
1: Turk J Pediatr. 2008 Sep-Oct;50(5):509-11.

Kidney stone and urinary bladder telangiectasia in a patient with TAR syndrome.

Akil I, Gözmen S, Yilmaz O, Taneli C.

Department of Pediatric Nephrology, Celal Bayar University Faculty of Medicine,
Manisa, Turkey.

TAR syndrome is a congenital malformation syndrome characterized by bilateral
absence of the radius and thrombocytopenia. The known urinary anomalies are
duplex ureter, dilatation of renal pelvis, horseshoe kidney and functional
problems like vesicoureteral reflux and pyelonephritis. In this report of a case 
with TAR syndrome, a kidney stone and bladder telangiectasia were found
coincidentally during the investigation of hematuria. TAR syndrome is discussed
in the light of the medical literature. To our knowledge, no case has been
reported demonstrating nephrolithiasis and bladder telangiectasia in TAR
patients.

Publication Types: 
    Case Reports

PMID: 19102062 [PubMed - indexed for MEDLINE]

2: AJR Am J Roentgenol. 2009 Jan;192(1):143-9.

CT with a computer-simulated dose reduction technique for detection of pediatric 
nephroureterolithiasis: comparison of standard and reduced radiation doses.

Karmazyn B, Frush DP, Applegate KE, Maxfield C, Cohen MD, Jones RP.

Department of Pediatric Radiology, Indiana University School of Medicine, Riley
Hospital for Children, 702 Barnhill Dr., Rm. 1053, Indianapolis, IN 46202, USA.

OBJECTIVE: The purpose of this study was to compare the diagnostic capabilities
of standard- and reduced-dose CT in the detection of nephroureterolithiasis in
children. MATERIALS AND METHODS: Forty-five patients 20 years old or younger
divided into two groups weighing 50 kg or less and more than 50 kg underwent
unenhanced 16-MDCT in the evaluation of acute flank pain. An investigational
computer-simulated tube current reduction tool was used to produce additional 80-
and 40-mA examination sets (total number of image sets=135). Three independent
blinded readers ranked random images for stones (confidence scale, 1-5, least to 
most), hydronephrosis, noise-based image quality, and presence of nonrenal
lesions. RESULTS: Compared with the standard tube current used for the original
CT scans, there was no significant reduction (p=0.37) in detection of renal
stones at the 80-mA setting (mean dose reduction, 67%; range, 43-81%); and at the
40-mA setting (mean dose reduction, 82%; range, 72-90%), the detection rate was
significantly lower (p=0.05). At the 40-mA setting, there was no significant
difference among the children weighing 50 kg or less (p=0.4). Detection of
ureteral stones and hydronephrosis was not significantly different at 80 and 40
mA; however, disease frequency was low, and no definite conclusion can be made.
CONCLUSION: Simulated dose reduction is a useful tool for determining diagnostic 
thresholds for MDCT detection of renal stones in children. Use of the 80-mA
setting for all children and 40 mA for children weighing 50 kg or less does not
significantly affect the diagnosis of pediatric renal stones.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 19098193 [PubMed - indexed for MEDLINE]

3: BMJ. 2008 Dec 18;337:a2991. doi: 10.1136/bmj.a2991.

Renal screening in children after exposure to low dose melamine in Hong Kong:
cross sectional study.

Lam HS, Ng PC, Chu WC, Wong W, Chan DF, Ho SS, Wong KT, Ahuja AT, Li CK.

Department of Paediatrics, The Chinese University of Hong Kong.
hshslam@cuhk.edu.hk

OBJECTIVE: To investigate the renal outcomes of children after exposure to low
dose melamine in Hong Kong. DESIGN: Cross sectional study. SETTING: Special
assessment centres, Hong Kong. PARTICIPANTS: 3170 children (1422 girls and 1748
boys) aged 12 years or less referred from territory-wide primary care clinics
after daily consumption for one month or more of milk products tainted with
melamine. MAIN OUTCOME MEASURES: Presence of renal stones and haematuria.
RESULTS: One child had a confirmed renal stone, seven were suspected of having
melamine related renal deposits, and 208 (6.6%) were positive for blood in urine 
by reagent strip. A proportion of these children were followed up at the special 
assessment centre, but only 7.4% of those positive for blood on reagent strip
were confirmed by microscopy, suggesting an overall estimated prevalence of less 
than 1% for microscopic haematuria. CONCLUSIONS: No severe adverse renal
outcomes, such as acute renal failure or urinary tract obstruction, were detected
in children after exposure to low dose melamine. Our results were similar to
territory-wide findings in Hong Kong. Even including the seven children with
suspected renal deposits, the prevalence of suspected melamine related
abnormalities on ultrasonography was only 0.2%. None of these children required
specific treatment. The prevalence of microscopic haematuria was probably
overestimated by the reagent strip. These data suggest that large scale and
urgent screening programmes may not be informative or cost effective for
populations who have been exposed to low dose melamine.

Publication Types: 
    Multicenter Study
    Research Support, Non-U.S. Gov't

PMID: 19097976 [PubMed - indexed for MEDLINE]

4: J Urol. 2009 Feb;181(2):796-800. Epub 2008 Dec 17.

Use of second look nephroscopy in children undergoing percutaneous
nephrolithotomy.

Roth CC, Donovan BO, Adams JM, Kibar Y, Frimberger D, Kropp BP.

Department of Urology, Children's Hospital of Oklahoma, University of Oklahoma
Health Sciences Center, Oklahoma City, Oklahoma 73104, USA.
christopher-roth@ouhsc.edu

PURPOSE: We determined the rate of stone clearance in children following
percutaneous nephrolithotomy, endoscopic assessment of residual stone and the
judicious use of second look nephroscopy. MATERIALS AND METHODS: We
retrospectively reviewed the charts of all children undergoing percutaneous
nephrolithotomy from 1996 to 2007. Cases were reviewed for pertinent details
including preoperative and postoperative imaging, specifics of the procedure and 
followup. On completion of percutaneous nephrolithotomy the collecting system was
assessed via combined nephrostogram and direct nephroscopy. If the collecting
system could not be completely visualized or all stone fragments could not be
cleared, the patient was referred for second look nephroscopy. Any residual stone
present on initial followup imaging constituted a treatment failure. RESULTS: A
total of 24 patients underwent percutaneous nephrolithotomy for 30 separate renal
calculi. Mean patient age was 9.6 years, and mean stone burden was 2.53 cm. The
success rate for percutaneous nephrolithotomy (inclusive of second look
nephroscopy) was 87%. Of 30 cases 16 were managed by second look nephroscopy,
with findings of residual fragments in all 16. Treatment failure was noted in 1
patient without second look nephroscopy and in 3 patients with second look
nephroscopy. Of the 4 patients with treatment failure all were eventually
rendered stone-free. CONCLUSIONS: Second look nephroscopy based on endoscopic
findings during initial percutaneous nephrolithotomy is a reliable method of
detecting and clearing residual stone fragments. Using such a protocol we
achieved a high success rate of stone clearance in a population of patients with 
a significant stone burden.

PMID: 19095267 [PubMed - indexed for MEDLINE]

5: J Urol. 2009 Feb;181(2):663-7. Epub 2008 Dec 16.

Does previous extracorporeal shock wave lithotripsy affect the performance and
outcome of percutaneous nephrolithotomy?

Yuruk E, Tefekli A, Sari E, Karadag MA, Tepeler A, Binbay M, Muslumanoglu AY.

Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey.

PURPOSE: ESWL and percutaneous nephrolithotomy are the primary treatment
modalities for kidney stones. Furthermore, percutaneous nephrolithotomy is first 
line treatment when ESWL fails. We assessed how previous ESWL affects the
performance and outcome of percutaneous nephrolithotomy. MATERIALS AND METHODS: A
total of 1,008 patients underwent percutaneous nephrolithotomy between 2002 and
2007, of whom 230 (22.8%) had a recent history of failed ESWL. Patient
characteristics, operative findings, success and complication rates in patients
with and without a history of ESWL were analyzed and compared. RESULTS: In the
post-ESWL group mean stone size was significantly lower and the mean +/- SD
interval between the last ESWL session and percutaneous nephrolithotomy was 3.4
+/- 2.1 months (range 1 to 12). Mean operative time and fluoroscopic screening
time were similar in the 2 groups (p >0.05). However, mean operative time per
cm(2) stone and fluoroscopic screening time per cm(2) stone were significantly
prolonged in the post-ESWL group (p <0.05). At a mean followup of 5.6 +/- 1.2
months (range 3 to 6) an overall success rate of 89% was achieved. Success and
complication rates were comparable in the 2 groups. CONCLUSIONS: Although similar
success and complication rates were achieved with percutaneous nephrolithotomy
after failed ESWL, percutaneous nephrolithotomy is usually more difficult with
prolonged operative time and fluoroscopic screening time per cm(2) stone due to
the tissue effects of ESWL and scattered stone fragments in the pelvicaliceal
system.

Publication Types: 
    Comparative Study

PMID: 19091339 [PubMed - indexed for MEDLINE]

6: Hong Kong Med J. 2008 Dec;14(6):427-31.

A report on a randomly sampled questionnaire survey about renal stone disease in 
Hong Kong.

Chan SW, Ng CF, Man CW, Chung R, Li SK.

Department of Surgery, Caritas Medical Centre, Shamshuipo, Hong Kong.
stevewh@gmail.com

OBJECTIVES: To investigate the prevalence and characteristics of patients with
renal stone in Hong Kong, and awareness of corresponding prevention strategies.
DESIGN: Telephone public survey. SETTING: Hong Kong community. PARTICIPANTS. A
public telephone survey concerning the occurrence of renal stone disease and the 
public awareness of the condition was performed. Respondents whose telephone
numbers were randomly selected by computer and the family member of the household
who had the closest birthday to that date was chosen for interview. Data
collected were further adjusted for the gender and age distribution of the Hong
Kong population in mid-2007. RESULTS: A total of 1010 Hong Kong citizens aged 18 
years or above were successfully interviewed in November 2007. Among them, 25
respondents themselves had a history of renal stones, yielding a point prevalence
of 2.5%. In addition, 70 respondents had family members with a history of renal
stones, yielding an estimated household point prevalence of 6.9%. Stone patients 
were mainly older, male, and imbibed less fluids than the average for all
respondents. The public's concepts with regard to the diet necessary and the
importance of taking more fluid to prevent stone formation was poor. CONCLUSION: 
Hong Kong has a relatively low prevalence of renal stone disease, compared to
neighbouring areas. However, the local public and affected patients had little
knowledge and awareness about this important health problem.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 19060340 [PubMed - indexed for MEDLINE]

7: J Endourol. 2008 Nov;22(11):2537-45.

Antioxidant therapy is associated with a reduction in the serum levels of
mediators of renal injury following lithotripsy for renal calculi.

Kehinde EO, Al-Awadi KA, Al-Hunayan A, Mojiminiyi OA, Memon A, Abdul-Halim H,
Fatinikun T.

Department of Surgery (Division of Urology), Faculty of Medicine, Kuwait
University, Safat, Kuwait. ekehinde@hsc.edu.kw

OBJECTIVE: To investigate the effects of antioxidant therapy on the levels of
mediators of shock wave induced renal injury in patients with renal calculi
treated with extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS: 
One hundred and twenty patients with renal calculi were divided into three
treatment groups: Group A patients (n = 39) served as a control group; Group B
patients (n = 41) were given 2 capsules of Nature Made((R)) antioxidants 2 hours 
before, and 2 and 8 hours after ESWL and Group C patients (n = 40) were given 2
capsules of the antioxidants at 2 and 8 hours after ESWL. Blood and urine samples
were obtained from all patients just before the start of treatment with ESWL, and
at 2 and 24 hours and on day 7 and 28 after ESWL. Levels of mediators of renal
injury such as serum alkaline phosphatase (ALP), C-reactive protein (CRP) and
lactate dehydrogenase (LDH) were measured. Urinary levels of albumin and ALP were
also determined as measures of renal tubular injury. RESULTS: Patients given
antioxidants had significantly reduced mean serum concentration of ALP (p <
0.001) at 24 hours, lower serum ALP and LDH on day 7 and 28, and lowest CRP on
day 28 after ESWL. They also had higher urine albumin (p < 0.001) and ALP (p <
0.001) levels (from 24 hours to day 28) compared with patients who were not given
antioxidants. CONCLUSION: These findings suggest that oral antioxidant therapy
prior to lithotripsy may reduce the severity of long term renal injury caused by 
the shock waves.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 19046094 [PubMed - indexed for MEDLINE]

8: J Ayub Med Coll Abbottabad. 2008 Jan-Mar;20(1):60-2.

Frequency of renal stone disease in patients with urinary tract infection.

Jan H, Akbar I, Kamran H, Khan J.

Surgical Unit, DHQ Hospital, Charsadda. hizbullahsgr@hotmail.com

BACKGROUND: To determine incidence of renal stone disease in patients with
urinary tract infection, this cross sectional study was conducted at Surgical
Unit of District Head Quarters Hospital, Charsadda over a period of one year from
January to December 2005. METHODS: One hundred consecutive patients were enrolled
in this study. All those patients who presented with urinary symptoms were
included. While patients with lower urinary tract stones, upper urinary tract
stones with renal failure, renal tumours and previous history of renal stones
disease were excluded. The data was obtained and analyzed by filling a specially 
designed proforma for each patient. RESULTS: All 100 patients were between age
ranges of 15-60 years (Mean age 37.5 years). Infection was present in 79% of
cases. The commonest organisms isolated according to culture report were E. Coli 
(30%), Proteus (19%), Klebsiella (11%), Pseudomonas (7%), Staphylococcus aureus
(3%) etc. The frequency of renal stone disease in patients with urinary tract
infection was 18.98%. (12.6% in male and 6.3% in female). Mean age of patients
with renal stones was 31.26 years and male to female ratio was 1.5:1. CONCLUSION:
Renal stone disease makes an important group among urinary stone diseases.
Urinary tract infection with certain bacteria plays an important role in the
synthesis of renal stones. A high incidence can be prevented by adopting a
variety of simple conservative measures.

PMID: 19024188 [PubMed - indexed for MEDLINE]

9: BJU Int. 2009 Jan;103(1):18-21. Epub 2008 Nov 18.

A critical analysis of the role of gut Oxalobacter formigenes in oxalate stone
disease.

Siva S, Barrack ER, Reddy GP, Thamilselvan V, Thamilselvan S, Menon M, Bhandari
M.

Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA.

Hyperoxaluria is a major risk factor for the formation of calcium oxalate stones,
but dietary restriction of oxalate intake might not be a reliable approach to
prevent recurrence of stones. Hence, other approaches to reduce urinary oxalate
to manage stone disease have been explored. The gut-dwelling obligate anaerobe
Oxalobacter formigenes (OF) has attracted attention for its oxalate-degrading
property. In this review we critically evaluate published studies and identify
major gaps in knowledge. Recurrent stone-formers are significantly less likely to
be colonized with OF than controls, but this appears to be due to antibiotic use.
Studies in animals and human subjects show that colonization of the gut with OF
can decrease urinary oxalate levels. However, it remains to be determined whether
colonization with OF can affect stone disease. Reliable methods are needed to
detect and quantify colonization status and to achieve durable colonization. New 
information about oxalate transport mechanisms raises hope for pharmacological
manipulation to decrease urinary oxalate levels. In addition, probiotic use of
lactic acid bacteria that metabolize oxalate might provide a valid alternative to
OF.

Publication Types: 
    Review

PMID: 19021605 [PubMed - indexed for MEDLINE]

10: J Urol. 2009 Jan;181(1):144-8. Epub 2008 Nov 13.

Comment in:
    J Urol. 2009 Jan;181(1):11-2.

Safety and efficacy of percutaneous nephrostolithotomy in patients on
anticoagulant therapy.

Kefer JC, Turna B, Stein RJ, Desai MM.

Stevan B. Streem Center for Endourology, Glickman Urological and Kidney
Institute, Cleveland Clinic, Cleveland, Ohio, USA.

PURPOSE: We assessed the safety and efficacy of percutaneous nephrostolithotomy
in patients requiring long-term anticoagulant therapy. MATERIALS AND METHODS: We 
reviewed the records of 792 patients undergoing percutaneous nephrostolithotomy
at our institution from 2000 to 2007, and identified 27 on anticoagulation
therapy (warfarin, clopidogrel or cilostazol) who underwent surgery after
perioperative reversal and reinitiation of anticoagulation. Warfarin was withheld
5 days preoperatively with enoxaparin bridging and resumed 5 days
postoperatively. Clopidogrel and cilostazol were stopped 10 days preoperatively
and resumed 5 days postoperatively. We subsequently analyzed changes in
preoperative and postoperative hemoglobin, serum creatinine and clotting
parameters, as well as intraoperative and postoperative bleeding or
thromboembolic complications. RESULTS: Overall the stone-free rate with
percutaneous nephrostolithotomy monotherapy was 93% (25 of 27 patients). A second
look procedure was required in 5 patients and a third procedure was required in
1. Mean hemoglobin decrease was 1.5 gm/dl (range 0 to 4.1) and mean change in
serum creatinine was 0.03 mg/dl (range 0 to 0.4). Two patients (7%) had
significant bleeding and 1 (4%) had a thromboembolic complication. All
complications were successfully managed conservatively or in a minimally invasive
manner. All patients were stone-free at 1-month followup. CONCLUSIONS: With
careful perioperative regulation of anticoagulation therapy and clotting
parameters, percutaneous nephrostolithotomy can be performed safely and
efficiently in properly selected patients requiring long-term anticoagulation.

PMID: 19012931 [PubMed - indexed for MEDLINE]

11: J Urol. 2009 Jan;181(1):139-43. Epub 2008 Nov 13.

The safety of ureteroscopy during pregnancy: a systematic review and
meta-analysis.

Semins MJ, Trock BJ, Matlaga BR.

James Buchanan Brady Urological Institute, The Johns Hopkins University School of
Medicine, Baltimore, Maryland, USA.

PURPOSE: We performed a literature review and analysis to compare the safety of
ureteroscopic stone removal during pregnancy with findings from a set of
contemporary studies of that procedure in nonpregnant patients. MATERIALS AND
METHODS: A systematic review of MEDLINE(R) and EMBASE(R) was done to identify all
reports of ureteroscopic stone removal in pregnant women. Complications were
stratified according to modified Clavien criteria. We then reviewed a
contemporary, multi-national meta-analysis of ureteroscopic stone removal
(American Urological Association/European Association of Urology 2007 Guideline
for the Management of Ureteral Calculi) to define the complication rate in a
series of nonpregnant patients. Complication rates in the 2 reviews were compared
using Fisher's exact test. RESULTS: A total of 14 reports of ureteroscopic stone 
removal in pregnant women were identified, representing 108 patients. Nine
complications were noted. By Clavien criteria 2 complications were level 1, 6
were level 2 and 1 was level 3. When compared to the multinational meta-analysis 
of ureteroscopy in nonpregnant women, there was no significant difference in the 
ureteral injury and urinary tract infection complication rates (p = 0.191 and
0.597, respectively). CONCLUSIONS: Our analysis shows that the safety of
ureteroscopic stone removal in pregnant patients is not significantly different
from the safety of that procedure in nonpregnant patients and in each cohort the 
complication rate is low. Therefore, ureteroscopic stone removal may reasonably
be considered appropriate first line therapy in pregnant patients with stone
disease.

Publication Types: 
    Meta-Analysis
    Review

PMID: 19012926 [PubMed - indexed for MEDLINE]

12: J Urol. 2009 Jan;181(1):149-53. Epub 2008 Nov 13.

Comment in:
    J Urol. 2009 Jan;181(1):11-2.

Synchronous bilateral percutaneous nephrostolithotomy: analysis of clinical
outcomes, cost and surgeon reimbursement.

Bagrodia A, Raman JD, Bensalah K, Pearle MS, Lotan Y.

Department of Urology, The University of Texas Southwestern Medical Center,
Dallas, Texas, USA.

PURPOSE: We compared clinical outcomes, cost and physician reimbursement between 
simultaneous bilateral percutaneous nephrostolithotomy and theoretical matched
staged bilateral percutaneous nephrostolithotomy. MATERIALS AND METHODS: Between 
September 2005 and May 2007 we performed 200 percutaneous nephrostolithotomies
including 17 synchronous bilateral procedures. Complete clinical and cost
information was available and recorded for 15 patients. To compare variables
between comparable synchronous and staged bilateral percutaneous
nephrostolithotomy 152 unilateral percutaneous nephrostolithotomies were used to 
obtain similar parameters that were then used to estimate the outcomes of
theoretical staged bilateral percutaneous nephrostolithotomy. Operative time,
hospital length of stay, cost and physician reimbursement were determined
according to CPT codes for stone complexity (50080 for stones less than 2 cm,
50081 for stones 2 cm or greater) to match case complexity per renal unit.
RESULTS: Mean patient age (+/-SD) in the synchronous bilateral percutaneous
nephrostolithotomy group was 51 (+/-11) years and 25% of patients had staghorn
calculi. The stone-free rate after the initial procedure was 27% (4 of 15) and
second look nephroscopy was performed in 10 patients. Complications occurred in 4
patients and none required transfusion. Mean overall cost of synchronous
bilateral percutaneous nephrostolithotomy was $10,129. Cumulative room time,
length of stay and cost were higher in the staged than synchronous percutaneous
nephrostolithotomies. Physician reimbursement was 11% to 46% less for synchronous
bilateral percutaneous nephrostolithotomy. CONCLUSIONS: Synchronous bilateral
percutaneous nephrostolithotomy benefits patients and third party payors by
decreasing cumulative operating room time, length of stay and cost. However,
there is a disincentive for surgeons, who are financially penalized for
performing synchronous bilateral percutaneous nephrostolithotomy. Third party
payors should consider revising putative reimbursement policies for synchronous
bilateral percutaneous nephrostolithotomy as it is cost-effective in appropriate 
patients.

Publication Types: 
    Comparative Study

PMID: 19012904 [PubMed - indexed for MEDLINE]

13: Am J Med Genet A. 2008 Dec 15;146A(24):3120-5.

A report of an apparent new genetic syndrome consisting of joint contractures,
keloids, large optic cup-to-disc ratio and renal stones.

Heyen CA, Delk PR, Bull MJ, Weaver DD.

Department of Medical and Molecular Genetics, Indiana University School of
Medicine, Indianapolis, Indiana 46202-5251, USA.

We report on a family with an apparently undescribed syndrome involving joint
contractures, keloids, an increased optic cup-to-disc ratio, and renal stones.
The propositus presented at 9 years of age with congenital contractures of his
distal interphalangeal (DIP) joints, progressive stiffness of the shoulders and
neck, a large optic cup-to-disc ratio, and mildly dysmorphic facies. He otherwise
has been normal. The propositus's brother, uncle, great-uncle, a half
great-uncle, and six male half-cousins once removed also have DIP joint
stiffness. The propositus' mother and brother also have an increased optic
cup-to-disc ratio. In addition, the great-grandfather, the uncle, the same six
male half-cousins once removed, and an affected daughter of a half-cousin have
keloids with the earliest age of onset of the keloids being 12 years. Further,
three of the above affected males have had uric acid renal stones. Dupuytren
contractures and subcutaneous nodules were also present in some affected males.
Given the family history, the pattern of inheritance appears to be X-linked. An
extensive literature search failed to reveal any previous reports associating
these manifestations and this inheritance pattern. Therefore, we think the
condition in this family comprises a new genetic syndrome. Copyright (c) 2008
Wiley-Liss, Inc.

Publication Types: 
    Case Reports

PMID: 19006219 [PubMed - indexed for MEDLINE]

14: J Chin Med Assoc. 2008 Oct;71(10):496-501.

Predictive factors of lower calyceal stone clearance after extracorporeal
shockwave lithotripsy (ESWL): the impact of radiological anatomy.

Lin CC, Hsu YS, Chen KK.

Division of Urology, Department of Surgery, Taipei Veterans General Hospital,
Taipei, Taiwan, ROC.

BACKGROUND: This study was carried out to determine whether or not there is a
significant relationship between the radiologic anatomy of the lower calyx, as
seen on preoperative intravenous urography (IVU), and the outcome of stone
clearance after extracorporeal shockwave lithotripsy (ESWL) for lower renal
calyceal stones. METHODS: Between June 1998 and April 2007, 112 patients with a
solitary lower renal calyceal stone measuring 20 mm or less in size were enrolled
in this retrospective study. Pretreatment IVU was reviewed for measuring the
anatomical predictors, such as lower pole infundibular length, infundibular width
(IW) and infundibulopelvic angle, while the stone location and size were
determined on plain abdominal X-ray. All patients were treated with ESWL using a 
Siemens Lithostar Plus lithotriptor and were followed-up for the outcome of stone
clearance 3 months after ESWL with plain abdominal X-ray films and
ultrasonography. RESULTS: Three months after ESWL, only 49 (43.7%) patients were 
stone-free. Under multivariate analysis with logistic regression, smaller stone
size (10 mm or less, p = 0.005) and greater IW (4 mm or more, p = 0.029) were
significant favourable predictors for better stone clearance. CONCLUSION: In
addition to the influence of stone size, lower pole anatomy, especially IW, has a
significant impact on stone clearance for lower calyceal stone after ESWL.

PMID: 18955183 [PubMed - indexed for MEDLINE]

15: J Urol. 2008 Dec;180(6):2616-9; discussion 2619. Epub 2008 Oct 31.

Pediatric flexible ureteroscopic lithotripsy: the children's hospital of
Philadelphia experience.

Kim SS, Kolon TF, Canter D, White M, Casale P.

Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia,
Pennsylvania 19035, USA.

PURPOSE: Therapeutic options currently available for urinary stones include shock
wave lithotripsy, percutaneous nephrolithotomy and ureteroscopic treatment. While
these treatment options have become the standard of care in the adult population,
the same has not necessarily been applied to the pediatric population, despite an
increasing prevalence of stone disease in children. We report our flexible
ureteroscopic experience with urinary stones in children. MATERIALS AND METHODS: 
A total of 170 ureteroscopic treatments were performed. Demographic information
was collected. Stone burden was measured in millimeters. Operative access,
operative times, intraoperative complications, stone-free status and
postoperative complications were evaluated. RESULTS: A total of 167 children (89 
boys and 78 girls) underwent 170 ureteroscopic procedures for urinary calculi.
Mean patient age was 62.4 months at the time of the procedure (range 3 to 218).
Mean followup was 19.7 months (range 6 to 39). Mean stone burden was 6.12 mm
(range 3 to 24), with an average of 1.3 stones per patient. Retrograde access
could not be obtained in 95 of the children (57%). No ureters were actively
dilated. Flexible ureteroscopy was performed in all cases regardless of stone
location. Stone clearance was 100% for stone burdens 10 mm or less and 97% for
burdens greater than 10 mm after 1 ureteroscopy. CONCLUSIONS: Pediatric
ureteroscopy is a safe and efficacious modality in the treatment of all upper
urinary tract calculi, including lower pole calculi.

PMID: 18950810 [PubMed - indexed for MEDLINE]

16: J Urol. 2008 Dec;180(6):2545-9. Epub 2008 Oct 19.

Percutaneous nephrolithotomy success in the transplant kidney.

Krambeck AE, Leroy AJ, Patterson DE, Gettman MT.

Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 
55906, USA. Krambeck.amy@mayo.edu

PURPOSE: Treatment for symptomatic calculi in the transplanted kidney can be
problematic. Percutaneous nephrolithotomy has routinely been used but concerns
exist about potential injury to adjacent organs using a percutaneous access
technique. We report our experience with percutaneous nephrolithotomy in the
transplant kidney. MATERIALS AND METHODS: A retrospective chart review from 1988 
to the present was performed of all cases of a renal transplant and subsequent
renal calculi treated with percutaneous nephrolithotomy. RESULTS: We identified
13 patients with a renal transplant who underwent percutaneous nephrolithotomy.
Presenting symptoms included renal failure in 46.1% of cases, hematuria in 23.1%,
urinary tract infection/pyelonephritis in 23.1%, pain in 15.4%, fever in 7.7% and
hydronephrosis in 7.7%. Average calculus size was 1.36 cm (range 0.2 to partial
staghorn). A single access tract was used in 12 cases and 2 access tracts were
used in 1. Ultrasonic lithotripsy was performed in 10 cases, basket extraction
was performed in 3 and the 2 techniques were performed in 1. No intraoperative
complications occurred. Nephrostogram 24 hours after the procedure demonstrated
no residual fragments in 10 patients (76.9%). Repeat endoscopy was required in 3 
patients to achieve subsequent stone-free status. Postoperative complications
developed in 3 patients, including sepsis, gastrointestinal bleeding and herpes
esophagitis, respectively. Mean followup was 5.3 years (range 0.6 to 9). The
single stone recurrence was treated with shock wave lithotripsy. Mean creatinine 
was stable at 2.0 mg/dl (range 0.9 to 3.9) preoperatively to 1.7 mg/dl (range 0.9
to 2.6) at the last visit (p = 0.311). CONCLUSIONS: Percutaneous nephrolithotomy 
is safe and effective in the transplanted kidney. Minimal postoperative
complications were noted and stone-free status was achieved in all cases. At
long-term followup there were few stone recurrences with stable graft function
after the procedure.

PMID: 18930500 [PubMed - indexed for MEDLINE]

17: J Urol. 2008 Dec;180(6):2489-93. Epub 2008 Oct 19.

Prognostic factors and percutaneous nephrolithotomy morbidity: a multivariate
analysis of a contemporary series using the Clavien classification.

de la Rosette JJ, Zuazu JR, Tsakiris P, Elsakka AM, Zudaire JJ, Laguna MP, de
Reijke TM.

Department of Urology, Academic Medical Center, University of Amsterdam,
Amsterdam, The Netherlands. j.j.delarosette@amc.uva.nl

PURPOSE: We stratified factors affecting treatment morbidity, compared the
outcomes of percutaneous nephrolithotomy procedures from a single department and 
provided evidence of treatment benefits when percutaneous nephrolithotomy is
performed in an expert setting. MATERIALS AND METHODS: Since the department
became a dedicated endourological center in 2002 we grouped all percutaneous
nephrolithotomy procedures into those performed before 2002 (group 1) and after
2002 (group 2). The modified Clavien classification was used to score morbidity. 
Independent variables with an influence on complications were studied including
stone size, operating time, operative complications, dilation device, urine
culture, group allocation and lithotripsy device. Contingency and logistic
regression were used for univariate and multivariate analysis. RESULTS: Of the
244 percutaneous nephrolithotomy procedures 68 comprised group 1 and 176 formed
group 2. Statistical preoperative differences were patient age, the use of
anticoagulants and positive urinary cultures. Group 1 had a complication rate of 
56.8% and group 2 had a complication rate of 37.2%. There were significant
differences between the groups (p = 0.007). Almost all complications were grade 1
to 2. On univariate analysis the influence variables were urine culture (OR
1.69), group allocation (OR 2.20), stone size (OR 2.28), dilation device (OR
4.8), lithotripsy device (OR 1.22), perioperative complications (OR 2.83) and
surgical time (OR 1.87). On multivariate analysis the independent factors in the 
complicated outcome were stone size (OR 1.25), type of lithotripsy device (OR
1.35) and incidence of perioperative complications (OR 3.71). CONCLUSIONS: The
dedicated setting for percutaneous nephrolithotomy at our center resulted in
decreased operative time, more uneventful procedures and decreased
hospitalization time. The modified Clavien morbidity score is a reliable tool for
more objective outcome comparisons after renal stone treatment.

Publication Types: 
    Comparative Study

PMID: 18930485 [PubMed - indexed for MEDLINE]

18: J Endourol. 2008 Nov;22(11):2501-6.

Lower calyceal occlusion by autologous blood clot to prevent stone fragment
reaccumulation after retrograde intra-renal surgery for lower calyceal stones:
first experience of a new technique.

Patel A.

Department of Urology, St. Mary's Hospital at Imperial College School of
Medicine, Praed Street, London, W2 1NY UK. anup.patel@imperial.ac.uk

PURPOSE: We tested the hypothesis that lower calyceal (LC) autologous blood clot 
(ABC) occlusion, after retrograde intra-renal surgery (RIRS) may prevent LC
fragment reaccumulation where all fragments cannot be directly removed. METHODS: 
Over two years, patients with LC stones >6 mm <2 cm, that had presented de-novo
or failed primary SWL or PNL elsewhere, were treated with RIRS. After intra-renal
relocation into a favorable lie, stones were fragmented with Holmium laser energy
to <3 mm, suitable for spontaneous passage. The LC was filled with 5-10 cc venous
autologous blood with the patient in reverse Trendelenberg, leaving the blood to 
clot. After confirmatory pyelogram a DJ stent was placed. Ultrasound and KUB at 3
months assessed stone free rate. RESULTS: This technique was tested in 35
patients with LC calculi (16 as primary treatment, and 19 as salvage for residual
fragments post SWL or PNL). Nine salvage patients had indwelling DJ stents (three
significantly encrusted at RIRS). Nine unstented patients had upper ureteral
tortuosities or narrowing limiting multiple instrument passes for stone removal. 
Median maximum stone dimension was 1.2 cm. All were successfully relocated &
fragmented. A Nitinol basket was required for stone relocation in 60%. All but
one occlusion procedures succeeded at the first attempt. None required
re-admission for clot colic. Only 8.6% required more than overnight hospital
stay. Three and six month stone free rates were 94% and 97% respectively.
CONCLUSIONS: The simple LC autologous blood clot occlusion technique after RIRS, 
for difficult LC stones, validates our hypothesis and results in excellent stone 
free rates, while minimizing ureteral trauma from multiple instrument passages
needed for active fragment removal. This study supports the need for multi-center
experience of this technique to validate our results.

Publication Types: 
    Clinical Trial

PMID: 18928383 [PubMed - indexed for MEDLINE]

19: J Am Coll Nutr. 2008 Oct;27(5):519-27.

Calcium supplementation and incident kidney stone risk: a systematic review.

Heaney RP.

Creighton University, Omaha, NE 68131, USA. rheaney@creighton.edu

BACKGROUND: A report of a small increase in kidney stone risk in the calcium
treatment arm of the Women's Health Initiative (WHI) led to a reduction in U.S.
calcium supplement sales. OBJECTIVE: To reassess kidney stone risk in
postmenopausal women using data accumulated in calcium supplement trials, bone
active agent registration trials, and in unpublished WHI data available online;
and to compare these estimates with formal published epidemiological studies of
stone risk. METHODS: Literature review of published studies relating calcium
intake to stone risk; adverse event report data from pharmaceutical industrial
trials designed to evaluate bone active agents. RESULTS: Stone risk in
postmenopausal women has increased substantially in the past 40 years, but
absolute population incidence estimates vary widely from a low of about 70
incidents/100,000/yr for Olmsted County, MN, today, to a concurrent high of
approximately 190/100,000/yr for the Nurses' Health Study II. Reported WHI
incidence rates are higher still, with values around 300/100,000/yr for various
WHI subgroupings. The reasons for these discordances are unclear. Despite this
uncertainty about background rate, most of the studies show no increase in stone 
risk with high calcium intake (from either diet or supplements). Contrariwise
there is a substantial body of evidence, both from controlled trials and from
observational studies, indicating that there is an inverse relationship between
calcium intake and stone risk.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18845701 [PubMed - indexed for MEDLINE]

20: Hong Kong Med J. 2008 Oct;14(5):399-401.

Cystinuria: a rare diagnosis that should not be missed.

Chiu PK, Chan ES, Hou SS, Ng CF.

Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong.

Cystinuria is a rare autosomal recessive defect causing recurrent urinary tract
stone formation. Morbidity from stone formation and repeated urological
interventions can be reduced by early diagnosis and adequate medical treatment.
In this review, we illustrate these points by discussing three patients with
cystinuria and give a brief review of its management.

Publication Types: 
    Case Reports

PMID: 18840913 [PubMed - indexed for MEDLINE]

21: J Endourol. 2008 Oct;22(10):2207-10.

Differences in computed tomography density of the renal papillae of stone formers
and non-stone-formers: a pilot study.

Eisner BH, Iqbal A, Namasivayam S, Catalano O, Kambadakone A, Dretler SP, Sahani 
DV.

Department of Urology, Massachusetts General Hospital, Harvard Medical School,
Boston, Massachusetts 02114, USA. beisner@partners.org

PURPOSE: It is thought that Randall's plaques, calcium deposits in the renal
papillae of patients with nephrolithiasis, may serve as a nidus for stone
formation. We examined the density of renal papillae in patients with stones and 
control patients using attenuation measurements (HU) on Computed Tomography (CT) 
to determine whether nephrolithiasis is associated with radiographic changes in
renal papillae. MATERIALS AND METHODS: Hounsfield density measurements of a 0.2
cm2 area of the renal papillae of 17 patients with a single renal calyceal
calculus and 15 age-matched control patients were performed. Measurements were
done for renal papillae upper, middle, and lower pole calyces for all patients.
Statistical comparisons were made using the student's t-test. RESULTS: Patients
with nephrolithiasis and control patients were similar with respect to mean age
(41.2 years versus 42.2 years, p=0.82) and baseline serum creatinine (0.86 mg/dl 
versus 0.93 mg/dl, p=0.21). Mean Hounsfield density of renal papillae of stone
patients in calyces with stones was significantly greater than that of
location-matched papillae from control patients (54.4 versus 36.6, p<0.0001).
Mean Hounsfield density of all papillae of the affected kidney (i.e., kidney with
stone) in stone patients was significantly greater than that of control patients 
(50.9 versus 36.4, p<0.0001). Mean Hounsfield density of all papillae in the
stone-free kidney of stone patients was significantly greater than that of
control patients (50.0 versus 36.1, p<0.0001). In stone patients, when comparing 
the affected kidney with the stone-free kidney, there was no difference in mean
papilla Hounsfield density (50.3 versus 50.9, p=0.59). CONCLUSIONS: Hounsfield
density of the renal papilla is significantly increased in patients with
nephrolithiasis when compared with age-matched controls. This is true of calyces 
with stones, calyces without stones in kidneys with stones, and calyces of the
contralateral stone-free kidney. There is no difference in renal papilla
Hounsfield density between kidneys with and without stones in patients with
nephrolithiasis. In the future, this information may be useful in predicting
which patients may develop nephrolithiasis.

PMID: 18831676 [PubMed - indexed for MEDLINE]

22: J Endourol. 2008 Oct;22(10):2251-5.

Concomitant percutaneous nephrolithotomy and transperitoneal laparoscopic
pyeloplasty for ureteropelvic junction obstruction complicated by stones.

Agarwal A, Varshney A, Bansal BS.

RG Stone Urological Research Institute, New Delhi, India.
dranshuman.agarwal@gmail.com

INTRODUCTION: Ureteropelvic junction (UPJ) obstruction and stones can co exist.
Therapeutic controversy exists regarding their ideal management. We present our
experience of combining Percutaneous nephrolithotomy (PNL) with laparoscopic
pyeloplasty (LP),in patients with UPJ obstruction with multiple secondary, in the
same session or staged manner. PATIENTS AND METHOD: From November 2006 till April
2008 ten patients underwent PNL with LP at our institution. Two of these patients
had recurrent obstruction and stones after PNL and endopyelotomy. All patients
had multiple calyceal and pelvic calculi (>10) with sizes ranging from 3 to 24
mm. Mean age of patients was 33 years (17-55). PNL was done in standard manner
and was followed by laparoscopic pyeloplasty. RESULT: Complete stone clearance
could be achieved in all by PNL. Procedure was staged in 2 due to the presence of
infected hydronephrosis. 9 patients underwent dismembered pyeloplasty and in 1
Fengerplasty was done. Reduction of baggy pelvis was required in 3 cases. Mean
operative time was 3. 9 hours (3-5). Postoperatively the nephrostomy was kept for
an average of 2 days (1-3). Drain was removed after an average of 3. 5 days
(3-5). Mean hospital stay was 5. 2 days (5-7). None of the patients required
blood transfusion. Stent was removed after 4 weeks. At 6 months patients are
stone free on ultrasound and show good drainage on renal scan. One year follow-up
is available for 5 patients which shows a stone free status and good drainage
across UPJ. CONCLUSION: Concomitant PNL and laparoscopic pyeloplasty are feasible
and safe for patients with UPJ obstruction complicated by multiple calculi. We
did not encounter any intraoperative difficulty during pyeloplasty following PNL.

PMID: 18831672 [PubMed - indexed for MEDLINE]

23: Leukemia. 2009 Jan;23(1):104-8. Epub 2008 Oct 2.

Asymptomatic kidney stones in long-term survivors of childhood acute
lymphoblastic leukemia.

Kaste SC, Thomas NA, Rai SN, Cheon K, McCammon E, Chesney R, Jones D, Pui CH,
Hudson MM.

Department of Radiological Sciences, Division of Diagnostic Imaging, University
of Tennessee at Memphis, Memphis, TN, USA. sue.kaste@stjude.org

We hypothesized an association between renal calculi and bone mineral density
(BMD) deficits, shown in adults, exists in survivors of childhood acute
lymphoblastic leukemia (ALL). Thus, we analyzed the associations between
quantitative computed tomography (QCT)-determined renal calcifications and
clinical parameters (gender, race, age at diagnosis and age at the time of QCT), 
BMD, treatment exposures and Tanner stage. We investigated the associations
between stone formation and nutritional intake, serum and urinary calcium and
creatinine levels, and urinary calcium/creatinine ratio. Exact chi(2)-test was
used to compare categorical patient characteristics, and the
Wilcoxon-Mann-Whitney test to compare continuous measurements. Of 424
participants, 218 (51.4%) were males; 371 (87.5%) were nonblack. Most (n=270;
63.7%) were >or=3.5 years at ALL diagnosis. Mean (s.d.) and median (range) BMD
Z-scores of the entire cohort were -0.4 (1.2) and -0.5 (-3.9 to 5.1),
respectively. Nineteen participants (10 males; 10 Caucasians) had kidney stones
(observed prevalence of 4.5%; 19/424) with a significant negative association
between stone formation and body habitus (body mass index, P=0.003). Stone
formation was associated with treatment protocol (P=0.009) and treatment group
(0.007). Thus, kidney stones in childhood ALL survivors could herald the future
deterioration of renal function and development of hypertension. Long-term
follow-up imaging may be warranted in these patients to monitor for progressive
morbidity.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18830261 [PubMed - indexed for MEDLINE]

24: Urol J. 2008 Summer;5(3):188-91.

Percutaneous management of urinary calculi in horseshoe kidneys.

Majidpour HS, Yousefinejad V.

Department of Urology, Tohid Hospital, Kurdistan University of Medical Sciences, 
Sanandaj, Iran. h_majidpour2007@yahoo.com

Urolithiasis in horseshoe kidney presents a unique challenge in decision-making
and technical aspects of calculus treatment. We present our experience with a
group of patients with symptomatic calculi in their horseshoe kidneys. We had 8
patients with 9 horseshoe kidneys bearing calculi. They all underwent
percutaneous nephrolithotomy. The median size of the calculi was 21 mm (range, 12
to 45 mm). Auxiliary therapeutic procedures were required in 2 patients who had
residual calculi on control imaging. The stone-free status was observed in 6
patients (75.0%) at discharge, and in 7 (87.5%) after 3 months of follow-up.
Surgical complications included bleeding in 2 patients that was controlled with
complete bed rest and blood transfusion, and pleural injury in 1 which was
managed conservatively.

PMID: 18825627 [PubMed - indexed for MEDLINE]

25: Urol J. 2008 Summer;5(3):149-55.

Effect of thymoquinone on ethylene glycol-induced kidney calculi in rats.

Hadjzadeh MA, Mohammadian N, Rahmani Z, Rassouli FB.

Department of Physiology, Mashhad University of Medical Sciences, Mashhad, Iran. 
hajzadehmr@mums.ac.ir

INTRODUCTION: The aim of this study was to investigate the effects of
thymoquinone, a major component of Nigella Sativa seeds on ethylene
glycol-induced kidney calculi in rats. MATERIALS AND METHODS: Sixty male Wistar
rats were randomly divided into 6 groups (intact control, ethylene glycol
control, and 4 experimental groups) and treated for 28 days according to the
protocol of the study. The rats in experimental groups received ethylene glycol
and intraperitoneal injection of thymoquinone either from the first day of the
study or the 15th day, with either doses of 5 mg/kg or 10 mg/kg. Blood and
24-hour urine samples were collected at baseline and on day 28. Urine oxalate and
citrate and serum electrolytes were also measured. On day 29, all rats were
decapitated and their kidney specimens were studied. RESULTS: On day 28, urine
oxalate concentration significantly decreased in the experimental groups compared
to the ethylene glycol group (P < .001). Also, serum calcium levels were
significantly higher in the experimental groups (P = .001). Calcium oxalate
deposits were smaller in the experimental groups than the ethylene glycol group. 
The mean number of deposits was lower in these groups, too (P < .001). Treatment 
with the lower dose of thymoquinone was associated with fewer deposits.
CONCLUSION: Thymoquinone significantly decreased the number and size of calcium
oxalate deposits in the renal tubules. The dose and duration of treatment,
however, does not have a linear relation with the outcomes. Further studies on
thymoquinone as a preventive and therapeutic drug for kidney calculi are
suggested.

PMID: 18825620 [PubMed - indexed for MEDLINE]

26: Urology. 2008 Nov;72(5):996-1000. Epub 2008 Sep 26.

Some criteria to attempt second side safely in planned bilateral simultaneous
percutaneous nephrolithotomy.

Ugras MY, Gedik E, Gunes A, Yanik M, Soylu A, Baydinc C.

Department of Urology, Inonu University Medical Faculty, Malatya, Turkey.
mugras@inonu.edu.tr

OBJECTIVES: To determine the validity of some criteria that could guide in the
decision to cancel or proceed with the second side of planned bilateral
simultaneous percutaneous nephrolithotomy (bsPCNL). METHODS: Patients with an
indication for bilateral PCNL were enrolled in this study. The operation was
stopped at the end of the initial side if operative time was >180 min, the
hemoglobin level was <11 g/dL, the hemoglobin decrease was >3 g/dL, the systolic 
arterial pressure was <100 mm Hg, the arterial oxygen saturation was <95%, the
arterial blood pH was <7.35, or the blood sodium was <128 mg/mL. The success and 
complication rates were compared in patients who underwent second side PCNL
(group 1) and those for whom the procedure was stopped after the initial side
(group 2). RESULTS: Of 42 planned bsPCNLs, 12 were stopped after the initial
side, with the cause being prolonged operative time in 7, hemoglobin decrease in 
6, systolic arterial pressure decrease in 2, arterial oxygen saturation decrease 
in 2, pH decrease in 1, and sodium decrease in 1. Differences in patient
characteristics, stone burdens, and overall success and complication rates were
insignificant. Transfusion, postoperative urinary infection, and prolonged urine 
drainage rates were similar, but the total hospitalization time was significantly
longer in group 2. One hydrothorax and one renal pelvic perforation occurred in
group 2. The need for transfusion correlated positively with the number of
nephrostomy tracts in group 2 (r = 0.895, P = .001). No such correlation was
found in group 1. CONCLUSIONS: Despite the best of intentions, about 30% of
anticipated bsPCNL cases might be limited to single-sided PCNL, depending on the 
intraoperative events. Our criteria seem reasonable, because similar success and 
complication rates were obtained with bilateral, separate-session PCNL and
bsPCNL. These criteria can be considered in the decision making to omit the
advantages of a single session for safety.

PMID: 18822452 [PubMed - indexed for MEDLINE]

27: Urology. 2008 Nov;72(5):991-5. Epub 2008 Sep 26.

Single center, single operator comparative study of the effectiveness of
electrohydraulic and electromagnetic lithotripters in the management of 10- to
20-mm single upper urinary tract calculi.

Jamshaid A, Ather MH, Hussain G, Khawaja KB.

Department of Surgery, Aga Khan University, Karachi, Pakistan.

OBJECTIVES: This study compared the efficacy and safety profile of
electrohydraulic (EH) and electromagnetic (EM) lithotriptors in the treatment of 
10- to 20-mm renal and proximal ureteric stones at a single center and by a
single operator. METHODS: Between January 2001 and December 2006, we sequentially
treated patients meeting study inclusion criteria with MPL 9000 Dornier EH for
the first 3 years, followed by the EM Siemens Modularis shockwave lithotripsy
(SWL) unit. A single operator performed all SWL treatments under the supervision 
of an admitting urologist. We analyzed the demographic features and stone- and
treatment-related parameters including complications for both groups. In each
group, the stone-free rate and efficiency quotient was determined at 1-3 months. 
RESULTS: Of 274 patients, we sequentially treated 112 using the EH lithotriptor, 
and 162 the EM lithotriptor. The pre-SWL patients and stone-related parameters
were similar in the two groups, except for diagnostic imaging modalities. The
mean number of SWL sessions, need for ancillary procedure, retreatment rate,
stone location, stone-free rate, and efficiency quotient were not significantly
different between groups. The mean number of shockwaves required for complete
fragmentation was 2977 and 6044 (P < .000) for the EH and EM groups,
respectively. CONCLUSIONS: Single center, single operator experience with two
types of lithotriptor indicated that both are equally efficacious, with similar
safety profiles. The only significant difference was that the EH lithotriptor
required fewer shockwaves for fragmentation.

Publication Types: 
    Comparative Study

PMID: 18822451 [PubMed - indexed for MEDLINE]

28: J Endourol. 2008 Sep;22(9):2175-9.

Anatomic predictors of formation of lower caliceal calculi: is it the time for
three-dimensional computed tomography urography?

El-Assmy A, Abo-Elghar ME, El-Nahas AR, Youssef RF, El-Diasty T, Sheir KZ.

Department of Urology, Urology & Nephrology Center, Mansoura University,
Mansoura, Egypt.

OBJECTIVE: To evaluate the various anatomic factors, using computed tomography
urography (CTU), that predispose to a lower-pole kidney stone formation on one
side compared with the other. Materials and METHODS: The study included 51
patients with a solitary lower-pole stone. Lower-pole infundibulopelvic angle
(IPA), infundibular width (IW), infundibular length (IL), caliceal volume (CV),
and number of minor calices of the affected lower calyx and normal contralateral 
kidney were measured based on CTU. The IPA was measured according to the methods 
of Sampaio and Elbahnasy. A comparison was made using multivariate analysis to
determine whether any of these measurements predisposed one side to form stones. 
RESULTS: The mean IPA was 80.9 degrees (Sampaio), and 52.3 degrees (Elbahnasy) on
the affected kidney and 87.5 degrees (P = 0.39) and 54 degrees (P = 0.36) on the 
normal side. The mean IW was 2.6 mm on affected side and 3.15 mm on the normal
side (P = 0.03). The mean IL was 19.7 mm and 15.3 mm (P < 0.001) on the affected 
and normal kidneys, respectively. Mean CV was 1123 mm(3) on affected side and 286
mm(3) on the normal side (P < 0.001). The mean number of minor calices was
comparable (n = 3) on both sides with no statistical significance. Using
multivariate analysis, only caliceal volume and IW sustained their significance
in the final model. CONCLUSIONS: CTU is a very useful imaging modality in the
diagnosis of intrarenal anatomic variation. Larger caliceal volume and narrower
IW are associated with stone formation in lower calyx.

PMID: 18811576 [PubMed - indexed for MEDLINE]

29: J Urol. 2008 Nov;180(5):2212-7. Epub 2008 Sep 20.

Atorvastatin inhibits renal crystal retention in a rat stone forming model.

Tsujihata M, Momohara C, Yoshioka I, Tsujimura A, Nonomura N, Okuyama A.

Department of Urology, Osaka University Graduate School of Medicine, Suita,
Japan. tsujihata@uro.med.osaka-u.ac.jp

PURPOSE: The interactions between crystals and renal tubular cells are important 
factors in urolithiasis formation. Moreover, some reports have suggested the
involvement of renal tubular cell injury in crystal-cell interaction processes.
Atorvastatin, which is a competitive inhibitor of 3-hydroxy-3-methylglutaryl
coenzyme A, is prescribed to decrease high cholesterol levels, and it has
anti-inflammation and anti-oxidization activities. Atorvastatin is also reported 
to control transforming growth factor-beta1 expression. We investigated whether
atorvastatin can prevent renal tubular cell injury by oxalate and inhibit renal
crystal retention. MATERIALS AND METHODS: Ten-week-old specific pathogen-free
male Sprague-Dawley rats were used. Atorvastatin (2 mg/kg) in 0.5% carboxymethyl 
cellulose was administered orally daily for 2 weeks. The rats were separated into
4 experimental groups, including group 1--water and 0.5% carboxymethyl cellulose 
daily, group 2--water and atorvastatin in 0.5% carboxymethyl cellulose daily,
group 3--1% ethylene glycol dissolved in water, 0.5 mug vitamin D3 dissolved in 1
ml salad oil and 0.5% carboxymethyl cellulose daily, and group 4--1% ethylene
glycol dissolved in water, 0.5 microg vitamin D3 dissolved in 1 ml salad oil and 
atorvastatin in 0.5% carboxymethyl cellulose daily. The ethylene glycol model of 
hyperoxaluria and the effect of atorvastatin treatment were analyzed in groups 1 
to 4. Urine samples were collected every 24 hours in metabolic cages and analyzed
immediately or stored at -70C until analysis. The rats were sacrificed after 2
weeks and the kidneys were removed for further examination. We measured urinary
N-acetyl glucosaminidase levels as a biomarker of renal tubular cell injury and
urinary 8-OHdG as a biomarker of oxidative stress in 24-hour urine samples.
Removed kidneys were used for quantitative analysis of the superoxide dismutase
level and the detection of apoptosis. Finally, we measured the amount of crystal 
deposits in renal tubular cells. RESULTS: Urinary N-acetyl glucosaminidase and
8-OHdG levels were decreased significantly by atorvastatin treatment in this
stone forming rat model. Atorvastatin treatment increased the superoxide
dismutase level and inhibited the degree of renal tubular cell N-acetyl
glucosaminidase compared with stone forming control group 3. A decrease in renal 
crystal retention was noted when excised kidneys were evaluated following
atorvastatin treatment. CONCLUSIONS: Atorvastatin was found to have inhibitory
effects on the renal tubular cell injury and oxidative stress caused by oxalate
and crystals. Atorvastatin inhibited renal crystal retention. We believe that
atorvastatin could help prevent and treat renal crystal formation.

PMID: 18804815 [PubMed - indexed for MEDLINE]

30: J Urol. 2008 Nov;180(5):2150-3; discussion 2153-4. Epub 2008 Sep 18.

Pediatric ureteroscopic management of intrarenal calculi.

Tanaka ST, Makari JH, Pope JC 4th, Adams MC, Brock JW 3rd, Thomas JC.

Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at
Vanderbilt, Nashville, Tennessee 37232-9820, USA. stacy.tanaka@vanderbilt.edu

PURPOSE: Data addressing ureteroscopic management of intrarenal calculi in
prepubertal children are limited. We reviewed our experience from January 2002
through December 2007. MATERIALS AND METHODS: We retrospectively reviewed
ureteroscopic procedures for intrarenal calculi in children younger than 14
years. Stone-free status was determined with postoperative imaging. Multiple
logistic regression analysis was used to assess the influence of preoperative
factors on initial stone-free status and the need for additional procedures.
RESULTS: Intrarenal calculi were managed ureteroscopically in 52 kidneys in 50
children with a mean age of 7.9 years (range 1.2 to 13.6). Mean stone size was 8 
mm (range 1 to 16). Stone-free rate after a single ureteroscopic procedure was
50% (25 of 50 patients) on initial postoperative imaging and 58% (29 of 50) with 
extended followup. Initial stone-free status was dependent on preoperative stone 
size (p = 0.005) but not stone location. Additional stone procedures were
required in 18 upper tracts. Younger patient age (p = 0.04) and larger
preoperative stone size (p = 0.002) were associated with the need for additional 
procedures. Additional procedures were required in more than half of the stones 6
mm or larger but in no stone smaller than 6 mm. CONCLUSIONS: Ureteroscopy is a
safe method for the treatment of intrarenal calculi in the prepubertal
population. Our ureteroscopic stone-free rate for intrarenal stones is lower than
that reported for ureteral stones. Parents should be informed that additional
procedures will likely be required, especially in younger patients and those with
stones larger than 6 mm.

PMID: 18804225 [PubMed - indexed for MEDLINE]

31: Urology. 2008 Nov;72(5):1006-11. Epub 2008 Sep 16.

Tamsulosin facilitates earlier clearance of stone fragments and reduces pain
after shockwave lithotripsy for renal calculi: results from an open-label
randomized study.

Naja V, Agarwal MM, Mandal AK, Singh SK, Mavuduru R, Kumar S, Acharya NC, Gupta
N.

Department of Urology, Postgraduate Institute of Medical Education and Research, 
Chandigarh, India.

OBJECTIVES: To evaluate the role of tamsulosin in the clearance of fragments
after extracorporeal shock wave lithotripsy (ESWL) to treat renal calculi.
METHODS: In this open-label prospective randomized study conducted at our
institute from 2006 to 2007, 139 patients with normal renal function and a single
radiopaque renal calculus, 5-20 mm, undergoing ESWL were enrolled. All patients
underwent ESWL every 3 weeks until success or for <or=3 months, whichever was
earlier. They were randomly assigned to 2 groups with respect to whether they had
received tamsulosin, 0.4 mg/d. The primary endpoint was the success rate, and the
secondary endpoints were clearance time, sessions required for clearance, pain
intensity, incidence of steinstrasse, and the need for auxiliary procedures.
RESULTS: Of the 139 patients, 51 in group 1 and 65 in group 2 completed the
requisite follow-up. The demographic profile of both groups was comparable. The
success rate after 1, 2, and 3 ESWL sessions was greater in group 1 than in group
2 (52.9%, 78.4%, and 94.1% vs 30.8%, 52.3%, and 75.4%; P = .016, P = .004, and P 
= .007, respectively). The total days required for success (35.53 +/- 19.47 vs
47.22 +/- 23.64; P = .006), total ESWL sessions required for success (1.66 vs
2.16; P = .005), and the pain experienced (visual analog scale score 28.67 +/-
20.35 vs 47.30 +/- 24.98, respectively; P = .0001) were significantly less in
group 1. Two patients in group 1 and 9 in group 2 developed steinstrasse (P =
.10); conservative management was successful in 1 patient in each group (P =
.345). Three patients in group 1 and 10 in group 2 required auxiliary procedures 
(P = .14). CONCLUSIONS: The results of our study have shown that tamsulosin
facilitates earlier clearance of fragments after ESWL to renal calculi and helps 
reduce the severity of the pain. It tended to facilitate spontaneous clearance of
steinstrasse; however, this requires additional evaluation.

Publication Types: 
    Randomized Controlled Trial

PMID: 18799202 [PubMed - indexed for MEDLINE]

32: Minerva Urol Nefrol. 2008 Sep;60(3):159-75.

The current status of percutaneous nephrolithotomy in the management of kidney
stones.

Yuhico MP, Ko R.

Department of Urology, Nepean Hospital, Kingswood, 2747 NSW, Australia.

Large kidney stones (>2 cm) is a common problem affecting all population groups
across the globe and may result in significant complications if left untreated.
The treatment for this condition has evolved dramatically over the past seven
decades with the advent of minimally invasive treatment options. At the forefront
of this paradigm shift is the development of percutaneous nephrolithotomy (PCNL).
This has resulted in shorter hospital stays, reduced postoperative pain, and
quicker convalescence compared with the previous criterion standard of open stone
surgery. PCNL is only one of the many minimally invasive treatment options
available for this condition, but remains the most efficient in all patient
groups. However, it continues to be one of the more challenging urological
procedures, which if not performed well, can be associated with significant
complications. Refinements in techniques, improvement in equipment and increasing
clinical experience have led to improved stone free rates being achieved with
acceptably low patient morbidity. In this article, authors review the technical
aspects, outcomes, and current role of PCNL in the treatment of large kidney
stones.

Publication Types: 
    Review

PMID: 18787511 [PubMed - indexed for MEDLINE]

33: N Engl J Med. 2008 Sep 11;359(11):1128-35.

Comment in:
    N Engl J Med. 2008 Dec 11;359(24):2615-6; author reply 2616-7.    N Engl J Med. 2008 Dec 11;359(24):2616; author reply 2616-7.    N Engl J Med. 2008 Sep 11;359(11):1171-3.

NHERF1 mutations and responsiveness of renal parathyroid hormone.

Karim Z, Gérard B, Bakouh N, Alili R, Leroy C, Beck L, Silve C, Planelles G,
Urena-Torres P, Grandchamp B, Friedlander G, Prié D.

INSERM Unité 845, Université Paris Descartes, Faculté de Médecine, Paris, France.

Impaired renal phosphate reabsorption, as measured by dividing the tubular
maximal reabsorption of phosphate by the glomerular filtration rate (TmP/GFR),
increases the risks of nephrolithiasis and bone demineralization. Data from
animal models suggest that sodium-hydrogen exchanger regulatory factor 1 (NHERF1)
controls renal phosphate transport. We sequenced the NHERF1 gene in 158 patients,
94 of whom had either nephrolithiasis or bone demineralization. We identified
three distinct mutations in seven patients with a low TmP/GFR value. No patients 
with normal TmP/GFR values had mutations. The mutants expressed in cultured renal
cells increased the generation of cyclic AMP (cAMP) by parathyroid hormone (PTH) 
and inhibited phosphate transport. These NHERF1 mutations suggest a previously
unrecognized cause of renal phosphate loss in humans. 2008 Massachusetts Medical 
Society

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18784102 [PubMed - indexed for MEDLINE]

34: BJU Int. 2008 Dec;102(11):1676-80. Epub 2008 Sep 8.

Urolithiasis in the horseshoe kidney: a single-centre experience.

Symons SJ, Ramachandran A, Kurien A, Baiysha R, Desai MR.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat,
India.

OBJECTIVE: To report the operative management and subsequent stone-free rates of 
patients with urolithiasis in a horseshoe kidney and treated at one centre.
PATIENTS AND METHODS: We retrospectively reviewed all patients presenting to our 
centre with a horseshoe kidney and urolithiasis over a 15-year period. The stone 
burden, surgical management, complications and stone clearance rates were
recorded. RESULTS: In all, 55 patients with urolithiasis in horseshoe kidney were
treated. Percutaneous nephrolithotomy (PCNL) was used in 60 renal units in 47
patients. Five patients had extracorporeal shock wave lithotripsy (ESWL), two had
flexible ureteroscopy and one had a laparoscopic pyelolithotomy for a stone
extending into the isthmus. PCNL was used for large stones (mean digitized
surface area = 614.32 mm(2)) and required one to four stages to achieve an
overall stone clearance rate of 88%. Stones were cleared at one sitting in 77% of
PCNL procedures, completely cleared in two-thirds of patients treated by ESWL,
and in both who had flexible ureteroscopy and the one treated with laparoscopic
pyelolithotomy. Complications were minimal, with 15% minor and 3% major
complications in the PCNL group only. CONCLUSION: Appropriate management of
urolithiasis within the horseshoe kidney depends not only on stone burden, but
also on stone location, calyceal configuration and malrotation. Stones can be
cleared successfully in almost all patients providing that all techniques are
available to the operating surgeon.

PMID: 18782315 [PubMed - indexed for MEDLINE]

35: Urol Res. 2008 Oct;36(5):251-8. Epub 2008 Sep 9.

Protein content of human apatite and brushite kidney stones: significant
correlation with morphologic measures.

Pramanik R, Asplin JR, Jackson ME, Williams JC Jr.

Litholink Corporation, 2250 West Campbell Park Drive, Chicago, IL 60612, USA.
rockypra@gmail.com

Apatite and brushite kidney stones share calcium and phosphate as their main
inorganic components. We tested the hypothesis that these stone types differ in
the amount of proteins present in the stones. Intact stones were intensively
analyzed by microcomputed tomography (micro CT) for both morphology (including
the volume of voids, i.e., space devoid of X-ray dense material) and mineral
type. To extract all proteins present in kidney stones in soluble form we
developed a three-step extraction procedure using the ground stone powder.
Apatite stones had significantly higher levels of total protein content and void 
volume compared to brushite stones. The void volume was highly correlated with
the total protein contents in all stones (r2 = 0.61, P < 0.0001), and brushite
stones contained significantly fewer void regions and proteins than did apatite
stones (3.2 +/- 4.5% voids for brushite vs. 10.8 +/- 11.2% for apatite, P <
0.005; 4.1 +/- 1.6% protein for brushite vs. 6.0 +/- 2.4% for apatite, P < 0.03).
Morphological observations other than void volume did not correlate with protein 
content of stones, and neither did the presence or absence of minor mineral
components. Our results show that protein content of brushite and apatite stones 
is higher than that was previously thought, and also suggest that micro
CT-visible void regions are related to the presence of protein.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 18779958 [PubMed - indexed for MEDLINE]

36: Urol Clin North Am. 2008 Aug;35(3):441-54, viii.

Minimally invasive approaches to upper urinary tract urolithiasis.

Wignall GR, Canales BK, Denstedt JD, Monga M.

Division of Urology, University of Western Ontario, 268 Grosvenor Street, London,
Ontario, Canada N6A 4V2.

The surgical management of urolithiasis is an ever-changing discipline that
presents unique challenges to the urologist. This article reviews the current
minimally invasive treatment options for upper urinary tract urolithiasis. First 
it examines several factors that influence stone-free rates, including Hounsfield
units of calculi, obesity, and lower pole factors. Surgical management of
ureteral calculi is reviewed along with a discussion of stone management in
high-risk patients including those who are pregnant. Surgical technique of
shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and
laparoscopy is discussed in depth, with attention paid to possible variations in 
technique.

Publication Types: 
    Review

PMID: 18761198 [PubMed - indexed for MEDLINE]

37: Urol Int. 2008;81(2):206-9. Epub 2008 Aug 29.

Age-related changes of urine calcium excretion after extracorporeal shock wave
lithotripsy due to artificial renal calcium leakage.

Oehlschläger S, Hakenberg OW, Froehner M, Wirth MP.

Department of Urology, Technical University, Dresden, Germany.

INTRODUCTION: Extracorporeal shock wave lithotripsy (ESWL) is the standard stone 
treatment. Increased excretion of tubular enzymes and hypercalciuria has been
reported after ESWL. We investigated the importance of renally induced
hypercalciuria after ESWL. MATERIAL AND METHODS: 30 calcium oxalate stoneformers 
(23 men, 7 women), mean age 53.3 (range 30-71) years, were evaluated
prospectively. Plasma calcium and creatinine concentrations and 8-hour overnight 
urine were measured before ESWL and on the 1st and 2nd days after ESWL. To
estimate the changes of tubular reabsorption, the calcium/creatinine clearance
ratios were calculated. RESULTS: Hypercalciuria (>5 mmol/24 h) was seen in 5/30
(16.7%) before, in 12/30 (40.0%) on day 1 and in 13/30 (43.3%) on day 2 after
ESWL. The mean plasma levels of calcium were significantly decreased from 2.36
mmol/l before to 2.28 mmol/l on day 2 after ESWL (p< 0.01). The mean
calcium/creatinine clearance ratio was significantly increased from 0.012 before 
to 0.019 after ESWL (p< 0.01). Before and on day 2 after ESWL, the
calcium/creatinine clearance ratio was significantly correlated with the age of
the patients (r = 0.33, p< 0.04). CONCLUSION: Our data show an age-related
significantly increased urine calcium excretion after ESWL possibly due to
decreased tubular calcium reabsorption. (c) 2008 S. Karger AG, Basel.

