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PubMed1986

[Epidemiological study on urolithiasis in Mie Prefecture. 1. Present status in 1985].

To determine the present status of urolithiasis in Mie Prefecture, we analyzed the 1,314 patients of urolithiasis at 17 Departments of Urology and 2 Departments of Medicine in 1985. The ratio of male patients to female patients was 2.6 to 1. The most frequent incidence of urolithiasis was observed in Iinan county. The incidence of urolithiasis in the urban area was the same as that in the country. Most of the stones (96.9%) were in the upper urinary tract. The incidence of lower urinary tract calculi tended to be high in southern Mie Prefecture. The ratio of upper urinary tract calculi to lower urinary tract calculi in the urban area was the same as that in the country. The peak incidence in males was in the forties, while that in females was in the fifties. The average age was 44.5 years old. Ureterolithotomy was the most frequent (37.5%) surgical therapy, percutaneous nephrolithotomy and shock wave lithotomy done in 8.0% and 6.3%, respectively. The most frequent component of the urinary tract calculi was calcium oxalate and/or calcium phosphate (84.0%). The incidence increased in summer (April through September).

Adult↗

PubMed1983

[Urinary tract infections and urolithiasis].

100 cases of urolithiasis in children treated in Pediatric Clinic of National Research Institute of Mother and Child in the period of 1976-1979 were analized . In 93 children the cause of urolithiasis was established. The most of them (31%) are cases of infection induced urinary stones. Among other reasons of urolithiasis the most common are: metabolic reasons in 26%, probably metabolic reasons in 13%, idiopathic oxalic lithiasis in 17% and others in 6%. At the moment of urolithiasis diagnosis in 94 children bacteriological investigations were done. In 54 cases, i.e. 57,4% infections of the urinary tract were found. 57,8% of boys and 62,2% of girls had urinary tract infections. The most frequent bacteria was urease producting Proteus sp. During 3 years of observation urinary tract infections in 67 children were found. Among bacteria causing the reinfections the most frequent were: Pseudomonas aeruginosa (25,4%), Klebsiella sp. (22,4%), Proteus sp. (19,9%) and E. coli (15%). In 9 cases the bacteriological analysis of removed stones were done. In 2 cases bacteria causing the infection were isolated from the stones, since they were not present in urine any more.

Adolescent↗

PubMed1982

Urolithiasis in children.

Between 1971 and 1980, 55 children with urolithiasis were assessed and treated. Pediatric urolithiasis accounted for 1:4090 hospital admissions. Forty percent of patients had no identifiable predisposition to urolithiasis. Eight patients presented with hematuria in the absence of renal colic suggesting that pediatric urolithiasis, although uncommon, is an important cause of painless hematuria.

Acidosis, Renal Tubular↗

PubMed1995

Evaluation of factors associated with development of calcium oxalate urolithiasis in cats.

OBJECTIVE: To evaluate dietary and environmental factors as potential risk factors for calcium oxalate urolithiasis in cats. DESIGN: Case-control study. ANIMALS: 84 cats with uroliths composed of at least 90% calcium oxalate and 258 age- and gender-matched control cats. PROCEDURE: Owners of cats with calcium oxalate urolithiasis and control cats were surveyed between November 1990 and August 1992. Owners completed a standard questionnaire administered during a single telephone interview. Data collected included information regarding signalment, environment, urination and defecation, diet, and medical history. RESULTS: Calcium oxalate uroliths tended to develop in middle- to older-aged, domestic shorthair cats of typical weight. A gender predilection was not detected. Factors associated with an increase in the risk of calcium oxalate urolithiasis in cats were feeding urine-acidifying diets, feeding a single brand of cat food without providing additional foods or table scraps, maintaining cats in an indoor-only environment, and being of the Persian breed. CLINICAL IMPLICATIONS: Control of diet and environment may help prevent calcium oxalate urolithiasis.

Age Distribution↗

PubMed1994

[Effect of urine alkalization on excretion of renal citrate and degree of urine saturation with calcium oxalate in patients with calcium-oxalate urolithiasis and in healthy subjects].

