Urolithiasis

In 1908, Drs. George Muller and Alexander Glass made the following statements about uroliths in dogs: ''When the stone is present and causing retention of urine, there is nothing left but to remove the stones by means of an operation called urethrotomy if the stone is lodged in the urethra at the posterior end of the bones of the penis or cystotomy if the stone is located in the bladder.'' 1 One hundred years later, surgery remains a common procedure for rapid removal of uroliths from the lower urinary tract of dogs. Incorporation of intracorporeal laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) has provided impetus for a paradigm shift in the way veterinarians manage urinary stones, however. These minimally invasive techniques provide a successful alternative to surgical urolith extraction. The term lithotripsy is derived from the Greek words ''lith'' meaning stone, and ''tripsis'' meaning to crush. A lithotriptor is a device for crushing or disintegrating uroliths. ESWL may be used to fragment and remove uroliths from the upper urinary tract, whereas intracorporeal laser lithotripsy may be used to fragment uroliths in the lower urinary tract by urethrocystoscopy. INTRACORPOREAL LITHOTRIPSY Successful medical application of intracorporeal lithotripsy depended on two technological advances: (1) delivery of energy capable of fragmenting uroliths without damaging adjacent tissue, and (2) cystoscopes capable of entering the narrow urethral

The aim of this study was to determine the prevalence, incidence, and risk factors of adult urolithiasis in Iran. A total of 8,413 persons aged over 14 years enrolled in this cross-sectional study. They were questioned on the occurrence of urinary stones during their lifetime (prevalence) and on acute urolithiasis in 2005 (incidence) by 62 general practitioners. The subjects were randomly identiWed from 30 counties of Iran. Data on risk factors for urolithiasis including age, race, education, body mass index, hypertension, and current use of medication were also obtained by self-administered questionnaire. Of the 7,649 participants who provided information, 5.7% (436) [95% conWdence interval (CI) 4.2-5.4], reported urinary stones. The prevalence increased from 0.9% in adults aged 15-29 years to 8.2% in those aged 60-69 years (test for trend, P = 0.001). Urolithiasis was slightly more frequent and persisted in males (6.1%) than females (5.3%) giving a male-to-female ratio of 1.15:1 [odds ratio (OR) 1.03; 95% CI 0.64-1.36; P = 0.814]. The annual incidence of urolith-iasis in 2005 was 145.1. The average cumulative recurrence rate was 16% after 1 year, 32% after 5 years, and 53% after 10 years. Urinary stones were more in number among men and women who lived in south central and southwest counties , with odds increasing from west to east and from north to south. A positive association was found between urolith-iasis and obesity (OR 1.74; 95% CI 1.21-2.31; P = 0.04), diuretic use (OR 1.62; 95% CI 1.18-2.70; P = 0.03), hyper-tension (OR 1.88; 95% CI 1.26-2.18; P = 0.04), unemployment (OR 2.10; 95% CI 1.43-2.14; P = 0.04), consumption of tea (OR 1.64; 95% CI 1.32-2.62; P = 0.03), consumption of cola (OR 1.49; 95% CI 1.23-2.19; P = 0.02), and meat consumption (OR 1.38; 95% CI 1.29-2.21; P = 0.02). This study provides a quantitative estimate of the prevalence , incidence, and main risk factors for adult urolithiasis in the Iranian population. Further studies are warranted in order to determine the incidence and prevalence of urolith-iasis in diVerent ethnic groups.

The objective of the study was to quantitatively measure the number of Oxalobacter formigenes (O. formigenes) colonizations in the gastrointestinal tract in calcium oxalate-forming patients with real-time polymerase chain reaction (PCR). Calcium oxalate-forming patients (n: 27) were included in the study. Serum calcium, sodium, potassium, urea and creatinine levels, as well as 24 h urine levels of calcium and oxalate were measured. The numbers of O. formigenes colonies in stool samples were detected by realtime PCR. One or two metabolic abnormalities were detected in 15 of 27 patients. The O. formigenes levels in patients with metabolic disturbance were signiWcantly decreased when compared to the patients with no metabolic abnormalities (p: 0.038). The undetectable levels of O. formigenes were encountered in one of Wve patients with hypercalciuria, in three of four patients with hyperoxaluria and in four of six patients with both hypercalciuria and hyperoxaluria. In nine patients with a history of stone recurrence, O. formigenes colonization was signiWcantly lower than the patients with the Wrst stone attack (p: 0.001). O. formigenes formation ceased or signiWcantly diminished in patients with calcium oxalate stones with a coexistence of both hyperoxaluria and hypercalciuria. The measurement of O. formigenes colonies by real-time PCR seemed to be an inconvenient and expensive method. For this reason, the real-time PCR measurements can be spared for the patients with stone recurrences and with metabolic abnormalities like hypercalciuria and hyperoxaluria. The exact measurement of O. formigenes may also help more accurate programming of O. formigenes-based treatments.