PMID: 18758221 [PubMed - indexed for MEDLINE]

38: Urol Int. 2008;81(2):135-8. Epub 2008 Aug 29.

Eicosapentaenoic acid has a preventive effect on the recurrence of
nephrolithiasis.

Yasui T, Suzuki S, Itoh Y, Tozawa K, Tokudome S, Kohri K.

Department of Nephro-urology, Nagoya City University Graduate School of Medical
Sciences, Nagoya, Japan. yasui@med.nagoya-cu.ac.jp

BACKGROUND: With a westernized diet the oxygenated products of renal
prostaglandin synthesis are metabolites of the n-6 series and these are known to 
play important roles in several pathophysiological processes involved in calcium 
stone formation. As eicosapentaenoic acid (EPA) administration is effective for
the prevention of hyperlipidemia and atherosclerosis, we suggest the use of EPA
as a possible method of preventing calcium stone formation. METHODS: We
administered a highly purified preparation of 1,800 mg/day EPA to 29 patients for
36.4 +/- 22.0 months after therapy for nephrolithiasis. We observed the urinary
stone recurrence in these patients over the course of 8 years (before, during and
after medication) and studied the preventive effect on the recurrence of
nephrolithiasis. We analyzed the effect of EPA administration and compared the
findings to those before and after administration. RESULTS: The incidence rates
of nephrolithiasis (times/year) before, during and after the administration of
EPA were 0.2283, 0.0693 and 0.1742, respectively. The incidence rate of
nephrolithiasis during the administration of EPA was significantly lower compared
the findings to those before and after its administration (p < 0.05). CONCLUSION:
The results suggest that EPA might reduce the risk of calcium stone formation.
(c) 2008 S. Karger AG, Basel.

Publication Types: 
    Comparative Study

PMID: 18758209 [PubMed - indexed for MEDLINE]

39: BJU Int. 2009 Jan;103(1):81-4. Epub 2008 Aug 22.

Extracorporeal shock wave lithotripsy in children: equivalent clearance rates to 
adults is achieved with fewer and lower energy shock waves.

Kurien A, Symons S, Manohar T, Desai M.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad Gujarat,
India.

OBJECTIVE: To compare the outcome, safety and efficiency of extracorporeal shock 
wave lithotripsy (ESWL) using an electromagnetic lithotripter for upper urinary
tract stones in children and adults. PATIENTS AND METHODS: We retrospectively
reviewed data over a 5-year period for patients with solitary, renal and upper
ureteric stones measuring <2 cm in whom ESWL was the treatment method. Group A
consisted of 44 children (mean [SD] age 5.9 [4.4] years) and group B of 562
adults (mean [SD] age 40.9 [13.1] years). The number and energy of SWs used was
not predetermined and was tailored until adequate fragmentation was achieved.
Initial stone reassessment was performed at 48 h and monthly thereafter. The
number of SWs, intensity of SWs, stone-free rate, auxiliary procedure rate,
re-treatment rate, complication rate and effectiveness quotient (EQ) were
assessed in each group. RESULTS: The stone-free rate with ESWL was 84% in
children and 87% in adults (P = 0.78). The EQ was 77% and 75% in children and
adults, respectively (P = 0.56). The mean (sd) number of SWs and energy required 
per session was 950 (349) and 11.83 (0.48) kV in children and 1262 (454) and
12.36 (0.34) kV in adults (P < 0.001). The re-treatment, auxiliary procedure and 
complication rates were similar in both groups. CONCLUSION: ESWL is as safe and
effective in children as in adults for solitary renal and upper ureteric stones
that are <2 cm. Children required significantly fewer and lower energy SWs to
achieve equivalent results.

Publication Types: 
    Evaluation Studies

PMID: 18727616 [PubMed - indexed for MEDLINE]

40: J Urol. 2008 Oct;180(4 Suppl):1865-8. Epub 2008 Aug 21.

Extracorporeal shock wave lithotripsy in pediatric patients using a late
generation portable lithotriptor: experience at Children's Hospital Boston.

Nelson CP, Diamond DA, Cendron M, Peters CA, Cilento BG.

Department of Urology, Children's Hospital Boston and Harvard Medical School,
Boston, Massachusetts, USA. caleb.nelson@childrens.harvard.edu

PURPOSE: Kidney stones in children are increasing in incidence. The continued
evolution of stone treatment modalities, including shock wave lithotripsy, makes 
the assessment of continuous outcomes essential. We describe contemporary shock
wave lithotripsy outcomes in pediatric patients. MATERIALS AND METHODS: A medical
record review was performed of all patients younger than 20 years who underwent
shock wave lithotripsy in 1998 to 2007. Patients were treated using a Dornier
Compact Delta lithotriptor with ultrasound and fluoroscopic imaging. Subjects
were defined as stone-free if imaging within 12 months showed no evidence of
stones with no additional treatment. Patient and treatment factors associated
with successful outcomes were analyzed. RESULTS: In 101 children a total of 114
treatment sequences were performed at a total of 150 shock wave lithotripsy
sessions. Mean patient age was 10.5 years and 53% of the patients were girls.
Mean stone diameter was 8 mm. Treatment was done for a solitary stone in 76% of
cases, for 2 stones in 17% and for 3 or more in 7% with a mean shock count of
2,247. One, 2 and 3 or more treatment sessions were done in 78%, 16% and 6% of
patients, respectively. The overall stone-free rate was 58.6%. However, the
stone-free rate was only 12.5% after treatment sequences in 20 children with a
history of anatomical urological conditions or surgery, while the stone-free rate
in children without urological conditions was 67% (p <0.0001). Another factor
associated with a decreased stone-free rate was stone size greater than 10 mm
(25% vs 63%, p = 0.01). Complications included requiring acute reevaluation or
treatment after 7% of shock wave lithotripsy sessions and 3.4% of patients
required readmission. CONCLUSIONS: Extracorporeal shock wave lithotripsy is
effective in many children with urolithiasis and it is well tolerated. However,
in some children, particularly those with a history of urological surgery or
congenital genitourinary conditions, success rates are low. These children may be
best treated with other modalities.

PMID: 18721967 [PubMed - indexed for MEDLINE]

41: AJR Am J Roentgenol. 2008 Sep;191(3):908-11.

Primary hyperparathyroidism: is there an increased prevalence of renal stone
disease?

Suh JM, Cronan JJ, Monchik JM.

Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown
University and Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA.

OBJECTIVE: Parathyroid adenomas cause hypercalcemia and are culprits in the
development of renal stone disease. With serum assays available, early detection 
of parathyroid tumors is possible. We performed this retrospective review to
determine whether the prevalence of nephrocalcinosis and nephrolithiasis is still
increased in patients with primary hyperparathyroidism compared with those not
affected by the disorder in view of the early detection of parathyroid adenomas. 
MATERIALS AND METHODS: We retrospectively reviewed the renal sonograms of 271
patients with surgically proven primary hyperparathyroidism. All patients had
undergone renal imaging within 6 months before parathyroid surgery. Our control
group consisted of 500 age-matched subjects who had right upper quadrant
sonograms obtained for various reasons. RESULTS: Nineteen (7.0%) of the 271
patients with primary hyperparathyroidism had renal stones, and eight (1.6%) of
the 500 subjects in the control group had stones. Pearson's chi-square analysis
showed that this difference in prevalence is significant (p < 0.0001).
CONCLUSION: Our results showed a fourfold increased prevalence of asymptomatic
renal stone disease in patients with surgically proven primary
hyperparathyroidism compared with subjects not affected by the disorder. The
National Institutes of Health consensus conference on asymptomatic primary
hyperparathyroidism recommended that patients with renal stone disease undergo
parathyroid surgery. These patients should undergo surgery even if they have
minimal or no elevation of the total serum calcium value and no other metabolic
manifestations of hyperparathyroidism. The finding of nephrocalcinosis or
nephrolithiasis is, therefore, a significant finding in evaluating patients for
parathyroid surgery. Routine imaging of the kidneys is necessary when primary
hyperparathyroidism is documented.

PMID: 18716127 [PubMed - indexed for MEDLINE]

42: Am J Physiol Renal Physiol. 2008 Nov;295(5):F1286-94. Epub 2008 Aug 20.

Evidence for increased postprandial distal nephron calcium delivery in
hypercalciuric stone-forming patients.

Worcester EM, Coe FL, Evan AP, Bergsland KJ, Parks JH, Willis LR, Clark DL,
Gillen DL.

Department of Medicine, University of Chicago School of Medicine, 5841 South
Maryland Ave, Chicago IL 60637, USA. eworcest@uchicago.edu

A main mechanism of idiopathic hypercalciuria (IH) in calcium stone-forming
patients (IHSF) is postprandial reduction of renal tubule calcium reabsorption
that cannot be explained by selective reduction of serum parathyroid hormone
levels; the nephron site(s) responsible are not as yet defined. Using fourteen
1-h measurements of the clearances of sodium, calcium, and endogenous lithium
during a three-meal day in the University of Chicago General Clinical Research
Center, we found reduced postprandial proximal tubule reabsorption of sodium and 
calcium in IHSF vs. normal subjects. The increased distal sodium delivery is
matched by increased distal reabsorption so that urine sodium excretions do not
differ, but distal calcium reabsorption does not increase enough to match
increased calcium delivery, so hypercalciuria results. In fact, urine calcium
excretion and overall renal fractional calcium reabsorption both are high in IHSF
vs. normal when adjusted for distal calcium delivery, strongly suggesting a
distal as well as proximal reduction of calcium reabsorption. The combination of 
reduced proximal tubule and distal nephron calcium reabsorption in IHSF is a new 
finding and indicates that IH involves a complex, presumably genetic, variation
of nephron function. The increased calcium delivery into the later nephron may
play a role in stone formation via deposition of papillary interstitial apatite
plaque.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18715937 [PubMed - indexed for MEDLINE]

43: J Urol. 2008 Oct;180(4):1532-7. Epub 2008 Aug 16.

New methods of assessing crystal growth and saturation of brushite in whole
urine: effect of pH, calcium and citrate.

Pak CY, Rodgers K, Poindexter JR, Sakhaee K.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, Dallas, Texas 75390-8885, USA.
charles.pak@utsouthwestern.edu

PURPOSE: Brushite crystallization might be important in stone formation and
prevention. To explore this question new methods for the saturation and crystal
growth of brushite were devised that are applicable to whole urine without any
computer program. MATERIALS AND METHODS: The saturation value
(concentration-to-product ratio) was determined by dividing the molar
concentration product of Ca ([Ca]) and phosphate ([P]), that is [Ca] x [P], of
original urine by the steady state solubility obtained after incubating with an
excess of brushite (10 mg/ml) for 5 hours. Crystal growth was measured from the
depletion of filtrate ([Ca] x [P]) 3 hours after seeding with brushite (0.25
mg/ml). To test the effect of pH, Ca and citrate the saturation value and crystal
growth were determined in 24-hour urine samples from 4 normal volunteers and 2
stone formers, and modified artificially to produce 4 ranges of pH, Ca and
citrate by adding acid, base, Ca or citrate. RESULTS: The saturation value and
crystal growth of brushite increased with an increase in pH or the Ca
concentration but they decreased when the citrate concentration increased. The
saturation value correlated strongly with crystal growth. CONCLUSIONS: The new
methods of brushite saturation value and crystal growth should help discern how
abnormalities in urinary pH, Ca and citrate interact to influence the formation
of Ca stones in cases of distal renal tubular acidosis and alkali therapy.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 18710766 [PubMed - indexed for MEDLINE]

44: BJU Int. 2008 Dec;102(11):1681-6. Epub 2008 Aug 14.

Effect of firing rate on the performance of shock wave lithotriptors.

Pishchalnikov YA, McAteer JA, Williams JC Jr.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, IN 46202-5120, USA. yura@anatomy.iupui.edu

OBJECTIVE: To determine the mechanism that underlies the effect of shock wave
(SW) rate on the performance of clinical lithotripters. MATERIALS AND METHODS:
The effect of firing rate on the pressure characteristics of SWs was assessed
using a fibre-optic probe hydrophone (FOPH 500, RP Acoustics, Leutenbach,
Germany). Shock waves were fired at slow (5-27 SW/min) and fast (100-120 SW/min) 
rates using a conventional high-pressure lithotriptor (DoLi-50, Dornier MedTech
America, Inc., Kennesaw, GA, USA), and a new low-pressure lithotriptor (XX-ES, Xi
Xin Medical Instruments Co. Ltd, Suzhou, PRC). A digital camcorder (HDR-HC3,
Sony, Japan) was used to record cavitation fields, and an ultrafast multiframe
high-speed camera (Imacon 200, DRS Data & Imaging Systems, Inc., Oakland, NJ,
USA) was used to follow the evolution of bubbles throughout the cavitation cycle.
RESULTS: Firing rate had little effect on the leading positive-pressure phase of 
the SWs with the DoLi lithotriptor. A slight reduction ( approximately 7%) of
peak positive pressure (P+) was detected only in the very dense cavitation fields
(approximately 1000 bubbles/cm(3)) generated at the fastest firing rate (120
SW/min) in nondegassed water. The negative pressure of the SWs, on the other
hand, was dramatically affected by firing rate. At 120 SW/min the peak negative
pressure was reduced by approximately 84%, the duration and area of the negative 
pressure component was reduced by approximately 80% and approximately 98%,
respectively, and the energy density of negative pressure was reduced by >99%.
Whereas cavitation bubbles proliferated at fast firing rates, HS-camera images
showed the bubbles that persisted between SWs were very small (<10 microm).
Similar results were obtained with the XX-ES lithotriptor but only after
recognizing a rate-dependent charging artefact with that machine. CONCLUSION:
Increasing the firing rate of a lithotriptor can dramatically reduce the negative
pressure component of the SWs, while the positive pressure remains virtually
unaffected. Cavitation increases as the firing rate is increased but as the
bubbles collapse, they break into numerous microbubbles that, because of their
very small size, do not pose a barrier to the leading positive pressure of the
next SW. These findings begin to explain why stone breakage in SWL becomes less
efficient as the firing rate is increased.

Publication Types: 
    Evaluation Studies
    Research Support, N.I.H., Extramural

PMID: 18710450 [PubMed - indexed for MEDLINE]

45: Can J Urol. 2008 Aug;15(4):4196-9.

Splenic rupture following shock wave lithotripsy.

White WM, Morris SA, Klein FA, Waters WB.

Division of Urologic Surgery, Section of Minimally Invasive Surgery and
Endourology, University of Tennessee, Knoxville, TN 37920, USA.

We present the case of a 61-year-old female who underwent extracorporeal shock
wave lithotripsy (ESWL) treatment of a 12 mm left ureteropelvic junction stone.
Following an uneventful and successful treatment, the patient was discharged. The
patient re-presented to the emergency room 24 hours later with abdominal pain and
hypotension. CT of the abdomen revealed a shattered spleen necessitating emergent
removal. The patient recovered without difficulty. Although splenic rupture
following shock wave lithotripsy (SWL) has been reported previously, this case
represents the only published report of splenic rupture with use of a third
generation electromagnetic lithotripter. Our report will highlight the details of
the case and comment on the salient literature concerning visceral injury
following lithotripsy.

Publication Types: 
    Case Reports

PMID: 18706152 [PubMed - indexed for MEDLINE]

46: Med J Malaysia. 2007 Jun;62(2):166-7.

Emphysematous pyelonephritis in a diabetic patient with pelvic-ureteric stone.

Chan AC, Rohan MJ, Hamid A, Azam A.

Department of Surgery, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala
Lumpur.

Emphysematous pyelonephritis is a rare but life threatening infection of kidney
that is characterized by gas formation within or around the kidney. We describe a
case of emphysematous pyelonephritis as a consequence of inadequately treated
pelvic-ureteric stone in a diabetic man and complement this with a brief review
of the literature pertaining in particular to the management of this condition.

Publication Types: 
    Case Reports

PMID: 18705456 [PubMed - indexed for MEDLINE]

47: Eur J Med Res. 2008 Jul 28;13(7):332-42.

Erratum in:
    Eur J Med Res. 2008 Sep 22;13(9):446.

Idiopathic recurrent calcium urolithiasis (IRCU): an acid meal challenge uncovers
inappropriate pH of postprandial, fasting and daily urine: a cross-sectional
study of male patients providing insight into post- and pre-load urinary stone
substances, crystallization risk, presence of stones, renal transport and
systemic metabolic factors.

Schwille PO, Wipplinger J.

Mineral Metabolism and Endocrine Research Laboratory, Department of Surgery,
University of Erlangen-Nurnberg, Germany. ml.rasenack@web.de

BACKGROUND: In IRCU the possible role of urinary pH (U-pH) as risk factor of
calcium (Ca) stones is poorly understood. OBJECTIVES: To evaluate in IRCU the
response to an oral acid load, focussing on post- and pre-load U-pH, other
urinary, renal and extra-renal factors, and linkage with Ca stones. - Methods:
237 male patients, either Ca stone-free (SF) or -bearing (SB), but without overt 
signs of systemic metabolic acidosis underwent a standardized laboratory
programme that included, besides collection of urine and blood, the intake of an 
oxalate-free acid test meal (proton content 120 mM). Established analytical
methods were used. RESULTS: In 79 patients the post-meal load U-pH was < or =
5.30 (in healthy individuals accepted as the upper limit after the same proton
load), but >5.30 in 158; in these two subsets the mean fasting pre-load U-pH was 
5.84 and 6.37 (p <0.001), the mean U-pH in 24 h urine 5.70 and 6.03 (p <0.001),
the mean score of stone formation activity 32 and 42 (p = 0.12), the SF/SB ratio 
35/44 and 76/82 (not significant). However, when in pre-load urine undissociated 
uric acid concentration was low due to the high pH, the SF/SB ratio was 53/66 (p 
= 0.038), whereas isolated increase of U-pH with SF/SB ratio 54/65 (p = 0.059),
urinary supersaturation with Ca phosphate (hydroxyapatite), Ca oxalate, uric
acid, and isolated decrease of concentration of total protein, total uric acid
and the crystallization inhibitors magnesium and citrate failed to affect
significantly the frequency distribution of SF and SB patients. Pre-load U-pH was
positively associated with urinary ratio sodium/proton excretion, renal reclaim
of sodium and protein, negatively associated with body mass index, fasting
insulinemia and uricemia, urinary protein concentration, renal reclaim of
phosphate. CONCLUSIONS: In IRCU 1) inappropriately high U-pH combined with
increase of proteinuria and alteration of renal-tubular transport are frequent;
2) disturbed interactions of renal proton generation with sodium handling,
urinary physico-chemical and systemic metabolic factors may initiate the
development of Ca-containing concretions, presumably Ca phosphate, at some yet
unknown renal anatomic site.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18700191 [PubMed - indexed for MEDLINE]

48: Int J Biol Sci. 2008 Aug 4;4(4):215-22.

Qualification and application of an ELISA for the determination of Tamm Horsfall 
protein (THP) in human urine and its use for screening of kidney stone disease.

Lau WH, Leong WS, Ismail Z, Gam LH.

School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM, Penang,
Malaysia.

Kidney stone disease affects 1 - 20% of the general population. At present, the
diagnosis of a stone is done using radiography method when noticeable symptoms
appeared. We developed a non-invasive quantitative assay for urinary THP, namely 
ELISA; whereby our previous study and other reports had shown the usefulness of
THP as biomarker for kidney stone disease. Since urine is biological fluid that
is easily obtainable, this method could be used as a screening assay for kidney
stone prior to confirmation with radiography. The ELISA gave assay linearity r(2)
> 0.999 within the range of 109 ng/mL to 945 ng/mL THP. Assay precisions were <
4% (C.V.) for repeatability and < 5% (C.V.) for reproducibility. Assay accuracy
range from 97.7% to 101.2% at the various THP concentrations tested. Assay
specificity and sensitivity were 80% and 86%, respectively. The cut-off points at
P < 0.05 were 37.0 and 41.2 mug/mL for male and female, respectively. The assay
is cost effective and rapid whereby the cost for assaying each urine sample in
duplicate is approximately USD0.35 and within 5 hours, 37 samples can be assayed 
alongside full range of standards and 3 QC samples in each plate. Furthermore,
sample preparation is relatively easy where urine sample was diluted 10 times in 
TEA buffer. The usability of the ELISA method for diagnosis of kidney stone
disease is evaluated with 117 healthy subjects and 58 stone formers.

PMID: 18695745 [PubMed - indexed for MEDLINE]

49: Urology. 2009 Jan;73(1):61-2. Epub 2008 Aug 9.

L-shaped cross-fused kidney with stone.

Chung SD, Chueh SC, Chiang HS, Liao CH.

Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban
Ciao, Taipei, Taiwan.

L-shaped crossed renal ectopia is a rare congenital anomaly. A unique stone
location on plain film and reconstructive computed tomography is demonstrated in 
a case of renal and ureteral calculi in a 58-year-old woman with right-to-left
cross-fused ectopic kidney.

Publication Types: 
    Case Reports

PMID: 18692871 [PubMed - indexed for MEDLINE]

50: Saudi Med J. 2008 Aug;29(8):1180-3.

Shock wave lithotripsy in patients with renal calculi.

Tayib AM, Mosli HA, Farsi HM, Atwa MA, Saada HA.

Department of Urology, King Abdulaziz University Hospital, Kingdom of Saudi
Arabia. amstayib@hotmail.com

OBJECTIVE: To demonstrate the efficacy of shock wave lithotripsy (SWL) in the
primary treatment of 1647 patients with renal calculi using a Dornier Doli U/50
lithotripter. METHODS: One thousand and six hundred forty-seven patients
underwent SWL as day-cases at King Abdulaziz University Hospital in Jeddah, Saudi
Arabia between October 2001 and July 2007, using intravenous sedation (Pethidine 
1mg/kg and Midazolam 5-10mg) for analgesia in 85.5% of the patients. The
treatment outcome of 2241 renal calculi was analyzed and stratified according to 
the size and the site of the stones. Recorded data included shock waves
intensity, number of shocks, treatment time, analgesia, stone related factors
such as size, site, number, nature, composition, and any related complications.
The stones were grouped into 5 groups according to the largest stone size in the 
kidney. Patients were followed up for 6-18 months, mean of 13 months. RESULTS:
Complete clearance of the stones occurred in 2154 kidneys (89.5%). At 3-months
follow up. The overall re-treatment rate was 57.2% and for each group it was 132 
(23.5%) for Group I, 254 (36.1%) for Gourp II, 473 (85.5%) for Group III, 278
(100%) for Group IV and 147 100% for Group V. Treatment failed in 87 patients
with stone size of 20-29mm in 57 patients, and in 30 patients with stone size of 
30-39mm. Fifty-six were solitary pelvic stones treated with ureteroscopy, while
31 were calyceal stones treated by other modalities such as
percutaneousnephro-lithotomy. The most common complication was pyelonephritis
with or without obstruction. CONCLUSION: Shock wave lithotripsy treatment was a
successful primary management of renal stones of variable sizes in 89.5% of the
treated kidneys.

PMID: 18690315 [PubMed - indexed for MEDLINE]

51: Urology. 2008 Nov;72(5):1013. Epub 2008 Aug 5.

Renal stone-associated squamous cell carcinoma and pyelo-colo-duodenal fistula.

Chung SD, Sun HD, Hung SF, Chiu B, Chen Y, Wu JM.

Department of Surgery, Divisions of Urology and General Surgery, Far Eastern
Memorial Hospital, Ban Ciao, Taipei, Taiwan.

A 74-year-old man with hypertension presented with foamy urine and intermittent
right upper quadrant abdominal pain. He had undergone 2 sessions of percutaneous 
nephrolithotripsy for right renal stones and shock wave lithotripsy 6 months
before for residual stones. Abdominal computed tomography showed stones in an
irregularly shaped right kidney and abscess formation that extended through the
colon and was communicating with the duodenum.

Publication Types: 
    Case Reports

PMID: 18684495 [PubMed - indexed for MEDLINE]

52: Arch Ital Urol Androl. 2008 Jun;80(2):56-8.

Percutaneous nephrolithotomy for pediatric renal calculus disease: 5 years of
local experience.

Romanowsky I, Lismer L, Asali M, Rosenberg E, Kaneti J.

Department of Urology, Soroka University Medical Center, Beer-Sheva, Israel.
igrom7@hotmail.com

INTRODUCTION: Pediatric renal calculus disease has been considered a management
dilemma. The various treatment modalities have different effects on the growing
kidney, with concern to the significant recurrence rate, and the long-term
outcome. We report our experience with performing percutaneous nephrolithotomy
(PCNL) monotherapy in staghorn or complex pediatric renal calculi. PATIENTS AND
METHODS: We retrospectively analyzed the results of PCNL in 9 children treated at
our institute between 2001 and 2006. A total of 9 children (10 renal units) with 
a mean age of 10.1 years underwent 10 percutaneous nephrolithotomies (PCNLs). One
patient underwent bilateral percutaneous nephrolithotomy at the initial
presentation. The average calculus size was 45.9 mm (range 15-65 mm). Of the
patients, 7 had complete or partial staghorn, 1 was a shock wave lithotripsy
(SWL) failure, and 1 had a stone located in a lower calyx with a narrowed
infundibulum; 7 from the 9 patients turned out to have some kind of a metabolic
disorder--cystinuria in 6 patients and hyperoxaluria in one patient. The
operations were performed under the guidance of monoplane fluoroscopy--standard
PCNL in 3 cases and percutaneous nephrolithotomy with minimal access (mini-perc) 
in 7 cases. A rigid nephroscope was used in all of the cases. The stones were
fragmented with pneumatic or ultrasonic devices and extracted with forceps.
RESULTS: Stone-free status was achieved in 8 renal units (80%) after a single
stage PCNL. With subsequent shock wave lithotripsy (SWL), the clearance rate had 
increased to 100%. The mean operating time was 88 minutes (range, 35 to 180
minutes) and no intraoperative or postoperative major complications were observed
and no blood transfusions were required. One patient had suffered from
intraoperative hypothermia, which had responded to conservative treatment.
CONCLUSIONS: PCNL is an effective and safe form of therapy in pediatric stone
disease. Since two-thirds of pediatric stone patients have an underlying
metabolic disorder, a close cooperation of adult and pediatric urologists,
nephrologists and radiologists is necessary in order to achieve good results in
the treatment of pediatric nephrolithiasis.

PMID: 18683810 [PubMed - indexed for MEDLINE]

53: Arch Ital Urol Androl. 2008 Jun;80(2):50-5.

Paediatric renal stone disease in Tunisia: a 12 years experience.

Alaya A, Nouri A, Najjar MF.

Department of Biochemistry and Toxicology, University Hospital, Fattouma
Bourguiba Hospital, Monastir, Tunisia. akram_alaya@yahoo.co.uk

OBJECTIVES: International studies may not reflect the real changes of stone
disease in our own country. In this retrospective work, we describe the evolution
of this pathology in Tunisia during the last 12 years. MATERIALS AND METHODS: The
records of 133 children with urolithiasis treated in Tunisia between 1994 and
2006 were reviewed. The physical and chemical analysis of stones was carried out 
respectively by a stereomicroscope and by infra-red spectroscopy and the
epidemiologic data were collected. RESULTS: The male prevalence of this pathology
is progressively declining. The male to female ratio, passed from 1.7 in the
1994-97 period to 1.5 in 2006. Upper urinary tract was most frequently affected
by this pathology. Over the last 12 year period urinary tract infection was in
continuous increase and currently reaches 50% being 21.9% in 1994. This explains 
the increasing frequency of struvite stones which passed from 15.6% in 1994 to
37.5% in 2006. Ammonium urate stones became more frequent in the last few years
being the main component in 25% of cases (12.5% in 1994-97). Calcium oxalate
monohydrate remains the most frequent stone component even if its frequency fell 
(59.4% in 1994 and 12.5% in 2006) in favour of the increase of phosphatic and
phospho-calcic stones. CONCLUSION: The rise in the frequency of struvite and
ammonium urate stone reflects an increase in the infectious risk factors in our
country.

PMID: 18683809 [PubMed - indexed for MEDLINE]

54: BJU Int. 2009 Jan;103(1):104-7. Epub 2008 Aug 1.

Effect of initial shock wave voltage on shock wave lithotripsy-induced lesion
size during step-wise voltage ramping.

Connors BA, Evan AP, Blomgren PM, Handa RK, Willis LR, Gao S.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, IN 46202, USA. connors@anatomy.iupui.edu

OBJECTIVE: To determine if the starting voltage in a step-wise ramping protocol
for extracorporeal shock wave lithotripsy (SWL) alters the size of the renal
lesion caused by the SWs. MATERIALS AND METHODS: To address this question, one
kidney from 19 juvenile pigs (aged 7-8 weeks) was treated in an unmodified
Dornier HM-3 lithotripter (Dornier Medical Systems, Kennesaw, GA, USA) with
either 2000 SWs at 24 kV (standard clinical treatment, 120 SWs/min), 100 SWs at
18 kV followed by 2000 SWs at 24 kV or 100 SWs at 24 kV followed by 2000 SWs at
24 kV. The latter protocols included a 3-4 min interval, between the 100 SWs and 
the 2000 SWs, used to check the targeting of the focal zone. The kidneys were
removed at the end of the experiment so that lesion size could be determined by
sectioning the entire kidney and quantifying the amount of haemorrhage in each
slice. The average parenchymal lesion for each pig was then determined and a
group mean was calculated. RESULTS: Kidneys that received the standard clinical
treatment had a mean (sem) lesion size of 3.93 (1.29)% functional renal volume
(FRV). The mean lesion size for the 18 kV ramping group was 0.09 (0.01)% FRV,
while lesion size for the 24 kV ramping group was 0.51 (0.14)% FRV. The lesion
size for both of these groups was significantly smaller than the lesion size in
the standard clinical treatment group. CONCLUSIONS: The data suggest that initial
voltage in a voltage-ramping protocol does not correlate with renal damage. While
voltage ramping does reduce injury when compared with SWL with no voltage
ramping, starting at low or high voltage produces lesions of the same approximate
size. Our findings also suggest that the interval between the initial shocks and 
the clinical dose of SWs, in our one-step ramping protocol, is important for
protecting the kidney against injury.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18680494 [PubMed - indexed for MEDLINE]

55: Urology. 2008 Nov;72(5):1156-8. Epub 2008 Jul 25.

Borrowing from interventional radiology: novel technique to dilate scarred
nephrostomy tract.

Williams SK, Bird VG, Maurici G, Leveillee RJ.

Department of Urology, University of Miami Miller School of Medicine, Miami,
Florida 33126, USA.

Balloon dilation is an effective method of percutaneous renal access, but it can 
be impossible in patients with perirenal scarring. We report the use of an
atherotomy cutting balloon for dilation of the chronic nephrostomy tract. The
ease of use makes this device a useful alternative to standard dilation
techniques.

Publication Types: 
    Case Reports

PMID: 18657309 [PubMed - indexed for MEDLINE]

56: J Endourol. 2008 Aug;22(8):1629-37.

Interaction of shockwaves with infected kidney stones: is there a bactericidal
effect?

Quintero Mdel S, Alvarez UM, Wacher C, Gutiérrez J, Castaño-Tostado E, Fernández 
F, Loske AM.

Faculty of Sciences , Universidad Nacional Autónoma de México, México D.F.,
México.

BACKGROUND AND PURPOSE: Many calculi contain bacteria, which can remain active
inside kidney stones and cause infection after lithotripsy. Reduction in renal
infections after extracorporeal shockwave lithotripsy has been observed; however,
results are controversial, and no information on the effect of shockwaves on
bacteria inside kidney stones has been reported. The purpose of this research was
to study whether bacteria inside kidney stones can be inactivated by shockwaves. 
MATERIALS AND METHODS: A series of infected artificial kidney stones were exposed
in vitro to either 90 or 400 shockwaves using a research electrohydraulic or a
commercial piezoelectric lithotripter. Two types of stones (soft and hard) were
manufactured by mixing gypsum cement and Vel-mix-stone with water. Half of the
stones were inoculated with Salmonella typhimurium. The suspension containing
stone powder and bacteria was inoculated on agar plates and incubated.
Bactericidal action was defined as the logarithmic viability reduction. RESULTS: 
About 95% of the bacteria were inactivated with 400 shockwaves using the
electrohydraulic lithotripter; however, most of the damage was associated with
the electromagnetic emission (ultraviolet radiation and visible light) generated 
at the spark gap. After 2730 shockwaves to stones placed inside a black
polypropylene bag, about 29% and 14% of all bacteria were inactivated with the
piezoelectric and the electrohydraulic lithotripter, respectively. In this case, 
the electromagnetic radiation was blocked by the black bag. CONCLUSIONS: Bacteria
inactivation is possible by in vitro shockwave application; however, according to
our results, no significant bactericidal effect is expected during extracorporeal
shockwave lithotripsy.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18657029 [PubMed - indexed for MEDLINE]

57: Urology. 2008 Sep;72(3):508-12. Epub 2008 Jul 23.

Percutaneous management of stones in transplanted kidneys.

Rifaioglu MM, Berger AD, Pengune W, Stoller ML.

Department of Urology, University of California, San Francisco, School of
Medicine, San Francisco, California 94143, USA.

OBJECTIVES: Stone disease is a rare complication after renal transplantation, and
the management of these stones can be difficult. In many cases, the best modality
to treat stones in transplanted kidneys/ureters is with a percutaneous approach. 
The goal of this study was to review our series of percutaneous nephrolithotomy
(PNL) to evaluate the success rates and present the key technical points to
achieve a successful outcome. METHODS: We retrospectively reviewed our series of 
PNL from January 1997 to December 2007 and identified 15 patients who had had PNL
performed in a transplanted kidney. We evaluated multiple perioperative variables
and how the patients' urolithiasis presented. We also collected intraoperative
data. RESULTS: A total of 15 patients underwent successful PNL in a transplanted 
kidney. In all patients, but 3, access into an anterior, upper pole calix was
achieved, and access was obtained with ultrasound guidance alone or a combination
of ultrasound guidance and fluoroscopy. Ten patients had a pre-existing
nephrostomy tube, and this was used in all but 1 patient. Of the 15 patients, 8
(53%) were treated with percutaneous flexible nephroscopy/ureteroscopy, and 7 had
tracts dilated to 30F to perform rigid PNL. All patients were rendered stone free
at the end of the procedure, no complications developed, and no patient required 
a blood transfusion. CONCLUSIONS: Nephrolithiasis in a transplanted kidney can be
challenging to diagnose and to treat. PNL is most often the best modality to
render patients stone free.

PMID: 18653217 [PubMed - indexed for MEDLINE]

58: Clin J Am Soc Nephrol. 2008 Sep;3(5):1453-60. Epub 2008 Jul 23.

Determinants of 24-hour urinary oxalate excretion.

Taylor EN, Curhan GC.

Renal Division and Channing Laboratory, Department of Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
entaylor@partners.org

BACKGROUND AND OBJECTIVES: Higher levels of urinary oxalate substantially
increase the risk of calcium oxalate kidney stones. However, the determinants of 
urinary oxalate excretion are unclear. The objective was to examine the impact of
dietary factors, age, body size, diabetes, and urinary factors on 24-h urinary
oxalate. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We conducted a
cross-sectional study of 3348 stone forming and non-stone-forming participants in
the Health Professionals Follow-up Study (men), the Nurses' Health Study (older
women), and the Nurses' Health Study II (younger women). RESULTS: Median urinary 
oxalate was 39 mg/d in men, 27 mg/d in older women, and 26 mg/d in younger women.
Participants in the highest quartile of dietary oxalate excreted 1.7 mg/d more
urinary oxalate than participants in the lowest quartile (P trend 0.001). The
relation between dietary and urinary oxalate was similar in individuals with and 
without nephrolithiasis. Participants consuming 1000 mg/d or more of vitamin C
excreted 6.8 mg/d more urinary oxalate than participants consuming <90 mg/d (P
trend < 0.001). Body mass index, total fructose intake, and 24-h urinary
potassium, magnesium, and phosphorus levels also were positively associated with 
urinary oxalate. Calcium intake and age were inversely associated with urinary
oxalate. After adjustment for body size, participants with diabetes excreted 2.0 
mg/d more urinary oxalate than those without diabetes (P < 0.01). CONCLUSIONS:
The impact of dietary oxalate on urinary oxalate appears to be small. Further
investigation of factors influencing urinary oxalate may lead to new approaches
to prevent calcium kidney stones.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18650406 [PubMed - indexed for MEDLINE]

59: J Endourol. 2008 May;22(5):889-93.

Safety and efficacy of synchronous percutaneous nephrostolithotomy and
contralateral ureterorenoscopy for bilateral calculi.

Mason BM, Koi PT, Hafron J, Milhoua P, Hoenig DM.

Department of Urology, Albert Einstein College of Medicine, Montefiore Medical
Center, Bronx, New York 10467, USA.

Herein we describe the technique and review the medical records of 26 patients
who underwent percutaneous nephrostolithotomy (PCNL) and simultaneous
contralateral retrograde ureterorenoscopy (URS) for bilateral urolithiasis of
discordant sizes at our institution. Preoperative factors, operative time, change
in hemoglobin, change in serum creatinine, stone free, and efficacy rates after a
single procedure were analyzed retrospectively. The total efficacy rate--defined 
as residual calculus of 4 mm or less--was 92.3%. A second look PCNL or URS was
used to target any residual calculi; 5 of the 26 (19%) patients required further 
therapy following the initial intervention. All cases that required a second look
were ultimately rendered stone-free. No preoperative factor was statistically
significant with respect to treatment failures. In terms of complications,
temporary, acute renal insufficiency occurred in 2 patients, (7.7%) and the
duration was transient. Performing synchronous PCNL and contralateral retrograde 
URS is efficient, safe, and not more dramatically lengthy in terms of operative
time or morbid in terms of complications when compared to a traditional
unilateral percutaneous procedure. In this approach, management of bilateral
urolithiasis in one operative procedure is practical and efficacious. The
approach allows patients to return to normal activity within the same time period
as those having a unilateral approach and to be free of stone without a need for 
a second, staged procedure.

PMID: 18643719 [PubMed - indexed for MEDLINE]

60: J Endourol. 2008 May;22(5):877-81.

Significance of lower-pole pelvicaliceal anatomy on stone clearance after
shockwave lithotripsy in nonobstructive isolated renal pelvic stones.

Sozen S, Kupeli B, Acar C, Gurocak S, Karaoglan U, Bozkirli I.

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

PURPOSE: To investigate the probable effect of lower-pole pelvicaliceal anatomy
on stone clearance after shockwave lithotripsy (SWL) in patients with
nonobstructive renal pelvic stones. PATIENTS AND METHODS: The clinical records of
patients with isolated renal pelvic stones who underwent SWL between 1996 and
2005 were reviewed. After excluding patients with obstruction leading to
dilatation, major anatomic abnormalities, noncalcium stones, metabolic
abnormalities, history of recurrent stone disease, multiple stones, and previous 
renal surgery, 153 patients were enrolled in the study. Lower pole
infundibulopelvic angle (IPA) and infundibular length and width were measured
from intravenous urography. Patients were classified into three groups according 
to stone burden (group 1, <100 mm(2); group 2, 101-200 mm(2); group 3, 201-400
mm(2)). RESULTS: The mean stone size was 142.08+/-86.3 mm(2). Overall stone-free 
rate was 53.6%. Localization of clinically significant or insignificant residual 
fragments was in the lower calix, renal pelvis, and both in 50 (32.6%), 29
(18.9%), and 8 (5.2%) patients, respectively. There was no statistically
significant difference in pelvicaliceal anatomic features except narrower IPA
(P=0.02) in group 1 patients with residual stones. CONCLUSION: The falling of
stone fragments to the lower calix in spite of the ureter whether clinically
significant or not after SWL of pelvic stones initially seems to be related to
stone burden rather than lower caliceal anatomy. However, existence of a more
narrow IPA in group 1 patients with residual fragments led us to believe that
lower-pole IPA can play a role in stone clearance, especially for smaller stones,
probably because of smaller residual fragment size or the more mobile nature of
the primary stone.

PMID: 18643718 [PubMed - indexed for MEDLINE]

61: J Urol. 2008 Sep;180(3):958-60; discussion 960. Epub 2008 Jul 17.

Decreased stone-free rates after percutaneous nephrolithotomy for high calcium
phosphate composition kidney stones.

Kacker R, Meeks JJ, Zhao L, Nadler RB.

Department of Urology, Feinberg School of Medicine, Northwestern University,
Chicago, Illinois 60611, USA.

PURPOSE: To our knowledge the most effective treatment in patients with renal
stones containing calcium phosphate remains unknown. An inverse correlation
exists between calcium phosphate stone composition and the stone-free rate of
shock wave lithotripsy. It is unknown whether this is due to treatment type
(shock wave lithotripsy) or to a feature unique to calcium phosphate stones. We
determined whether calcium phosphate stone composition affects the stone-free
rate of percutaneous nephrolithotomy. MATERIALS AND METHODS: Percutaneous
nephrolithotomy was performed in 111 patients between 2001 and 2006 and stone
fragments were analyzed for calcium phosphate composition. Patients were
categorized into groups based on calcium phosphate content. All patients
underwent preoperative computerized tomography. Patients were considered
stone-free after percutaneous nephrolithotomy when fragments were 2 mm or less on
noncontrast computerized tomography. RESULTS: A total of 213 percutaneous
nephrolithotomies were performed. An increased percent of calcium phosphate was
related to a decreased percutaneous nephrolithotomy success rate (p = 0.005),
independent of preoperative stone burden (p = 0.8). Patients with greater than
60% calcium phosphate stones were significantly less likely to be stone-free
after percutaneous nephrolithotomy than those with less calcium phosphate (60%,
OR 2.45, 95% CI 1.103-5.4401 vs 80%, OR 3.72, 95% CI 1.33-10.44). CONCLUSIONS:
High calcium phosphate renal stone content leads to a decreased stone-free rate. 
Further study is required to determine the mechanism of stone resilience as well 
as the most appropriate treatment modality in patients with high calcium
phosphate composition kidney stones.

PMID: 18639270 [PubMed - indexed for MEDLINE]

62: J Endourol. 2008 Aug;22(8):1665-8.

Phenytoin metabolite renal calculus: an index case.

Kalorin CM, Bauer R, White MD.

Department of Urology, Albany Medical Center, Albany, New York 12208, USA.
carminkalorin@yahoo.com

INTRODUCTION: Drugs and their metabolites are known factors in 1% to 2% of all
kidney stones. Certain antiepileptic drugs are known to cause stone formation.
Phenytoin is used as a first line antiepileptic therapy for many seizure
disorders. We present what we believe to be the first report of a phenytoin
metabolite urinary stone. METHODS: A 79-year-old woman with a fever and seizure
disorder was found to have a right pelvic kidney with hydronephrosis and multiple
large calcifications. She had been taking the antiepileptic medication phenytoin 
for the past 10 years. Average total serum phenytoin level from the year prior
was in the normal range. Free phenytoin levels were not routinely monitored, but 
the one value available was elevated at 5.1 ng/dL. The patient underwent a
percutaneous nephrolitomy, ultimately expiring from medical complications after
the procedure. Final stone analysis revealed a composition of 35% phenytoin
metabolite (5-(para-hydroxyphenyl)-5-phenylhydantoin) and 65% proteinaceous
material. An extensive review of literature including PubMed, MedLine, and
various internet search engines was performed, searching for any prior reports of
urinary calculi formed from phenytoin or its metabolite. RESULTS: No previous
reports of phenytoin or phenytoin metabolite urinary stones were found in the
medical literature. Phenytoin has many known ill effects on the genitourinary
system including acute interstitial nephritis, nephrotic syndrome, acute renal
failure, and priapism. Now we can add urinary lithiasis to the list of its
potential adverse effects. This article represents the first report of a
phenytoin metabolite urinary stone. CONCLUSION: A metabolite of the commonly used
antiepileptic medication phenytoin can cause clinically relevant urolithiasis
leading to significant morbidity and even mortality. Clinicians should have an
increased level of suspicion for metabolite stone formation in symptomatic
patients taking antiepileptic medications. Further studies on phenytoin
metabolism and its potential for inducing urinary lithiasis should be performed.

Publication Types: 
    Case Reports

PMID: 18620500 [PubMed - indexed for MEDLINE]

63: J Endourol. 2008 Aug;22(8):1613-6.

Ayurvedic medicine and renal calculi.

Kieley S, Dwivedi R, Monga M.

Department of Urologic Surgery, University of Minnesota, Minneapolis, MN 55455,
USA.

OBJECTIVE: To explore the supportive evidence for the use of Ayurvedic medicine
in the management of existing and recurrent nephrolithiasis. METHOD: Nine
Ayurvedic medicines commonly utilized in the management of nephrolithiasis were
identified by discussions with Ayurvedic practitioners in India. Mechanistic and 
clinical studies evaluating the use of these agents were identified using the
Medline database and bibliographies suggested by Ayurvedic practitioners. The
articles were then critically reviewed and summarized. RESULTS: Four in vitro
mechanistic studies, eight animal studies, and seven human trials were
identified. Phyllanthus niruri has undergone mechanistic in vitro, animal, and
clinical trials that support its impact on calcium oxalate crystallization.
Preliminary clinical trials have evaluated the role of Dolichos biflorus and
Orthosiphon grandiflorus in the prevention of urolithiasis and fish stone as a
method of stone expulsion, yet the treatment effect and mechanism of action
remains to be elucidated. CONCLUSION: Ayurvedic medicine holds promise as a
complementary approach to the management and prevention of nephrolithiasis. The
best studied compound is P. niruri. Further controlled randomized clinical trials
are justified to support or refute the potential benefits demonstrated in these
initial studies.

PMID: 18620498 [PubMed - indexed for MEDLINE]

64: Urology. 2008 Nov;72(5):1164-8. Epub 2008 Jul 10.

Dual source computed tomography: a novel technique to determine stone
composition.

Matlaga BR, Kawamoto S, Fishman E.

The Russell H Morgan Department of Radiology and Radiological Science, James
Buchanan Brady Urological Institute, The Johns Hopkins University School of
Medicine, Baltimore, Maryland 21209, USA. bmatlaga@jhmi.edu

INTRODUCTION: Dual source computed tomography (CT), a novel technology that
employs two different x-ray sources, may provide an image resolution that has not
been possible with conventional single source CT. We tested the ability of dual
source CT imaging to distinguish calcium oxalate (CaOx) stones from calcium
phosphate (CaP) stones, and both types of calciferous stones from uric acid (UA) 
stones. METHODS: CaOx, CaP, and UA stones were placed in a tissue phantom and
imaged with dual source multidetector CT at both 80kV and 140 kV. Hounsfield
units (HU) of each stone were recorded for the 140 kV and the 80 kV datasets by
drawing regions of interest by circle, hand-drawing, and using a volume
calculation method. The differences between, and the ratios of, the HU obtained
by the two energy sources were compared among the stone groups. RESULTS: Between 
CaOx and CaP stones, HU differences (80kV-140kV difference, hand-drawing
technique: CaOx = 270.7; CaP = 369.5; UA = 11.45; P = 0.020 for CaOx vs. CaP; P <
0.001 for CaOx and CaP vs. UA) as well as ratios (140kV:80kV ratio, hand-drawing 
technique: CaOx = 1.44; CaP = 1.51; UA = 1.04; P = 0.001 for CaOx vs. CaP; P <
0.001 for CaOx and CaP vs. UA) were significantly different. There were no
significant differences in stone size among the groups. CONCLUSIONS: Dual source 
CT has the ability to distinguish not only between calciferous stones and uric
acid stones, but also among stones composed of different calcium salts. Further
studies are warranted to confirm these findings in a clinical setting.

PMID: 18619656 [PubMed - indexed for MEDLINE]

65: J Endourol. 2008 Jul;22(7):1447-51.

Tubeless percutaneous nephrolithotomy for staghorn stones.

Falahatkar S, Khosropanah I, Roshani A, Neiroomand H, Nikpour S, Nadjafi-Semnani 
M, Akbarpour M.

Department of Urology, Urology Research Center, Razi Hospital, Guilan University 
of Medical Science, Rasht, Islamic Republic of Iran. falahatkar_s@yahoo.com

PURPOSE: To assess the outcome and safety of tubeless percutaneous
nephrolithotomy (PCNL) to treat patients with staghorn stones. PATIENTS AND
METHODS: Between March 2006 and March 2007, 75 patients underwent 82 PCNLs at our
hospital. Of that total, 42 procedures were done without a nephrostomy tube
(tubeless group) and 40 procedures were done with insertion of a nephrostomy tube
at the end of the procedure (standard group). RESULTS: The mean age was 41.55 +/-
15.15 years and 50.29 +/- 9.42 years in the tubeless group and the standard
group, respectively. Seven patients had bilateral stones. None of our patients
had organ trauma or any other significant complication. The average operative
time was shorter in the tubeless group than in the standard group (93.76 v 109.98
minutes, respectively; P = 0.03). The mean analgesic doses given postoperatively 
were 79.17 +/- 62.2 and 93.75 +/- 40.7 mg of meperidine in the tubeless group and
the standard group, respectively, with no statistically significant difference.
The mean postoperative hospital stay was 1.7 +/- 0.6 days in the tubeless group
and 4 +/- 1.6 days in the standard group (P < 0.0001). The stone-free rate was 37
units (88.09%) and 35 units (87.5%) units in the tubeless and standard groups,
respectively. CONCLUSIONS: Complications, operative time, and the length of
hospitalization in selected patients undergoing tubeless PCNL were all lower than
those seen in the standard group. Tubeless PCNL was thus found to be safe and
effective, even in patients with staghorn stones.

Publication Types: 
    Evaluation Studies

PMID: 18613776 [PubMed - indexed for MEDLINE]

66: Expert Opin Biol Ther. 2008 Aug;8(8):1159-66.

Biofilms in nephrology.

Marcus RJ, Post JC, Stoodley P, Hall-Stoodley L, McGill RL, Sureshkumar KK,
Gahlot V.

Division of Nephrology & Hypertension, Allegheny General Hospital, Pittsburgh, PA
15212, USA. rmarcus@wpahs.org

BACKGROUND: Biofilms are bacterial communities ubiquitous to moist environments. 
Biofilm formation is a factor in the development and persistence of infectious
diseases. In clinical nephrology, biofilms influence the development of kidney
stones and affect dialysis systems, including peritoneal and central venous
catheters. Biofilms also play critical roles in persistent and resistant renal
and urinary tract infections. OBJECTIVE: To describe the physiology of biofilms
and potential effects of biofilms upon infectious diseases, focusing on the role 
of biofilms in kidney stones, indwelling catheters and dialysis equipment.
METHODS: A literature search with Medline to identify pertinent English language 
articles published up to early 2008 using the keywords biofilm, nephrology,
renal, calculi and infection. RESULTS/CONCLUSION: Biofilms are ubiquitous in
clinical nephrology and play a role in the pathogenesis of resistant infections. 
Strategies for reducing the effects of biofilms in nephrology are described.

Publication Types: 
    Review

PMID: 18613767 [PubMed - indexed for MEDLINE]

67: Urology. 2008 Nov;72(5):1018-21. Epub 2008 Jun 30.

Single-institutional study on role of ureteroscopy and retrograde intrarenal
surgery in treatment of pediatric renal calculi.

Dave S, Khoury AE, Braga L, Farhat WA.

Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada.

OBJECTIVES: Ureteroscopy (URS) is accepted as a primary modality to treat
ureteral calculi in children and extracorporeal shock wave lithotripsy and
percutaneous nephrolithotomy continue to be the primary option for renal stones. 
We report our experience with the use of URS in managing pediatric upper tract
calculi and evaluate the results in relation to stone location, size, and the use
of URS as a primary or secondary treatment modality. METHODS: A retrospective
chart review was performed for all children who underwent URS for renal stones
from 1999 to 2004. Success was defined as complete radiologic clearance. RESULTS:
A total of 19 patients (mean age 6.9 years) with 23 calculi underwent URS and
were followed up for a mean of 23 months. The stones were located in the renal
pelvis in 8 patients, and the polar regions in 4 and 7 patients had partial
staghorn calculi with >1 caliceal extension. The primary and secondary success
rate for patients with renal calculi was 80% (5 of 8) and 66% (2 of 3) for pelvic
stones and 100% (4 of 4) for polar stones. Only 1 of the partial staghorn calculi
was completely cleared with URS. Complications included distal ureteral
perforation in 1 and urinoma in 1. CONCLUSIONS: URS achieves reasonable results
with minimal complications in pediatric patients with renal pelvic calculi. Polar
stones required multiple sessions for complete clearance, and staghorn calculi
were not amenable to URS. Additional studies are necessary to define the role of 
URS as an option in the surgical treatment of children with renal calculi.

PMID: 18585764 [PubMed - indexed for MEDLINE]

68: Med Hypotheses. 2008 Oct;71(4):584-90. Epub 2008 Jun 24.

A hypothesis for anti-nanobacteria effects of gallium with observations from
treating kidney disease.

Eby GA.

George Eby Research, 14909-C Fitzhugh Road, Austin, TX 78736, United States.
george.eby@george-eby-research.com

Nanobacteria, 100-fold smaller than common bacteria, have been purported to exist
in urine, and by precipitating calcium and other minerals into carbonate apatite 
around themselves, induce the formation of surrounding kidney stones.
Nanobacteria-like structures have also been shown in blood, within arteries,
aortic aneurysms, and cardiac valves. Gallium has antibiotic properties to
iron-dependent bacteria and has potent anti-inflammatory, anticancer and
anti-hypercalcemic properties, and it readily reverses osteoporosis. It was
hypothesized that gallium nitrate might have benefit in treating kidney stones.
Gallium nitrate (120mg gallium) was mixed with water making two liters of a
gallium mineral water drink to treat chronic, treatment-resistant kidney stone
pain and urinary tract bleeding in a 110 pound woman. On the third day of gallium
mineral water treatment, the urine appeared snow white, thick (rope-like) and
suggestive of a calcific crystalline nature. After release of the white urine,
the urine returned to normal in color, viscosity and pH, kidney pain was no
longer present, and there was no further evidence of blood in the urine. There
were no treatment side effects or sequela. For a one year observation period
thereafter, no kidney stones, white urine, kidney or urinary tract pain or blood 
in the urine was noted. The hypothetical susceptibility of nanobacteria to
gallium treatment also suggests application to atherosclerosis and other
diseases. Although some support for gallium in treating kidney stones is
presented, this hypothesis is built upon another hypothesis, is extremely
speculative, and alternative explanations for the white urine exist. Further
research into gallium's effects on kidney disease and other nanobacteria-induced 
diseases such as cardiovascular diseases is suggested.

PMID: 18579317 [PubMed - indexed for MEDLINE]

69: J Endourol. 2008 Jun;22(6):1213-7.

Use of the Escape nitinol stone retrieval basket facilitates fragmentation and
extraction of ureteral and renal calculi: a pilot study.

Kesler SS, Pierre SA, Brison DI, Preminger GM, Munver R.

Department of Urology, Hackensack University Medical Center, Hackensack, New
Jersey 07601, USA. stukesler@yahoo.com

BACKGROUND AND PURPOSE: Advances in ureteroscope and stone basket design have
catapulted ureteroscopy to the forefront of surgical stone management; however,
persistent problems such as stone migration continue to challenge urologists. The
Escape nitinol stone retrieval basket (Boston Scientific, Natick, MA) is a stone 
basket designed to capture calculi and facilitate simultaneous laser lithotripsy 
in situ. We report our initial experience with the Escape basket for the
management of urinary calculi and compare the use of this device with other
methods of optimizing ureteroscopic stone management. PATIENTS AND METHODS: A
prospective evaluation of 23 patients undergoing ureteroscopic
holmium:yttrium-aluminum-garnet laser lithotripsy of urinary calculi was
performed at two institutions by two surgeons (R.M. and G.M.P). The Escape basket
was used to prevent retrograde ureteral stone migration or to facilitate
fragmentation and extraction of large renal calculi. Patient demographics and
perioperative parameters were assessed. RESULTS: Twenty-three patients (16 men, 7
women), with a mean age of 55.5 years (range 33-74 yrs) were treated for renal (n
= 9) or ureteral (n = 14) calculi. The mean stone diameter was 1.4 cm (range
0.4-2.5 cm), mean fragmentation time was 44.1 minutes (range 10-75 min), and mean
energy used was 3.1 kJ (range 0.4-10.6 kJ). No complications were encountered.
Eighty-seven percent (20/23) of patients were rendered completely stone free
after ureteroscopic laser lithotripsy using the Escape basket. Of the three
patients with residual calculi, one patient with a 2.5-cm renal calculus had
residual fragments larger than 3 mm, and two patients with large renal calculi
had residual fragments smaller than 3 mm. CONCLUSIONS: The Escape basket appears 
to be safe and effective in preventing stone migration and facilitating
ureteroscopic laser lithotripsy and stone extraction.

Publication Types: 
    Clinical Trial

PMID: 18578653 [PubMed - indexed for MEDLINE]

70: Can J Urol. 2008 Jun;15(3):4072-6; discussion 4076-7.

Tubeless percutaneous nephrolithotomy for complex renal stone disease: single
center experience.

Malcolm JB, Derweesh IH, Brightbill EK, Mehrazin R, DiBlasio CJ, Wake RW.

Department of Urology, University of Tennessee Health Science Center, Memphis,
Tennessee 38163, USA.

OBJECTIVE: Tubeless percutaneous nephrolithotomy (PCNL) has become an option for 
treatment of renal stone disease, though no clearly defined algorithm exists for 
selection of patients suitable to tubeless PCNL. We investigated our experience
with tubeless PCNL to evaluate its safety and efficacy for cases of complex renal
calculi. PATIENTS AND METHODS: Retrospective review of all tubeless PCNLs
performed for complex renal calculus disease (bilateral stones, partial/complete 
staghorn, infundibular stenosis/calyceal diverticulum, pre-existing renal
insufficiency) between January 2001 and January 2006. All patients had a ureteral
stent placed in an antegrade fashion following stone treatment, and a foley
catheter remained in place overnight. No patient received nephrostomy tube (NT). 
Imaging (CT or KUB) was obtained at the first outpatient follow-up visit. Patient
demographics, incidence of complications, clinical outcomes and stone-free rates 
were noted and analyzed. "Stone free" was defined as negative imaging (CT or
KUB). RESULTS: Forty-two patients (47 renal units) were treated with tubeless
PCNL for complex renal stone disease (5 bilateral, 25 total/partial staghorn, 12 
renal insufficiency, and 10 infundibular stenosis or calyceal diverticulum). Mean
age was 58.2+/-9.4 years. Mean length of hospital stay was 2.1 days. Mean
preoperative and postoperative hematocrit were 40.5+/-4.5 and 37.2+/-5.8,
respectively (p=0.001). Single-procedure stone free rate was 74.5%, and the
two-procedure stone free rate was 91.5%. One patient (2.4%) required a blood
transfusion and one patient (2.4%) developed urosepsis. CONCLUSIONS: Tubeless
PCNL is safe and effective and can be utilized in cases of complex renal stone
disease.

PMID: 18570711 [PubMed - indexed for MEDLINE]

71: Kidney Int. 2008 Oct;74(7):919-24. Epub 2008 Jun 18.

Acidic polyanion poly(acrylic acid) prevents calcium oxalate crystal deposition.

Kleinman JG, Alatalo LJ, Beshensky AM, Wesson JA.

Division of Nephrology, Department of Medicine, Medical College of Wisconsin and 
the Department of Veterans Affairs Medical Center, Milwaukee, Wisconsin 53295,
USA. Kleinman@mcw.edu

Acidic macromolecules inhibit calcium oxalate nucleation, growth, aggregation and
attachment to cells in vitro. To test for such an effect in vivo we used osmotic 
minipumps to continuously infuse several doses of the 5.1 kDa poly(acrylic acid) 
(pAA(5.1)) into rats fed a diet which causes renal calcium oxalate crystal
deposition. Although kidneys of rats receiving the saline control contained
calcium oxalate crystals, measured by polarized light microscopy, those of
animals given pAA(5.1) had significantly lower numbers of crystals in various
zones of the kidney. Delivery of pAA(5.1) to urine was confirmed by measuring
excretion of infused biotinylated pAA(5.1). Both the derivatized and unlabelled
pAA(5.1) had the same effects on crystallization in vitro. Our study shows that
acidic polymers hold promise as effective therapies for kidney stones likely
through prevention of calcium oxalate crystal aggregate formation.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18563053 [PubMed - indexed for MEDLINE]

72: Ultrasound Med Biol. 2008 Oct;34(10):1651-65. Epub 2008 Jun 17.

A passive acoustic device for real-time monitoring of the efficacy of shockwave
lithotripsy treatment.

Leighton TG, Fedele F, Coleman AJ, McCarthy C, Ryves S, Hurrell AM, De Stefano A,
White PR.

Institute of Sound and Vibration Research, University of Southampton,
Southampton, UK.

Extracorporeal shockwave lithotripsy (ESWL) is the preferred modality for the
treatment of renal and ureteric stone disease. Currently X-ray or ultrasound
B-scan imaging are used to locate the stone and to check that it remains targeted
at the focus of the lithotripter during treatment. Neither imaging modality is
particularly effective in allowing the efficacy of treatment to be judged during 
the treatment session. A new device is described that, when placed on the
patient's skin, can passively monitor the acoustic signals that propagate through
the body after each lithotripter shock, and which can provide useful information 
on the effectiveness of targeting. These acoustic time histories are analyzed in 
real time to extract the two main characteristic peak amplitudes (m(1) and m(2)) 
and the time between these peaks (t(c)). A set of rules based on the acoustic
parameters was developed during a clinical study in which a complete set of
acoustic and clinical data was obtained for 30 of the 118 subjects recruited. The
rules, which complied with earlier computational fluid dynamics (CFD) modeling
and in vitro tests, allow each shock to be classified as "effective" or
"ineffective." These clinically-derived rules were then applied in a second
clinical study in which complete datasets were obtained for 49 of the 85 subjects
recruited. This second clinical study demonstrated almost perfect agreement
(kappa = 0.94) between the number of successful treatments, defined as >50%
fragmentation as determined by X-ray at the follow-up appointment, and a
device-derived global treatment score, TS(0), a figure derived from the total
number of effective shocks in any treatment. The acoustic system is shown to
provide a test of the success of the treatment that has a sensitivity of 91.7%
and a specificity of 100%. In addition to the predictive capability, the device
provides valuable real-time feedback to the lithotripter operator by indicating
the effectiveness of each shock, plus an indication TS(t) of the cumulative
effectiveness of the shocks given so far in any treatment, and trends in key
parameters. This feedback would allow targeting adjustments to be made during
treatment. An example is given of its application to mistargeting because of
respiration. tgl@soton.ac.uk

Publication Types: 
    Clinical Trial, Phase I
    Clinical Trial, Phase II
    Research Support, Non-U.S. Gov't

PMID: 18562085 [PubMed - indexed for MEDLINE]

73: Langmuir. 2008 Jul 15;24(14):7058-60. Epub 2008 Jun 17.

An understanding of renal stone development in a mixed oxalate-phosphate system.

Guan X, Wang L, Dosen A, Tang R, Giese RF, Giocondi JL, Orme CA, Hoyer JR,
Nancollas GH.

Department of Chemistry, University at Buffalo, The State University of New York,
Buffalo, New York 14260, USA.

The in vivo formation of calcium oxalate concretions having calcium phosphate
nidi is simulated in an in vitro (37 degrees C, pH 6.0) dual constant composition
(DCC) system undersaturated (sigma DCPD = -0.330) with respect to brushite (DCPD,
CaHPO 4 . 2H 2O) and slightly supersaturated (sigma COM = 0.328) with respect to 
calcium oxalate monohydrate (COM, CaC2O4 . H2O). The brushite dissolution
provides calcium ions that raise the COM supersaturation, which is
heterogeneously nucleated either on or near the surface of the dissolving calcium
phosphate crystals. The COM crystallites may then aggregate, simulating kidney
stone formation. Interestingly, two intermediate phases, anhydrous dicalcium
phosphate (monetite, CaHPO4) and calcium oxalate trihydrate (COT), are also
detected by X-ray diffraction during this brushite-COM transformation. In support
of clinical observations, the results of these studies demonstrate the
participation of calcium phosphate phases in COM crystallization providing a
possible physical chemical mechanism for kidney stone formation.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18557638 [PubMed - indexed for MEDLINE]

74: J Urol. 2008 Aug;180(2):612-4. Epub 2008 Jun 12.

A randomized controlled trial of nephrostomy placement versus tubeless
percutaneous nephrolithotomy.

Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH.

Solent Department of Urology, St. Mary's Hospital, Portsmouth, United Kingdom.
timj@crook69.wanadoo.co.uk

PURPOSE: We established whether totally tubeless percutaneous nephrolithotomy
with no nephrostomy or ureteral stent is a safe management technique. MATERIALS
AND METHODS: Patients were randomized to have a nephrostomy placed (group 1
control) or none (group 2 treatment). A total of 25 patients were randomized to
each group. Cases were considered uncomplicated and suitable for randomization if
there was no significant bleeding or residual stone load, the pelvicaliceal
system was intact and there was no evidence of a residual ureteral stone. The
primary outcome measure was length of stay, and secondary outcomes were analgesic
requirements and postoperative complications such as bleeding, infection or
ureteral obstruction. Hospital readmission rates and stone clearance rates were
also recorded. RESULTS: Mean stone size was 21.6 vs 17.5 mm. There were no
transfusions in either group. Hemoglobin change was 2.03 vs 1.18 gm/dl and mean
creatinine increase was 0.029 vs -0.111 mg/dl. There were no differences in
hemorrhage, infection and serum parameters. There were no readmissions in either 
group. Mean length of stay was 3.4 vs 2.3 days (p <0.05). CONCLUSIONS: This trial
demonstrates that percutaneous nephrolithotomy without nephrostomy or stent is a 
safe and well tolerated procedure in selected patients. Length of stay was
reduced with no major complications in either group. We believe that totally
tubeless percutaneous nephrolithotomy may be considered an accepted standard of
care for selected cases and it is possible to reserve placement of a nephrostomy 
tube or internal ureteral stent for specific indications.

Publication Types: 
    Randomized Controlled Trial

PMID: 18554657 [PubMed - indexed for MEDLINE]

75: J Urol. 2008 Aug;180(2):676-80. Epub 2008 Jun 12.

Safety and efficacy of supracostal percutaneous nephrolithotomy in pediatric
patients.

