraoperative complication (1 %): a ureteral wound with contrast leakage. The rate of transfer to conventional hospitalization was 2.2 %. Stone size influenced the stone-free status (p

Introduction: Hereditary xanthinuria, due to a purine metabolism disorder, is a rare cause of urinary lithiasis in children. Case: We report the case of a three and half-year old child, who presented recurrent urinary lithiasis that, has led to the destruction of the right kidney. Infrared spectrophotometric analysis of the calculus showed that it was composed of 100% xanthine. Laboratory tests revealed hypouricemia and hypouricosuria with elevated urinary excretion of oxypurines. These findings led to a diagnosis of hereditary xanthinuria. Conclusions: Early diagnosis of this rare disease is essential to avoid its complications. Metabolic causes must be sought in children with lithiasis.

Urethral lithiasis is a rare disorder, representing 1–2% of cases of urinary lithiasis in developed countries. In developing countries, the risk of disease occurrence is even higher, probably due to the increased number of patients with bladder stones. In men, the majority of stones migrate and stop at the urethral level due to the presence of an obstacle and secondary lithiasis may increase in size in this segment.

Percutaneous nephrolitotomy in bariatric surgery patients. Is there an increased risk of complications Introduction: To report a patient with a history of bariatric surgery and staghorn calculi of the left kidney, who had a colonic perforation after percutaneous renal surgery. Material and Methods: A 38 years old male patient, with a history of gastric bypass, underwent a left percutaneous nephrolithotomy due to staghorn renal calculi. In the procedure, the colon was incidentally perforated during the percutaneous access. Results: The patient developed a sepsis and fecal material appeared surrounding the nephrostomy tube. A transverse colostomy was performed, with improvement of the sepsis and a spontaneous resolution of the nephro-colonic fi stula. Conclusion: Is known that bariatric surgery is associated with the novo urinary lithiasis. Besides, there are anatomical changes in between intraabdominal viscera. Radiological studies and a adequate surgical strategy are fundamental to avoid severe surgical complications in kidney stone disease.