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PubMed2003

[Urolithiasis in those patients with myelodysplasia].

OBJECTIVE: To evaluate incidence and treatments of urolithiasis in myelodysplastic patients. PATIENTS AND METHODS: During the past 27 years 303 myelodysplastic patients, 160 men and 143 women, have been treated and 50 of them were operated on with bladder augmentation procedures. Their medical records were retrospectively reviewed. RESULTS: Urolithiasis occurred 20 times in 15 patients, 11 men and 4 women, where calculi developed 18 times in the bladder and twice in the kidney. Prevalence of urolithiasis was 20% (10/50) in those who had undergone bladder augmentation and 2% (5/253) in those who had not had this surgery, where the difference was statistically significant between the two groups (p < 0.01). Overall, 5% of all the patients suffered from stones in the urinary tract. Bladder calculi were endoscopically treated in 11 occasions or were resolved with suprapubic lithotomy in 4 cases. Small stones in the bladder were spontaneously delivered 3 times and extracorporeal shock wave lithotripsy (ESWL) was necessary for a renal calculus in one patient. The last patient having a renal stone has been put under care. Majority of stone compositions consisted of magnesium ammonium phosphate (MAP). CONCLUSION: It was found that urolithiasis was 10 times more prevalent in those patients operated on with enterocystoplasty than those without bladder augmentation and that intermittent clean catheterization and regular bladder irrigation were of necessity to prevent urolithiasis for those having enterocystoplasty.

Adolescent↗

PubMed2001

Absent hematuria and expensive computerized tomography: case characteristics of emergency urolithiasis.

PURPOSE: We validated the descriptive characteristics of emergency cases presenting with urolithiasis, determined the incidence of normal urinalysis in such cases and compared the expense of diagnostic computerized tomography (CT) and excretory urography (IVP). MATERIALS AND METHODS: We retrospectively reviewed the charts of all consecutive patient visits to a community emergency department for 48 months. Explicit protocols for case selection, data abstraction and monitoring were used to maximize accuracy. Entry criteria were urolithiasis diagnosed by IVP, CT or stone passage, and urinalysis. Data analysis included descriptive statistics and the calculation of confidence intervals. RESULTS: From 159,083 emergency visits during this period 397 met study entry criteria. Absent hematuria was noted in 9% (95% confidence interval 7% to 12%) of patients with proved urolithiasis. There was no correlation of the degree of obstruction with absent hematuria. Most patients presenting with painful urolithiasis were male (73%), in the fifth decade of life (mean age 47 years), had stones in the mid ureter (32%) or at the ureterovesicular junction (44%) and received opiates for pain control (91%). Of the patients 48% presented between 5 p.m. and 7 a.m. when the radiology department was available only for emergency imaging. The diagnosis was made by CT in half of the patients, who were charged $1,409. The maximal insurance reimbursement was $673. The diagnosis was made by IVP in half of the patients, who were charged $445. The maximal insurance reimbursement was $141. CONCLUSIONS: Hematuria is not universally present in patients with painful urolithiasis and does not correspond to the degree of obstruction. Despite previous reports to the contrary, CT is significantly more expensive for patients than IVP.

Adolescent↗

PubMed2004

[Age of onset of urolithiasis: relation to clinical and metabolic risk factors].

OBJECTIVES: To determine the age of onset of urolithiasis in patients with urinary calcium stones and to establish the relationship between age of onset and clinical profile and metabolic risk factors. METHODS: A total of 500 patients with the diagnosis of calcium urinary lithiasis (average age 47.4 years, range 20-75) were asked regarding the age of onset of the disease. Age of onset of urinary stone disease was compared with other factors such as gender, family history of lithiasis, clinical course, unique or recurrent episodes, and metabolic disturbances found in a comprehensive metabolic evaluation, using the chi-square test for categorical variables and analysis of variance (one way-ANOVA) with the Scheffe test for continuous variables. RESULTS: Mean age of onset of urinary stone disease was 38 years (range 4-73 years). This age of onset was lower in patients with low diuresis (31 years), family history of urolithiasis (32 years), hypercalciuria (36 years), recurrent disease (37 years), and hyperuricosuria (37 years). Significant differences were found in patients who had family history of urolithiasis (32 years) vs. those who did not have (40 years) (p < 0.01); patients with recurrent disease (37 years) vs. patients with a unique lithiasic episode (43 years) (p < 0.001); patients with hypercalciuria (36 years) vs. those who did not have (39 years) (p < 0.05); and also patients with low diuresis (31 years) vs. those with higher diuresis (39 years) (p < 0.001). CONCLUSIONS: The average age of onset of urolithiasis is significantly earlier in patients with low fluid intake habits, family history of urolithiasis, hypercalciuria and recurrent stone disease.