El-Nahas AR, Shokeir AA, El-Kenawy MR, Shoma AM, Eraky I, El-Assmy AM, Ghaly AM, 
El-Kappany HA.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura,
Egypt.

PURPOSE: This study was conducted to evaluate the safety and efficacy of the
supracostal approach for percutaneous nephrolithotomy in pediatric patients.
MATERIALS AND METHODS: We retrospectively reviewed 60 percutaneous
nephrolithotomy procedures done in 50 children (32 boys and 18 girls) between
2000 and 2007. Mean patient age was 7 +/- 4 years (range 9 months to 14 years).
Noncontrast computerized tomography was the primary radiological investigation
for most of the cases. The subcostal approach was used in 40 procedures, and the 
supracostal approach (above the 12th rib) was required in 20. We compared both
approaches regarding preoperative characteristics, stone-free and complication
rates, and the need for auxiliary procedures. RESULTS: The preoperative
characteristics of the patients, urinary tracts and stones were comparable for
both treatment groups. There were no major complications. Significant bleeding
requiring blood transfusion was observed in 3 patients (5%), transient fever in 3
(5%) and urinary leakage through the nephrostomy site in 3 (5%). The distribution
of complications among subcostal and supracostal approaches was comparable. Of
the 60 renal units 46 (77%) were stone-free after percutaneous nephrolithotomy at
discharge from the hospital. Of the remaining 14 units 9 (15%) were stone-free
after shock wave lithotripsy and 5 (8%) had insignificant residual stones.
Therefore, the overall stone-free rate at 3 months was 92.5%. Comparing the
subcostal and supracostal approaches, there were no significant differences
between hospital stays, complication rates, unplanned auxiliary procedures, and
stone-free rates at discharge home and at 3-month followup. CONCLUSIONS:
Percutaneous nephrolithotomy for treating renal stones in children provides a
high degree of safety and efficacy whether a supracostal or subcostal approach is
used.

Publication Types: 
    Comparative Study

PMID: 18554648 [PubMed - indexed for MEDLINE]

76: Arch Ital Urol Androl. 2008 Mar;80(1):21-6.

SWL: our twenty-four year experience.

Zanetti G, Trinchieri A, Montanari E, Rocco F.

Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Clinica
Urologica I Università degli Studi di Milano, Italy. gp.zanetti@tiscali.it

Treatment of renal and ureteral stones by SWL has been proved safe and effective 
in the last 25 years. We reviewed our twenty-four year experience, which began in
January 1985 with an original HM3 Dornier lithotripter and has continued along
the years with second and multifunctional third generation lithotripters.
Dysrhythmias occurred almost exclusively in stone kidney treatments and never in 
distal ureteral ones. No significant correlation was found between the side of
the treated kidney, the number and strength of shockwaves, or the administration 
of analgesics and the occurrence of dysrhythmia. SWL without ECG triggering was
not associated with the occurrence of dysrhythmic episodes of any particular
clinical significance. We followed for an average of 42 months patients treated
with SWL for different types of stones. At discharge, 31.5% of the patients were 
stone free, whereas 65.3% had stone dust or passable fragments. At three-month
follow-up, 64.8% were stone free and 33.6% had dust or passable fragments. After 
a follow-up of over 24 months, 55% of the patients were still stone free,
recurrence was observed in 13.8% and regrowth of fragments in 22.3% of the
patients. Small fragments less than 5 mm are defined as clinically insignificant 
residual fragments (CIRF); although they are likely to pass spontaneously and
remain asymptomatic, they are considered by some authors a factor that favours
regrowth and an increased risk for symptomatic episodes. Patients with fragments 
in our experience do not require systematic retreatment but they could be
followed and treated if necessary if stones recur or symptoms persist. Most of
the CIRF pass spontaneously after treatment without any complication, but since
about 20% of patients become symptomatic or require intervention, a close
follow-up is required. Extracorporeal shock wave lithotripsy is the first choice 
treatment today for most renal and ureteral stones, however adequate evaluation
of the patient and of the stone is required, and all possible treatment options
should be considered.

Publication Types: 
    Review

PMID: 18533621 [PubMed - indexed for MEDLINE]

77: Arch Ital Urol Androl. 2008 Mar;80(1):18-20.

Ureteroscopic management of stones in anomalous kidneys.

Ferrandino MN, Preminger GM.

Comprehensive Kidney Stone Center, Duke University Medical Center, Division of
Urologic Surgery, Durham, North Carolina 27710, USA. michael.ferrandino@duke.edu

Surgical management of stones in anomalous kidney presents a problem for urologic
surgeons. Various minimally invasive management options have been previously
reported including shock wave lithotripsy (SWL), percutanteous nephrolithitomy
(PNL), as well as ureteroscopy. While all of their techniques work well in select
populations, recent improvements in endoscopic technology and intracorporeal
lithotripsy make ureteroscopy possible for most cases of stones in ectopic,
pelvic, or transplant kidneys. Additionally, many of the limitations of shock
wave lithotripsy and/or percutaneous neprholithotomy can be overcome with a
ureteroscopic approach. As new endoscopic technology and adjunctive device
developments continue to enter the urologist's armamentarium the role of
ureteroscopy continues to expand. Once unapproachable stones may now be addressed
via flexible ureteroscopes, improved baskets, and holmium lasers. In conclusion
ureteroscopic management of urolithiasis in anomalously located kidneys is a
viable approach. Success rates are similar to those reported for SWL and the
morbidity is less than PNL. With increasing dissemination of ureteroscopic
skills, improved technology and enhanced adjunctive devices (i.e.; sheaths and
baskets), ureteroscopy should play a larger role in the management of these
challenging patients, with subsequently reduced patient morbidity.

PMID: 18533620 [PubMed - indexed for MEDLINE]

78: Arch Ital Urol Androl. 2008 Mar;80(1):13-7.

Stones of the upper urinary tract. Update on minimal-invasive endourological
treatment.

Lahme S, Zimmermanns V, Hochmuth A, Liske P.

Department of Urology, Hospital St. Trudpert, Pforzheim, Germany.
sven.lahme@trudpert.de

So far extracorporal shockwave lithotripsy (SWL) is the treatment of choice for
upper urinary tract stones. Since the introduction of new minimal-invasive
endourological procedures, such as retrograde flexible uretero-renoscopy (fURS)
and minimal-invasive percutaneous nephrolithotomy (Mini-Perc), alternative
treatment modalities are available, which show enhanced stone-free rates and
decreased treatment morbidity even in unfavorable stone localizations of the
lower calix and calyceal diverticulum stones. In experienced hands modern
endourological approaches are suitable as first-line treatment of upper urinary
tract stones. Even in elderly patients and large stone burden the endourological 
techniques show acceptable results.

PMID: 18533619 [PubMed - indexed for MEDLINE]

79: Arch Ital Urol Androl. 2008 Mar;80(1):5-12.

Infections and urolithiasis: current clinical evidence in prophylaxis and
antibiotic therapy.

Zanetti G, Paparella S, Trinchieri A, Prezioso D, Rocco F, Naber KG.

Clinica Urologica, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e 
Regina Elena, Università degli Studi di Milano, Milano, Italy.
gp.zanetti@tiscali.it

Urinary tract infections and urosepsis are complications which can precede or
follow a kidney stone treatment. Often the stones themselves are the source of
infection, whether they are infection stones or not. Systemic infections are
difficult to foresee, and neither a pre-operative negative urine culture nor an
antibiotic prophylaxis avoid infectious complications for certain. The primary
predictive risk factors of urosepsis are: patient conditions, urinary tract
infection or a history of recurrent infections, characteristics of the stone, and
anatomy of the urinary tract. Infection stones are still a matter of debate,
concerning both the aetiology of the disease and its treatment. Positive cultures
are not only found with struvite stones, but also with apatite and calcium
oxalate stones. Currently, a long-term antibiotic therapy is advised in patients 
affected by infection stones. Antibiotic therapy should prevent not only septic
complications but also recurrence or re-growth of stones after treatment.
Different antibiotic modalities are recommended, sometimes together with urease
inhibitors. Mid-stream urine culture is the easiest available pre-treatment
parameter notwithstanding its poor predictive value. In case of suspected or
proven urinary infection, an appropriate antibiotic therapy should always be
administered prior to surgical procedure. There is, however, controversy
regarding the antibiotic use, its role, expediency, and duration of prophylaxis
in relation to the various surgical procedures, and the way infectious
complications are considered and classified. When antibiotic prophylaxis is
considered, its duration should be clearly established prior to surgery; duration
may vary depending on the type of surgery or the type of antibiotic. Furthermore,
prophylaxis should be administered only for a limited amount of time. In
infection stones, in immuno-compromised patients or in patients with anatomical
anomalies or diabetes, the risk of post-treatment infection and sepsis is higher 
Hence there is agreement on the need for prophylaxis and antibiotic therapy The
most recent literature has shown excellent results with fluoroquinolones both in 
prophylaxis and therapy, concerning post-operative infection control after
percutaneous as well as ureteroscopic removal of stones. No agreement has yet
been reached on antibiotic prophylaxis modalities prior to percutaneous or
ureteroscopic removal and its usefulness for SWL.

Publication Types: 
    Review

PMID: 18533618 [PubMed - indexed for MEDLINE]

80: Arch Ital Urol Androl. 2008 Mar;80(1):1-4.

Epidemiology of renal colic in a district general hospital.

Trinchieri A, Cappoli S, Esposito N, Acquati P.

Urology Unit, Ospedale A. Manzoni, Lecco, Italy. a.trinchieri@ospedale.lecco.it

BACKGROUND/AIMS: To assess the incidence of renal colic and the results of
emergency management. METHODS: During a 12 month period data of patients with
symptoms of renal colic were collected. RESULTS: A total of 495 visits were
registered. The M/F was 2.19. Mean age was higher in males (45.5+/-13.0 vs
42.5+/-15.5 years, P=0.025). Three patients were hospitalised for immediate
urinary diversion due to anuria or sepsis. Fifty-three patients recovered without
performing any pharmacological treatment. Analgesic treatment (mainly NSAID) was 
offered to 439 patients. After a 6 hour period 36 patients were admitted to the
hospital owing to persistent pain. Pain was reduced in 403 patients (91.8%) who
were offered outpatient renal ultrasound within 48 hours. Twenty-five patients
(6.2%) required deferred hospitalisation. Follow up with renal ultrasound was
obtained in 213. CONCLUSION: Renal colics accounted for 0.9% of ambulatory care
visits to our emergency departments with an annual rate of 0.158 visits per 100
in the general population. NSAIDs were efficacious in the management of colic.
Diagnostic work up was able to demonstrate the presence of a stone in 56% of the 
subjects presenting with renal colic whereas alternative diagnoses were
demonstrated in 12%.

PMID: 18533617 [PubMed - indexed for MEDLINE]

81: Urology. 2008 Aug;72(2):278-81. Epub 2008 Jun 4.

Acetazolamide is an effective adjunct for urinary alkalization in patients with
uric acid and cystine stone formation recalcitrant to potassium citrate.

Sterrett SP, Penniston KL, Wolf JS Jr, Nakada SY.

Division of Urology, University of Wisconsin, Madison, Wisconsin 53792, USA.

OBJECTIVES: Acetazolamide has been proposed as a treatment adjunct for patients
with cystine and uric acid stone formation recalcitrant to standard alkalization 
therapy. We evaluated the effect of acetazolamide in urinary alkalization in
patients with uric acid and cystine stone formation recalcitrant to potassium
citrate alone. METHODS: An institutional review board-approved, retrospective
chart review identified 12 patients at 2 sites who had been prescribed
acetazolamide as a treatment adjunct to potassium citrate for uric acid or
cystine stones from 1997 to 2007. We evaluated the urine studies, metabolic
evaluations, surgical interventions, and stone recurrence or growth. RESULTS: The
mean follow-up was 46.1 months (range 11-86). Ten patients (83%) were categorized
as compliant. Of the 2 patients excluded from the study, 1 was noncompliant with 
the medication, and the other was lost to follow-up. Of the 10 patients who were 
compliant with the treatment, 5 (50%) developed adverse effects from the
medication requiring discontinuation. Of the remaining 5 patients (50%) who
tolerated the medication and remained compliant, 3 (60%) were stone free at a
mean follow-up of 42 months. Two patients continued to form stones, including one
who developed calcification of an existing uric acid stone. Both patients
required surgical intervention. The mean urinary pH before treatment was 5.9
(range 5-7) and after treatment was 7.2 (range 6.5-8.5; P = .001). CONCLUSIONS:
Acetazolamide was effective in increasing the urinary pH in patients with uric
acid and cystine stone formation who were already taking potassium citrate.
Caution must be taken when prescribing acetazolamide, because it could be poorly 
tolerated and can induce calcium phosphate stone formation.

PMID: 18533229 [PubMed - indexed for MEDLINE]

82: Nat Clin Pract Nephrol. 2008 Jul;4(7):368-77. Epub 2008 Jun 3.

Oxalate in renal stone disease: the terminal metabolite that just won't go away.

Marengo SR, Romani AM.

Department of Physiology and Biophysics at Case Western Reserve University School
of Medicine, Cleveland, OH 44106-4970, USA. srm10@case.edu

The incidence of calcium oxalate nephrolithiasis in the US has been increasing
throughout the past three decades. Biopsy studies show that both calcium oxalate 
nephrolithiasis and nephrocalcinosis probably occur by different mechanisms in
different subsets of patients. Before more-effective medical therapies can be
developed for these conditions, we must understand the mechanisms governing the
transport and excretion of oxalate and the interactions of the ion in general and
renal physiology. Blood oxalate derives from diet, degradation of ascorbate, and 
production by the liver and erythrocytes. In mammals, oxalate is a terminal
metabolite that must be excreted or sequestered. The kidneys are the primary
route of excretion and the site of oxalate's only known function. Oxalate
stimulates the uptake of chloride, water, and sodium by the proximal tubule
through the exchange of oxalate for sulfate or chloride via the solute carrier
SLC26A6. Fecal excretion of oxalate is stimulated by hyperoxalemia in rodents,
but no similar phenomenon has been observed in humans. Studies in which rats were
treated with (14)C-oxalate have shown that less than 2% of a chronic oxalate load
accumulates in the internal organs, plasma, and skeleton. These studies have also
demonstrated that there is interindividual variability in the accumulation of
oxalate, especially by the kidney. This Review summarizes the transport and
function of oxalate in mammalian physiology and the ion's potential roles in
nephrolithiasis and nephrocalcinosis.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18523430 [PubMed - indexed for MEDLINE]

83: Expert Opin Pharmacother. 2008 Jun;9(9):1509-18.

Pharmacotherapy of kidney stones.

Pak CY.

University of Texas Southwestern Medical Center, Center for Mineral Metabolism
and Clinical Research, 5323 Harry Hines Boulevard, Dallas, TX 75390-8885, USA.
charles.pak@utsouthwestern.edu

BACKGROUND: Kidney stones are associated with various biochemical disturbances in
urine. Various drugs and dietary changes have been recommended to halt stone
recurrence. OBJECTIVE: To determine whether a correction of urinary abnormalities
by appropriate pharmacological agents and dietary modification may ameliorate
stone disease. METHODS: A review of the literature was conducted on the role of
diet, metabolic disorders and drugs for stone prevention. RESULTS/CONCLUSION:
Metabolic risk factors are hypercalciuria, hypocitraturia, hyperoxaluria,
hyperuricosuria, and abnormally low urinary pH. Dietary-environmental risk
factors include high urinary sodium and low urine volume. Rare or less commonly
encountered risk factors are high urinary cystine, and alkaline urine from an
infection with urea-splitting organisms. To ameliorate or correct the above
disturbances, all patients should be offered dietary modification, including
restricted intake of sodium, oxalate and animal proteins. Useful drugs include
thiazide or indapamide to control hypercalciuria, potassium citrate to correct
hypocitraturia and undue urinary acidity, and allopurinol for co-existing
hyperuricemia or marked hyperuricosuria.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 18518781 [PubMed - indexed for MEDLINE]

84: J Bone Miner Res. 2008 Oct;23(10):1629-37.

Morphological conversion of calcium oxalate crystals into stones is regulated by 
osteopontin in mouse kidney.

Okada A, Nomura S, Saeki Y, Higashibata Y, Hamamoto S, Hirose M, Itoh Y, Yasui T,
Tozawa K, Kohri K.

Department of Nephrourology, Nagoya City University Graduate School of Medical
Sciences, Mizuho-cho, Mizuho-ku, Nagoya City, Aichi, Japan.
a-okada@med.nagoya-cu.ac.jp

An important process in kidney stone formation is the conversion of retentive
crystals in renal tubules to concrete stones. Osteopontin (OPN) is the major
component of the kidney calcium-containing stone matrix. In this study, we
estimated OPN function in early morphological changes of calcium oxalate crystals
using OPN knockout mice: 100 mg/kg glyoxylate was intra-abdominally injected into
wildtype mice (WT) and OPN knockout mice (KO) for a week, and 24-h urine oxalate 
excretion showed no significant difference between WT and KO. Kidney crystal
depositions were clearly detected by Pizzolato staining but not by von Kossa
staining in both genotypes, and the number of crystals in KO was significantly
fewer than in WT. Morphological observation by polarized light optical
microphotography and scanning electron microphotography (SEM) showed large
flower-shaped crystals growing in renal tubules in WT and small and uniform
crystals in KO. X-ray diffraction detected the crystal components as calcium
oxalate monohydrate in both genotypes. Immunohistochemical staining of OPN showed
that the WT crystals contained OPN protein but not KO crystals. We concluded that
OPN plays a crucial role in the morphological conversion of calcium oxalate
crystals to stones in mouse kidneys.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18505365 [PubMed - indexed for MEDLINE]

85: J Urol. 2008 Jul;180(1):379-87. Epub 2008 May 21.

Apatite induced renal epithelial injury: insight into the pathogenesis of kidney 
stones.

Escobar C, Byer KJ, Khaskheli H, Khan SR.

Department of Pathology, College of Medicine, University of Florida, Gainesville,
Florida 32610, USA.

PURPOSE: Kidney stone formation is associated with the deposition of
hydroxyapatite as subepithelial plaques or tubular deposits in the renal
papillae. We investigated the effect of renal epithelial exposure to
hydroxyapatite crystals in vitro to develop an insight into the pathogenesis of
kidney stones. MATERIALS AND METHODS: NRK52E cells (No. CRL-1571, ATCC) were
exposed to 67 or 133 microg/cm(2) hydroxyapatite (No. 21223, Sigma-Aldrich) or
calcium oxalate monohydrate crystals (No. 27609, BDH Industries, Poole, United
Kingdom). In some studies cells were also exposed to crystals from the basal
side. After 3 or 6 hours of exposure medium was analyzed for lactate
dehydrogenase, 8-isoprostane and H(2)O(2). Medium collected after cell exposure
on the apical side was also analyzed for the production of monocyte
chemoattractant protein-1 and prostaglandin E2. Cells were stained with DAPI to
determine apoptotic activity and examined by scanning electron microscopy to
observe crystal-cell interaction. RESULTS: Cell exposure to hydroxyapatite
resulted in H(2)O(2) and 8-isoprostane production as well as in lactate
dehydrogenase release. Apical exposure appeared more provocative and injurious
than basal exposure. Exposure to hydroxyapatite for 6 hours resulted in increased
apoptotic activity. Apical exposure also resulted in increased monocyte
chemoattractant protein-1 and prostaglandin E2 production. CONCLUSIONS: Cell
exposure to hydroxyapatite crystals induced oxidative stress and lipid
peroxidation. It caused up-regulation of the inflammation mediators that may be
responsible for the kidney inflammation in patients with stones that is
associated with tubular hydroxyapatite deposition. It may also have a role in the
eruption of subepithelial Randall's plaques to the papillary surface.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18499159 [PubMed - indexed for MEDLINE]

86: Int J Nanomedicine. 2008;3(1):105-15.

Association between Randall's plaque and calcifying nanoparticles.

Ciftçioğlu N, Vejdani K, Lee O, Mathew G, Aho KM, Kajander EO, McKay DS, Jones
JA, Stoller ML.

Nanobac Pharmaceuticals, Johnson Space Center, Houston, TX, USA.

OBJECTIVES: Randall initially described calcified subepithelial papillary
plaques, which he hypothesized as nidi for urinary calculi. The discovery of
calcifying nanoparticles (CNP), also referred to as nanobacteria, in calcified
soft tissues has raised another hypothesis about their possible involvement in
urinary stone formation. This research is the first attempt to investigate the
potential association of these two hypotheses. METHODS: We collected renal
papilla and blood samples from 17 human patients who had undergone laparoscopic
nephrectomy. Immunohistochemical staining (IHS) was applied using monoclonal
antibody (mAb) against CNP. Homogenized papillary tissues and serum samples were 
cultured for CNP. Scanning electron microscopy (SEM) and energy dispersive X-ray 
spectroscopy (EDS) were performed on papillary samples. Serum samples were tested
for CNP antigen and antibody with enzyme-linked immunosorbent assay (ELISA).
RESULTS: Randall's plaques (RP) were visible on gross inspection in 11 out of 17 
samples. IHS was positive for CNP antigen in 8 of the visually positive samples, 
but in only 1 of the remaining samples. SEM revealed spherical apatite-formations
in 14 samples confirmed by EDS analysis. In cultures, all serum samples and 13
tissue homogenates grew CNP. In ELISA, 14 samples were positive for CNP-antigen
and 11 samples were positive for CNP-antibody. CONCLUSION: There was evidence of 
a link between detection of CNP and presence of RP. Although causality was not
demonstrated, these results suggest that further studies with negative control
samples should be made to explore the etiology of RP formation, thus leading to a
better understanding of the pathogenesis of stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18488421 [PubMed - indexed for MEDLINE]

87: Vet Pathol. 2008 May;45(3):417-26.

Characterization of melamine-containing and calcium oxalate crystals in three
dogs with suspected pet food-induced nephrotoxicosis.

Thompson ME, Lewin-Smith MR, Kalasinsky VF, Pizzolato KM, Fleetwood ML, McElhaney
MR, Johnson TO.

Department of Veterinary Pathology, Armed Forces Institute of Pathology, 6825
16th Street, Washington, DC 20306-6000, USA. Michelle.Thompson@afip.osd.mil

The histomorphologic characteristics and chemical composition of the crystals
associated with suspected pet food-induced nephrotoxicosis in 3 dogs are
described. Kidney specimens from 2 dogs, a 3-year-old Parson Russell Terrier and 
a 3-year-old Bernese Mountain Dog, were examined. Both developed acute renal
failure after eating canned pet food on the 2007 Menu Foods recall list. The
third case was a kidney specimen from a 1-year-old mixed-breed dog from a similar
2004 outbreak of canine renal failure in Taiwan, which occurred after eating a
commercial dog food. Hematoxylin and eosin (HE), 72-hour Oil Red O (ORO72h),
Alizarin Red S (pH 4.1-4.3), and Von Kossa stains; infrared (IR) spectroscopy;
and scanning electron microscopy with energy dispersive X-ray analysis (SEM/EDXA)
were performed to determine the histomorphologic characteristics and chemical
composition of the crystals observed in each case. Histomorphologic findings in
each case included acute, marked tubular degeneration and necrosis with many
intratubular birefringent crystals, and lymphoplasmacytic interstitial nephritis.
In each case, most of the crystals were rough, pale brown, and stained with
ORO72h but did not stain with Alizarin Red S (pH 4.1-4.3) or Von Kossa stains;
these features were consistent with a plastic or lipid. IR spectroscopy and
SEM/EDXA results were consistent with melamine-containing crystals. A second
crystal type identified in each case was smooth and platelike with staining
characteristics and IR spectroscopy and SEM/EDXA results consistent with calcium 
oxalate crystals. Melamine-containing crystals have distinct light microscopic,
histochemical, and SEM/EDXA characteristics that facilitate their identification 
in tissue.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 18487505 [PubMed - indexed for MEDLINE]

88: J Endourol. 2008 Jun;22(6):1219-25.

The presence of horseshoe kidney does not affect the outcome of percutaneous
nephrolithotomy.

Miller NL, Matlaga BR, Handa SE, Munch LC, Lingeman JE.

Department of Urologic Surgery, Vanderbilt University School of Medicine,
Nashville, Tennessee 37232, USA. nicole.miller@vanderbilt.edu

BACKGROUND AND PURPOSE: Large or complex calculi within a horseshoe kidney can
present a challenge because many cases are associated with other aberrant
anatomy. We performed a study to define the outcome of patients with a horseshoe 
kidney who were treated with percutaneous nephrolithotomy (PNL). PATIENTS AND
METHODS: From August 1999 to February 2007, 44 PNLs were performed in 35 patients
for calculi within a horseshoe kidney. Mean age was 55.4 years. Parameters
evaluated to assess the outcomes of PNL included presenting symptoms, stone
burden, location of access, stone-free rate, need for secondary intervention,
length of stay (LOS), complication rate, stone analysis, and metabolic data.
RESULTS: The average stone burden per kidney was 2.59 cm (range 1-6.2 cm). Single
percutaneous access was used in 97.7%. Location of the access tract was upper
pole (82.2%), interpolar (13.4%), and lower pole (4.4 %). Flexible nephroscopy
was performed in all patients. The stone-free rate after primary PNL was 84.1%.
Second-look nephroscopy was performed in five kidneys. Overall stone-free rate
was 93.2%. Average LOS was 1.92 days (range 1-4 d). Overall complication rate was
14.3%. Stone analysis revealed predominantly calcium stones, and metabolic
abnormalities were demonstrated in all patients with 24-hour urine studies.
CONCLUSIONS: PNL is the treatment of choice for large and/or complex stones. The 
presence of a horseshoe kidney does not affect the outcome of PNL. Upper pole
access is usually preferred, and flexible nephroscopy is essential to maximize
stone-free rates. SA and metabolic data support the premise that calculus
formation is a metabolic event.

PMID: 18484885 [PubMed - indexed for MEDLINE]

89: J Endourol. 2008 Jun;22(6):1161-7.

Second prize: Comprehensive proteomic analysis of human calcium oxalate
monohydrate kidney stone matrix.

Canales BK, Anderson L, Higgins L, Slaton J, Roberts KP, Liu N, Monga M.

Department of Urologic Surgery, Molecular Biology and Biophysics, University of
Minnesota, Minneapolis, Minnesota, USA. benjamin.canales@urology.ufl.edu

BACKGROUND AND PURPOSE: Previous efforts to identify the protein content of stone
matrix have been limited by the lack of technology necessary to analyze the
highly insoluble protein-crystalline complex. Our study objective is to
characterize the matrix of calcium oxalate monohydrate (COM) stones using a
comprehensive proteomics approach. MATERIALS AND METHODS: Seven pure COM stones
were powdered, and proteins were extracted using four different buffer solutions.
Detergent cleanup spin columns or concentrators were used to remove detergent and
to exchange buffers before trypsin digestion. Tryptic peptides were analyzed with
reversed-phase, high-performance liquid chromatography (RP-HPLC) and tandem mass 
spectrometry (MS/MS) using a QSTAR Pulsar i quadrapole time of flight mass
spectrometer. Tandem mass spectra were searched against National Center for
Biotechnology Information human nonredundant database using ProteinPilot 1.0
software (Applied Biosystems, Inc.) for protein hits; peptide MS/MS spectra were 
manually inspected. RESULTS: Of the four buffers, only 2% sodium dodecyl sulfate 
(SDS) samples had normal HPLC and MS/MS elution patterns. We identified 68
distinct proteins with 95% confidence. More than 50 of the proteins have not been
previously identified in stone matrix. Of particular note, a significant number
of inflammatory proteins were identified, including immunoglobulins, defensin -3,
clusterin, complement C3a, kininogen, and fibrinogen. CONCLUSIONS: SDS reducing
buffer was efficient at solubilizing proteins from stone matrix for further
MS-based proteomic analysis. A variety of cellular, structural, and plasma
proteins comprise COM stone matrix. Several of the stone proteins are involved in
cell injury pathways, which suggests that inflammation plays a role in human COM 
stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18484873 [PubMed - indexed for MEDLINE]

90: Urol Int. 2008;80(3):306-9. Epub 2008 May 14.

Laparoscopic pyeloplasty with concomitant pyelolithotomy--is it an effective mode
of treatment?

Srivastava A, Singh P, Gupta M, Ansari MS, Mandhani A, Kapoor R, Kumar A, Dubey
D.

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow, India. anees@sgpgi.ac.in

INTRODUCTION: Pelviureteric junction (PUJ) obstruction and concomitant renal
calculus disease may coexist. We present our experience with simultaneous
laparoscopic pyeloplasty and pyelolithotomy in such patients. METHOD: 20 patients
(20 renal units) underwent transperitoneal laparoscopic pyeloplasty and
concomitant pyelolithotomy at our institution. An initial dismembering of the PUJ
followed by removal of the calculi with rigid or semi-rigid graspers were done.
Calyceal stones were removed with the aid of a flexible cystoscope,
rigid/flexible ureteroscope and simultaneous fluoroscopy. The pyeloplasty was
subsequently performed in all cases. RESULT: A median of 2 stones (range 1-12)
were recovered from the 20 renal units. Complete stone clearance was possible in 
15/20 patients (75%). Three patients underwent subsequent extracorporeal
shock-wave lithotripsy and 2 required percutaneous nephrolithotomy. All patients 
were rendered stone-free at 6 months' follow-up. Diuretic renography at follow-up
revealed improved drainage in 18/20 (90%) patients; 2 patients had an equivocal
drainage pattern but their symptoms disappeared. CONCLUSION: Laparoscopic
pyeloplasty with concomitant pyeloplasty is feasible and effective, however
patients must be counseled about the possibilities of ancillary procedures to
achieve complete stone clearance. 2008 S. Karger AG, Basel

PMID: 18480637 [PubMed - indexed for MEDLINE]

91: Int J Urol. 2008 Jul;15(7):630-5. Epub 2008 May 8.

Risk of renal stone formation induced by long-term bed rest could be decreased by
premedication with bisphosphonate and increased by resistive exercise.

Okada A, Ohshima H, Itoh Y, Yasui T, Tozawa K, Kohri K.

Department of Nephro-urology, Nagoya City University Graduate School of Medical
Sciences, Nagoya, Japan.

OBJECTIVES: To clarify the influence of long-term bed rest on renal stone
formation and to analyze the mechanism of bed-rest-induced stone formation and
prevention by bisphosphonate and bed-rest exercise. METHODS: Twenty-five men aged
26-48 years and divided into control (CON: n = 9), exercise (EX: n = 9), and
pamidronate (PMD: n = 7) groups, rested on a 6 degrees head-down tilt bed for 90 
days. The exercise group carried out resistive exercise every 3 days. Pamidronate
(60 mg) was intravenously given 2 weeks before the initiation of bed rest.
Abdominal X-ray examination and urine biochemistry were carried out during 90
days of bed rest and 90 days of reloading. RESULTS: Renal stone formation was
observed in two (22.2%) and four (44.4%) subjects in the control and exercise
groups, respectively. No stone was seen in the pamidronate group. In the exercise
group, urinary oxalate and phosphate excretion were significantly higher than in 
the control group. In the pamidronate group, urinary calcium excretion and
relative supersaturation of calcium oxalate and brushite were lower than in the
control group throughout the bed-rest and recovery period. CONCLUSION: Long-term 
bed-rest-induced renal stone formation was found to be induced by increased
urinary calcium and subsequent crystal formation of calcium oxalate and calcium
phosphate. Exercise during bed rest for the prevention of bone mineral loss and
contracture might increase the risk of renal stone formation. Pamidronate is
useful for the prevention of renal stone formation during and after bed rest.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18479353 [PubMed - indexed for MEDLINE]

92: Urol Res. 2008 May;36(2):99-102. Epub 2008 May 10.

Kidney stones during pregnancy: an investigation into stone composition.

Ross AE, Handa S, Lingeman JE, Matlaga BR.

James Buchanan Brady Urological Institute, The Johns Hopkins University School of
Medicine, 600 North Wolfe Street, Baltimore, MD 21209, USA.

Kidney stones can be a source of considerable morbidity for pregnant women.
Although there is a body of literature confirming that different stone
compositions predominate for different age and sex cohorts, there have been no
similar reports characterizing the nature of stone disease during pregnancy. We
performed a multi-institutional study to define the composition of renal calculi 
diagnosed during pregnancy. We retrospectively reviewed the records from two
stone referral centers of all patients diagnosed with a de novo kidney stone
during pregnancy who underwent a procedure for the purpose of stone removal from 
June 2001 through September 2007. A total of 27 patients were identified, with a 
mean age of 26.8 years (range, 21-34). Twenty patients (74%) had no history of
prior stone formation. Seven patients (26%) had previously formed stones,
although none of these patients had a known kidney stone at the time they became 
pregnant. Stones were removed in the first, second, third trimester and
immediately post-partum in 4, 52, 22, and 22% respectively. Stone removal was
performed without complication in all cases. Analysis found that in 74% of all
cases (20 patients) stones were composed predominantly of calcium phosphate
(hydroxyapatite). In 26% of cases, (7 patients) the stones were composed
predominantly of calcium oxalate. Of the seven patients with prior stone history,
three patients had previously formed calcium phosphate stones and four patients
had previously formed calcium oxalate stones. Calcium oxalate calculi are the
most common stone in non-pregnant women of a comparable age as our subjects.
However, our present data suggest that stones detected during pregnancy are most 
commonly composed of calcium phosphate (hydroxyapatite). Indeed, it is the
minority of stones that are composed of calcium oxalate. Although the reason for 
this unusual preponderance of calcium phosphate calculi is unclear, physiologic
alterations that occur during pregnancy may be influential.

Publication Types: 
    Multicenter Study

PMID: 18470509 [PubMed - indexed for MEDLINE]

93: Urology. 2008 Aug;72(2):291-3. Epub 2008 May 12.

Fungal urosepsis after ureteroscopy in cirrhotic patients: a word of caution.

Beck SM, Finley DS, Deane LA.

Department of Urology, University of California, Irvine, School of Medicine,
Orange, California 92868, USA. sbeck@uci.edu

OBJECTIVES: Fungal sepsis after ureteroscopy (URS) is rarely reported. We report 
on 2 cases of acute fungemia that developed after routine ureteroscopic stone
manipulation in patients with advanced liver cirrhosis. This represents a unique 
and high-risk population, and, to our knowledge, these are the first such cases
reported. METHODS: We performed a retrospective review of the medical records of 
2 patients with Child-Pugh class B and C liver cirrhosis who had undergone
ureteroscopy (URS) and holmium laser lithotripsy for obstructing ureteral
calculi. RESULTS: The treated stones measured 10 mm and 12 mm and were at the
right ureteropelvic junction and left ureterovesical junction, respectively. Both
patients had had indwelling ureteral stents in place for 1 and 2 months before
URS plus holmium laser lithotripsy, with negative preoperative urine cultures.
Each procedure was uncomplicated, and a ureteral stent was left in situ in each
case. Within 12 hours of URS, each patient became tachycardic, hypotensive, and
febrile. Blood, urine (proximal to the stone), and stone cultures were positive
for Candida albicans in both patients. They were both successfully treated with
intravenous fluconazole and subsequently discharged from the hospital on
postoperative day 12 and 13, respectively. CONCLUSIONS: Patients with advanced
liver disease appear to be at greater risk of fungal sepsis after otherwise
uncomplicated URS and stone manipulation. Consideration should be given to
prophylactic antifungal therapy, in addition to the standard antibacterial
prophylaxis for such procedures.

Publication Types: 
    Case Reports

PMID: 18468666 [PubMed - indexed for MEDLINE]

94: Urol J. 2008 Winter;5(1):24-7.

Percutaneous nephrolithotomy in patients with solitary kidney.

Mahboub MR, Shakibi MH.

Department of Urology, Imam Reza Hospital, Mashhad University of Medical
Sciences, Mashhad, Iran. j_darabi@yahoo.com

INTRODUCTION: The aim of this study was to evaluate percutaneous nephrolithotomy 
(PCNL) in the patients with solitary kidneys. MATERIALS AND METHODS: Between 1995
and 2005, we had 11 patients with a solitary kidney and kidney calculi who
underwent PCNL at our center. Tubeless and standard PCNLs were performed in 3 and
7 patients. In 1 patient, we could not achieve access to the system due to the
stricture of the infundibulum. RESULTS: The calculi were extracted or fragmented 
successfully in 10 patients. In 2 patients with residual calculi, a double-J
catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was
performed. Retroperitoneal hematoma was detected in 3 cases by ultrasonography 1 
week after the procedure, which was treated conservatively. Also, fever occurred 
in 3 patients after the procedure which was treated successfully. The patients
were discharged on the 3rd and 4th postoperative days. CONCLUSION: Although PCNL 
is accompanied by the risk of complications such as severe bleeding that may
result in kidney loss in patients with a solitary kidney, the rate of success and
complications seem to be similar to the other patients if careful operation and
correct selection of candidates are done. Therefore, we recommend cautious
performance of PCNL in patients with solitary kidneys.

PMID: 18454422 [PubMed - indexed for MEDLINE]

95: Int J Urol. 2008 May;15(5):399-402.

Results of treatment of renal calculi with lower-pole fluoroscopically guided
percutaneous nephrolithotomy.

Nishizawa K, Yamada H, Miyazaki Y, Kobori G, Higashi Y.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.
nishizaw@kuhp.kyoto-u.ac.jp

OBJECTIVE: To prospectively assess the clinical efficacy and safety of lower-pole
fluoroscopically guided percutaneous nephrolithotomy (PNL). METHODS: A total of
90 renal units in 87 patients underwent lower-pole fluoroscopically guided PNL
for renal calculi. The average patient age was 56.0 years. Staghorn calculi were 
present in 41 renal units. There were 22 were upper pole, 54 middle pole, 76
lower pole, 70 pelvic and 18 ureteropelvic junction calculi. Patients without
significant residual fragments greater than 3mm on postoperative day 2 were
defined as primarily successful. Significant residual fragments were treated with
shock wave lithotripsy (SWL) every other day from postoperative day 3. RESULTS:
Mean operative time was 129.5 min (SD, 49.0). Blood transfusion was required in
four patients. Septic shock developed in three patients. Sixty-three percent of
the patients (57 of 90 procedures) were primarily successful after PNL: 83.7% of 
non-staghorn patients (41 of 49 procedures) and 39.0% of staghorn patients (16 of
41 procedures). Of the 33 patients with significant residual fragments, 13
staghorn and six non-staghorn patients had residual fragments in their middle
calyces. Of the preoperative variables, staghorn calculus and calculus in the
middle calyx were significant predictors of significant residual fragments after 
PNL. After adjunctive SWL, the overall success rate was 94.5%. CONCLUSIONS: Our
study suggests that lower-pole fluoroscopically guided PNL is a safe and
effective therapy for patients with staghorn or non-staghorn calculi. In patients
with staghorn calculi or calculi in the middle calyx, adjunctive treatment is
sometimes required to treat significant residual fragments.

PMID: 18452455 [PubMed - indexed for MEDLINE]

96: Kidney Int. 2008 May;73(10):1103-5.

When proton pumps go sour: Urinary acidification and kidney stones.

Wagner CA.

Institute of Physiology and Zurich Center for Integrative Human Physiology,
University of Zurich, Zurich, Switzerland. Wagnerca@access.uzh.ch

H(+)-ATPases mediate urinary acidification along the collecting duct, and
mutations in their B1 and a4 subunits result in distal renal tubular acidosis.
The pathomechanisms by which these mutations affect pump activity are only poorly
understood. Common polymorphisms may impair pump activity and may link the pump
to a higher risk for alkaline urine and the development of kidney stones.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18449176 [PubMed - indexed for MEDLINE]

97: Kidney Int. 2008 Jul;74(2):223-9. Epub 2008 Apr 30.

Histopathology and surgical anatomy of patients with primary hyperparathyroidism 
and calcium phosphate stones.

Evan AE, Lingeman JE, Coe FL, Miller NL, Bledsoe SB, Sommer AJ, Williams JC, Shao
Y, Worcester EM.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46223, USA. evan@anatomy.iupui.edu

Using a combination of intra-operative digital photography and micro-biopsy we
measured renal cortical and papillary changes in five patients with primary
hyperparathyroidism and abundant calcium phosphate kidney stones. Major tissue
changes were variable papillary flattening and retraction, dilation of the ducts 
of Bellini, and plugging with apatite deposits of the inner medullary collecting 
ducts and ducts of Bellini. Some of the papillae in two of the patients contained
plentiful large interstitial deposits of Randall's plaque and where the deposits 
were most plentiful we found overgrowth of the attached stones. Hence, this
disease combines features previously described in brushite stone
formers--dilation, plugging of ducts and papillary deformity--with the
interstitial plaque and stone overgrowth characteristic of routine idiopathic
calcium oxalate stone formers, suggesting that these two patterns can coexist in 
a single patient.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18449170 [PubMed - indexed for MEDLINE]

98: Am J Kidney Dis. 2008 May;51(5):741-7. Epub 2008 Mar 20.

Metabolic syndrome and self-reported history of kidney stones: the National
Health and Nutrition Examination Survey (NHANES III) 1988-1994.

West B, Luke A, Durazo-Arvizu RA, Cao G, Shoham D, Kramer H.

Division of Nephrology, University of Arizona, Tucson, AZ 85724, USA.
bradfordw9@hotmail.com

BACKGROUND: Metabolic syndrome affects approximately 25% of the American
population. Components of metabolic syndrome, such as obesity, hypertension, and 
diabetes, were associated with kidney stone disease, but no published large-scale
study examined the association between metabolic syndrome and history of kidney
stones. STUDY DESIGN: Cross-sectional analysis. The American Heart Association
and National Heart, Lung, and Blood Institute statement on metabolic syndrome was
used to define metabolic syndrome. SETTING & PARTICIPANTS: A national probability
sample of the US population National Health and Nutrition Examination Survey aged
20 years and older. PREDICTOR: Metabolic syndrome as defined by the American
Heart Association and National Heart, Lung, and Blood Institute. OUTCOMES &
MEASUREMENTS: Self-reported history of kidney stones. RESULTS: Of all adults
older than 20 years, 4.7% reported a history of kidney stones. The prevalence of 
self-reported history of kidney stones increased with the number of metabolic
syndrome traits from 3% with 0 traits to 7.5% with 3 traits to 9.8% with 5
traits. After adjustment for age and other covariates, the presence of 2 or more 
traits significantly increased the odds of self-reported kidney stone disease.
The presence of 4 or more traits was associated with an approximate 2-fold
increase in odds of self-reported kidney stone disease. LIMITATIONS:
Cross-sectional design, absence of dietary data. CONCLUSION: Metabolic syndrome
traits are associated with a self-reported history of kidney stones. This
association should be verified in prospective studies.

PMID: 18436084 [PubMed - indexed for MEDLINE]

99: Nat Clin Pract Urol. 2008 Jun;5(6):340-4. Epub 2008 Apr 22.

A case of a lower pole renal calculus managed with percutaneous nephrolithotomy.

Tseng KS, Matlaga BR.

Bloomberg School of Public Health, The Johns Hopkins University School of
Medicine, Baltimore, MD 21209, USA.

BACKGROUND: A 50-year-old man presented to an outpatient urology clinic with
left-sided flank pain. He had received treatment for a left renal pelvis calculus
5 years earlier; shock wave lithotripsy had been unsuccessful and ureteroscopic
laser lithotripsy had left the patient with a 2 mm residual stone fragment. The
fragment was deemed clinically insignificant, and the patient remained
asymptomatic without any further follow-up. INVESTIGATIONS: Physical examination,
CT of the abdomen and pelvis, and complete metabolic evaluation. DIAGNOSIS: Left 
lower pole renal calculus and idiopathic hypercalciuria. MANAGEMENT: The patient 
was counseled about his treatment options, and he elected to undergo percutaneous
nephrolithotomy. After a single-stage procedure, CT confirmed a stone-free state.
The patient was administered thiazide therapy and dietary counseling to treat his
hypercalciuria. This condition resolved, and the patient remained stone-free 1
year after treatment.

Publication Types: 
    Case Reports

PMID: 18431357 [PubMed - indexed for MEDLINE]

100: J Endourol. 2008 May;22(5):901-4.

Balloon dilatation versus Amplatz dilatation for nephrostomy tract dilatation.

Gönen M, Istanbulluoglu OM, Cicek T, Ozturk B, Ozkardes H.

Department of Urology, Baskent University Medical Research and Teaching Center,
Konya, Turkey. mgonen01@hotmail.com

PURPOSE: In this study, we present our experience using balloon and Amplatz
dilatation to establish a percutaneous tract. We also discuss advantages and risk
factors of both techniques. MATERIALS AND METHODS: We retrospectively reviewed
medical records of 229 patients who had undergone 235 percutaneous
nephrolithotomy procedures. The nephrostomy tract had been dilated using a
balloon (42 patients) or Amplatz (187 patients) dilator. Total operating time,
preoperative and postoperative hemoglobin concentrations, number of tracts
required, stone burden, blood transfusion rates, tract dilatation failures, and
the cost of the dilatation system were compared between the groups. RESULTS:
There were no statistically significant differences in operative time
(85.7+/-43.2 v 86.3+/-41.2 minutes; P=0.42), preoperative hemoglobin
concentration (14.1+/-1.1 v 13.8+/-1.4 mg/dL; P= .153), postoperative hemoglobin 
concentration (11.6+/-1.7 v 11.2+/-1.5 mg/dL; P= .601), or blood transfusion rate
(18.6% v 21.3%; P= .687) between the two groups. Also, there were no differences 
in failure rates between the two groups. CONCLUSIONS: The Amplatz dilator is
comparable with the balloon dilator with regard to efficacy, speed, and safety.
The Amplatz dilator is more cost-effective than the balloon dilator. However,
kidney hypermobility may be a significant problem during Amplatz dilatation.

Publication Types: 
    Comparative Study

PMID: 18429681 [PubMed - indexed for MEDLINE]

101: J Ethnopharmacol. 2008 May 22;117(3):491-5. Epub 2008 Mar 14.

Uricosuric effect of Roselle (Hibiscus sabdariffa) in normal and renal-stone
former subjects.

Prasongwatana V, Woottisin S, Sriboonlue P, Kukongviriyapan V.

Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen,
Thailand. vitoon@kku.ac.th

AIM OF THE STUDY: The Roselle (Hibiscus sabdariffa) was investigated for its
uricosuric effect. MATERIALS AND METHODS: A human model with nine subjects with
no history of renal stones (non-renal stone, NS) and nine with a history of renal
stones (RS) was used in this study. A cup of tea made from 1.5 g of dry Roselle
calyces was provided to subjects twice daily (morning and evening) for 15 days. A
clotted blood and two consecutive 24-h urine samples were collected from each
subject three times: (1) at baseline (control); (2) on days 14 and 15 during the 
tea drinking period; and (3) 15 days after the tea drinking was stopped
(washout). Serum and 24-h urinary samples were analyzed for uric acid and other
chemical compositions related to urinary stone risk factors. RESULTS: All
analyzed serum parameters were within normal ranges and similar; between the two 
groups of subjects and among the three periods. Vis-à-vis the urinary parameters,
most of the baseline values for both groups were similar. After taking the tea,
the trend was an increase in oxalate and citrate in both groups and uric acid
excretion and clearance in the NS group. In the RS group, both uric acid
excretion and clearance were significantly increased (p<0.01). When the
fractional excretion of uric acid (FEUa) was calculated, the values were clearly 
increased in both the NS and SF groups after the intake of tea and returned to
baseline values in the washout period. These changes were more clearly observed
when the data for each subject was presented individually. CONCLUSIONS: Our data 
demonstrate a uricosuric effect of Roselle calyces. Since the various chemical
constituents in Roselle calyces have been identified, the one(s) exerting this
uricosuric effect need to be identified.

PMID: 18423919 [PubMed - indexed for MEDLINE]

102: J Urol. 2008 Jun;179(6):2229-32. Epub 2008 Apr 18.

Long-term effects of extracorporeal shock wave lithotripsy on renal function: our
experience with 156 patients with solitary kidney.

el-Assmy A, el-Nahas AR, Hekal IA, Badran M, Youssef RF, Sheir KZ.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura,
Egypt. a_assmy@yahoo.com

PURPOSE: We studied the long-term impact of shock wave lithotripsy on renal
function, stone recurrence and hypertension in patients with a solitary kidney.
Patients with a solitary kidney provide a unique opportunity to evaluate any
clinically significant change in renal function. MATERIALS AND METHODS: We
retrospectively reviewed the records of 156 patients with stones in a solitary
kidney treated with shock wave lithotripsy monotherapy. Treatment outcome was
evaluated after 3 months. Long-term followup (more than 12 months) was available 
for 108 patients. Serum creatinine, systolic and diastolic blood pressure, new
onset hypertension, calculated glomerular filtration rate, and kidney morphology 
were determined before and after treatment, and compared by chi-square, paired
and unpaired t tests. RESULTS: After 3 months the overall stone-free rate was
80.8% (126 of 156). Renal obstruction caused by steinstrasse after shock wave
lithotripsy occurred in 14 (8.9%) patients. Secondary procedures were required in
20 (12.8%) patients. Followup ranged from 1 to 16 years with a mean of 3.8 (SD
+/- 3.5). After long-term followup the stone-free rate was 76.8% and real stone
recurrence developed in 18.5% of patients. There was no significant difference in
any evaluated pretreatment or posttreatment parameters. CONCLUSIONS: The
demonstrated effectiveness, small number of complications at short-term followup,
insignificant effect on renal function, blood pressure and relatively small
number of recurrences at the long-term followup confirm that shock wave
lithotripsy is not only effective but is also safe in the long run.

PMID: 18423733 [PubMed - indexed for MEDLINE]

103: J Urol. 2008 Jun;179(6):2238-43; discussion 2243. Epub 2008 Apr 18.

Determinants of quality of life for patients with kidney stones.

Bensalah K, Tuncel A, Gupta A, Raman JD, Pearle MS, Lotan Y.

Department of Urology, University of Texas Southwestern Medical Center at Dallas,
Dallas, Texas 75390-9110, USA.

PURPOSE: We evaluated various factors relating to quality of life in a population
of patients with stones. MATERIALS AND METHODS: A total of 155 patients seen at
our urology clinic for stones between January and May 2007 were prospectively
questioned regarding stone history and were administered the SF-36 questionnaire 
to assess quality of life. Age, body mass index, American Society of
Anesthesiologists score, number of stone episodes, interval from the last stone
episode, number of surgical procedures for stones and associated complications,
missed days of work and long-term medical treatment were elicited from the
patients. Individual SF-36 domains and composite scores were compared to those of
the American general population. Univariate and multivariate regression analyses 
were performed to assess the impact of all covariates on quality of life scores. 
RESULTS: Patients with stones scored lower than the average American population
in 5 of the 8 domains of the SF-36 as well as in the physical composite score.
Multivariate regression modeling showed that increasing body mass index and age
were the strongest predictors of decreased physical well-being. The number of
stone episodes did not influence SF-36 scores, although the number of surgical
procedures impacted physical and mental components. The number of ureteroscopy
procedures and stent placements primarily impacted mental well-being. Medical
therapy, particularly the use of potassium citrate, was associated with more
favorable quality of life. CONCLUSIONS: Various factors impact quality of life in
patients with urolithiasis but the most important are body mass index, age and
the number of surgical procedures. Prospective longitudinal studies may further
elucidate the determinants of quality of life and they might be used to optimize 
patient care.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18423704 [PubMed - indexed for MEDLINE]

104: J Urol. 2008 Jun;179(6):2233-7. Epub 2008 Apr 18.

Long-term outcomes of percutaneous nephrolithotomy compared to shock wave
lithotripsy and conservative management.

Krambeck AE, LeRoy AJ, Patterson DE, Gettman MT.

Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 
55906, USA. Krambeck.amy@mayo.edu

PURPOSE: Percutaneous nephrolithotomy is successful at achieving stone-free
status but long-term safety data are lacking. We report our long-term experience 
with percutaneous nephrolithotomy and compare these results with other treatment 
modalities. MATERIALS AND METHODS: We identified 87 patients treated with
percutaneous nephrolithotomy from 1983 to 1984 who continue to receive care at
our institution. Retrospective chart review was performed. Long-term results were
compared to those of a group of 288 patients with stones treated nonsurgically
(controls) and a group of 288 patients treated with shock wave lithotripsy
followed for 19 years. RESULTS: Average followup was 19.2 years (range 12.7 to
23.0). After percutaneous nephrolithotomy new onset renal insufficiency was noted
in 9 patients (10.6%), hypertension in 29 (34.1%), diabetes mellitus in 20
(23.5%) and ureteropelvic junction obstruction in 3 (3.5%). Stone recurrence
occurred in 32 patients (36.8%). Recurrent stone events were associated with
residual fragments after percutaneous nephrolithotomy (p = 0.049). Compared to
shock wave lithotripsy there were no significant differences in the development
of renal insufficiency, hypertension or diabetes mellitus. Stone recurrence was
more common following shock wave lithotripsy (53.5%) compared to percutaneous
nephrolithotomy (p = 0.033). Compared to controls there were no significant
differences in the development of renal insufficiency or hypertension. On
univariate analysis percutaneous nephrolithotomy was associated with the
development of diabetes mellitus (p <0.001) but this association did not persist 
in multivariate analysis. CONCLUSIONS: At 19 years of followup stone recurrences 
were less frequent following percutaneous nephrolithotomy compared to shock wave 
lithotripsy. Recurrent stone events were associated with residual fragments after
percutaneous nephrolithotomy. Percutaneous nephrolithotomy was not associated
with the development of adverse medical conditions compared to shock wave
lithotripsy or conservatively managed stone cases.

Publication Types: 
    Comparative Study

PMID: 18423676 [PubMed - indexed for MEDLINE]

105: J Endourol. 2008 Apr;22(4):627-30.

The role of extracorporeal shockwave lithotripsy in an asymptomatic special
patient group with small renal calculi.

Bedir S, Goktas S, Akay O, Sumer F, Seckin B, Dayanc M.

Department of Urology, Gulhane Military Medical Academy, School of Medicine,
Ankara, Turkey. sbedir@gata.edu.tr

BACKGROUND AND PURPOSE: Data concerning extracorporeal shock wave lithotripsy
(SWL) management of small (< or = 5 mm) asymptomatic renal caliceal stones are
lacking in the literature. In this study, we aimed to determine the effectiveness
of SWL in a special group of patients who had very small (< or = 5 mm)
asymptomatic renal caliceal stones. The group of patients consisted of pilots,
gendarmes, and soldiers, such as commandos, for whom treatment was obligatory and
who had to be stone free because of their military duties. PATIENTS AND METHODS: 
We retrospectively examined SWL data and retrieved information for 84 patients
with small asymptomatic renal caliceal stones. The SWL sessions were performed
with a Siemens Lithostar lithotriptor. The mean age of the patients was 34 +/- 13
years. The mean stone size was 4.8 +/- 0.4 mm. The mean numbers of shockwaves and
energy used were 2707 +/- 1742 and 18 +/- 2 kV, respectively. The location of
stones were: 11 right upper calix, 10 right middle calix, 17 right lower calix,
13 left upper calix, 16 left middle calyx, and 17 left lower calix. Eighty-four
patients underwent 101 SWL sessions. Only eight patients had second and three
patients had third SWL treatments. SWL was performed five times for only one
patient. All mean values were realized with an SPSS 10.0 statistical program.
RESULTS: After the first, second, and third SWL sessions, the stone-free rate was
calculated as 87%, 93% and 94%, respectively. Only five patients with lower renal
caliceal stones were not stone free. The reported complications were macroscopic 
hematuria necessitating medical attention in four patients, skin ecchymosis in
seven patients, severe colic pain in two patients, and urinary-tract infection in
one patient. There was no need for hospitalization for these complications.
CONCLUSION: SWL is effective and safe in patients with very small (< or = 5 mm)
asymptomatic renal caliceal stones in all locations.

PMID: 18419208 [PubMed - indexed for MEDLINE]

106: Ann Pharmacother. 2008 May;42(5):692-7. Epub 2008 Apr 15.

Efficacy of tamsulosin with extracorporeal shock wave lithotripsy for passage of 
renal and ureteral calculi.

Losek RL, Mauro LS.

College of Pharmacy, University of Toledo, Toledo, OH 43606, USA.
laurie.mauro@utoledo.edu

OBJECTIVE: To review the evidence for the safety and efficacy of adjunctive
tamsulosin in enhancing the efficacy of renal and ureteral stone clearance when
used with extracorporeal shock wave lithotripsy (ESWL). DATA SOURCES: A search of
MEDLINE (1950-January 2008), PubMed (1950-January 2008), and the Iowa Drug
Information System (1966-January 2008) was performed using the search terms
tamsulosin and extracorporeal shock wave lithotripsy. MeSH headings included
lithotripsy and adrenergic alpha-antagonists. Additional references were found by
searching bibliographic references of resulting citations. STUDY SELECTION AND
DATA EXTRACTION: All studies utilizing tamsulosin therapy after a single session 
of ESWL or after the development of steinstrasse, an accumulation of stone
fragments that obstructs the ureter, were included. DATA SYNTHESIS: To date, 5
prospective studies have evaluated the efficacy of tamsulosin combined with ESWL 
in enhancing the passage of renal and ureteral stones. In one trial, 12-week
renal stone clearance was 60% in the control group compared with 78.5% in the
tamsulosin group (p = 0.037). Among trials that evaluated overall ureteral stone 
clearance, efficacy rates were 33.3-79.3% in the control groups compared with
66.6-96.6% in the tamsulosin groups. Reports of pain and supplemental analgesic
dosing were consistently lower with tamsulosin, but data on the incidence of
subsequent retreatment with ESWL or ureteroscopy was rarely reported. Adjunctive 
tamsulosin particularly enhanced the passage of renal stones 10-24 millimeters in
diameter. Overall, tamsulosin was well tolerated. CONCLUSIONS: Overall, evidence 
suggests that adjunctive tamsulosin therapy combined with ESWL is safe and
effective in enhancing stone clearance in patients with renal stones 10-24
millimeters in diameter. Evidence regarding ureteral stone clearance is
inconclusive, although adjunctive tamsulosin has been reported to reduce painful 
episodes. Larger prospective trials evaluating different dosages and stone
locations, as well as the ability of tamsulosin to reduce repeat ESWL or more
invasive methods such as ureteroscopy should be performed.

Publication Types: 
    Review

PMID: 18413683 [PubMed - indexed for MEDLINE]

107: Nat Med (Tokyo). 2008 Jul;62(3):300-7. Epub 2008 Apr 12.

Evaluation of Sesbania grandiflora for antiurolithiatic and antioxidant
properties.

Doddola S, Pasupulati H, Koganti B, Prasad KV.

Institute of Pharmaceutical Technology, Sri Padmavati Mahila Visva Vidyalayam
(Women's University), Tirupati, 517 502, India.

In the indigenous system of medicine in India, the plant Sesbania grandiflora is 
claimed to be useful for various ailments, and one such use is for the treatment 
of renal calculi. The major purpose of this study is to investigate the potential
of S. grandiflora in the treatment of renal calculi. The leaf juice of S.
grandiflora was evaluated for median lethal dose, gross behavioral changes,
antiurolithiatic and antioxidant activities. The antiurolithiatic activity was
evaluated by a calculi-producing diet model, using gentamicin (subcutaneously)
and 5% ammonium oxalate in rat feed to induce calcium oxalate-type stones. The
parameters monitored in the present study are calcium and oxalate deposition in
the kidney, kidney weights, urinary excretion of calcium and oxalate. The in vivo
antioxidant parameters lipid peroxidation, glutathione reductase and catalase
were monitored. The plant juice was also evaluated for scavenging of nitric oxide
and 2-diphenyl-2-picryl hydrazyl free radicals. The leaf juice of S. grandiflora 
was safe orally and exhibited no gross behavioral changes except for an increase 
in urination. The leaf juice of S. grandiflora showed significant
antiurolithiatic activity against calcium oxalate-type stones and also exhibited 
antioxidant properties. The results obtained in this study provide evidence for
the efficacy of the leaf juice of S. grandiflora as antiurolithiatic agent.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18408896 [PubMed - indexed for MEDLINE]

108: Contrib Nephrol. 2008;160:142-58.

Proteomics and kidney stone disease.

Thongboonkerd V.

Medical Proteomics Unit & Medical Molecular Biology Unit, Office for Research and
Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand. thongboonkerd@dr.com

Kidney stone disease (nephrolithiasis) is an ancient and common affliction. It
has been recognized for a long time with evidence of stone found in approximately
7,000-year-old mummies and remains a common problem worldwide, indicating
ineffective prevention in the past. Precise pathogenic and molecular mechanisms
of kidney stone formation are still poorly understood and should be further
elucidated. Also, identification of novel therapeutic targets for better
therapeutic outcome and successful prevention of the occurrence and recurrence of
the stone are crucially required. One of the most promising tools for current and
future biomedical research is proteomics, which has been extensively and widely
applied to the nephrology field during the past 5 years. Its high-throughput
capability holds a great promise also to kidney stone research. This chapter
provides a brief overview of proteomic methodologies recently used for the
investigation of nephrolithiasis and recent proteomic studies of nephrolithiasis 
are summarized.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 18401167 [PubMed - indexed for MEDLINE]

109: J Endourol. 2008 May;22(5):883-7.

Local anesthesia with 20-mL prilocaine infiltration: the ultimate point for
analgesia during shockwave lithotripsy?

Yilmaz E, Batislam E, Tuglu D, Yuvanc E.

Faculty of Medicine, Department of Urology, University of Kirikkale, Kirikkale,
Turkey. erdaly69@mynet.com

PURPOSE: The effectiveness of 10 mL and 20 mL local prilocaine infiltration for
analgesic purposes during shockwave lithotripsy (SWL) was compared, and the
differences in pain intensity and need for additional analgesics were defined.
PATIENTS AND METHODS: One hundred and twenty-one patients between the ages of 16 
and 69 with kidney stones were randomly separated into two groups. The 60
patients in group 1 received 10 mL prilocaine subcutaneously and deep lumbar
infiltration into the area 1 cm below the twelfth rib 2 minutes before SWL. The
61 patients in group 2 received 20 mL subcutaneously and deep lumbar infiltration
of prilocaine to the same locale, again 2 minutes before the process. All the
patients received one session of SWL. For measurement of pain intensity, the 0 to
100 mm visual analog scale (VAS) was used at 1 minute and every 10 minutes during
the process. Intravenous fentanyl was administered to patients who had steady or 
increasing intensity of pain during the process. RESULTS: VAS values were
statistically significantly higher in patients in group 1 compared with patients 
in group 2 during the process. While 40 patients received additional analgesia in
group 1, only three patients in group 2 needed additional analgesia. CONCLUSION: 
Use of 20 mL subcutaneous and deep lumbar prilocaine infiltration during SWL for 
analgesic purposes is recommended as an efficient, cost-effective,
anesthetist-independent, and reliable method.

Publication Types: 
    Randomized Controlled Trial

PMID: 18393643 [PubMed - indexed for MEDLINE]

110: Urology. 2008 Apr;71(4):586-91; discussion 591-2.

Shock wave lithotripsy for renal stones is not associated with hypertension and
diabetes mellitus.

Sato Y, Tanda H, Kato S, Ohnishi S, Nakajima H, Nanbu A, Nitta T, Koroku M,
Akagashi K, Hanzawa T.

Department of Urology, Sanjukai Urological Hospital, Sapporo, Japan.
ysato@sanjukai.or.jp

OBJECTIVES: To clarify the influences of shock wave lithotripsy (SWL) treatments 
for renal and ureteropelvic junction stones on new onsets of hypertension and
diabetes mellitus (DM). METHODS: We compared the new onsets of hypertension and
DM after SWL in renal and ureteral stone groups. The renal stone group consisted 
of 772 patients treated with SWL, who had a possibility of renal and pancreatic
shock wave damage. The ureteral stone group consisted of 505 patients treated
with SWL, who were unlikely to have suffered SWL damage in the kidney and
pancreas areas. Both treatment groups received SWL between 1984 and 1994.
RESULTS: The rates of new onset of hypertension in the renal stone and ureteral
stone groups were 22.8% and 20.0% in men and 23.1% and 20.5% in women,
respectively. The rates of new onset of DM in the renal stone and ureteral stone 
groups were 7.4% and 11.0% in men and 8.7% and 8.7% in women, respectively. There
was no significant difference in the new onsets of hypertension and DM between
renal and ureteral stone groups depending on each age decade or sex. Treatment
for renal stone was not a significant risk factor for new onsets of hypertension 
and DM by logistic regression analysis. CONCLUSIONS: Our findings suggest that
SWL treatment for renal and UPJ stones might not be associated with new onset of 
hypertension or DM.

PMID: 18387387 [PubMed - indexed for MEDLINE]

111: Congenit Heart Dis. 2006 Sep;1(5):251-3.

Renal calculi complicating short-term furosemide therapy after congenital heart
surgery.

Ali SK.

Sudan Heart Center, Khartoum, Sudan. sulafakhalid2000@yahoo.com

BACKGROUND: Renal calcification is a known complication of Furosemide therapy.
METHODS: We describe 3 children who were diagnosed with renal calculi, not
nephrocalcinosis, following the use of Furosemide for 4 weeks. All the infants
(24, 18, and 8 months) had successful repair/palliation of congenital heart
disease. The dose of Furosemide was 1-2 mg/kg/day and the duration between
starting treatment and development of hematuria was 4 weeks. RESULTS: In all 3
patients renal ultrasound confirmed the presence of renal calculi with no
nephrocalcinosis. On follow-up, hematuria improved after 3-4 months. CONCLUSION: 
Renal calculi can complicate short-term Furosemide treatment in children after
repair of congenital heart disease. Patients on Furosemide should be closely
monitored by urine analysis and/or urine calcium/creatinine ratio for early
detection of this complication.

Publication Types: 
    Case Reports

PMID: 18377534 [PubMed - indexed for MEDLINE]

112: Emerg Med Australas. 2008 Apr;20(2):105-11.

Acute complications following extracorporeal shock-wave lithotripsy for renal and
ureteric calculi.

Doran O, Foley B.

Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand. 
owend@adhb.govt.nz

Extracorporeal shock-wave lithotripsy remains a widely utilized treatment
modality for renal and some ureteric calculi. The treatment is generally
considered very safe. However, minor complications occur in a significant number 
of patients. Serious complications, causing ongoing morbidity or mortality, are
rare, affecting less than 1% of patients. A review of the literature on the
adverse effects of the treatment, with an emphasis on those which might present
to ED is presented.

Publication Types: 
    Case Reports
    Review

PMID: 18377399 [PubMed - indexed for MEDLINE]

113: J Endourol. 2008 May;22(5):919-22.

Retrograde holmium:YAG laser disintegration of stones in pelvic ectopic kidneys: 
would it minimize the risk of surgery?

Fayad AS.

