The management of stone disease

Journal of Surgery

Introduction: Urolithiasis has afflicted humans since centuries dating back to 4000BC, with the disease prevalence differing in various parts of the world. Contrary to earlier studies that depicted urinary stone disease as rare in Nigeria, recent reports have shown an increasing incidence. We aim to document the pattern and management of urinary tract calculi seen at the

Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 2014

Non-contrast computed tomography (NCCT) is the diagnostic choice for renal stone disease. Knowing the composition of a stone before passage can help to choose a better management. We sought to determine whether the Hounsfield unit (HU) measured by NCCT can predict the composition. 180 urinary stones from patients seen at Shariati, Kashani and Alzahra CT centers, were submitted to stone analysis, 2012. All scans had been interpreted for HU. Primitive statistical findings showed an effect of size on the HU. To avoid confounding bias, Hounsfield Density (HD: HU/largest transverse diameter) was calculated. Statistical comparisons were performed between composition with HU and HD. Calcium stones had specific ranges for HD and HU. No non-calcium stone had HU more than 448 and HD greater than 50 HU/mm. NCCT can differentiate just Calcium from non-calcium stones.

journal of medical science and clinical research

Background: Renal stone or calculus is one the most common disease of the urinary tract. Sharp, server pain from the kidney stones brings over 4,50,000 people to emergency department every year. The surgical management of renal stone disease have changed dramatically. Here a clinical study of 25 patients of renal calculus has been under taken. An attempt has made to study the ectiopathology of stone formation with clinical features and its surgical management. Methods: in this study all patients diagnosed as renal calculi and admitted in surgical and urology wards at heritage institute of medical sciences varanasi during the period of October 2016 to june 2017. A detailed history, complete physical examination routine and specific investigation were done. Inclusion criteria:  All Cases of renal calculi managed by non operative medical line of treatment.  Stones below the pelviureteric junction.  Renal stones in immune compromised patients.  Associated neoplaisa (Benign, and malignant)  Associated congenital renal ureteric and urinary bladder anomalies. Results and Conclusion: 25 cases were studied, incidence is common between 3 rd and 5 th decase. 14 (56%) were of mixed diet. All the 25 cases have presented with pain in the lumbar region of login. After investigations different surgical procedures were under taken on these patients and there were no operative difficulties encountered. Out of 25 patients only 15 patients turned up for follow up all were symptom free till their last visit, remaining 10 patients did not come for follow up all were symptom free till their last visit, nephrolithiasis,

Journal of endourology / Endourological Society, 2015

Objective: To assess trends in urological surgical management of upper tract urolithiasis in Brazil over the past 15 years. Patients and Methods: The Public Health System of Brazil (SUS) provides health coverage to 47-74% of the population. SUS has a longitudinal hospital inpatient database (SIH/SUS). Hospital discharges between January 1st./1998 and December 31st./2012 were abstracted from the SIH/SUS. All inpatient hospitalizations for patients of any age with a primary/secondary diagnosis code of N20.x (calculus of kidney or ureter) were abstracted (ICD-9/10). All urolithiasis-related procedure codes were analyzed. The absolute number of procedures/year and the proportion among all techniques were analyzed for Brazil and also separately for the five distinguish regions of the country. Prevalence trends over the studied period were quantified by the estimated annual percent change (EAPC) using the least squares linear regression methodology. Significance was set at p<0.05. Resu...