The aim of the study was to compare the renal citrate excretion and the degree of urine saturation with calcium oxalate in patients with active calcium oxalate urolithiasis and in healthy subjects under basal conditions and after alkalization. There were 20 women before menopause with calcium stone disease aged 33.5 +/- 7.1 in the first group and 20 healthy women aged 32.3 +/- 7.6 in the second one. Sodium bicarbonate was administrated intravenously in a dose 16.8 g during 2 h. 24h excretion of calcium, magnesium and citrate, the degree of urine saturation with calcium oxalate and pH of urine before and after alkalization were evaluated. Hypocitraturia occurred in 45% of patients under basal conditions. The degree of urine saturation with calcium oxalate was significantly higher in women with nephrolithiasis (p < 0.01). A significant increase of citrate excretion (p < 0.001) and a decrease of calcium excretion (p < 0.05) after alkalization took place in both groups. The degree of urine saturation with calcium oxalate decreased significantly in patients with urolithiasis and in healthy subjects. During acute alkalosis, induced by sodium bicarbonate, increase of citrate excretion was observed in patients with urolithiasis in spite of hypocitraturia under basal conditions. This indicates that kidney function following alkalization is normal in "stone kidney". Significantly decreased saturation of urine with calcium oxalate was due to the decrease of calcium excretion and the increase of citrate excretion. In conclusion, the results show that the use of alkalizing factors in prevention of recurrent calcium urolithiasis is justifiable.

Adult↗

PubMed1996

Erection failure as a sequela to obstructive urolithiasis in a male goat.

A 14-month-old 40-kg Anglo-Nubian buck was referred for erection failure after recurrent bouts of obstructive urolithiasis. Previous episodes of obstructive urolithiasis were treated successfully with amputation of the urethral process, followed by an exploratory celiotomy and insertion of an indwelling Foley catheter into the bladder. The buck had been capable of intromission prior to the most recent episode of urethral obstruction. The results of physical examination and electroejaculation did not reveal any abnormalities, except failure to achieve erection. Contrast radiography of the corpus cavernosum penis (CCP), however, revealed failure of contrast media to migrate proximal to the sigmoid flexure. A diagnosis of obstruction of the CCP caused by cavernositis and fibrosis secondary to urolithiasis was made. A poor prognosis was given for breeding soundness. Although breeding soundness following obstructive urolithiasis may be enhanced by surgical intervention, impotence may result from obstruction of blood flow through the CCP secondary to urethral rupture or urethritis.

Amputation, Surgical↗

PubMed1997

[Diagnosis, prophylaxis and treatment of urolithiasis].

Urolithiasis is a disease with complex and not fully explained etiology and pathogenesis. In its development there play role multiple factors, such as individual features of the kidneys and urinary tract, co-existing infections with urease-producing pathogens and environmental factors. Advance in the field of organ imaging has enabled development of new harmless diagnostic procedures that allowed for fast diagnosis, and current methods of treatment (USR, PCNL and ESWL) have significantly limited the number of surgical procedures performed because of urolithiasis. Introduction of these treatment methods markedly disturbed used for a long time scheme of management and in many cases it limited invasiveness of the treatment and shortened hospitalisation time. Unfortunately, not all urology departments in Poland have access to the newest methods of treatment, thus a percentage of patients treated with traditional methods is still high. Used nowadays methods of diagnosis and treatment have not fully solved a problem of urolithiasis metaphylaxis, and urolithiasis still remains a serious disease that requests close cooperation of the patients, nephrologist and urologist.

Humans↗

PubMed1998

Association between hyperadrenocorticism and development of calcium-containing uroliths in dogs with urolithiasis.

