Cases reported "Urinary Calculi"

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1/18. Percutaneous chemolysis--an important tool in the treatment of urolithiasis.

    Persistent residual calculi after therapy, i.e. extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolitholapaxy (PNL), as well as pyelo- and nephrolithotomy are big problems in the treatment of urolithiasis. Furthermore, the therapy of stones is problematic in patients with inadequate drainage, impaired kidney function, or with high risks against anaesthetics. Between 1991 and 1997 percutaneous antegrade chemolysis was carried out in eleven patients. In nine of them complete dissolution of stones was achieved. In two further cases, in which calcium oxalate was the main component of the stones, chemolysis was unsuccessful. Through our own cases and under consideration of the literature, we will show that percutaneous chemolysis in these cases is useful and effective in the treatment of urolithiasis.
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2/18. urolithiasis following formation of a continent urostomy: case report and review of the literature.

    BACKGROUND: Formation of urinary stones in a continent urostomy (indiana pouch) has been described as a late complication. Management of a patient with symptomatic multiple large stones and review of the literature are outlined. CASE REPORT: A 32-year-old woman presented with recurrent urinary tract infections and pyelonephritis 6 years after a total pelvic exenteration and creation of a continent urostomy for central recurrent carcinoma of the cervix after radical pelvic radiation. Multiple large stones were found to be the underlying etiology. laparotomy, enterocystotomy, and removal of stones were performed without apparent complication. CONCLUSION: It is recommended that for single calculi or multiple small stones, electroshock wave lithotripsy or the percutaneous endoscopic approach be considered. For larger stones the use of laparotomy and enterocystostomy may be appropriate.
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3/18. Bilateral extracorporeal shock wave lithotripsy in a spinal cord injury patient with a cardiac pacemaker.

    OBJECTIVES: To review the precautions to be observed before and during extracorporeal shock wave lithotripsy (ESWL) in spinal cord injury (SCI) patients with a cardiac pacemaker and the safety of bilateral ESWL performed on the same day. DESIGN: A case report of bilateral ESWL in a SCI patient with a permanent cardiac pacemaker. SETTING: The Regional spinal injuries Centre, Southport, the lithotripsy Unit, the Royal Liverpool University hospitals NHS trust, Liverpool, and the Department of cardiology, Manchester Royal Infirmary, Manchester, UK. SUBJECT: A 43-year-old male sustained a T-4 fracture and developed paraplegia with a sensory level at T-2. During the post-injury period, he developed episodes of asystole requiring implantation of a dual chamber (DDD) permanent pacemaker. Twenty-one months later, he developed a right ureteric calculus with hydronephrosis. A radio-opaque shadow was seen in the left kidney with no hydronephrosis. During right ureteric stenting, the ureteric stone was pushed into the renal pelvis. 1,500 shock waves were delivered to this stone on the right side, followed by ESWL to the left intra-renal stone with 1250 shock waves. RESULTS: The patient tolerated ESWL to both kidneys. The pacemaker was reprogrammed to a single chamber ventricular pacing mode at 30 beats per minute with a reduced sensitivity during lithotripsy. There were no untoward cardiac events during or after lithotripsy. The serum creatinine was 45 micromol/l before lithotripsy and 44 micromol/l two weeks after ESWL. CONCLUSION: SCI patients with a cardiac pacemaker may be able to undergo extracorporeal shock wave lithotripsy following temporary reprogramming of the pacemaker. Bilateral, simultaneous ESWL is safe in the vast majority of patients provided that there is no risk of simultaneous ureteric obstruction by stone fragments. However, it should be remembered that a decrease in renal function could occur following bilateral ESWL of renal calculi.
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4/18. cystine urinary lithiasis in thailand: a report of five cases.