Urology, Cairo University, Kasr El-Aini Hospital, Cairo, Egypt.
amffayad@yahoo.com

PURPOSE: To study the safety and efficacy of the holmium:YAG laser for
disintegration of stones in pelvic ectopic kidneys. PATIENTS AND METHODS: Between
October 2005 and October 2006 four consecutive patients with large obstructing
calculi (>3 cm in diameter) in the pelves of pelvic ectopic kidneys were prepared
to be treated using retrograde ureterorenoscopy and holmium:YAG laser
lithotripsy. All the patients were investigated with x-rays of the kidney,
ureters, and bladder (KUB) and intravenous urography (IVU). Holmium:YAG laser
lithotripsy was performed in a retrograde manner using energy ranging from 1 to
1.5 J/pulse with a frequency ranging from 15 to 20 Hz. RESULTS: Four patients
were included in the study. The average age of the patients was 44 years (range
35-56 years). The average operative time for the laser lithotripsy procedure was 
120 minutes (range 100-180 minutes). Three of the patients (75%) were rendered
stone-free at 3 months. None of the patients developed back-pressure changes,
gross hematuria, or abdominal pain during the follow-up period. One of the
patients could not be treated endoscopically and required open surgery. Hospital 
stay ranged between 2 and 3 days. CONCLUSION: Retrograde ureteroscopy and
holmium:YAG laser lithotripsy is efficacious for managing patients with stones in
pelvic kidneys. The procedure is safe and effective and avoids the complications 
of open surgery.

PMID: 18370611 [PubMed - indexed for MEDLINE]

114: J Endourol. 2008 Apr;22(4):631-6.

Current practice patterns in the management of upper urinary tract calculi in the
north central United States.

Bandi G, Best SL, Nakada SY.

Division of Urology, Department of Surgery, University of Wisconsin, Madison,
Wisconsin, USA.

PURPOSE: To determine the current practice patterns in the management of upper
urinary tract calculi in a large group of urologists in the north central United 
States. MATERIALS AND METHODS: An email survey was sent to 790 practicing members
of the North Central Section of the American Urological Association. The survey
consisted of questions pertaining to practice and training background, and case
scenarios with treatment options for upper urinary tract calculi of different
sizes at various locations. The responses were then statistically analyzed to
determine practice trends. RESULTS: Seven urologists did not fill out the survey,
as they did not manage patients with stone disease. The overall response rate was
23% (167/783). Although more than 75% of urologists were trained to perform
extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous 
nephrolithotomy (PCNL) during their residency, only 61% and 17% were trained to
perform open stone surgery (OSS) and medical expulsive therapy (MET),
respectively. Twelve percent of respondents were fellowship trained in
endourology. Observation was most commonly recommended for asymptomatic renal
calculi <5 mm in size (92%). Although SWL continues to be the most commonly
utilized therapy for renal (43%-92%) and proximal ureteral calculi <20 mm in size
(29%-51%), and PCNL for renal calculi >20 mm in size (72%-92%), many urologists
(48%) favored PCNL for lower pole calculi 10 to 20 mm in size. Use of URS was
mostly favored for distal (44%-90%) and proximal ureteral calculi (23%-46%),
while MET was recommended for small ureteral calculi <5 mm in size (25%-32%).
Fellowship-trained endourologists, academic urologists, and urologists in
practice for less than 5 years were more likely to utilize URS, PCNL, and MET,
and less likely to utilize SWL for urinary calculi. CONCLUSION: The results of
this survey suggest that practice patterns for treatment of stone disease match
the treatment approach recommended in the published literature. This information 
can be further utilized for assessment of guidelines for the treatment of stone
disease.

PMID: 18366318 [PubMed - indexed for MEDLINE]

115: Urol Int. 2008;80(2):141-4. Epub 2008 Mar 19.

Management of cystinuric patients: an observational, retrospective, single-centre
analysis.

Ahmed K, Khan MS, Thomas K, Challacombe B, Bultitude M, Glass J, Tiptaft R,
Dasgupta P.

Department of Urology, Guy' and St. Thomas' NHS Trust, GKT School of Medicine,
London, UK. kahmed198@yahoo.co.uk

OBJECTIVE: A critical appraisal of the management of patients with cystine stones
treated in our unit in the past 6 years and to analyze the outcome of
multimodality therapies. STUDY DESIGN: An observational, single-centre
retrospective study. METHODS: We reviewed the records of all patients with stones
referred to our centre over a 6-year period from 1998 to 2005. Data recorded
included demographic details, medical therapies received/prescribed, compliance
with medical therapies, mode of treatment, stone clearance and any recurrence
during this period of study. RESULTS: A total of 30 cystinuric patients were
treated in our institution over the period of 6 years from 1998 to early 2005. Of
these 16 were males and 14 females with an average age at last follow-up of 39
years (range 15-70). Two patients were successfully managed medically. The
remaining patients (n = 28) underwent a total of 237 procedures (pre- and
postreferral to our unit), with an average of 7.9 procedures per patient for 126 
stone episodes (4.2 episodes/patient). The modes of treatment included
extracorporeal shockwave lithotripsy (n = 143), ureterorenoscopy and
intracorporeal lithotripsy (n = 50), percutaneous nephrolithotomy (n = 28) and
open procedures (n = 16). Two patients needed open surgery at our unit. Prior to 
referral to our dedicated unit, patients had received treatment with
extracorporeal shockwave lithotripsy (multiple sessions), ureteroscopy (n = 14), 
percutaneous nephrolithotomy (n = 4) and open stone removal (n = 14). Most of the
stones at our unit were managed using minimally invasive therapies. CONCLUSION:
Compliance of cystinuric patients with medical treatment is often poor and
patients experience recurrent stone episodes requiring multiple interventions.
Modern management of cystine calculi should be with staged minimally invasive
procedures to avoid the complications of multiple open procedures wherever
possible along with appropriate medical prophylaxis.

PMID: 18362482 [PubMed - indexed for MEDLINE]

116: Semin Nephrol. 2008 Mar;28(2):200-13.

The acute and long-term adverse effects of shock wave lithotripsy.

McAteer JA, Evan AP.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, IN 46202-5120, USA. mcateer@anatomy.iupui.edu

Shock wave lithotripsy (SWL) has proven to be a highly effective treatment for
the removal of kidney stones. Shock waves (SWs) can be used to break most stone
types, and because lithotripsy is the only noninvasive treatment for urinary
stones, SWL is particularly attractive. On the downside SWL can cause vascular
trauma to the kidney and surrounding organs. This acute SW damage can be severe, 
can lead to scarring with a permanent loss of functional renal volume, and has
been linked to potentially serious long-term adverse effects. A recent
retrospective study linking lithotripsy to the development of diabetes mellitus
has further focused attention on the possibility that SWL may lead to
life-altering chronic effects. Thus, it appears that what was once considered to 
be an entirely safe means to eliminate renal stones can elicit potentially severe
unintended consequences. The purpose of this review is to put these findings in
perspective. The goal is to explain the factors that influence the severity of
SWL injury, update current understanding of the long-term consequences of SW
damage, describe the physical mechanisms thought to cause SWL injury, and
introduce treatment protocols to improve stone breakage and reduce tissue damage.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 18359401 [PubMed - indexed for MEDLINE]

117: Semin Nephrol. 2008 Mar;28(2):111-9.

Role of interstitial apatite plaque in the pathogenesis of the common calcium
oxalate stone.

Evan AP, Lingeman JE, Coe FL, Worcester EM.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, IN 46202-5120, USA. evan@anatomy.iupui.edu

By using intraoperative papillary biopsy material from kidneys of idiopathic
calcium oxalate, intestinal bypass for obesity, brushite, cystine, and distal
renal tubular acidosis stone formers during percutaneous nephrolithotomy, we have
determined that idiopathic calcium oxalate stone formers appear to be the special
case, although the most commonly encountered one, in which stones form external
to the kidney and by processes that do not involve the epithelial compartments.
It is in this one group of patients that we find not only abundant interstitial
plaque, but also strong evidence that the plaque is essential to stone formation.
The initial site of plaque formation is always in the papillary tip, and must be 
in the basement membrane of the thin loop of Henle. With time, plaque spreads
throughout the papilla tip to the urothelium, which under conditions we do not
understand is denuded and thereby exposes the apatite deposits to the urine. It
is on this exposed apatite that a stone forms as an overgrowth, first of
amorphous apatite and then layers of calcium oxalate. This process generates an
attached stone fixed to the side of a papilla, allowing the ever-changing urine
to dictate stone growth and composition.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 18359392 [PubMed - indexed for MEDLINE]

118: Semin Nephrol. 2008 Mar;28(2):99-110.

Evaluation of the kidney stone patient.

Asplin JR.

Litholink Corporation, Chicago, IL 60612, USA. jasplin@litholink.com

Kidney stones are one of the most common chronic disorders in industrialized
countries. In patients with kidney stones, the goal of medical therapy is to
prevent the formation of new kidney stones and to reduce growth of existing
stones. The evaluation of the patient with kidney stones should identify dietary,
environmental, and genetic factors that contribute to stone risk. Radiologic
studies are required to identify the stone burden at the time of the initial
evaluation and to follow up the patient over time to monitor success of the
treatment program. For patients with a single stone an abbreviated laboratory
evaluation to identify systemic disorders usually is sufficient. For patients
with multiple kidney stones 24-hour urine chemistries need to be measured to
identify abnormalities that predispose to kidney stones, which guides dietary and
pharmacologic therapy to prevent future stone events.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 18359391 [PubMed - indexed for MEDLINE]

119: J Endourol. 2008 Mar;22(3):427-34.

Tubeless percutaneous nephrolithotomy: is it really less morbid?

Singh I, Singh A, Mittal G.

Division of Urology, University College of Medical Sciences (University of Delhi)
and GTB Hospital, Delhi, India. iqbalsinghp@yahoo.co.uk

PURPOSE: To prospectively evaluate and study the role, relative safety, and
effectiveness of "tubeless" percutaneous nephrolithotomy (PCNL) and whether it is
really less morbid vis-à-vis PCNL with a nephrostomy tube; to compare the
postoperative pain, analgesia requirement, hospital stay, return to work time,
and other parameters in patients undergoing tubeless PCNL and standard PCNL.
PATIENTS AND METHODS: Sixty selected patients underwent PCNL. A single urologist 
(IS) was the surgeon, and a resident administered random chit numbers, and
recorded pain scores and results of all the chosen parameters. Patients who
fulfilled the entry criteria for a tubeless PCNL protocol were randomized to
either the omission of a nephrostomy tube (tubeless PCNL with Double-J stent) or 
to the placement of a 22F nephrostomy tube. The recorded data were analyzed with 
respect to several parameters. RESULTS: The mean age, stone burden, and
preoperative hemoglobin, blood urea, and serum creatinine values were not
significantly different between the two groups. However, the operative time (P < 
0.001), analgesia requirement (P < 0.001), and hospital stay and time to return
to normal activity (P < 0.001) were significantly lower in the tubeless PCNL
group. CONCLUSIONS: Significantly less pain, lower analgesia requirement, and
shorter hospital stay with early return to normal activities were observed in the
tubeless PCNL group v the primary nephrostomy tube PCNL group. Tubeless PCNL in
selected patients is a secure, effective, and less morbid procedure that does not
compromise patient safety and concerns. We recommend that tubeless PCNL be the
preferred procedure in selected patients for management of nephrolithiasis.

Publication Types: 
    Randomized Controlled Trial

PMID: 18355137 [PubMed - indexed for MEDLINE]

120: Urology. 2008 Jul;72(1):61-4. Epub 2008 Mar 17.

The University of Michigan experience with percutaneous nephrostolithotomy for
urinary matrix calculi.

Rowley MW, Faerber GJ, Wolf JS Jr.

Department of Urology, University of Michigan Health System, Ann Arbor, Michigan 
48109, USA.

OBJECTIVES: To evaluate commonalities in presentation and long-term efficacy of
treatment by percutaneous nephrostolithotomy of matrix stones, a rare form of
urinary calculi. METHODS: The clinical data of 9 consecutive patients with
urinary matrix calculi in 11 kidneys treated at our institution between 1995 and 
2007 were retrospectively reviewed. RESULTS: The matrix component in all 11
kidneys was successfully treated with percutaneous nephrostolithotomy, with few
complications. Among 8 patients (9 kidneys) with follow-up, none has had
recurrence of matrix stones after a mean follow-up of 3.8 years. Along with
previously known risk factors for matrix stones, such as urinary tract infections
and renal insufficiency, we identified smoking as another possible risk factor.
Long-term antimicrobial prophylaxis was used in only 1 patient and thus does not 
seem necessary for prevention of recurrence. CONCLUSIONS: Matrix stone treatment 
with percutaneous nephrostolithotomy is durable and should remain the treatment
modality of choice.

PMID: 18342922 [PubMed - indexed for MEDLINE]

121: Pediatr Nephrol. 2008 Jul;23(7):1129-33. Epub 2008 Mar 7.

Metabolic risk factors in children with kidney stone disease.

Spivacow FR, Negri AL, del Valle EE, Calviño I, Fradinger E, Zanchetta JR.

Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires,
Argentina.

The evaluation of metabolic risk factor in children with renal stone disease is
the basis of medical treatment aimed at preventing recurrent stone events and the
growth of preexisting calculi. In this retrospective study, we evaluated the
metabolic risk factors and clinical and family histories of 90 children with
kidney stone disease who had been referred to our institution and subjected to
clinical tests using a standardized protocol. The mean age of our pediatric
patients was 10.7 years, and the male:female ratio was 1.14:1.0. Biochemical
abnormalities were found in 84.4% of all cases. A single urine metabolic risk
factor was present in 52.2% (n = 47) of the patients, and multiple risk factors
were present in the remaining 31.1% (n = 28). Idiopathic hypercalciuria (alone or
in combination) and hypocitraturia (alone or in combination) were the most
frequent risk factors identified in 40 and 37.8% of these patients, respectively.
Renal colic or unspecified abdominal pain were the most frequent forms of
presentation (76.9%), with 97.5% of stones located in the upper urinary tract. In
most patients, stone disease was confirmed by renal ultrasonography (77%). A
positive family history in first-degree and second-degree relatives was found in 
46.2 and 32.5% of the cases, respectively. We conclude that specific urine
metabolic risk factors are found in most children with kidney stones and that
hypocitraturia is as frequent as hypercalciuria. Very often there is a positive
family history of renal stone disease in first- and second-degree relatives.

PMID: 18324422 [PubMed - indexed for MEDLINE]

122: J Am Soc Nephrol. 2008 Jun;19(6):1197-203. Epub 2008 Mar 5.

Oxalobacter formigenes may reduce the risk of calcium oxalate kidney stones.

Kaufman DW, Kelly JP, Curhan GC, Anderson TE, Dretler SP, Preminger GM, Cave DR.

Slone Epidemiology Center at Boston University, 1010 Commonwealth Avenue, Boston,
MA 02215, USA. dkaufman@slone.bu.edu

Most kidney stones are composed primarily of calcium oxalate. Oxalobacter
formigenes is a Gram-negative, anaerobic bacterium that metabolizes oxalate in
the intestinal tract and is present in a large proportion of the normal adult
population. It was hypothesized that the absence of O. formigenes could lead to
increased colonic absorption of oxalate, and the subsequent increase in urinary
oxalate could favor the development of stones. To test this hypothesis, a
case-control study involving 247 adult patients with recurrent calcium oxalate
stones and 259 age-, gender-, and region-matched control subjects was performed. 
The prevalence of O. formigenes, determined by stool culture, was 17% among case 
patients and 38% among control subjects; on the basis of multivariate analysis
controlling demographic factors, dietary oxalate, and antibiotic use, the odds
ratio for colonization was 0.3 (95% confidence interval 0.2 to 0.5). The inverse 
association was consistently present within strata of age, gender,
race/ethnicity, region, and antibiotic use. Among the subset of participants who 
completed a 24-h urine collection, the risk for kidney stones was directly
proportional to urinary oxalate, but when urinary factors were included in the
multivariable model, the odds ratio for O. formigenes remained 0.3 (95%
confidence interval 0.1 to 0.7). Surprisingly, median urinary oxalate excretion
did not differ with the presence or absence of O. formigenes colonization. In
conclusion, these results suggest that colonization with O. formigenes is
associated with a 70% reduction in the risk for being a recurrent calcium oxalate
stone former.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18322162 [PubMed - indexed for MEDLINE]

123: J Endourol. 2008 Jan;22(1):127-32.

Preparation of artificial kidney stones of reproducible size, shape, and mass by 
precision injection molding.

Carey RI, Kyle CC, Carey DL, Leveillee RJ.

Department of Urology, University of Miami, Miami, FL, USA.
Rcarey@urologytreatment.com

PURPOSE: To prepare artificial kidney stones of defined shape, size, mass, and
material composition via precision injection molding of Ultracal 30 cement
slurries into an inexpensive biodegradable mold. MATERIALS AND METHODS: A calcium
alginate and silica-based mold was used to prepare casts of varying shapes in a
reproducible manner. Ultracal 30 cement slurries mixed 1:1 with water were
injected into these casts and allowed to harden. The artificial stones were
recovered and their physical properties determined. Ex-vivo and in-vivo responses
to holmium laser lithotripsy were examined. RESULTS: Spheres, half spheres,
cylinders, cubes, tapered conical structures, and flat angulated structures were 
prepared with high precision without post-molding manipulations. Large spheres of
average mass 0.661 g (+/- 0.037), small spheres of average mass 0.046 g (+/-
0.0026), and hexagons of average mass 0.752 g (+/- 0.0180) were found to have
densities (1610-1687 kg/m(3)) within the expected range for Ultracal 30 cement
stones. Ex-vivo holmium laser lithotripsy of small spheres in saline showed
uniformly reproducible efficiencies of comminution. Implantation of a tapered
conical stone into the ureter of a porcine model demonstrated stone comminution
in vivo consistent with that seen in the ex-vivo models. CONCLUSIONS: We present 
an environmentally safe, technically simple procedure for the formation of
artificial kidney stones of predetermined size and shape. The technique does not 
require the use of hazardous solvents or postprocedural processing of the stones.
These stones are intended for use in standardized experiments of lithotripsy
efficiency in which the shape of the stone as well as the mass can be
predetermined and precisely controlled.

Publication Types: 
    In Vitro

PMID: 18315483 [PubMed - indexed for MEDLINE]

124: J Endourol. 2008 Jan;22(1):47-50.

First digital flexible ureterorenoscope: initial experience.

Mitchell S, Havranek E, Patel A.

St. Mary's Hospital, St. Mary's Campus, Praed Street, London, U.K.
anup.patel@imperial.ac.uk

BACKGROUND: Flexible ureterorenoscopy is a minimally invasive procedure that is
rapidly gaining popularity as a treatment for patients with upper urinary tract
lithiasis. One of the main drawbacks is the limited visualization imposed by
fiberoptic technology in an endoscope, often only 7 to 8F and the fragility of
fiber-based optics in a flexible endoscope. MATERIALS AND METHODS: We report our 
initial experience with digital flexible URS and holmium laser lithotripsy using 
digital image capture in three patients. Two patients had upper tract calculi (1 
cm lower pole calculus and 8 mm caliceal diverticular stone, respectively), and
one patient underwent diagnostic URS. RESULTS: After basket capture and
intrarenal relocation of the lower pole stone, complete stone destruction was
achieved. Similarly, the caliceal diverticular stone was destroyed after holmium 
laser incision of the caliceal diverticulum. Remarkable improvement in image
quality was observed throughout the procedures in comparison with current
fiberoptic image acquisition. Minor image interference was noted during
fluoroscopic screening, which increased slightly during laser activation.
CONCLUSIONS: The first digital flexible ureterorenoscope provided excellent image
quality and zoom capability, with a substantial improvement compared with
fiberoptic technology. It does not require a separate light source and is an
important step for the continued evolution of flexible URS as a therapeutic
modality for upper urinary tract pathology.

PMID: 18315473 [PubMed - indexed for MEDLINE]

125: Urology. 2008 Feb;71(2):218-22.

Confident intraoperative decision making during percutaneous nephrolithotomy:
does this patient need a second look?

Portis AJ, Laliberte MA, Holtz C, Ma W, Rosenberg MS, Bretzke CA.

Metropolitan Urologic Specialists PA, St. Paul, Minnesota, USA.
aportis@metro-urology.com

OBJECTIVES: To evaluate intraoperative decision making regarding the necessity of
second-look nephroscopy after percutaneous nephrolithotomy. METHODS: Percutaneous
nephrolithotomy was performed cooperatively by a urologist and radiologist
equipped with a high-resolution C-arm. Ultrasonic lithotripsy was performed
followed by thorough flexible nephroscopy and fluoroscopy. At conclusion patients
were prospectively classified as radiologically and/or endoscopically stone free.
If confident that complete stone clearance had been atraumatically achieved, a
ureteral stent was placed. If there was suspicion of trauma or residual calculi, 
a nephrostomy tube was inserted. Postoperative CT was performed and allowed
fragment classification as stone free, less than 2 mm, 2 to 4 mm, or 4 mm or
greater. RESULTS: Average stone dimensions were 640.2 +/- 412.5 mm2 in 39
consecutive renal units. Computed tomographic imaging demonstrated that 26 renal 
units (66.7%) were stone free after primary procedure, with 5 (12.8%), 5 (12.8%),
and 3 (7.7%) having fragments less than 2 mm, 2 to 4 mm, and greater than 4 mm,
respectively. Of the 34 renal units considered endoscopically and
fluoroscopically stone free, postoperative CT demonstrated 9 with residual
fragments, all less than 4 mm. Of the 5 renal units not considered radiologically
and endoscopically stone free, 4 had fragments on CT. Nephrostomy tubes were
avoided in 33 patients. This intraoperative decision was supported by negative
predictive values of 100%, 88%, and 73% at postoperative CT fragment detection
thresholds of 4 mm, 2 mm, and 0 mm, respectively. CONCLUSIONS: Rigorous fragment 
detection allows confident intraoperative decision making regarding the necessity
of second-look nephroscopy.

PMID: 18308087 [PubMed - indexed for MEDLINE]

126: Can J Urol. 2008 Feb;15(1):3928-9.

Suture urolithiasis in the renal pelvis secondary to prior subtotal colectomy.

Lavallee LT, McCarthy JP, Norman RW.

Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.

We report upon a patient who underwent a subtotal colectomy 2 years prior to
presenting for a percutaneous nephrolithotomy of a large stone in the left renal 
pelvis. At the time of surgery, a non-absorbable suture was found embedded in the
stone. Both stone and suture were removed percutaneously.

Publication Types: 
    Case Reports

PMID: 18304407 [PubMed - indexed for MEDLINE]

127: Int J Urol. 2008 Mar;15(3):276-8.

Laparoscopic assisted percutaneous nephrolithotomy in ectopic pelvic kidneys.

Mousavi-Bahar SH, Amir-Zargar MA, Gholamrezaie HR.

Department of Urology, Ekbatan Hospital, Hamadan University of Medical Sciences, 
Hamadan, Iran. shmbahar@yahoo.com

Three patients underwent laparoscopic assisted percutaneous nephrolithotomy
(PNL). A kidneys, ureter and bladder (KUB), and intravenous pyelogram (IVP) of
the first patient showed a 3 cm calculus in a right side ectopic pelvic kidney
overlying on the sacrum. The second patient had bilateral ectopic kidneys. The
right kidney was located in the true pelvis without calculi and the left kidney
was located in the iliac cavity with a 2.5 cm calculus in the renal pelvis. The
third one had a 4 cm stone in the infundibulum of the upper calyx of the left
pelvic ectopic kidney. All of them had a history of failed shock wave lithotripsy
after two sessions. Then the patients were scheduled for laparoscopic assisted
percutaneous removal of calculi. Under fluoroscopic control the best access route
was located and the kidney was punctured. A 24F nephroscope was introduced and
all calculi were disintegrated and removed. Operating time was 150, 120 and 110
min in cases 1, 2 and 3, respectively. Complete stone clearance was documented
with a plain X-ray KUB film and ultrasonography. Finally the patients underwent
IVP three months following the operation. They were all well and there were no
early or late complications.

PMID: 18304232 [PubMed - indexed for MEDLINE]

128: Arch Ital Urol Androl. 2007 Dec;79(4):147-50.

Spastic paraparesis as a complication of percutaneous nephrolithothripsy (PNL) on
a calyceal calculus of the left kidney.

Pellegrinelli M, Castiglioni C, Morini O, Franzini A.

Department of Legal and Economic Systems, Faculty of Law, University of
Milan-Bicocca. moira.pellegrinelli@unimib.it

A patient developed spastic paraparesis after surgery with ultrasound
lithothripsy and litholapaxy of fragments of a renal calyceal calculus in
middle-upper diverticulum. It was first assumed that the event could be due to
transient spinal ischemia, caused by vasospasm of Adamkiewicz artery, secondary
to blood engorgement of the area around the vessel. In order to clarify possible 
implications of medical liability, the Authors took into account the
etio-pathogenetic mechanisms of the complication and analyzed the medico-legal
aspects, with particular reference to the indication for surgery, which was not
absolute in the case under scrutiny. In connection with the latter aspect, the
Authors considered the conclusions of a recent sentence of the Court of Milan,
whereby, despite the negative opinion of the experts specifically appointed, a
case of medical liability was identified as a consequence of algodystrophy
resulting from a cardiosurgical intervention. According to the Court, it is for
the medical staff to demonstrate that they did all they could to prevent the
complication and that such complication did not arise from a mistake on their
part.

Publication Types: 
    Case Reports

PMID: 18303729 [PubMed - indexed for MEDLINE]

129: Curr Opin Urol. 2008 Mar;18(2):229-34.

Prevention and treatment of complications following percutaneous nephrolithotomy.

Skolarikos A, de la Rosette J.

Department of Urology, Athens Medical School, Sismanoglio Hospital, Athens,
Greece.

PURPOSE OF REVIEW: The aim of this article is to identify classification and
grading systems of percutaneous nephrolithotomy-related complications and
evidence for the prevention and treatment of these complications. RECENT
FINDINGS: A total complication rate of up to 83% following percutaneous
nephrolithotomy was recognized. These complications were mostly clinically
insignificant including minor bleeding or fever. The frequency of major
complications was 0.9-4.7% for septicemia, 0.6-1.4% for renal hemorrhage
requiring intervention, 2.3-3.1% for pleural injury and 0.2-0.8% for colonic
injury. The significance of grading perioperative complications according to
their severity, emphasizing the need for a unique and broadly accepted
classification system, which could be helpful for monitoring and reporting
outcomes emerged from the current review. The modified Clavien system has
recently been used for this purpose. Proper patient selection, preoperative
imaging for planning the operation, adequate antibiotic prophylaxis and therapy, 
manipulation of the collecting system only under fluoroscopic or endoscopic
control, use of a continuous flow system, use of normal saline as irrigant fluid,
judicious stone fragmentation and finally fluoroscopic monitoring of nephrostomy 
tube insertion and removal are necessary to prevent percutaneous nephrolithotomy 
complications. Appropriate treatment has been sufficiently described in the
literature. SUMMARY: Currently, a high index of suspicion and prompt recognition 
and institution of appropriate treatment of percutaneous nephrolithotomy-related 
complications is fundamental to limit morbidity.

Publication Types: 
    Review

PMID: 18303550 [PubMed - indexed for MEDLINE]

130: Curr Opin Urol. 2008 Mar;18(2):224-8.

Management of staghorn calculus: single puncture with judicious use of the
flexible nephroscope.

Williams SK, Leveillee RJ.

Department of Urology, Miller School of Medicine, University of Miami, Miami,
Florida, USA.

PURPOSE OF REVIEW: To focus on the technique and results of a single percutaneous
puncture for the management of staghorn renal calculi. RECENT FINDINGS: The
success rate for treating staghorn calculi with a single percutaneous puncture is
over 90%. Animal and clinical studies seem to suggest that a single percutaneous 
access may be associated with reduced morbidity when compared with multiple
percutaneous access punctures. SUMMARY: A single percutaneous access, whenever
feasible, offers reduced morbidity without compromising excellent stone-free
rates in the management of staghorn calculi.

Publication Types: 
    Review

PMID: 18303549 [PubMed - indexed for MEDLINE]

131: Curr Opin Urol. 2008 Mar;18(2):220-3.

Management of the staghorn calculus: multiple-tract versus single-tract
percutaneous nephrolithotomy.

Ganpule AP, Desai M.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat,
India.

PURPOSE OF REVIEW: Complete removal of stones is crucial for preventing
recurrence and morbidity. Currently percutaneous nephrolithotomy is the preferred
treatment modality. The debate continues over the use of single tract versus
multiple tract percutaneous nephrolithotomy. We review papers on the topic
published over the past 12-24 months. RECENT FINDINGS: Articles related to single
and multiple tracts were reviewed. We discuss the morbidities, advantages and
disadvantages of both the approaches. To decrease the number of tracts few
authors have shown the efficacy of flexible ureteroscopy and nephroscopy as an
adjuvant procedure. The authors state that this option effectively decreases the 
disadvantages of multiple tracts, namely blood loss complications, without
compromising on stone free rates. SUMMARY: Several techniques have been described
for percutaneous access and stone removal, all of them associated with inherent
problems. Although feasible, access to all the calices will be difficult through 
one percutaneous tract because of the peculiarities of the renal collecting
system, in which case, multiple-access percutaneous nephrolithotomy is the
mainstay of the treatment. The crucial point to understand is that all cases
should be dealt with on an individual basis.

Publication Types: 
    Review

PMID: 18303548 [PubMed - indexed for MEDLINE]

132: Curr Opin Urol. 2008 Mar;18(2):214-9.

Management options for lower pole renal calculi.

Raman JD, Pearle MS.

Department of Urology, University of Texas Southwestern Medical Center, Dallas,
Texas, USA.

PURPOSE OF REVIEW: The optimal treatment of lower pole renal calculi is
controversial. Shock wave lithotripsy, ureteroscopy and percutaneous
nephrostolithotomy all constitute viable therapeutic options in select patients. 
RECENT FINDINGS: Lower pole stones smaller than 1 cm in diameter can be managed
with observation, shock wave lithotripsy or ureteroscopy. Patients electing
expectant management should be counseled regarding the potential for
stone-related symptom progression and need for future intervention. Shock wave
lithotripsy and ureteroscopy have similar stone-free rates, although shock wave
lithotripsy may be preferable due to more favorable secondary outcomes. Lower
pole stones 1-2 cm in diameter are best managed with percutaneous
nephrostolithotomy, although ureteroscopy is an option in select patients,
particularly those not considered candidates for percutaneous nephrostolithotomy.
Finally, patients with lower pole stones larger than 2 cm are best served with
percutaneous nephrostolithotomy, as the morbidity in experienced hands is low and
stone-free rates are unequivocally higher than those of other treatment
modalities. SUMMARY: A variety of factors, including patient body habitus, local 
renal anatomy, cost and patient preference, must be taken into consideration when
determining the optimal treatment modality for lower pole renal calculi.

Publication Types: 
    Review

PMID: 18303547 [PubMed - indexed for MEDLINE]

133: J Endourol. 2008 Mar;22(3):497-502.

A percutaneous subcostal approach for intercostal stones.

Rehman J, Chughtai B, Schulsinger D, Adler H, Khan SA, Samadi D.

Department of Urology, Albany Medical Center, Albany, New York, USA.
jrehman@notes.cc.sunysb.edu

PURPOSE: Percutaneous upper pole access may be obtained via the supracostal or
subcostal approach. The more cranial the location of the percutaneous nephrostomy
tract, the greater the risk of incurring intrathoracic complications. We describe
a technique for safely accessing the upper pole calix via a subcostal approach,
even when the stone is located well above the 12th rib. In our patient the stone 
was located between the 11th and 12th ribs, and the upper pole extended to above 
the 10th rib. METHODS: A 78-year-old man with multiple medical problems had a
symptomatic upper right pole stone located between 11th and 12th ribs. Due to its
size (3 x 2.2 cm), neither a ureteroscopic nor shockwave approach was thought
feasible. We elected to angle the access tract both laterally and cranially in
order to course below the 12th rib, but still enter the upper pole calix.
RESULTS: Although this tract entered the calix obliquely, instruments were
readily passed after sheath placement and the stone was completely removed. An
ultrasonic lithotripsy device and suction was used to fragment and evacuate the
stone. Postoperatively there were no intrathoracic or pulmonary complications.
CONCLUSIONS: The direct percutaneous approach to the upper pole of the kidney
requires careful methodology based on a clear understanding of the anatomy of the
kidney and surrounding structures. For upper-pole renal calculi located above the
12th rib that are not amenable to shockwave lithotripsy or ureteroscopy, a
subcostal angled percutaneous approach can be safely made in selected cases. With
this method, the risk of intrathoracic complications may be reduced.

Publication Types: 
    Case Reports

PMID: 18298314 [PubMed - indexed for MEDLINE]

134: J Synchrotron Radiat. 2008 Mar;15(Pt 2):158-61. Epub 2008 Feb 19.

An attempt at kidney stone analysis with the application of synchrotron
radiation.

Siritapetawee J, Pattanasiriwisawa W.

College of Medicine and Public Health, Ubon Rajathanee University, Warinchamrap, 
Ubon Ratchathani 34190, Thailand. jaruwan_siritape@yahoo.com

X-ray absorption near-edge spectroscopy (XANES) is a spectroscopic technique
using synchrotron light to determine the valence state of excited atoms as well
as the electronegativity of their neighbouring atoms. XANES spectra can provide
information about the chemical bond in the second coordination shell of the
excited atom. In this study, XANES spectra of unknown compounds from human kidney
stones were recorded around the K-edges of sulfur, phosphorus and calcium. The
XANES results agree well with the diffractogram data of the same stones obtained 
through an X-ray powder diffraction (XRPD) technique. By comparing the
measurement techniques presented here, it is shown that XANES requires a smaller 
amount of each sample than XRPD for analysis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18296782 [PubMed - indexed for MEDLINE]

135: J Urol. 2008 Apr;179(4):1615-9. Epub 2008 Mar 4.

Urinary trefoil factor 1 is a novel potent inhibitor of calcium oxalate crystal
growth and aggregation.

Thongboonkerd V, Chutipongtanate S, Semangoen T, Malasit P.

Medical Molecular Biology Unit, Office for Research and Development, Faculty of
Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
thongboonkerd@dr.com

PURPOSE: Crystal growth and aggregation are the important mechanisms of calcium
oxalate stone formation in the kidney. Recently we successfully purified trefoil 
factor 1 from human urine and used an oxalate depletion assay to indirectly infer
its inhibitory activity against calcium oxalate crystal growth. We searched for
direct evidence to define the inhibitory activity of urinary trefoil factor 1
against calcium oxalate crystal growth. Moreover, we also evaluated whether
urinary trefoil factor 1 has any effects on calcium oxalate crystal aggregation
and transformation. MATERIALS AND METHODS: Isolated and aggregated forms of
calcium oxalate monohydrate crystals were produced in the absence or presence of 
7, 70 and 700 ng/ml urinary trefoil factor 1, nephrocalcin as a positive control 
or lysozyme (Sigma-Aldrich) as a negative control. RESULTS: The data clearly
indicated that urinary trefoil factor 1 and nephrocalcin at physiological levels 
could effectively inhibit calcium oxalate monohydrate crystal growth and
aggregation, whereas lysozyme did not affect the growth and aggregation of
calcium oxalate monohydrate crystals. At a supraphysiological concentration of 4 
microg/ml urinary trefoil factor 1 and nephrocalcin could transform calcium
oxalate monohydrate crystals to the dihydrate type, which has much less
adsorptive capability. CONCLUSIONS: To our knowledge these data provide the first
direct evidence that urinary trefoil factor 1 is a novel potent inhibitor of
calcium oxalate crystal growth and aggregation, and can transform calcium oxalate
monohydrate crystals to the dihydrate type.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18295252 [PubMed - indexed for MEDLINE]

136: J Endourol. 2008 Feb;22(2):343-6.

Ureteroscopic versus percutaneous treatment for medium-size (1-2-cm) renal
calculi.

Chung BI, Aron M, Hegarty NJ, Desai MM.

Stevan B. Streem Section of Endourology and Stone Disease, Glickman Urological
Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

PURPOSE: To compare the outcomes of percutaneous nephrolithotomy (PCNL) and
ureterorenoscopy (URS) for 1- to 2-cm renal calculi with specific reference to
the stone clearance rate and morbidity. PATIENTS AND METHODS: The records of 27
patients who underwent either PCNL (N = 15) or URS (N = 12) by standard
techniques over an 8-month period for renal calculi between 1 and 2 cm were
reviewed retrospectively. Demographic, intraoperative, and postoperative data
were accrued and compared to identify any statistically significant differences. 
The median stone burden was slightly but not significantly higher in the PCNL
group (1.8 cm v 1.25 cm; P = 0.19). Postoperative plain films were used to
confirm stone clearance. RESULTS: The procedure was technically successful in all
27 patients. No patient in either group required a repeat session or ancillary
procedure. All 15 PCNL procedures were completed through a single percutaneous
tract. The PCNL and URS groups were equivalent with respect to operative time
(79.0 minutes v 68.5 minutes) and incidence of complications (2 v 0). No patient 
in either group had significant hemorrhage or required blood transfusion. The
overall stone-free rate was 87% for PCNL and 67% for URS (P = 0.36). CONCLUSIONS:
Both PCNL and URS are effective options for renal calculi between 1 and 2 cm. The
stonefree and complication rates for PCNL are higher, but the differences were
not statistically significant in our series. The operative times are
statistically equivalent, despite the potentially longer fragmentation times
required for URS. The choice of treatment ultimately depends on the individual
surgeon's preference and level of expertise.

Publication Types: 
    Comparative Study

PMID: 18294042 [PubMed - indexed for MEDLINE]

137: J Endourol. 2008 Feb;22(2):281-4.

Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a
randomized clinical trial.

Basiri A, Ziaee AM, Kianian HR, Mehrabi S, Karami H, Moghaddam SM.

Urology/Nephrology Research Center, Tehran, Iran. basiri@unrc.ir

PURPOSE: Achieving access to the pyelocaliceal system in percutaneous
nephrolithotomy (PCNL) is routinely performed using fluoroscopic guidance. We
compared ultrasonography-guided access for PCNL with conventional
fluoroscopy-guided access. PATIENTS AND METHODS: In a clinical trial, 100
patients with no abnormality of the upper urinary tract were selected from among 
candidates for PCNL and randomly assigned to two 50-patient groups:
ultrasonography-guided access (group 1) versus fluoroscopy-guided access (group
2). In group 1, location of the target calix was identified in the transverse and
sagittal planes by real-time ultrasonography when patients were in the prone
position. Puncture of the target calix was attempted with a Chiba needle attached
to the side of the ultrasound probe. If access to the collecting system was
achieved, the site of puncture was controlled using fluoroscopy. In group 2,
access was achieved using fluoroscopy guidance. Tract dilatation and stone
extraction were the same in both groups. The mean age of patients was 40.7 +/- 12
years and 41.6 +/- 13.7 years in groups 1 and 2, respectively (P = 0.4). The male
to female ratio in groups 1 and 2 was 34/16 and 31/19, respectively (P = 0.5).
RESULTS: On average, duration of access was 11 +/- 3.5 minutes and 5.5 +/- 1.7
minutes in groups 1 and 2, respectively (P = 0.0001). Duration of radiation
exposure, on average, was 0.69 +/- 0.26 minutes and 0.95 +/- 0.44 minutes in
groups 1 and 2, respectively (P = 0.0001). CONCLUSION: Access for PCNL using
ultrasonography guidance is an acceptable alternative to fluoroscopy and
decreases radiation hazards.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 18294034 [PubMed - indexed for MEDLINE]

138: J Endourol. 2008 Feb;22(2):273-5.

Tubeless percutaneous nephrolithotomy: what about replacing the Double-J stent
with a ureteral catheter?

Mouracade P, Spie R, Lang H, Jacqmin D, Saussine C.

Department of Urology, Strasbourg University Hospital, Strasbourg, France.
pmouracade@hotmail.com

PURPOSE: To evaluate the feasibility and safety of replacing the Double-J stent
with a ureteral catheter in tubeless percutaneous nephrolithotomy (PCNL).
MATERIALS AND METHODS: From August 1998 to February 2007, 33 patients underwent
tubeless PCNL for renal calculi by the same surgeon. A retrograde 7F ureteral
catheter was placed at the beginning of the surgery in all patients. A
nephrostomy tube was not used in any patient. At the end of the procedure, the
working tract was electrocauterized using a 26F resectoscope with a rollerball
electrode; no hemostatic sealant was used. The ureteral catheter was the sole
means of drainage left in place. The incidence and type of complications, the
operative time, the length of hospitalization, the rate of transfusion, and the
degree of pain were obtained by chart review. RESULTS: In this group of patients,
the mean stone burden was 17.25 mm. The mean operative time was 71.5 min. The
mean length of hospitalization was 1.9 day (range 1 to 7 days). The mean
hemoglobin decrease was 0.8 g/dL. No blood transfusions were needed. The mean
visual analog pain intensity scale was 1.87. Complications developed in five
(15%) patients, of whom one needed a Double-J stent placement. The complications 
were pyelonephritis, urinary extravasation, sustained hematuria, and renal colic.
The ureteral catheter was removed by postoperative day 1 in 91% of patients.
CONCLUSIONS: Replacing the Double-J stent with a ureteral catheter in tubeless
PCNL is an effective procedure and can be performed in patients with a moderate
stone burden. The electrocauterization of the bleeding points at the end of
percutaneous renal surgery with a rollerball resectoscope is safe.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 18294032 [PubMed - indexed for MEDLINE]

139: J Urol. 2008 Apr;179(4):1415-9. Epub 2008 Mar 4.

Safety and efficacy of flexible ureterorenoscopy and holmium:YAG lithotripsy for 
intrarenal stones in anticoagulated cases.

Turna B, Stein RJ, Smaldone MC, Santos BR, Kefer JC, Jackman SV, Averch TD, Desai
MM.

Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
44195, USA.

PURPOSE: We compared perioperative outcomes in patients undergoing
ureterorenoscopy and Ho:YAG lithotripsy for renal calculi with or without
anticoagulation. MATERIALS AND METHODS: We reviewed the records of all patients
undergoing flexible ureterorenoscopy and Ho:YAG lithotripsy for renal calculi at 
2 institutions from 2001 to 2007. We identified 37 patients on anticoagulation
with Coumadin, clopidogrel or aspirin in whom anticoagulation therapy was not
discontinued before surgery. Data on the anticoagulation group were
retrospectively compared to those on a contemporary matched cohort of 37 controls
without anticoagulation who underwent a similar operative procedure. The 2 groups
were compared with regard to the stone-free rate, and intraoperative and
postoperative complications with specific reference to bleeding and
thromboembolism. RESULTS: The 2 groups were matched for stone size, stone
location, number of stones, bilateral procedures and concomitant ureteral stones.
Anticoagulation group patients were older (58.2 vs 50.4 years, p = 0.0209) and
had a greater American Society of Anesthesiologists score (2.8 vs 1.9, p <0.0001)
compared to the control group. No procedure had to be terminated in the
anticoagulation group due to poor visibility from bleeding. The median
postoperative hemoglobin decrease was greater in the anticoagulation group than
in the control group (0.6 vs 0.2 gm/dl, p <0.0001). The stone-free rate (81.1% vs
78.4%, p = 0.7725), intraoperative complications (0% vs 3%, p = 0.3140),
postoperative complications (11% vs 5%, p = 0.3943) and hemorrhagic or
thromboembolic adverse events were comparable in the 2 groups. CONCLUSIONS: When 
necessary, ureterorenoscopy and Ho:YAG lithotripsy can be performed safely and
efficaciously for renal calculi in patients on anticoagulation therapy without
the need for perioperative manipulation.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 18289567 [PubMed - indexed for MEDLINE]

140: AJR Am J Roentgenol. 2008 Mar;190(3):720-8.

Characterization of human renal stones with MDCT: advantage of dual energy and
limitations due to respiratory motion.

Grosjean R, Sauer B, Guerra RM, Daudon M, Blum A, Felblinger J, Hubert J.

Interventional and Diagnostic Adaptative Imaging, INSERM ERI 13, Nancy
University, Centre Hospitalier Universitaire Nancy (TD4), Rue du Morvan, 54511
Vandoeuvre-les-Nancy Cedex, France. r.grosjean@chu-nancy.fr

OBJECTIVE: Our aim was to determine, using CT attenuation values, the chemical
composition of 241 human renal stones placed in a jelly phantom and to analyze
the influence of respiratory motion on the classification. MATERIALS AND METHODS:
The stones were placed in a jelly simulating the X-ray attenuation of the
kidneys. A dynamic platform was used to apply to the phantom free-breathing
motion (sinusoidal motion in z-axis) and motion due to lack of maintenance of a
breath-hold (5 mm x s(-1) in z-axis). Determination of the chemical composition
was performed with mean CT attenuation values obtained at 80 and 120 kV and with 
dual-energy CT attenuation values. RESULTS: Two hundred forty-one human urinary
stones were classified into six groups: uric acid, cystine, struvite, weddellite 
(calcium oxalate dihydrate), whewellite (calcium oxalate monohydrate), and
brushite. With no motion, the use of dual energy enabled differentiation of all
of the types of stones with statistically significant differences. Uric acid (-20
+/- 22 H), cystine (106 +/- 19 H), struvite (271 +/- 16 H), weddellite (323 +/- 5
H), brushite (415 +/- 30 H), and whewellite (510 +/- 17 H) were identified as
distinct groups. Motion-induced mean CT attenuation values were significantly
different from those obtained with no motion. With motion, dual-energy CT
attenuation values did not allow differentiation of all stone types. CONCLUSION: 
Dual-energy CT attenuation values can be used to predict the chemical composition
of stones in vitro. However, when slight motion is applied to renal stones during
image acquisition, the values become significantly different from those obtained 
with no motion. Consequently, confusion arises in differentiating stone types. A 
perfect breath-hold has to be performed for in vivo use of attenuation value to
discern stone type.

PMID: 18287444 [PubMed - indexed for MEDLINE]

141: Anat Rec (Hoboken). 2008 Mar;291(3):325-34.

Renal intratubular crystals and hyaluronan staining occur in stone formers with
bypass surgery but not with idiopathic calcium oxalate stones.

Evan AP, Coe FL, Gillen D, Lingeman JE, Bledsoe S, Worcester EM.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, IN 46223, USA. evan@anatomy.iupui.edu

Whether idiopathic calcium oxalate (CaOx) stone formers form inner medullary
collecting duct (IMCD) crystal deposits bears on pathogenetic mechanisms of stone
formation. In prior work, using light and transmission electron microscopy, we
have found no IMCD crystal deposits. Here, we searched serial sections of
papillary biopsies from a prior study of 15 idiopathic calcium oxalate stone
formers, 4 intestinal bypass patients with CaOx stones, and 4 non-stone-forming
subjects, and biopsies from an additional hitherto unreported 15 idiopathic
calcium oxalate stone formers and 1 bypass patient using polarized light oil
immersion optics, for deposits overlooked in our original study. We found no IMCD
deposits in any of 1,500 serial sections from the 30 idiopathic calcium oxalate
stone formers, nor in 87 additional sections from a frozen idiopathic calcium
oxalate stone former biopsy sample processed without exposure to aqueous
solutions. Among 4 of the 5 bypass patients but in none of the 30 idiopathic
calcium oxalate stone formers or 4 normal stone formers, we found tiny
birefringent thin crystalline overlays on scattered IMCD cell membranes. We also 
found IMCD lumen deposits in two bypass patients that contained mixed
birefringent and nonbirefringent crystals, presumably CaOx and apatite. In the
bypass patients, we observed focal apical IMCD cell hyaluronan staining, which
was absent in idiopathic calcium oxalate stone formers. The absence of any IMCD
deposits in 1,500 serial sections of biopsies from 30 idiopathic calcium oxalate 
stone formers allows us to place the upper limit on the probability of their
occurrence at approximately 0.002 and place the lower limit of their size at the 
resolution of the optics (<0.2 mu). The tiny deposits in bypass patients may be
the initial crystal lesion.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18286613 [PubMed - indexed for MEDLINE]

142: Urol Res. 2008 May;36(2):77-97. Epub 2008 Feb 20.

The future of stone research: rummagings in the attic, Randall's plaque,
nanobacteria, and lessons from phylogeny.

Ryall RL.

Flinders University School of Medicine, Department of Surgery, Flinders Medical
Centre, Bedford Park, SA, 5042, Australia. rose.ryall@flinders.edu.au

The prevention or cure of stone disease will be achieved only by identifying
biochemical, physiological and molecular mechanisms operating before the
formation of a calculus. Yet, the gradual increase in the total number of papers 
devoted to the study of kidney stones that has occurred since the beginning of
the 21st century can be attributed almost entirely to papers concerned with the
investigation of factors associated with urolithiasis after stones have already
formed. The need to prevent stones by discovering how the human body routinely
stops their formation in those of us who do not suffer from them is therefore as 
exigent as ever and a new approach to investigating the causes of stones is
urgently needed. In this paper, I develop the view that stone research will best 
progress by examining and understanding how healthy plants and animals control
the formation of biominerals. In addition to structures like bones, teeth, shells
and spines, many organisms spanning the entire phylogenetic tree form intra- and 
extracellular granules which are use as storage depots for calcium and other
important ions, which they can reclaim to maintain homeostasis or to satisfy
specific needs during periods of high demand, such as shell formation, moulting
or skeletal development. These electron-dense granules, which also bear an
uncanny resemblance to calcified nanobacteria, are remarkably similar in general 
structure, size and composition to particles observed in healthy human kidneys
and in Randall's plaque. Therefore, it is likely that the granules in human
kidneys fulfil analogous functions to those in other organisms-particularly in
calcium homeostasis. Their study in a large range of creatures has already
provided a deep well of information about their structure, movement, composition,
macromolecular content, synthesis and resorption, from which we can draw to
quench our thirst for knowledge of basic mechanisms and events involved in the
formation of human kidney stones.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 18286270 [PubMed - indexed for MEDLINE]

143: BJU Int. 2008 May;101(10):1293-6. Epub 2008 Feb 18.

Laparoscopic anatrophic nephrolithotomy for managing large staghorn calculi.

Simforoosh N, Aminsharifi A, Tabibi A, Noor-Alizadeh A, Zand S, Radfar MH,
Javaherforooshzadeh A.

Shaheed Labbafinejad Hospital, Urology Nephrology Research Center, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran. simforoosh@iurtc.org.ir

OBJECTIVES: To evaluate the efficacy of a laparoscopic approach for managing
large staghorn renal calculi. PATIENTS AND METHODS: Laparoscopic transperitoneal 
anatrophic nephrolithotomy was used to duplicate open anatrophic nephrolithotomy 
in five patients (three men) with large staghorn renal stones unsuitable for
percutaneous nephrolithotomy. Only the renal artery was clamped, using a bulldog 
clamp. The stone was removed through a nephrotomy incision on the Brodel line,
which was closed using 3/0 polyglactin continuous sutures, and sutures were
buttressed by haemostatic clips instead of knots. Intraoperative ultrasonography 
was used in the last two patients to evaluate residual stones. RESULTS: The mean 
(range) stone size was 53 (45-65) mm, the patient age was 53 (45-58) years, and
the warm ischaemia and operative duration were 32 (29-35) and 170 (120-225) min, 
respectively. No blood transfusion was needed during or after surgery. All of the
procedures were uneventful and there was no urine leakage after surgery. Only an 
8-mm and a 6-mm residual stone remained in the first and third patients, in the
lower and middle calyces, respectively. Both of them were subsequently treated
with shock wave lithotripsy. An intravenous pyelogram after surgery showed a
functional corresponding renal unit, with a significant improvement in
obstruction in all patients. CONCLUSION: Laparoscopic anatrophic nephrolithotomy 
is a promising alternative for patients who are candidates for open surgery, with
an acceptable stone-free rate. While offering a minimally invasive approach, it
can minimize the need for secondary invasive interventions. Further patients and 
a longer follow-up are needed before this is suggested as the preferred method in
selected patients in the future.

Publication Types: 
    Evaluation Studies

PMID: 18284405 [PubMed - indexed for MEDLINE]

144: J Am Acad Dermatol. 2008 Mar;58(3):488-9.

Sweet's syndrome-like neutrophilic dermatosis resulting from exposure to a
radiocontrast agent.

Alper Y, Sprecher E, Bergman R, Birnbaum RF.

Department of Dermatology, Rambam Medical Center, and Technion-Israel Institute
of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel.

Radiocontrast agents are known to be the cause of many cutaneous manifestations. 
The present report describes a unique case of a Sweet's syndrome-like
neutrophilic dermatosis that recurred three times over 5 years following
administration of a radiocontrast agent administered during the course of an
intravenous pyelography.

Publication Types: 
    Case Reports

PMID: 18280347 [PubMed - indexed for MEDLINE]

145: Urology. 2008 May;71(5):801-5. Epub 2008 Feb 15.

Evaluation of the effects of relationships between main spatial lower pole
calyceal anatomic factors on the success of shock-wave lithotripsy in patients
with lower pole kidney stones.

Sahinkanat T, Ekerbicer H, Onal B, Tansu N, Resim S, Citgez S, Oner A.

Department of Urology, University of Kahramanmaras Sutcuimam School of Medicine, 
Kahramanmaras, Turkey. tskanat@yahoo.com

OBJECTIVES: To evaluate the effects of lower pole calyceal anatomy on lower pole 
stone clearance after shock-wave lithotripsy (SWL). METHODS: A total of 133
patients who had single lower pole radio-opaque stones treated with SWL alone and
who became stone-free or had clinically insignificant residual fragments (CIRF)
were included in the study. Pre-shock-wave lithotripsy intravenous urograms were 
used to determine the lower pole infundibular width and length, lower pole
infundibulopelvic (LPIP) angle, caliceal pelvic height (CPH), and lower
infundibular length-to-width ratio. In addition, to evaluate the relationship
between LPIP and CPH, a more simple alternative measurement instead of LPIP
angle, called the parenchyma-to-ureter distance (PUD), was suggested. The
correlation between LPIP and PUD was then examined, and a good correlation was
found between these values (P <0.000, r = 0.64). The PUD/CPH ratio was also
calculated. RESULTS: The stone-free rate was 62%. According to the cutoff points,
the lower infundibular length-to-width ratio and PUD/CPH ratio were different in 
the stone-free and CIRF groups by univariate analysis but not by multivariate
analysis. CONCLUSIONS: None of the anatomic factors had a statistically
significant effect in predicting the success of SWL in patients with lower pole
stones. Nevertheless, evaluation of relationships between lower pole anatomic
factors may offer some help in reaching a more accurate interpretation of lower
pole stone clearance after SWL.

PMID: 18279941 [PubMed - indexed for MEDLINE]

146: Urology. 2008 Apr;71(4):581-5. Epub 2008 Feb 15.

Tubeless PCNL with patient in supine position: procedure for all seasons?--with
comprehensive technique.

Rana AM, Bhojwani JP, Junejo NN, Das Bhagia S.

Kidney Centre Postgraduate Training Institute, Karachi, Pakistan.
rana_abdulmajid@hotmail.com

OBJECTIVES: Percutaneous nephrolithotomy (PCNL) has historically been performed
with the patient in the prone position, which has inherent drawbacks. Supine PCNL
has numerous benefits in terms of safety, efficacy, and versatility and is
comparable with respect to vascular and bowel injury. This study was intended to 
prove that PCNL with the patient in the supine position is an alternative method 
of doing PCNL along with comprehensive technique. METHODS: A total of 184
patients with 191 renal units underwent tubeless supine PCNL from 2005 to May
2007. Their mean age was 32 years and mean weight 62 kg. After insertion of a
retrograde 5F ureteral catheter, the patient was placed in the supine position
with a small towel roll under the ipsilateral flank, raising it by 20 degrees.
Caliceal entry was achieved with an 18-gauge spinal needle, and the tract was
dilated up to 27F with Alkans dilators over a 0.032-in. guidewire using
fluoroscope only, with the patient under general anesthesia. RESULTS: Primary
stone clearance was achieved in 84% patients. Of the 184 patients, 94% had a
single and 6% had a double tract; 72% of patients had a lower, 25% a middle, and 
3% an upper caliceal puncture. The mean single stone size was 3.5 cm, and the
mean multiple stone burden was 12 cm. No vascular or splanchnic injury or bowel
transgression was observed. Tubeless PCNL was possible in 87% patients; 4%
patients required transfusion, and 1 patient each had a perinephric collection
and a plural effusion. CONCLUSIONS: Tubeless PCNL with the patient in the supine 
position is an independent method of treating renal stones without complementing 
PCNL in the prone position. It adds ease and comfort to the patient,
anesthesiologist, and surgeon.

PMID: 18279935 [PubMed - indexed for MEDLINE]

147: Urology. 2008 Jun;71(6):1039-42. Epub 2008 Feb 15.

Aggressive approach to staghorn calculi-safety and efficacy of multiple tracts
percutaneous nephrolithotomy.

Singla M, Srivastava A, Kapoor R, Gupta N, Ansari MS, Dubey D, Kumar A.

Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate
Institute of Medical Sciences, Lucknow, India. manishsingla76@yahoo.co.in

OBJECTIVES: To evaluate the safety and efficacy of an aggressive approach to
staghorn calculi using multiple-tract percutaneous nephrolithotomy. METHODS: We
retrospectively analyzed the data from 149 patients with staghorn calculi, who
underwent percutaneous nephrolithotomy using multiple (two or more) access
tracts, at our institute from 1999 to 2006. The data were analyzed with regard to
stone burden, stone clearance, perioperative morbidity, complications, and the
number of ancillary procedures. RESULTS: A total of 164 renal units in 149
patients (118 men and 31 women, mean age 39.8 years, range 12 to 65 years) were
treated. Of the 164 renal units, 43 (26.2%) had a complete staghorn, 85 (51.8%)
had a partial staghorn and 36 (21.9%) had a borderline stone bulk. A total of 420
tracts were established in the 164 renal units. The maximal number of tracts used
in a single renal unit was six (range two to six), most required three tracts.
Supracostal access was established in 98 renal units (59.7%). The complications
included blood transfusion in 46 patients, pseudoaneurysm in 4, sepsis in 8,
hydrothorax in 7, hemothorax in 1, and perinephric collection in 1 patient. A
complete stone clearance rate of 70.7% was achieved after a single session of
percutaneous nephrolithotomy that increased to 89% after a second-look procedure 
(n = 30) and extracorporeal shock wave lithotripsy (n = 16). CONCLUSIONS: The
results of our study have shown that an aggressive approach to staghorn calculi
using multiple-tract percutaneous nephrolithotomy is safe and effective in
achieving a greater stone clearance rate with acceptable morbidity. A supracostal
approach can be used more often without increasing the risk of significant
complications.

PMID: 18279934 [PubMed - indexed for MEDLINE]

148: Hum Mol Genet. 2008 Jun 1;17(11):1613-8. Epub 2008 Feb 13.

Gain-of-function haplotype in the epithelial calcium channel TRPV6 is a risk
factor for renal calcium stone formation.

Suzuki Y, Pasch A, Bonny O, Mohaupt MG, Hediger MA, Frey FJ.

Institute of Biochemistry and Molecular Medicine, University of Bern, Bern,
Switzerland.

The rate-limiting step of dietary calcium absorption in the intestine requires
the brush border calcium entry channel TRPV6. The TRPV6 gene was completely
sequenced in 170 renal calcium stone patients. The frequency of an ancestral
TRPV6 haplotype consisting of three non-synonymous polymorphisms (C157R, M378V,
M681T) was significantly higher (P = 0.039) in calcium stone formers (8.4%;
derived = 502, ancestral = 46) compared to non-stone-forming individuals (5.4%;
derived = 645, ancestral = 37). Mineral metabolism was investigated on four
different calcium regimens: (i) free-choice diet, (ii) low calcium diet, (iii)
fasting and (iv) after a 1 g oral calcium load. When patients homozygous for the 
derived haplotype were compared with heterozygous patients, no differences were
found with respect to the plasma concentrations of 1,25-vitamin D, PTH and
calcium, and the urinary excretion of calcium. In one stone-forming patient, the 
ancestral haplotype was found to be homozygous. This patient had absorptive
hypercalciuria. We therefore expressed the ancestral protein (157R+378V+681T) in 
Xenopus oocytes and found a significantly enhanced calcium permeability when
tested by a (45)Ca(2+) uptake assay (7.11 +/- 1.93 versus 3.61 +/- 1.01
pmol/min/oocyte for ancestral versus derived haplotype, P < 0.01). These results 
suggest that the ancestral gain-of-function haplotype in TRPV6 plays a role in
calcium stone formation in certain forms of absorptive hypercalciuria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18276610 [PubMed - indexed for MEDLINE]

149: J Endourol. 2008 Mar;22(3):423-5.

Percutaneous nephrolithotomy in patients with previous open nephrolithotomy:
one-shot versus telescopic technique for tract dilatation.

Amjadi M, Zolfaghari A, Elahian A, Tavoosi A.

Division of Urology, Tabriz, Iran. amjadizm@yahoo.com

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) can be done in
patients who have previously had open nephrolithotomy. Currently, dilatation of
the nephrostomy tract is achieved using an Amplatz renal dilator or telescopic
metal dilators in these patients. The aim of this study was to compare the safety
and efficacy of the "one-shot" procedure in patients with previous open
nephrolithotomy with those of the current telescopic technique. PATIENTS AND
METHODS: Thirty-one patients with past history of open surgery for kidney stone
disease underwent PCNL at our institution from February 2006 to March 2007.
Patients were randomly divided into two groups according to dilation technique
used: group A (telescopic procedure) and group B (one-shot procedure). X-ray
exposure, blood loss, and complications were evaluated. RESULTS: No significant
difference in hemoglobin decrease was seen in the two groups. The stone-free and 
complication rates were the same in the two groups. Fluoroscopy time during the
one-shot procedure was significantly shorter than that of the telescopic
procedure (P < 0.000). CONCLUSION: Our experience indicated that the one-shot
procedure is feasible in patients with previous open nephrolithotomy. It is as
safe and effective as the telescopic procedure, with significant reduction in
x-ray exposure.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 18271716 [PubMed - indexed for MEDLINE]

150: Urol J. 2007 Fall;4(4):217-20.

Changes in intrarenal resistive index following electromagnetic extracorporeal
shock wave lithotripsy.

Mohseni MG, H Khazaeli M, Aghamir SM, Biniaz F.

Department of Urology, Sina Hospital, Tehran University of Medical Sciences,
Tehran, Iran.

INTRODUCTION: Our aim was to study the changes in resistive index (RI) of the
ipsilateral and contralateral kidneys following electromagnetic extracorporeal
shock wave lithotripsy (SWL) of the kidney calculi. MATERIALS AND METHODS: Using 
color Doppler ultrasonography, the RI was determined in 21 patients with
unilateral caliceal and pelvic kidney calculi. The RI of the interlobar renal
arteries were measured for the regions near and far from the calculi (distance,
less and more than 2 cm), before, 30 minutes after, and 1 week after SWL. The
same measurements were carried out for the contralateral kidney. Changes in the
RI values and their relation with age were evaluated. RESULTS: The RI near the
calculi increased 30 minutes after SWL from 0.594 +/- 0.062 to 0.620 +/- 0.048 (P
= .003; 95% confidence interval, 0.020 to 0.073), but returned to the pre-SWL
values 1 week later. The RI values of the region remote from the calculus and in 
the contralateral kidney did not change significantly. There was a weak
correlation between age and the RI far from the calculus before and 1 week after 
SWL. There were no relationships between the RI and age, sex, weight, blood
pressure, and smoking. CONCLUSION: The results suggest that SWL of the kidney
calculi changes the RI only near the calculus which is immediate, transient, and 
not age-related.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18270945 [PubMed - indexed for MEDLINE]

151: Eur Urol. 2008 Jul;54(1):196-202. Epub 2008 Feb 4.

Comment in:
    Eur Urol. 2008 Jul;54(1):202-3.    Eur Urol. 2008 Jul;54(1):203.

Modified supine versus prone position in percutaneous nephrolithotomy for renal
stones treatable with a single percutaneous access: a prospective randomized
trial.

De Sio M, Autorino R, Quarto G, Calabrò F, Damiano R, Giugliano F, Mordente S,
D'Armiento M.

Clinica Urologica, Seconda Università degli Studi, Naples, Italy.
marcdesio@tin.it

OBJECTIVES: To compare operative time, safety, and effectiveness of percutaneous 
nephrolithotomy in the supine versus prone position in a prospective randomized
trial. MATERIAL AND METHODS: From October 2005 to June 2007, 75 patients (33 men,
42 women; mean age, 39.3 yr) were prospectively enrolled and randomly divided
into group A (39 patients, supine position) and group B (36 patients, prone
position). Inclusion criteria were diagnosis of single or multiple renal stones
(pelvic-caliceal) treatable with a single percutaneous access, stone diameter
>2.5cm, body mass index (BMI) <30kg/m(2), and no contraindications to perform the
operation in the prone position. Exclusion criteria were stones in more than one 
calyx, complete staghorn stones, and coexisting renal anomalies. RESULTS: The two
groups were comparable in age, BMI, male-to-female ratio, and stone size. No
significant difference was ascertained between the two groups in terms of
stone-free rate (group A, 88.7% vs. group B, 91.6%, p=0.12), mean blood loss
(group A, Delta hemoglobin -2.3g/dl vs. group B, -2.2g/dl, p=0.23), and mean
hospital stay (group A, 4.3 d vs. group B, 4.1 d, p=0.18). The only significant
difference reported was mean operative time (group A, 43min vs. group B, 68min,
p<0.001). No blood transfusions were needed and no organ injuries were reported. 
CONCLUSIONS: In this carefully selected patient population with uncomplicated
renal stones, the supine position was similar to the prone position for
percutaneous stone removal.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 18262711 [PubMed - indexed for MEDLINE]

152: BJU Int. 2008 Mar;101(5):599-602.

Upper-pole puncture in percutaneous nephrolithotomy: a retrospective review of
treatment safety and efficacy.

Raza A, Moussa S, Smith G, Tolley DA.

The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, Scotland, 
UK.

OBJECTIVE: To review the safety and efficacy of supracostal puncture during
percutaneous nephrolithotomy (PCNL) for renal calculi. PATIENTS AND METHODS: Over
a 12-year period, 66 patients had either an upper-pole puncture alone or combined
with middle- or lower-pole puncture during PCNL for renal calculi. All punctures 
were made by an experienced uroradiologist and were either supra- or subcostal.
We retrospectively reviewed all case notes and radiographs to determine
stone-clearance rates and complications associated with the site and number of
punctures. RESULTS: There was an overall stone-free rate of 78% with upper-pole
puncture alone or combined with middle- or lower-pole puncture. There was a 3%
thoracic complication rate with upper pole punctures, and an overall complication
rate of 30% for both thoracic and non-thoracic complications. CONCLUSION:
Upper-pole puncture in PCNL is associated with minimum morbidity if done by an
experienced urologist or radiologist. The stone-free rate appears to be more
dependent on stone size and complexity than the site of puncture.