Adult↗

PubMedDate not supplied

Comparison of spiral CT and US in the evaluation of pediatric urolithiasis.

The objective of the study was to determine the value of spiral computerized tomography (CT) in detecting urolithiasis in pediatric patients and compare its efficacy with ultrasound (US). Twenty-nine infants aged between 2 to 94 months with clinical presentation suggestive of urolithiasis and a negative or indeterminate plain film were included in the study. Abdominal US and spiral CT were performed in all patients. Presence, size and localization of stones were noted for each patient on both CT and US. The diagnosis of urolithiasis was confirmed by passage of stones spontaneously, extracorporeal shockwave lithotripsy (ESWL), surgery, or clinical follow-up. Presence of stones was confirmed in 23 of 29 patients (79%). Eight patients had single stone and the remaining 15 had multiple stones either in a single localization (single kidney or single ureter) or multiple localizations. Spiral CT detected 57 stones (45 renal and 12 ureteral). US detected 34 stones (59.6%) in 18 (78.2%) patients. US was able to localize 31 stones (68.8%) in 21 kidneys (75%), and 3 stones (25%) in 11 ureters (27.2%). Spiral CT is very effective in the diagnosis of pediatric urolithiasis. Spiral CT is more efficient than US in imaging pediatric patients with symptoms and signs of urolithiasis, when KUB is inconclusive.

Female↗

PubMed2006

[Urolithiasis in children in Tunisia: current features based on a series of 104 cases].

UNLABELLED: The clinical and laboratory characteristics of urolithiasis in Tunisian children have evolved continuously since the 1980s. This retrospective study defines the current status of urolithiasis in children in Tunisia. PATIENTS AND METHODS: All 104 children (age: 8-192 months) of our series were hospitalized for urolithiasis. A first-line metabolic, urine and plasma work-up was performed in 96 patients. Physical and chemical analysis of the stones was performed by stereomicroscopy and infrared spectroscopy, respectively. Statistical analysis of the results was performed with SPSS 11.0 software. The Chi-square test was used for comparison of percentages. RESULTS: Our study shows a male predominance of urolithiasis with a sex ratio of 1.53. The clinical features were dominated by urinary tract infections (28.8%). Stones were situated in the upper tract in 75% of cases and the lower tract in 25% of cases. Urine culture was positive in 15 patients. Identification of the crystalline composition showed that whewellite was the most frequent crystalline species in children (80.0%) and infants (57.1%). Ammonium acid urate was more frequent in infants. CONCLUSION: In this study, we observed changes in the epidemiological characteristics (bladder stones and infection stones) of urolithiasis in children over the last decade in Tunisia. The patient's age is an important factor that must be taken into account during aetiopathogenic work-up.

Adolescent↗

PubMed1991

[Epidemiologic study on urolithiasis in Mie prefecture. 2. Present status in 1988].

To determine the current status of urolithiasis in 1988, in comparison with that in 1985, we analyzed the 1937 patients of urolithiasis at 17 departments of urology in Mie Prefecture and 2 departments of urology in Wakayama Prefecture. The ratio of male to female patients was 2.6 to 1.0. Geographically, the number of urolithiasis patients was most frequently distributed in Matsusaka City. The frequency of urolithiasis in the urban area was almost the same as that in the rural area. Most of the stones (96.3%) were in the upper urinary tract. The frequency of lower urinary tract calculi tended to be high in southern Mie Prefecture. The ratio of the upper urinary tract calculi to the lower urinary tract calculi in the urban area was higher than in the rural area. The age distribution in males was in the forties, while that in females was in the fifties. The average age was 46.4 years old. The surgical treatment was performed in 671 patients (34.6%) and the extracorporeal shock wave lithotripsy (ESWL) was the most frequent mode of treatment (85.0%), followed by cysto-lithotripsy (4.2%) and percutaneous nephro-uretero-lithotripsy (2.4%). The most frequent component of the urinary tract calculi was calcium oxalate and/or calcium phosphate (81.7%). The stone patient increased in the number during the summer season (July, August and September). In conclusion, in 1988 when the ESWL treatment started in Mie Prefecture, the epidemiologic features of urolithiasis was characterized as follows: the number of patients increased and the broad application of the ESWL treatment resulted in the decreased number of patients with spontaneous discharge and the increased number of patients with recurrent stones and with bilateral or multiple complex stones.