OBJECTIVE: To determine, among dogs with urolithiasis, whether dogs that had hyperadrenocorticism would be more likely to have calcium-containing uroliths than would dogs that did not have clinical evidence of hyperadrenocorticism. DESIGN: Retrospective case-control study. ANIMALS: 20 dogs that had urolithiasis and hyperadrenocorticism and 42 breed-matched dogs that had urolithiasis but did not have clinical evidence of hyper-adrenocorticism. PROCEDURE: Signalment, urolith composition, results of bacterial culture of urine, and results of adrenal axis tests were recorded. A multivariate logistic regression model was created, including terms for age, sex, and hyperadrenocorticism. The outcome variable was presence or absence of calcium-containing uroliths. RESULTS: Among dogs with urolithiasis, those that had hyperadrenocorticism were 10 times as likely to have calcium-containing uroliths as were dogs that did not have clinical evidence of hyperadrenocorticism (odds ratio, 10.5; 95% confidence interval, 1.5 to 23.4). Neutered and sexually intact females were less likely to have calcium-containing uroliths than were neutered males (odds ratios, 0.041 [95% confidence interval, 0.0057 to 0.29] and 0.024 [95% confidence interval, 0.0012 to 0.51, respectively). CLINICAL IMPLICATIONS: Prompt diagnosis and treatment of hyperadrenocorticism may decrease prevalence of calcium-containing uroliths in dogs.

Adrenocortical Hyperfunction↗

PubMed2026

Epidemiology, diagnosis, and surgical management of urolithiasis in older adults: overview from EAU endourology.

PURPOSE OF REVIEW: Population ageing is changing everyday urological practice. The number of older adults is increasing, and urology already treats a patient population that is, on average, older than the general population. Consequently, older adults with urolithiasis represent a core part of contemporary endourological practice. Given this, a focused review of the available evidence is valuable to inform clinical practice. RECENT FINDINGS: A peak in stone disease can occur in older adults who may also be less likely to present with the classical features of renal colic. As such, delayed or missed diagnosis may carry greater clinical consequences. Although the literature remains relatively limited, ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy remain feasible options in appropriately selected older adults. In this group in particular, broader health associations merit consideration, as the presence of urolithiasis in older adults may reflect overall health status in later life. SUMMARY: The burden of urolithiasis in older adults is increasing and now represents a routine component of everyday clinical practice. Clinical presentation may differ from that seen in younger "index" patients, and complications may have a greater impact on recovery and function. Management should therefore be individualized, taking into account comorbidity, frailty, functional status, and the patient's own priorities.

Humans↗

PubMed2026

Desmodium styracifolium Total Flavone Capsules for Urolithiasis: A Phase 3 Randomized Clinical Trial.

IMPORTANCE: No oral medication is currently approved for the management of urolithiasis. Guang Jing Qian Cao (Desmodium styracifolium total flavone capsules; hereinafter, Guang Jing), a traditional Chinese herbal extract, has shown clinical benefits for urolithiasis, but randomized clinical trials are needed to assess its effectiveness. OBJECTIVE: To evaluate whether Guang Jing improves stone passage rates (SPRs) compared with placebo in adults with urolithiasis. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled, phase 3 randomized clinical trial was conducted at 34 sites in China from December 2017 to April 2020. Participants included adults (aged 18-70 years) with diagnosed ureteral stones. Data analysis was conducted on November 4, 2020. INTERVENTION: Participants were randomized 3:1 to receive oral Guang Jing (0.6 g) or matching placebo 3 times daily for 28 days, in addition to investigator-prescribed background medication. MAIN OUTCOMES AND MEASURES: The primary outcome was SPR by day 28, confirmed by computed tomography. Secondary outcomes included SPR by day 14, stone migration rate, and stone migration distance. Between-group comparisons were performed using the Cochran-Mantel-Haenszel test for categorical outcomes and t tests for continuous outcomes. RESULTS: A total of 606 participants were randomly assigned to receive Guang Jing (n = 458) or placebo (n = 148). Their mean (SD) age was 43.0 (12.0) years, 474 (78.2%) were male, and the mean (SD) stone size was 0.6 (0.1) cm. The SPR by day 28 was significantly higher for the Guang Jing group compared with the placebo group (204 of 457 [44.6%] vs 50 of 148 [33.8%]; relative risk, 1.32 [95% CI, 1.03-1.69]; P = .03), with an absolute risk difference of 10.9 (95% CI, 2.0-19.7) percentage points. No significant between-group differences in SPR by day 14 (Guang Jing vs placebo: 133 [29.1%] vs 33 [22.3%]; P = .14) or stone migration distance (mean [SD], 29.5 [51.8] mm vs 29.7 [43.8] mm; P = .11) were observed. Adverse event rates were similar for the Guang Jing and placebo groups (88 [19.3%] vs 27 [18.2%]). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, treatment with Guang Jing significantly increased the expulsion of 5- to 10-mm ureteral stones by day 28, with a favorable safety profile. These findings suggest that Guang Jing may be an additional medical expulsive therapy option for appropriately selected patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR-IIR-17013275.