PMID: 18257858 [PubMed - indexed for MEDLINE]

153: J Endourol. 2008 Mar;22(3):463-4.

Case report: percutaneous nephrolithotomy for a stone on a Hem-o-lok clip.

Dasgupta R, Hannah K, Glass J.

Department of Urology, Guys Hospital, London, United Kingdom. ranandg@yahoo.co.uk

A patient was referred to our department for management of a renal pelvis
"stone." During percutaneous nephrolithotomy, the stone was discovered to have
formed around a Hem-o-lok clip, retained from a previous surgical procedure. As
with other surgical foreign bodies, the Hem-o-lok acts as a nidus for stone
formation if in prolonged contact with urine. It is radiolucent and therefore
crucial to apply with caution in proximity to the urinary tract.

Publication Types: 
    Case Reports

PMID: 18257741 [PubMed - indexed for MEDLINE]

154: J Endourol. 2008 Mar;22(3):447-51.

Percutaneous management of large renal stones in a private practice community
setting.

Meinbach DS, Modling D.

Urology Centers of Alabama, Birmingham, Alabama, USA. dmeinbach@gmail.com

PURPOSE: Recent evidence suggests that increasing numbers of patients with large 
renal stones are treated at tertiary care centers. Studies of practice patterns
in the community have demonstrated that private practice urologists perform few
percutaneous nephrolithotomies (PCNLs) and rely heavily on interventional
radiologists to obtain renal access. We reviewed our series of PCNLs performed in
a community setting, with a focus on success rates and complications, to compare 
results and effectiveness rates with those of tertiary care centers. PATIENTS AND
METHODS: All patients undergoing PCNL for large renal calculi from 1993 to 2006
were included. All procedures were performed by a single surgeon who obtained
percutaneous renal access without the assistance of a radiologist. Data were
retrospectively reviewed to determine clinical success rates, intraoperative and 
postoperative complications, and rate of additional procedures. RESULTS: Two
hundred and four PCNLs were performed in 170 patients. In 43 cases, more than one
percutaneous tract was created. Mean blood loss was 260 mL (range 50-800 mL), and
transfusion was necessary in 2% (4/204). In 194 (95.1%) procedures, treatment was
considered successful with asymptomatic fragments of 4 mm or smaller. Of these,
there was no significant stone burden after a single procedure in 117. Mean
hospital stay was 3 days (range 1-15 days). No intraoperative complications
occurred. The overall complication rate was 6.9%. CONCLUSIONS: The high success
rate of our single, private practice experience is comparable to that of major
academic centers. We believe PCNL can be safely and effectively performed in the 
private practice setting by urologists trained in the procedure.

PMID: 18257739 [PubMed - indexed for MEDLINE]

155: Br J Radiol. 2008 Feb;81(962):e35-6.

Milk of calcium collection in the differential diagnosis of giant renal calculus.

Ulusan S, Koc Z.

Baskent University Faculty of Medicine, Department of Radiology, Adana Teaching
and Medical Research Center, Yuregir, Adana, Turkey. sulusan@hotmail.com

A 29-year-old man presented with milk of calcium that completely filled the
right-sided renal collecting system and ureter and was thought to be a giant
renal calculus. Plain radiographs and computed tomographic findings of this
rarity, which has not been reported previously, are reviewed.

Publication Types: 
    Case Reports
    Review

PMID: 18238910 [PubMed - indexed for MEDLINE]

156: Int Urol Nephrol. 2008;40(3):595-602. Epub 2008 Jan 26.

Renal geology (quantitative renal stone analysis) by 'Fourier transform infrared 
spectroscopy'.

Singh I.

Division of Urology, Department of Surgery, University College of Medical
Sciences, University of Delhi & GTB Hospital, F-14 South Extension Part-2, New
Delhi 110049, India. iqbalsinghp@yahoo.co.uk

AIM: To prospectively determine the precise stone composition (quantitative
analysis) by using infrared spectroscopy in patients with urinary stone disease
presenting to our clinic. To determine an ideal method for stone analysis
suitable for use in a clinical setting. METHODS: After routine and a detailed
metabolic workup of all patients of urolithiasis, stone samples of 50 patients of
urolithiasis satisfying the entry criteria were subjected to the Fourier
transform infrared spectroscopic analysis after adequate sample homogenization at
a single testing center. RESULTS: Calcium oxalate monohydrate and dihydrate stone
mixture was most commonly encountered in 35 (71%) followed by calcium phosphate, 
carbonate apatite, magnesium ammonium hexahydrate and xanthine stones.
CONCLUSIONS: Fourier transform infrared spectroscopy allows an accurate, reliable
quantitative method of stone analysis. It also helps in maintaining a
computerized large reference library. Knowledge of precise stone composition may 
allow the institution of appropriate prophylactic therapy despite the absence of 
any detectable metabolic abnormalities. This may prevent and or delay stone
recurrence.

PMID: 18228157 [PubMed - indexed for MEDLINE]

157: J Urol. 2008 Mar;179(3):832-6. Epub 2008 Jan 25.

Living renal donor allograft lithiasis: a review of stone related morbidity in
donors and recipients.

Strang AM, Lockhart ME, Amling CL, Kolettis PN, Burns JR.

Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama
35294-3411, USA. strang88@hotmail.com

PURPOSE: The use of screening computerized tomography angiography has resulted in
the increased detection of incidental nephrolithiasis in potential living renal
donor candidates. We reviewed current acceptance guidelines for donors with stone
disease as well as data on stone related outcomes in donors with stone disease
and recipients who received a kidney with a stone left in situ. MATERIALS AND
METHODS: We performed a medical literature search in English using MEDLINE/PubMed
that addressed renal donor allograft lithiasis. We then analyzed the literature
with respect to the historical evolution of this concept, current guidelines
regarding the acceptance of donors with stones and stone related morbidity in
recipients and donors. RESULTS: The prevalence of asymptomatic solitary
nephrolithiasis has increased with the widespread use of screening computerized
tomography angiography during renal donor evaluation. Few studies have addressed 
the risk of stone related morbidity in donors and recipients. Short-term studies 
have shown little stone related morbidity in patients who donate or receive an
allograft with a stone left in situ. Consensus statements from transplant
societies around the world offer guidance for determining donor eligibility.
CONCLUSIONS: The available literature on stone related morbidity in donors and
recipients is extremely limited. It would appear that the risk of recurrence and 
subsequent morbidity in renal donors with a solitary kidney is low but not
insignificant. Rare stone related adverse events are reported for recipients of
an allograft with a stone left in situ. Renal donors and recipients should be
educated regarding their unique risk perspectives. Long-term followup is
mandatory.

Publication Types: 
    Review

PMID: 18221961 [PubMed - indexed for MEDLINE]

158: AJR Am J Roentgenol. 2008 Feb;190(2):W125-7.

Nonobstructing renal stones on unenhanced CT: a real cause for renal colic?

Furlan A, Federle MP, Yealy DM, Averch TD, Pealer K.

Department of Radiology, University of Pittsburgh Medical Center (Presbyterian
Campus), 200 Lothrop St., Rm. 3950 CHP MT, Pittsburgh, PA 15213, USA.

OBJECTIVE: The purpose of this study was to evaluate the incidence of
nonobstructing renal stones on unenhanced CT in patients presenting to the
emergency department with renal colic and to determine whether this finding might
be the cause of patients' symptoms. CONCLUSION: Nonobstructing renal stones on
unenhanced CT are a frequent finding in patients evaluated in the emergency
department for suspected renal colic. These stones are usually not recognized as 
the cause of pain by physicians and may be responsible for multiple clinical and 
radiologic evaluations. In the absence of other clinical or CT evidence of a
separate cause, these stones are likely to be the cause of a patient's acute
pain.

PMID: 18212194 [PubMed - indexed for MEDLINE]

159: J Endourol. 2008 Feb;22(2):285-9.

Prospective randomized comparison of a combined ultrasonic and pneumatic
lithotrite with a standard ultrasonic lithotrite for percutaneous
nephrolithotomy.

Lehman DS, Hruby GW, Phillips C, Venkatesh R, Best S, Monga M, Landman J.

Columbia University Medical Center, Department of Urology, New York, New York,
USA.

PURPOSE: To compare the efficiency and cost effectiveness of a combined pneumatic
and ultrasonic lithotrite (Lithoclast Ultra) and a standard ultrasonic
lithotrite, (LUS-1) during percutaneous nephrolithotomy. MATERIALS AND METHODS:
In a prospective randomized trial, 30 patients undergoing percutaneous
nephrolithotomy (PCNL) were randomized to PCNL with either the combined pneumatic
and ultrasonic lithotrite (PUL) or a standard ultrasonic lithotrite (SUL).
Patient demographics, stone composition, location, pre- and post-operative stone 
burden, fragmentation rates, and device failures were compared. RESULTS: There
were 13 patients in the PUL group and 17 patients in the SUL group. Stone burden 
and location were equal. Overall, 64% of the PUL group had hard stones (defined
as stones that were either pure or a mixture of cystine [3], calcium oxalate
monohydrate [CaOxMono; 2], and calcium phosphate [CaPO4; 2]), and four had soft
stones (3 struvite and 1 uric acid [UA]). In the SUL group, there were eight hard
stones (5 CaOxMono and 3 CaPO4), and six soft stones (4 calcium oxalate dihydrate
[CaOxDi] and 2 UA) (P = 0.51). Stone composition data were unavailable for five
patients. Fragmentation time for the PAL was 37 minutes versus 31.5 minutes for
the SUL (P = 0.22). Stone retrieval and mean operative times were similar for
both groups. There were a total of three (23.1%) device-related problems in the
PUL group, and eight (47%) in the SUL group. There was one (7.7%) device
malfunction in the PUL group due to probe fracture. There were two (11.7%) device
failures in the SUL group; one failure required the device to be reset every 30
minutes, and the second was an electrical failure. Suction tubing obstruction
occurred twice (15.3%) in the PUL group and 35.3% in the SU group (P = 0.35). The
stone-free rates for the PUL and SUL were 46% and 66.7%, respectively (P = 0.26).
CONCLUSION: Although the PUL was more costly, stone ablation and clearance rates 
were similar for both the combined pneumatic and ultrasonic device and the
standard ultrasonic device. When stratified with respect to stone composition,
the PUL was more efficient for harder stones, and the SUL was more efficient for 
softer stones.

Publication Types: 
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 18208361 [PubMed - indexed for MEDLINE]

160: J Urol. 2008 Mar;179(3):981-4. Epub 2008 Jan 22.

Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or 
greater--is this the new frontier?

Breda A, Ogunyemi O, Leppert JT, Lam JS, Schulam PG.

Department of Urology, David Geffen School of Medicine at University of
California-Los Angeles, Los Angeles, California, USA.

PURPOSE: Percutaneous nephrolithotomy has been the standard of care for
intrarenal calculi greater than 2 cm. Flexible ureteroscopy with holmium laser
lithotripsy is a minimally invasive treatment modality that is able to treat
large intrarenal calculi with the potential to decrease morbidity, while
maintaining a high level of efficacy. MATERIALS AND METHODS: A total of 15
patients with a single intrarenal calculus 2 cm or greater were treated with
retrograde ureteroscopic nephrolithotripsy. Lithotripsy was performed with a
7.2Fr flexible ureteroscope and 200 micron laser fiber. The stone-free rate was
defined as the absence of any stones in the kidney or residual stone fragments
less than 1 mm, which is too small to be extracted with a basket or a grasper.
All patients underwent followup ureteroscopy within 15 days after the last
procedure and renal ultrasound 30 days after the last treatment. RESULTS: There
were a total of 15 intrarenal calculi 20 to 25 mm (mean 22) in diameter. The mean
number of procedures was 2.3 (range 2 to 4). The overall stone-free rate was
93.3%. One patient (6.6%) had a residual 5 mm stone fragment in the lower pole of
the kidney, which was followed expectantly for 2 years with no change in size.
There were no major complications. There were 3 minor complications (20%),
including 1 emergency room visit for fever and pain, and 2 cases of gross
hematuria. All cases were performed on an outpatient basis. CONCLUSIONS: In
select patients with a single intrarenal calculus 2 cm or greater small diameter 
flexible ureteroscopy with holmium laser lithotripsy may represent an alternative
therapy to standard percutaneous nephrolithotomy with acceptable efficacy and low
morbidity.

PMID: 18207179 [PubMed - indexed for MEDLINE]

161: J Urol. 2008 Mar;179(3):964-8; discussion 968-9. Epub 2008 Jan 22.

Prospective study of the long-term effects of shock wave lithotripsy on renal
function and blood pressure.

Eassa WA, Sheir KZ, Gad HM, Dawaba ME, El-Kenawy MR, Elkappany HA.

Department of Urology, Urology and Nephrology Center, Mansoura University,
Mansoura, Egypt.

PURPOSE: We clarified the long-term effects of extracorporeal shock wave
lithotripsy on renal function and blood pressure, and its relation to body mass
index and type of lithotriptor. MATERIALS AND METHODS: A total of 100 patients
with a single radiopaque renal stone 2 cm or less in length were followed for 18 
to 57 months (mean 43.6 +/- 13.8) after being stone-free by extracorporeal shock 
wave lithotripsy monotherapy using 2 lithotriptors. Mean patient age was 47.9 +/-
9.1 years (range 23 to 66). Nuclear scintigraphy using
(99m)technetium-mercaptoacetyltriglycine was done for all patients before
extracorporeal shock wave lithotripsy, as well as at the last followup visit to
estimate glomerular filtration rate, clearance and split renal function. Blood
pressure measurements were recorded at admission and at each followup visit.
RESULTS: Before extracorporeal shock wave lithotripsy treated side mean
(99m)technetium-mercaptoacetyltriglycine clearance, glomerular filtration rate
and split function were 146.22 +/- 59.48, 52.66 +/- 13.69 and 49.7 +/- 7.31,
respectively. At the last followup visit they were 145.1 +/- 58.82 (p = 0.842),
54.85 +/- 15.75 (p = 0.114) and 49.96 +/- 8.68 (p = 0.577), respectively. Of 100 
patients 18 were hypertensive before extracorporeal shock wave lithotripsy and 21
were hypertensive at the last followup visit. Mean diastolic blood pressure
before extracorporeal shock wave lithotripsy was 80.2 +/- 6.2 vs 80.6 +/- 7.8 mm 
Hg (p = 0.674) at the end of followup. Mean systolic blood pressure before
extracorporeal shock wave lithotripsy was 121.2 +/- 9 vs 121.55 +/- 10.2 mm Hg by
the end of the study (p = 0.748). There were no statistically significant
differences among body mass index groups or lithotriptor groups. CONCLUSIONS:
Extracorporeal shock wave lithotripsy is a safe procedure and has no significant 
long-term effects on renal function or blood pressure regardless of the type of
machine used or body mass index.

Publication Types: 
    Randomized Controlled Trial

PMID: 18207167 [PubMed - indexed for MEDLINE]

162: Ann R Coll Surg Engl. 2008 Jan;90(1):40-4.

Comment in:
    Ann R Coll Surg Engl. 2008 Sep;90(6):530.

Contemporary practice of percutaneous nephrolithotomy: review of practice in a
single region of the UK.

Srirangam SJ, Darling R, Stopford M, Neilson D.

Department of Urology, Blackburn Royal Infirmary, Blackburn, UK.
sjsrirangam@yahoo.co.uk

INTRODUCTION: Most series of percutaneous nephrolithotomy (PCNL) from single
specialised centres represent optimum results achievable and may not reflect
outcomes of everyday practice. We analysed the practice in our region. PATIENTS
AND METHODS: Medical records of 178 patients undergoing PCNL in 2002 in 12
participating hospital trusts were retrospectively analysed. RESULTS: Even
outside the tertiary referral centres, there was a 6-fold difference between
trusts in the frequency of PCNL. In 28% of cases, another stone-removing modality
had been tried first. Failed renal puncture was a major cause of abandoning
surgery (9%). An indication of the difficulty in obtaining complete stone
clearance is that only 107 (60%) operation notes recorded complete clearance,
while 75 (42%) patients required a subsequent procedure (13% a secondary PCNL).
Use of supra 12th rib punctures was small (6%) as was the rate of 'tube-less'
PCNL (4%). Some 22% had simultaneous ureteric stent insertion. Approximately 8%
of cases required a blood transfusion. Thirty-eight patients (23%) had a proven
infection (UTI) pre-operatively (> 10(4) organisms; > 10 white blood cells) with 
almost all patients receiving antibiotics at anaesthesia induction. Postoperative
sepsis rates (temperature > 38.5 degrees C) were similar in those with and
without a pre-operative UTI (18.4% versus 14.3%) and pre-operative antibiotics
appeared to have little extra protective effect. Severe sepsis was rare with no
patient requiring intensive care admission for this reason. Median length of stay
postoperatively was 5 days. CONCLUSIONS: These results present important figures 
to quote when counselling patients pre-operatively, albeit that the degree of
difficulty (and hence the likelihood of problems) is identifiable from stone and 
anatomical configurations. In addition, the present data are a more accurate
reflection of urinary stone surgery in non-tertiary, general urological practice.

Publication Types: 
    Multicenter Study

PMID: 18201499 [PubMed - indexed for MEDLINE]

163: Toxicol Appl Pharmacol. 2008 Apr 15;228(2):165-78. Epub 2007 Dec 4.

Dosimetry considerations in the enhanced sensitivity of male Wistar rats to
chronic ethylene glycol-induced nephrotoxicity.

Corley RA, Wilson DM, Hard GC, Stebbins KE, Bartels MJ, Soelberg JJ, Dryzga MD,
Gingell R, McMartin KE, Snellings WM.

Biological Monitoring and Modeling, Battelle Pacific Northwest Division, 902
Battelle Boulevard, Richland, WA 99352, USA. rick.corley@pnl.gov

Male Wistar rats have been shown to be the most sensitive sex, strain and species
to ethylene glycol-induced nephrotoxicity in subchronic studies. A chronic
toxicity and dosimetry study was therefore conducted in male Wistar rats
administered ethylene glycol via the diet at 0, 50, 150, 300, or 400 mg/kg/day
for up to twelve months. Subgroups of animals were included for metabolite
analysis and renal clearance studies to provide a quantitative basis for
extrapolating dose-response relationships from this sensitive animal model in
human health risk assessments. Mortality occurred in 5 of 20 rats at 300
mg/kg/day (days 111-221) and 4 of 20 rats at 400 mg/kg/day (days 43-193), with
remaining rats at this dose euthanized early (day 203) due to excessive weight
loss. Increased water consumption and urine volume with decreased specific
gravity occurred at 300 mg/kg/day presumably due to osmotic diuresis. Calculi
(calcium oxalate crystals) occurred in the bladder or renal pelvis at > or =300
mg/kg/day. Rats dying early at > or =300 mg/kg/day had transitional cell
hyperplasia with inflammation and hemorrhage of the bladder wall. Crystal
nephropathy (basophilic foci, tubule or pelvic dilatation, birefringent crystals 
in the pelvic fornix, or transitional cell hyperplasia) affected most rats at 300
mg/kg/day, all at 400 mg/kg/day, but none at < or =150 mg/kg/day. No significant 
differences in kidney oxalate levels, the metabolite responsible for renal
toxicity, were observed among control, 50 and 150 mg/kg/day groups. At 300 and
400 mg/kg/day, oxalate levels increased proportionally with the nephrotoxicity
score supporting the oxalate crystal-induced nephrotoxicity mode of action. No
treatment-related effects on the renal clearance of intravenously infused
(3)H-inulin, a marker for glomerular filtration, and (14)C-oxalic acid were
observed in rats surviving 12 months of exposure to ethylene glycol up to 300
mg/kg/day. In studies with naïve male Wistar and F344 rats (a less sensitive
strain), a significant difference was observed in oxalate clearances between
young rats (i.e. Wistar clearance < F344) but not in age-matched old rats.
Regardless, the ratios of oxalate:inulin clearances in these two strains of rats,
including those exposed to ethylene glycol, were all < 1, suggesting that a
fraction of the filtered oxalate is reabsorbed. Other species, including humans, 
typically have clearance ratios >1 and are more effective at clearing oxalic acid
by both glomerular filtration and active secretion. Thus, the lower renal
clearance and kidney accumulation of oxalates in male Wistar rats enhances their 
sensitivity, which will be a factor in human risk assessments. The benchmark dose
values (BMD05, BMDL05) were 170 mg/kg/day and 150 mg/kg/day for nephropathy, and 
170 mg/kg/day and 160 mg/kg/day for birefringent crystals, using incidence times 
severity data in each case. The NOAEL of 150 mg/kg/day is the same as that
reported after 16-week exposure and appears to be a threshold dose below which no
renal toxicity occurs, regardless of exposure duration.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18191429 [PubMed - indexed for MEDLINE]

164: J Endourol. 2007 Dec;21(12):1439-44.

Ureteroscopy for stone treatment using new 270 degrees semiflexible endoscope: in
vitro, ex vivo, and clinical application.

Wendt-Nordahl G, Trojan L, Alken P, Michel MS, Knoll T.

Department of Urology, University Hospital Mannheim, Mannheim, Germany.

BACKGROUND AND PURPOSE: The use of flexible ureteroscopy for diagnosis and
management of upper urinary tract diseases is limited both by loss of maximum
active deflection through the inserted working probes and a high frequency of
damage with consequent costs. A newly developed ureteroscope (Flex-X, Karl Storz)
with a maximized angle of deflection was introduced to overcome these problems.
The aim of our study was to compare this new ureteroscope with an established
device in vitro, ex vivo, and in a clinical approach. MATERIALS AND METHODS:
Angles of maximum active deflection and maximum irrigation flow were measured for
both scopes in vitro with an empty working channel and after introduction of
different lithotripsy and stone extraction probes. In addition, the loss of
maximum active deflection and broken optical fibers of the scopes were assessed
after 100 flexible ureteroscopies in an ex-vivo pig cadaver model. The clinical
performance of both ureteroscopes was evaluated in 32 patients for management of 
lower pole stones. RESULTS: The new ureteroscope displays highly improved
deflection compared with the standard scope; deflection angles as much as 270
degrees with an empty working channel were achieved. Thin probes did not inhibit 
maximum deflection. Durability in ex vivotrials was high. Only minimal loss of
maximum deflection and three broken optical fibers were observed. In clinical
usage, a stone-free rate of 100% was achieved after 4 weeks. In three patients,
the opening mechanism of a basket did not work with maximum deflection because of
high friction. CONCLUSION: The new ureterorenoscope facilitates retrograde stone 
management and might diminish repair intervals. Further development of comparable
devices will support flexible ureterorenoscopy as a standard stone management
procedure.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 18186680 [PubMed - indexed for MEDLINE]

165: J Endourol. 2007 Dec;21(12):1429-32.

Percutaneous nephrolithotomy of patients with staghorn stone and incidental
purulent fluid suggestive of infection.

Hosseini MM, Basiri A, Moghaddam SM.

Division of Endourology, Urology and Nephrology Research Center, Peymanieh
Hospital, Jahrom University of Medical Sciences, Jahrom, Iran.

BACKGROUND AND PURPOSE: Patients undergoing percutaneous nephrolithotomy (PCNL)
sometimes have purulent fluid in the puncture site in spite of having no signs or
symptoms of infection preoperatively. We report the safety and effectiveness of
PCNL in 45 patients with staghorn renal stones and incidental purulent fluid in
the pelvicaliceal system. PATIENTS AND METHODS: Of 1264 patients who underwent
PCNL at our medical center from February 2002 to May 2006, 45 patients had
purulent fluid in the initial puncture. These patients were asymptomatic, and the
preoperative work-up did not suggest infection. In 29 patients (group 1), stone
removal was accomplished during the first session, while for 16 patients (group
2), a nephrostomy tube remained in place and stone removal occurred 3 to 5 days
later when results of urine and nephrostomy fluid cultures were negative. We
studied preoperative findings, stone-free rate, intraoperative and postoperative 
complications, and final outcome of these patients. RESULTS: The stone-free rate 
was almost similar in the two groups (86.2% v 81.25%, P = 0.9). In groups 1 and
2, three (10.3%) and two (12.5%) patients experienced low-grade fever for 12 to
24 hours (P = 0.179). In group 1, urine cultures revealed Escherichia coli in
three patients and Pseudomonas aeruginosa in two patients, while 24 (82.7%)
patients had negative fluid cultures. In group 2, results of urine cultures
showed E coli in two patients and Klebsiella pneumoniae in one patient; results
of urine cultures of 13 (81.2%) patients were negative (P = 0.78). Mean operative
time was 70 minutes in both groups. No intraoperative or postoperative
complications other than fever were seen in both groups. CONCLUSION: In patients 
who undergo PCNL, purulent fluid may be found incidentally in the puncture site. 
PCNL may be performed with full antibiotic coverage at the same session.

Publication Types: 
    Comparative Study

PMID: 18186679 [PubMed - indexed for MEDLINE]

166: J Endourol. 2007 Dec;21(12):1415-20.

One-stage tract dilation for percutaneous nephrolithotomy: is it justified?

Ziaee SA, Karami H, Aminsharifi A, Mehrabi S, Zand S, Javaherforooshzadeh A.

Department of Urology, Shaheed labbafinezhad Hospital, Shaheed Beheshti Medical
University, Tehran, Iran.

PURPOSE: To assess the feasibility of one-stage acute dilation of the nephrostomy
tract with a 30F Amplatz dilator in patients who are candidate for percutaneous
nephrolithotomy (PCNL) regardless of whether there is a previous renal scar to
make the procedure less time consuming and more cost effective. PATIENTS AND
METHODS: The outcomes of one-stage tract dilation for PCNL in 100 consecutive
patients with and without a history of ipsilateral open stone surgery (OSS),
treated by one surgeon, were examined prospectively. Forty-six patients (group 1)
had a history of ipsilateral OSS, and 54 patients (group 2) did not have this
history. Demographic data as well as intraoperative information, such as access
time and radiation exposure time during access, were recorded. The success of the
access technique and its bleeding complications were analyzed between the two
groups. RESULTS: By applying a "one-stage" technique, the targeted calix could be
entered with a success rate of 93%. There was no difference in the procedural
success rate between groups 1 and 2 (93.5% v 92.6%, respectively). All seven
failed attempts (7%; three with previous OSS) were managed successfully using an 
Alken dilator to gain access to the proposed calix in the same session. Previous 
OSS did not impact access time, radiation exposure time during access,
postoperative hemoglobin drop, and bleeding complications. There were no visceral
and vascular injuries. CONCLUSIONS: One-stage tract dilation for PCNL is a safe
and effective method in almost every adult patient.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 18186676 [PubMed - indexed for MEDLINE]

167: J Endourol. 2007 Dec;21(12):1403-5.

Impact of fasting on shockwave lithotripsy in renal stones: a randomized
controlled trial.

Hosseini SR, Mohseni MG, Mohammadi A, Tajik P.

Department of Urology, School of Medicine, Medical Sciences/University of Tehran,
Iran. rhosseinim@yahoo.com

PURPOSE: We evaluated the impact of fasting on the effectiveness of shockwave
lithotripsy (SWL) in patients with renal calculi. PATIENTS AND METHODS: The study
was a randomized controlled trial for patients with renal stones. Between May
2005 and November 2006, patients (n = 97) with a single radio-opaque renal stone 
(7-21 mm) who were candidates for SWL were enrolled. Patients were randomized to 
fasting (F, n = 49) and nonfasting (NF, n = 48) groups. F group patients were
asked to fast for 12 hours before SWL. Urine specific gravity (SG) was measured
after fasting. All patients were monitored every 2 weeks until complete stone
clearance. Treatment effectiveness was defined as complete clearance up to 3
months. RESULTS: There were 32 men in the F group and 28 men in the NF group. The
mean age was 37.9 +/- 8.5 years in the F group and 39.1 +/- 7.7 years in the NF
group. The mean body mass index was 22.8 +/- 2.5 and 23.1 +/- 2.6 in F and NF
patients, respectively. The urine SG in the F group (1.036 +/- 0.004) was
significantly higher than in the NF group (1.013 +/- 0.004; P < 0.001). At
3-month follow-up, the overall stone-free rate using SWL was 86.1% in the F
group, which was higher than the rate of 72.9% in the NF group; however, the
difference was not statistically significant (P = 0.16). CONCLUSION: Fasting
significantly changes the urine SG but does not have a significant impact on the 
effectiveness of SWL for isolated renal stones.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 18186675 [PubMed - indexed for MEDLINE]

168: J Endourol. 2008 Jan;22(1):25-8.

Case report: bilateral simultaneous tubeless and stentless percutaneous
nephrolithotomy.

Istanbulluoglu OM, Ozturk B, Cicek T, Gonen M, Ozkardes H.

Baskent University, Feritpasa Mah Kerkuk Cad, Konya, Turkey. drokanist@yahoo.com

A 39-year-old man underwent percutaneous nephrolithotomy (PCNL) for bilateral
renal stone without stent and tube insertion. To our knowledge, this is the first
report of bilateral simultaneous tubeless and stentless PCNL. The advantage of
this technique in renal stone surgery is discussed.

Publication Types: 
    Case Reports

PMID: 18177242 [PubMed - indexed for MEDLINE]

169: J Endourol. 2008 Jan;22(1):91-6.

Rapid prototyping model for percutaneous nephrolithotomy training.

Bruyère F, Leroux C, Brunereau L, Lermusiaux P.

Department of Urology, University Hospital of Tours, 2 boulevard Tonnelé, Tours, 
France. f.bruyere@chu-tours.fr

PURPOSE: Rapid prototyping is a technique used for creating computer images in
three dimensions more efficiently than classic techniques. Percutaneous
nephrolithotomy (PCNL) is a popular method to remove kidney stones; however,
broader use by the urologic community has been hampered by the morbidity
associated with needle puncture to gain access to the renal calix (bleeding,
pneumothorax, hydrothorax, inadvertent colon injury). A training model to improve
technique and understanding of renal anatomy could improve complications related 
to renal puncture; however, no model currently exists for resident training.
MATERIALS AND METHODS: We created a training model using the rapid prototyping
technique based on abdominal CT images of a patient scheduled to undergo PCNL.
This allowed our staff and residents to train on the model before performing the 
operation. This model allowed anticipation of particular difficulties inherent to
the patient's anatomy. RESULTS: After training, the procedure proceeded without
complication, and the patient was discharged at postoperative day 1 without
problems. CONCLUSIONS: We hypothesize that rapid prototyping could be useful for 
resident education, allowing the creation of numerous models for research and
surgical training. In addition, we anticipate that experienced urologists could
find this technique helpful in preparation for difficult PCNL operations.

Publication Types: 
    In Vitro

PMID: 18177240 [PubMed - indexed for MEDLINE]

170: J Endourol. 2008 Jan;22(1):19-24.

Tubeless percutaneous nephrolithotomy in patients with previous ipsilateral open 
renal surgery: a feasibility study with review of literature.

Shah HN, Mahajan AP, Hegde SS, Bansal M.

Department of Urology, R.G. Stone Urological Research Institute, 21A, 14A Road,
Ahimsa Marg Khar (West), Mumbai, India. drhemendrashah@yahoo.co.in

PURPOSE: To present our initial experience of tubeless percutaneous
nephrolithotomy (PCNL) in patients with previous ipsilateral open renal surgery. 
PATIENTS AND METHODS: Twenty-five patients with previous ipsilateral open renal
surgery underwent tubeless PCNL at our institute. Patients with large renal
and/or upper ureteral calculi, irrespective of the number and size of the stones,
amount of hydronephrosis, or the renal parameters, were selected for the
procedure. Exclusion criteria were patients needing more than two percutaneous
tracts, significant bleeding, and a significant residual stone burden that would 
necessitate a staged PCNL. The perioperative outcome of these patients (study
group) was retrospectively compared with an historic cohort of the same number of
patients with a history of open surgery for renal calculi who underwent
ipsilateral PCNL with routine placement of a nephrostomy tube (control group).
RESULTS: The two groups had comparable demographic data. Patients in the study
group needed less postoperative analgesia (P = 0.000). They were discharged a
mean of 10 hours earlier (P = 0.000). Two patients in both groups required blood 
transfusion. No urinoma or urinary leak from the nephrostomy site occurred in the
study group. The incidence of other postoperative complications was comparable in
both groups. Complete stone clearance was achieved in 88% of patients in the
study group and 84% patients in the control group. CONCLUSION: The tubeless
approach in patients with a history of open renal surgery is associated with
decreased analgesia requirement and hospital stay without compromising stone-free
rates or increasing the complications.

Publication Types: 
    Review

PMID: 18177238 [PubMed - indexed for MEDLINE]

171: J Pak Med Assoc. 2007 Dec;57(12):584-6.

Safety and efficacy of tubeless percutaneous nephrolithotomy.

Shaikh AH, El Khalid S, Nabi N.

Department of Urology, The Kidney Centre Postgraduate Institute, Karachi.

OBJECTIVE: To determine the safety and efficacy of tubeless percutaneous
nephrolithotomy (PCNL). METHODS: A quasi-experimental study conducted on 50
patients, at a specialized urology centre. RESULTS: The primary success rate of
the procedure in terms of stone clearance was 70%. Mean length of hospital stay
was 2.44 days. There were no significant complications during or after the
surgery. CONCLUSION: Tubeless PCNL is a safe and effective modification of the
conventional procedure. Absence of the nephrostomy tube may help in keeping the
patient comfortable after the surgery and reduction in the length of hospital
stay.

PMID: 18173039 [PubMed - indexed for MEDLINE]

172: Kidney Int. 2008 Jan;73(2):139-40.

Comment on:
    Kidney Int. 2008 Jan;73(2):207-12.

Fructose intake as a risk factor for kidney stone disease.

Asselman M, Verkoelen CF.

Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
m.asselman@erasmusmc.nl

Taylor and Curhan report that consumption of fructose is independently associated
with an increased risk of incident kidney stones. What could be the mechanisms
underlying the relation between fructose intake and stone risk? And how should we
incorporate this finding into the dietary advice that we give to our patients to 
prevent kidney stone formation?

Publication Types: 
    Comment

PMID: 18165809 [PubMed - indexed for MEDLINE]

173: Urology. 2007 Dec;70(6):1043-6; discussion 1046-7.

Shock wave lithotripsy success for renal stones based on patient and stone
computed tomography characteristics.

Weld KJ, Montiglio C, Morris MS, Bush AC, Cespedes RD.

Department of Urology, Wilford Hall Medical Center, Lackland Air Force Base,
Texas 78236, USA. Kyle.weld@lackland.af.mil

OBJECTIVES: To determine the patient and noncontrast computed tomography (NCCT)
stone characteristics that predict either of 2 extracorporeal shock wave
lithotripsy (ESWL) outcomes: stone-free (SF) status or ESWL success. METHODS: The
records of 200 consecutive patients with nephrolithiasis treated with ESWL were
reviewed. Patient age, sex, stone laterality, body surface area, body mass index,
maximal stone dimension, mean stone Hounsfield units (HU), stone Hounsfield
density, skin-to-stone distance (SSD), and intrarenal stone location were studied
as potential predictors. Patients with no calcifications on postoperative
kidneys, ureters, and bladder (KUB) at 6 weeks were defined as SF. ESWL success
was defined as SF or remaining stone fragments less than 4 mm. RESULTS:
Intrarenal stone location was found to be the only predictor of SF status. Renal 
pelvic/ureteropelvic junction (UPJ) stones cleared better than calyceal stones,
and upper/middle calyceal stones cleared better than lower calyceal stones. Stone
size, mean HU, and location predicted ESWL fragmentation success. Smaller stones 
and stones with lower mean HU levels were more successfully fragmented. Higher SF
and ESWL success rates were found with a shorter SSD among calyceal stones when
renal pelvic/UPJ stones were excluded from analysis. CONCLUSIONS: Stone location 
is the most important factor in achieving SF status after ESWL. NCCT stone
characteristics such as stone size, mean HU, and intrarenal location are
important predictors of ESWL success.

PMID: 18158009 [PubMed - indexed for MEDLINE]

174: J Endourol. 2008 Feb;22(2):267-71.

Totally tubeless percutaneous nephrolithotomy.

Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH.

The Solent Department of Urology, St Mary's Hospital, Portsmouth, United Kingdom.
timj@crook69.wanadoo.co.uk

PURPOSE: To establish if totally tubeless percutaneous nephrolithotomy (PCNL) is 
a safe management technique. PCNL is a well-established option for upper tract
stones. The procedure traditionally concludes with the placement of a nephrostomy
drainage tube but in those patients in whom there has been minimal blood loss and
complete stone clearance, it may not be necessary to place a nephrostomy.
PATIENTS AND METHODS: Totally tubeless PCNL was performed in uncomplicated cases,
when there was no significant bleeding or residual stone load, an intact
pelvicaliceal system, and no evidence of a residual ureteral stone. RESULTS: 100 
procedures were analyzed during a 10-year period from 1996 to 2006. The mean
stone size was 15.9 mm (range 7-40 mm). Mean residual stone load was 1.74 mm
(range 1-10 mm). Access was considered difficult in 2%. Transfusion rate was 1%
with a mean fall in hemoglobin of 1.4 g/dL ([-0.4] - [+5.6] g/dL), and a mean
rise in creatinine level of 0.3 micromol/L ([-43] - [+52] micromol/L). The minor 
sepsis rate was 5%, and the major sepsis rate was 1%. The readmission rate was
1%. The mean length of stay was 2.9 days (range 1-10 d). Secondary treatment was 
required in 5%, and stone clearance rate at 3 months was 90%. CONCLUSION: This
study demonstrates that PCNL without nephrostomy or stent is a safe and
well-tolerated procedure in selected patients. It is the authors' belief that
totally tubeless PCNL may be considered an accepted standard of care for selected
patients, and it is possible to reserve placement of a nephrostomy tube or
internal ureteral stent for specific indications.

Publication Types: 
    Comparative Study

PMID: 18095863 [PubMed - indexed for MEDLINE]

175: J Endourol. 2008 Jan;22(1):35-40.

Does the metabolic syndrome or its components affect the outcome of percutaneous 
nephrolithotomy?

Tefekli A, Kurtoglu H, Tepeler K, Karadag MA, Kandirali E, Sari E, Baykal M,
Muslumanoglu AY.

Department of Urology, Haseki Teaching and Research Hospital, Haseki, Istanbul,
Turkey. atefekli@yahoo.com

PURPOSE: Metabolic syndrome is a cluster of cardiovascular disease risk factors. 
We assessed the impact of these medical disorders on the outcome of percutaneous 
nephrolithotomy (PCNL). PATIENTS AND METHODS: Data from 430 consecutive PCNL
procedures were retrospectively reviewed. The presence of serum lipid
abnormalities (SLA), hypertension (HT), diabetes (DM), and obesity was
investigated. Patients were determined to have the metabolic syndrome according
to the definition of the International Diabetes Federation. Success rate, need
for auxiliary procedures, and major complication rates of PCNL were analyzed
separately for patients with or without DM, SLA, HT, obesity, and the metabolic
syndrome, and were compared. RESULTS: SLA, HT, and DM were observed in 123
(28.6%), 108 (25.1%), and 44 (10.2%) patients, respectively. Body mass index was 
>30 kg/m2 in 74 (17.2%) patients. Metabolic syndrome was diagnosed in 41 (9.5%)
patients. An overall success rate of 96.3% for PCNL was achieved. Success rates
were not significantly (P > 0.05) influenced by the presence of SLA, HT, DM,
obesity, or the metabolic syndrome. Major complications were encountered in 49
(11.4%) patients and were 2.5 to 2.7 times more common in patients with DM, HT,
and the metabolic syndrome. In patients with DM, auxiliary treatment alternatives
were necessary in 20.5%, while they were indicated in 10.9% of patients without
DM (P = 0.046). Presence of the metabolic syndrome was also associated with an
increased necessity for auxiliary treatments after PCNL (P = 0.048). CONCLUSIONS:
Our results indicate that the metabolic syndrome and its components (DM and HT)
significantly augment auxiliary treatment and complication rates after PCNL.

PMID: 18095862 [PubMed - indexed for MEDLINE]

176: Int Urol Nephrol. 2008;40(3):603-8. Epub 2007 Dec 19.

Tubeless percutaneous neprolithotomy: the new gold standard.

Al-Ba'adani TH, Al-Kohlany KM, Al-Adimi A, Al-Towaity M, Al-Baadani T, Alwan M,
Al-Hussieni M, Al-Germozi S, Al-Masani M, Al-Badwy K, El-Nono IH.

Urology Department, Urology and Nephrology Center, Al-Thawra Modern General
Teaching Hospital, Medical College-Sana'a University, P.O. Box 18682 Sana'a,
Yemen. drtowfik@hotmail.com

PURPOSE: We present our experience with tubeless percutaneous nephrolithotomy
(PCNL). PATIENTS AND METHODS: Between July 2004 and December 2006, 121 patients
(82 males and 39 females) with 18-70 mm (mean 31.19 mm) renal stones underwent
tubeless PCNL leaving only a 6 Fr externalized ureteric catheter. Their ages
ranged between 4 and 80 years (mean 37.27). Two patients had bilateral disease,
so a total of 123 renal units are included. The procedure was performed under
general anesthesia in the prone (110 units) or supine position (13 units). A
total of 133 punctures were performed. The punctures were single (114 units),
double (8 units), or triple (1 unit). The approach was subcostal through the
lower calyx (n=110) or middle calyx (n=10), or supracostal through the middle
calyx (n=8) or upper calyx (n=5). RESULTS: Mean operative time was 46.30 min
(range 15-100). Mean reduction in hemoglobin level was 1.57 g (range 0.3-4) with 
blood transfusion rate 4.13%. Complication rate was 9.9% in the form of perirenal
collection (five patients), urinary leakage (two patients), fever (four
patients), and hydrothorax (one patient). The ureteric catheter was left for 7-72
h (mean 45.67). Postoperative analgesia was required in 22 patients (18.2%) with 
mean 22.9 mg diclofenac sodium per patient. Mean hospital stay was 50.69 h (range
12-96) with 106 units (86.18%) rendered stone free, 13 (10.57%) with
insignificant residuals, and four units (3.25%) were left with significant
residual stones. CONCLUSIONS: Tubeless PCNL is a good option in non-complicated
PCNL with the advantages of reduced hospital stay, low postoperative pain, and
little need for postoperative analgesia.

PMID: 18092142 [PubMed - indexed for MEDLINE]

177: Transplant Proc. 2007 Dec;39(10):3533-5.

Extracorporeal shock wave lithotripsy of impacted radiolucent stone at the right 
pyeloureteric junction and oral dissolution therapy in a patient with
transplanted liver: a case report.

Mokos I, Pasini J, Hrstić I, Stern-Padovan R, Cacic Z, Knezevic N.

Department of Urology, University, Hospital Center Zagreb, Zagreb, Croatia.
ivica.mokos@zg.htnet.hr

Extracorporeal shock wave lithotripsy (ESWL) is a safe, effective method to treat
urinary lithiasis. The success rate in ESWL depends on stone location, size,
number, and fragility as well as calceal anatomy and patency of the urinary
tract. An association of calcineurin inhibitors and uric acid urolithiasis has
been reported in renal allograft recipients, but the mechanism remains unknown.
Herein we have reported the case of 68-year-old male patient who developed
cryptogenic cirrhosis and underwent liver transplantation. Seven years after
transplantation, the patient was admitted to the hospital with right renal colic.
An 8.9-mm radiolucent stone at the pyeloureteric junction was associated with
moderate consecutive hydronephrosis. The second stone was located in a lower
renal calyx. After a failed attempt at retrograde ureteral stenting, we performed
a percutaneous nephrostomy. Antegrade pyelography with following ESWL treatment
resulted in disintegration of the obstructive stone at the pyeloureteric
junction. Afterward, we performed antegrade placement of a double-J stent.
Residual stones in the lower renal calyx were successfully treated with a 3-month
course of oral intake of a dissolution agent-potassium sodium hydrogen citrate.
In this case, we have discussed ESWL and oral dissolution therapy of radiolucent 
stones in a hydronephrotic right kidney, which resulted in stone-free disease
after 3 months of combined therapy. There was neither clinical nor biochemical
damage to the transplanted liver.

Publication Types: 
    Case Reports

PMID: 18089430 [PubMed - indexed for MEDLINE]

178: BJU Int. 2008 Jun;101(11):1420-6. Epub 2007 Dec 5.

Evaluation of a synchronous twin-pulse technique for shock wave lithotripsy: a
prospective randomized study of effectiveness and safety in comparison to
standard single-pulse technique.

Sheir KZ, Elhalwagy SM, Abo-Elghar ME, Ismail AM, Elsawy E, El-Diasty TA, Dawaba 
ME, Eraky IA, El-Kenawy MR.

Department of Urology, Urology and Nephrology Center, Mansoura University,
Mansoura, Egypt. kzsheir@hotmail.com

OBJECTIVE: To asses the efficacy and safety of bidirectional synchronous
twin-pulse extracorporeal shock wave lithotripsy (ESWL) compared with standard
ESWL. PATIENTS AND METHODS: Between March 2003 and December 2006, 240 patients
with a radio-opaque single renal stone of <or=25 mm were randomized to treatment 
either by the Twinheads (TH) lithotripter (FMD, Lorton, Virginia, USA) or the
Dornier Lithotripter S (DLS, Dornier MedTech Europe GmbH, Germering, Germany).
Before and after ESWL, urinary N-acetyl-B-glucosaminidase (NAG) levels were
assessed and patients were evaluated with dynamic MRI. The efficacy and
complications were compared, with success defined as no residual fragments.
RESULTS: For stones of >10 mm the rate for the failure of disintegration was
13.3% for the DLS vs 1.4% for the TH (P = 0.009). For stones of <or=10 mm the
stone-free rate was 74.4% for the TH vs 67.7% for the DLS (P = 0.6), while for
stones of >10 mm it was 78.1% and 66.7%, respectively (P = 0.14). The median
(range) number of sessions in both groups was 2 (1-5). After ESWL urinary NAG
levels were increased significantly in both groups; in the TH group it declined
below the level before ESWL after 2 days, while in the DLS group it remained high
after 7 days. In the DLS group four patients developed subcapsular or parenchymal
haematoma after ESWL, vs none in the TH group. There was loss of corticomedullary
differentiation after ESWL in three patients in the DLS group and only one in the
TH group. In the DLS group there was a statistically significantly decrease in
bilateral renal perfusion after ESWL, but no changes in the TH group.
CONCLUSIONS: Synchronous twin-pulse ESWL has clinical advantages over standard
ESWL in terms of safety and efficacy.

Publication Types: 
    Randomized Controlled Trial

PMID: 18070192 [PubMed - indexed for MEDLINE]

179: Urol Res. 2008 Feb;36(1):51-60. Epub 2007 Dec 7.

Treatment of renal calculi by lithotripsy: minimizing short-term shock wave
induced renal damage by using antioxidants.

Al-Awadi KA, Kehinde EO, Loutfi I, Mojiminiyi OA, Al-Hunayan A, Abdul-Halim H,
Al-Sarraf A, Memon A, Abraham MP.

Department of Surgery (Division of Urology), Mubarak Hospital, Faculty of
Medicine, Kuwait University, P.O. Box 33575, Rawda, Area Code 73456, Kuwait.
kamalawadi@yahoo.com

Treatment with extracorporeal shock wave lithotripsy (ESWL), the preferred method
of treating kidney stones <3 cm in size, has been shown to induce silent and
often self-limiting acute and chronic lesions in the kidneys and adjacent organs.
We conducted a randomized clinical trial to determine whether ESWL produces
ischaemia and reperfusion injury in the kidneys and whether oral administration
of antioxidants reduces the degree of short-term renal injury in patients treated
with ESWL. The study included 120 patients with renal stones (1-3 cm in size)
treated with ESWL. The patients were divided into three groups--patients in group
A (n=39) served as a control group and were not given any antioxidants; patients 
in group B (n=41) were given two capsules of antioxidants "Nature Made R: " 2 h
before ESWL, and 2 and 8 h after ESWL; and patients in group C (n=40) were given 
two capsules of the antioxidants 2 and 8 h after ESWL. Double 'J' stents were
inserted in patients before treatment with ESWL. Blood and urine samples were
obtained from all patients just before the start of treatment with ESWL, and at 2
and 24 h and on 7th and 28th day after ESWL. Serum levels of malondialdehyde
(MDA), alpha-tocopherol, cholesterol, albumin and ascorbic acid, and
alpha-tocopherol/cholesterol ratio were determined. Urinary levels of albumin and
beta(2) microglobulin were also determined as measures of renal tubular injury.
At 24 h after ESWL, patients given antioxidants (groups B + C) had significantly 
reduced mean serum concentration of MDA (P<0.001); higher levels of serum
ascorbic acid (P<0.001) and serum albumin (P<0.001); lower
alpha-tocopherol/cholesterol ratio, lower urinary albumin and beta(2
)microglobulin levels compared with patients who did not receive antioxidants
(group A). These findings suggest that treatment with ESWL generates free
radicals through ischaemic/reperfusion injury mechanism, and that oral
administration of antioxidant may protect these patients from short term renal
injury caused by ESWL.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 18064446 [PubMed - indexed for MEDLINE]

180: Kidney Int. 2008 Feb;73(4):489-96. Epub 2007 Dec 5.

24-h uric acid excretion and the risk of kidney stones.

Curhan GC, Taylor EN.

Department of Medicine, Renal Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, Massachusetts 02115, USA. gcurhan@partners.org

There is uncertainty about the relation between 24-h urinary uric acid excretion 
and the risk of calcium oxalate nephrolithiasis. In addition, the risk associated
with different levels of other urinary factors needs clarification. We performed 
a cross-sectional study of 24-h urine excretion and the risk of kidney stone
formation in 3350 men and women, of whom 2237 had a history of nephrolithiasis.
After adjusting for other urinary factors, urinary uric acid had a significant
inverse association with stone formation in men, a marginal inverse association
with risk in younger women, and no association in older women. The risk of stone 
formation in men and women significantly rose with increasing urine calcium and
oxalate, and significantly decreased with increasing citrate and urine volume,
with the change in risk beginning below the traditional normal thresholds. Other 
urinary factors were also associated with risk, but this varied by age and
gender. Our study does not support the prevailing belief that higher urine uric
acid excretion increases the risk for calcium oxalate stone formation. In
addition, the current definitions of normal levels for urinary factors need to be
re-evaluated.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18059457 [PubMed - indexed for MEDLINE]

181: Nat Clin Pract Urol. 2007 Dec;4(12):671-6.

Management of renal stone disease in obese patients.

Vujovic A, Keoghane S.

St Mary's Hospital, Portsmouth, UK.

Obesity represents an increasing burden to health care resources. Nephrolithiasis
is associated with obesity and type 2 diabetes and the consumption of diets rich 
in protein, fat and carbohydrates; this article addresses some of the
pathophysiological mechanisms associated with stone formation in these patients. 
Management of stone disease can be more difficult in obese patients; even
diagnosis can be problematic because imaging techniques are less sensitive in
these patients. Treatment with extracorporeal shockwave lithotripsy and surgery
in obese patients can be challenging, and outcome data for the different
treatments are discussed in this Review.

Publication Types: 
    Review

PMID: 18059347 [PubMed - indexed for MEDLINE]

182: J Clin Microbiol. 2008 Feb;46(2):804-6. Epub 2007 Dec 5.

Gardnerella vaginalis bacteremia in a previously healthy man: case report and
characterization of the isolate.

Lagacé-Wiens PR, Ng B, Reimer A, Burdz T, Wiebe D, Bernard K.

Department of Medical Microbiology and Infectious Diseases, Faculty of Medicine, 
University of Manitoba, Winnipeg, Canada.

Gardnerella vaginalis in women causes vaginitis or infections in other sites,
such as the urinary tract, but is an infrequent cause of bacteremia. Bacteremia
in men is very rare and is typically associated with immunocompromised states.
Here we describe G. vaginalis bacteremia in a previously healthy man with renal
calculi and urosepsis.

Publication Types: 
    Case Reports

PMID: 18057138 [PubMed - indexed for MEDLINE]

183: J Endourol. 2007 Dec;21(12):1433-7.

Percutaneous nephrolithotomy in the supine position: a neglected approach?

Steele D, Marshall V.

Urology Unit, Department of Surgical Services, Royal Adelaide Hospital, South
Australia.

PURPOSE: The aim of the study was to demonstrate the safety and effectiveness of 
single-stage percutaneous nephrolithotomy performed in the supine position.
PATIENTS AND METHODS: A single surgeon performed 322 consecutive percutaneous
nephrolithotomies in patients in the supine position between 1999 and 2006, which
were studied prospectively. RESULTS: There were no complications related to the
supine position, and in only one patient was there failed access. This patient's 
kidney was subsequently punctured with the patient in the supine position. There 
were no colonic injuries, no pneumothoraces, and a transfusion rate of 3.7%.
Surgery on all patients with stones, including staghorn calculi and bilateral
stones managed synchronously, was in the supine position. The median time to
percutaneous access in a timed cohort of 27 patients was 5 minutes. The stone
clearance rate was 91%. The median length of hospital stay was reduced from 6
days in the initial unstented patients to 3 days in the study overall when most
patients received stents. CONCLUSIONS: Percutaneous nephrolithotomy in the supine
position is safe, effective, and suitable for the majority of patients. It offers
the potential advantages of better urethral access, less patient handling, and
the need to only drape once, thus reducing the overall operative time compared to
the traditional prone position.

Publication Types: 
    Comparative Study
    Multicenter Study

PMID: 18052822 [PubMed - indexed for MEDLINE]

184: J Endourol. 2007 Dec;21(12):1411-3.

Tubeless percutaneous nephrolithotomy: 5 years of experience in 201 patients.

Karami H, Jabbari M, Arbab AH.

Department of Urology, Urology and Nephrology Research Center, Shohada-e-Tajrish 
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
info@drhosseinkarami.com

BACKGROUND AND PURPOSE: Our aim was to evaluate the safety, effectiveness, and
feasibility of tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND
METHODS: From June 2000 to September 2005, 201 patients with renal stones >2 cm
underwent tubeless PCNL by a single surgeon. We report details of the outcomes.
RESULTS: The complete stone clearance rate was 91.04% (183 patients). After
surgery, 18 patients (8.96%) had stones (mean size = 7 mm) detected on a plain
abdominal radiograph or ultrasonographic examination and were referred for
shockwave lithotripsy. The mean stone size was 30 mm (range 20-40 mm). The mean
operative time was 35 minutes (range 30-60 min), and the mean hospital stay was
3.5 days (range 2-5 days). Postoperative ultrasonography did not reveal
considerable fluid collection. There were no visceral injuries. Twenty-two
(10.9%) patients received a transfusion, and 16 (7.9%) patients had urinary tract
infection. CONCLUSION: In our experience, tubeless PCNL is safe, effective, and
feasible without any discomfort for patients.

PMID: 18052821 [PubMed - indexed for MEDLINE]

185: Hinyokika Kiyo. 2007 Nov;53(11):771-6.

Results of extracorporeal shock wave lithotripsy for the treatment of upper
urinary tract stones.

Tomomasa H, Kaneko S, Ogawa K, Satoh S, Muramatsu H, Satoh M, Umeda T, Okada E,
Iizumi T.

Department of Urology, Ageo Central General Hospital.

The treatment results of 697 renal units in 687 patients treated for upper
urinary tract stones using a Piezolith 2500 at the Ageo Central General Hospital 
during the 5-year period between August 1999 and July 2004 were analyzed. The
stone-free rate and the success rate were calculated according to the stone size 
and location. Univariate and multivariate logistic regression analyses were
performed to estimate the effect of the patient age, sex, affected side, stone
location and stone size on the stone-free rate and the success rate. Overall, the
stone-free rate and the success rate at 3 months after treatment were 82.6% and
91.9%, respectively. The stone-free rates in renal and ureteral stones were 60.5%
and 88.7%, respectively. The success rates for renal and ureteral stones were
93.6% and 91.6%, respectively. In a univariate logistic regression analysis,
patient age and stone size were significant negative factors for both the
stone-free rate and the success rate and the stone location in ureter was a
significant positive factor only for the stone-free rate. In a multivariate
analysis, stone location in the ureter had a positive effect on the stone-free
rate, although a negative effect on the success rate. Extracorporeal shock wave
lithotripsy for upper urinary tract stones was an effective and safe treatment
modality. However, if pre-treatment factors indicate unfavorable outcome, the
other treatment options should be considered for the first line therapy.

PMID: 18051800 [PubMed - indexed for MEDLINE]

186: Surg Laparosc Endosc Percutan Tech. 2007 Oct;17(5):472-3.

Delayed pneumothorax after tubeless percutaneous nephrolithotomy.

Jou YC, Cheng MC, Shen CH, Lin CT, Chen PC.

Department of Urology, Chiayi Christian Hospital, Chiayi, Taiwan.

Percutaneous nephrolithotomy is the treatment of choice for large urinary stone
and staghorn stone. Supracostal access through the upper calyx provides a
straight tract along the long axis of the kidney and is the optimal route for the
treatment of staghorn stone. However, the supracostal access bears higher risk
for pleural or lung injury resulting in hydrothorax or pneumothorax. Percutaneous
nephrolithotomy induced pneumothorax usually occurs immediately after operation. 
We report a case of delayed pneumothorax after tubeless percutaneous
nephrolithotomy for a complete staghorn stone.

Publication Types: 
    Case Reports

PMID: 18049420 [PubMed - indexed for MEDLINE]

187: Kidney Int. 2008 Feb;73(4):423-9. Epub 2007 Nov 28.

Effect of bolus and divided feeding on urine ions and supersaturation in genetic 
hypercalciuric stone-forming rats.

Bushinsky DA, Michalenka AC, Strutz KL, Donahue S, Asplin JR.

Nephrology Division, Department of Medicine, University of Rochester School of
Medicine, Rochester, New York 14642, USA. David_Bushinsky@URMC.Rochester.edu

Because urine ion excretion varies throughout the day, clinicians monitor 24 h
urine samples to measure ion excretion and supersaturation in kidney stone
patients. However, these results are averages and may not reflect maximal
supersaturation which drives stone formation. We measured ion excretion and
saturation in genetic hypercalciuric stone-forming rats on both a normal or low
calcium diet over 0-3, 3-6 and 6-24 h using two feeding protocols, where the
daily food allotment was fed either as a bolus or divided into three portions.
With a normal calcium diet, urine calcium, oxalate, volume, and calcium oxalate
supersaturation were significantly greater on the bolus compared to the divided
feeds in the prandial and postprandial periods. Bolus eaters also excreted more
calcium and oxalate and had increased volume over 24 h. Maximal calcium oxalate
supersaturation was greater during the initial time periods than during the
entire 24 h, regardless of the feeding schedule. With the low calcium diet, the
effect of bolus feeding was reduced. Thus, urine ion excretion and
supersaturation vary with the type of feeding. If these results are confirmed in 
man, it suggests that eating as a bolus may result in greater prandial and
postprandial calcium oxalate supersaturation. This may increase growth on
Randall's plaques and promote stone disease.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 18046318 [PubMed - indexed for MEDLINE]

188: J Endourol. 2007 Dec;21(12):1485-7.

Case report: hand-assisted laparoscopic radical heminephrectomy for renal-cell
carcinoma in a horseshoe kidney.

Araki M, Link BA, Galati V, Wong C.

Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma
City, Oklahoma, USA.

A 63-year-old woman with an incidentally detected 10-cm enhancing renal mass in
the left moiety of a horseshoe kidney was treated with a transperitoneal
hand-assisted laparoscopic (HAL) radical heminephrectomy. The operative time was 
273 minutes, and estimated blood loss was 250 mL. To our knowledge, this is the
initial case of HAL radical heminephrectomy for renal-cell carcinoma in a
horseshoe kidney. Appropriate pre-operative imaging and surgical technique for
the isthmusectomy are highlighted.

Publication Types: 
    Case Reports

PMID: 18044995 [PubMed - indexed for MEDLINE]

189: J Endourol. 2007 Nov;21(11):1277-80.

Prestenting improves ureteroscopic stone-free rates.

Rubenstein RA, Zhao LC, Loeb S, Shore DM, Nadler RB.

Department of Urology, Northwestern University Feinberg School of Medicine,
Chicago, Illinois 60611, USA. rrubenstein@ameritech.net

PURPOSE: Although the use of stents after ureteroscopy has been studied
extensively, relatively little has been published about stent placement before
complicated ureteroscopic procedures. In this study, we examined our experience
with stent placement before ureteroscopic management of renal and ureteral stone 
disease. PATIENTS AND METHODS: A total of 90 patients underwent ureteroscopic
surgery on 115 renal units by a single surgeon from 2001 to 2006. All patients
had documented follow-up with imaging either by CT or intravenous urography (IVU)
with tomography. Patients were classified into two groups depending on whether
they had a stent placed before ureteroscopy. Baseline characteristics, operative 
indications for stent placement, stone-free rates, and complications were
compared between groups. RESULTS: Baseline characteristics were similar between
the groups. The majority of patients received stents before stone management
because of technical considerations during surgery (17/36, 47%) or infection
(13/36, 37%). Strict stone-free rates after ureteroscopic treatment were 47% in
the 79 procedures without previous stents, compared with 67% in the 36 procedures
with prestenting (P < 0.05). Including small fragments (2 mm or smaller),
stone-free rates improved to 54% v 78%, respectively (P < 0.02). Complications
were not significantly different in the two groups (P = 0.70). CONCLUSION:
Although routine stent placement is not necessary before all ureteroscopic
procedures, we demonstrate that it is associated with good stone-free rates and
few complications. In this retrospective cohort, prestenting was associated with 
significantly higher stone-free rates. Prestenting should be considered in
challenging cases.

PMID: 18042014 [PubMed - indexed for MEDLINE]

190: Acad Radiol. 2007 Dec;14(12):1441-7.

Noninvasive differentiation of uric acid versus non-uric acid kidney stones using
dual-energy CT.

Primak AN, Fletcher JG, Vrtiska TJ, Dzyubak OP, Lieske JC, Jackson ME, Williams
JC Jr, McCollough CH.

CT Clinical Innovation Center, Department of Radiology, Mayo Clinic College of
Medicine, 200 First Street SW, Rochester, MN 55905, USA. primak.andrew@mayo.edu

RATIONALE AND OBJECTIVES: To determine the accuracy and sensitivity for
dual-energy computed tomography (DECT) discrimination of uric acid (UA) stones
from other (non-UA) renal stones in a commercially implemented product. MATERIALS
AND METHODS: Forty human renal stones comprising uric acid (n=16), hydroxyapatite
(n=8), calcium oxalate (n=8), and cystine (n=8) were inserted in four porcine
kidneys (10 each) and placed inside a 32-cm water tank anterior to a cadaver
spine. Spiral dual-energy scans were obtained on a dual-source, 64-slice computed
tomography (CT) system using a clinical protocol and automatic exposure control. 
Scanning was performed at two different collimations (0.6 mm and 1.2 mm) and
within three phantom sizes (medium, large, and extra large) resulting in a total 
of six image datasets. These datasets were analyzed using the dual-energy
software tool available on the CT system for both accuracy (number of stones
correctly classified as either UA or non-UA) and sensitivity (for UA stones).
Stone characterization was correlated with micro-CT. RESULTS: For the medium and 
large phantom sizes, the DECT technique demonstrated 100% accuracy (40/40),
regardless of collimation. For the extra large phantom size and the 0.6-mm
collimation (resulting in the noisiest dataset), three (two cystine and one small
UA) stones could not be classified (93% accuracy and 94% sensitivity). For the
extra large phantom size and the 1.2-mm collimation, the dual-energy tool failed 
to identify two small UA stones (95% accuracy and 88% sensitivity). CONCLUSIONS: 
In an anthropomorphic phantom model, dual-energy CT can accurately discriminate
uric acid stones from other stone types.

PMID: 18035274 [PubMed - indexed for MEDLINE]

191: J Clin Lab Anal. 2007;21(6):426-31.

Multiple risk markers for atherogenesis associated with chronic inflammation are 
detectable in patients with renal stones.

Tsao KC, Wu TL, Chang PY, Sun CF, Wu LL, Wu JT.

Department of Pathology, Chang Gung Memorial Hospital, Taipei, Taiwan.

Patients with renal stones are known to be at risk of clinical complications such
as cardiovascular disease (CVD), nephropathy, and cancer. Recently, it has been
realized that almost all risk markers for CVD, nephropathy, etc. are all markers 
associated with the sequence of reactions of chronic inflammation. It has been
reported that chronic inflammation is involved not only in the pathogenesis of
nephrolithiasis but also contributes to the development of clinical complications
in this condition; therefore, we decided to find out whether these multiple
markers are detectable in patients with renal stones so that they can be used to 
predict the risk of clinical complications in these patients. There were 33
patients with nephrolithiasis included in this study. We found that almost all
major markers of chronic inflammation were elevated in patients with renal
stones, including proinflammatory cytokine, acute inflammation markers, adhesion 
molecules, urinary microalbumin (uMA), myeloperoxidase (MPO),
8-hydroxydeoxyguanosine (8-OHdG), 3-nitrotyrosine (3NT), and monocyte
chemoattractant protein. It appears that it is possible to assess the risk of
clinical complications by monitoring these markers in patients with renal stones.

PMID: 18022927 [PubMed - indexed for MEDLINE]

192: Conf Proc IEEE Eng Med Biol Soc. 2007;2007:2187-90.

Ultrasonic renal-stone tracking with mesh regularization.

Tsao J, He JH.

Dept. of EE. And Inst. of Comm., National Taiwan University, Taipei, Taiwan, ROC.
tsaor215@cc.ee.ntu.edu.tw

The efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) depends greatly on
the capability to focus shock waves on renal stone. To achieve automatic focusing
on moving target, the target must be under tracking. A mesh-based block matching 
algorithm is proposed for renal stone tracking using ultrasound image sequence.
Since multiple targets are tracked together, the mesh-based tracking algorithm
can provide a function of contextual regularization for solving the target
missing and image degradation problems in renal stone tracking. Recorded
ultrasound images of kidney during ESWL treatment are modified for demonstrating 
the capability of this algorithm.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18002423 [PubMed - indexed for MEDLINE]

193: J Urol. 2008 Jan;179(1):194-7; discussion 197. Epub 2007 Nov 14.

Comment in:
    J Urol. 2008 Aug;180(2):785.    Nat Clin Pract Urol. 2008 Sep;5(9):478-9.

The effect of shock wave rate on the outcome of shock wave lithotripsy: a
meta-analysis.

Semins MJ, Trock BJ, Matlaga BR.

James Buchanan Brady Urological Institute, The Johns Hopkins University School of
Medicine, Baltimore, Maryland 21287, USA.