    cystine urinary stone is an autosomal recessive hereditary disease, frequently recurring and resisting fragmentation by Shockwave lithotripsy. As cases have never been reported before in thailand, five cases of renal cystine stones at Ramathibodi Hospital were reported. Two were in the same family. In all cases the stones were removed by open surgery or percutaneous nephrolithotomy. Postoperatively, all the stones were analyzed by infrared spectroscopy for cystine. In two cases, cystine stones were also identified by scanning electron microscopy. urine was analyzed for cystine by sodium cyanide-nitroprusside test, its concentration by spectrophotometry and cystine crystals were identified by the new crystal induction technique under light microscopy. By high-performance liquid chromatography (HPLC) test, urinary dibasic amino acids (ornithine, lysine, arginine) in these cases were also found to be significantly elevated. Clinical findings, diagnosis, treatment and prevention of cystine stones are reviewed.
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5/18. urolithiasis and primary parathyroid adenoma: report of one case.

    A 12-year-old girl was admitted to ward because of persistent left flank pain, vomiting, and hematuria. A stone was located at the ureteropelvic junction of the left kidney, as determined by means of abdominal sonography. Metabolic investigation for a renal stone revealed that she had hypercalcemia, hypophosphatemia, and hypercalciuria. hyperparathyroidism was diagnosed based on the hypercalcemia and inappropriately elevated serum parathyroid hormone level. A parathyroid adenoma was successfully diagnosed by using thallium/technetium subtraction parathyroid scanning. Extracorporeal shock wave lithotripsy was performed to treat the renal stone, and the parathyroid adenoma was successfully removed. The patient's postoperative course was uneventful. This case is presented because urolithiasis and hyperparathyroidism are rare in children. Metabolic evaluation is mandatory in children with a renal stone. Further investigation for the hyperparathyroidism should be performed if hypercalcemia associated with hypercalciuria is documented.
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6/18. The clinical implications of brushite calculi.

    The clinical history of 30 patients with a total of 46 proved brushite urinary calculi was reviewed. The patients were active metabolically with 87% having a history of multiple calculi. Of the brushite stones 61% appeared hyperdense on x-ray but they had no consistent shape. Of the patients who were metabolically evaluated 82% had treatable abnormalities. Treatment with percutaneous nephrostolithotomy or ureteroscopy and ureteral lithotripsy was 92% successful in rendering the patient stone-free, whereas, extracorporeal shock wave lithotripsy monotherapy resulted in a stone-free rate of only 11%. Brushite stone patients require aggressive treatment, full metabolic evaluation and close clinical followup.
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7/18. Renal loss following extracorporeal shock wave lithotripsy.

    A patient with life-threatening retroperitoneal hemorrhage after extracorporeal shock wave lithotripsy is presented. Despite angioinfarction of the involved renal unit, nephrectomy ultimately was required to control bleeding. The urological and hematological aspects of the management are discussed.
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8/18. Ambulatory treatment by extracorporeal shock wave lithotripsy for an urethral stone in a hypospadic boy.

    A 13-year-old hypospadic boy with a urethral stone was successfully treated with extracorporeal shock wave lithotripsy after various unsuccessful attempts at urological extraction. The easiness of ESWL application in this case and the quick elimination of the stone suggest that ESWL should be considered in the management of urethral calculi.
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9/18. Extracorporeal shock wave lithotripsy for the treatment of bulbous urethral stones.

    Extracorporeal shock wave lithotripsy was used to treat multiple, large, bulbous urethral calculi in a paraplegic man. Prior attempt at endoscopic extraction was unsuccessful owing to the size and location of the calculi. Two treatments of 3,000 shocks each resulted in fragmentation of the calculi
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10/18. Treatment of unusual Kock pouch urinary calculi with extracorporeal shock wave lithotripsy.

    Since the establishment of extracorporeal shock wave lithotripsy for the treatment of upper urinary tract calculi, further potential applications have been explored. We report the successful use of extracorporeal shock wave lithotripsy for the treatment of obstructive calculi on staples within the afferent nipple of a Kock pouch ureteroileal urinary diversion.
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