Cystinuria is an autosomal recessive disorder caused by defective transport of cystine and dibasic amino acids in the proximal renal tubules and small intestine. So far, more than 128 mutations in SLC3A1 gene, and 93 in SLC7A9 gene have been described as a cause of cystinuria. We present a molecular characterization of the cystinuria in 47 unrelated south-east European families. The molecular methodology included direct sequencing, single strand conformational polymorphism, and restriction fragment length polymorphism. A total of 93 (94.9 %) out of 98 unrelated cystinuric chromosomes have been characterized. Mutations in SLC3A1 gene account for 64.3 % and in SLC7A9 gene for 30.6 % of the cystinuric chromosomes. Ten different mutations in SLC3A1 gene were found, and two of them were novel (C242R and L573X), while in SLC7A9 gene seven mutations were found, of which three were novel (G73R, V375I and c.1048_1051delACTC). The most common mutations in this study were T216M (24.5 %), M467T (16.3 %) and R365L (11.2 %) in SLC3A1 and G105R (21.4 %) in SLC7A9 gene. A population specificity of cystinuria mutations was observed; T216M mutation was the only mutation present among Electronic supplementary material The online version of this article (

Xanthinuria is a very rare disease in cats. Its etiology may have a genetic origin or may be due to an iatrogenic xan- thine-dehydrogenase inhibition that finally results in urolithiasis. The present work reports two cases of xanthine uro- lithiasis in European Shorthair unrelated male and female cats. Both uroliths were analyzed by stereoscopic microsco- py, infrared spectroscopy and scanning electron microscopy. Besides the report of these two clinical cases, a detailed pathophysiologic review and some updated recommendations for diagnosis and treatment for this condition were done.

Urolithiasis is a common worldwide problem with high recurrence. This review covers forty four (44) families starting from alphabet A to L and includes Bignoniaceae (05) Juglandaceae (01) plant used globally in different countries. The plants of three families Asteraceae, Fabaceae and Lamiaceae are revisited to provide updated information. This review will not only be useful for the general public but also attract the scientific world for antiurolithiatic drug discovery.

Objective To evaluate the natural course of the stone disease in pediatric patients from different perspectives among which the spontaneous passage and stone recurrence rates evaluated during the follow-up. Materials and methods A total of 142 children referring with primary urinary stone disease were evaluated and followed. All children in the study were divided into two groups with respect to the age (Group 1: 0-5 years and Group 2: 6-15 years). Children were followed with respect to spontaneous passage rates, recurrence-regrowth rates, physical as well as the renal growth rates. Results Stone recurrence has been noted in 44% of patients in group 1, this value was 31% in group 2. Children with at least one identifiable metabolic abnormality tended to have higher recurrence rates than the others despite conservative measures. The average stone recurrence rate in children without any metabolic abnormality was 14% and nearly 50% in children with an identifiable metabolic abnormality. Conclusions We may emphasize that due to the high recurrence and re-growth rates, all children with urinary stone disease should be followed closely with regular visits. The evaluation of metabolic risk factors in children with renal stone disease is the basis of medical treatment aimed at preventing recurrent stone events and the growth of pre-existing calculi.

