Search

Background: A plethora of novel therapeutic strategies, notably urolithiasis therapy, are currently being spoke of into traditional medicine. A particularly significant herbal remedy that is employed in indigenous medicine for its antiurolithiatic property is Acalypha indica Linn. Although A. indica is widely used in traditional medicine as an antiurolithiatic, there is currently no scientific data to substantiate this claim. Moreover, deriving inferences from the suggested theories and limited in vitro investigation casts doubt on its significance. Hence, this work focuses on the preliminary evaluation, acute oral toxicity and in vitro evaluation for antiurolithiatic activity of A. indica. Materials and Methods: Phytochemical evaluation was carried out using various standardized tests. Acute toxicity studies for Methanolic and Ethanolic extract of Roots and Leaves was conducted according to OECD guideline 420 using Wistar albino rats. The inhibitory activity of the extracts with concentrations of 100, 200, 400, 600, 800 and 1000 μg/mL on the nucleation of Calcium oxalate (CaOx) crystals was determined by a spectrophotometric assay. Results: A phytochemical screening resulted in identification of secondary metabolites such as carbohydrates, alkaloids, flavonoids, saponins and terpenoids with varying amounts in each extract. There were no signs of toxicity in the initial investigation on a single rat given a dosage of 2000 mg/kg of methanolic and ethanolic root and leaf extracts. The maximum inhibition was observed in Methanolic Root Extract (71.26%) at a concentration of 1000 mg/mL, which is followed by Ethanolic Leaf Extract (60.91%) at the same concentration. Conclusion: Acalypha indica Linn. was discovered to possess therapeutic value in the management of urolithiasis. [ABSTRACT FROM AUTHOR]

Urolithiasis is the most prevalent condition of the urinary system, characterized by the formation of stones inside the urinary tract. It is urgent to look for a natural urolithiasis therapy due to the serious side effects of conventional medications. Hydro-alcoholic (80% v/v) extract of the aerial parts of Ocimum kilimandscharicum (OK) and its ethyl acetate, chloroform, n-butanol, aqueous, and n-hexane fractions were subjected to in vitro antiurolithiatic screening as well as preliminary screening of phytochemicals. The in vitro antiurolithiatic activity of O. kilimandscharicum was studied using its hydroalcoholic extract (HAEOK). Calcium phosphate test using a colorimetric approach and calcium oxalate assay using a titrimetric model were used to determine the proportion of calcium oxalate crystals that dissolved. Total phenolic content (TPC) and total flavonoid content (TFC) were measured for the extract and fractions of OK. Ethyl acetate fraction (EAFOK) had a greater capacity to suppress crystal formation in both the calcium phosphate and calcium oxalate assays. The percent dissolution of calcium oxalate by HAEOK and EAFOK (31.48 ± 0.920% and 39.21 ± 0.903%) and calcium phosphate crystals by HAEOK and EAFOK (59.03 ± 0.820% and 66.62 ± 0.468%) was determined, respectively. At p < 0.05 and p < 0.01, differences between the results were regarded as significant. Cystone was employed as a standard drug. This study revealed that EAFOK showed significant antiurolithiatic activity. The antiurolithiatic activity of the extract/fraction was attributed to the steroids, triterpenoids, and flavonoid content of OK. [ABSTRACT FROM AUTHOR]

Introduction. Currently, single- and multifactorial criteria are employed to evaluate the quality of urolithiasis treatment utilizing lithotripsy. Among the most utilized single factors that influence the efficacy of urolithiasis therapy are the stone-free rate (SFR), the duration of lithotripsy, the level of intra- and post-operative complications, and hospital stay following lithotripsy. A more promising approach is the integrated indicator of the efficacy of urolithiasis management using the lithotripter, which considers all the aforementioned factors. It is an urgent task to determine the extent to which alterations in individual variables impact the value of an integrated assessment of the efficacy of laser lithotripsy-based urolithiasis intervention.Objective. To study the dependence of the integral efficiency indicator on the magnitude of influencing factors in the treatment of urolithiasis using transurethral thulium lithotripsy.Materials & methods. We used the method of mathematical modeling of the integral criterion for urolithiasis treatment efficacy using the Scilab v.6.02 software package to determine the extent to which individual factors influence the overall effectiveness of laser thulium lithotripsy.Results. Graphical dependences of the index of urolithiasis treatment efficacy for lithotripsy on the complication rate (at different values of surgery time and dependence of urolithiasis treatment efficacy on SFR at different values of complication rate, surgery time and hospital stay) were obtained. A software system for determining the integral index of urolithiasis treatment efficiency for lithotripsy was developed.Conclusion. The resulting dependencies of the index of urolithiasis treatment efficacy for lithotripsy can be used to evaluate the impact of the complication grade and the SFR on the value of the efficacy index and to devise measures to enhance it. The software developed for the calculation of this index allows to obtain the required value at different input influencing parameters.

