11/89. Chemolysis of residual stone fragments after extensive surgery for staghorn calculi.Chemical dissolution of residual stone fragments was attempted in twelve instances via nephrostomy tube irrigation. Appropriate solutions containing either hemiacidrin or sodium bicarbonate were used for struvite and uric acid stones, respectively. Precautions were taken to prevent and recognize outflow obstruction and urinary infection. Seventy-five per cent of the stones so treated were completely dissolved, and there were no major complications. The incidence of retained stones, natural history, and indications for chemical dissolution are reviewed.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
12/89. Giant stone in a complete duplex ureter with ureterocele. A case report.We describe a case of a monolateral duplex system and a ureterocele containing a gigantic stone in a 65-year-old woman who presented with pyelonephritis without any previous history of urinary tract infections or stone disease. Stone removal and double left ureteroneocystostomy with plastic widening of a narrowed obstructive side were performed. The ureteral stone measured 10.5 cm in greatest diameter, weighed 85 g and contained calcium oxalates and phosphates. Three months after surgery, radiology (intravenous urography and cystography) showed left unobstructed upper and lower urinary tracts and the absence of vesicoureteral reflux. urine culture was negative 3, 6 and 9 months after surgery.- - - - - - - - - - ranking = 2keywords = urinary (Clic here for more details about this article) |
13/89. Obstructive nephropathy secondary to sulfasalazine calculi.The incidence of drug-induced stone disease is 0.44%. A 57-year-old woman with ulcerative colitis presented with obstructive nephropathy and pyelonephritis. She underwent cystoscopy, bilateral retrograde pyelography, and bilateral ureteral stent placement. A 6-cm bladder calculus and two 3-mm right distal ureteral calculi were discovered. Later, cystolithotomy was performed. The stone analysis demonstrated sulfapyridine, a sulfasalazine metabolite. patients with inflammatory bowel disease can develop urolithiasis owing to acidic urine and low-volume urine production. patients receiving aminosalicylates are at an increased risk of urolithiasis and may benefit from oral hydration and urinary alkalization.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
14/89. Use of percutaneous nephrostomy in hydronephrosis of pregnancy.Traditional methods of urinary diversion in pregnancy include retrograde passage of ureteral catheter or stents and operative nephrostomy. These techniques are, however, associated with the use of anesthesia, are technically difficult to perform, and may induce labor. We report the use of percutaneous nephrostomy in four pregnant patients, two with obstruction due to ureteral calculi and two with infected hydronephrosis. The procedure provided rapid relief from pain and pyosepsis, and allowed uneventful continuation of the pregnancy to full-term, with preservation of renal function.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
15/89. Squamous metaplasia mimicking papillary carcinoma in the upper urinary tract.We experienced a case of squamous metaplasia mimicking papillary urothelial cell carcinoma in the upper urinary tract. A 69-year-old woman, who complained of gross hematuria and intermittent left flank dull pain underwent nephrectomy with the clinical diagnosis of papillary urothelial carcinomas in the left upper urinary tract according to positive split urine cytology and tumorous filling defects of contrast media by the abdominal CT scan. Pathological diagnosis was squamous metaplasia and concomitant foreign body granuloma. Those changes were judged due to a tiny calculus in the ureter. Our presented case implies that a tiny calculus can cause the metaplastic change in the urothelial epithelium and the combination of radiographical and cytological diagnoses would not be enough to lead the correct diagnosis and the definitive surgical treatment against protruding lesions in the upper urinary tract requires more reliable diagnostic modalities.- - - - - - - - - - ranking = 7keywords = urinary (Clic here for more details about this article) |
16/89. In situ extracorporeal shock wave lithotripsy of ureteral calculi with the MPL-9000X lithotriptor.Within the wide armamentarium of urinary stone treatment modalities extracorporeal shock wave lithotripsy (ESWL) has been established as the first line procedure. With the Dornier MPL-9000X lithotriptor one has the choice of ultrasound or fluoroscopic localization of calculi throughout the entire urinary tract. Except for the kidney, ultrasound guidance is preferred for calculi in the distal ureter, while fluoroscopy is generally used on the proximal two-thirds of the ureter. Between January and December 1990, 123 ESWL treatments were performed on 83 patients suffering from ureteral calculi with an average stone size of 9.3 x 6 mm. Median treatment parameters were 1,597 shock waves at 19.3 kv. for 43 minutes. For stones in the upper two-thirds of the ureter sedation analgesia was given, while ESWL on the pelvic ureter did not create intolerable pain. Of the treatments 69% were done on an outpatient basis. In situ ESWL treatment of urinary calculi was successful in 72 patients (86.7%), and 20 patients (24.1%) were treated with multiple treatment sessions. ESWL therapy for 47 stones in the distal ureter showed better results than for 33 stones plus 2 steinstrasse in the proximal part (95.5% versus 80% stone-free rate). Of 4 patients with mid ureteral calculi 2 could be rendered stone-free by ESWL alone. Auxiliary procedures, such as percutaneous nephrostomy or ureteral splints, had to be performed in 15.7%. Final endoscopic stone extraction was done in 7 cases and open surgery in 4, constituting a 13.3% failure rate for ESWL therapy. The results prove that the MPL-9000X lithotriptor is effective for primary noninvasive stone treatment.