Humans↗

PubMed2026

Temporal evolution of minimally invasive pediatric urolithiasis treatment over 30 years.

Urolithiasis in children has increased substantially over the past 30 years, and surgical management maintains an important role in treatment. Technological advances such as lasers and miniaturization have broadened treatment options, and researchers investigate the best indications for each procedure. The aim was to identify publication trends in the field and explore reasons why Extracorporeal Shockwave Lithotripsy is being gradually less applied in the treatment of pediatric urolithiasis. A Reverse Systematic Review of the literature was conducted regarding the surgical treatment of urolithiasis in children. Five databases were screened, gathering all articles from inception that were evaluated in systematic reviews. We examined 123 publications, 197 reports, and 15,878 procedures, consisting of the largest studied population in the field. There was an increasing number of publications, although in progressively less prestigious journals. The number of studies on miniaturized percutaneous techniques and flexible ureteroscopy has increased closely with the rise in popularity of these procedures worldwide, mainly driven by studies from Asia, Europe, and North America. A trend of self-renewed interest is fueled by technological innovation and has led to fewer publications on Extracorporeal Shockwave Lithotripsy over the years. This review highlights the fact that, despite positive results in recent studies, the low popularity of ESWL within the scientific community is driving a decline in the technique's indications. Moreover, based on the findings of this study, key research priorities include continued reporting of high-quality outcomes, and technological progress in ESWL would contribute meaningfully to the field.

Humans↗

PubMed2006

Comparison of three techniques for the diagnosis of urinary tract infections in dogs with urolithiasis.

OBJECTIVES: To identify an appropriate sampling technique(s) to accurately detect the bacteria causing urinary tract infections in dogs with urolithiasis. METHODS: Twenty-one dogs with urolithiasis were included in the study. Three types of samples were taken from each dog. Urine was collected by cystocentesis, and a urinary bladder mucosal biopsy and urolith were retrieved during cystotomy. The samples were then cultured on blood agar and MacConkey's agar to identify the bacteria associated with urinary tract infections. RESULTS: Bacterial urinary tract infection was found in 16 cases (76.19 per cent). The most prevalent bacteria found to cause urinary tract infection were Escherichia coli (n=7), followed by coagulase-positive Staphylococcus species (n=4), Klebsiella pneumoniae (n=2), Pseudomonas aeruginosa (n=2) and Proteus mirabilis (n=1). In the case of a positive urine culture, the same bacteria were also cultured from the urinary bladder mucosal biopsy alone or from both the urinary bladder mucosal biopsy and urolith. However, in the case of a negative urine culture, bacteria were found to be present in the urinary bladder mucosal biopsy or urolith cultures in 23.81 per cent of dogs. The uroliths that gave positive culture results were either infection-induced uroliths composed of struvite and calcium carbonate phosphate, ammonium acid urate only or metabolic uroliths composed of calcium oxalate and calcium phosphate, or calcium phosphate only. All the uroliths that gave negative culture results were metabolic uroliths composed of calcium oxalate and/or calcium phosphate, and uric acid and calcium phosphate. CLINICAL SIGNIFICANCE: When the culture from the urine obtained by cystocentesis is negative, cultures of urinary bladder mucosal biopsy and urolith are recommended in dogs with urolithiasis in order to accurately assess the microbiological status of the urinary tract.

Animals↗

PubMed1982

Hypercalciuria in children with urolithiasis.