Adolescent↗

PubMedDate not supplied

[The characteristics of histocompatibility antigen distribution in urolithiasis patients with a phosphorus metabolic disorder].

Phosphorus metabolic disturbances play a great role in the occurrence of urolithiasis. This study covered 150 patients with urolithiasis to establish correlations between the frequency of histocompatibility antigens and the increase in blood and urinary phosphorus levels. The HLA antigens were identified by the routine microlymphocytotoxic method involving a histotyping serum panel. The ABO antigens and rhesus were determined by the agglutination method by using reference sera. The study revealed specific distribution of histocompatibility antigens in urolithiasis patients with disturbed phosphorus metabolism. Hyperphosphatemia correlated with the higher frequency of HLA-B35 (chi 2 = 9.89) and E/E system rhesus (chi 2 = 8.63); hyperphosphaturia showed a negative association with the HLA-A28 antigens (chi 2 = 9.7), as well as with E/e (chi 2 = 14.69) and e/e (chi 2 = 39.36) and a positive association with HLA-B13 (chi 2 = 5.98) and B35 (chi 2 = 36.58). The highest relative risk for hyperphosphatemia associated with the B27 and B35 antigens was observed with genetic predisposition, being 3.63 and 7.13, respectively. B12- and B35-positive individuals were at higher risk for hyperphosphaturia up to 11.25. There were significant differences in antigen frequency, and sex, genetic predisposition to urolithiasis, association of phosphorus metabolic disturbances with other metabolic disorders, and their effects of parathyroid lesions, etc. The findings reveal the immunogenetically induced risk for the occurrence and development of urolithiasis with disturbed phosphorus metabolism to make goal-oriented prophylactic measures.

ABO Blood-Group System↗

PubMed1996

Urolithiasis and cystic fibrosis.

PURPOSE: We determined whether cystic fibrosis patients are at increased risk for the development of urolithiasis. MATERIALS AND METHODS: Telephone interviews were conducted with 201 cystic fibrosis patients older than 15 years to identify those with a history of urolithiasis. Histories were confirmed by chart review, and only patients with urolithiasis documented by excretory urography, renal ultrasound or spontaneous passage of a stone were included. RESULTS: A total of 11 patients (5.5%) had documented urolithiasis, with 2 or more episodes in 7. Mean age at initial episode was 27.0 years (range 19 to 33). CONCLUSIONS: Cystic fibrosis patients may be at increased risk for urolithiasis compared to age-specific prevalence rates for stone disease in the general population.

Adult↗

PubMed1996

[Risk factors in calcium urolithiasis].

The aim of the study has been to evaluate, retrospectively, if the association of urolithiasis different pathogenetic factors increases stone formation and recurrences. The study included 41 children, 20 males and 21 females, aged 3-15 years, divided into three groups: patients with hypercalciuric or normocalciuric urolithiasis and isolated hypercalciuria. In all of them renal function, blood and urinary pH, serum and urinary electrolytic levels, citraturia (dosed with anenzymatic quantitative method), oxalaturia (enzymatic colorimetric method), urinary glycosaminoglycans (dosed by means of cetylpyridinum chloride precipitation and quantitative analysis) have been considered. Statistical analysis was done using Student's "t"-test, with p < 0.05. In all children with hypercalciuric urolithiasis who during the follow-up presented a decreased citraturia, the number of recurrences increased and was above two. The children who during the follow-up remained hypercalciuric without urolithiasis, in spite of the high familiarity, presented an increased citraturia. In conclusion the association between hypercalciuria and low citraturia increases the risk of stone formation and recurrences in children with calcic urolithiasis.

Adolescent↗

PubMed1996

Clinical approach to children with urolithiasis.

Urinary stones are being recognized more frequently in children. As a result of major advancements in the urological therapies available to children with obstructed uropathy, infection-related stones no longer dominate the clinical manifestations of pediatric urolithiasis. Clinical manifestations of urolithiasis in children differ somewhat from adults and change during childhood. Causes of urolithiasis in children are remarkably similar to those of adults, although diagnostic criteria frequently vary throughout childhood. Hypercalciuria is the most common metabolic cause of pediatric urolithiasis. This article presents a general overview of urolithiasis in children and a practical approach to the medical evaluation of such children.

Age of Onset↗

PubMed1997

[Idiopathic hypercalciuria: clinical manifestation, outcome and risk for urolithiasis in children].