CHARACTERISTIC AND MANAGEMENT OF URINARY TRACT STONES IN SUNAN KUDUS ISLAMIC HOSPITAL : A DESCRIPTIVE STUDY 1Indra Fahri, 1Muhammad Taufiq Reza 1Department of Urology, Sunan Kudus Islamic Hospital ABSTRACT Objective: To identify the characteristic and management of urinary tract stones at the Urology Department of Sunan Kudus Islamic Hospital in January 2021 – December 202. Material & Methods: This was a descriptive retrospective research conducted at Urology Department of Sunan Kudus Islamic Hospital. The data were obtained from medical records of patients diagnosed with urinary tract stone, with the amount of data collected was 100. The variables included were age, sex, chief complaint, comorbidities, stone location, treatment, and complication. Stone locations differentiated into inferior pole of kidney, superior pole of kidney, medial pole of kidney, proximal ureter, medial of ureter, distal part of pelvis renalis, bladder, and ureterovesical junction. Result: Most of the patient are aged 46-60 years old(605). Male gender comprises 66% of the patient, then female gender is 34% of the patient. The chief complaint of the patient is lumbar pain ( 56%), lumbar pain, nausea and vomitus ( 40%), retensio urine (4%). Patient comorbidities are diabetes mellitus (83%), hypertension (10%), and hypercholesterolemia (7%). The most common site of stone is the inferior pole of the kidney (26%), followed by mid pole of kidney (18%) and proximal ureter (15%). Most patient are managed by ureteroscopy (51%) followed by extracorporeal shockwave lithotripsy (31%). The most common complication is acute kidney injury (74%). Conclusion: Characteristic and management of urinary tract stone at Urology Department of Sunan Kudus Hospital are as follows: the age 46-60 years old as the most prevalent age of urinary stone patients. Most patient have a male gender. Most of the chieft complaint is lumbar pain. The highest number of comorbidities in our patients are diabetes mellitus. The inferior pole of the kidney is the most common site of stones. Our patient is most commonly treated with ureteroscopy. Acute kidney injury is the most common complications. Keywords: Urinary stone, age group, gender, chief complaint, location of urinary stone, comorbidities, urinary stone management, urinary stone complications

Arab Journal of Urology, 2012

Objective: To highlight the role of open stone surgery in the management of urolithiasis in the current era of minimally invasive therapies. The introduction and continuous development of extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy and percutaneous nephrolithotomy (PCNL) over the past 30 years have led to a significant change in the current management of urolithiasis, where the indications for open stone surgery have been narrowed significantly, making it a second-or third-line treatment option. Methods: We reviewed the most recent guidelines published by the European Association of Urology and the American Urological Association, and reviewed reports through a MEDLINE search to identify the indications and current role of open stone surgery.

Therapeutic advances in urology, 2010

Nephrolithiasis is a highly prevalent condition with a high recurrence rate that has a large impact on the quality of life of those affected. It also poses a great financial burden on society. There have been great advancements in the surgical treatment of stone disease over the past several decades. The evolution of surgical technique appears to have overshadowed the importance of prevention of stone disease despite evidence showing medical therapies significantly decreasing stone recurrence rates. Herein we review the metabolic evaluation of stone formers with the use of specific blood and urine tests. We complete our discussion with a review of the medical management of stone formers providing both general recommendations as well as reviewing focused therapies for specific metabolic abnormalities and medical conditions.

Urolithiasis

Despite the successful achievements with SWL there is presently a trend towards the preferred use of invasive endoscopic procedures rather than a non-invasive approach by means of SWL. This development is an effect of a considerable discrepancy in SWL results. Literature data name stone-free rates for renal and ureteral stones in the range of 32-90 % and 43-98 %, respectively, and a similar variation in terms of successful stone disintegration. Proper use of the lithotripsy system and correct application of shock waves are crucial aspects for the SWL outcome regarding efficacy and safety. Before asking for technical improvement it needs to be pointed out that a significant fraction of patients with inferior SWL results could have been better treated if the SWL technique had been used in an appropriate way. Lack of interest in SWL and the false assumption that it is the lithotripter rather than the operator that is responsible for the treatment result are a bad prerequisite for success. All users should be aware, that SWL is a complex technology with potential risks and that they must have basic knowledge of the underlying physics as well as of characteristics and features of the used lithotripsy system. Sufficient analgesia, fixation of the patient, proper coupling of the shock wave system and a slow shock wave administration rate are important measures to ensure a good stone disintegration. Patient adapted selection of shock wave parameters, pretreatment with low shock wave energy and renoprotective drugs like calcium channel blockers or antioxidants seem to be beneficial for a reduction of tissue traumatization. Stonefree rate after SWL can be improved with supporting measures like physical therapy (percussion, diuresis, inversion) and short term medical therapy (medical expulsive therapy) with a1-receptor blockers or calcium channel blockers. In spite of all newly arisen discussion SWL still remains the only non-invasive treatment modality for urolithiasis besides conservative stone management and it plays a major role in stone therapy due to its efficacy, low rate side effects and comfortable application, without the need of general anaesthesia and-last but not leastpatients' acceptance. COI: No.