Urolithiasis is the most prevalent condition of the urinary system, characterized by the formation of stones inside the urinary tract. It is urgent to look for a natural urolithiasis therapy due to the serious side effects of conventional medications. Hydro-alcoholic (80% v/v) extract of the aerial parts of Ocimum kilimandscharicum (OK) and its ethyl acetate, chloroform, n-butanol, aqueous, and n-hexane fractions were subjected to in vitro antiurolithiatic screening as well as preliminary screening of phytochemicals. The in vitro antiurolithiatic activity of O. kilimandscharicum was studied using its hydroalcoholic extract (HAEOK). Calcium phosphate test using a colorimetric approach and calcium oxalate assay using a titrimetric model were used to determine the proportion of calcium oxalate crystals that dissolved. Total phenolic content (TPC) and total flavonoid content (TFC) were measured for the extract and fractions of OK. Ethyl acetate fraction (EAFOK) had a greater capacity to suppress crystal formation in both the calcium phosphate and calcium oxalate assays. The percent dissolution of calcium oxalate by HAEOK and EAFOK (31.48 ± 0.920% and 39.21 ± 0.903%) and calcium phosphate crystals by HAEOK and EAFOK (59.03 ± 0.820% and 66.62 ± 0.468%) was determined, respectively. At p < 0.05 and p < 0.01, differences between the results were regarded as significant. Cystone was employed as a standard drug. This study revealed that EAFOK showed significant antiurolithiatic activity. The antiurolithiatic activity of the extract/fraction was attributed to the steroids, triterpenoids, and flavonoid content of OK.

There is continuing debate about whether abundant citrate plays an active role in biomineralization of bone. Using solid state NMR dipolar dephasing, we examined another normally mineralized hard tissue, mineralized articular cartilage, as well as biocalcifications arising in pathological conditions, mineralized intimal atherosclerotic vascular plaque, and apatitic uroliths (urinary stones). Residual nondephasing C NMR signal at 76 ppm in the spectra of mineralized cartilage and vascular plaque indicates that a quaternary carbon atom resonates at this frequency, consistent with the presence of citrate. The presence, and as yet unproven possible mechanistic involvement, of citrate in tissue mineralization extends the compositional, structural, biogenetic, and cytological similarities between these tissues and bone itself. Out of 10 apatitic kidney stones, five contained NMR-detectable citrate. Finding citrate in a high proportion of uroliths may be significant in view of the use of citrate in urolithiasis therapy and prophylaxis. Citrate may be essential for normal biomineralization (e.g., of cartilage), play a modulatory role in vascular calcification which could be a target for therapeutic intervention, and drive the formation of apatitic rather than other calcific uroliths, including more therapeutically intractable forms of calcium phosphate. [ABSTRACT FROM AUTHOR]

The high recurrence rate has always been a problem associated with urolithiasis. This study aimed to explore the effectiveness of single interventions, combined therapies, and surgical and nonsurgical interventions. Herein, three lithotripsy procedures—extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and ureteroscopic lithotripsy (URSL)—were assessed and a retrospective cohort was selected in order to further analyze the association with several risk factors. Firstly, a population-based cohort from the Taiwan National Health Insurance Research Database (NHIRD) from 1997 to 2010 was selected. In this study, 350 lithotripsy patients who underwent re-treatment were followed up for at least six years to compare re-treatment rates, with 1400 patients without any lithotripsy treatment being used as the comparison cohort. A Cox proportional hazards regression model was applied. Our results indicate that the risk of repeat urolithiasis treatment was 1.71-fold higher in patients that received lithotripsy when compared to patients that were not treated with lithotripsy (hazard ratio (HR) 1.71; 95% confidence interval (CI) = 1.427–2.048; p < 0.001). Furthermore, a high percentage of repeated treatment was observed in the ESWL group (HR 1.60; 95% CI = 1.292–1.978; p < 0.001). Similarly, the PCNL group was also independently associated with a high chance of repeated treatment (HR 2.32; 95% CI = 1.616–3.329; p < 0.001). Furthermore, age, season, level of care, and Charlson comorbidities index (CCI) should always be taken into consideration as effect factors that are highly correlated with repeated treatment rates. [ABSTRACT FROM AUTHOR]