Urolithiasis adalah kondisi terbentuknya urolith atau kalkuli yang berlebihan pada saluran perkencingan, seperti pada vesika urinaria, ginjal, ureter dan uretra. Kejadian terbentuknya urolith pada vesika urinaria biasa terjadi pada hewan domestik (anjing dan kucing) terutama karena pola pakan yang buruk. Anjing pug bernama Bimo, umur 4 tahun, berjenis kelamin jantan, dan memiliki berat badan 7 kg menunjukkan gejala klinis kesulitan kecing (dysuria), dengan volume urin yang masih normal, saat kencing punggung diangkat ke atas (kifosis). Anjing ini sudah pernah didiagnosa urolithiasis,sudah pernah diobati dan sudah dikastrasi.  Hasil pemeriksaan hematologi dengan interpretasi anemia mikrositik normokromik, leukositosis dan Lympositosis. Hasil pemeriksaan dipstick test blood (-), bilirubin (+), urinobilinogen (-), keton (-), protein (-), nitrit (-), glukosa (-), pH (5), berat jenis (1.005), leukosit (++). Pemeriksaan sedimen urin ditemukan adanya kalkuli tripel fosfat. Hasil dari USG ditemukan adanya kalkuli pada ginjal dan vesika urinaria. Dapat disimpulkan dari pemeriksaan klinis dan pemeriksaan laboratorium bahwa anjing pug yang bernama Bimo mengalami urolithiasis. Terapi yang diberikan yaitu dengan kateterisasi urin, pemberian ciprofloxacin (antibiotika), furosemide (diuretika), nephrolite, dan vitamin B komplek sebagai suportif.

Introduction ! Urinary stones affect 10-12 % of the population in industrialized countries . There are only a few geographical areas in which stone disease is rare, e.g., in Greenland and in the coastal areas of Japan . The incidence of urinary stones has been increasing over the last years while the age of onset is decreasing . With a prevalence of > 10% and an expected recurrence rate of~50 %, stone disease has an important effect on the healthcare system . Once recurrent, the subsequent relapse risk is raised and the interval between recurrences is shortened . Features associated with recurrence include a young age of onset, positive family history, infection stones and underlying medical conditions . Epidemiological studies revealed that nephrolithiasis is more common in men (12 %) than in women (6%) and is more prevalent between the ages of 20 to 40 in both sexes . The etiology of this disorder is multifactorial and is strongly related to dietary lifestyle habits or practices . Increased rates of hypertension and obesity, which are linked to nephrolithiasis, also contribute to an increase in stone formation . Management of stone disease depends on the size and location of the stones (see below). Stones larger than 5 mm or stones that fail to pass through should be treated by some interventional procedures such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PNL) . Unfortunately, the propensity for stone recurrence is not altered by removal of stones with ESWL and stone recurrence is still about 50% [9]. In addition, ESWL might show some significant side effects such as renal damage, ESWL induced hypertension or renal impairment [10].

http://medplants.blogspot.com/ : Medicinal plants have curative properties due to the presence of various complex chemical substance of different composition which are found as secondary metabolites in one or more parts of these plants.  Triphala Karpa Chooranam a traditional medicine used for curing kidney stones contains Terminalia chebula ,  Phyllanthus emblica ,  Terminalia bellerica , Karungali sathu and Vengai sathu.  Preclinical evaluation of the herbal formulation shows significant antiurolithiatic action against ethylene glycol and calcium oxalate induced urolithiasis in rat model. The histopathology of the kidney section shows no damaged cells of formulation treated and Cystone treated (750mg/kg) compared with that of the control animals. The urine analysis showed reduction in the excretion of oxalate crystals in both test and the standard treated groups.

The purpose of presenting review was to share the medicinal and surgical contribution of Greco-Arabic Muslim scientists in diagnosis, surgery and natural medicines for the management and treatment of urolithiasis. The contribution of, Ibn Zuhr was highlighted. The data compilation was preliminary and much more efforts are still needed to restore the missing continuity in the history of medicine.