PURPOSE: Although experimental evidence suggests that the rate of shock wave
delivery can affect the outcome of shock wave lithotripsy, clinical studies
produce conflicting results. We performed a systematic review and meta-analysis
to define the effect of shock wave rate on the outcome of shock wave lithotripsy.
MATERIALS AND METHODS: A search of MEDLINE and EMBASE was performed and all
randomized controlled trials comparing SWL treatment at 60 shocks per minute to
120 shocks per minute were included in the analysis. Data from 4 trials (589
patients) were pooled. The primary outcome measure was treatment outcome
(success, failure), as defined by the authors of the source studies. The
difference in the proportion of patients with a successful treatment outcome was 
compared between the 60 and 120 shocks per minute groups as a risk difference,
and risk differences were pooled across the 4 trials with a fixed effects model. 
RESULTS: Patients treated at a rate of 60 shocks per minute had a significantly
greater likelihood of a successful treatment (risk difference 10.2, 95% CI
3.7-16.8, p = 0.002). CONCLUSIONS: Our meta-analysis suggests that patients
treated at a rate of 60 shocks per minute have a significantly greater likelihood
of a successful treatment outcome than patients treated at a rate of 120 shocks
per minute.

Publication Types: 
    Meta-Analysis
    Review

PMID: 18001796 [PubMed - indexed for MEDLINE]

194: J Urol. 2008 Jan;179(1):198-200; discussion 200. Epub 2007 Nov 14.

Detection of residual stones after percutaneous nephrolithotomy: role of
nonenhanced spiral computerized tomography.

Osman Y, El-Tabey N, Refai H, Elnahas A, Shoma A, Eraky I, Kenawy M, El-Kapany H.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
y_osman99@yahoo.com

PURPOSE: We addressed the impact of stone density and size on the role of
computerized tomography for diagnosing residual stones after percutaneous
nephrolithotomy. MATERIALS AND METHODS: We prospectively evaluated 100 renal
units that underwent percutaneous nephrolithotomy. The study included 55 opaque
and 45 lucent or faint stones. Patients were examined after the procedure by
plain x-ray of the kidneys, ureters and bladder, linear tomography, ultrasound
and spiral computerized tomography. Minute residual stones were defined as 1 or 2
caliceal stones less than 5 mm, as measured by computerized tomography. RESULTS: 
Stone-free status was achieved in 38 renal units. Minute and significant residual
stones were detected in 26 and 36 renal units, respectively. For faint and lucent
stones sensitivity for overall stone detection was 100% for computerized
tomography, 11.1% for plain x-ray, 22.2% for linear tomography and 22.2% for
ultrasound (p <0.05). Sensitivity for detecting significant residual stones was
100% for computerized tomography, 20% for plain x-ray, 33.3% for linear
tomography and 20% for ultrasound (p <0.05). For opaque stones sensitivity for
overall stone detection was 100% for computerized tomography, 62.9% for plain
x-ray, 74.3% linear tomography and 48.6% for ultrasound (p <0.05). Sensitivity
for detecting significant residual stones was 100% for computerized tomography,
85.7% for plain x-ray (p not significant), 95.2% for linear tomography (p not
significant) and 57.1% for ultrasound (p <0.05). CONCLUSIONS: Computerized
tomography provides the most sensitive tool for detecting residual stones after
percutaneous nephrolithotomy. Nevertheless, it should not be routinely performed 
in patients with opaque stones because it yields no statistically valuable
increase in the diagnosis of significant residual stones compared with that of
plain x-ray and linear tomography.

PMID: 18001795 [PubMed - indexed for MEDLINE]

195: Urol J. 2007 Summer;4(3):147-50.

Erratum in:
    Urol J. 2007 Fall;4(4):254.

Percutaneous nephrolithotomy of kidney calculi in horseshoe kidney.

Darabi Mahboub MR, Zolfaghari M, Ahanian A.

Department of Urology, Imam Reza Hospital, Mashhad University of Medical
Sciences, Mashhad, Iran. j_darabi@yahoo.com

INTRODUCTION: The aim of this study was to evaluate percutaneous nephrolithotomy 
(PCNL) in horseshoe kidneys with calculi. MATERIALS AND METHODS: Between 1995 and
2005, we performed PCNL in 9 patients with horseshoe kidney. In 3 of them, there 
was a single calculus and the rest had multiple calculi in the pelvis and at
least 1 in the calyxes. Ultrasonography, plain abdominal radiography, and
intravenous urography (IVU) were performed in all patients. We used fluoroscopy
for entering the system and then, pneumatic or ultrasonic lithotripsy was used.
RESULTS: In all except 1 patient (88.9%) we could access the system. Single
calculi in 3 patients were removed. In 5 patients with multiple calculi, the
calculus causing obstruction was removed, and in 3, the calculi located in the
calyxes were removed too. Consequently, 66.7% were stone-free at the end of the
procedure. In 2 patients, there were residual calculi in the calyxes and they
underwent candidates for extracorporeal shockwave lithotripsy. CONCLUSION:
Percutaneous nephrolithotomy can be used in patients with horseshoe kidney if the
patient selection is appropriate and the surgeon is experienced enough. The
success rate and complications are the same as the patients with normal anatomy. 
However, access to the lower calyx is more difficult due to its anatomic status.

PMID: 17987576 [PubMed - indexed for MEDLINE]

196: Urol J. 2007 Summer;4(3):142-5; discussion 145-6.

Family history and age at the onset of upper urinary tract calculi.

Ahmadi Asr Badr Y, Hazhir S, Hasanzadeh K.

Department of Urology, Sina Hospital, Tabriz University of Medical Sciences,
Tabriz, Iran. yadollahahmadi@yahoo.com

INTRODUCTION: The aim of this study was to evaluate the effect of family history 
on the age of urinary calculus formation and its relation with characteristics of
the calculi and patients. MATERIALS AND METHODS: In a cross-sectional study in
Tabriz, a total of 210 patients with upper urinary tract calculi were evaluated. 
Their demographics and clinical characteristics and detailed information on their
family history were recorded. RESULTS: Of the patients, 28.6% had a positive
family history for urinary calculi. Siblings were the majority of the affected
family members (71.1%). The rate of a positive family history was slightly higher
in women than in men (30.0% versus 28.1%; P = .20). The mean age at the disease
onset of the men with and without a positive family history was 37.2 years versus
39.3 years, respectively (P = .20). Such a difference was not detected in the
female patients, either (P = .63). In general, the calculi were more detected on 
the left renal unit, but more prevalent on the right side in patients with a
positive family history (P = .008). No relation was found between the number and 
size of the calculi and the family history. CONCLUSION: About one-third of the
patients with urinary calculi had a positive family history too. Men with
affected family members are slightly more susceptible to the disease at younger
ages. There might be differences in the side of the calculi and family members
with a history of disease that warrants further studies.

PMID: 17987575 [PubMed - indexed for MEDLINE]

197: South Med J. 2007 Nov;100(11):1081-4.

Comment in:
    South Med J. 2007 Nov;100(11):1069.

The effect of aminophylline on renal colic: a randomized double blind controlled 
trial.

Djaladat H, Tajik P, Fard SA, Alehashemi S.

Department of Urology, Mohammadi Hospital, Hormozgan University of Medical
Sciences, Bandar Abbas, Iran. hoomanj@yahoo.com

OBJECTIVE: To evaluate the efficacy of aminophylline infusion as a painkiller
compared with placebo in patients with acute renal colic. PATIENTS AND METHODS:
From March to August 2005, 141 patients with clinical renal colic, who were under
60 years of age, had no history of heart or hepatic failure, asthma, theophylline
or beta blocker use, reaction to methylxantines, pregnancy or breast feeding, and
were not prescribed spasmolytic or analgesics, entered our study. They were
randomly assigned to receive either 375 mg of aminophylline or placebo infusion
under double blind conditions. Pain intensity was recorded using a visual analog 
scale (VAS), before drug administration and 30 and 60 minutes afterwards. The
drug effectiveness was defined as > or =40% decrease in pain intensity 60 minutes
after the onset of infusion, without exacerbation during the following 4 hours.
RESULTS: Seventy patients received aminophylline; it was effective in 45 (64%;
95% confidence interval 52-75%). Alternatively, placebo was effective in 12 of 71
control patients (17%; 95% confidence interval 9-28%); (P < 0.001). Thirty and 60
minutes after administration, aminophylline reduced pain by 24% and 39%
respectively, as compared with 6% and 8% pain reduction in the placebo group.
CONCLUSION: This prospective study provides remarkable information about the
efficacy of aminophylline on pain relief and decreasing narcotic usage in
symptomatic urinary calculi. It is safe, inexpensive, with minute side effects
and can be considered a good alternative or additive to narcotic analgesics in
the management of renal colic.

Publication Types: 
    Randomized Controlled Trial

PMID: 17984737 [PubMed - indexed for MEDLINE]

198: BJU Int. 2007 Dec;100(6):1339-43.

Prospective evaluation of acute endocrine pancreatic injury as collateral damage 
of shock-wave lithotripsy for upper urinary tract stones.

Wendt-Nordahl G, Krombach P, Hannak D, Häcker A, Michel MS, Alken P, Knoll T.

Department of Urology, University Hospital Mannheim, Germany.
gunnar.wendt-nordahl@uro.ma.uni-heidelberg.de

There has been controversy over whether extracorporeal shock wave lithotripsy
(ESWL) can cause damage to the endocrine cells of the pancreas, leading to the
later development of diabetes mellitus. Authors from Germany prospectively
evaluated acute endocrine pancreatic injury as collateral damage caused by the
ESWL for treating upper urinary tract stones. In a careful study they showed that
there was no effect on serum levels of variables indicating exocrine and
endocrine pancreatic tissue damage, suggesting that the idea that ESWL might lead
to future diabetes mellitus is unlikely to be correct. OBJECTIVE: To detect acute
damage to pancreatic cells by extracorporeal shock wave lithotripsy (ESWL), with 
a focus on endocrine function, as recently the development of diabetes mellitus
has been suggested to be a late complication of treatment of upper urinary tract 
stones, and injury to pancreatic tissue by ESWL, leading to insufficient
endocrine function, has been proposed as an explanation of this effect. PATIENTS 
AND METHODS: The study included 12 consecutive patients treated with ESWL for
proximal ureteric or kidney stones, using a third-generation electromagnetic
lithotripter. To evaluate pancreatic tissue injury caused by ESWL we determined
blood variables known to indicate exocrine and endocrine pancreatic cell damage; 
blood samples were taken before, during, immediately after, and 1 h and 24 h
after ESWL to determine the serum levels of amylase, lipase, insulin, glucose,
c-peptide and glucagon. Eight patients treated with ESWL for distal ureteric
stones were evaluated in the same way and served as the control group. RESULTS:
Neither the variables indicating islet cell damage (c-peptide, insulin and
glucagon), nor those indicating damage of exocrine pancreatic cells (amylase and 
lipase) changed significantly over the time course in both groups. CONCLUSION: We
could detect no immediate effect on the serum levels of variables indicating
exocrine or endocrine pancreatic tissue damage caused by ESWL for urinary tract
stones. The hypothesis that ESWL leads to pancreatic trauma with consecutive
development of diabetes mellitus therefore seems unlikely.

PMID: 17979932 [PubMed - indexed for MEDLINE]

199: Singapore Med J. 2007 Nov;48(11):e289-92.

Urinothorax: an unusual cause of pleural effusion.

Handa A, Agarwal R, Aggarwal AN.

Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and
Research, Sector 12, Chandigarh 160012, India.

Urinothorax refers to the presence of urine in the pleural space secondary to
obstructive uropathy, and is an unusual cause of pleural effusion. The importance
of recognising this entity lies in the fact that the condition is completely
reversible following relief of urinary tract obstruction. We describe a
35-year-old man who developed urinothorax following a percutaneous
nephrolithotomy for renal calculi. We also reviewed the literature for reported
cases between 1968 and 2006.

Publication Types: 
    Case Reports

PMID: 17975679 [PubMed - indexed for MEDLINE]

200: J Endourol. 2007 Oct;21(10):1179-82.

Ureteroscopic management of lower-pole stones in a pediatric population.

Cannon GM, Smaldone MC, Wu HY, Bassett JC, Bellinger MF, Docimo SG, Schneck FX.

Department of Urology, Children's Hospital, Boston, Boston, Massachusetts 02115, 
USA. glenn.cannon@childrens.harvard.edu

PURPOSE: We report our experience with ureteroscopy to treat lower-pole calculi
in children. PATIENTS AND METHODS: A retrospective review was conducted of all
ureteroscopic procedures for lower-pole stone disease at a pediatric institution 
from 2000 through 2005. A total of 13 girls and 8 boys with a mean age of 15
years (range 1-20 years) underwent flexible ureteroscopy for lower-pole calculi. 
The mean stone burden was 12 mm. Stone-free status was defined by postoperative
abdominal radiography, CT, or ultrasonography. RESULTS: Ureteral stenting was
performed preoperatively in 38% and postoperatively in 71% of the patients.
Ureteral-access sheaths were placed in 43%. There were no intraoperative or
postoperative complications. With a mean follow-up of 11 months, 76% of the
children were stone-free. The success rate for stones <15 mm was 93% v 33% for
stones > or =15 mm (P = 0.01). CONCLUSION: Ureteroscopy and laser lithotripsy are
safe and effective in children with lower-pole calculi. Ureteroscopy can be
considered a primary treatment option for children with lower-pole calculi <15
mm.

PMID: 17949321 [PubMed - indexed for MEDLINE]

201: J Endourol. 2007 Oct;21(10):1131-6.

Combination of laparoscopy and nephroscopy for treatment of stones in pelvic
ectopic kidneys.

El-Kappany HA, El-Nahas AR, Shoma AM, El-Tabey NA, Eraky I, El-Kenawy MR.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura,
Egypt.

PURPOSE: To present the combination of laparoscopy and nephroscopy for the
treatment of stones in pelvic ectopic kidneys. PATIENTS AND METHODS: The series
included seven male and four female patients (mean age 43 +/- 9 years).
Laparoscopy-assisted percutaneous nephrolithotomy (PCNL) was performed for
caliceal stones in five patients after failure of shockwave lithotripsy, while
laparoscopic pyelolithotomy was performed for large or branched renal pelvic
stones in six patients. RESULTS: The mean operative time was 164 +/- 30 minutes. 
There were neither complications nor conversions to open surgery. The stone-free 
rate was 91% (10 patients). One patient had a residual caliceal fragment that was
treated with shockwave lithotripsy. The mean hospital stay was 3.5 +/- 0.7 days. 
CONCLUSION: The combination of laparoscopy and nephroscopy is feasible, safe, and
effective for the treatment of stones in pelvic kidneys.

PMID: 17949310 [PubMed - indexed for MEDLINE]

202: Conf Proc IEEE Eng Med Biol Soc. 2006;1:2774-5.

Computed tomography of kidney stones for extracorporeal shock wave lithotripsy.

Rodríguez AO, Cadena M, Azpiroz J, Gutiérrez J, Bustos J, Castaño E, Loske AM.

CIIIM, Univ. Autonoma Metropolitana, Mexico City, Mexico. arog@xanum.uam.mx

Methods to predict fragmentation efficiency are still needed for extracorporeal
shock wave lithotripsy (ESWL). Imaging studies of kidney stones could be a useful
tool to guide ESWL. Artificial and real kidney stones were analyzed using
standard clinical CT imaging procedures. The objective was to compare CT image
properties of phantom and real kidney stones. Image properties of both groups
were compared and show a good agreement between them. These preliminary images
will be used to measure CT attenuation coefficients of real and artificial stones
and find a relationship between attenuation values and the fragmentation
coefficient of renal calculi exposed to shock waves.

Publication Types: 
    Evaluation Studies
    In Vitro

PMID: 17946980 [PubMed - indexed for MEDLINE]

203: Conf Proc IEEE Eng Med Biol Soc. 2006;1:2746-9.

Ultrasound image analysis for renal stone tracking during extracorporeal shock
wave lithotripsy.

Manousakas I, Pu YR, Chang CC, Liang SM.

Dept. of Biomed. Eng., I-Shou Univ., Kaohsiung, Taiwan. i.manousakas@ieee.org

Although extracorporeal shock wave lithotripsy (ESWL) is the standard procedure
for treating renal stones, little work has been done on ways to minimize the side
effects and on treatment optimization. A system that uses ultrasound imaging for 
real time renal stone monitoring is presented here and some aspects of the image 
analysis module are described. The improved system has proved to be more robust
than the unmodified system. With such a system, the injury on healthy tissues is 
reduced while the treatment time is shortened.

Publication Types: 
    Clinical Trial

PMID: 17945734 [PubMed - indexed for MEDLINE]

204: BJU Int. 2008 Mar;101(6):731-5. Epub 2007 Oct 17.

Multimodal evaluation of renal perfusional changes due to extracorporeal shock
wave lithotripsy.

Mitterberger M, Pinggera GM, Neururer R, Peschel R, Aigner F, Gradl J, Bartsch G,
Kendler D, Karakolcu F, Frauscher F, Pallwein L.

Department of Urology, Medical University Innsbruck, Austria.
michael.mitterberger@uibk.ac.at

OBJECTIVES: To examine the effect of extracorporeal shock wave lithotripsy (ESWL)
on renal perfusion before and after treatment, by assessing renal resistive index
(RI) using colour Doppler ultrasonography (CDUS), magnetic resonance perfusion
imaging (MRPI), radionuclide renography and big-endothelin-1 values (Big-ET-1).
PATIENTS AND METHODS: In 69 normotensive patients the RI was measured before, 1, 
3, 6 and 24 h after ESWL using CDUS. The RI values, measured in
interlobar/arcuate arteries, were correlated with the findings on MRPI, done
before and within 24 h after ESWL. In addition, renal plasma flow (RPF, assessed 
on radionuclide renography) and Big-ET-1 levels (a potent vasoconstrictor
peptide), served as a control for evaluating renal perfusion. The patients were
stratified in three age groups, i.e. <or=39, 40-59 and >or=60 years, with 23
patients in each group. RESULTS: The mean (sd) RI increased significantly in the 
treated kidneys, from 0.64 (0.05) before to 0.72 (0.08) after ESWL (P = 0.001).
Only in patients aged >or=60 years did the RI continue to increase over the 24 h.
MRPI showed a decrease of renal blood flow (RBF) in all age groups, but most
significantly in those aged >or=60 years. The radionuclide renography and
big-ET-1 levels changed significantly only in the oldest group. The best
correlation was between RI and RBF changes detected by MRPI. CONCLUSIONS: ESWL
obviously causes disturbances of renal perfusion, particularly in elderly
patients (>or=60 years). Measurement of RI with Doppler techniques might provide 
useful information for the clinical diagnosis of renal damage.

PMID: 17941931 [PubMed - indexed for MEDLINE]

205: J Endourol. 2007 Sep;21(9):977-84.

Safety and efficacy of tubeless percutaneous renal surgery.

Abou-Elela A, Emran A, Mohsen MA, Reyad I, Bedair AS, Kader MA.

Department of Urology, Cairo University, Cairo, Egypt. ashrafboelela@yahoo.co.uk

PURPOSE: We challenge the requirement for routine placement of a nephrostomy tube
after percutaneous renal surgery, assessing the outcome, safety, and efficacy of 
tubeless procedures. PATIENTS AND METHODS: A total of 128 patients underwent
tubeless percutaneous renal surgery from May 2001 to May 2004: stone extraction
in 120 patients and endopyelotomy +/- stone extraction in 8. The stone sizes
ranged from 2 to 7 cm with a mean of 4.1 cm. An external ureteral catheter was
used in 120 patients and was removed after 24 hours if a retrograde study
revealed no extravasation. An antegrade Double-J stent was used in 8 patients and
removed 4 to 6 weeks postoperatively. Among the 128 patients treated by the
tubeless technique, we met situations that mandated insertion of a nephrostomy
tube in 18. RESULTS: The stone free-rate was 90.4%. The mean hospital stay was
1.7 days. The incidence of significant intraoperative bleeding was 1.5% and that 
of significant postoperative hematuria was 4.6%. Postoperative sonography
revealed a small perirenal collection (<50 mL) in 10 patients (7.8%) and
significant perirenal collections (100-250 mL) in 3 (2.3%). The postoperative
retrograde study revealed minor extravasation in 14 patients (12%) and
significant extravasation in 3 (2.3%) CONCLUSION: Tubeless percutaneous renal
surgery with an externalized ureteral catheter is a safe procedure that is
suitable for any patient who can be rendered stone free with a single procedure
regardless of the initial stone burden.

PMID: 17941772 [PubMed - indexed for MEDLINE]

206: J Endourol. 2007 Sep;21(9):973-6.

Tubeless percutaneous nephrolithotomy with antegrade stent tether: clinical
experience.

Shpall AI, Parekh AR, Bellman GC.

Department of Urology, Kaiser Foundation Hospital, Los Angeles, California.

BACKGROUND AND PURPOSE: A limitation of tubeless percutaneous nephrolithotomy
(PCNL) is the need for post-operative office cystoscopy to remove the ureteral
stent. We developed a novel technique of intraoperative stent placement that
allows removal via the flank. Herein, we report on our initial clinical
experience. PATIENTS AND METHODS: Thirty consecutive patients (36 renal moieties)
undergoing tubeless PCNL had ureteral stents placed at the end of the procedure
with a stent tether exiting the flank incision. Patients were discharged home
with the tether protected by a clear occlusive bandage. The stents were removed
in the office between 3 and 12 days postoperatively by gently pulling on the
tether. Patients were assessed for difficulty in removing the stent, leakage of
urine from the flank, and any other postoperative complications. RESULTS: All
stents could be removed from the flank using the tether. No urine leakage was
noted in any patient, nor did any patient develop any complication related to
stent placement or removal. Stents from several manufacturers were employed, with
no difference noted. Patients reported no additional discomfort from the presence
of the flank tether, and no significant pain was noted during stent removal.
CONCLUSION: Utilization of the tether to remove the ureteral stent via the flank 
after tubeless PCNL is a feasible, safe, and cost-effective improvement on the
standard tubeless PCNL technique. This modification obviates postoperative office
cystoscopy, allowing easy removal of a stent.

PMID: 17941771 [PubMed - indexed for MEDLINE]

207: J Endourol. 2007 Sep;21(9):967-72.

Tubeless percutaneous nephrolithotomy: safe even in supracostal access.

Sofikerim M, Demirci D, Huri E, Erşekerci E, Karacagil M.

Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey.
drmus42@hotmail.com

PURPOSE: This study was designed to determine the outcome and safety of tubeless 
percutaneous nephrolithotomy (PCNL) in the treatment of renal calculi. PATIENTS
AND METHODS: Between November 2005 and March 2006, 48 patients were randomized to
either an 18F Re-entry nephrostomy tube (group 1) or a 6F Double-J stent (group
2). The two groups were well matched for age, sex, stone size, stone laterality, 
and number of previous renal procedures. All PCNL procedures were performed by
the same surgeon. Postoperative visual analog pain scale (VAS) scores at 8 and 24
hours and 14 days after surgery, in-hospital analgesic use, length of hospital
stay, success rate, blood transfusion rate, and postoperative complications were 
compared for the two groups. RESULTS: The mean hospital stays in groups 1 and 2
were 3.1 and 1.6 days, respectively (P = 0.003). The mean VAS scores 8 and 24
hours after surgery were significantly lower in group 2 than in group 1 (P =
0.001). The postoperative analgesic requirement (diclofenac sodium) was
significantly higher in group 1 (263 mg) than in group 2 (120 mg; P = 0.02). The 
rate of blood transfusion in the two groups was similar (P = NS). There was no
difference between the groups in VAS scores on postoperative day 14. The number
of supracostal accesses was significantly higher in group 2 than in group 1 (P = 
0.02). The stone-free rates and the numbers of patients with insignificant
residual fragments were similar in the two groups. There was no urine leakage or 
formation of urinoma in patients with Double-J stents. CONCLUSION: Tubeless PCNL 
is safe and effective even after supracostal access and is associated with less
postoperative pain and a shorter hospital stay.

Publication Types: 
    Randomized Controlled Trial

PMID: 17941770 [PubMed - indexed for MEDLINE]

208: J Endourol. 2007 Sep;21(9):961-6.

Critical prospective appraisal of renal morphology and function in children
undergoing shockwave lithotripsy and percutaneous nephrolithotomy.

Wadhwa P, Aron M, Bal CS, Dhanpatty B, Gupta NP.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

PURPOSE: To assess the effect of shockwave lithotripsy (SWL) and percutaneous
nephrolithotomy (PCNL) on renal morphology and function in children undergoing
therapy for upper-tract urolithiasis. PATIENTS AND METHODS: Fourteen patients
less than 13 years of age with renal or upper-ureteral calculi who were found
suitable for primary SWL or PCNL were evaluated for alteration of renal
morphology and function after treatment. Of the 18 renal units treated, SWL and
PCNL were performed in 9 units each. The average stone size was 880.2 mm2 (range 
110-3800 mm2; median 660 mm2). All children underwent ultrasonic estimation of
renal length and parenchymal thickness, 99m technetium dimercaptosuccinic acid
(DMSA) and 99m Tc-ethylene dicystine (EDC) scintigraphy, and glomerular
filtration rate (GFR) estimation prior to intervention and at 3 and 6 months of
follow-up. RESULTS: Extracorporeal lithotripsy achieved complete clearance in 8
renal units (88%), requiring an average of 6333 shockwaves and an average of 2.2 
sessions per renal unit. The efficiency quotient was 42. Percutaneous surgery
likewise achieved complete stone clearance in 88% of renal units, with three
units requiring more than one tract. Mixed calcium oxalate monohydrate and
dihydrate accounted for the majority of the stones. The mean preintervention GFR 
was 78.3 +/- 14.6 mL/min/1.73 m2 (median 82.5 mL/min/1.73 m2; range 54-98.6
mL/min/1.73 m2), whereas the mean GFR at 3 months was 78.95 +/- 14.4 mL/min/1.73 
m2 (median 78.95 mL/min/1.73 m2; range 52-98 mL/min/1.73 m2). A marginal
improvement of an average of 0.65 mL/min was noted. Split function EDC scans
demonstrated improved drainage in five cases after intervention; the rest were
unchanged. Preintervention DMSA scans revealed renal cortical scars in three
children. None of the renal units had developed fresh scars at follow-up scans.
None of the children developed new-onset hypertension, proteinuria, or alteration
in renal size. CONCLUSION: In the present study, pediatric SWL and PCNL were not 
found to cause adverse renal morphologic or functional alteration. Stone
clearance resulted in marginally improved function and better drainage.

PMID: 17941769 [PubMed - indexed for MEDLINE]

209: J Endourol. 2007 Sep;21(9):957-60.

Impact of type of anesthesia on efficacy of medstone STS lithotripter.

Lee C, Weiland D, Ryndin I, Ugarte R, Monga M.

Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
55455-0392, USA.

PURPOSE: To evaluate the impact of the type of anesthesia on treatment efficacy, 
using a comparison of general anesthesia (GEN) and monitored anesthesia care with
intravenous sedation (MAC), for patients undergoing extracorporeal shockwave
lithotripsy (SWL) on the Medstone STS lithotripter. PATIENTS AND METHODS: A
case-control study was conducted of 660 patients treated from 1986 to 2002.
General anesthesia and MAC were utilized in 330 procedures each. Case matching
was performed for stone size, stone location, and body mass index. All
lithotripter units were staffed by a rotating schedule of the same 10
SWL-certified radiologic technicians. Patient characteristics, treatment
parameters, complications, repeat procedures, and secondary procedures were
recorded. Stone-free success rates (no residual fragments) were reported by the
treating physician on the basis of plain radiographs. Chi-square analysis was
used to compare patients in the two groups. RESULTS: The overall stone-free rate 
was better with GEN (67%) than MAC (55%; P = 0.04). Stone-free rates were not
affected for stones <or=10 mm (GEN 69%, MAC 63%; P = 0.42). The type of
anesthetic impacted stone-free rates in the upper calix (GEN 75%, MAC27%; P =
0.05). CONCLUSIONS: This study helps define that population that may benefit most
from the use of GEN: those with stones >10 mm or in an upper calix. General
anesthesia may decrease excursion of the calculus out of the focal area secondary
to breathing or patient movement.

PMID: 17941768 [PubMed - indexed for MEDLINE]

210: J Endourol. 2007 Sep;21(9):951-6.

Comparative results of shockwave lithotripsy for renal calculi in upper, middle, 
and lower calices.

Turna B, Ekren F, Nazli O, Akbay K, Altay B, Ozyurt C, Cikili N.

Department of Urology, Ege University Medical Faculty, Izmir, Turkey.
burakturna@gmail.com

BACKGROUND AND PURPOSE: To assess the results of shockwave lithotripsy (SWL) for 
renal calculi in upper, middle, and lower calices according to the stone burden. 
PATIENT AND METHODS: A series of 52 female and 66 male patients with a mean age
of 47.8 years and isolated single caliceal stones who underwent SWL monotherapy
were enrolled. Stone burden, stone location, number of sessions/shockwaves, and
auxiliary procedures were noted for each patient. Stones were located in the
upper, middle, and lower calices of 35, 43, and 40, patients respectively, with
mean stone burdens of 81.4 mm2, 75.2 mm2, and 96.3 mm2, respectively. Patients
were evaluated with intravenous urography, plain film, or ultrasonography.
Success was determined 3 months after the last session. Re-treatment rates were
calculated. The effect of anatomic factors on the success of treatment for
lower-caliceal stones also was determined. RESULTS: The mean stone burden, median
number of treatment sessions, and mean number of shockwaves were 84.2 mm2, 2, and
4344, respectively. The auxiliary procedure rate was 16.1%, and the re-treatment 
rate was 71.2%. Failure was noted in 26 patients (22%). The stone-free rates for 
stones in the upper, middle, and lower calices were 82.8%, 83.4%, and 67.5%,
respectively (P = 0.14). The stone-free rates for stones <100 mm2 and 100 to 200 
mm2 were 91.2% and 65.5%, respectively (P = 0.001). The efficiency quotient was
49.8, 44.8, and 32.5 for upper-, middle-, and lower-caliceal stones,
respectively. Infundibular length (P = 0.006) and infundibular width (P + 0.036) 
were significant in determining the stone-free rate after treatment of
lower-caliceal stones. CONCLUSIONS: We recommend SWL as the first choice for
treatment of stones <200 mm2 in the upper and middle calices. Extracorporeal
lithotripsy is one of the options for lower-caliceal stones <200 mm2 but has high
re-treatment and auxiliary-procedure rates in these cases.

Publication Types: 
    Comparative Study

PMID: 17941767 [PubMed - indexed for MEDLINE]

211: J Clin Ultrasound. 2008 Jan;36(1):16-9.

Phase inversion harmonic imaging improves assessment of renal calculi: a
comparison with fundamental gray-scale sonography.

Ozdemir H, Demir MK, Temizöz O, Genchellac H, Unlu E.

Department of Radiology, Trakya University School of Medicine, Edirne, Turkey.

PURPOSE: To compare phase inversion harmonic imaging (PIHI) with fundamental
imaging (FI) in the evaluation of renal calculi. METHODS: Thirty adult patients
with renal calculi (17 men, 13 women; mean age 44 years [range, 25-71]) underwent
transabdominal sonographic examination of the urinary system. Both kidneys and
renal calculi were examined with PIHI and FI. Overall renal conspicuity, calculus
visibility, and clarity of posterior shadowing were assessed subjectively using a
4-point scale (0 being the worst, 3 being the best). The maximum diameter of the 
calculi was measured using both techniques. The effect of body mass index on
qualitative scoring and quantitative measurements was evaluated. RESULTS: PIHI
improved overall renal conspicuity compared with FI (p < 0.001). The visibility
of the calculi and clarity of posterior shadowing were significantly better with 
PIHI than with FI (p < 0.001 for both parameters). The maximum diameter of
calculi was larger with PIHI than with FI (p < 0.001). The superiority of PIHI
over FI regarding overall conspicuity of the kidney, visibility of the calculus, 
and clarity of posterior shadowing scores increased in the obese group (p < 0.001
for all 3 parameters). The mean calculus diameter difference between the 2
techniques was significantly higher in the obese group. CONCLUSION: The routine
use of PIHI is recommended in the evaluation of renal calculi. (c) 2007 Wiley
Periodicals, Inc.

Publication Types: 
    Comparative Study

PMID: 17937423 [PubMed - indexed for MEDLINE]

212: Hinyokika Kiyo. 2007 Sep;53(9):631-4.

Case report of renal pelvic adenocarcinoma associated with a renal stone that
produced carbohydrate antigen 125 and carbohydrate antigen 19-9.

Azumi M, Hou K, Numata A, Taniguchi N, Saga Y, Hashimoto H, Kakizaki H.

The Department of Urology, Asahikawa Medical College.

A 68-year-old man underwent left side simple nephrectomy for symptomatic severe
hydronephrosis with decreased function due to a renal stone. Because of severe
adhesion around the kidney, the renal pelvic wall was torn during the operation. 
Pathological diagnosis was papillary adenocarcinoma of the renal pelvis with
positive staining for carbohydrate antigen 125 (CA125) and carbohydrate antigen
19 9 (CA19-9). Retrospective analysis of preoperative blood sample showed a high 
level of CA125 and CA19-9. Four-cycle adjuvant chemotherapy with
paclitaxel/carboplatin (TJ regimen) was performed. However, local recurrence
developed 1 month after the termination of chemotherapy. Although papillary
adenocarcinoma of the renal pelvis is extremely rare, the possibility of renal
pelvic tumor should be kept in mind for patients who have a long-standing renal
stone and hydronephrosis with irregularity at the renal pelvic wall. CA125 and
CA19-9 can be useful markers for upper urinary tract tumor.

Publication Types: 
    Case Reports

PMID: 17933139 [PubMed - indexed for MEDLINE]

213: Kidney Int. 2008 Jan;73(2):207-12. Epub 2007 Oct 10.

Comment in:
    Kidney Int. 2008 Jan;73(2):139-40.

Fructose consumption and the risk of kidney stones.

Taylor EN, Curhan GC.

Renal Division and Channing Laboratory, Department of Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
entaylor@partners.org

Fructose consumption has markedly increased over the past decades. This intake
may increase the urinary excretion of calcium, oxalate, uric acid, and other
factors associated with kidney stone risk. We prospectively examined the
relationship between fructose intake and incident kidney stones in the Nurses'
Health Study I (NHS I) (93,730 older women), the Nurses' Health Study II (NHS II)
(101,824 younger women), and the Health Professionals Follow-up Study (45,984
men). Food frequency questionnaires were used to assess free fructose and sucrose
intake every 4 years. Total-fructose intake was calculated as free fructose plus 
half the intake of sucrose, and expressed as percentage of total energy. Cox
proportional hazard regressions were adjusted for age, body mass index (BMI),
thiazide use, caloric intake, and other dietary factors. We documented 4902
incident kidney stones during a combined 48 years of follow-up. The multivariate 
relative risks of kidney stones significantly increased for participants in the
highest compared to the lowest quintile of total-fructose intake for all three
study groups. Free-fructose intake was also associated with increased risk.
Non-fructose carbohydrates were not associated with increased risk in any cohort.
Our study suggests that fructose intake is independently associated with an
increased risk of incident kidney stones.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17928824 [PubMed - indexed for MEDLINE]

214: BJU Int. 2008 Feb;101(3):382-8. Epub 2007 Oct 8.

Independent assessment of a wide-focus, low-pressure electromagnetic
lithotripter: absence of renal bioeffects in the pig.

Evan AP, McAteer JA, Connors BA, Pishchalnikov YA, Handa RK, Blomgren P, Willis
LR, Williams JC Jr, Lingeman JE, Gao S.

Department of Anatomy & Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46202-5120, USA. evan@anatomy.iupui.edu

OBJECTIVE: To assess the renal injury response in a pig model treated with a
clinical dose of shock waves (SWs) delivered at a slow rate (27 SW/min) using a
novel wide focal zone (18 mm), low acoustic pressure (<20 MPa) electromagnetic
lithotripter (Xi Xin-Eisenmenger, XX-ES; Xi Xin Medical Instruments Co. Ltd.,
Suzhou, PRC). MATERIALS AND METHODS: The left kidneys of anaesthetized female
pigs were treated with 1500 SWs from either an unmodified electrohydraulic
lithotripter (HM3, Dornier MedTech America, Inc., Kennesaw, GA, USA; 18 kV, 30
SW/min) or the XX-ES (9.3 kV, 27 SW/min). Measures of renal function (glomerular 
filtration rate, GFR, and renal plasma flow) were collected before and after SW
lithotripsy, and kidneys were harvested for histological quantification of
vascular haemorrhage, expressed as a percentage of the functional renal volume
(FRV). A fibre-optic probe hydrophone was used to characterize the acoustic
field, and the breakage of gypsum model stones was used to compare the function
of the two lithotripters. RESULTS: Kidneys treated with the XX-ES showed no
significant change in renal haemodynamic function and no detectable tissue
injury. Pigs treated with the HM3 had a modest decline from baseline (
approximately 20%) in both GFR (P > 0.05) and renal plasma flow (P = 0.064) in
the treated kidney, but that was not significantly different from the control
group. Although most HM3-treated pigs showed no evidence of renal tissue injury, 
two had focal injury measuring 0.1% FRV, localized to the renal papillae. The
width of the focal zone for the XX-ES was approximately 18 mm and that of the HM3
approximately 8 mm. Peak positive pressures at settings used to treat pigs and
break model stones were considerably lower for the XX-ES (17 MPa at 9.3 kV) than 
for the HM3 (37 MPa at 18 kV). The XX-ES required fewer SWs to break stones to
completion than did the HM3, with a mean (sd) of 634 (42) and 831 (43) SWs,
respectively (P < 0.01). However, conditions were different for these tests
because of differences in physical configuration of the two machines. CONCLUSION:
The absence of renal injury with the wide focal zone XX-ES lithotripter operated 
at low shock pressure and a slow SW rate suggests that this lithotripter would be
safe when used at the settings recommended for patient treatment. That the injury
was also minimal using the Dornier HM3 lithotripter at a slow SW rate implies
that the reduced tissue injury seen with these two machines was because they were
operated at a slow SW rate. As recent studies have shown stone breakage to be
improved when the focal zone is wider than the stone, a wide focal zone
lithotripter operated at low pressure and slow rate has the features necessary to
provide better stone breakage with less tissue injury.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17922871 [PubMed - indexed for MEDLINE]

215: BJU Int. 2008 Mar;101(5):535-9. Epub 2007 Oct 8.

Comment in:
    BJU Int. 2008 Nov;102(9):1178.

Percutaneous nephrolithotomy made easier: a practical guide, tips and tricks.

Ko R, Soucy F, Denstedt JD, Razvi H.

Division of Urology, Department of Surgery, The University of Western Ontario,
London, Canada. raykhko@yahoo.com.au

Percutaneous nephrolithotomy (PCNL) plays an integral role in managing large
renal stones. Establishing percutaneous renal access is the most crucial step in 
the procedure and requires a thorough understanding of renal, retroperitoneal and
thoracic anatomy to minimize the risk of complications. Moreover, access to
fluoroscopy and the proper equipment are critical to ensuring complete stone
removal. In this review we describe the technique of PCNL used in a high-volume
endourology centre, where the urologist is involved in all aspects of the
procedure.

Publication Types: 
    Review

PMID: 17922862 [PubMed - indexed for MEDLINE]

216: Urology. 2007 Nov;70(5):856-60. Epub 2007 Oct 24.

Lemonade therapy increases urinary citrate and urine volumes in patients with
recurrent calcium oxalate stone formation.

Penniston KL, Steele TH, Nakada SY.

Department of Surgery, Division of Urology, University of Wisconsin School of
Medicine and Public Health, Madison, Wisconsin 53792-3236, USA.

OBJECTIVES: Potassium citrate is prescribed to patients with calcium oxalate
(CaOx) stone formation to increase urinary citrate and pH, thus reducing CaOx
crystal formation. Lemonade therapy (LT) might also increase urinary citrate and 
the total urine volume. We compared the effects of LT alone (group 1, n = 63) and
potassium citrate plus LT (group 2, n = 37) in patients with CaOx stone formation
on the urinary citrate and total urine volume to determine the efficacy of LT.
METHODS: Adult patients with CaOx stone formation and three or more clinic visits
from 1996 to 2005 and three or more UroRisk profiles were included in our
retrospective analysis. RESULTS: Urinary citrate increased maximally by 203 and
346 mg/day for groups 1 and 2, respectively. The maximal total urine volume
increase was 763 and 860 mL/day for groups 1 and 2, respectively. The urinary
citrate and total urine volume increased sooner during follow-up for group 1. By 
the last clinic visit, the urinary citrate and total urine volume had decreased
in both groups. However, group 1 sustained a greater total urine volume than did 
group 2 (2.35 +/- 0.10 standard error versus 2.17 +/- 0.12 L/day). Urinary
citrate was greater in group 1 (765 +/- 56 standard error versus 548 +/- 56
mg/day for group 2), but the change from baseline to the last visit was
significant (P = 0.008) only in group 2. CONCLUSIONS: LT resulted in favorable
changes in urinary citrate and total urine volume in our series. Potassium
citrate with LT was more effective than LT alone at increasing urinary citrate.
Because maximal changes for urinary citrate and total urine volume were achieved 
earlier in follow-up, individualized encouragement and motivation should be
provided to patients at each visit for sustained prevention.

Publication Types: 
    Comparative Study

PMID: 17919696 [PubMed - indexed for MEDLINE]

217: Exp Physiol. 2008 Jan;93(1):43-9. Epub 2007 Oct 2.

Renal calcium stones: insights from the control of bone mineralization.

Moochhala SH, Sayer JA, Carr G, Simmons NL.

Epithelial Research Group, Institute for Cell and Molecular Biosciences, Medical 
School, Framlington Place, University of Newcastle upon Tyne, Newcastle upon Tyne
NE2 4HH, UK.

Extracellular pyrophosphate (PPi) plays a central role in the control of normal
bone mineralization since it antagonizes inorganic phosphate in the promotion of 
hydroxyapatite deposition. Studies using knock-out mice have established the
functional importance of PPi generation via nucleotide pyrophosphatase
phosphodiesterases (NPP) and of PPi transmembrane transport by the progressive
ankylosis (ANK) protein. Tissue non-specific alkaline phosphatase activity
counteracts this by hydrolysis of PPi to inorganic phosphate. The molecular
nature and transport function of ANK are reviewed. A close parallel is drawn
between the controlled mineralization of bone and the prevention of abnormal
calcium crystal deposition within the kidney, especially when concentrated urine 
is produced. Pyrophosphate is present in urine, and ANK is expressed in the
cortical collecting duct where PPi transport to both the tubular lumen and the
renal interstitium may occur. Pyrophosphate may also be generated here by
nucleoside triphosphate diphosphohydrolases (NTPD2 and 3) together with NPP1.
Alkaline phosphatase activity is restricted to the proximal nephron, remote from 
these sites of PPi generation, transport and function. The physiological
importance of PPi generation and transport in preventing idiopathic calcium renal
stone disease and nephrocalcinosis now needs to be established.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 17911353 [PubMed - indexed for MEDLINE]

218: Int Urol Nephrol. 2008;40(2):263-7.

Supracostal access for percutaneous nephrolithotomy: less morbid, more effective.

Sukumar S, Nair B, Ginil KP, Sanjeevan KV, Sanjay BH.

Department of Urology, Amrita Institute of Medical Sciences and Research Centre, 
Kochi, Kerala 682 026, India. sukumarsudhi@aims.amrita.edu

OBJECTIVES: The aim of this research was to study the success and morbidity of
supracostal access for percutaneous nephrolithotomy (PCNL), as it is often
avoided for fear of complications. MATERIALS AND METHODS: Between July 2000 and
May 2007, 565 patients underwent PCNL, of whom 110 had a supracostal access. All 
procedures were performed in a single sitting under general anesthesia. Data were
analyzed prospectively for indications, stone clearance rates, and preoperative
and postoperative complications. RESULTS: Indications for supracostal access
included large pelvic stones in 39 patients, partial or complete staghorn stones 
in 32, calyceal stones with major stone bulk above the level of 12th rib in 35,
and upper ureteric stones in four. Patients' ages ranged between 13 and 71 years 
(mean 44.2 years). Fifty-six cases were left sided and 54 right sided, whereas
103 (93.6%) were radiopaque stones. All tracts were in the 11th intercostal
space, though one had an additional tract in the tenth space. Single-tract access
was used in 101 cases (91.8%), but nine (8.2%) required a second tract. Overall
stone clearance rate with PCNL monotherapy was 86.4%, and this increased to 97.3%
with secondary procedures. Overall complication rate was 11.8% and included
hydrothorax/hemothorax in ten, perinephric collection in one, infection/sepsis in
two, and excessive bleeding in two. Postoperative hospital stay ranged from 2 to 
15 days. CONCLUSIONS: The supracostal approach gives high stone clearance rates
with acceptable morbidity rates and should be attempted in selected cases.
Complications when present may be managed easily with conservative measures.

PMID: 17899435 [PubMed - indexed for MEDLINE]

219: Urol Res. 2007 Dec;35(6):287-93. Epub 2007 Sep 26.

Morphology of crystals in calcium oxalate monohydrate kidney stones.

Sandersius S, Rez P.

Department of Physics, Arizona State University, Tempe, AZ, 85287-1504, USA.

Both scanning electron microscopy and atomic force microscopy (AFM) have shown
that calcium oxalate monohydrate kidney stones are made up from arrangements of
sub micron crystals. The purpose of this investigation was to determine the
morphology of these crystals which was obscured by the presence of organic matrix
in our earlier study. Sections of stones were treated to remove the protein
component of the matrix and then imaged using AFM. Images obtained after
proteolysis show that the crystals are in the form of plates stacked on (100)
surfaces. These results were confirmed by scanning electron microscopy
observations from selected regions of calcium oxalate kidney stone surfaces. The 
observed crystal sizes are consistent with both the known matrix mass fraction
and crystallite growth in the passage through the collecting duct.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17899050 [PubMed - indexed for MEDLINE]

220: Am J Physiol Renal Physiol. 2007 Dec;293(6):F1935-43. Epub 2007 Sep 26.

Renal calcinosis and stone formation in mice lacking osteopontin, Tamm-Horsfall
protein, or both.

Mo L, Liaw L, Evan AP, Sommer AJ, Lieske JC, Wu XR.

Dept. of Urology, New York Univ. School of Medicine, Veterans Affairs Medical
Center in Manhattan, 423 E23 St., Rm. 18064S, New York, NY 10010, USA.
xue-ru.wu@med.nyu.edu

Although often supersaturated with mineral salts such as calcium phosphate and
calcium oxalate, normal urine possesses an innate ability to keep them from
forming harmful crystals. This inhibitory activity has been attributed to the
presence of urinary macromolecules, although controversies abound regarding their
role, or lack thereof, in preventing renal mineralization. Here, we show that 10%
of the mice lacking osteopontin (OPN) and 14.3% of the mice lacking Tamm-Horsfall
protein (THP) spontaneously form interstitial deposits of calcium phosphate
within the renal papillae, events never seen in wild-type mice. Lack of both
proteins causes renal crystallization in 39.3% of the double-null mice.
Urinalysis revealed elevated concentrations of urine phosphorus and brushite
(calcium phosphate) supersaturation in THP-null and OPN/THP-double null mice,
suggesting that impaired phosphorus handling may be linked to interstitial
papillary calcinosis in THP- but not in OPN-null mice. In contrast,
experimentally induced hyperoxaluria provokes widespread intratubular calcium
oxalate crystallization and stone formation in OPN/THP-double null mice, while
completely sparing the wild-type controls. Whole urine from OPN-, THP-, or
double-null mice all possessed a dramatically reduced ability to inhibit the
adhesion of calcium oxalate monohydrate crystals to renal epithelial cells. These
data establish OPN and THP as powerful and functionally synergistic inhibitors of
calcium phosphate and calcium oxalate crystallization in vivo and suggest that
defects in either molecule may contribute to renal calcinosis and stone
formation, an exceedingly common condition that afflicts up to 12% males and 5%
females.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17898038 [PubMed - indexed for MEDLINE]

221: Urol Int. 2007;79 Suppl 1:16-9.

Stone composition: where do we stand?

Saita A, Bonaccorsi A, Motta M.

Department of Urology, University of Catania, Catania, Italy.

Kidney stones are a common disorder of the urinary tract. Nephrolithiasis is a
morbid and expensive disease. The prevalence and incidence are estimated at 5-10%
and 100-300/100,000/year, respectively. Relapses occur in 50-70% of all cases.
For these reasons, prevention of stone formation is of great importance. Knowing 
the composition of the calculus is thus fundamental for a more complete
evaluation of the metabolic study. The nature of the calculus in fact helps the
physician to find a convenient metaphylaxis consisting of both sanitary and
therapeutic measures. Study of the composition of urinary stones remains one of
the most interesting aspects of the lithiasic pathology today. Presently
crystallographic examination constitutes one of the most precise and less
expensive methodologies to identify the nature of the concretion. This method
also allows the urologist to catalogue the typology of the lithiasis during
endoscopy. Copyright 2007 S. Karger AG, Basel.

Publication Types: 
    Review

PMID: 17726347 [PubMed - indexed for MEDLINE]

222: ScientificWorldJournal. 2007 Sep 17;7:1563-6.

Perirenal hematomas induced by extracorporeal shock wave lithotripsy (ESWL).
Therapeutic management.

Labanaris AP, Kühn R, Schott GE, Zugor V.

Department of Urology, Martha Maria Medical Center, Academic Hospital of Erlangen
University, Nurnberg, Germany. labanaris@web.de

Extracorporeal shock wave lithotripsy (ESWL) is nowadays accepted as the
treatment of choice for the majority of patients with renal or proximal ureteral 
calculi. Although, a relatively noninvasive modality with low morbidity, minor or
major complications can be noted. A relative severe complication for the patient 
and confusing for the treating physician is the perirenal hematoma. With review
the literature and an example of perirenal hematoma induced by ESWL in a patient 
treated in our department, we describe its therapeutic management.

Publication Types: 
    Case Reports
    Review

PMID: 17891316 [PubMed - indexed for MEDLINE]

223: Expert Opin Drug Saf. 2007 Sep;6(5):547-57.

Increased propensity for calcium phosphate kidney stones with topiramate use.

Vega D, Maalouf NM, Sakhaee K.

University of Texas Southwestern Medical Center, Department of Internal Medicine 
and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research,
5323 Harry Hines Boulevard, Dallas, TX 75390-8885, USA.

Topiramate (TPM) is a neuromodulatory agent that was initially approved as an
antiepileptic drug and is increasingly used in the treatment of a number of
neurological and metabolic disorders. Among its various pharmacological actions, 
TPM has been shown to inhibit the activity of specific carbonic anhydrase enzymes
in the kidney. This action is associated with the development of metabolic
acidosis, hypocitraturia, hypercalciuria and elevated urine pH, leading to an
increased risk of kidney stone disease. Despite the cautionary note in the
package insert of TPM, the extent of these complications has not been fully
explored. Few prescribing physicians are aware of these complications,
underscoring the need for improved surveillance. Because the drug is among the
most frequently prescribed agents in the US, more controlled studies are required
to determine the prevalence of kidney stone disease among TPM users, and the
optimal approach to prevent and treat nephrolithiasis in these individuals.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 17877442 [PubMed - indexed for MEDLINE]

224: Urol Res. 2007 Dec;35(6):313-7. Epub 2007 Sep 15.

Diagnostic value of colour Doppler twinkling artefact in sites negative for
stones on B mode renal sonography.

Turrin A, Minola P, Costa F, Cerati L, Andrulli S, Trinchieri A.

Department of Radiology, Lecco Hospital, Lecco, Italy.
turrin.be@ospedale.lecco.it

The aim of the study was to investigate the diagnostic value of the colour
Doppler twinkling artefact (TA) in renal stone disease. To enhance the evidence
of TA, a preliminary in vitro study was performed to optimise the setting of
colour Doppler sonography. In the in vitro study, an oxen kidney was examined
using an high-frequency (12.5 MHz) linear array probe in a water bath before and 
after the inoculation of an aliquot of powder obtained by fragmentation of a
calcium oxalate stone. In the clinical study, 67 patients with diagnosis of
urinary stone based on B-mode sonography and 67 matched control subjects were
examined with colour Doppler sonography using a low-frequency (2.5 MHz)
curvilinear phased array probe. In vitro, the injection of calcium oxalate powder
in a bovine kidney sample induced the appearance of spots without any back
shadowing appearance on B mode but with a large number of TA on colour Doppler.
In vivo, TA was much more frequent in patients with stone disease (95.5%)
compared to controls (9.0%) (P < 0.001). TA was highly associated to renal stone 
disease and was also present in renal areas where a stone was undetected with B
mode approach suggesting its diagnostic role although further studies are needed 
to confirm its accuracy. The type of instrumentation and its setting is crucial
to obtain reproducible results.

Publication Types: 
    Clinical Trial

PMID: 17874239 [PubMed - indexed for MEDLINE]

225: Ann N Y Acad Sci. 2007 Nov;1116:461-84. Epub 2007 Sep 13.

Genetics of hypercalciuric nephrolithiasis: renal stone disease.

Stechman MJ, Loh NY, Thakker RV.

Academic Endocrine Unit, Nuffield Department of Clinical Medicine, Oxford Centre 
for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington,
Oxford, UK.

Renal stone disease (nephrolithiasis) affects 5% of adults and is often
associated with hypercalciuria. Hypercalciuric nephrolithiasis is a familial
disorder in more than 35% of patients, and may occur as a monogenic disorder, or 
as a polygenic trait involving 3 to 5 susceptibility loci in man and rat,
respectively. Studies of monogenic forms of hypercalciuric nephrolithiasis in
man, for example, Bartter syndrome, Dent's disease, autosomal dominant
hypocalcemic hypercalciuria (ADHH), hypercalciuric nephrolithiasis with
hypophosphatemia, and familial hypomagnesemia with hypercalciuria have helped to 
identify a number of transporters, channels, and receptors that are involved in
regulating the renal tubular reabsorption of calcium. Thus, Bartter syndrome, an 
autosomal recessive disease, is caused by mutations of the bumetanide-sensitive
Na-K-Cl (NKCC2) cotransporter, the renal outer-medullary potassium channel
(ROMK), the voltage-gated chloride channel, CLC-Kb, or in its beta subunit,
Barttin. Dent's disease, an X-linked disorder characterized by low molecular
weight proteinuria, hypercalciuria, and nephrolithiasis, is due to mutations of
the chloride/proton antiporter, CLC-5; ADHH is associated with activating
mutations of the calcium-sensing receptor, which is a G protein-coupled receptor;
hypophosphatemic hypercalciuric nephrolithiasis associated with rickets is due to
mutations in the type 2c sodium-phosphate cotransporter (NPT2c); and familial
hypomagnesemia with hypercalciuria is due to mutations of paracellin-1, which is 
a member of the claudin family of membrane proteins that form the intercellular
tight junction barrier in a variety of epithelia. These studies have provided
valuable insights into the renal tubular pathways that regulate calcium
reabsorption and predispose to kidney stones and bone disease.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 17872384 [PubMed - indexed for MEDLINE]

226: J Urol. 2007 Nov;178(5):2124-7. Epub 2007 Sep 17.

Extraosseous bone formation in the renal pelvis.

Samad L, Arif M, Zaidi Z.

Kidney Center Postgraduate Training Institute, Karachi, Pakistan.

PURPOSE: We evaluated the frequency and features of extraosseous bone formation
in the kidneys of patients undergoing percutaneous nephrolithotomy. MATERIALS AND
METHODS: Percutaneous nephrolithotomy was performed in 621 patients at our
institution between 1997 and 2006. In 21 cases metaplastic bone arising from the 
urothelium was observed. Clinical, radiographic and histopathological features of
this group were studied in detail. RESULTS: Patient age ranged from 7 to 40 years
(median 11). Extraosseous bone formation was identified in 7 right (33%) and 14
left (67%) kidneys. In all cases extraosseous bone was identified at the angle of
the pelvis and ureter, just proximal to the ureteropelvic junction. The typical
radiographic appearance of a radiopaque eccentric halo surrounding an area of
lesser radiological density connected with the urothelium was seen in 10 of 13
radiographs (77%). Histopathological evaluation showed well formed trabecular
bone with surface osteoblastic activity, areas of intratrabecular adipose bone
marrow and hematopoietic cells in 5 cases (24%); woven bone intimately related to
trabecular bone with scattered hematopoietic cells in 14 (67%); and entirely
woven bone with associated mineral deposits and prominent fibroblastic
proliferation in 2 (10%). CONCLUSIONS: Although rarely reported in the
literature, metaplastic bone formation in the renal pelvis was seen relatively
frequently in our patient population. The pathogenesis of this phenomenon is not 
clearly understood. Recognition of extraosseous bone is important, since it has
implications for management and prognosis. In-depth studies of this phenomenon
are required to arrive at any conclusions regarding its etiology.

PMID: 17870125 [PubMed - indexed for MEDLINE]

227: J Urol. 2007 Nov;178(5):2128-31; discussion 2131. Epub 2007 Sep 17.

Is ureteroscopy first line treatment for pediatric stone disease?

Smaldone MC, Cannon GM Jr, Wu HY, Bassett J, Polsky EG, Bellinger MF, Docimo SG, 
Schneck FX.

Division of Pediatric Urology, Children's Hospital of Pittsburgh, Pittsburgh,
Pennsylvania 15213-3232, USA. smaldonemc@upmc.edu

PURPOSE: We report our current outcomes for ureteroscopic management of pediatric
stone disease. MATERIALS AND METHODS: We carried out a retrospective review of
all ureteroscopic procedures for kidney or ureteral calculi performed between
2001 and 2005. Stone location and size, preoperative and postoperative stenting, 
intraoperative dilation, use of ureteral access sheath, stone-free rates and
complications were noted. RESULTS: A total of 100 patients (58% female, mean age 
13.2 years) underwent 115 procedures. Stones were located in the renal pelvis in 
6% of patients, upper pole in 10%, mid ureter in 11%, lower pole in 17%, proximal
ureter in 19% and distal ureter in 37%. Mean stone size was 8.3 mm (median 7.0), 
with a mean of 1.5 stones per patient. Preoperative stenting was used in 54% of
patients, and a stent was placed postoperatively in 76%. Ureteral coaxial
dilators and ureteral access sheaths were used in 70% and 24% of patients,
respectively. There were no major intraoperative complications, although 5
patients required stent placement for ureteral perforation or extravasation. One 
patient had a ureteral stricture requiring ureteral reimplantation. Mean followup
was 10.1 months (median 2.6). Stone-free rate was 91% on followup ultrasound,
abdominal radiography or computerized tomography. Seven patients required staged 
ureteroscopic procedures to achieve stone-free status. While the number of
percutaneous nephrolithotomy and shock wave lithotripsy cases remained stable,
the number of ureteroscopic cases increased 7-fold during this period.
CONCLUSIONS: Improved ureteroscopic access to stones throughout the pediatric
urinary tract and stone-free rates that are comparable to the adult population
have led to the adoption of ureteroscopy as first line therapy in children at our
institution.

PMID: 17870124 [PubMed - indexed for MEDLINE]

228: J Clin Anesth. 2007 Aug;19(5):351-5.

Anesthetic considerations during percutaneous nephrolithotomy.

Rozentsveig V, Neulander AZ, Roussabrov E, Schwartz A, Lismer L, Gurevich B,
Klein Y, Weksler N.

Division of Anesthesiology, Department of Urology, Soroka University Medical
Center and Faculty of Health Sciences, Ben-Gurion University of the Negev,
Beer-Sheva 84101, Israel. amaliaro@012.net.il

STUDY OBJECTIVE: To assess anesthesia-related complications during and following 
percutaneous nephrolithotomy (PCNL) for staghorn stones. DESIGN: Prospective
study and a detailed case report. SETTING: Medical center in southern Israel.
PATIENTS: 20 consecutive patients undergoing PCNL for staghorn stones.
INTERVENTIONS: All patients underwent PCNL during general anesthesia.
MEASUREMENTS: Duration of surgery, esophageal temperature, hemoglobin (Hb)
concentration, and requirements for blood transfusion, mean volume of irrigation 
fluid, and serum sodium and potassium concentration were recorded. MAIN RESULTS: 
Mean age was 50.7 +/- 14.9 y (range, 26-76 y). Mean duration of the procedure was
120.0 +/- 42.5 min (range, 75-240 min). Mean volume of irrigation fluid was 34.1 
+/- 15.3 L (range, 18-80 L). There was a significant decrease in Hb concentration
from 13.7 +/- 1.71 to 12.2 +/- 1.4 g/dL, but no patient required blood
transfusion. There was a statistically significant reduction in esophageal
temperature from 36.4 degrees C +/- 0.32 degrees C to 35.2 degrees C +/- 0.5
degrees C. There were no significant changes in sodium or potassium concentration
before or after PCNL. CONCLUSIONS: Anesthesia during PCNL for staghorn stones is 
a challenge because of the possibility of fluid absorption, dilutional anemia,
hypothermia, or significant blood loss.

Publication Types: 
    Case Reports

PMID: 17869985 [PubMed - indexed for MEDLINE]

229: J Endourol. 2007 Aug;21(8):860-1.

Laparoscopic pyelolithotomy: indications and technique.

Kramer BA, Hammond L, Schwartz BF.

Division of Urology, Southern Illinois University School of Medicine,
Springfield, Illinois 62794-9665, USA.

BACKGROUND AND PURPOSE: Laparoscopic pyelolithotomy, although uncommonly
performed, may be considered in patients who have renal anomalies, are poorly
compliant, and have a large single renal-pelvic calculus. We present our
experience with this procedure in five patients. PATIENTS AND METHODS: Three
patients underwent laparoscopic pyelolithotomy because of a horseshoe kidney, one
for a pelvic kidney, and one for a large renal-pelvic calculus. All stones were
solitary with a mean size of 2280 mm2 (range 540-8200 mm2). All were approached
transperitoneally with passage of a flexible cystoscope through a laparoscopic
port to aid in stone extraction. RESULTS: All cases were completed
laparoscopically. The length of surgery was 74, 92, 134, 158, and 159 minutes.
There were no minor or major complications, and the estimated blood loss was <50 
mL in all cases. All patients were discharged on postoperative day 1 with the
drains removed. Four patients were stented for 4 to 6 weeks. The remaining
patient was not stented because of poor compliance. The stents were removed with 
office cystoscopy. All patients were stone free on follow-up imaging.
CONCLUSIONS: Laparoscopic pyelolithotomy can be done safely, effectively, and
efficiently with proper patient selection and adherence to standard laparoscopic 
surgical principles.

Publication Types: 
    Clinical Trial

PMID: 17867941 [PubMed - indexed for MEDLINE]

230: Scand J Urol Nephrol. 2007;41(5):414-8. Epub 2007 Jun 6.

Artificial neural networks for assessing the risk factors for urinary calcium
stones according to gender and family history of stone.

Dussol B, Verdier JM, Goff JM, Berthezene P, Berland Y.

Centre de Néphrologie et de Transplantation Rénale, Hôpital de la Conception,
Marseille, France. bdussol@ap-hm.fr

OBJECTIVE: In a previous work, we evidenced that artificial neural networks
(ANNs) were more informative than classical statistical analyses for assessing
the risk of idiopathic calcium nephrolithiasis in male stone-formers. MATERIAL
AND METHODS: We compared risk factors for idiopathic calcium nephrolithiasis
(age, body mass index, calcemia, calcium oxalate supersaturation, and 24-h
calciuria, oxaluria, uricosuria, citraturia, urea, and sodium) in four
populations: men and women with and without a family history of stone (FHS). A
total of 119 males (58 with an FHS, 61 without) and 59 females (30 with an FHS,
29 without) were compared to healthy controls. For each variable, receiver
operating characteristic (ROC) curve indices were calculated by means of ANNs.
RESULTS: In men without an FHS, the most discriminant variables were 24-h urea
(ROC curve index 0.76), supersaturation (ROC curve index 0.72), 24-h calciuria
(ROC curve index 0.68), 24-h uricosuria (ROC curve index 0.64), 24-h oxaluria
(ROC curve index 0.63), 24-h sodium (ROC curve index 0.62), and calcemia (ROC
curve index 0.60). In men with an FHS, only supersaturation (ROC curve index
0.67) was discriminant. In women without FHS, calcemia (ROC curve index 0.67),
24-h calciuria (ROC curve index 0.64), and 24-h uricosuria (ROC curve index 0.62)
were discriminant. In women with an FHS, supersaturation (ROC curve index 0.70), 
24-h uricosuria (ROC curve index 0.69), 24-h urea (ROC curve index 0.68), and
24-h calciuria (ROC curve index 0.67) were discriminant. CONCLUSIONS: Risk
factors for idiopathic calcium nephrolithiasis were roughly the same in men with 
or without an FHS, and in women with an FHS. In these patients, calcium oxalate
supersaturation and 24-h urea were the most discriminant factors. Conversely, in 
women without an FHS, calcium abnormalities (calcemia, 24-h calciuria) were
discriminant and should prompt a search for infraclinical primary
hyperparathyroidism or sarcoidosis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17853052 [PubMed - indexed for MEDLINE]

231: Scand J Urol Nephrol. 2008;42(2):143-7.

Lornoxicam in extracorporeal shock-wave lithotripsy; comparison with tenoxicam
and placebo in terms of analgesic consumption.

Bilir A, Gulec S, Turgut M, Cetinkaya D, Erkan A, Kurt I.

Departments of Anaesthesiology and Reanimation, Osmangazi University Medical
Faculty, Eskisehir, Turkey. aytbilir@yahoo.com

OBJECTIVE: To assess the analgesic efficacy of lornoxicam and compare it with
that of tenoxicam in patients undergoing extracorporeal shock-wave lithotripsy
(ESWL) for renal stones. MATERIAL AND METHODS: The study was carried out in a
randomized, double-blind fashion and involved 60 patients (American Society of
Anesthesiologists physical status I-II) undergoing ESWL who were divided into
three groups. Patients in the placebo group (n = 20) received saline and those in
the lornoxicam group (n = 20) received lornoxicam 8 mg intravenously 60 min
before the procedure. In the tenoxicam group, patients (n = 20) received
tenoxicam 20 mg intravenously at the same time point. All patients were started
on patient-controlled i.v. meperidine analgesia during the procedure. The
effectiveness was assessed by using a visual analog scale (VAS) and by
calculating the total analgesic consumption of meperidine during the procedure.
Arterial blood pressure, oxygen saturation, and respiratory rate were recorded
throughout the procedure; nausea and vomiting, agitation, and respiratory
depression were assessed. RESULTS: Compared with patients in the placebo group,
patients in the lornoxicam and tenoxicam groups received smaller doses of
meperidine at all time points (p < 0.05). After 30, 45, and 60 min of ESWL,
patients in the lornoxicam group required significantly smaller doses of
meperidine than those in the tenoxicam group (p < 0.05). Patients in the placebo 
group showed higher VAS scores than those in the lornoxicam and tenoxicam groups 
at 15, 30 and 60 min. The VAS score in the lornoxicam group was lower than that
in the tenoxicam group at 15, 30, and 45 min, but the difference between the
groups was statistically significant only at 45 min (1 and 3, respectively; p <
0.05). CONCLUSION: In patients undergoing ESWL the i.v. administration of a
single dose of 8 mg lornoxicam provides significantly better pain control
compared with tenoxicam 20 mg and placebo, without increasing adverse
side-effects.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 17853036 [PubMed - indexed for MEDLINE]

232: Scand J Urol Nephrol. 2008;42(2):158-63.