Introduction: Indication of ureteroscopy for the treatment of urolithiasis has expanded immensely over the last decade. Fiber-optic and digital reusable instruments present the standard in clinical practice, but various newly available single-use devices might offer an exciting alternative. To date, the evidence is limited to clinical evaluation and efficacy of single-use ureteroscopes (URS) compared to standard instruments. Therefore, we evaluate a single-use instrument's clinical characteristics and efficacy in direct comparison with a fiber-optic and digital device. Methods: A prospective study was conducted for patients undergoing endoscopic therapy for urolithiasis at a tertiary care center. We evaluated the different instruments' clinical performance in categories of visibility, the stability of visibility, irrigation flow, and surgeon's satisfaction. Statistical analyses were performed by SPSS using the Chi-Quadrat and Kruskal-Wallis test. A p value of p ≤ 0.05 was defined as statistically significant. Results: A total number of 77 patients were included and distributed as follows: 35 (46.7%) single-use, 19 (25.3%) digital, and 23 (28%) fiber-optic URS. Patients' characteristics were homogenous over the three cohorts in sex, stone amount, and localization. The stone-free rate was equal in all three cohorts (p = 0.31). We identify stability of visibility, irrigation flow, and satisfaction were equal in all cohorts (p = 0.73; p = 0.20; p = 0.20). We report a significant difference in visibility, with 100% rated excellent in the digital URS group (p = 0.028). Discussion/Conclusions: Single-use URS achieve comparable clinical outcomes with equal stone-free rates in direct comparison with fiber-optic and digital reusable instruments. Accordingly, single-use devices present an adequate alternative for endoscopic therapy of urolithiasis. [ABSTRACT FROM AUTHOR]

Purpose: Stent encrustation is not uncommonly encountered with a high number of ureteric stents. The exact pathophysiology is not well understood. Therefore, we investigated the relationship between the use of sodium citrate and likelihood of stent encrustation. Methods: This prospective, randomised, intervention study was conducted between October 2018 and October 2019 in a tertiary hospital. Overall, 115 patients with ureteral stents that were inserted after lithotripsy surgeries were recruited. The study subjects were randomised into two groups: one group was administered sodium citrate (Utix sachets) three times per day until stent removal (intervention group), and the second group was not administered Utix sachets (control group). Stents were removed after 1 month and inspected under macroscopic visualisation from the proximal to distal end for any crystallisation; a second inspection was done with a 60 × magnification lens. Any crystallisation observed was considered to be encrustation. Results: Patients who had Utix sachets post-insertion of a ureteric stent constituted 50.4% of the study cohort. The rate of encrustation in the control group was 52.6%. In the intervention group, the rate of encrustation was 46.6%. The difference was not statistically significant with the chi-squared test (p value, 0.514). Conclusion: Alkaline citrate medications had no significant effect on stent encrustation rate. More studies are needed to elucidate different agents and their roles in reducing stent encrustation as it incurs high morbidity. [ABSTRACT FROM AUTHOR]

Alkaline citrates have been used as an efficient therapy in hypocitraturic calcium nephrolithiasis, uric acid lithiasis, cystinuria, and renal tubular acidosis. Furthermore, alkaline citrates are very effective in treating and preventing hyperchloremic metabolic acidosis in patients with urinary diversion. The main physiological effects during urolithiasis therapy have been significant increases in urinary pH, in citrate and potassium, and a decrease in calcium excretion. This paper reviews current indications, therapy modalities, and metaphylactic use reported in the literature and/or recommended by the Deutsche Gesellschaft für Urologie (DGU) and the European Association of Urology (EAU). It is intended to give useful advice for the urologist's daily practice. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of potassium citrate administration on the composition of encrusted material on the ureteral stent after Double-J insertion. Methods: We designed a randomized clinical trial for our study; 65 patients that underwent transurethral lithotripsy and Double-J stent insertion were included in the study after informed consent and divided into two groups. In the first group (33 patients) potassium citrate was prescribed after surgery till stent removal and the second group (32 patients) followed without prescribing this medication. After stent removal, encrusted materials on removed stents were analyzed then the type and composition of encrusted material compared with the primary stone that was removed. Results: Our results revealed that the type and composition of primary stone and encrusted stone were similar in patients that do not receive potassium citrate (p-value of 0.073, 0.251 and 0.944 for calcium oxalate, uric acid, and calcium phosphate respectively). In patients that taking potassium citrate rate of calcium oxalate (p-value < 0.001) and uric acid (p-value < 0.001) material on encrusted stent significantly decreased compared with the non-intervention group. Conclusion: Results of this study revealed that taking of potassium citrate after ureteral stent insertion significantly decreases the formation of calcium oxalate and uric acid encrusted material on Double-J stent so it could be recommended for prevention of stent encrustation in patients that primary stone analysis are calcium oxalate and uric acid stone. [ABSTRACT FROM AUTHOR]

