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Urolithiasis: Diagnostic and Therapeutic Aspects in Urology Department of N’Djamena in Chad  [PDF]
Kimassoum Rimtebaye, Franklin Danki Sillong, Arya Zarif Agah Tashkand, Mignagnal Kaboro, Lamine Niang, Serigne Magueye Gueye
Open Journal of Urology (OJU) , 2015, DOI: 10.4236/oju.2015.511032
Abstract: Introduction: To study the clinical, paraclinical, diagnostic aspects and manage patients with urolithiasis according to the available technical facilities in urology department of N’Djamena in Chad. Urolithiasis is defined as the presence of one or more stony concretions located at any level of a segment of the urinary tract: calyx, renal pelvis, ureters, bladder and urethra. Materials and Methods: This was a descriptive type of a prospective study over a period of 4 years, from January 2008 to December 2011, involving 233 patients with urolithiasis treated in the urology department. Clinical and paraclinical examinations were the basis for the selection of patients. Informed consent of patient or their parents (for minors) was obtained for the anonymous use of records and photographs for scientific aims. Results: Urolithiasis represented 5.72% (233/4072) of all urological pathologies. Male dominance was significant with a sex ratio of 4.5/1. The age group of 0 - 10 years was the most affected with a staff of 67 (28.75%). The clinic was dominated by dysuria (44.63%), renal colic (33.91%) and hematuria (9.01%). The main anatomical location was bladder (62.23%). The management was essentially medical and surgical. We recorded 7 cases of death or post-interventional hospital mortality rate of 3%. Conclusion: Urolithiasis is a real public health problem in Chad. Due to the inadequacy of the technical platform, the management was based on the open surgery. Etiological research was impossible by lack of technical laboratory platform.
Giant Pyonephrosis Due to Urolithiasis and Diabetes: A Case Report  [PDF]
Alan Hasigov, Jean Paul Ndamba Engbang, Felix Fidarov
Open Journal of Urology (OJU) , 2016, DOI: 10.4236/oju.2016.67021
Abstract: Pyonephrosis results from upper urinary tract infection in combination with obstruction and hydronephrosis. The consequence of that is the suppurative destruction of the renal parenchyma. Instead of infection and obstruction which play a role in its etiology, some factors can be considered as risk for pyonephrosis, such as immunosuppression due to medications (steroids), disease (diabetes mellitus, acquired immunodeficiency syndrome [AIDS]). Patients with pyonephrosis may present clinical symptoms and signs such as fever, flank pain and nephromegaly. The diagnose is performed using imaging means (computed tomography, ultrasound). Without treatment, the disease can progress to the urosepsispyonephrosis, which is the most redoubtable complication. The chosen treatment for patients remains nephrostomy or nephrectomy. In some cases, partial nephrectomy may be an option. We are presenting a case of a diabetic patient who with a giant pyonephrosis.
Stein, Stau, Tumor: Die starken Seiten der Nierensonographie
Kathrein H
Journal für Gastroenterologische und Hepatologische Erkrankungen , 2008,
Abstract: Gastroenterologen sollten sich bei der Sonographie des Abdomens nicht nur auf die Verdauungsorgane beschr nken, sondern in einem Untersuchungsgang auch andere Organe und Strukturen des Abdomens und Retroperitoneums beurteilen. Einerseits kann die Sonographie wesentlich und kosteneffizient zur Abkl rung abdomineller Beschwerden beitragen, andererseits gibt es zahlreiche Berührungspunkte zwischen gastrointestinalen und renalen Erkrankungen. In der Diagnose der Urolithiasis ist die Sonographie in der Hand des Geübten gleich effizient wie die Ausscheidungsurographie mit Leerbild. Das Erkennen einer Harnstauung ist einfach und verl sslich, in hohem Prozentsatz sind die H he einer Obstruktion und deren Ursache zu erfassen. Der erweiterte Ureter ist darstellbar. Renale Raumforderungen sind h ufige Zufallsbefunde. Die Sonographie kann zwar gut zwischen liquiden und soliden Raumforderungen differenzieren, eine Dignit tsbeurteilung solider Ver nderungen ist aber nicht m glich. Die Sonographie mit Echokontrastverst rkern vermag sogenannte Pseudotumoren und Niereninfarkte eindeutig zuordnen, ihre Bedeutung in der Abkl rung solider L sionen ist nicht eindeutig gekl rt.