OBJECTIVE: The purpose of this study was to investigate the clinical manifestations, outcome and risk factors for urolithiasis of untreated idiopathic hypercalciuria (IH) in children. PATIENTS AND METHODS: During a 5 year period, all children with hematuria, lower urinary tract symptoms (LUS), or abdominal pain who were observed to have IH (urinary calcium > 4 mg/kg/day) were included in the study. The relationship between some variables (age, gender, hypercalciuria subtype, and clinical features) and urolithisis was analyzed. RESULTS: We studied 76 children with IH (9 with renal IH, 49 with absorptive IH and 18 with undetermined IH). Hematuria (46%), LUS (27.6%), lumbar pain (22%) and abdominal pain (15.7%) were the most common initial symptoms. We found a significant difference between age and clinical presentation. LUS were found more frequently in young children (46.4%) and flank pain in older patients (47.8%). Hematuria was age dependent. Eighteen (23%) patients developed urolithiasis. These 18 patients tended to be older (9.3 vs 6 years) than the other 58 children. Age at diagnosis presented a linear relationship with the development of urolithiasis (p < 0.001). Significant relative risk for urolithiasis (4.3) was found in those children who initially presented with lumbar pain. In all other parameters measured (calciuria, uricosuria, oxaluria, citraturia) and clinical characteristics analyzed, there were no statistically significant differences between those with and without stones. CONCLUSIONS: An age-dependent clinical pattern can be established for children with hypercalciuria. Significant risk for urolithiasis accompanies those children who are diagnosed later (> 9 years) and who initially present with lumbar pain.

Abdominal Pain↗

PubMed2006

The risk of urolithiasis recurrence may be reduced with anti-nanobacterial therapy.

Urolithiasis is a common disorder responsible for serious human suffering and economic cost to society. Approximately 13% of men and 7% of women in the United States will be diagnosed with urolithiasis at some time in their lives with a recurrence rate of more than 50% in 5 years. Even if some risk factors are defined for stone formation, none of them can fully explain the etiopathogenesis. A controversial pathogen bacteria called 'nanobacteria' (NB) has been associated with several diseases including stone formation in some studies. It is thought to be the nidi for the stone formation after its' isolation from the renal stones and the occurrence of the stone after the percutaneus renal injection of NB. The clinical trials demonstrated that the eradication of NB prevented the calcifications in coronary arteries and prostate with an acceptable level by performing a novel combination therapy called 'ComET' which comprises a tetracycline antibiotic, nutraceutical and EDTA. Based on these findings, we hypothesize that the risk of urolithiasis recurrence may be reduced with combined anti-nanobacterial therapy. Long term prospective studies should be designed for evaluating the patients with positive NB cultures. If our hypotheses can be further supported with clinical trials it may change the approach of the medical management for urolithiasis.

Anti-Bacterial Agents↗

PubMed1978

Recurrences in primarily infected and uninfected urolithiasis.

An analysis was carried out of 640 patients treated because of urolithiasis at the Urological Clinic of the Medical Academy in Warsaw in the years 1971--1974. Factors conducive to stone formation were analyzed. In infected urolithiasis, different bacterial floras were found in men and women. The importance of infections acquired in hospital by patients is emphasized. In primarily uninfected urolithiasis there were 35 per cent recurrences, as against 53 per cent recurrences in infected urolithiasis.

Adult↗

PubMed2004

[Indinavir urolithiasis in HIV-positive patients. Treatment and prophylaxis].

TARGET: The approximate incidence of indinavir urolithiasis in HIV positive patients receiving the drug is 10%. The exact mechanism of lithogenesis is still unknown. Pure indinavir stones are radiolucent on plane abdominal X-ray or CT scan. Indinavir urolithiasis can be associated with acute unilateral renal colic or severe azotaemia. MATERIAL AND METHODS: 20 HIV patients were treated conservatively by increasing oral fluid intake (urine production of 2 l/day and more), discontinuation of indinavir therapy for 1 week and acidification of urine with l-methionin (urine pH 5,3-5,8). Some patients were additionally treated with endoscopic procedures. RESULTS: In all patients renal function normalized. Increase of oral fluid intake, especially during the first 2 hours after intake of indinavir and during night prevented recurrence of indinavir urolithiasis. CONCLUSION: HIV positive patients with renal colic or renal insufficiency and roentgenological absence of radio-opaque stone formations should make the urologist consider indinavir urolithiasis as a possible diagnosis.

Acquired Immunodeficiency Syndrome↗

PubMed1998

N-acetyl-beta-D-glucosaminidase excretion in healthy children and in pediatric patients with urolithiasis.