The pathogenetic roles of idiopathic renal hypercalciuria and absorptive hypercalciuria in children with urolithiasis have not yet been determined. Oral calcium loading studies were performed in 21 children with unexplained calcareous urolithiasis. Thirteen children, aged 20 months to 17 years, were found to have renal hypercalciuria after an overnight fast (urinary calcium-urinary creatinine [UCa/UCr] ratio in milligrams, greater than 0.21). Four children were found to have absorptive hypercalciuria. In this group, fasting UCa/UCr values were normal (SEM, 0.12 +/- 0.02); however, UCa/UCr values were elevated (SEM, 0.31 +/- 0.01) after the oral calcium load. Serum parathyroid hormone values were normal in all children with hypercalciuria. Urinary calcium excretion was normal in four patients. These data indicate that hypercalciuria may frequently occur in children with urolithiasis and that detailed metabolic evaluation is warranted in children with kidney stone disease.

Absorption↗

PubMed2004

Surface-enhanced laser desorption/ionization-time of flight-mass spectrometry (SELDI-TOF-MS): a new proteomic urinary test for patients with urolithiasis.

SELDI-TOF-MS is a highly sensitive protein-analysis tool capable of detecting minute protein profile differences between biological samples. As proteins have been associated with urinary tract calculi, protein-based urinalysis may offer insights into their diagnosis. The purpose of this study was to evaluate SELDI-TOF-MS as a potential method for identifying urinary biomarkers of urolithiasis. Midstream sterile urine samples were obtained from 25 male patients with a confirmed diagnosis of urolithiasis (test group) and 25 male subjects with no known history of the disease (controls). Urinary levels of oxalate, total protein, albumin, and osteopontin were determined. Protein profiles were generated using SELDI-TOF-MS.SELDI-TOF-MS profiling revealed a relationship between protein peak intensities at 67 and 24 kDa that differed between the two groups. The ratio of p67:p24 was found to be less than 1.0 in all of the control samples (mean 0.26), while 18 out of 25 (72%) of the test group samples displayed a ratio greater than 1.0 (total group mean 4.75, P<0.001). Albumin, total protein, and oxalate levels were higher in the test group than the controls. Although SELDI-TOF-MS is not yet in widespread use in hospital and diagnostic laboratories, this system represents a promising new method for rapidly identifying patients with urolithiasis.

Albumins↗

PubMed1984

Epidemiology and socioeconomic aspects of urolithiasis.

This epidemiologic study reveals that the occurrence of urolithiasis in the nineteenth century population in Europe is quite similar to that of the twentieth century in Asia. The analogy is demonstrated for age distribution, stone localization, male/female ratio, and stone composition. The distribution of urolithiasis in a low socioeconomic level population is defined by: highest frequency in childhood, more than 40% bladder stones, less than 20% female patients, less than 40% calcium-oxalate stones, and more than 30% uric acid/urate stones. Typical for a population with a high level these characteristics of urolithiasis are: highest frequency among adults, less than 10% bladder stones, more than 25% female patients, more than 60% calcium oxalate stones, and less than 20% uric acid/urate stones. In partially developed countries those values fall in between.

Age Factors↗

PubMed2004

Evaluation and treatment of pediatric idiopathic urolithiasis-revisited.