Cytoprotective role of the aqueous extract of Terminalia chebula on renal epithelial cells
Tayal, S.;Duggal, S.;Bandyopadhyay, P.;Aggarwal, A.;Tandon, S.;Tandon, C.;
International braz j urol , 2012, DOI: 10.1590/S1677-55382012000200008
Abstract: purpose: kidney stone is one of the most prevalent diseases worldwide. calcium oxalate (caox) has been shown to be the main component of the majority of stones formed in the urinary system of the patients with urolithiasis. the present study evaluates the antilithiatic properties of terminalia chebula commonly called as "harad" which is often used in ayurveda to treat various urinary diseases including kidney stones. materials and methods: the antilithiatic activity of terminalia chebula was investigated on nucleation and growth of the calcium oxalate crystals. the protective potency of the plant extract was also tested on oxalate induced cell injury of both nrk-52e and mdck renal epithelial cells. results: the percentage inhibition of caox nucleation was found 95.84% at 25μg/ml of terminalia chebula aqueous extract which remained almost constant with the increasing concentration of the plant extract; however, plant extract inhibited caox crystal growth in a dose dependent pattern. when mdck and nrk-52e cells were injured by exposure to oxalate for 48 hours, the aqueous extract prevented the injury in a dose-dependent manner. on treatment with the different concentrations of the plant extract, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. conclusion: our study indicates that terminalia chebula is a potential candidate for phytotherapy against urolithiasis as it not only has a potential to inhibit nucleation and the growth of the caox crystals but also has a cytoprotective role.
Changes in calcium oxalate crystal morphology as a function of supersaturation
Carvalho, Mauricio;Vieira, Marcos A.;
International braz j urol , 2004, DOI: 10.1590/S1677-55382004000300005
Abstract: purpose: to study the changes in calcium oxalate crystal morphology induced by different levels of supersaturation (ss) in human urine. materials and methods: twenty-four hours urine samples from 5 normal men were collected. each specimen was centrifuged and filtered. about 200 ml of each sample was dialyzed overnight. aliquots of 2 ml of urine was then added to a 24-wells tissue culture plate and checked for crystal absence. calcium oxalate crystals were precipitated from each sample by adding sodium oxalate and calcium chloride in sufficient quantities to induce spontaneous crystallization. finally, each plate hole was examined with an inverted polarized microscope (x500 magnification). initial ss of each sample relative to calcium oxalate was calculated using an iterative computer program. results: crystal formation was connecte to relative calcium oxalate (caox) ss. at ss of 10, small crystals of similar shape were formed, mainly caox dihydrate morphology. at ss of 30, there was an enormous increase in the number of crystals, that kept the same size. ss greater than 50 produced larger crystals with different shapes and multiple crystalline aggregates. urine was able to tolerate, i.e., to avoid crystal formation, until ss ratios of approximately 10. conclusions: relative caox ss and the concentration ratio of calcium to oxalate are important determinanting factors of crystal morphology. non-dialyzable urinary proteins can act as inhibitors and influence the structure of formed crystals. additional studies from patients with kidney stones are needed in order to establish whether crystal size and habit distribution are different from crystals in normal urine.
Percutaneous nephrolithotomy with and without retrograde pyelography: a randomized clinical trial
Tabibi, Ali;Akhavizadegan, Hamed;Nouri-Mahdavi, Kia;Najafi-Semnani, Mohammad;Karbakhsh, Mojgan;Niroomand, Ali R.;
International braz j urol , 2007, DOI: 10.1590/S1677-55382007000100004
Abstract: objective: since the introduction of percutaneous nephrolithotomy (pcnl), many changes have been added regarding the entrance to pyelocalyceal system such as insertion of the needle pointed to an opaque stone as a guided landmark. we aim at comparing the outcomes of managing renal calculi with and without retrograde pyelography. materials and methods: in a randomized clinical trial, 55 cases with opaque renal calculi candidates for pcnl with stone in one calyce, in the pelvis or both in one calyce and the pelvis simultaneously were included in a nine-month study. they were randomized into 2 groups, noncatheterized (n = 28) and catheterized (n = 27), called intervention and control groups, respectively. results: the 2 groups had similar distributions regarding gender, age, duration of operation, length of hospital stay, past history of any surgical procedures on kidney, and stone size. outcome (residual stone based on aforementioned management) was evaluated with plain x-ray on the morning following the operation. postoperative hemoglobin decrease was significantly higher in controls than in the intervention group (p < 0.001) (with no clinical significance). no difference in outcome, postoperative fever, duration of surgery, duration of hospital stay and radiation exposure was observed between the 2 groups. conclusion: our findings showed no differences in major clinical outcomes between the 2 groups (with and without catheter insertion for retrograde pyelography).