Urolithiasis is a complex process characterized by supersaturation and retention of salts within the kidney and also a debilitating problem worldwide. Here, we have investigated antiurolithiatic effect of trans-cinnamic acid (t-CA) against ethylene glycol (EG) induced urolithiasis in rats. Urolithiasis was induced in Wistar albino rats using 0.75% v/v EG in drinking water for 28 days. t-CA was administered @200 and 400 mg/kg along with EG for 28 days. Biochemical, urine and histopathological analysis were performed to observe the calcium oxalate (CaC2O4) deposits and renal tissue damage. The EG group showed significant rise in urine oxalate, calcium, phosphate, and renal tissues oxalates, as compared to normal group. Serum creatinine and uric acid levels were also increased significantly in EG-treated group. Histopathological studies showed marked renal tissue damage and the presence of CaC2O4 crystals. Further, treatment of t-CA significantly ameliorated oxalate, calcium, magnesium, phosphate (urine) and creatinine, uric acid (serum) in EG-induced urolithiasis after 28 days. Moreover, t-CA-treated groups showed reversal of renal tissue damage and reduced level of CaC2O4. Interestingly, t-CA @400 mg/kg, was more effective in preventing the urolithiasis and regeneration of renal tissues in rats. [ABSTRACT FROM AUTHOR]

Purpose: The guidelines of the German, European, and American Urological Associations on urolithiasis advise against general ureteral stenting before and after an uncomplicated ureterorenoscopy (URS). However, German and European guidelines state that stenting prior to URS facilitates stone extraction and reduces intraoperative complications. According to the published literature, German practice seems to deviate from recommendations. This nationwide survey aimed to evaluate the treatment modalities of urolithiasis. Methods: In November 2018 and March 2019, a total of 199 urological hospital departments in Germany were anonymously surveyed about operative care of symptomatic urolithiasis. The response rate was 72.9%. The survey consisted of 25 questions about diagnostics, surgical technique, and aftercare of the URS. This questionnaire is available in the appendix. Results: A primary URS is performed in ≤10% in 49.6% of the hospitals. In every second urological department (49.7%), the German Diagnosis Related Group (G-DRG) system influences the period of pre-stenting before a secondary URS. After a secondary URS, which is performed in 53.8% of the departments in over 80% of the patients, 14% of the departments omit stenting. The standard for stenting seems to be a 28-cm-long 7 Charrière double-J stent in Germany. Conclusion: In Germany, the percentage of primary URS is low, and a ureter stenting is performed in most of the urological departments after URS. Delaying therapy due to economic aspects is the standard in almost half of all urological departments. [ABSTRACT FROM AUTHOR]