- - - - - - - - - - ranking = 3keywords = urinary (Clic here for more details about this article) |
17/89. Distinguishing stent from stone: use of bone windows.OBJECTIVES: To present a simple method to assist in distinguishing stents or nephrostomy tubes from urinary tract stones. Non-contrast computed tomography (CT) is now routinely used for the diagnosis and follow-up of urinary tract stones. When stents or nephrostomy tubes are in place, it may be difficult to differentiate the stent from the stone. methods: Three representative patients with ureteral stents or nephrostomy drainage catheters (stents/tubes) who were suspected of having residual urinary tract stones were studied by visualizing the suspicious density on CT. Abdominal windows were used for initial viewing, then bone windows were used, and the two techniques were compared. The Hounsfield units (HU) of the various stents/tubes were measured in vitro to establish reference points. The pixel densities of stones have a known range and, in our experience, may be as high as 1600 HU. RESULTS: Using the abdominal window, no difference was observed in the radiographic appearance of the stents/tubes compared with urinary calculi. However, when viewed in the bone window, the stone appeared less dense than the stent/tube. The in vitro pixel densities of the stents/tubes measured 1600 to 2600 HU compared with the calculi, which do not exceed 1600 HU. CONCLUSIONS: Using the abdominal window, stents and stones may have the same CT appearance. However, the bone window allows a visual distinction between a stent/tube and a stone. This distinction is accounted for by differences in pixel density. This observation allows one to distinguish a stent/tube from a stone on CT in patients in whom a nephrostomy tube or ureteral stent is present.- - - - - - - - - - ranking = 4keywords = urinary (Clic here for more details about this article) |
18/89. urinary calculi associated with solvent abuse.We describe 3 cases of urinary calculi that developed during the course of long-term solvent abuse. The patients regularly sniffed a lacquer thinner (major component toluene) or a cement (xylene and cyclohexane) for 2 to 6 years before the development of urolithiasis. The occurrence of proteinuria and hematuria was closely related to solvent sniffing in 2 of the 3 patients. Regular, long-term solvent abuse must be included in the causes of urolithiasis, particularly in juveniles and young adults.- - - - - - - - - - ranking = 1keywords = urinary (Clic here for more details about this article) |
19/89. sulfadiazine-related obstructive urinary tract lithiasis: an unusual cause of acute renal failure after kidney transplantation.We report on the first case of acute renal failure related to obstructive urinary tract lithiasis involving sulfadiazine crystals in a kidney transplant recipient. This patient had disseminated toxoplasmosis which was treated by sulfadiazine (4 g/day) and pyrimethamine (50 mg/day). In the fourth week of anti-toxoplasmosis therapy, he presented with obstructive acute renal failure: the plasma creatinine level increased from 220 micromol/l to 547 micromol/l. Apercutaneous pyelography was conducted showing the presence of a lithiasis located at the junction between the graft ureter and the bladder. Six days later, he underwent surgery to retrieve an orange-colored, friable stone. Its spectrophotometric analysis confirmed that the stone consisted of N-acetyl sulfadiazine crystals.- - - - - - - - - - ranking = 5keywords = urinary (Clic here for more details about this article) |
20/89. Retroperitoneoscopic pyelolithotomy as initial treatment for upper urinary tract large stone.We report a case in which retroperitoneoscopic pyelolithotomy was the procedure selected to treat a large stone in the upper urinary tract. A 71-year-old woman who had multiple cerebral infarction and dementia was admitted with a persistent high fever unresponsive to antibiotics. The diagnosis was pyelonephritis and urosepsis associated with ureteral calculus. A large calculus(3.0 x 2.0 cm)was found in the left ureter at the L3 level. She underwent nephrostomy of the left side. After the patient's general condition had improved, surgery was performed successfully with an uneventful recovery. The findings in this case confirm that retroperitoneoscopic surgery allows removal of a large stone in a single, minimally invasive procedures.- - - - - - - - - - ranking = 5keywords = urinary (Clic here for more details about this article) |
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