Dados demográficos, clínicos e laboratoriais de pacientes com litíase urinária em Fortaleza, Ceará
Silva, Silvia Fernandes Ribeiro da;Silva, S?nia Leite da;Campos, Henry de Holanda;Daher, Elizabeth De Francesco;Silva, Carlos Ant?nio Bruno da;
Jornal Brasileiro de Nefrologia , 2011, DOI: 10.1590/S0101-28002011000300004
Abstract: objective: to describe the demographic, clinical and laboratory data of patients with urolithiasis in fortaleza, ceará, brazil. patients and methods: secondary data were collected from the medical records of 197 patients with urolithiasis, during the period 1996-2006. clinical evaluation and 24-h urine collection for measurements of urinary volume, creatinine, calcium, phosphorous, uric acid, sodium, potassium and magnesium were performed. density and ph value were determined in a first-voided morning urine sample. cystinuria was detected by stone and/or crystal analysis. results: the male/female ratio was 1:1.7. the average age of symptom onset was 35.8 ± 13.3 years, with no significant difference between the genders. the most affected age range was 20-39 years (56.3%). patients reported renal colic (72.4%), emergency room attendance (69.5%), a single episode of lithiasis (46.7%) or recurrent episodes (53.3%). the right kidney was most often affected in women (44.4%), while men suffered predominantly from bilateral lithiasis (39.7%). the main metabolic changes observed were hypernatriuria (80.7%), hypercalciuria (48.7%), hyperuricosuria (17.3%), and cystinuria in 5 patients (2.5%). the average ph value and density were 5.74 ± 0.59 and 1015.6 ± 7.1, respectively. urinary volume was low in 43% of the cases. conclusion: lithiasis was most prevalent in adults aged 20-39 years, and affected predominantly women in our region. the most frequent metabolic changes, in descending order, were hypernatriuria, followed by hypercalciuria and hyperuricosuria, associated with low fluid intake.
Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento: Factors Predicting Success after Three Weeks of Follow-Up
Vivaldi,B.; Fernández,M.I.; López,J.F.; Fuentes,F.; Urzúa,C.; Krebs,A.; Domenech,A.; Figueroa,P.A.; Pizzi,P.; Westendarp,M.; Zambrano,N.; Castro,M.; Coz,L.F.;
Actas Urológicas Espa?olas , 2011, DOI: 10.4321/S0210-48062011000900004
Abstract: introduction: the aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (swl) at 3 weeks of follow-up in our center. material and methods: the medical records of 116 patients with solitary urinary calculi who underwent single-session swl in our department between october 2007 and august 2009 were reviewed. all preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. success was defined as complete clearance or the persistence of fragments < 2mm on a plain film at 3 weeks of follow-up. the impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. results: the single-session swl success rate at 3 weeks was 49.1%. stone size <8mm, stone area < 30mm2, stone location (mid- and distal ureter), stone density <1000 hu and intraoperative fragmentation showed a significant association with swl success in the univariate analysis (p<0.05). stone area (or 2.9), ureteral stone location (or 3.4) and intraoperative fragmentation (or 4.2) were the only predictors of success in the multivariate analysis. conclusions: stone area and ureteral stone location provide important information when deciding about the indication of a swl in a patient with stone disease. however, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment.
Litiasis renal en el área III de Zaragoza: bioquímica y epidemiología
Aibar Arregui,M.A.; Gutiérrez Samper,A.P.; Rodrigo Val,M.P.; Laborda Ezquerra,K.; Hernández Bono,A.B.; Blasco Villacampa,G.;
Actas Urológicas Espa?olas , 2004, DOI: 10.4321/S0210-48062004000900005
Abstract: the urolithiasis is a very common disease that it causes, in addition to the suffering for the patients, an important cost sanitary partner. the composition of the renal stones that can influence in the treatment and later evaluation of the disease, varies in the different zones. in our work the composition of the renal stones received in the biochemistry department of the h.c.u of zaragoza studies during year 2002, with a brief approach to the epidemiology of the disease in the area iii of zaragoza. the rate of incidence was of 0.35 % with a clear predominance in men; the most frequent renal stones were those of pure calcium oxalate or calcium oxalate combined with apatite carbonate, although the percentage of samples gathered with respect to the total of diagnoses as soon as it surpassed 10%. not found significant differences between the composition of the renal stones coming from the different zones from our area, nor based on the sex of the patients. given the influence of the composition of the urolithiasis for its treatment, we must insist on the collection of the greater number of samples for its analysis, although the epidemiologic data and the study of the urinary sediment can be used in the practice.
Técnicas cirúrgicas para urolitíase obstrutiva em pequenos ruminantes: relato de casos
Dória, R. G. S.;Canola, P.A.;Dias, D.P.M.;Pereira, R.N.;Valad?o, C.A.A.;
Arquivo Brasileiro de Medicina Veterinária e Zootecnia , 2007, DOI: 10.1590/S0102-09352007000600012
Abstract: two cases in wich the penectomy and perineal penile transposition were the surgical technique of choice, technique of choice were described showing 50% of success. there are also reported four cases in wich cystotomy followed by cystostomy showed 100% of success, one case in wich the cystotomy alone was unsuccessfully, one case in wich only the clinical treatment was efficient and two cases showing 100% of unsuccessful despite of the surgical technique used due to the advanced stage of azotemy and toxemic shock of the animals. this article presents a study of urolithiasis in goats and sheep, from 2003 to 2005, aiming to describe the causes and the consequences of the therapeutic procedures followed.
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