Introduction: Contemporary, flexible stone baskets are unable to extract submillimeter stone fragments at the time of ureteroscopic laser lithotripsy. In this in vitro study, the feasibility of suctioning submillimeter fragments with a standard Luer Lock syringe through the working channel of a flexible ureteroscope was assessed. Materials and Methods: Phantom stones made from industrial plaster were mechanically fragmented into ≤1 and ≤0.5-mm groups. Both stone groups were divided into five preweighed trial samples. Each stone group was then mixed in a beaker filled with normal saline. A standard 10-mL Luer Lock syringe was connected to a fiber-optic ureteroscope with a 1.2-mm working channel. The syringe was then used to suction stone fragments from the beaker. The suctioned stone fragments and the stone fragments remaining in the beaker after removing the overlying solution were separated, centrifuged with supernatant removed, and dried in an incubator set at 33°C for 1 week. Dried weights were recorded. Results: Mean total weights for ≤0.5 and ≤1.0-mm stone groups at baseline were 0.807 and 0.806 g, respectively. The mean percentages of stone fragments suctioned through the ureteroscope for ≤0.5 and ≤1.0-mm groups were 86% and 86%, respectively (p = 0.973). During suctioning, 64% of stones in the ≤0.5-mm group were trapped in either the working channel of the ureteroscope or within the Luer Lock syringe compared with 78% of stones in the ≤1-mm group (p = 0.001) requiring cessation of the procedure to clear the channel. Conclusions: It is feasible to suction submillimeter stone fragments by connecting a Luer Lock syringe to the working channel of a flexible ureteroscope. The limiting factor for removing stone fragments appears to be the small working channel of flexible ureteroscopes as trapping of fragments during suctioning is common and requires time-consuming removal of the endoscope and clearing of the channel. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to provide a comprehensive review of recent machine learning (ML) and deep learning (DL) applications in urological practice. Numerous studies have reported their use in the medical care of various urological disorders; however, no critical analysis has been made to date. Methods: A detailed search of original articles was performed using the PubMed MEDLINE database to identify recent English literature relevant to ML and DL applications in the fields of urolithiasis, renal cell carcinoma (RCC), bladder cancer (BCa), and prostate cancer (PCa). Results: In total, 43 articles were included addressing these four subfields. The most common ML and DL application in urolithiasis is in the prediction of endourologic surgical outcomes. The main area of research involving ML and DL in RCC concerns the differentiation between benign and malignant small renal masses, Fuhrman nuclear grade prediction, and gene expression-based molecular signatures. BCa studies employ radiomics and texture feature analysis for the distinction between low- and high-grade tumors, address accurate image-based cytology, and use algorithms to predict treatment response, tumor recurrence, and patient survival. PCa studies aim at developing algorithms for Gleason score prediction, MRI computer-aided diagnosis, and surgical outcomes and biochemical recurrence prediction. Studies consistently found the superiority of these methods over traditional statistical methods. Conclusions: The continuous incorporation of clinical data, further ML and DL algorithm retraining, and generalizability of models will augment the prediction accuracy and enhance individualized medicine. [ABSTRACT FROM AUTHOR]

Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate the thermal effect of Ho:YAG laser lithotripsy in a standardized in vitro model via real-time temperature measurement.Methods: Our model comprised a 20 ml test tube simulating the renal pelvis that was immersed in a 37 °C water bath. Two different laser fibers [FlexiFib (15-45 W), RigiFib 1000 (45-100 W), LISA laser products OHG, Katlenburg-Lindau, Germany] were placed in the test tube. An Ho:YAG 100 W laser was used in all experiments (LISA). Each experiment involved 120 s of continuous laser application, and was repeated five times. Different laser settings (high vs. low frequency, high vs. low energy, and long vs. short pulse duration), irrigation rates (0 up to 100 ml/min, realized by several pumps), and human calcium oxalate stone samples were analyzed. Temperature data were acquired by a real-time data logger with thermocouples (PICO Technology, Cambridgeshire, UK). Real-time measurements were assessed using MatLab®.Results: Laser application with no irrigation results in a rapid increase in temperature up to ∆28 K, rising to 68 °C at 100 W. Low irrigation rates yield significantly higher temperature outcomes. Higher irrigation rates result immediately in a lower temperature rise. High irrigation rates of 100 ml/min result in a temperature rise of 5 K at the highest laser power setting (100 W).Conclusions: Ho:YAG laser lithotripsy might be safe provided that there is sufficient irrigation. However, high power and low irrigation resulted in potentially tissue-damaging temperatures. Laser devices should, therefore, always be applied in conjunction with continuous, closely monitored irrigation whenever performing Ho:YAG laser lithotripsy. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a recently reported new bioadhesive system for the retrieval of small residual fragments (RFs) after intracorporeal lithotripsy, we systematically compared this system with coagulum lithotomy in retrograde intrarenal surgery. Materials and Methods: We extracted 30 human stone fragments (≤1 mm) in an ex vivo porcine kidney model using a flexible ureteroscope for three groups: (1) the novel bioadhesive, (2) autologous blood as a natural adhesive, and (3) (control group) a conventional retrieval basket. Each group consisted of 15 test runs. Outcomes were evaluated regarding the macroscopic stone-free rate (SFR), retrieval time, and number of ureteral passages. Results: For groups 1 and 2, a significant advantage in stone clearance, mean retrieval time, and number of retrievals was detected compared to the control group ( p = 0.001). The time and number of retrievals were significantly lower in group 1 (10:36 minutes, p = 0.001) than in group 2 (26:12 minutes, p = 0.001), with shorter clotting time and better visibility. Conclusions: These data show the general feasibility of intrarenal RF embedding to improve the SFR. Our data furthermore suggest the superiority of the artificial bioadhesive embedding agent over the application of native blood. Further in vivo studies and other research are necessary to confirm the adhesive's effect in patients. [ABSTRACT FROM AUTHOR]