Medicinal plants are the gift of nature and play an important role as a part of our diet to maintain health. They also serve as a versatile weapon to combat against a number of diseases. Every civilization has its own experience and knowledge of therapeutic uses of plants. The belief and observations regarding traditionally used medicinal plants, increasing the interest of people to use them against urolithiasis. Urolithiasis is a common problem afflicted for many centuries with high recurrence. World population of about 12% suffers with urolithiasis. All over the world in different countries and cultures people use plants for the prevention and cure of kidney stone according to their ethnopharmacological information. These formulations are very effective that's why these are used for hundreds of years. This review covers the eighty (80) medicinal plants of most cited family Asteraceae against urolithiasis along with their historical antiurolithiatc background shared in well-known books of Dioscorides, Pliny the Elder, Al Razi and Ibn Sina. This information was extracted to compose antiurolithiatic plants with their parts and formulations used in 21 countries such as Algeria, Scientifically proved pharmacological activities of the same part of plant have direct (litholytic) and in direct pharmacological effects like analgesic, anti-inflammatory, antioxidant, astringent, demulcent, diuretic, litholytic, lithotriptic, antiurolithiatic, antispasmodic, ACE inhibition and Phospholipase A2 inhibition also shared as a plausible mechanism of action. The route of administration is oral in all cases. Hopefully, this book will not only be useful for the general public but also attract the scientific world for antiurolithiatic drug discovery. This valuable ethnopharmacological information will provide the opportunities for the future research and development of new natural antiurolithiatic compounds.

Urolithiasis is a common worldwide problem with high recurrence. This review covers Euphorbiaceae twenty (20), Cucurbitaceae eighteen (18), Acanthaceae and Amaranthaceae fifteen (15), Cupressaceae twelve (12), Caryophyllaceae eleven (11), Anacardiaceae ten (10), Amaryllidaceae, Apocynaceae and Asparagaceae nine (09), Ericaceae and Equisetaceae eight (08), Arecaceae and Caesalpiniaceae seven (07), Chenopodiaceae six (06), Aspleniaceae, Capparidaceae and Crassulaceae five (05) plants used globally in different countries.

Siddha is one of the Indian systems of medicine which is widely practised in Tamil Nadu, India. Siddha insists to lead a healthy life both phjsic ally and mentally by keeping pace with the laws of nature. Siddhas have classified 4448 diseases, based on the three humoral pathologies. Among them Kalladaippu noi (Urolithiasis) is classified under neerinai arukkal noigal. They consider that the dietary factor play a vital role in the formation of calculi. Also pitha humor is said to be the major causative factor of this disease. Many formulations are indicated for Urolithiasis in Siddha literature. Kara sooda sathu parpam is a herbo mineral drug indicated for urolithiasis. The ingredients are strongly indicated for the disease. Here the article is focused to explore the efficacy of the drug for urolithiasis in various literatures and scientific studies.

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6–12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor...

Context: Incidence, prevention, and management of complications of percutaneous nephrolitholapaxy (PNL) still lack consensus. Objective: To review the epidemiology of complications and their prevention and management. Evidence acquisition: A literature review was performed using the PubMed database between 2001 and May 1, 2011, restricted to human species, adults, and the English language. The Medline search used a strategy including medical subject headings (MeSH) and free-text protocols with the keywords percutaneous, nephrolithotomy, PCNL, PNL, urolithiasis, complications, and Clavien, and the MeSH terms nephrostomy, percutaneous/ adverse effects, and intraoperative complications or postoperative complications. Evidence synthesis: Assessing the epidemiology of complications is difficult because definitions of complications and their management still lack consensus. For a reproducible quality assessment, data should be obtained in a standardized manner, allowing for comparison. An approach is the validated Dindo-modified Clavien system, which was originally reported by seven studies. No deviation from the normal postoperative course (Clavien 0) was observed in 76.7% of PNL procedures. Including deviations from the normal postoperative course without the need for pharmacologic treatment or interventions (Clavien 1) would add up to 88.1%. Clavien 2 complications including blood transfusion and parenteral nutrition occurred in 7%; Clavien 3 complications requiring intervention in 4.1.%; Clavien 4, life-threatening complications, in 0.6%; and Clavien 5, mortality, in 0.04%. High-quality data on complication management of rare but potentially debilitating complications are scarce and consist mainly of case reports. Conclusions: Complications after PNL can be kept to a minimum in experienced hands with the development of new techniques and improved technology. A modified procedure-specific Clavien classification should be established that would need to be validated in prospective trials.

Urolithiasis is a common worldwide problem with high recurrence. This review covers thirteen (13) antiurolithiatic plants of family Boraginaceae, twenty (20) from Brassicaceae, twenty three (23) from Malvaceae and twenty four (24) from Poaceae used globally in different countries. Hopefully, this review will not only be useful for the general public but also attract the scientific world for antiurolithiatic drug discovery.