Hyperoxaluria was reported to induce renal damage, probably due to toxic effects on renal tubules. Such tubular damage might be expressed by an increase in urinary excretion of marker enzymes such as N-acetyl-beta-D-glucosaminidase (NAG). We set out to examine a possible relationship between the excretion of NAG and that of urinary lithogenic and stone-inhibitory substances by analyzing 24-h urine specimens from 56 children with urolithiasis and 25 healthy children with normal renal function and without a history of urolithiasis. The NAG excretion was higher in patients with urolithiasis (3.5 +/- 0.51 U/g creatinine) as compared with healthy subjects (1.33 +/- 0.14 U/g creatinine, P < 0.05). A positive correlation between NAG and oxalate excretion was observed in female patients (r = 0.56: P < 0.01). In conclusion, the increase in urinary NAG in children with urolithiasis might express renal tubular damage. It seemed, however, not to be specifically related to the excretion of a single lithogenic substance.

Acetylglucosaminidase↗

PubMed2005

Urolithiasis in adolescent children.

Idiopathic urolithiasis in children has become more frequent in the past few decades as a result of increasing affluence and rapid change in our society's dietary habits. In Western societies, calcium stones in the kidney and ureter predominate. Pediatric urolithiases, unlike the adult form, require a comprehensive metabolic evaluation, because metabolic and enzymatic derangements play an important role in their pathogenesis. The recent advancements in endoscopic procedures, interventional radiology, and lithotripsy have allowed children to be managed effectively without open surgery. Pediatric urolithiasis requires a close working relationship between the urologist for acute surgical management of urolithiasis and the nephrologists for prevention of stone formation. In many children and adolescents with urolithiasis, a nonpharmacologic approach involving the adoption of healthy nutrition habits may suffice.

Adolescent↗

PubMed1992

Determinant role of testosterone in the pathogenesis of urolithiasis in rats.

By using an ethylene glycol-induced urolithiasis model, we assessed the role of testosterone in the pathogenesis of urolithiasis. The intact and castrated male and female rats were fed with 0.5% ethylene glycol in drinking water for four weeks. The renal excretions of oxalate, citrate and other electrolytes were measured, and the stone and crystal deposit were examined microscopically. The results showed that drinking a loading of 0.5% ethylene glycol for four weeks produced hyperoxaluria in all rats, but the intact male rats excreted more urinary oxalate than any other groups of rats. The ethylene glycol-fed rats exhibited hypocitraturia except the castrated male rats. However, urolithiasis occurred in intact male but not female rats. Castration in male rats fed with ethylene glycol dramatically decreased the incidence of renal stone from 71.4% (5/7) to 14.3% (1/7). On the other hand, there was still no renal stone formed in the oophorectomized female rats which received ethylene glycol treatment. These data indicate that serum testosterone level plays a determinant role in urolithiasis formation.

Animals↗

PubMedDate not supplied

Bone mineral density loss in patients with urolithiasis: a follow-up study.

BACKGROUND: Recurrent calcium urolithiasis is often associated with disorders of calcium metabolism. The purpose of this investigation was to assess bone mineral content (BMC) and bone mineral density (BMD) over a period of 1 year in patients with urolithiasis and to determine the factors that could have influenced the changes in bone density during that period. METHODS: The patient group comprised 34 men aged 41.2 plus minus 7.9 years with recurrent urolithiasis. A wide spectrum of biochemical measurements was performed. Bone mineral density (g/cm(2)), bone mineral content (BMC), and bone area (BA) were measured twice during a period of 1 year at the lumbar spine (L2-L4), femoral neck, Ward triangle, and trochanter, using dual energy absorptiometry. Patient results were compared to those obtained from 30 healthy male controls of a comparable age group. RESULTS: Nine patients were hypercalciuric, while the majority of the remaining metabolic parameters were within the reference values. Bone mineral content and bone areas at all regions were lower in patients comparing to controls, but not significantly. The greatest annual reduction of BMD was noticed at Ward triangle (-5.70% in patients and -2.36% in controls), followed by femoral neck (-4.06% patients, -2.03% controls) and trochanter (-3.06% patients, -1.39% controls). There was no significant decrease of the BMD of the spine. Analyzing the influence of age, body mass index (BMI), metabolic parameters, and dietary calcium intake on the annual reduction of bone density, we found that age, hyperuricosuria, and calcium intake were significantly associated with bone loss in that time period. CONCLUSIONS: Bone mass reduction in patients with urolithiasis over a 1-year period did not differ significantly from that in controls and was principally related to age, hyperuricosuria, and calcium dietary restriction but not to increased calcium excretion.

Absorptiometry, Photon↗