High sodium levels in cat food have been controversial for a long time. Nonetheless, high sodium levels are used to enhance water intake and urine volume, with the main objective of reducing the risk of urolithiasis. This article is a review of current evidence of the putative risks and benefits of high dietary sodium levels. Its secondary aim is to report a possible safe upper limit (SUL) for sodium intake. The first part of the manuscript is dedicated to sodium physiology, with a focus on the mechanisms of sodium homeostasis. In this respect, there is only few information regarding possible interactions with other minerals. Next, the authors address how sodium intake affects sodium balance; knowledge of these effects is critical to establish recommendations for sodium feed content. The authors then review the consequences of changes in sodium intake on feline health, including urolithiasis, blood pressure changes, cardiovascular alterations and kidney disease. According to recent, long-term studies, there is no evidence of any deleterious effect of dietary sodium levels as high as 740 mg/MJ metabolizable energy, which can therefore be considered the SUL based on current knowledge. [ABSTRACT FROM AUTHOR]

Current surgical safety guidelines and checklists are generic and are not specifically tailored to address patient issues and risk factors in surgical subspecialties. Patient safety in surgical subspecialties should be templated on general patient safety guidelines from other areas of medicine and mental health but include and develop specific processes dedicated for the care of the surgical patients. Safety redundant systems must be in place to decrease errors in surgery. Therefore, different surgical subspecialties should develop a specific curriculum in patient safety addressing training in academic centers and application of these guidelines in all practices. Clearly, redundant safety systems must be in place to decrease errors in surgery, in analogy to safety measures in other high-risk industries. Specific surgical subspecialties are encouraged to develop a specific patient safety curriculum that address training in academic centers and applicability to daily practice, with the goal of keeping our surgical patients safe in all disciplines. The present review article is designed to outline patient safety practices that should be adapted and followed to fit particular specialties. [ABSTRACT FROM AUTHOR]

The simultaneous surgical management of ureteropelvic junction obstruction (UPJO) with concomitant renal stones has evolved the last 20 years; hence, the ideal minimally invasive technique is still controversial. Laparoscopic and robot-assisted laparoscopic operations allow precise surgical maneuvers and were thought to simplify the reconstruction steps of the procedure, especially in the treatment of complex cases with large stones. The aim of this study was to summarize the available perioperative and functional outcomes of minimally invasive available techniques. A non-systematic review of the literature was performed using a free-text protocol in the MEDLINE database. The terms used were 'ureteropelvic junction obstruction,' 'renal calculi' and 'renal stones.' Furthermore, other significant relevant studies cited in the reference lists of the selected papers were also evaluated in the structure of this review. Currently, available evidence suggests that both laparoscopic and robotic-assisted techniques offer excellent surgical solutions in the field of UPJO reconstruction and renal stones removal. In the hands of experienced surgeons, laparoscopic and robotic pyeloplasty with concomitant stone removal is a safe procedure with high stone-free rates and UPJ patency. Minimally invasive pyeloplasty should constitute the first choice of treatment for concomitant renal stones and ureteropelvic junction obstruction. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the effectiveness of percutaneous nephrolithotomy (PNL), stone-free rates, and related complications in children with radiolucent renal stones. A total of 56 patients aged <16 years from four institutions were enrolled in our study. Asymptomatic, clinically insignificant residual fragments measuring <4 mm or a complete stone-free status was accepted as the criterion for clinical success. Complications were evaluated according to the modified Clavien classification. The mean age of the patients was 7.8 ± 4.5 years. The mean stone size was calculated as 24.07 ± 10.4 mm. The median operative and fluoroscopy times were 53.2 min (15-170 min) and 172.4 s (5-520 s), respectively. The success rate after PNL monotherapy was 87.4 %; the total success rate with shock wave lithotripsy used as an auxillary treatment method was detected as 94.6 %. The total complication rate was 19.6 % (11 patients). No adjacent organ injury was observed. All of the complications that occurred were minor according to the Clavien classification (Clavien Grades I-II). PNL can be applied to radiolucent pediatric renal stones in children with similar success, and complication rates as noted for radiopaque stones. [ABSTRACT FROM AUTHOR]