La litiasis urinaria consiste en la presencia de componentes de la orina en fase sólida en el aparato urinario; denominados cálculos; Cuando los cálculos aparecen en el riñón se habla de nefrolitiasis, mientras que si tales cálculos se localizan en cualquier punto del aparato urinario, desde las papilas renales hasta el meato uretral, reciben la denominación de urolitiasis. Se hablará sobre también las clasificaciones de los cálculos además de las patologías que en su consecuencia presentan una formación de cálculos (litiasis); se hablara sobre los tratamientos quirúrgicos que se realizan además de el tratamiento nutricional y farmacológico.

Urolithiasis is a common problem afflicted for many centuries with high recurrence. This review covers the forty nine (49) antiurolithiatic plants of family Lamiaceae used in 11 different countries. Hopefully, this review will not only be useful for the general public but also attract the scientific world for antiurolithiatic drug discovery.

Urolithiasis is a common problem afflicted for many centuries with high recurrence. The aim of this review is to provide comprehensive information about traditionally used antiurolithiatic plants and their scientifically proved pharmacological activities like analgesic, anti-inflammatory, antioxidant, astringent, demulcent, diuretic, litholytic, lithotriptic, antiurolithiatic, antispasmodic, ACE inhibition and Phospholipase A2 inhibition as a plausible mechanism of action. A total of 503 species, 365 genera and 119 families were cited for treating kidney stones. The most cited families are Asteraceae (41), Fabaceae (34), Lamiaceae (26), Apiaceae (21), Rosaceae (19) and Poaceae (16). The most common used plant parts are root and rhizome (25%), mode of preparation decoction (62%) and route of administration is oral in all cases. This review will provide the opportunities for the future research and development of new natural antiurolithiatic compounds. Introduction The belief and observations regarding traditionally used medicinal plants, increasing the interest of people to use natural medicine for their primary health care needs. A wide range of medicinal plants have been used in different countries and cultures as a prophylactic and curative agent for urolithiasis. Most of the remedies are very useful, but their mechanism of action remains unclear. Scientific studies reveal the mechanism of actions of these antiurolithiatic plants and the results show very interesting and multidimensional action, responsible for their effectiveness at different stages of urolithiasis, such as, the diuretic action increases the quantity of fluid going pass through the kidneys as a result flush out the deposits. Therefore, the increase in urine volume decreases the saturation of the salts and prevents the precipitation of the crystals at physiological pH. Breaking, disintegration and dissolution of preformed stones (litholytic activity) and binding inhibition among particles to form stones (lithotriptic activity) play an important role in this pathological condition. Crystal inhibitors decrease crystal nucleation, aggregation and growth. Furthermore, they inhibit crystallization by their adsorption to the crystal surface which makes them unable for renal tubular attachment (crystallization inhibition activity). In urine different crystalloids like oxalate, uric acid, calcium and cystine are present with mucin and sulphuric acid colloids in dissolved form. The disturbance in crystalloid-colloid balance (increase in crystalloid and decrease in colloid) causes renal stone formation. Renal exposure to oxalate and calcium oxalate causes lipid peroxidation, produces Reactive Oxygen Species followed by renal cell injury and inflammation. This loss of membrane integrity, promotes fibrosis and collagen formation, facilitates calcium oxalate retention and subsequent stone formation [1, 2]. Renin-Angiotensin System activates the NADPH oxidase in renal cells, which produces Reactive Oxygen Species. Angiotensin converting enzyme inhibition significantly reduces calcium oxalate crystal deposition and renal inflammation. The Reactive Oxygen Species end up phospholipase A 2 activation through nuclear transcription factor NF-κB. Activation of cytosolic phospholipase A 2 generates arachidonic acid and lysophosphatidylcholine, which increase reactive oxygen species production that in turn increase in cell death and crystal formation [1, 3]. The obstructing stone causes renal colic and in this condition an antispasmodic activity of the smooth muscles along with analgesic and anti-inflammatory activities play an important role in symptomatic relief from renal colic and dysuria. Antispasmodics help in stone passage. The obstruction of urine outflow by stones decreases the glomerular filtration rate (GFR) resulting nitrogenous waste (urea, creatinine and uric acid) accumulation in blood