Irrigation with isoproterenol during ureterorenoscopy causes no systemic
side-effects.

Jung HU, Jakobsen JS, Frimodt-Moeller PC, Osther PJ.

Department of Urology, Fredericia Hospitals, Fredericia, Denmark.
helene.jung@ki.au.dk

OBJECTIVE: Ureterorenoscopy causes complications that may be related to high
intrarenal pressures generated during irrigation. Endoluminal isoproterenol
administration has been shown to reduce pelvic pressure in pigs. The objective of
this study was to investigate possible systemic side-effects of isoproterenol
irrigation during ureterorenoscopy in humans. MATERIAL AND METHODS: Seven
patients undergoing ureterorenoscopy due to renal stone disease were included. A 
5-Fr catheter was retrogradely placed in the renal pelvis for pressure
measurements. Prior to irrigation with isoproterenol (0.1 microg/ml),
ureterorenoscopy was performed with saline irrigation. Renal pelvic pressure,
blood pressure and heart rate were measured before and after isoproterenol
irrigation. Venous blood was drawn for isoproterenol measurements. RESULTS:
Endoluminal isoproterenol irrigation produced no changes in mean heart rate (HR) 
or mean arterial pressure (MAP). MAP (+/- SEM) was 56 (2.7) mmHg during saline
irrigation and 58 (+/- 2.4) mmHg during isoproterenol irrigation. HR was 60 (+/- 
4) beats/min before and 61 (+/- 4) beats/min during isoproterenol irrigation.
Neither the difference in MAP = 0.10) nor the difference in HR (p = 0.23) were
significant. Pelvic pressure was significantly lower during isoproterenol
irrigation [19 (+/- 3) mmHg] compared to saline irrigation [35 (+/- 2.6) mmHg] (p
= 0.0006). Pelvic pressure reached very high levels (> 300 mmHg), especially
during injection of contrast medium. CONCLUSION: Endoluminal isoproterenol
irrigation during ureterorenoscopy causes no cardiovascular side-effects and the 
drug may reduce renal pelvic pressure.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17853007 [PubMed - indexed for MEDLINE]

233: Urol Int. 2007;79(2):124-8.

Clinical predictors of stone fragmentation using slow-rate shock wave
lithotripsy.

Li WM, Wu WJ, Chou YH, Liu CC, Wang CJ, Huang CH, Lee YC.

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

AIM: To determine efficacy and clinical predictors of stone fragmentation when
using slow-rate shock wave lithotripsy (SWL). PATIENTS AND METHODS: In total, 116
patients with radiopaque urinary tract stones were randomized into two groups: 57
patients were treated with SWL at 90 shocks/min, and 59 patients were treated
with SWL at 120 shocks/min. The efficacy of SWL was evaluated within 1 month
after treatment. Patient characteristics, features of stones, and SWL conditions 
were reviewed. Success rates relating to individual parameters were assessed by
using chi-square and Student t tests. All factors were further entered into
multivariate logistic regression analysis. RESULTS: There were no statistically
significant differences between the two groups with regard to age, sex, site and 
size of the stones, renal function, and total number of shock waves. In
univariate analysis, the success rate was significantly related to shock wave
frequency (p = 0.023), length and width of the stones (p < 0.001), total number
of shock waves (p = 0.047), and age (p = 0.049). In multivariate analysis,
however, only shock wave rate and stone length remained statistically significant
(p = 0.021 and p = 0.046, respectively). The overall success rate was
significantly higher in the group treated with 90 shocks/min (p = 0.02). However,
this higher success rate was statistically significant only in patients with a
stone length > or = 10 mm (50.0 vs. 18.5%, p = 0.019). CONCLUSION: SWL at 90
shocks/min yielded better outcomes than SWL at 120 shocks/min, particularly in
patients with stone lengths > or = 10 mm. 2007 S. Karger AG, Basel

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 17851280 [PubMed - indexed for MEDLINE]

234: BJU Int. 2007 Dec;100(6):1356-60. Epub 2007 Sep 11.

Comment in:
    BJU Int. 2008 Mar;101(5):644.    Nat Clin Pract Urol. 2008 Jun;5(6):300-1.

Outcomes using a fourth-generation lithotripter: a new benchmark for comparison?

Nomikos MS, Sowter SJ, Tolley DA.

Department of Urology, The Scottish Lithotriptor Centre, Western General
Hospital, Edinburgh, UK.

OBJECTIVE: To evaluate the efficacy of a fourth-generation lithotripter, the
Sonolith Vision (Technomed Medical Systems, Vaulx-en-Velin, France) for treating 
single previously untreated renal calculi, and to compare the results with the
reference standard HM-3 (Dornier MedTech Europe GmbH, Wessling, Germany) in the
same population originally studied by the USA Cooperative Study Group in 1986.
PATIENTS AND METHODS: The Sonolith Vision uses an innovative electroconductive
shock-wave generator with an elliptical reflector specially designed to give the 
maximum concentration of energy on the stone. We reviewed the treatment sessions 
from our prospectively maintained database of the first 1000 consecutive patients
with urinary stone disease who were treated with the Sonolith Vision between
September 2004 and March 2006. Patients with previously untreated solitary renal 
calculi in anatomically normal kidneys were included. The outcome was assessed by
plain films for radio-opaque stones, and renal ultrasonography for radiolucent
stones, at 1 and 3 months after lithotripsy; the results were analysed according 
to stone size and location. RESULTS: Data from 309 patients who had a complete
follow-up and with 373 renal calculi that matched the above criteria were
analysed. The initial fragmentation rate was 94%. The stone-free rate for stones 
of <10 mm was 77%, for 11-20 mm was 69% and for >20 mm was 50%. The overall
stone-free rate 3 months after lithotripsy was 75%. Within a month of
lithotripsy, 221 patients (59%) became stone-free. Additional procedures to
render patients stone-free after lithotripsy were needed in only 22 cases (7%).
The overall efficiency quotient was 62%. The stone-free rates for lower, upper,
middle calyceal and renal pelvic calculi were 74%, 70%, 78.5% and 75%,
respectively. There were no serious complications. CONCLUSIONS: When similar
populations of stone formers were assessed the Sonolith Vision achieved a high
success rate, comparable with that using the HM-3 machine but with lower
analgesia requirements and very low re-treatment rates. This method of comparison
belies the commonly held view that newer lithotripters are less effective than
the original spark-gap machines.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 17850387 [PubMed - indexed for MEDLINE]

235: Urology. 2007 Aug;70(2):242-5; discussion 245.

Simple trigonometry on computed tomography helps in planning renal access.

Bilen CY, Koçak B, Kitirci G, Danaci M, Sarikaya S.

Department of Urology, Hacettepe Universitesi Tip Fakültesi, Ankara, Turkey.
cybilen@yahoo.com

OBJECTIVES: To retrospectively assess the usefulness of the measurements on
preoperative computed tomography (CT) of patients with urinary stone disease for 
planning the access site using vertical angulation of the C-arm. METHODS: Of the 
patients who underwent percutaneous nephrolithotomy from November 2001 to October
2006, 41 patients with superior calix access had undergone preoperative CT. The
depth of the target stone (y) and the vertical distance from that point to the
first rib free slice (x) were measured on CT. The limit of the ratio of x over y 
was accepted as 0.58, with ratios below that indicating that infracostal access
could be achieved by vertical angulation of the C-arm. RESULTS: We achieved an
approach to the superior calix through an infracostal access in 28 patients. The 
preoperative trigonometric study on CT predicted 24 of them. The stone-free rate 
was 92.6%, and no chest-related complications developed. CONCLUSIONS: Simple
trigonometry on CT of the patients with complex stones could help endourologists 
in planning renal access.

PMID: 17826479 [PubMed - indexed for MEDLINE]

236: Urol Res. 2007 Oct;35(5):225-30. Epub 2007 Sep 5.

Pre- and perioperative predictors of short-term clinical outcomes in patients
undergoing percutaneous nephrolitholapaxy.

Olbert PJ, Hegele A, Schrader AJ, Scherag A, Hofmann R.

Department of Urology and Pediatric Urology, Philipps-University Medical School, 
Baldingerstr, 35043 Marburg, Germany. peter.olbert@med.uni-marburg.de

Percutaneous nephrolitholapaxy (PCNL) with modern stone disintegration
technologies is the treatment of choice for patients with extensive stone burden 
or stones refractory to extracorporeal shock wave lithotripsy. However, little is
known about factors predicting unfavourable outcome in terms of perioperative
complications, residual stone burden or prolonged hospitalization. The aim of
this study was to evaluate preoperative, patient- and stone-related parameters
that might influence the perioperative course and short-term clinical outcomes.
In a prospective study, age, sex, body mass index (BMI), bidimensional size,
side, pre-existent urinary tract infection, pre-existent hydronephrosis and
previous kidney surgery were used as independent variables in both univariate and
multiple regression models in 109 PCNL patients in order to predict the partition
of patients rendered stone free at hospital discharge, duration of surgery,
length of inpatient hospital stay and the occurrence of major complications.
Univariate and multiple regression analysis revealed that stone size was the only
factor influencing duration of surgery (P < 0.001) and hospitalization (P =
0.02), but had no predictive potential for major complications. Univariate
analysis showed a trend towards longer inpatient hospital stay and clinically
relevant residuals in patients with lower BMI (P = 0.05 and 0.06); however, after
controlling for the other confounding variables, this was only reproducible for
residual stone burden. The other patient- and stone-related factors did not
adversely affect the outcome measures. In our patient sample treated with PCNL by
LithoClast Master/Ultra we found evidence that large stone burden is a prognostic
factor predicting longer surgery and prolonged hospitalization. In addition,
patients with lower BMIs might be at higher risk of not being stone free at
hospital discharge accompanied by prolonged inpatient treatment.

PMID: 17786419 [PubMed - indexed for MEDLINE]

237: JSLS. 2007 Apr-Jun;11(2):258-60.

Laparoscopic transmesocolic pyelolithotomy in an ectopic pelvic kidney.

Gupta NP, Yadav R, Singh A.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
narmadagupta@hotmail.com

Management of large calculi in ectopic pelvic kidneys poses a challenge to the
urologist. Risk of injury to surrounding abdominal viscera and vasculature makes 
open surgery as well as percutaneous nephrostolithotomy in an ectopic kidney a
challenging procedure. Laparoscopic management avoids open surgery and associated
morbidity and offers added safety. We report the management of symptomatic stones
in a pelvic ectopic kidney lying anterior to the L5 vertebra and sacrum by
transmesocolic laparoscopic pyelolithotomy in an 11-year-old child. Complete
stone clearance was achieved with no complications and an uneventful
postoperative recovery. The patient was discharged 72 hours after the surgery.

Publication Types: 
    Case Reports

PMID: 17761093 [PubMed - indexed for MEDLINE]

238: Anat Rec (Hoboken). 2007 Oct;290(10):1315-23.

Mechanism of formation of human calcium oxalate renal stones on Randall's plaque.

Evan AP, Coe FL, Lingeman JE, Shao Y, Sommer AJ, Bledsoe SB, Anderson JC,
Worcester EM.

Department of Anatomy and Cell Biology, Indiana University, School of Medicine,
Indianapolis, Indiana 46223, USA. evan@anatomy.iupui.edu

Although calcium oxalate (CaOx) renal stones are known to grow attached to renal 
papillae, and specifically to regions of papillae that contain Randall's plaque
(interstitial apatite deposits), the mechanisms of stone overgrowth on plaque are
not known. To investigate the problem, we have obtained biopsy specimens from two
stone patients that included an attached stone along with its tissue base and
have studied the ultrastructural features of the attachment point using light and
transmission electron microscopy, Fourier transform infrared spectroscopy
(mu-FTIR), and immunohistochemical analysis. The epithelium is disrupted at the
attachment site. The denuded plaque that borders on the urinary space attracts an
envelope of ribbon-like laminates of crystal and organic matrix arising from
urine ions and molecules. Into the matrix of this ribbon grow amorphous apatite
crystals that merge with and give way to the usual small apatite crystals
imbedded in stone matrix; eventually CaOx crystals admix with apatite and become 
the predominant solid phase. Over time, urine calcium and oxalate ions gradually 
overgrow on the large crystals forming the attached stone. (c) 2007 Wiley-Liss,
Inc.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17724713 [PubMed - indexed for MEDLINE]

239: Rocz Panstw Zakl Hig. 2007;58(1):61-7.

Tea and coffee as the main sources of oxalate in diets of patients with kidney
oxalate stones.

Gasińska A, Gajewska D.

Department of Dietetics, Warsaw Agricultural University, 02-776 Warsaw.
azorro@interia.pl

We analyzed nutritional habits of 22 stone formers with special regard to oxalate
content as one of the main nutritional lithogenic factors associated with kidney 
stones. Daily dietary oxalate intake was 354 +/- 261 mg and 406 +/- 265 mg in men
and women respectively. These values were much higher than those found by other
researches. The main sources of oxalate in diets were regular tea and coffee
(80-85%). Only 15-20% of oxalate was derived from other plant foods. Patients did
not adhere to high fluid diet and, what is more, as common beverage they chose
rich-oxalate black tea. Patients' daily intake of calcium was low and didn't
exceed 520 mg. Vitamin C consumption was higher than Polish Dietary Reference
Intake (DRI) and vitamin B6 lower than DRI. In the management of stone patients, 
to lower the risk of recurrence, appropriate diet (according to the type of
stone) should be provided by dietitian.

PMID: 17711092 [PubMed - indexed for MEDLINE]

240: J Bone Miner Res. 2007 Dec;22(12):1893-902.

Aromatase deficiency causes altered expression of molecules critical for calcium 
reabsorption in the kidneys of female mice *.

Oz OK, Hajibeigi A, Howard K, Cummins CL, van Abel M, Bindels RJ, Word RA, Kuro-o
M, Pak CY, Zerwekh JE.

Department of Radiology, University of Texas Southwestern Medical Center, Dallas,
TX 75390-9153, USA. Orhan.Oz@UTSouthwestern.edu

Kidney stones increase after menopause, suggesting a role for estrogen
deficiency. ArKO mice have hypercalciuria and lower levels of calcium transport
proteins, whereas levels of the klotho protein are elevated. Thus, estrogen
deficiency is sufficient to cause altered renal calcium handling. INTRODUCTION:
The incidence of renal stones increases in women after menopause, implicating a
possible role for estrogen deficiency. We used the aromatase deficient (ArKO)
mouse, a model of estrogen deficiency, to test the hypothesis that estrogen
deficiency would increase urinary calcium excretion and alter the expression of
molecular regulators of renal calcium reabsorption. MATERIALS AND METHODS: Adult 
female wildtype (WT), ArKO, and estradiol-treated ArKO mice (n = 5-12/group) were
used to measure urinary calcium in the fed and fasting states, relative
expression level of some genes involved in calcium reabsorption in the distal
convoluted tubule by real-time PCR, and protein expression by Western blotting or
immunohistochemistry. Plasma membrane calcium ATPase (PMCA) activity was measured
in kidney membrane preparations. ANOVA was used to test for differences between
groups followed by posthoc analysis with Dunnett's test. RESULTS: Compared with
WT, urinary Ca:Cr ratios were elevated in ArKO mice, renal mRNA levels of
transient receptor potential cation channel vallinoid subfamily member 5 (TRPV5),
TRPV6, calbindin-D28k, the Na+/Ca+ exchanger (NCX1), and the PMCA1b were
significantly decreased, and klotho mRNA and protein levels were elevated.
Estradiol treatment of ArKO mice normalized urinary calcium excretion, renal mRNA
levels of TRPV5, calbindin-D(28k), PMCA1b, and klotho, as well as protein levels 
of calbindin-D28k and Klotho. ArKO mice treated with estradiol had significantly 
greater PMCA activity than either untreated ArKO mice or WT mice. CONCLUSIONS:
Estrogen deficiency caused by aromatase inactivation is sufficient for renal
calcium loss. Changes in estradiol levels are associated with coordinated changes
in expression of many proteins involved in distal tubule calcium reabsorption.
Estradiol seems to act at the genomic level by increasing or decreasing (klotho) 
protein expression and nongenomically by increasing PMCA activity. PMCA, not
NCX1, is likely responsible for extruding calcium in response to in vivo
estradiol hormonal challenge. These data provide potential mechanisms for
regulation of renal calcium handling in response to changes in serum estrogen
levels.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17708714 [PubMed - indexed for MEDLINE]

241: J Endourol. 2007 Jul;21(7):684-7.

Effectiveness of noncontrast computed tomography in evaluation of residual stones
after percutaneous nephrolithotomy.

Park J, Hong B, Park T, Park HK.

Department of Urology, University of Ulsan College of Medicine, Asan Medical
Center, Seoul, Korea.

PURPOSE: We prospectively compared the sensitivity of antegrade pyelography
(AGP), plain film radiography (KUB film), and noncontrast thin-slice abdominal CT
for detecting residual stones after percutaneous nephrolithotomy (PCNL). PATIENTS
AND METHODS: We prospectively evaluated 50 patients (53 renal units) who
underwent PCNL for radiopaque renal pelvic stones with noncontrast abdominal CT 1
month postoperatively. We compared the number and size of residual fragments, as 
determined by immediate postoperative AGP and 1-month KUB film and CT scan.
RESULTS: Stone-free rates according to AGP, KUB film, and noncontrast CT were
73.6% (39/53), 62.3% (33/53), and 20.8% (11/53), respectively. However, if
clinically insignificant residual fragments are included in the success rates,
these rates increased to 84.9% (45/53), 83.0% (44/53), and 41.5% (22/53),
respectively. Of the 22 patients in whom residual stones were detected by CT but 
not by KUB film, 10 (45.5%) had stones >4 mm in diameter on CT, with a mean size 
of 7.4 mm. The sensitivity for the detection of residual fragments was 47.6% for 
KUB films as judged by noncontrast CT. After CT, seven patients received
extracorporeal shockwave lithotripsy for residual stones. CONCLUSIONS:
Noncontrast thin-slice abdominal CT was the most accurate imaging method to
determine the stone-free rate after PCNL. Noncontrast abdominal CT gives accurate
information for selecting patients who may benefit from additional treatment and 
for planning follow-up.

Publication Types: 
    Evaluation Studies

PMID: 17705749 [PubMed - indexed for MEDLINE]

242: Urol J. 2007 Spring;4(2):86-90.

Ethanolic extract of nigella sativa L seeds on ethylene glycol-induced kidney
calculi in rats.

Hadjzadeh MA, Khoei A, Hadjzadeh Z, Parizady M.

Department of Physiology, Ghaem Hospital, Mashhad University of Medical Sciences,
Mashhad, Iran. Ms-hajzadeh@mums.ac.ir

INTRODUCTION: The aim of this study was to investigate the effects of the
ethanolic extract of Nigella sativa L (NS) seeds on kidney calculi in rats.
MATERIALS AND METHODS: Thirty-two Wistar rats were randomly divided into 4
groups: group A received tap drinking water for 30 days (intact control). Groups 
B, C, and D received 1% ethylen glycol for induction of calcium oxalate calculus 
formation. As the preventive, and treatment subjects, rats in groups C and D
received ethanolic extract of NS, 250 mg/kg, in drinking water since day 0 and
day 14, respectively. Urine was collected on days 0, 7, 14, and 30 of the study
period. After 30 days, the kidneys were removed and prepared for histologic
evaluation of calcium oxalate deposits. Urine calcium oxalate concentrations were
determined by atomic absorption. RESULTS: The number of CaOx deposits was
significantly greater in group B (P = .001). Calcium oxalate concentrations in
the urine on days 14 and 30 increased significantly in group B and were higher
than those in group C (P = .006 and P = .002, respectively). Urine oxalate
concentration in group D decreased on day 30 and was lower than that in group B
(P = .04). CONCLUSION: Treatment of rats with ethanolic extract of NS reduced the
number of calcium oxalate deposits in a group of rats that received ethanolic
extract of NS. The NS could also lower the urine concentration of calcium
oxalate. We suggest further studies on the therapeutic and preventive effects of 
the NS on kidney calculus formation in human.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17701927 [PubMed - indexed for MEDLINE]

243: J Emerg Med. 2007 Aug;33(2):127-9. Epub 2007 Jun 5.

Spontaneous rupture of the renal pelvis caused by calculus: a case report.

Koktener A, Unal D, Dilmen G, Koc A.

Department of Radiology, School of Medicine, Fatih University, Ankara, Turkey.

Rupture of the urinary collecting system associated with peripelvic extravasation
of the urine is an unusual condition and commonly associated with obstructing
calculus. We report a patient, recently given chemotherapy due to lymphoma, with 
acute abdomen symptoms. He had a renal pelvis rupture with perirenal
extravasation of urine, an uncommon condition due to a stone in the ureter.
Diagnosis was suspected on serial ultrasonography, and confirmed by computed
tomograhy. Diagnosis, follow-up, and therapeutic approach are discussed.

Publication Types: 
    Case Reports

PMID: 17692761 [PubMed - indexed for MEDLINE]

244: Ann R Coll Surg Engl. 2007 Jul;89(5):526-8.

Day-case rigid and flexible ureteroscopy.

Bromwich EJ, Lockyer R, Keoghane SR.

Department of Urology, St Mary's Hospital, Portsmouth, UK.
emma.bromwich@virgin.net

INTRODUCTION: The aim of this study was to evaluate the feasibility of rigid and 
flexible ureteroscopy as a day-surgery procedure. PATIENTS AND METHODS: All
patients requiring elective ureteroscopy from March 2004 were considered for a
day-surgery procedure. The standard day-surgery exclusions existed but there were
no urological criteria for exclusion. A single consultant urologist performed or 
supervised all procedures. RESULTS: A total of 64 patients underwent 50 rigid and
14 flexible procedures. Six diagnostic ureteroscopies were performed. There was a
96% stone clearance rate. Five patients required an unplanned admission within
the first 2 weeks' postoperatively. Three of these patients were admitted on the 
day of surgery, two for pain and one for social reasons. Two patients were
admitted at 24 h and 48 h, respectively, for urinary retention. CONCLUSIONS:
Ureteroscopy, both rigid and flexible, is a safe procedure for the day-surgery
setting. Routine use of prophylactic antibiotics, intravenous non-steroidal
anti-inflammatory drugs resulted in an acceptable re-admission rate.

Publication Types: 
    Evaluation Studies

PMID: 17688729 [PubMed - indexed for MEDLINE]

245: ANZ J Surg. 2007 Sep;77(9):765-7.

Hand-assisted laparoscopy on a shoestring.

Antony L, Laim E, Chung SS.

Port Moresby General Hospital, Port Moresby, Papua New Guinea.

BACKGROUND: Hand-assisted laparoscopic surgery is useful in difficult
laparoscopic operations. Expensive and cumbersome devices are necessary to ensure
airtightness between the surgeon's hand and the abdominal wall so that
pneumoperitoneum can be maintained. METHOD: A simple method of maintaining
pneumo-peritoneum in hand-assisted laparoscopic surgery was carried out by tying 
a strong nylon suture in a criss-cross fashion on one end of the incision.
Airtightness was maintained by tightening the suture around the wrist and wedging
the dorsum of the hand against the abdominal wall. RESULT: The method was used
successfully to remove a pyonephrotic left kidney in a 28-year-old man from Papua
New Guinea. CONCLUSION: Hand-assisted laparoscopic operations can be carried out 
expediently and inexpensively without specialized equipment by simply tying a
shoestring suture at one end of the wound.

Publication Types: 
    Case Reports

PMID: 17685955 [PubMed - indexed for MEDLINE]

246: Acta Chir Belg. 2007 Jun;107(3):336-7.

Life-threatening biliary complications after percutaneous nephro-lithotomy: a
case report.

Ricciardi S, Sallustio P, Troisi R.

Department of General Surgery, Hepato-Biliary and Liver Transplantation Service, 
Ghent University Hospital Medical School, Ghent, Belgium.

Percutaneous nephrolithotomy is an option for the management of kidney stones.
Rarely, life-threatening complications occur. A case of severe necrosis of the
extrahepatic biliary tree after percutaneous neprolithotomy is hereby reported. A
55 years old woman underwent an emergency nephrectomy for bleeding the day after 
this procedure. One week later she developed an acute abdomen due to biliary
peritonitis originating from necrosis of the choledochus and associated duodenal 
perforation. External biliary derivation, duodenal exclusion and gastro-jejunal
anastomosis were carried out. Putative risk factors are in the following
discussed.

Publication Types: 
    Case Reports

PMID: 17685267 [PubMed - indexed for MEDLINE]

247: Urol Clin North Am. 2007 Aug;34(3):431-41.

Treatment of stones associated with complex or anomalous renal anatomy.

Gupta M, Lee MW.

Columbia University School of Medicine, College of Physicians & Surgeons, 11th
Floor Department of Urology, 161 Fort Washington Avenue, New York, NY 10032, USA.
guptama@pol.net

This article reviews the most common renal anomalies and the management of
patients with calculus disease in anomalous kidneys. The emphasis is on minimally
invasive techniques to achieve a stone-free status with minimal morbidity.

Publication Types: 
    Review

PMID: 17678992 [PubMed - indexed for MEDLINE]

248: Urol Clin North Am. 2007 Aug;34(3):409-19.

Treatment selection and outcomes: renal calculi.

Wen CC, Nakada SY.

Private Practice, 3300 Webster St. Ste 710, Oakland, CA 94609, USA.

This article summarizes the history of how renal stones have been treated over
the centuries and reviews current treatments and outcomes for renal stones. The
authors provide an algorithm based on available outcome data for shock wave
lithotripsy, ureteroscopy, and percutaneous nephrolithotomy.

Publication Types: 
    Review

PMID: 17678990 [PubMed - indexed for MEDLINE]

249: Urol Clin North Am. 2007 Aug;34(3):397-408.

Advances in ureterorenoscopy.

Beiko DT, Denstedt JD.

Department of Urology, Queen's University, Kingston General Hospital, 76 Stuart
Street, Kingston, Ontario K7L 2V7, Canada. beikod@kgh.kari.net

There has been a shift toward minimally invasive surgery in all surgical
subspecialties in recent decades. Ureterorenoscopy represents an area in which
there have been numerous advances that have resulted in excellent patient
outcomes with low morbidity. Technologic advances such as miniaturization of
ureteroscopes and improved video imaging have expanded the indications for
ureteroscopy. The entire upper urinary tract can now be accessed for diagnosis
and treatment of many common urologic conditions. Technologic research and
development will continue to drive future improvements in the technique and
applications for ureteroscopy.

Publication Types: 
    Review

PMID: 17678989 [PubMed - indexed for MEDLINE]

250: Urol Clin North Am. 2007 Aug;34(3):383-95.

Advances in percutaneous nephrostolithotomy.

Deane LA, Clayman RV.

Department of Urology, University of California Irvine, UCI Medical Center,
Orange, CA 92868, USA.

Percutaneous nephrolithotomy was first performed in 1976. In the past 30 years,
many refinements to the procedure have been made and it has become the gold
standard for the management of large and complex renal calculi. This article
reviews advances made in the field and highlights the nuances of the technique.
The large published series are reviewed and their results discussed.

Publication Types: 
    Review

PMID: 17678988 [PubMed - indexed for MEDLINE]

251: Urol Clin North Am. 2007 Aug;34(3):375-82.

New concepts in shock wave lithotripsy.

Weizer AZ, Zhong P, Preminger GM.

Department of Urology, University of Michigan, 3875 Taubman Center, 1500 East
Medical Center Drive, Ann Arbor, MI 48109-0330, USA.

This monograph reviews the basic principles of shock wave lithotripsy. The focus 
is on new research on stone fragmentation and tissue injury and how this improved
understanding of shock-wave technology is leading to modifications in lithotripsy
that will allow this therapy to be a safer, more effective treatment for
nephrolithiasis.

Publication Types: 
    Review

PMID: 17678987 [PubMed - indexed for MEDLINE]

252: Urol Clin North Am. 2007 Aug;34(3):363-74.

Pathophysiology and management of infectious staghorn calculi.

Healy KA, Ogan K.

Department of Urology, The Emory Clinic, Emory University School of Medicine,
1365 Clifton Rd., Suite B, Atlanta, GA 30322, USA.

The American Urological Association Nephrolithiasis Guidelines Panel recently
conducted a critical meta-analysis of the existing literature to determine the
optimal management for staghorn calculi. This article briefly discusses the
pathophysiology of staghorn calculi and, based on the panel's recommendations,
examines the alternative medical treatments (eg, chemolysis) and surgical
treatments (eg, shock wave lithotripsy, open surgery, ureteroscopy, and
percutaneous nephrolithotomy) available for staghorn patients. Considering the
various modalities for staghorn disease, percutaneous nephrolithotomy should be
the first-line treatment for most patients based on its superior efficacy and low
morbidity.

Publication Types: 
    Review

PMID: 17678986 [PubMed - indexed for MEDLINE]

253: Urol Clin North Am. 2007 Aug;34(3):323-34.

Pathophysiology and management of calcium stones.

Park S, Pearle MS.

Department of Urology, University of Washington Medical Center, Box 356510, 1959 
NE Pacific, Seattle, WA 98195, USA.

Nephrolithiasis is a common disorder that accounts for significant cost,
morbidity, and loss of work. There is a one in eight lifetime chance of being
diagnosed with urinary stones. Calcium is the most common component of renal
stones in individuals in industrialized nations. Calcium stones form as a result 
of a variety of environmental and metabolic abnormalities that change the urinary
environment and increase supersaturation of stone-forming salts. Understanding
the pathophysiology of stone disease can help direct treatment toward correction 
of the underlying abnormalities. Current medical and dietary therapeutic regimens
have been shown to significantly reduce the risk of recurrent stone formation.

Publication Types: 
    Review

PMID: 17678983 [PubMed - indexed for MEDLINE]

254: Urol Clin North Am. 2007 Aug;34(3):315-22.

Evaluation of the recurrent stone former.

Chandhoke PS.

Department of Urology, Northwest Permanente, Portland, OR 97015-9764, USA.
paramjit.s.chandhoke@kp.org

For frequent stone formers, and even for some first-time stone formers interested
in preventing future episodes of renal colic, a metabolic evaluation is
necessary. The urologist, rather than members of other medical specialties, seems
to have the primary responsibility of the medical management of stone disease.
Thus, it is essential for the urologist to have a good working knowledge of the
principles of metabolic evaluation and kidney stone prevention. This article
provides guidelines related to metabolic evaluation and the prevention of kidney 
stones.

Publication Types: 
    Review

PMID: 17678982 [PubMed - indexed for MEDLINE]

255: Urol Clin North Am. 2007 Aug;34(3):295-313.

Pathogenesis of renal calculi.

Miller NL, Evan AP, Lingeman JE.

Clarian Health Partners, USA.

Recent reports suggest that kidney stone disease prevalence is increasing.
Despite significant treatment advances, the inciting factor and sequence of
events leading to kidney stone formation remain elusive; however, recent efforts 
to understand the pathogenesis of nephrolithiasis have led to a delineation of
the human surgical anatomy, histopathology, and metabolic factors in a variety of
kidney stone formers. This article reviews the fundamental concepts of calculus
formation, and the leading theories of stone pathogenesis, focusing on recent
data from human papillary and renal cortical biopsies in stone formers that
provide evidence for the role of Randall's plaque in kidney stone disease
pathogenesis. These data suggest there are individual stone-forming phenotypes
with unique surgical anatomy, histology, and metabolic profiles.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 17678981 [PubMed - indexed for MEDLINE]

256: Urol Clin North Am. 2007 Aug;34(3):287-93.

Epidemiology of stone disease.

Curhan GC.

Channing Laboratory and Renal Division, Department of Medicine, Brigham and
Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA
02115, USA. gary.curhan@channing.harvard.edu

Epidemiology has improved our understanding and management of stone disease.
Epidemiologic studies, by quantifying patterns and burden of disease, have helped
identify risk factors, leading to changes in clinical practice and providing
insights into pathophysiologic processes related to stone formation. Because
nephrolithiasis is a complex disease, an understanding of the epidemiology,
particularly the interactions among different factors, may help lead to
approaches that reduce the risk of stone formation.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 17678980 [PubMed - indexed for MEDLINE]

257: JSLS. 2007 Jan-Mar;11(1):116-8.

Laparoscopic retrieval of a migrated Amplatz sheath.

Castillo OA, Metrebian E, Vitagliano G.

Section of Endourology and Laparoscopic Urology, Department of Urology, Clínica
Santa Maria, Santiago de Chile, Chile. octaviocastillo@vtr.net

OBJECTIVES: Percutaneous nephrolithotomy is a relatively safe technique. However,
it is not exempt from complications, some of which can be severe and even fatal. 
Some complications may be plausible for laparoscopic management. We report our
experience in the management of a rare complication by laparoscopic means.
METHODS: We report the case of an Amplatz sheath that inadvertently migrated out 
of the renal parenchyma during a percutaneous nephrolithotomy. Patient data,
procedure conditions, and laparoscopic retrieval of the sheath are detailed.
RESULTS: The Amplatz sheath was successfully retrieved laparoscopically. Total
operative time was 180 minutes. Operative bleeding was minimal. The postoperative
period was uneventful, and the patient was discharged on postoperative day 3.
CONCLUSIONS: Laparoscopy must be regarded as an option for the management of a
surgical complication, especially if a minimally invasive approach is to be kept.

Publication Types: 
    Case Reports

PMID: 17651571 [PubMed - indexed for MEDLINE]

258: Int J Urol. 2007 Jul;14(7):665-7.

Three-dimensional assessment of urinary stone on non-contrast helical computed
tomography as the predictor of stonestreet formation after extracorporeal shock
wave lithotripsy for stones smaller than 20 mm.

Yoshida S, Hayashi T, Morozumi M, Osada H, Honda N, Yamada T.

Department of Urology, Saitama Medical Center, Saitama Medical School, Kawagoe,
Saitama, Japan. soichiroyoshida2000@yahoo.co.jp

The incidence of stonestreet formation after extracorporeal shock wave
lithotripsy (ESWL) rises with increasing stone burden. However, stonestreet after
ESWL is often experienced even in stones smaller than 20 mm. To examine whether
the non-contrast helical computed tomography (CT) data could predict stonestreet 
formation in these stones, 53 radiopaque stones of 5-20 mm treated with ESWL were
evaluated. Maximal dimension was measured on plain radiograph. From an
attenuation value histogram graphed from the CT data, total stone volume and mean
attenuation value were calculated. Seven stonestreets longer than 25 mm
developed. There was no significant difference in maximal dimension and total
stone volume between stones that did and stones that did not develop stonestreet.
Mean attenuation value was the sole significant predictive factor. Application of
mean attenuation value with cut-off level of 650 HU would anticipate stonestreet 
formation with a sensitivity of 85.7% and a specificity of 71.7%. The estimated
risk of stonestreet formation is high in the treatment of stones with higher mean
attenuation value.

PMID: 17645618 [PubMed - indexed for MEDLINE]

259: J Endourol. 2007 Jun;21(6):574-7.

Value of intravenous urography before shockwave lithotripsy in the treatment of
renal calculi: a randomized study.

Sameh WM.

Urology Department, Alexandria University, Alexandria, Egypt.

PURPOSE: To study the impact of preprocedure intravenous urography (IVU) on the
outcome of SWL for renal stones. PATIENTS AND METHODS: Two hundred patients with 
radiopaque renal stones <or=2.5 cm on plain radiographs and no or mild renal
backpressure on ultrasonographic examination were allocated randomly to two
treatment groups. Group I (n = 100) had IVU before the start of SWL, whereas
patients in the second group (n = 100) underwent SWL without IVU. Thirteen
patients in the IVU group and seven patients in the no-IVU group were excluded
from the study. Patients in both groups received the same treatment and follow-up
protocols. Intraoperative and postoperative complications were evaluated in all
patients. An endpoint assessment by plain film was done 3 months after the
conclusion of treatment to evaluate the success and stone-free rates. RESULTS:
The success rate (81.6% in group 1 v 77.4% in group 2), stone-free rate (65.5% v 
62.3%), re-treatment rate (59.8% v 69.9%), auxiliary-procedure rate (6.9% v
5.4%), and complication rate (11.5% v 14%) were similar in the two groups.
CONCLUSION: It is not necessary to obtain an IVU for patients who have renal
calculi with no or minimal back pressure before scheduling them for SWL, thus
minimizing the cost, avoiding exposure to contrast medium, and reducing radiation
exposure.

Publication Types: 
    Randomized Controlled Trial

PMID: 17638548 [PubMed - indexed for MEDLINE]

260: J Urol. 2007 Sep;178(3 Pt 1):921-4. Epub 2007 Jul 16.

Comment in:
    J Urol. 2007 Sep;178(3 Pt 1):752.

Tubeless percutaneous nephrolithotomy--should a stent be an integral part?

Mandhani A, Goyal R, Vijjan V, Dubey D, Kapoor R.

Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
anm9118@nyp.org

PURPOSE: We compared the outcome of tubeless percutaneous nephrolithotomy with or
without Double-J(R) stent. MATERIALS AND METHODS: From January 2004 to March 2006
patients with renal stones matched for age and stone size who underwent tubeless 
percutaneous nephrolithotomy were prospectively evaluated in 2 groups treated by 
2 surgeons. Group 1 had a Double-J stent and group 2 did not. Inclusion criteria 
for tubeless percutaneous nephrolithotomy included contralateral normal kidney,
intact pelvicaliceal system, complete stone clearance under fluoroscopy and
single infracostal puncture. These groups were compared for analgesic
requirement, hospital stay, and intraoperative and postoperative complications.
RESULTS: During a period of 27 months 52 patients (57 renal units) underwent
tubeless percutaneous nephrolithotomy. Group 1 had 25 (28 renal units) and group 
2 had 27 patients (29 renal units). Mean stone volume was 4.34 +/- 2.12 cm(3) in 
group 1 and 4.14 +/- 1.14 cm(3) in group 2. Mean pain score was 2.96 +/- 1.24 and
2.82 +/- 0.81 in groups 1 and 2, respectively. Analgesic (intramuscular or oral
diclofenac sodium) requirement and mean hospital stay was comparable in groups 1 
and 2, eg 170 +/- 110 vs 163.24 +/- 98.07 mg and 2.52 +/- 0.12 vs 2.35 +/- 0.12
days. Two patients in group 1 and 1 in group 2 had urinary leak from the
percutaneous nephrolithotomy tract. Similarly 3 patients in group 1 had severe
stent related problems and 1 required early removal of the Double-J stent.
CONCLUSIONS: Avoiding use of the Double-J stent may not compromise the safety of 
tubeless percutaneous nephrolithotomy.

Publication Types: 
    Clinical Trial

PMID: 17632155 [PubMed - indexed for MEDLINE]

261: J Urol. 2007 Sep;178(3 Pt 1):916-20; discussion 920. Epub 2007 Jul 16.

Comment in:
    J Urol. 2007 Sep;178(3 Pt 1):752.

Renal access by urologist or radiologist for percutaneous nephrolithotomy--is it 
still an issue?

El-Assmy AM, Shokeir AA, Mohsen T, El-Tabey N, El-Nahas AR, Shoma AM, Eraky I,
El-Kenawy MR, El-Kappany HA.

Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura,
Egypt.

PURPOSE: Despite evidence that urologists can safely acquire percutaneous renal
access for percutaneous nephrolithotomy, many centers still rely on
interventional radiologists to obtain renal access. In this study we evaluated
percutaneous access for percutaneous nephrolithotomy obtained by interventional
radiologists or urologists, and compared access outcomes and complications.
MATERIALS AND METHODS: The surgical records of 1,121 patients with 1,155 stone
bearing kidneys treated with percutaneous nephrolithotomy between 1999 and 2003
were reviewed. Patients were stratified according to percutaneous renal access
into 509 patients with 661 access procedures performed by urologists and 612
patients with 612 access procedures performed by interventional radiologists.
RESULTS: Both groups were comparable except there was a higher incidence of
multiple stones in the urologist access group. Urologists had a significantly
greater rate of using multiple and supracostal tracts compared to radiologists.
The stone-free rates were 83.4% and 86.1% for urologist and radiologist access
groups, respectively (p = 0.1). Major complications were seen in 74 patients
(6.6%). Both groups had similar complication rates except for significant
bleeding in the urology group (4.3%) compared with 2.1% in the radiology cohort
(p = 0.02). Further multivariate analysis showed that bleeding was not related to
the type of access whether performed by urologist or radiologist. CONCLUSIONS:
The urologist is able to safely and effectively obtain percutaneous renal access 
for percutaneous nephrolithotomy as a single stage procedure. Despite more
complex stones and higher access difficulty in the urology access group, access
related complications and stone-free rates were comparable. We recommend
percutaneous access training in urology training programs.

Publication Types: 
    Comparative Study

PMID: 17632136 [PubMed - indexed for MEDLINE]

262: Urol Int. 2007;79(1):19-23.

A high association of upper urinary tract transitional cell carcinoma with
nonfunctioning kidney caused by stone disease in Taiwan.

Yeh CC, Lin TH, Wu HC, Chang CH, Chen CC, Chen WC.

Department of Urology, China Medical University Hospital, Taichung, Taiwan, ROC.

INTRODUCTION: Although many studies have reported that upper urinary tract stones
in patients with nonfunctioning kidneys are associated with malignancy, the
incidence and frequency of the tumor cell type remain unclear. Therefore, we
aimed to investigate the percentage of malignancies present in patients with
nonfunctional kidneys who underwent nephrectomy. MATERIALS AND METHODS: From July
1995 to December 2005, we reviewed a total of 47 patients who underwent
nephrectomy to treat a nonfunctional kidney due to urolithiasis with clinical
symptoms such as complicated chronic infection. Pathology revealed malignancies
in 24 patients. Relationships between clinical presentations and malignancy were 
analyzed. RESULTS: Malignancy was diagnosed in 24 patients after nephrectomy.
Image studies revealed possible malignancy in only 7 patients before surgery. A
high incidence (17/24) of transitional cell carcinoma was noted. The remaining
malignancies included 5 renal cell carcinomas, 1 squamous cell carcinoma and 1
epidermoid carcinoma. There were 5 deaths during the follow-up interval.
CONCLUSIONS: There is a high incidence of malignancy associated with
nonfunctional kidney caused by stone disease. We suggest careful examination of
the pathological specimens from nephrectomy for nonfunctional kidney regardless
of clinical manifestations.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17627162 [PubMed - indexed for MEDLINE]

263: Int Braz J Urol. 2007 May-Jun;33(3):313-8; discussion 319-22.

Randomized prospective evaluation of nephrostomy tube configuration: impact on
postoperative pain.

Weiland D, Pedro RN, Anderson JK, Best SL, Lee C, Hendlin K, Kim J, Monga M.

Department of Urologic Surgery, University of Minnesota, Minneapolis, MN 55455,
USA.

OBJECTIVE: Conduct a prospective randomized single-blind comparison of two
nephrostomy catheter designs, evaluating specifically intraoperative placement
and postoperative comfort. MATERIALS AND METHODS: The single-blind, prospective
randomized trial was conducted with institutional review board approval. All
patients undergoing percutaneous nephrolithotomy who gave informed consent were
randomized to placement of either a Boston Scientific Flexima 8.3F pigtail
nephrostomy tube #27-180 (PIG) or a Boston Scientific 8.2F nephroureteral stent
#410-126 (NUS). Randomization was concealed from the surgeon until time of
placement. Subjective intraoperative placement characteristics were rated by the 
surgeon on a scale of 1 = excellent, 2 = fair, 3 = good and 4 = poor. The
patient's postoperative pain intensity was evaluated with a Visual Analog Pain
Score (0 = no pain to 10 = worst pain). RESULTS: Nine patients were randomized to
each group. The PIG group was rated significantly better than the NUS group with 
regards to ease of placement (p = 0.007) and radiopacity of the tube (p = 0.007) 
by surgeon. Visual analog pain scores on postoperative day one, was significantly
lower in the PIG group (mean = 2+/-2) than the NUS group (mean = 5+/-1) (p
=0.004). The mean amount of intra-venous morphine equivalent given in the PIG
group (mean = 1+/4 Eq morphine) was less on average compared to the NUS group
(mean = 6+/13 Eq morphine), but the differences did not reach statistical
significance (p = 0.06). CONCLUSIONS: Following percutaneous nephrolithotomy, use
of a small pig-tail nephrostomy tube results in greater ease of placement and
less postoperative pain than a nephroureteral catheter.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17626647 [PubMed - indexed for MEDLINE]

264: Acta Cir Bras. 2007 Jul-Aug;22(4):285-90.

The repeated extracorporeal shock waves and the renal parenchyma injury on normal
and diabetic rats.

Kira VM, Fagundes DJ, Bandeira CO, Fagundes AT, Ortiz V.

State University of Maringá, Paraná, Brazil.

PURPOSE: To assess the effect of repeated extracorporeal shock waves (ESW) on
renal parenchyma of normal and diabetic rats. METHODS: 40 normal rats (A) and 40 
diabetic rats (B) were assigned for ESW (Direx Tripter X1 - 14 KVA) as follow:
A1/B1 and A3/B3 no ESW; A2/B2 one ESW (2,000 SW); A4/B4 two ESW (4,000 SW) in an 
elapsed 14 days. All the animals were sacrificed 3 days after the ESW and samples
of renal parenchyma were histological prepared, stained by H&E. For each animal
the frequency of hemorrhage focus (HF) in the subcapsular, interstitial and
glomerulus area was calculated (percentage) on 20 randomly histological sections.
RESULTS: No one HF was identified in all normal or diabetic animals without ESW
(A1, A3 and B1, B3). In the normal rats the HF frequency was similar to one ESW
(subcapsular =15%; interstitial =20% and glomerular =10%) or repeated ESW
(subcapsular =25%; interstitial =20%; glomerular=10%). In diabetic rats the
occurrence of HF with repeated ESW was more frequent (subcapsular =40%;
interstitial =30% and glomerular =10%) than with a single ESW (subcapsular =25%; 
interstitial =15% and glomerular =15%). CONCLUSION: A single ESW or a repeated
ESW caused a mild and similar damage on renal cortex of normal rats. In diabetic 
rats the repeated ESW may result in an accumulated damage, especially with focus 
of hemorrhage in subcapsular and interstitial tissue and glomerulus edema.

PMID: 17625667 [PubMed - indexed for MEDLINE]

265: J Child Neurol. 2007 Apr;22(4):375-8.

Kidney stones and the ketogenic diet: risk factors and prevention.

Sampath A, Kossoff EH, Furth SL, Pyzik PL, Vining EP.

School of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

A cohort study was performed of children started on the ketogenic diet for
intractable epilepsy from 2000 to 2005 (n = 195). Children who developed kidney
stones were compared with those without in terms of demographics, urine
laboratory markers, and intervention with urine alkalinization (potassium
citrate). Thirteen children (6.7%) developed kidney stones. The use of oral
potassium citrate significantly decreased the prevalence of stones (3.2% vs
10.0%, P = .049) and increased the mean time on the ketogenic diet before a stone
was first noted (260 vs 149 patient-months, P = .29). The prevalence of kidney
stones did not correlate with younger age or use of carbonic anhydrate inhibitors
(eg, topiramate or zonisamide) but trended toward higher correlation with the
presence of hypercalciuria (92% vs 71%, P = .08). No child stopped the diet due
to stones; in fact, the total diet duration was longer (median 26 vs 12 months, P
< .001). Kidney stones continue to occur in approximately 1 in 20 children on the
ketogenic diet, and no statistically significant risk factors were identified in 
this cohort. As oral potassium citrate was preventative, prospective studies
using this medication empirically are warranted.

Publication Types: 
    Clinical Trial
    Research Support, N.I.H., Extramural

PMID: 17621514 [PubMed - indexed for MEDLINE]

266: ScientificWorldJournal. 2006 Apr 18;6:2411-9.

Papillary and nonpapillary calcium oxalate monohydrate renal calculi: comparative
study of etiologic factors.

Pieras E, Costa-Bauzá A, Ramis M, Grases F.

University Hospital Son Dureta, Palma de Mallorca, Spain. 32477apa@comb.es

Calcium oxalate monohydrate (COM) renal calculi can be classified into two
groups: papillary and nonpapillary. In this paper, a comparative study between
etiologic factors of COM papillary and nonpapillary calculi is performed. The
study included 40 patients with COM renal calculi. The urine of these individuals
was analyzed. Case history, lifestyle, and dietetic habits were obtained. No
significant differences between urinary biochemical data of both groups were
observed; 50% of COM papillary stone formers and 40% of COM nonpapillary stone
formers had urolithiasis family history. A low consumption of phytate-rich
products was observed for both groups. A relationship between profession with
occupational exposure to cytotoxic products and COM papillary renal lithiasis was
detected. The results suggest that COM papillary calculi would be associated to
papillary epithelium alterations together with a crystallization inhibitors
deficit, whereas COM nonpapillary calculi would be associated to the presence of 
heterogeneous nucleants and a crystallization inhibitors deficit.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17619710 [PubMed - indexed for MEDLINE]

267: ScientificWorldJournal. 2006 Mar 23;6:2388-95.

Predictors of success after extracorporeal shock wave lithotripsy (ESWL) for
renal calculi between 20-30 mm: a multivariate analysis model.

El-Assmy A, El-Nahas AR, Abo-Elghar ME, Eraky I, El-Kenawy MR, Sheir KZ.

Urology & Nephrology Center, Urology Department, Mansoura University, Mansoura,
Egypt. unc@mans.edu.eg

The first-line management of renal stones between 20-30 mm remains controversial.
The Extracorporeal Shock Wave Lithotripsy (ESWL) stone-free rates for such
patient groups vary widely. The purpose of this study was to define factors that 
have a significant impact on the stone-free rate after ESWL in such controversial
groups. Between January 1990 and January 2004, 594 patients with renal stones
20-30 mm in length underwent ESWL monotherapy. Stone surface area was measured
for all stones. The results of treatment were evaluated after 3 months of
follow-up. The stone-free rate was correlated with stone and patient
characteristics using the Chi-square test; factors found to be significant were
further analyzed using multivariate analysis. Repeat ESWL was needed in 56.9% of 
cases. Post-ESWL complications occurred in 5% of cases and post-ESWL secondary
procedures were required in 5.9%. At 3-month follow-up, the overall stone-free
rate was 77.2%. Using the Chi-square test, stone surface area, location, number, 
radiological renal picture, and congenital renal anomalies had a significant
impact on the stone-free rate. Multivariate analysis excluded radiological renal 
picture from the logistic regression model while other factors maintained their
statistically significant effect on success rate, indicating that they were
independent predictors. A regression analysis model was designed to estimate the 
probability of stone-free status after ESWL. The sensitivity of the model was
97.4%, the specificity 90%, and the overall accuracy 95.6%. Stone surface area,
location, number, and congenital renal anomalies are prognostic predictors
determining stone clearance after ESWL of renal calculi of 20-30 mm. High
probability of stone clearance is obtained with single stone < or = 400 mm2
located in renal pelvis with no congenital anomalies. Our regression model can
predict the probability of the success of ESWL in such controversial groups and
can define patients who would need other treatment modality.

PMID: 17619706 [PubMed - indexed for MEDLINE]

268: Int Urol Nephrol. 2008;40(1):31-7. Epub 2007 Jul 6.

The impact of pelvicaliceal features on problematic lower pole stone clearance in
different age groups.

Gurocak S, Kupeli B, Acar C, Tan MO, Karaoglan U, Bozkirli I.

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.
sgurocakmd@yahoo.com

AIM: Our aim was to evaluate the impact of pelvicaliceal variables in pediatric
and adult age groups who underwent SWL for lower caliceal calculi. METHODS: 25
pediatric and 78 adult patients treated with extracorporeal shock wave
lithotripsy (SWL) between 1996 and 2004 were enrolled into the study after
exclusion of patients with hydronephrosis, major renal anatomic anomalies,
non-calcium stones, history of recurrent stone disease and previous renal
surgery. Lower pole infundibulopelvic angle (IPA), infundibular length (IL),
infundibular width (IW) and pelvicaliceal volume were measured from pre-SWL
intravenous urography. The pelvicaliceal stone load (PSL) index implicating the
stone burden of each patient described as the relationship between stone volume
and total estimated pelvicaliceal volume for stone-bearing kidney was also
calculated. RESULTS: Sixty-eight percent of adult and 80% of pediatric patients
became stone-free after SWL. The statistical insignificance between PSL index
(p=0.097) of two groups shows that both groups shared a similar stone burden.
According to SWL outcome, mean IPA values of stone-free and residual patients
were 46.85 degrees and 30 degrees in pediatric group, respectively (p=0.01),
whereas these values were 48.08 degrees and 43.06 degrees in the adult group,
respectively (p=0.352). In the pediatric age group, stone-free and cumulative
success rates increased with increasing IPA but this correlation was
statistically insignificant (p: 0.263). CONCLUSIONS: Lower caliceal anatomy has a
higher impact on stone clearance after SWL in pediatric patients and urologists
can expect better SWL outcomes from pediatric population with solitary lower
caliceal stone than adults under the same conditions.

Publication Types: 
    Comparative Study

PMID: 17619163 [PubMed - indexed for MEDLINE]

269: Br J Nutr. 2007 Dec;98(6):1224-8. Epub 2007 Jul 9.

Urinary phosphorus rather than urinary calcium possibly increases renal stone
formation in a sample of Asian Indian, male stone-formers.

Berkemeyer S, Bhargava A, Bhargava U.

University of Delhi, Delhi, India. s.berkemeyer@web.de

The contribution of dietary Ca and P in renal stone formation is debated. Thus,
the main objective was to investigate if there were any differences in the
dietary, serum and urine values of Ca and P in stone formers (SF) compared with
healthy controls (HC). The secondary aim was to analyse if dietary, serum and
urine Ca and P correlated. The study enrolled ten patients with renal stones
admitted for stone removal and ten healthy controls. Their dietary
macronutrients, Ca and P intakes were calculated from 2-d dietary records. On the
second day of dietary record 24-h urine was collected and on the third day
morning a 5 ml blood sample was collected. Biochemical analyses were conducted
for serum and urine Ca, P and uric acid with qualitative renal stone analysis.
All the dietary intakes and urine P were significantly higher (P < 0.05) in SF
than in HC. Correlation results showed that in SF dietary Ca correlated to serum 
and urine Ca. No such correlations were seen for P. Additionally, in SF urine Ca 
correlated to dietary proteins and fats but not to carbohydrates. None of the
biochemical values lay outside the normal range of values. The study suggests
urine P rather than urine Ca to be probably at work in the formation of renal
stones. Limitation of protein intake with normal Ca intakes could provide a
suitable measure to avoid renal stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17617937 [PubMed - indexed for MEDLINE]

270: Clin Chim Acta. 2007 Sep;384(1-2):41-7. Epub 2007 May 26.

Identification of myeloperoxidase, alpha-defensin and calgranulin in calcium
oxalate renal stones.

Mushtaq S, Siddiqui AA, Naqvi ZA, Rattani A, Talati J, Palmberg C, Shafqat J.

Department of Biological and Biomedical Sciences, Research Laboratory, Juma
Building, Pakistan.

BACKGROUND: In order to understand the mechanism of stone genesis, it is
essential to determine the characteristics of macromolecules constituting the
urinary stones. We characterized proteins from the inner core and outer matrix of
calcium oxalate (CaOx) renal stones. METHODS: Inner core and outer matrix of CaOx
renal stones were separated and proteins were extracted with a buffer containing 
SDS and beta-mercaptoethanol. Proteins were analyzed and purified by SDS-PAGE and
RP-HPLC respectively. The protein bands from gel and protein fractions were
sequenced by MALDI TOF mass spectrometry. ELISA, western and slot blot
immunoassays were performed to confirm the identity of the proteins in stones and
urine of the stone formers. The potential of the identified protein as an
effective promoter or inhibitor was assessed by observing their effects on CaOx
crystallization using aggregometer. RESULTS: The inner core extract predominantly
exhibited protein species in the molecular weight range of 12-14 kDa. However, a 
66 kDa band, identified as osteopontin was also detected in the inner core along 
with outer matrix and in the urine of stone formers and non stone formers.
Purification of low molecular weight proteins was carried out by reversed phase
HPLC. Tandem mass spectrometry analysis identified them as myeloperoxidase chain 
A (MPO-A), alpha-defensin, and calgranulin. ELISA, western blot and slot-blot
immuno-assays further confirmed their presence restricted to the inner core and
not in the outer matrix. Turbidity assays showed that low molecular weight renal 
stone proteins promoted the aggregation of CaOx crystals. CONCLUSIONS: Persistent
hyperoxaluria leads to tubular epithelial injury, resulting in the release of
these anti-inflammatory proteins. These proteins could have been first adsorbed
on CaOx crystals thereby become a part of nucleation process leading to inner
matrix formation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17610860 [PubMed - indexed for MEDLINE]

271: J Am Diet Assoc. 2007 Jul;107(7):1191-4; quiz 1195-6.

Food oxalate: factors affecting measurement, biological variation, and
bioavailability.

Massey LK.

Department of Food Science and Human Nutrition, Washington State University,
Spokane, WA 99210-1495, USA. massey@wsu.edu

Food and nutrition professionals provide medical nutrition therapy for patients
with kidney stones. If the stones contain oxalate or the patient has been
diagnosed with hyperoxaluria, reduction of dietary oxalate may be appropriate.
Differences in oxalate values for a single food may be due to analytical methods,
and/or biological variation from several sources, including cultivar, time of
harvest, and growing conditions. Bioavailability of food oxalate and, thus, urine
oxalate, will also be affected by salt forms of oxalate, food processing and
cooking methods, meal composition, and the presence of Oxalabacter formigenes in 
the patient's gut. Dietary advice for reducing urinary oxalate should include
both reduction of dietary oxalate and simultaneous consumption of calcium-rich
food or supplement to reduce oxalate absorption.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 17604750 [PubMed - indexed for MEDLINE]

272: Am J Physiol Renal Physiol. 2007 Sep;293(3):F732-40. Epub 2007 Jun 27.

Slc7a9 knockout mouse is a good cystinuria model for antilithiasic
pharmacological studies.

Font-Llitjós M, Feliubadaló L, Espino M, Clèries R, Mañas S, Frey IM, Puertas S, 
Colell G, Palomo S, Aranda J, Visa J, Palacín M, Nunes V.

Medical and Molecular Genetics Center, Institut d'Investigació Biomèdica de
Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.

Cystinuria is a hereditary disorder caused by a defect in the apical membrane
transport system for cystine and dibasic amino acids in renal proximal tubules
and intestine, resulting in recurrent urolithiasis. Mutations in SLC3A1 and
SLC7A9 genes, that codify for rBAT/b(0,+)AT transporter subunits, cause type A
and B cystinuria, respectively. In humans, cystinuria treatment is based on the
prevention of calculi formation and its dissolution or breakage. Persistent
calculi are treated with thiols [i.e., d-penicillamine (DP) and
mercaptopropionylglycine (MPG)] for cystine solubilization. We have developed a
new protocol with DP to validate our Slc7a9 knockout mouse model for the study of
the therapeutic effect of drugs in the treatment of cystine lithiasis. We
performed a 5-wk treatment of individually caged lithiasic mutant mice with a
previously tested DP dose. To appraise the evolution of lithiasis throughout the 
treatment a noninvasive indirect method of calculi quantification was developed: 
calculi mass was quantified by densitometry of X-ray images from cystinuric mice 
before and after treatment. Urine was collected in metabolic cage experiments to 
quantify amino acids in DP-treated and nontreated, nonlithiasic mutant mice. We
found significant differences between DP-treated and nontreated knockout mice in 
calculi size and in urinary cystine excretion. Histopathological analysis showed 
that globally nontreated mutant mice had more severe and diffuse urinary system
damage than DP-treated mice. Our results validate the use of this mouse model for
testing the efficacy of potential new drugs against cystinuria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17596531 [PubMed - indexed for MEDLINE]

273: Curr Med Res Opin. 2007 Aug;23(8):1765-73.

Zonisamide and renal calculi in patients with epilepsy: how big an issue?

Wroe S.

National Hospital for Neurology & Neurosurgery, Queen Square, London, UK.
S.wroe@prion.ucl.ac.uk <wroe@prion.ucl.ac.uk>

OBJECTIVES: To determine the prevalence of renal calculi in patients treated with
zonisamide during randomized, controlled and open-label clinical trials, and from
post-marketing surveillance data. METHODS: Reports of renal calculi from four
placebo-controlled double-blind trials of zonisamide, their long-term open-label 
treatment extension phases, and the US/European zonisamide clinical trial
programme were reviewed. One double-blind study and its extension included
routine ultrasound screening to identify asymptomatic calculi. Post-marketing
surveillance data were also investigated, as was concomitant treatment with
topiramate. RESULTS: No symptomatic renal calculi were reported during four
randomized double-blind, placebo-controlled trials involving 848 subjects
(including 498 zonisamide recipients) treated for up to 3 months. In long-term
extension studies with treatment for up to 24 months, symptomatic renal calculi
were reported in 9/626 (1.4%) patients. Pooled safety data from all US/European
clinical trials identified 15/1296 (1.2%) patients with symptomatic renal calculi
during treatment for up to 8.7 years. Post-marketing surveillance revealed nine
cases from 59 667 patient-years of exposure in the USA, and 14 from 709 294
patient-years of exposure in Japan; only one case occurred during concomitant
topiramate and zonisamide treatment. No imbalance in electrolyte levels was found
from 35 patients receiving such co-treatment in clinical trials. CONCLUSIONS: The
available data suggest that the risk of developing renal calculi during
zonisamide treatment is low. Data are insufficient to determine whether
concomitant treatment with topiramate increases the risk of renal stones.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17594758 [PubMed - indexed for MEDLINE]

274: Int J Urol. 2007 Jun;14(6):558-60.

Percutaneous nephrolithotomy of a staghorn stone in thoracic ectopic kidney.

Singh P, Vijjan V, Gupta M, Dubey D, Srivastava A.

Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate
Institute of Medical Sciences, Lucknow, India.

Congenital thoracic ectopic kidney is a very rare developmental anomaly and the
rarest form of all ectopic kidneys. It is usually asymptomatic and discovered
incidentally on routine chest radiography. Herein we reported the first case of
staghorn stone in a thoracic kidney managed successfully by percutaneous
nephrolithotomy.

Publication Types: 
    Case Reports

PMID: 17593105 [PubMed - indexed for MEDLINE]

275: Nat Clin Pract Nephrol. 2007 Jul;3(7):397-404.

Hypercalcemia and diabetes insipidus in a patient previously treated with
lithium.

Khairallah W, Fawaz A, Brown EM, El-Hajj Fuleihan G.

Division of Endocrinology, American University of Beirut, Lebanon.

BACKGROUND: A 65-year-old woman presented with decreased oral intake, a reduced
level of consciousness, hypercalcemia and hypernatremia. She had previously
received lithium for 20 years for a schizoaffective disorder, but this treatment 
had been discontinued 3 years before presentation. INVESTIGATIONS: Physical
examination, laboratory studies including measurement of serum calcium and
parathyroid hormone levels, measurement of urine and serum osmolalities before
and after desmopressin administration, blood and urine cultures, and a CT scan of
the abdomen. DIAGNOSIS: Urosepsis, dehydration, kidney stone disease,
hyperparathyroidism, and nephrogenic diabetes insipidus. MANAGEMENT: Hydration,
antibiotics, intravenous pamidronate for rapid control of hypercalcemia,
parathyroidectomy, surgical removal of the large kidney stones, a low-protein and
low-sodium diet, and initiation of treatment with a thiazide diuretic.

Publication Types: 
    Case Reports

PMID: 17592473 [PubMed - indexed for MEDLINE]

276: Phytother Res. 2007 Oct;21(10):921-5.

Prophylaxis effect of Trigonella foenum graecum L. seeds on renal stone formation
in rats.

Laroubi A, Touhami M, Farouk L, Zrara I, Aboufatima R, Benharref A, Chait A.

Laboratory of Animal Physiology Unit of Ecophysiology, Cadi-Ayyad University,
Faculty of Science Semlalia Marrakech, Morocco. lar_amine@yahoo.fr

Despite considerable progress in medical therapy, there is no satisfactory drug
to treat kidney stones. Therefore, the current study aimed to look for an
alternative by using Trigonella foenum graecum (Tfg) on nephrolithiasic rats as a
preventive agent against the development of kidney stones, which is commonly used
in Morocco as a phytotherapeutic agent. The inhibitory effect of the aqueous
extract of Tfg seeds was examined on the formation of calcium oxalate renal
stones induced by ethylene glycol (EG) with ammonium chloride. At the end of the 
experiment all kidneys were removed and examined microscopically for possible
crystal/stone locations and the total calcium amount in the renal tissue was
evaluated. The blood was recovered to determine the levels of calcium,
phosphorus, creatinine and urea. The results showed that the amount of
calcification in the kidneys and the total calcium amount of the renal tissue in 
rats treated with Tfg were significantly reduced compared with the untreated
group. Consequently, Tfg may be a useful agent in the treatment of patients with 
calcic urolithiasis.

PMID: 17582593 [PubMed - indexed for MEDLINE]

277: Surg Radiol Anat. 2007 Jul;29(5):393-5. Epub 2007 Jun 21.

A report of unusual crossed fused renal ectopia and minimal invasive management
of calculi.

Larré S, Carpentier X, Sèbe P, Tassart M, Cussenot O, Traxer O.

Service d'Urologie, Hôpital Tenon, APHP, Paris, France.
stephane.larre@hmn.aphp.fr

Crossed renal ectopias with fusion are rare anomalies of the kidney. Urinary
upper tract anatomy is modified and urinary stones may occur. We report such a
case, with precise anatomical description of the kidneys and the successful
management of a stone with minimal invasive techniques.

Publication Types: 
    Case Reports

PMID: 17581696 [PubMed - indexed for MEDLINE]

278: Surg Laparosc Endosc Percutan Tech. 2007 Jun;17(3):179-83.

Outcome of percutaneous surgery stratified according to body mass index and
kidney stone size.

Sergeyev I, Koi PT, Jacobs SL, Godelman A, Hoenig DM.

Departments of Urologic Surgery and Radiology, Albert Einstein College of
Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.