This review summarizes recent literature on advances regarding renal and ureteral calculi, with particular focus in areas of recent advances in the overall field of urolithiasis. Clinical management in everyday practice requires a complete understanding of the issues regarding metabolic evaluation and subgrouping of stone-forming patients, diagnostic procedures, effective treatment regime in acute stone colic, medical expulsive therapy, and active stone removal. In this review we focus on new perspectives in managing nephrolitihiasis and discuss recentadvances, including medical expulsive therapy, new technologies, and refinements of classical therapy such as shock wave lithotripsy, give a fundamental modification of nephrolithiasis management. Overall, this field appears to be the most promising, capable of new developments in ureterorenoscopy and percutaneous approaches. Further improvements are expected from robotic-assisted procedures, such as flexible robotics in ureterorenoscopy. [ABSTRACT FROM AUTHOR]

Background: Urolithiasis is one of the most common conditions seen in emergency departments (ED) worldwide, with an increasing frequency in geriatric patients (>65 years). Given the high costs of emergency medical urolithiasis treatment, the need to optimise management is obvious. We aimed to determine risk factors for hospitalisation and evaluate diagnostic and emergency treatment patterns by ED physicians in geriatric urolithiasis patients to assist in optimising treatment. Methods: After receiving ethics committee approval, we examined the records of emergency urolithiasis admissions to our ED between January 2000 and December 2010 to determine risk factors for hospitalisation and to evaluate current diagnostic and emergency treatment patterns in geriatric urolithiasis patients. Results: 1,267 consecutive patients at least 20 years of age with confirmed urolithiasis (1,361 ED visits) and complete follow-up data were analyzed. Geriatric patients comprised 10% of urolithiasis patients with more than half of them experiencing their first urolithiasis episode at ED admission. Although stone site, side and size did not significantly differ between groups, urinary stone disease was more severe in the elderly. The risk of severe complications correlated with increasing age, female sex and diabetes mellitus. Geriatric patients had a two-fold greater likelihood of being hospitalised. A significantly lower percentage of geriatric patients received combined analgesic therapy for pain management (37% vs. 64%, p = <0.001) and supportive expulsive treatment (9% vs. 24%, p = <0.001). Conclusion: Geriatric patients with urolithiasis have a higher morbidity than younger patients and may be undertreated concerning analgetic and expulsive treatment in ED. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficiency and spontaneous expulsion rates of tamsulosin and Rowatinex in patients with distal ureteral stones. Methods: Between March and July 2009, 90 patients with distal ureteral stones <10 mm in size were included in the study. Patients were randomized in 3 groups: Group 1 ( n = 31, those received 0.4 mg tamsulosin once daily), Group 2 ( n = 30, those received 100 mg Rowatinex capsules 3 times a day), and Group 3 ( n = 29, those received diclofenac 100 mg once daily). All patients were followed up for 10 days. Results and conclusions: Mean age of the patients was 42.4 ± 16.1 (range, 22-75), 46.5 ± 16.5 (range, 22-76), and 43.5 ± 16.6 (range, 18-71) years in Groups 1-3, respectively. On admission, 37.8% had hematuria and 78.9% had lower urinary tract symptoms (LUTS). No statistically significant differences were detected between the three groups regarding patient age, gender, mean stone size, stone location, stone site, additional analgesic requirement, number of ureteral colics during the treatment, and upper urinary tract dilation. The mean stone expulsion time was 3.5 days in Group 1, 6 days in Group 2, and 7 days in Group 3 ( P = 0.02). Stone expulsion rate was significantly high in Group 1 compared to Group 2 ( P = 0.002). Similarly, stone expulsion rate was significantly high in Group 1 compared to Group 3 ( P = 0.001). Medical treatment with tamsulosin seems to be effective in patients with distal ureteral stones <10 mm in size. However, use of Rowatinex does not seem to have any significant effect on clearance rate of distal ureteral calculi. [ABSTRACT FROM AUTHOR]

The effects of temperature and multifunctional sodium carboxylate additives on the phase composition and morphology of calcium oxalate (CaOxa) crystals grown in silica gel system were systematically investigated using scanning electron microscopy (SEM), powder X-ray diffraction (XRD), and Fourier-transform infrared spectra (FT-IR). The sodium carboxylates investigated include: monocarboxylate sodium acetate (NaAc), disodium tartrate (Na2tart), trisodium citrate (Na3cit), and the disodium salt of ethylenediaminetetraacetic acid (Na2edta). The temperature range was from 7°C to 67°C. The crystallization temperature affects the phase compositions, the growth rate, and the morphology of CaOxa. First, the logarithm of the percentage of calcium oxalate dihydrate (COD) formed at a certain temperature (T) is proportional to the reciprocal of temperature (1/T). Second, the weight of CaOxa crystals decreases as decreasing the temperature. At a given temperature, the ability of the sodium carboxylates to induce COD follows the order: Na2edta Na3cit Na2tart NaAc. Third, the multicarboxylates can decrease the surface area of calcium oxalate monohydrate (COM). It makes the edges and tips of COM crystals blunt and oval. All the three changes, an increase of the content of COD, a decrease of the weight of CaOxa crystals, and a decrease of the surface area of COM crystals, can inhibit the formation of CaOxa stones. These results support the clinical use of citrates and may be helpful in elucidating the mechanisms of the formation of CaOxa calculus. [ABSTRACT FROM AUTHOR]