2019

Stone may form at any level in the urinary tract, but mostly in the kidney. Urolithiasis (Stone formation in the urinary tract) is a very common problem with the reported increasing prevalence across the world. Males are affected somewhat more than females. It is imperative to increase understanding of the concept of its formations, particularly about the various causative factors, which play a role to lead its initiation. Here in, we reviewed the literature of medical science, particularly Arabic, Persian and Urdu manuscripts/literature of Unani medical system, having information regarding the formation and causative factors of this disorder. Google scholar, PubMed, Science direct and Ovid were searched to review the literature of modern research publications containing information on the subject. At the conclusion, it was noticed that the incidence and prevalence of Urolithiasis is increasing across the sex, race and age of the patients all over the world and role of diet is seeme...

Curēus, 2024

This study reviews the challenges and management strategies for complex renal stones in Africa. Historically viewed as infection or struvite stones, recent studies highlight diverse compositions of staghorn stones. These complex stones pose significant risks, including recurrent urinary tract infections and renal impairment. In the past, conservative management of staghorn stones was associated with high morbidity; thus, surgical intervention was necessary for complete eradication. While percutaneous nephrolithotomy (PCNL) remains the standard, it carries notable risks, leading to a shift towards minimally invasive techniques. This study reviews challenges and management practices for complex renal stones and staghorn calculi in African countries, evaluating stone-free rates and associated complications. A scoping review of the literature, following the Preferred Reporting Items for Systematic Reviews and Metaanalysis guidelines, was performed. A systematic search was conducted in PubMed, African Journal Online (AJOL) and Google Scholar, yielding 1,101 articles, but only 11 articles satisfied the inclusion criteria. The study included 1,513 patients with 1,582 renal units, predominantly male (67.2%) with an average age of 40.7 years. Percutaneous nephrolithotomy (PCNL) was the primary treatment for the majority (71.3%), followed by open surgery (21.9%), laparoscopic surgery (4.1%), and retrograde intrarenal surgery (RIRS) (2.7%). The stone clearance rates for PCNL, open surgery, laparoscopic pyelolithotomy, and RIRS were 82.8%, 83.7%, 100%, and 92.8%, respectively. Stone sizes ranged between 22 and 80 mm, with 66% being staghorn stones. Complication rates were highest for open surgery (30.8%) and lowest for RIRS (4.7%). Despite PCNL being the global standard, African studies still indicate a high reliance on open surgery, likely due to healthcare infrastructure, resource availability and socioeconomic factors. Enhancing access to urological care and addressing healthcare disparities are imperative for improving staghorn stone management in Africa.

International Journal of Research in Medical Sciences

Background: Urinary tract stone disease (urolithiasis) is still a significant health issue throughout the world. In Asia, regions with very high urolithiasis incidence stretch from Sudan, Saudi Arabia, United Arab Emirates, Pakistan, India, Myanmar, Thailand, Indonesia, and Philippines. Demographic and regional variations in cases of urolithiasis may provide clues to their etiology and prevalence. The aim of this study was to determine the characteristics of urolithiasis patients and their management in Makassar.Methods: This was a single centre retrospective descriptive study using data from patient medical records at Dr. Wahidin Sudirohusodo Hospital Makassar in 2015-2017. Patients’ demographic, clinical, and management characteristics were recorded.Results: From 1,166 urolithiasis patients, author found men were more dominant than women with ratio of 2.2: 1. Age distribution were more common in the range of 40-60 years (58.32%). The distribution of patients with high Body Mass In...