Urolithiasis is a common worldwide problem with high recurrence. This review covers twenty three (23) families starting from alphabet S to Z. It includes Solanaceae (12); Zingiberaceae (09); Scrophulariaceae and Urticaceae (08); Verbenaceae (07); Ulmaceae, Valerianaceae and Vitaceae (05); Zygophyllaceae (04); Sapotaceae, Saxifragaceae and Typhaceae (03); Smilacaceae (02); Salicaceae, Salvadoraceae, Santalaceae, Simaroubaceae, Tamaricaceae, Tiliaceae, Theaceae, Tropaeolaceae, Violaceae and Xanthorrhoeaceae (01) plant used globally in different countries. Hopefully, this review will not only be useful for the general public but also attract the scientific world for antiurolithiatic drug discovery.

Urolithiasis is a common worldwide problem with high recurrence. This review covers the forty one (41) antiurolithiatic plants of family Rosaceae used in 14 different countries. Hopefully, this review will not only be useful for the general public but also attract the scientific world for antiurolithiatic drug discovery.

Sclérose en plaques ; Lithiase urinaire ; Calculs phosphatiques ; Infection urinaire Résumé But. -Le but de notre travail a été de déterminer la nature des calculs urinaires ainsi que les principaux processus lithogènes chez des patients atteints de sclérose en plaques (SEP) ayant développé secondairement une lithiase urinaire. Patients et méthode. -Il s'agit d'une étude rétrospective portant sur 60 calculs qui provenaient de 49 patients lithiasiques dont 30 femmes et 19 hommes. Les calculs ont été analysés par microscopie optique et spectroscopie infrarouge.

Diet modification plays an important role in nephrolithiasis. Development of an easy, ready-to-use beverage such as a commercial juice drink to use as a preventive treatment for renal calculi formation would be widely welcomed. We previously developed a novel Drosophila model for the study of nephrolithiasis. It provides a new well-established drug discovery platform for this common disease. In our current study, we used the Drosophila model to investigate the preventive effects of various commercial juices as potential treatments for nephrolithiasis. Our results showed that apple, cranberry, orange, and pomegranate juices failed to reduce calcium oxalate (CaOx) crystal formation, whereas our positive controldpotassium citrate (K-citrate)dsignificantly prevented CaOx crystal formation. Unlike the commercial fruit juices that were tested, the administration of K-citrate significantly ameliorated the ethylene glycol (EG)-induced life-span reduction in treated flies. These results * Corresponding author. indicate that EG-induced CaOx nephrolithiasis in Drosophila can be prevented by K-citrate, but not by commercial citrate-containing juices. However, the inhibitory capability of citratecontaining juices to reduce renal stone formation in humans requires further elucidation.

Obstructive urolithiasis is the retention of
urine subsequent to lodgement of calculi anywhere
in the urinary conduct. Male buffalo calves are most
frequently presented to the polyclinic, I.V.R.I, with
the retention of urine in the peak winter due to the
decline in water intake and deficiency of vitamin A.
Rupture of the urinary bladder or urethra, uraemia
and death are observed as the most common sequel
to obstructive urolithiasis especially in buffalo
calves. Though it has been found that calves below
the 6th month of age are most commonly affected, in
this study most reported cases were 3 and 4 months
old. Rupture of the bladder was found to occur after
the 3rd day of retention of urine but it was also seen
before 3rd day in those cases in which frusemide
was given by quacks. Buffalo calves with retention
of urine for 6 days or more are presented in the
fewest numbers due to the death caused by uraemia
after rupture of the bladder. Urethral rupture is the
worst sequel, occurring in those cases where the
calculi are lodged in the glans penis.

Adenine phosphoribosyltransferase (APRT) deficiency, cystinuria, Dent disease, familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC), and primary hyperoxaluria (PH) are rare but important causes of severe kidney stone disease and/or chronic kidney disease in children. Recurrent kidney stone disease and nephrocalcinosis, particularly in pre-pubertal children, should alert the physician to the possibility of an inborn error of metabolism as the underlying cause. Unfortunately, the lack of recognition and knowledge of the five disorders has frequently resulted in an unacceptable delay in diagnosis and treatment, sometimes with grave consequences. A high index of suspicion coupled with early diagnosis may reduce or even prevent the serious long-term complications of these diseases. In this paper, we review the epidemiology, clinical features, diagnosis, treatment, and outcome of patients with APRT deficiency, cystinuria, Dent disease, FHHNC, and PH, with an emphasis on childhood manifestations.