Extracorporal shock wave lithotripsy has rapidly become established world wide as a routine method for treatment of nephro-and ureterolithiasis. Although initial studies showed no tissue damaging effect by the shock waves, we found in an animal experiment using canine kidneys, the ESWL induced damage to the renal parenchyma is more marked than originally assumed. The damage is limited to the area that was focused on, and heals relatively rapidly by connective tissue encapsulation with final cicatrisation without any further residual effects being observed until now. This parenchymal damage is probably also the cause of the macrohaematuria that is always observed during therapy. The resulting tissue damage is not extensive enough to cause demonstrable reduction of function as measured by the usual methods (serum creatinine, creatinine clearance, isotopy renography, i/v-urography). The main clinical complication is the large subcapsular haematoma which, according to present knowledge, could well result from a lesion of the larger peripheral vessels. Damage to other organs such as subserous colonic and small bowel haematomata are to be expected although they do not lead to clinical symptoms. [ABSTRACT FROM AUTHOR]

An animal model involving rats fed with different diets (high protein, high carbohydrate, high lipid, high fiber and control balanced diet) was used to evaluate the dietary effects on the main oxalocalcic urolithogenic parameters. It was found that the inhibitory factors that prevent calcium oxalate stone formation (citrate and magnesium) were clearly more favourable in the group of rats fed with a balanced diet. However, factors favouring the heterogeneous calcium phosphate nucleation were also found in the balanced diet. On the other hand, factors facilitating the heterogeneous uric acid nucleation were found in rats treated with high protein, high lipid, high carbohydrate and high fiber diets. In conclusion it seems that the balanced diet appears to be the less lithogenic one. [ABSTRACT FROM AUTHOR]

Copyright of World Journal of Surgery is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hexosaminidase isoenzymes P from serum of pregnant women and I from serum of leukemic children were compared using various biochemical methods, namely, ion exchange chromatography, isoelectric focusing, and molecular weight determination by gel filtration. Isoenzyme I is activated by calcium, magnesium, and manganese. The molecular weight of isoenzyme I was 110 000 compared to 130 000 of isoenzyme P. The widely differing molecular weights exclude the so far suggested identity of both enzymes. Both isoenzyme P and isoenzyme I possess β-chains, however, they differ in chain structure and glycosylation. This different structure of isoenzyme P may be one of the reasons for its increase during pregnancy due to the resulting impaired clearance by liver sinusoidal cells. [ABSTRACT FROM AUTHOR]

During the last few years, there has been relevant progress in both understanding and managing urolithiasis. Our knowledge of stone formation has changed; although the importance of urine biochemistry was questioned by several investigators years ago, the decisive role of cellular processes (induced by oxidative stress) and the renal papilla has only recently been generally accepted as the most important step in stone formation. For calcium oxalate urolithiasis, the formation of papillary calcifications plays a key role and is of prognostic relevance. Further research has to concentrate on these aspects of preventing urolithiasis. Stone prevention (metaphylaxis) is a major issue when considering the burden it places on healthcare systems. An effective metaphylaxis could lower the cost of stone therapy significantly. For uric acid urolithiasis, so far there is only preliminary information available showing that papillary plaques are not as important as they are in calcium oxalate urolithiasis. Concerning stone management, endourology has improved stone therapy significantly during the last few years. Morbidity decreased and success (stone-free) rates increased. Therefore, the indications for extracorporeal shockwave lithotripsy (ESWL) narrowed. ESWL, however, still has its place in stone therapy. There is not one single treatment modality that is equally effective for all situations. It is important to observe the differential indications for different stones depending on size, localization, and composition.

Urolithiasis plays a quantitatively important role among the urologic diseases. Renal hydrogen ion excretion (ie, the urine pH) is generally accepted as a urinary risk factor in most types of [...]