Türk Üroloji Dergisi/Turkish Journal of Urology, 2015

Objective: The prevalence of stone diseases is high in Turkey. Thanks to the technological improvements and to the increase in the number of qualified and experienced specialists in the last thirty years, there has been an increase in the application of minimally invasive methods in the stone disease surgery. This study, with a sample survey of Western Black Sea region, aims at revealing the changes and improvements in the treatment of stone diseases in different centers in Anatolia within the last ten years. Material and methods: Six centers in 4 of the provinces of the Western Black Sea Region were selected and the patients' files were retrospectively analyzed. The treatment methods that were recommended for and/or applied to the patients diagnosed with urinary stone diseases were recorded by years. The urinary stone diseases were divided into three separate groups; kidney, ureters and bladder. Treatment options were recorded into categories as open surgery, percutaneous nephrolithotripsy, retrograde intrarenal surgery, semirigid ureterorenoscopy, flexible ureterorenoscopy, and ESWL. Results: A total of 26044 patients with stone diseases have been treated in the above-mentioned centers for the last 10 years. The distributions of the stone diseases in relation to their localization were as follows:-kidney stones: 9040 (34.7%), ureter stones: 15264 (58.6%), and bladder stones: 1740 (6.7%). As for the distribution of the treatment in relation to the treatment methods, it was seen that open surgery for 1032 (4%) patients, endoscopic surgery for 15038 (58%) patients, and ESWL for 9974 (38%) patients had been applied. While URS and PCNL are currently the commonly used treatment methods in the Western Black Sea Region, RIRS has begun to be used in a limited number of patients for the last 3 years. Conclusion: Though being a little late, the advances in endrourology offer practical applications in the Western Black Sea region as well. Although this study suggests implications for the evaluating of the periphery outcomes of the improvements in stone disease treatments, for the planning of training schemes, and for equipment planning, further research based on more data from more centers is needed to have a nationwide perspective.

The incidence of urolithiasis in Manipur is very high. From hospital records for a period of 7 years and 3 months, it was observed to be 11.6% of all general surgery cases in the General Hospital, Imphal. This is alarmingly high. The social, eating, drinking, and living habits are different among the three major populations in this state. The prevalence was minimal among Tribals. Compared to them the prevalence was about one and one half times higher among Muslims (also called Pangals) and seven times higher among Hindus. Surprisingly, the incidence of renal calculus was higher in females. One hundred ninety-six stones were studied by wet chemical analysis. Calcium and oxalate were present in all stones. Phosphate was present in 194 stones and uric acid (including urate) was present in 146 stones.

World journal of nephrology, 2015

Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis. While classical therapeutic options are available for all stone types, the number of randomized controlled studies and extensive meta-analyses focusing on their efficiency are inadequate. Various alternative therapeutic options to these medical therapies also stand out in recent years. The etiology of urolithiasis is multifactorial and not always related to nutritional factors. Nutrition therapy seems to be useful, either along with pharmacological therapy or as a monotherapy. General nutrition guidelines are useful in promoting public health and developing nutrition plans that reduce the risk or attenuate the effects of diseases affected by nutrition. Nutrition therapy involves t...

World Journal of Nephrology and Urology

Background: Urolithiasis presents serious hazard which significantly elevates the cost of national health expenditure in almost every part of both the hemispheres. There is high risk of hospitalization with loss of valuable human resource and decreased productivity along with it. Risk factors still evade the exact etiology and search for optimal serum panel is still in its infancy. Urolithiasis incidence has gradually increased in last 3 decades which suggests that some constant metabolic and urinary parameters are implicated in the risk of occurrence of urinary stone. The present study is intended to identify a panel of serum parameters, urinary parameters, radiological characteristics and correlating it with the clinical severity of stone disease. Methods: The present study was conducted at the Department of Urology at GMCH Guwahati. The authors retrospectively analyzed 151 patients undergoing stone surgery from a period of January 2016 to August 2017. Data comprised of all serum and urinary examinations done 1 week preoperatively and radiological scans within 1 month before surgery. Spearman test was used to determine correlation and analysis of variance (ANOVA) was applied for comparison between more than two categories. Results: Stone multiplicity was positively correlated with upper tract stone sides (r = 0.530, P < 0.01), large stone volume (r = 0.172, P < 0.02), stone recurrence, urinary infection and urine protein. Upper tract stone sides number was positively correlated with upper tract obstruction sides (r = 0.542, P < 0.03), large stone volume (r =-0.321, P < 0.01). Upper tract obstruction sides number was positively correlated with large stone volume (r =-0.848, P < 0.01). Conclusions: Results demonstrated that urinary tract obstruction and total stone volume significantly correlated with abnormal serum panel, urinary profile and were harbinger of complex stone pattern.