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.

Urolithiasis is a common problem afflicted for many centuries with
high recurrence. This review covers the forty two (42) medicinal plants
of family Apiaceae used in 18 different countries such as Algeria,Bosnia, Bulgaria, Canada, Herzegovina, Iran, Iraq, Italy, Jordan, Kyrgyzstan, Lebanon, Libya, Pakistan, Palestine, Spain, Tunisia, Turkey and Uzbekistan.Their historical antiurolithiatc background shared in well known books of Dioscorides (17plants), Ibn Sina (06 plants), Daoud al- Antaki (02 plants), Al Razi, Al-Baitar, Pliny the Elder and (01 plant contributed by each). Among the plant parts fruits were noted the most common (29%) followed by leaves and roots (17% each), whole plant (12%), seeds (10%), flowers (07%), stem (04%) and aerial parts (02%). In terms of preparation, decoction was observed most common (68%), followed by infusion (24%), oleo gum resin and plant gum (04% each).
The route of administration is oral in all cases. Hopefully, this review will not only be useful for the general public but also attract the scientific world for antiurolithiatic drug discovery.

Xylazine–ketamine combination was evaluated for its efficacy and safety after epidural administration in uraemic and healthy goats. The combination (xylazine 0.025 mg/kg and ketamine 2.5 mg/kg) was administered to uraemic (n = 6) and healthy (n = 6) animals in the lumbosacral epidural space. The combination was evaluated in terms of clinical, physiological, haematological and biochemical parameters. The onset of analgesia was faster in healthy animals than in uraemic animals. Xylazine and ketamine produced complete analgesia of tail, perineum, inguinal and thigh regions in all animals of both groups. However, healthy animals showed longer duration of complete analgesia than did uraemic animals. Greater ataxia was recorded in healthy animals than in uraemic animals. The heart rate showed a significant decrease in both groups; however, respiratory rate and rectal temperature did not show any significant changes. Haemoglobin, packed cell volume and total leukocyte count decreased non-significantly in both groups. Total leukocyte count was significantly higher in uraemic animals. A significantly higher value of urea nitrogen and creatinine was recorded in uraemic animals. The blood electrolytes (Na+, K+ and Cl−) and blood gases (P o 2 and P co 2) did not show any significant changes in both groups; however, base excess was significantly higher in uraemic animals. The effects produced by the combination on different systems were transient and values normal as the effect of the drugs wore off. The results suggest that the combination when used epidurally in uraemic goats produced effective and safe surgical analgesia.

We studied the eVects of an intravenous hydroxypyruvate load on endogenous oxalogenesis in rats receiving a standard diet or a vitamin-B6-deWcient diet. Twelve male Wistar rats were randomized to two groups and were fed either a standard diet or a vitamin-B6-deWcient diet for 3 weeks. Then the animals received an intravenous infusion of 100 mg/ml (960.6 mol/ml) of hydroxypyruvate slowly over 10 min. Urine samples were collected just before hydroxypyruvate infusion and at hourly intervals until 5 h afterward. Urinary oxalate, glycolate, and citrate levels were measured by capillary electrophoresis. Hourly urinary oxalate excretion peaked within 2 h, while urinary glycolate excretion peaked at 1 h, after the hydroxypyruvate load in both control and vitamin-B6-deWcient rats. Both urinary oxalate and glycolate excretion were higher in vitamin-B6-deWcient rats than in control rats. Infusion of hydroxypyruvate increased the 5-h urinary oxalate and glycolate excretion to 0.68% (6.56 mol) and 0.53% (5.10 mol) of the administered dose (mol/mol), respectively, in the control rats, while oxalate and glycolate excretion, respectively, increased to 2.43% (23.36 mol) and 0.79% (7.59 mol) of the dose in the vitamin-B6-deWcient rats. Urinary citrate excretion was signiWcantly lower at baseline and all other times in the vitamin-B6-deWcient rats than in the control rats. In conclusion, a hydroxypyruvate load increased endogenous oxalate synthesis in control rats, and its synthesis was even greater in vitamin-B6-deWcient rats. Vitamin B6 deWciency also resulted in signiWcant hypocitraturia.