The objective of the study was to update the evaluation and treatment of idiopathic urolithiasis in children in Western society. A secondary goal was to evaluate patients' compliance with high fluid intake. Over 2 years we prospectively studied children referred to us for idiopathic urolithiasis confirmed radiographically, excluding those with secondary disorders. A metabolic urinalysis, which included calcium, citrate, uric acid, oxalate, cystine, and creatinine, was ordered in all patients. Hypercalciuric patients were first treated with a low-sodium (Na)/high-potassium (K) diet and if hypercalciuria persisted, thiazides or potassium citrate was added. Follow-up ultrasound scans were scheduled every 10-12 months. Urine specific gravity (SG) measured during clinic visits was used to assess compliance with high fluid intake. A survey was sent to pediatric urologists and nephrologists to establish a recommended maximal SG value. Thirty healthy school-aged children served as controls. There were 45 children (24 males, 21 females) aged 10.4+/-2.0 years (median 11.0) studied. Stones were retrieved and analyzed in 28 showing calcium composition in all. Urine chemistry analysis was incomplete in 3, and in the others showed hypercalciuria in 33 (78.6%), hypocitraturia in 1 (2.4%), and normal values in 8 (19.0%). Treatment of 33 hypercalciuric patients consisted of diet alone in 13, potassium citrate in 17, thiazides in 2, and potassium citrate and thiazide in 1. All 33 achieved normocalciuria, apart from 2 who remained mildly hypercalciuric on diet alone. The 12 normocalciuric children were treated by diet modification alone. Follow-up ultrasonography showed no new stones in 36 of 39 patients. In 3, new stone formation was associated with recurrence of hypercalciuria after the potassium citrate dose was lowered or discontinued. Upon their first clinic visit, the urine SG of stone formers (1.021+/-0.007) was significantly higher than the maximum SG recommended by 18 physicians of 1.010+/-0.003 ( P<0.001), and not different from the SG in the control group (1.018+/-0.007). Urine SG at follow-up visits was unchanged in stone formers. We therefore propose a step-wise approach in evaluating children with idiopathic urolithiasis in Western society, in which first only urine calcium is studied. Only if urine calcium is normal, should other chemistries be studied. In many hypercalciuric children, low-Na/high-K diet alone is effective, while in most others the addition of potassium citrate is well tolerated, normalizes calciuria, and protects against new stone formation. Children rarely comply with the recommendation of high fluid intake.

Child↗

PubMed2005

Etiological and clinical patterns of childhood urolithiasis in Iraq.

This study was conducted to evaluate the etiological and clinical characteristics of urolithiasis in Iraqi children. From 1999 to 2004, 204 children with renal calculi were evaluated. The age range of the patients was 4 months to 14 years, 61.3% of the patients were under 5 years. Male to female ratio was 2.8:1. The mean age at onset of symptoms was 3.2 years, and stone disease was diagnosed at a mean of 3.5 years. Hematuria (44.6%) and pain (28.4%) were the main clinical presentation. Of the 204 patients 45.1% had a family history of stones. Consanguinity was recorded in 72%; 75.5% had metabolic disorders. Stones were located at multiple sites in 80 patients, or 39.2%; 58 of these 80, or 72.5%, had metabolic disorders. Multiple stones were present in 47 (23%); 72.3% were related to metabolic disorders. In 126 patients, or 61.8%, both kidneys were involved equally. Bladder stones were found in 11.3%. Staghorn calculi occurred in 29 patients, or 14.2%; 27 of these had recurrent urinary tract infection (UTI). Nephrocalcinosis was diagnosed in 7, or 3.4%; all had metabolic disorders. Etiology of stone formation was established in 189 patients, or 92.6%, whereas 15, or 7.4%, had idiopathic stones. Metabolic disorders were the commonest cause in 106 patients (52%); 52 patients were classified as infective (25.5%). Anatomical defects were present in 25 (12.2%) and 6 children (2.9%) with primary endemic bladder calculi. Coexisting UTI was common (36.8%) in the metabolic group. We concluded that urolithiasis is a serious problem among Iraqi children, with early onset of presentation. Metabolic disorders were the major causes, but can be masked by associated UTI. Proper management of UTI with a careful metabolic assessment of young stone formers is valuable in combating urolithiasis.

Adolescent↗

PubMed1993

Management and complications of urolithiasis during pregnancy.

OBJECTIVE: To identify all pregnant women with urolithiasis, and to determine the mode of diagnosis and treatment with reference to obstetric outcome. METHOD: From January 1, 1986 to December 31, 1991, relevant medical records were retrospectively analyzed. RESULTS: Among 21,597 deliveries 10 pregnant women were diagnosed as having urolithiasis. They constituted 0.04% of all women who delivered at the Department of Obstetrics and Gynecology in Rijeka during this period. Conservative treatment was successful in 5 patients. Ureteral stents were inserted in 3 patients, nephrostomy was performed in 1 patient and a nephrectomy was necessary in 1 patient because of a nonfunctional kidney and chronic pyelonephritis. CONCLUSION: In our series all applied procedures in diagnosis and treatment of urolithiasis resulted in favorable maternal and perinatal outcome.

Adult↗