OBJECTIVE: To stratify outcome and morbidity of percutaneous nephrostolithotomy
(PCNL) with regard to body mass index (BMI) and kidney stone burden. METHODS: The
charts of 148 patients who underwent PCNL procedures were reviewed
retrospectively. Hospital stay, blood loss, maximal temperature during inpatient 
stay, and stone-free outcomes were evaluated. Patients were divided into 3 groups
depending on their BMIs: <25 kg/m, 25 to 29.9 kg/m, and >30 kg/m. Kidney stone
burden was measured in terms of square area in millimeters, as measured by
retrospective review of computerized tomography scans. Preoperative computerized 
tomography scan for measurement of stone burden was available for only 85
patients who are included in the study. Analysis of variance for a single
variable was performed with regard to the values of the hospital stay,
postoperative maximal temperature, and hemoglobin change. RESULTS: Of the 85
patients, 37 (43.5%) were obese or morbidly obese (BMI, >30 kg/m), 33 (38.8%)
were overweight (BMI, 25 to 29.9 kg/m), and 15 (17.7%) were within or below their
ideal weight (BMI, <25 kg/m). No statistically significant difference among the 3
groups was seen for stone-free rate, postoperative fever, or change in hemoglobin
when stratified by BMI alone or by BMI and kidney stone burden. However,
significantly longer length of stay for the group with BMI <25 kg/m was observed 
when stratifying either by BMI alone (P=0.01) or by BMI and kidney stone burden
(P=0.03). CONCLUSIONS: In this retrospective review of patients with kidney
stones undergoing PCNL, the stone-free outcome and associated morbidity of PCNL
(except for the length of hospital stay) is independent of both patients' BMI and
stone burden when stratifying by commonly defined parameters.

PMID: 17581461 [PubMed - indexed for MEDLINE]

279: JSLS. 2006 Oct-Dec;10(4):504-6.

Conservative management of a splenic injury related to percutaneous
nephrostolithotomy.

Carey RI, Siddiq FM, Guerra J, Bird VG.

University of Miami, Department of Urology, Miami, Florida, USA.

INTRODUCTION: Injury to intraperitoneal organs is unusual during percutaneous
renal surgery. We report a splenic injury during upper pole percutaneous renal
access for nephrostolithotomy that was managed conservatively. METHODS: A
52-year-old male with left upper pole renal stones associated with a narrow upper
pole infundibulum underwent upper pole renal access prior to percutaneous
nephrostolithotomy (PCNL). The access was performed in the 10th to 11th
intercostal space, and the patient underwent PCNL with stone clearance. Plain
film radiography after percutaneous access and PCNL revealed no pneumothorax or
hydrothorax. The patient was discharged on postoperative day one with the
nephrostomy tube in place. RESULTS: On postoperative day 5, the patient was
evaluated for persistent flank pain and bleeding from the nephrostomy tube.
Computerized tomography revealed a transsplenic percutaneous renal access. The
patient was admitted to the hospital, and the general surgery service was
consulted. The patient was placed on strict bedrest. His hematocrit was within
normal limits and remained stable. The nephrostomy tube was kept in place for 2
weeks. A pullback nephrostogram revealed no perirenal leak, and no evidence was
present of acute bleeding. Follow-up computerized tomography on the same day
revealed no evidence of acute bleeding. The patient was discharged without
further complications and remains stone free at 1-year follow-up. CONCLUSIONS: A 
transsplenic renal access that was dilated and through which a successful left
percutaneous nephrostolithotomy was performed is a highly unusual complication
related to upper pole left renal access. We were able to manage this complication
with conservative measures.

Publication Types: 
    Case Reports

PMID: 17575767 [PubMed - indexed for MEDLINE]

280: J Urol. 2007 Jul;178(1):15-23. Epub 2007 May 11.

Techniques for fluoroscopic percutaneous renal access.

Miller NL, Matlaga BR, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine and International Kidney Stone Institute, Indianapolis, Indiana
46202, USA.

PURPOSE: Percutaneous nephrolithotomy has undergone considerable evolution since 
its introduction in the 1970s, which has been driven by advances in access
techniques, instrumentation and endoscopic technology. Recent reports suggest an 
increase in the number of percutaneous stone treatments being performed. However,
despite the increasing use of percutaneous nephrolithotomy a minority of
urologists obtain their own access. We reviewed the techniques for performing
safe and effective percutaneous renal access. MATERIALS AND METHODS: A literature
search using Entrez PubMed was performed. All relevant literature concerning
techniques for fluoroscopic percutaneous renal access published within the last
20 years was reviewed. RESULTS: The success of percutaneous nephrolithotomy is
critically dependent on achieving suitable percutaneous access. The ideal site of
percutaneous puncture should be selected to maximize the use of rigid
instruments, minimize the risk of complications and attain stone-free status.
Familiarity with basic renal anatomy is essential to obtain access safely.
Adherence to basic principles allows the establishment of percutaneous access in 
a straightforward and efficient manner. Certain clinical situations may require
special access techniques. CONCLUSIONS: Percutaneous nephrolithotomy is the
treatment of choice for complex stone disease. While the efficacy of percutaneous
nephrolithotomy relies on the establishment of effective percutaneous access,
there are considerable advantages for the urologist able to achieve access.

Publication Types: 
    Review

PMID: 17574053 [PubMed - indexed for MEDLINE]

281: Urology. 2007 Jun;69(6):1013-6.

Comparison between lemonade and potassium citrate and impact on urine pH and
24-hour urine parameters in patients with kidney stone formation.

Koff SG, Paquette EL, Cullen J, Gancarczyk KK, Tucciarone PR, Schenkman NS.

Department of Surgery, Urology Service, Walter Reed Army Medical Center,
Washington, DC 20307-5001, USA. stacey.koff@na.amedd.army.mil

OBJECTIVES: The past few decades have been notable for advances in minimally
invasive techniques to treat kidney stones. Despite successful surgical
management of calculi, the impact of diet on stone disease prevention remains an 
important factor. Dietary modifications can be applied to prevent stone
recurrence in an economical manner that is acceptable to patients. Lemonade has
been studied in the past and found to increase urinary citrate levels in small
groups of patients. The present study examined the effect of lemonade intake on a
change in urinary pH and improvement of urinary stone risk factors compared with 
potassium citrate treatment. METHODS: A total of 21 stone-forming patients were
treated with lemonade therapy and potassium citrate supplementation in a
prospective cross-over trial. we performed 24-hour urine collections at baseline 
and with each treatment arm. the results between the two groups were examined to 
determine whether differences existed in the urinary stone risk factors. RESULTS:
Potassium citrate, but not lemonade, improved citrate levels and urinary ph to a 
significant degree. patients taking potassium citrate had a significantly
decreased urine volume compared with their urine volume drinking lemonade.
neither lemonade nor potassium citrate affected the uric acid levels to a
significant degree. CONCLUSIONS: The results of our study have shown that
lemonade did not provide improvements in urinary citrate or pH levels but did
assist patients in maintaining urine output compared with potassium citrate
therapy.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 17572176 [PubMed - indexed for MEDLINE]

282: J Pak Med Assoc. 2007 May;57(5):222-5.

Percutaneous nephrolithotomy (PCNL) in horse shoe kidneys.

Razvi S, Zaidi Z.

The Kidney Centre Postgraduate Training Institute, Karachi.

OBJECTIVE: To review our experience of PCNL in horse shoe kidneys. METHODS:
Between June 2001 and January 2005 we performed PCNL in 16 Horse shoe kidneys in 
14 patients with calculi, 2 patients had bilateral calculi. Percutaneous puncture
was made with patient in prone position. Their ages ranged between 4 to 52 years 
with a mean age of 26.3 years. Our mean stone burden was 820 mm2 (range 40-1370
mm2). PCNL access tract was made in upper pole of the kidney in 13 (80%) while 3 
(20%) had mid-pole access. RESULTS: Stone clearance after primary PCNL was
achieved in 12 kidneys. Of the remaining 4 kidneys, 2 underwent re-look PCNL via 
the same tract and one more kidney was rendered stone free, while the other had
an insignificant residue of 3mm. Hence we achieved a stone clearance rate of 81% 
after primary and secondary PCNL. Further 2 kidneys underwent single session ESWL
for residual stones and became stone free improving our complete stone clearance 
rate after auxiliary procedure to 93.7%. Mean hospital stay for these patients
was 3.8 days (range 3-10 days). Follow up available for these HSK patients with
PCNL was 11 to 49 months with a mean follow up of 29.1 months. Complications were
seen in 3 (21%) patients who developed transient post operative pyrexia and 1
(7%) patient presented on the 18th post operative day with a stone fragment in
ureter and leakage from PCNL site. He was managed by ureteric catheterization for
48 hours when he passed the fragment spontaneously and became dry. None of our
patients developed post PCNL bleeding or wound infection. CONCLUSION: PCNL in
horse shoe kidneys is no more difficult than normal kidneys and does not carry a 
greater risk than reported for normal kidneys. This effective modality resulted
in almost 93% stone clearance with minimal complications.

PMID: 17571475 [PubMed - indexed for MEDLINE]

283: Urol Res. 2007 Aug;35(4):201-6. Epub 2007 Jun 13.

CT visible internal stone structure, but not Hounsfield unit value, of calcium
oxalate monohydrate (COM) calculi predicts lithotripsy fragility in vitro.

Zarse CA, Hameed TA, Jackson ME, Pishchalnikov YA, Lingeman JE, McAteer JA,
Williams JC Jr.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
635 Barnhill Drive, Indianapolis, IN 46202, USA.

Calcium oxalate monohydrate (COM) stones are often resistant to breakage using
shock wave (SW) lithotripsy. It would be useful to identify by computed
tomography (CT) those COM stones that are susceptible to SW's. For this study, 47
COM stones (4-10 mm in diameter) were scanned with micro CT to verify composition
and also for assessment of heterogeneity (presence of pronounced lobulation,
voids, or apatite inclusions) by blinded observers. Stones were then placed in
water and scanned using 64-channel helical CT. As with micro CT, heterogeneity
was assessed by blinded observers, using high-bone viewing windows. Then stones
were broken in a lithotripter (Dornier Doli-50) over 2 mm mesh, and SW's counted.
Results showed that classification of stones using micro CT was highly repeatable
among observers (kappa = 0.81), and also predictive of stone fragility. Stones
graded as homogeneous required 1,874 +/- 821 SW/g for comminution, while stones
with visible structure required half as many SW/g, 912 +/- 678. Similarly, when
stones were graded by appearance on helical CT, classification was repeatable
(kappa = 0.40), and homogeneous stones required more SW's for comminution than
did heterogeneous stones (1,702 +/- 993 SW/g, compared to 907 +/- 773). Stone
fragility normalized to stone size did not correlate with Hounsfield units (P =
0.85). In conclusion, COM stones of homogeneous structure require almost twice as
many SW's to comminute than stones of similar mineral composition that exhibit
internal structural features that are visible by CT. This suggests that stone
fragility in patients could be predicted using pre-treatment CT imaging. The
findings also show that Hounsfield unit values of COM stones did not correlate
with stone fragility. Thus, it is stone morphology, rather than X-ray
attenuation, which correlates with fragility to SW's in this common stone type.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17565491 [PubMed - indexed for MEDLINE]

284: Vet Rec. 2007 Jun 9;160(23):787-94.

Radiographic signs of renal disease in rabbits.

Harcourt-Brown F.

The radiological features of 65 rabbits with suspected renal disease are
reviewed. The radiological features included a generalised increase in bone
opacity (osteosclerosis), renomegaly, nephroliths, ureteroliths and soft tissue
mineralisation. One or more of these changes were present on radiographs of 57 of
the 65 rabbits. Renal disease was suspected because of the clinical signs and the
presence of kidney stones and/or high blood concentrations of urea and
creatinine. Significant renal disease was confirmed in 14 cases that were
examined postmortem. Blood urea and creatinine concentrations were measured in 47
cases but not all the rabbits had high levels of both. Blood calcium
concentration was high in 33 of the 38 rabbits in which it was measured. Serum
phosphate was high in 17 and low in five of 34 rabbits in which it was measured. 
Hyperphosphataemia was associated with generalised osteosclerosis and aortic
calcification. Rabbits with osteosclerosis were thin, depressed and unwilling to 
move. Thirty-eight of 41 rabbits that were tested were seropositive for
antibodies to Encephalitozoon cuniculi. Histological lesions suggestive of E
cuniculi infection were found in all 13 cases that were examined postmortem,
although the organisms were visible in only one case.

PMID: 17558026 [PubMed - indexed for MEDLINE]

285: BJU Int. 2007 Jul;100(1):151-6.

Management of calyceal diverticular stones with extracorporeal shock wave
lithotripsy and percutaneous nephrolithotomy: long-term outcome.

Turna B, Raza A, Moussa S, Smith G, Tolley DA.

Department of Urology and Scottish Lithotriptor Centre, Western General Hospital,
Edinburgh, UK. burakturna@gmail.com

OBJECTIVE: To review patients with an extended follow-up after extracorporeal
shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) for calyceal
diverticular stones (CDS), over a 15-year period, assessing the long-term
outcome. PATIENTS AND METHODS: In all, 56 patients were treated for symptomatic
CDS disease by ESWL (38) or PCNL (18). The stone-bearing diverticula were in the 
upper calyces in 26, middle calyces in 24 and lower calyces in six patients, and 
in the right kidney in 22 and in the left in 34. The most frequent symptom was
ipsilateral flank pain (84%) and 32% of patients presented with associated
chronic urinary tract infections. In a retrospective analysis, we assessed stone 
size, diverticulum location, stone-free rate, symptom-free rate, complications
and extended follow-up. RESULTS: In the short-term in the ESWL group, 21% of
patients were stone-free and 61% were asymptomatic; 8% developed symptoms and 8% 
developed recurrence or stone-growth in the long term. There were six minor
complications. In the PCNL group, 15 patients (83%) were stone-free in the short 
term; two had a recurrence (11%) and two had stone growth (11) in the long term. 
There were three complications after PCNL. CONCLUSIONS: This series shows that
PCNL is an effective and durable means of treating CDS, regardless of stone size 
or location of the diverticulum. Despite low stone-free rates with ESWL, most
patients were rendered symptom-free with minimal complications. The long-term
recurrence rates, 8% for ESWL and 11% for PCNL, were comparable.

PMID: 17552962 [PubMed - indexed for MEDLINE]

286: BJU Int. 2007 Oct;100(4):891-7. Epub 2007 Jun 6.

Naturally produced crystals obtained from kidney stones are less injurious to
renal tubular epithelial cells than synthetic crystals.

Escobar C, Byer KJ, Khan SR.

Department of Pathology, College of Medicine, University of Florida, Gainesville,
Florida, USA.

OBJECTIVE: To determine the differences in cell responses to synthetic and
biological crystals of calcium oxalate (CaOx) and brushite MATERIALS AND METHODS:
Nephrolithiasis depends on crystal retention within the kidneys, often promoted
by crystal attachment to the injured renal epithelium; studies often use various 
crystals that might be injurious to cells and cause the exposure of crystal
binding molecules on cell surfaces, thus promoting crystal attachment and
retention. The synthetic crystals used in these studies might be more injurious
than the biological crystals naturally produced in the kidneys and that form
kidney stones. We exposed the renal epithelial cell line NRK 52E in vitro to CaOx
or brushite crystals at 67 or 133 microg/cm(2) for 3 or 6 h. Synthetic crystals
were purchased and the biocrystals were obtained by pulverizing CaOx and brushite
stones. We determined the release of lactate dehydrogenase (LDH), hydrogen
peroxide (H(2)O(2)) and 8-isoprostane (8-IP), and monocyte chemoattractant
protein-1 (MCP-1), as markers of injury, oxidative stress and inflammation,
respectively. Cells were also examined after trypan blue staining to determine
their membrane integrity. We also examined crystals of CaOx by scanning electron 
microscopy both in the native state as well as after decalcification. RESULTS:
Exposure to both the synthetic and biological crystals resulted in a significant 
increase in LDH release and trypan blue staining, as a sign of crystal-induced
injury. There was increased production of H(2)O(2) and 8-IP, suggesting the
development of oxidative stress. In addition MCP-1 production was also
significantly increased. However, the synthetic crystals caused significantly
higher increases in all the indicators than the biological crystals. CONCLUSIONS:
These results indicate that even though both synthetic and naturally produced
biocrystals invoke a response from the renal epithelial cells, the latter are
significantly less injurious and inflammatory. Exposure to low concentrations of 
these crystals alone might not invoke an inflammatory response, cause the
uncovering of crystal binding molecules on epithelial cell surfaces, and promote 
crystal attachment and retention.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17550416 [PubMed - indexed for MEDLINE]

287: BJU Int. 2007 Nov;100(5):1137-41. Epub 2007 Jun 5.

A new transportable shock-wave lithotripsy machine for managing urinary stones: a
single-centre experience with a dual-focus lithotripter.

De Sio M, Autorino R, Quarto G, Mordente S, Giugliano F, Di Giacomo F, Neri F,
Quattrone C, Sorrentino D, De Domenico R, D'Armiento M.

Clinica Urologica, AOU Policlinico, Seconda Università degli Studi, Napoli,
Italy.

OBJECTIVE: To assess the efficacy and safety of a transportable extracorporeal
shock wave lithotripsy (ESWL) machine, the Modulith SLX-F2(TM) (Storz Medical
Italia, Rome, Italy), in the management of solitary urinary calculi. PATIENTS AND
METHODS: The study included 233 patients (mean age 51 years; 172 male, 61 female)
with symptomatic solitary renal (group A, 170, mean diameter 15.5 mm) or ureteric
stones (group B, 63, mean diameter 9.5 mm) treated in a tertiary care
institution. Exclusion criteria for the analysis were: pelvi-ureteric junction
obstruction, multiple stones, stone diameter >2 cm, stones in a lower calyx with 
unfavourable anatomy, active infection, or impacted ureteric stones. Selected
patients had ureteric stenting before treatment, and all patients were treated
with no anaesthesia. Hospitalization, complications and subsequent auxiliary
procedures were evaluated. Patients were assessed after a single ESWL session and
after 3 months by a plain abdominal film and renal ultrasonography. Stone-free
status was defined as no evidence of calculi, and clinical success as the
presence of stone fragments of <4 mm. An efficiency quotient (EQ) was calculated 
for the ESWL treatment. Pain was assessed using a visual analogue scale. RESULTS:
The mean number of shocks used was 3779 and the mean (range) treatment time was
35 (5-55) min. The overall clinical success rate after one ESWL session was 83.7%
and 82.5% for renal and ureteric stones, respectively, and the overall 3-month
stone-free rate was 77% and 74.6%, respectively; the overall EQ was 0.64. When
risk factors for persistent calculi were analysed simultaneously in a logistic
regression model, only stones of >1 cm were statistically significant (P < 0.05).
Most patients reported that pain during ESWL was mild to moderate and easily
tolerated. Only minor complications occurred, with an overall complication rate
of 3.8%. CONCLUSIONS: This transportable lithotripter is a safe and effective
device for managing solitary stones throughout the urinary tract. Its main
advantage is represented by the dual-focus system. Moreover, it shares with other
contemporary machines several important features such as outpatient setting, no
need for anaesthesia, easy patient positioning, and the capability of ancillary
procedures.

Publication Types: 
    Evaluation Studies

PMID: 17550410 [PubMed - indexed for MEDLINE]

288: World J Urol. 2007 Aug;25(4):415-21. Epub 2007 May 25.

Type of renal calculi: variation with age and sex.

Costa-Bauzá A, Ramis M, Montesinos V, Grases F, Conte A, Pizá P, Pieras E, Grases
F.

Laboratory of Renal Lithiasis Research, Faculty of Sciences, Universitary
Institute of Health Sciences Research (IUNICS), University of Balearic Islands,
07122 Palma de Mallorca, Spain.

The aim of this paper is to study the variations in the percentage of the
different types of renal stones with age and sex. Renal calculi were classified
according to their composition and structure. Stone formers were divided
according to age and sex, and the percentage of each kind of calculi in the
different considered age periods for men and women were determined. It was found 
that calcium oxalate dihydrate calculi decreased with age, but only in men. These
calculi were also clearly predominant in men. Hydroxyapatite calculi decreased
with age in both men and women, but they were predominant in women. Uric acid
calculi increased with age in both men and women, but were predominant in men.
Finally, it was found that calcium oxalate monohydrate unattached calculi
increased with age in both men and women. As a main novelty, the study here
presented demonstrates the importance of distinguishing between calcium oxalate
monohydrate papillary stones and calcium oxalate monohydrate unattached stones,
since the etiologic factors responsible for their origin must be clearly
different.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17525848 [PubMed - indexed for MEDLINE]

289: J Endourol. 2007 May;21(5):545-50.

A biological model to teach percutaneous nephrolithotomy technique with
ultrasound- and fluoroscopy-guided access.

Häcker A, Wendt-Nordahl G, Honeck P, Michel MS, Alken P, Knoll T.

Department of Urology, University Hospital Mannheim, Ruprecht-Karls University of
Heidelberg, Germany. axel.haecker@chir.ma.uni-heidelberg.de

PURPOSE: To develop a training model for simulated percutaneous nephrolithotomy
(PCNL) under ultrasound and fluoroscopy-guided access. MATERIALS AND METHODS: The
laboratory model for PCNL described by Hammond and associates (J Urol
2004;172:1950-1952) was modified. We used an ex-vivo perfused porcine kidney
(freshly removed after commercial slaughtering), a chicken carcass (supermarket),
as well as the standard equipment for PCNL. For imaging, ultrasound (7.5 MHz) and
a fluoroscopy unit are necessary. Artificial stone material is implanted in the
renal pelvis. The ureter is cannulated for retrograde pyelography and the renal
artery and vein for continuous perfusion. The perfused kidney surrounded by
ultrasound gel is placed in the eviscerated chicken carcass. RESULTS: The model
is low cost and simple to set up, with a preparation time of about 15 minutes.
The equipment used in clinical practice can be employed for renal access, tract
dilation, nephroscopy, stone disintegration, and stone removal. Imaging is
feasible under fluoroscopic and ultrasound guidance. CONCLUSIONS: This biological
training model simulates realistically the clinical procedure of PCNL under
ultrasound and fluoroscopic guidance. Teaching and skill acquisition are
practicable.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17523912 [PubMed - indexed for MEDLINE]

290: J Endourol. 2007 May;21(5):530-2.

Case report: intrarenal arteriovenous fistula after ureteroscopic stone
extraction with holmium laser lithotripsy.

Tiplitsky SI, Milhoua PM, Patel MB, Minsky L, Hoenig DM.

Department of Urology, Montefiore Medical Center, Bronx, New York 10467, USA.
stiplits@montefiore.org

A 79-year-old woman presented with gross hematuria 10 days after flexible
ureteroscopic stone extraction with holmium laser lithotripsy. Work-up revealed a
bleeding intrarenal arteriovenous fistula that was embolized. To our knowledge,
this is the first report of this complication causing delayed hematuria after
ureterorenoscopy.

Publication Types: 
    Case Reports

PMID: 17523908 [PubMed - indexed for MEDLINE]

291: J Endourol. 2007 May;21(5):520-4.

Percutaneous nephrolithotomy in patients with kidney malformations.

Mosavi-Bahar SH, Amirzargar MA, Rahnavardi M, Moghaddam SM, Babbolhavaeji H,
Amirhasani S.

Department of Urology, Ekbatan Hospital, Hamadan University of Medical Sciences, 
Hamadan, Iran.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) for complex calculi
within malformed kidneys can be challenging because of the abnormal anatomy. We
present our 7-year experience with PCNL in such patients. PATIENTS AND METHODS:
We performed PCNL on 16 patients with complex calculi and anomalous kidneys,
including 7 with horseshoe kidneys, 5 with rotation anomalies, 3 with ectopic
kidneys, and 1 with a small kidney. After appropriate preoperative evaluation,
the procedure was performed by choosing either anterior or posterior approaches
depending on the kidney anomaly. When required, ultrasonography, laparoscopy, or 
both were used, as well as fluoroscopy to control the procedures. RESULTS: A
single-stage PCNL resulted in complete clearance in 13 patients (81%). A
second-look procedure, alone or followed by shockwave lithotripsy, conferred
stone clearance in one patient with a malrotated kidney and two with staghorn
calculi in horseshoe kidneys. More than one tract was needed in two patients. The
procedure was guided by laparoscopy in two patients with calculi in ectopic left 
kidneys. Serious complications were not encountered. CONCLUSION: Patients with
malformed kidneys and complex calculi can be managed safely and effectively with 
PCNL when they are properly selected and appropriately assessed before operation.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 17523906 [PubMed - indexed for MEDLINE]

292: J Endourol. 2007 May;21(5):515-9.

Quality of life after percutaneous nephrolithotomy for caliceal diverticulum and 
secluded lower-pole renal stones.

Staios D, Andrews HO, Shaik T, Buchholz NN.

Endourology & Stone Service, Department of Urology, Barts & The London NHS Trust 
London, UK.

BACKGROUND AND PURPOSE: The treatment of caliceal diverticulum and deeply
secluded lower-pole stones is challenging, and the indications are controversial.
This study assessed the changes in the quality of life (QoL) of patients
undergoing percutaneous nephrolithotomy (PCNL) for symptomatic caliceal
diverticula and deep lower-pole calculi to determine whether there is a change in
the "bother factor" in order to improve treatment strategies for this group of
patients. PATIENTS AND METHODS: Twenty-two patients undergoing PCNL were
evaluated prospectively using the SF36 QoL questionnaire before and 6 weeks after
PCNL. The results before and after PCNL were compared individually and by group
and analyzed statistically. A P value <or=0.05 was considered significant.
RESULTS: Most (87%) of the patients were completely stone free after the
procedure. Significant QoL findings were a reduction in symptoms interfering with
performance at work (40%) and improved general health (33%). Although there was
an overall improvement in QoL across the entire group, this reached statistical
significance for only two of the seven domains of the questionnaire. CONCLUSIONS:
In spite of a high stone-free rate, fewer than half of patients benefited
subjectively from the procedure in terms of improvement of QoL. Therefore,
patients should be made aware of the limited impact of surgical treatment on QoL,
and asymptomatic patients can be given the option of further watchful waiting.

PMID: 17523905 [PubMed - indexed for MEDLINE]

293: J Endourol. 2007 May;21(5):508-14.

Simultaneous bilateral percutaneous nephrolithotomy: a single-center experience.

Desai M, Grover R, Manohar T, Ganpule A.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
mrdesai@mpuh.org

PURPOSE: To evaluate the safety and efficacy of simultaneous bilateral
percutaneous nephrolithotomy (SBPCNL) for bilateral renal calculus disease.
PATIENTS AND METHODS: A retrospective study was conducted from June 1996 to
February 2006 involving 38 male and 7 female patients with a mean age of 44 years
(range 5-73 years) with 90 affected renal units who underwent SBPCNL under
general anesthesia. Those patients with established nephrostomy tracts were
excluded from the study group. RESULTS: The average duration of the procedure was
107 +/- 43 minutes (range 60-220 minutes). The average drop in hemoglobin was 2
+/- 1.2 g/dL (range 0.3-5.6 g/dL), with 3 patients (7%) requiring blood
transfusion. In 87% of patients, a single stage was performed on both sides,
while 13% required two stages on one side. A single tract was on both sides
utilized in 78%, while 22% of the patients required two tracts on one side. None 
required two tracts on both sides or more than one stage on both sides. The
stone-clearance rate was 96%. The average hospital stay was 6 days. Complications
consisted of renal-pelvic perforation in two patients and transient pyrexia in
five. Three patients had persistent urine leak on one side, of which two stopped 
spontaneously and one necessitated ureteral stenting. CONCLUSION: Simultaneous
bilateral PCNL is a safe procedure and can be used effectively in adults as well 
as in children. In addition to being cost effective, it involves only a single
anesthesia with a shorter hospital stay and faster convalescence. However,
patients with a large stone burden or complex pelvicaliceal anatomy should not be
selected for SBPCNL.

PMID: 17523904 [PubMed - indexed for MEDLINE]

294: J Endourol. 2007 May;21(5):494-8.

The Medstone fixed, mobile, and modular configurations: impact on efficacy.

Nicholson A, Lee C, Ugarte R, Best S, Monga M.

Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
55455-0392, USA.

PURPOSE: To evaluate the efficacy of three lithotripter configurations that
utilize the Medstone STS treatment head. PATIENTS AND METHODS: From 1999 through 
2002, 13,131 patients were treated with the Medstone STS fixedsite unit (STS-FIX;
52%), the mobile coach-transportable unit (STS-MOB; 26%), or the modular
operating-room unit (STS-T; 22%). All units were staffed by a rotating schedule
of the same ten SWL-certified radiological technicians. The treating urologists
reported follow-up that included plain abdominal radiography to document
stone-free rate (no residual fragments) and the need for auxiliary procedures or 
re-treatment. An efficiency quotient (EQ) was calculated for each unit. RESULTS: 
The overall stone-free rate for the STS-FIX, STS-MOB, and the STS-T was 59%, 62%,
and 65%, respectively. The STS-FIX had the lowest stone-free rate for lower-pole 
stones (48%) and stones 21 mm to 30 mm (30%) compared with the STS-MOB (57% and
62%, respectively) and the STS-T (59% and 54%, respectively). However, the
STS-FIX had a higher stone-free rate in the middle ureter (86%) than the STS-T
(67%) and STS-MOB (65%). The STS-FIX required more post-SWL procedures overall
(12%) than the STSMOB (4%) and STS-T (5%). The re-treatment rates for the
STS-FIX, STS-MOB, and STS-T were 7%, 6%, and 6%, respectively. The STS-T had the 
highest overall EQ (59) followed by the STS-MOB (56) and the STSFIX (50).
CONCLUSIONS: New configurations of the STS lithotripter have a significant
positive impact on efficacy compared with the original fixed machine.
Availability of real-time fluoroscopy with the STS-T may impact the higher EQ of 
this machine.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 17523901 [PubMed - indexed for MEDLINE]

295: J Endourol. 2007 May;21(5):490-3.

Impact of renal function on efficacy of extracorporeal shockwave lithotripsy.

Lee C, Ugarte R, Best S, Monga M.

Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
55455, USA.

BACKGROUND AND PURPOSE: Adequate urine production and excretion may be important 
for clearance of stone fragments after extracorporeal shockwave lithotripsy
(SWL). This study evaluated the impact of renal function, measured by
preoperative serum creatinine concentration, on the efficacy of SWL. PATIENTS AND
METHODS: From 1986 to 2001, 27,299 patients with urolithiasis were treated with
Medstone STS lithotripters. Seven hundred ninety-eight of these patients (2.92%) 
had serum creatinine concentrations >or=2.0 mg/dL. Perioperative renal function
(serum creatinine), treatment parameters, stone-free success rate (no residual
fragments on plain film), and perioperative complications and procedures were
recorded. RESULTS: The stone-free rate for patients with serum creatinine values 
from 2.0 to 2.9 mg/dL (56.69%) was significantly less than that seen in patients 
with a creatinine concentration <2.0 mg/dL (66.20%). The retreatment rate and
secondary-procedure rate were significantly higher in patients with higher serum 
creatinine values (9.62% and 8.92%, respectively) than in those with serum
creatinine within the normal range (6.07% and 4.27%, respectively). There was no 
significant difference in the stone-free rate, re-treatment rate, and
secondary-procedure rate of patients with serum creatinine >or=3.0 mg/dL in
comparison with patients with values <2 mg/dL. Complication rates were higher for
patients with serum creatinine values >4.0 mg/dL (10.91%) than for patients with 
creatinine <2.0 mg/dL (2.62%). CONCLUSIONS: The efficacy of SWL is decreased in
patients with serum creatinine concentrations of 2.0 to 2.9 mg/dL, and the
complication rate is higher in patients with serum creatinine >4.0 mg/dL.
Preoperative counseling may include a discussion of the impact of renal
insufficiency on success and complication rates associated with SWL.

PMID: 17523900 [PubMed - indexed for MEDLINE]

296: J Endourol. 2007 May;21(5):460-5.

Aid to percutaneous renal access by virtual projection of the ultrasound puncture
tract onto fluoroscopic images.

Mozer P, Conort P, Leroy A, Baumann M, Payan Y, Troccaz J, Chartier-Kastler E,
Richard F.

Service d'Urologie, Groupe Hospitalier Pitié-Salpétrière, Paris, France.
pierre.mozer@psl.aphp.fr

BACKGROUND AND PURPOSE: Percutaneous renal access in the context of percutaneous 
nephrolithotomy (PCNL) is a difficult technique, requiring rapid and precise
access to a particular calix. We present a computerized system designed to
improve percutaneous renal access by projecting the ultrasound puncture tract
onto fluoroscopic images. MATERIALS AND METHODS: The system consists of a
computer and a localizer allowing spatial localization of the position of the
various instruments. Without any human intervention, the ultrasound nephrostomy
tract is superimposed in real time onto fluoroscopic images acquired in various
views. RESULTS: We tested our approach by laboratory experiments on a phantom.
Also, after approval by our institution's Ethics Committee, we validated this
technique in the operating room during PCNL in one patient. CONCLUSION: Our
system is reliable, and the absence of image-processing procedures makes it
robust. We have initiated a prospective study to validate this technique both for
PCNL specialists and as a learning tool.

Publication Types: 
    Evaluation Studies
    Validation Studies

PMID: 17523896 [PubMed - indexed for MEDLINE]

297: Expert Opin Pharmacother. 2007 Jun;8(8):1117-25.

Medical management of urinary stone disease.

Park S.

Department of Urology, University of Washington Medical Center, 1959 NE Pacific
Ave., Box 356510, Seattle, WA 98195, USA. spark1@u.washington.edu

Kidney stones occur in approximately 10% of patients in their lifetimes, and > 10
crystal types have been reported in the literature. After treatment, a subset of 
these patients will have recurrent calculi, leading to significant morbidity and 
potential for serious chronic renal disease. Detailed metabolic evaluation is
indicated in patients at high risk for stone recurrence, as a reversible
metabolic abnormality can be identified in > 90% of them. Once the patient's
underlying physicochemical and physiologic derangements are defined, targeted
medical therapy can be initiated in order to prevent growth of pre-existing
stones and new stone formation. In this report, the author provides a
comprehensive review of the presently available selective and nonselective
pharmacologic treatments for stones. Several exciting investigational
pharmaceutical agents for kidney stone prevention are also discussed. Although
many of these agents are effective, there remain clinical scenarios in which
existing medicines are insufficient.

Publication Types: 
    Review

PMID: 17516875 [PubMed - indexed for MEDLINE]

298: Aviat Space Environ Med. 2007 Apr;78(4 Suppl):A9-13.

Renal stone formation among astronauts.

Pietrzyk RA, Jones JA, Sams CF, Whitson PA.

Wyle Laboratories , Houston, TX, USA.

INTRODUCTION: With the continued construction of the International Space Station,
humans are living longer in the microgravity environment of space. However, many 
questions still exist as to the physiological effects of spaceflight on the human
body. Bone loss, cardiovascular changes, and muscle atrophy are well-documented
health risks to humans during spaceflight. Another potential serious health
complication is the development of renal stones. The development of a renal stone
may not only impact the health of the crewmember, but also the success of the
mission. METHODS: A retrospective analysis of astronaut data from 24-h urine
samples collected prior to launch and immediately after landing was performed.
Urine characteristics associated with renal stone formation were analyzed and the
relative injury supersaturations of stone-forming constituents calculated.
RESULTS: In the current study, previously collected data to identify urinary
factors associated with renal stone formation demonstrated an increased risk in
astronauts who had actually formed a renal stone. Increased urinary
supersaturation of the stone-forming salts was observed in those astronauts who
formed renal stones. Similar changes in urinary supersaturation were noted among 
many astronauts after landing, indicating an increased postflight risk for stone 
formation. CONCLUSIONS: An assessment program should be undertaken to identify
and evaluate astronauts with elevated risk factors prior to flight and
immediately following landing. Individualized recommendations can be prescribed
to astronauts and may include dietary changes, increased fluid intake, or
medications to minimize the risk of stone formation.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17511294 [PubMed - indexed for MEDLINE]

299: J Urol. 2007 Jun;177(6):2361-5.

A polymorphism of matrix Gla protein gene is associated with kidney stones.

Gao B, Yasui T, Itoh Y, Tozawa K, Hayashi Y, Kohri K.

Department of Nephro-urology, Nagoya City University Graduate School of Medical
Sciences, 1 Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan.

PURPOSE: Matrix Gla protein, a potent calcification inhibitor in arterial
vessels, is also expressed in the kidney and is up-regulated following the
administration of ethylene glycol, a precursor of oxalate. Considering the
analogous characteristics between arterial calcification and kidney stones, we
identified variants of the human matrix Gla protein gene and investigated whether
there is an association between MGP genetic polymorphisms and kidney stones.
MATERIALS AND METHODS: We studied single nucleotide polymorphisms in matrix Gla
protein in 122 kidney stone cases and 125 controls. We resequenced the human
genomic MGP gene, including the 1,000 bp promoter 5'-untranslated region, 4 exons
and 3'-untranslated regions, and we performed systematic genetic analysis. A
single nucleotide polymorphism was genotyped using a fluorescent 5'endonuclease
assay and its association with kidney stones was analyzed. RESULTS: We observed
19 polymorphisms. A single nucleotide polymorphism was associated with kidney
stones (OR 0.51, 95% CI 0.30-0.87; p = 0.012). The G allele carrier had a 2-fold 
decreased kidney stone risk compared with A allele carriers in single nucleotide 
polymorphism 11 (OR 0.55, 95% CI 0.31-1.00, p = 0.047). We found no association
between the polymorphism and kidney stone clinical characteristics. CONCLUSIONS: 
Our findings show that an MGP gene polymorphism is associated with kidney stones 
and influences genetic susceptibility to kidney stones. In the future functional 
assays of the polymorphism should permit better understanding of the role of
matrix Gla protein genetic variants and kidney stones.

PMID: 17509359 [PubMed - indexed for MEDLINE]

300: J Urol. 2007 Jun;177(6):2306-9; discussion 2309-10.

Early results of robot assisted laparoscopic lithotomy in adolescents.

Lee RS, Passerotti CC, Cendron M, Estrada CR, Borer JG, Peters CA.

Department of Urology, Children's Hospital Boston, Boston, Massachusetts, USA.

PURPOSE: The treatment of large stone burdens in children is difficult and often 
requires multiple procedures using a combination of therapies. Recently,
laparoscopy has been shown to be effective in the management of larger stone
burdens. We report our experience with robot assisted laparoscopic lithotomy in
adolescents, and describe our technique. MATERIALS AND METHODS: We
retrospectively reviewed our experience with robot assisted laparoscopic
pyelolithotomy in 5 patients operated on between 2002 and 2005. Mean patient age 
at surgery was 16.6 years, and mean followup was 15.4 months. RESULTS: Cystine
was the etiology in 4 patients with staghorn stones. The remaining patient had
calcium oxalate stones and concurrent ureteropelvic junction obstruction. After
pyelotomy stones were removed by a robotic grasper or by a flexible cystoscope
introduced through a robotic port. One of the patients had an indwelling ureteral
stent placed preoperatively, while 4 had stents placed robotically
intraoperatively. Mean operative time was 315.4 minutes (range 165.0 to 462.0),
and mean estimated blood loss was 19.0 ml (0.0 to 50.0). Mean hospital stay was
3.8 days (range 2.3 to 5.7), and mean narcotic usage was 2.1 mg/kg morphine (1.5 
to 3.5). One patient with a cystine staghorn calculus required conversion to an
open procedure because of inability to remove the stone. Of the 4 cases completed
robotically 3 were rendered stone-free and 1 had a residual 6 mm lower pole
stone. CONCLUSIONS: The early results of robot assisted laparoscopic lithotomy
reveal that the procedure is safe and efficacious. Further prospective studies
comparing other minimally invasive procedures used for similar stone burdens are 
needed to determine the benefits of this procedure and its role in stone
management.

PMID: 17509345 [PubMed - indexed for MEDLINE]

301: J Urol. 2007 Jun;177(6):2189-92.

Prospective long-term followup of patients with asymptomatic lower pole caliceal 
stones.

Inci K, Sahin A, Islamoglu E, Eren MT, Bakkaloglu M, Ozen H.

Faculty of Medicine, Department of Urology, Hacettepe University, Sihhiye, Ankara
06100, Turkey. kuinci@hacettepe.edu.tr

PURPOSE: The intervention time of asymptomatic lower pole calculi remains
controversial. In this prospective study we evaluated the natural history and
progression rate of asymptomatic lower pole stones. MATERIALS AND METHODS:
Patients were followed every 6 months. Computerized tomography in even years,
ultrasound scan in odd years after initial visit and abdominal plain films
between these visits were evaluated. The largest diameter was measured for each
calculus and the cumulative diameter was calculated for cases of multiple stones.
Disease progression was defined as pain experienced during followup, stone growth
or the need for intervention. RESULTS: A total of 24 patients, 14 male and 10
female, were followed for a mean of 52.3 months (range 24 to 72). Of the 24
patients 3 had bilateral lower pole stones. Mean cumulative stone diameter at
presentation was 8.8 mm (range 2.0 to 26.0). Progression in stone size was
demonstrated in 9 of 27 renal units (33.3%) with 2 (11.1%) requiring
intervention. There was no need for intervention during the first 2 years of
followup. Three stones passed spontaneously without any symptoms. Pain developed 
in 3 patients during followup, and 2 of them passed a stone and responded to the 
analgesics without further treatment. None of the patients had a pyelonephritic
attack during followup. CONCLUSIONS: Our results showed that observation could be
considered for patients with asymptomatic lower pole stones. However, patients
should be counseled about the 33% disease progression and 11% intervention rates.

PMID: 17509315 [PubMed - indexed for MEDLINE]

302: J Urol. 2007 Jun;177(6):2185-8.

Is there a role for tamsulosin in shock wave lithotripsy for renal and ureteral
calculi?

Bhagat SK, Chacko NK, Kekre NS, Gopalakrishnan G, Antonisamy B, Devasia A.

Departments of Urology and Biostatistics, Christian Medical College, Ida Scudder 
Road, Vellore, Tamil Nadu 632004, India.

PURPOSE: We evaluated the effect of the alpha-blocker tamsulosin on stone
clearance, analgesic requirements and steinstrasse in shock wave lithotripsy for 
solitary renal and ureteral calculus. MATERIALS AND METHODS: A prospective,
double-blind, randomized placebo controlled study was performed during 1 year
involving 60 patients with a solitary renal or ureteral calculus undergoing shock
wave lithotripsy. The control group (30) received 0.4 mg tamsulosin and the study
group (30) received placebo daily until stone clearance or for a maximum of 30
days. An oral preparation of dextropropoxyphene hydrochloride and acetaminophen
was the analgesic used on an on-demand basis. The parameters assessed were stone 
size, position, clearance time, effect on steinstrasse and analgesic requirement.
RESULTS: The overall clearance rate was 96.6% (28 of 29) in the study group and
79.3% (23 of 29) in the control group (p = 0.04). With larger stones 11 to 24 mm 
the difference in the clearance rate was significant (p = 0.03) but not so with
the smaller stones 6 to 10 mm (p = 0.35). The average dose of analgesic used was 
lower with tamsulosin than with controls, without statistical significance.
Steinstrasse resolved spontaneously in the tamsulosin group whereas 25% (2 of 8) 
required intervention in the placebo group. There was no difference between the 2
groups with regard to age, stone size or location. CONCLUSIONS: The alpha-blocker
tamsulosin seemed to facilitate stone clearance, particularly with larger stones 
during shock wave lithotripsy for renal and ureteral calculus. It also appeared
to improve the outcome of steinstrasse. Tamsulosin may have a potential role in
routine shock wave lithotripsy.

Publication Types: 
    Randomized Controlled Trial

PMID: 17509314 [PubMed - indexed for MEDLINE]

303: J Urol. 2007 Jun;177(6):2179-84.

Reduction of renal stone risk by potassium-magnesium citrate during 5 weeks of
bed rest.

Zerwekh JE, Odvina CV, Wuermser LA, Pak CY.

Center for Mineral Metabolism and Clinical Research, and the Department of
Physical Medicine and Rehabilitation, University of Texas Southwestern Medical
Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
joseph.zerwekh@utsouthwestern.edu

PURPOSE: Exposure to the microgravity environment of space increases the risk of 
kidney stone formation, particularly for calcium oxalate and uric acid stones.
This study was performed to evaluate the efficacy of potassium alkali as
potassium-magnesium citrate in reducing renal stone risk and bone turnover.
MATERIALS AND METHODS: This study was performed as a double-blind, placebo
controlled trial. We studied 20 normocalciuric subjects randomized to either
placebo or potassium-magnesium citrate (42 mEq potassium, 21 mEq magnesium, 63
mEq citrate per day) before and during 5 weeks of strict bed rest. The study was 
performed in the General Clinical Research Center and under a controlled dietary 
regimen composed of 100 mEq of sodium, 800 mg of calcium, 0.8 gm/kg animal
protein and 2,200 kcal per day. Two 24-hour urine collections were obtained under
oil each week for assessment of stone risk parameters and relative saturation of 
calcium oxalate, brushite and undissociated uric acid. Blood was also collected
for determination of serum immunoreactive parathyroid hormone and vitamin D
metabolites. RESULTS: Bed rest promoted a rapid increase in urinary calcium
excretion of approximately 50 mg per day in both groups. Despite this increase
subjects treated with potassium-magnesium citrate demonstrated significant
decreases in the relative saturation of calcium oxalate and in the concentration 
of undissociated uric acid compared to placebo. Immunoreactive parathyroid
hormone, serum 1,25-dihydroxyvitamin D and intestinal calcium absorption all
decreased in both groups with no difference in response between the 2 treatment
arms. CONCLUSIONS: Provision of alkali as potassium-magnesium citrate is an
effective countermeasure for the increased risk of renal stone disease associated
with immobilization. Despite an increase in urine calcium concentration, the
relative saturation of calcium oxalate decreased due to citrate chelation of
calcium and the concentration of undissociated uric acid decreased due to the
significant increase in urine pH.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17509313 [PubMed - indexed for MEDLINE]

304: J Urol. 2007 Jul;178(1):314-9. Epub 2007 May 17.

Enhanced kidney stone fragmentation by short delay tandem conventional and
modified lithotriptor shock waves: a numerical analysis.

Tham LM, Lee HP, Lu C.

Institute of High Performance Computing, Singapore. thamlm@ihpc.a-star.edu.sg

PURPOSE: We evaluated the effectiveness of modified lithotriptor shock waves
using computer models. MATERIALS AND METHODS: Finite element models were used to 
simulate the propagation of lithotriptor shock waves in human renal calculi in
vivo. Kidney stones were assumed to be spherical, homogeneous, isotropic and
linearly elastic, and immersed in a continuum fluid. Single and tandem shock wave
pulses modified to intensify the collapse of cavitation bubbles near the stone
surface to increase fragmentation efficiency and suppress the expansion of
intraluminal bubbles for decreased vascular injury were analyzed. The
effectiveness of the modified shock waves was assessed by comparing the states of
loading in the renal calculi induced by these shock waves to those produced by
conventional shock waves. RESULTS: Our numerical simulations revealed that
modified shock waves produced marginally lower stresses in spherical renal
calculi than those produced by conventional shock waves. Tandem pulses of
conventional or modified shock waves produced peak stresses in the front and back
halves of the renal calculi. However, the single shock wave pulses generated
significant peak stresses in only the back halves of the renal calculi.
CONCLUSIONS: Our numerical simulations suggest that for direct stress wave
induced fragmentation modified shock waves should be as effective as conventional
shock waves for fragmenting kidney stones. Also, with a small interval of 20
microseconds between the pulses tandem pulse lithotripsy using modified or
conventional shock waves could be considerably more effective than single pulse
lithotripsy for fragmenting kidney stones.

PMID: 17499770 [PubMed - indexed for MEDLINE]

305: J Urol. 2007 Jul;178(1):160-4; discussion 164. Epub 2007 May 17.

Auricular acupressure as a treatment for anxiety before extracorporeal shock wave
lithotripsy in the elderly.

Mora B, Iannuzzi M, Lang T, Steinlechner B, Barker R, Dobrovits M, Wimmer C,
Kober A.

Department of Anesthesia and Intensive Care, Medical University of Vienna,
Vienna, Austria.

PURPOSE: Auricular acupuncture at the relaxation point has been shown to be
effective treatment for anxiety. We hypothesized that auricular acupressure may
decrease anxiety in elderly individuals who are transported by ambulance before
receiving ESWL. MATERIALS AND METHODS: We enrolled 100 patients with renal
calculi who were transported to the local hospital by special ambulance,
accompanied by 2 paramedics. Paramedic 1 performed data collection, while
paramedic 2 performed auricular acupressure in patients randomly assigned to a
relaxation group and a sham treated group. Anxiety was measured using a visual
analog scale score on a scale of 0 to 100 mm. RESULTS: Each group consisted of 50
patients with similar demographic characteristics. The relaxation group had
significantly decreased anxiety scores upon arrival at the hospital and lower
anticipation of pain scores (mean+/-SD 57.6+/-21.8 to 15.4+/-9.8 and 35.7+/-29.7 
to 9.5+/-4.1 mm VAS) than the sham treated group (55.5+/-25.9 to 49.8+/-28.9 and 
37.7+/-24.1 to 33.8+/-25.2 mm VAS, respectively, 2-way repeated measure ANOVA
each p=0.001). Estimated waiting times for treatment did not differ significantly
between the 2 groups (5.0+/-2.5 and 5.5+/-2.95, respectively, repeated measures
ANOVA p=0.83). The Post-Intervention Anxiety visual analog scale demonstrated the
significant superiority of the true treatment group (19.5+/-5.9 and 66.8+/-27.9
mm VAS, respectively, p=0.001). CONCLUSIONS: Elderly patients who received
auricular acupressure at specific relaxation points while being transported to
the hospital were less anxious, anticipated less pain and were more optimistic
about the outcome of treatment that they will receive than the sham treated
group. These data prove that this is an effective treatment for anxiety that
improves the patient overall perception of ESWL.

Publication Types: 
    Randomized Controlled Trial

PMID: 17499304 [PubMed - indexed for MEDLINE]

306: J Urol. 2007 Jul;178(1):165-8; discussion 168. Epub 2007 May 17.

Percutaneous nephrolithotripsy with the patient in a modified supine position.

Neto EA, Mitre AI, Gomes CM, Arap MA, Srougi M.

Division of Urology, São Paulo University Medical School, São Paolo, Brazil.

PURPOSE: The supine position has potential advantages over the prone position for
percutaneous nephrolithotripsy but it is neglected by most urologists. We
analyzed the efficacy and safety of percutaneous nephrolithotripsy with the
patient in a modified supine position. MATERIALS AND METHODS: In a prospective
study 88 consecutive patients underwent percutaneous nephrolithotripsy in a
modified supine position. Mean+/-SD stone size was 3.6+/-1.9 cm and 26 patients
(29.5%) had complete staghorn stones. Ten patients (11.4%) also had ureteral
stones and underwent concomitant ureteroscopy. Complications and success rates
were analyzed. RESULTS: The lower, middle and upper calix was the only access in 
42 (47.7%), 10 (11.4%) and 5 patients (5.7%), respectively. Four patients (4.5%) 
had supracostal access. A single percutaneous nephrolithotripsy session was
needed in 78 patients (88.6%), while 10 (11.4%) required 2 sessions. A total of
62 patients (70.5%) were stone-free. Five patients (5.7%) required blood
transfusion. Postoperative complications included ureteral obstruction due to
migration of stones in 3 cases (3.4%), serious bleeding requiring arterial
embolization in 2 (2.3%) and prolonged fever in 4 (4.5%). The need for direct
access to the upper pole and the need for concomitant ureteroscopy did not affect
the success and complication rates of percutaneous nephrolithotripsy. The colon
was never damaged and we had no cases of hydrothorax, kidney loss or sepsis.
CONCLUSIONS: Percutaneous nephrolithotripsy with the patient in a modified supine
position is effective and safe. It may be considered for most patients requiring 
percutaneous nephrolithotripsy, especially if concomitant ureteroscopy is
planned.

PMID: 17499302 [PubMed - indexed for MEDLINE]

307: J Huazhong Univ Sci Technolog Med Sci. 2007 Apr;27(2):197-9.

Neodymium:Yttrium Aluminum Garnet laser for mini-percutaneous treatment of upper 
urinary tract stones.

Luo H, Liu X, Lv S.

Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China.
drluohb@163.com

To observe the efficacy and safety of mini-percutaneous nephrolithotomy with
Neodymium: Yttrium Aluminum Garnet (Nd-YAG) laser in the treatment for upper
urinary tract stones, from December 2005 to September 2006, 31 patients with
renal stones, 15 patients with ureteral stones and 7 patients with renal and
ureteral stones underwent mini-percutaneous nephrolithotomy with Nd-YAG laser by 
combination of rigid ureteroscope and flexible ureteroscope under B-ultrasound
guidance. Clinical data including operation time, lithotripsy time, complications
and stone-free rate were analyzed retrospectively. Our study showed that the
percutaneous renal access (F14-F18) was successfully established under
B-ultrasound guidance in all cases. Immediate phase: lithotripsy was performed in
47 cases through single tract, and in one case through two tracts. Delayed phase 
II lithotripsy was done in 5 cases of renal stones. Operation time ranged from 55
to 180 min with an average time of 100+/-15 min. Lithotripsy time was from 25 to 
135 min and the average lithotripsy time was 65+/-11 min. No severe complications
occurred in our series. Complex renal stones were cleared in 34 of 38 cases
(89.5%). All ureteral stones were completely removed in 15 cases (100%). It was
concluded that mini-percutaneous nephrolithotomy with Nd:YAG laser for the
treatment of upper urinary tract stones by combination of rigid ureteroscope and 
flexible ureteroscope has the advantages of effectiveness, mini-invasion, shorter
operative time and safety.

PMID: 17497296 [PubMed - indexed for MEDLINE]

308: Urol Int. 2007;78(4):370-3.

Bilateral percutaneous nephrolithotomy in a patient with hemophilia A disorder.

Kural AR, Demirkesen O, Alici B, Obek C, Tunc B, Ozkan B.

Department of Urology, University of Istanbul, Cerrahpasa School of Medicine,
Istanbul, Turkey. kural@superonline.com

A 50-year-old man with hemophilia A presented with recurrent hematuria due to
renal stone disease. He was receiving approximately 50,000 units of recombinant
factor (rF) VIII concentrate every year due to hematuria. Between 1996 and 2002, 
his serum creatinine level increased from 0.7 to 1.2 ng/ml. In an effort to
resolve the problems of excessive blood loss with transfusions, recurrent rF VIII
replacements and deteriorating renal function, he was offered treatment with
percutaneous nephrolithotomy (PNL) in conjunction with rF VIII administration. He
underwent left PNL for left staghorn calculi in November 2002 with administration
of 52,000 units rF VIII, and another PNL for the right kidney in April 2004 with 
the administration of 90,500 units rF VIII. A pneumatic lithotriptor was used in 
both operations. The serum creatinine level was 0.8 ng/ml upon completion of
treatment and the patient was symptom and stone free at 10-month follow-up. He
has not suffered from hematuria since that time. We conclude that bleeding
disorders may not be a contraindication for PNL if corrected and monitored
appropriately.

Publication Types: 
    Case Reports

PMID: 17495500 [PubMed - indexed for MEDLINE]

309: Urol Nurs. 2007 Apr;27(2):113-22, 143; quiz 123.

Dietary and holistic treatment of recurrent calcium oxalate kidney stones: review
of literature to guide patient education.

Flagg LR.

The University Hospital, Cincinnati, OH, USA.

Urolithiasis is a condition that can cause significant morbidity among patients. 
Dietary manipulations traditionally advised include fluid, protein, oxalate,
calcium, citrate, and sodium changes in the diet. Evidence-based practice
guidelines suggest that there is not ample evidence to confidently recommend
dietary changes, since inadequate studies have been done to quantify the risks of
diet in stone formation. While fluid intake patterns have the weightiest evidence
in the literature, not even fluid intake meets the guidelines for evidence-based 
practice. Health care providers should recognize that current patient education
is largely based on intuition. It behooves us as clinicians to look critically at
all our practices, review the available literature, and question what we believe 
we know. A summary of available literature is provided to guide the clinician in 
educating patients in reducing their risk of recurrent calcium oxalate stone
disease.

Publication Types: 
    Review

PMID: 17494450 [PubMed - indexed for MEDLINE]

310: Urol Res. 2007 Aug;35(4):165-71. Epub 2007 May 5.

A new electromagnetic shock-wave generator "SLX-F2" with user-selectable dual
focus size: ex vivo evaluation of renal injury.

Leistner R, Wendt-Nordahl G, Grobholz R, Michel MS, Marlinghaus E, Köhrmann KU,
Alken P, Häcker A.

Department of Urology, University Hospital Mannheim, Faculty of Clinical Medicine
Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135
Mannheim, Germany.

Storz Medical AG (Kreutzlingen/Switzerland) has developed a new electromagnetic
shockwave (SW) generator, the "SLX-F2", which allows the user to choose between a
small-focus, high-pressure treatment regime or a wide-focus, low-pressure option.
The aim of this study was to investigate, under standardized conditions, the
impact of these two different treatment regimes on SW-induced renal injury.
SW-induced renal injury was investigated by using the standardized model of the
perfused ex vivo kidney. SWs were applied under ultrasound control in the
parenchyma of a kidney pole. Different SW numbers (20, 50, 125, 250, 500, 1,000) 
were applied in three groups: group A was treated with a wider focus (80 MPa),
groups B (60 MPa) and C (120 MPa) with a smaller focus (each parameter setting
was repeated ten-fold). Disintegration capacity (measured by crater volume in
cubes of plaster of Paris) was the same in groups A and C. After SW exposure,
barium sulphate suspension was perfused through the renal artery. The maximum
diameter (mm) of the extravasation in the cortex, representing the extent of
vascular injury, was measured on X-ray mammography films. H&E staining was
performed. In all three groups (A, B, C) a higher number of SWs caused the
diameter of the extravasate to increase, with statistical significance appearing 
at 1,000 shots versus 20 shots (p < 0.05). Vascular injury was not influenced by 
the focal size and positive peak pressure at identical SW numbers applied.
Histology of the focal area showed gap-like defects. Our ex vivo data show that
renal vascular injury is independent of the focal diameter of the SW generator at
the same peak positive pressure and disintegration power. This confirms the in
vivo findings that show renal injury caused by SW as being related to the number 
of SWs administered. Clinical studies are needed to investigate whether there is 
any advantage to offering both treatment regimes in one SW machine-for example,
by using the "wide-focus, low-pressure" option for kidney stones and the
"small-focus, high-pressure" regimen for stones in the ureter. The renal injury
caused by either regime remains comparable.

Publication Types: 
    Evaluation Studies

PMID: 17483935 [PubMed - indexed for MEDLINE]

311: Urol Res. 2007 Jun;35(3):123-8. Epub 2007 May 3.

Biochemical characterization of primary hyperparathyroidism with and without
kidney stones.

Odvina CV, Sakhaee K, Heller HJ, Peterson RD, Poindexter JR, Padalino PK, Pak CY.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, Dallas, TX 75390-8885, USA.
Clarita.odvina@utsouthwestern.edu

The exact metabolic-physiological background for kidney stone formation in
primary hyperparathyroidism (PHPT) is unclear. To obtain clarification, this
retrospective data analysis was conducted in 131 patients with PHPT who had
undergone a detailed ambulatory evaluation on a random diet since 1980. The
baseline biochemical presentation of 78 patients with PHPT with stones was
compared with that of 53 patients without stones. Compared to those without
stones, the stone-forming patients had a more marked hypercalciuria (343 +/- 148 
vs. 273 +/- 148 mg/day, P < 0.01). Urinary saturation of calcium oxalate and
brushite was significantly higher in stone-formers. Serum PTH and fasting urinary
calcium were similar between the two groups, but serum phosphorus was
significantly lower in stone-formers. Serum calcitriol (available in some
patients) showed a slightly higher mean value in stone-formers but the difference
was not significant. The increment in urinary calcium after oral load of 1-g
calcium was twofold higher among stone-formers. Radial shaft and L2-L4 bone
mineral densities resided within the normal ranges. Stone-formers with PHPT
display exaggerated urinary calcium excretion due to intestinal hyperabsorption
of calcium, contributing to a greater enhancement of the saturation of
stone-forming calcium salts.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 17476495 [PubMed - indexed for MEDLINE]

312: Int J Urol. 2007 Apr;14(4):344-9.

Associations between renal sodium-citrate cotransporter (hNaDC-1) gene
polymorphism and urinary citrate excretion in recurrent renal calcium stone
formers and normal controls.

Okamoto N, Aruga S, Matsuzaki S, Takahashi S, Matsushita K, Kitamura T.

Department of Urology, University of Tokyo, Tokyo, Japan.

PURPOSE: Urinary citrate is a potent inhibitor of renal stone formation. Its
excretion is regulated by Na(+)/dicarboxylate cotransporter-1 (NaDC-1), which is 
expressed on the apical membrane of renal proximal tubules. Many patients with
calcium urolithiasis exhibit hypocitraturia, however, the mechanisms are not
perfectly understood. We examined whether or not the I550V polymorphism in human 
NaDC-1 gene (hNaDC-1) influenced urinary citrate excretion. MATERIALS AND
METHODS: I550V polymorphism was investigated in 105 patients with recurrent renal
calcium stone formation (RSF) and 107 age-matched healthy volunteers with
non-renal stone formation (NSF), using polymerase chain reaction (PCR)
restriction fragment length polymorphism analysis and two 24-h urine samples.
RESULTS: Overall and in the RSF groups, subjects with a BB (homozygous for the
digested Bcl-I allele) genotype exhibited a significantly lower urinary citrate
excretion level than subjects with a bb (homozygous for the undigested allele)
genotype. Genotype distributions between subjects with hypocitraturia and
normocitraturia were significantly different, with the BB genotype being more
frequently observed in subjects with hypocitraturia - both overall and in each of
the RSF and NSF groups. Although the BB genotype was observed more frequently in 
the RSF group than in the NSF group, no statistical differences among the
distributions of the three genotypes (BB, Bb [heterozygous] and bb) were observed
between the RSF and NSF groups. CONCLUSION: These results suggest that the B
allele of I550V polymorphism of hNaDC-1 may be associated with a reduction in
urinary citrate excretion and contribute to hypocitraturia in recurrent renal
stone formers.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17470169 [PubMed - indexed for MEDLINE]

313: J Zoo Wildl Med. 2007 Mar;38(1):114-20.

Urate nephrolithiasis in a northern elephant seal (Mirounga angustirostris) and a
California sea lion (Zalophus californianus).

Dennison S, Gulland F, Haulena M, De Morais H, Colegrove K.

The Marine Mammal Center, Marin Headlands, Sausalito, California 94965, USA.

Nephrolithiasis has rarely been reported in marine mammals. During 2004 and 2005,
two cases of nephrolithiasis were diagnosed during routine necropsy examination, 
one in a northern elephant seal (Mirounga angustirostris) and one in a California
sea lion (Zalophus californianus). Nephroliths were found throughout both kidneys
during necropsy examination, varying in size from 1-10 mm in diameter in the
northern elephant seal and from 1-15 mm in diameter in the California sea lion.
Necropsy and histopathology revealed nephroliths in association with renal pelvic
dilation and pyelonephritis in both animals. In addition, hydronephrosis was
noted in the sea lion. Nephroliths were composed of uric acid and ammonium urate 
in the northern elephant seal and of ammonium urate in the California sea lion.
The underlying disease leading to nephrolith formation was not determined;
however, it is hypothesized that unknown metabolic derangements due to
morphologic or physiologic differences may have played a role. This is the first 
report of urate nephrolithiasis in the California sea lion and northern elephant 
seal.

Publication Types: 
    Case Reports
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17469285 [PubMed - indexed for MEDLINE]

314: Scand J Urol Nephrol. 2007;41(3):204-7.

Retrograde intra-renal surgery for stone extraction.

Zilberman DE, Mor Y, Duvdevani M, Ramon J, Winkler HZ.

Section of Endourology, Department of Urology, The Chaim Sheba Medical Center,
Tel-Hashomer, Ramat-Gan, Israel. dorit1e@yahoo.com

OBJECTIVE: To assess various clinical parameters affecting the efficacy and
safety profile of retrograde intra-renal surgery (RIRS) for stone extraction.
MATERIAL AND METHODS: Between the years 2001 and 2003, 63 patients underwent RIRS
in our department for renal calculi, including 25 who had stones >/=20mm in size.
RESULTS: Among the 63 patients who underwent the operation, 19 (30%) had
infectious complications postoperatively. Although neither preoperative stenting 
nor stone burden were found to have any direct implication on postoperative
course, a trend was seen as 64% of the infected patients had initially had large 
renal stones (>/=20mm in diameter) and 59% had been preoperatively drained.
CONCLUSIONS: RIRS is currently considered to be a safe standard retrograde
endoscopic procedure for treating renal calculi. However, patients with stones>20
mm in diameter or multiple small calculi, especially in the presence of
pre-existing tubes or following prior urinary tract infections, represent a
subgroup of patients that are, in general, at higher risk of remarkable
infectious complication rates and are likely to experience less satisfying
stone-free rates when RIRS surgery is performed.

Publication Types: 
    Clinical Trial

PMID: 17469028 [PubMed - indexed for MEDLINE]

315: Ann Clin Biochem. 2007 May;44(Pt 3):312-4.

Quartz renal calculi: were we being led up the garden path?

Sies CW, Cadwallader J, Florkowski CM, Woods SH, George PM.

Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New
Zealand. chris.sies@cdhb.govt.nz

Quartz stones are often considered to be of non-human origin or factitious,
although in some cases, they may have a biological aetiology. X-ray diffraction
(XRD) spectroscopy was used to analyse fragmented renal stones from a 61-year-old
lady who presented with bilateral nephrocalcinosis. Analysis of the calculi from 
the left kidney showed a mixed composition: 50% calcium oxalate monohydrate and
50% quartz. This case highlights the usefulness of XRD in the differentiation of 
authentic from possibly factitious renal calculi.

Publication Types: 
    Case Reports

PMID: 17456303 [PubMed - indexed for MEDLINE]

316: Scand J Urol Nephrol. 2007;41(2):115-9.

Urinary calculi following traumatic spinal cord injury.

Hansen RB, Biering-Sørensen F, Kristensen JK.

Clinic for Spinal Cord Injuries, Copenhagen University Hospital, Copenhagen,
Denmark. rikke@dadlnet.dk

OBJECTIVE: To investigate the time aspect of the development of renal and bladder
calculi in individuals with traumatic spinal cord injury (SCI) and a possible
relation between the development of calculi and the bladder-emptying method.
MATERIAL AND METHODS: The study comprised a retrospective data collection from
medical records and a questionnaire follow-up at least 10 years after the SCI.
RESULTS: A total of 236 individuals with SCI (82% male, 18% female; 47%
tetraplegic, 53% paraplegic) who were injured between 1956 and 1990 participated 
in the study and the response rate was 84.6%. The mean age at the time of
follow-up was 50.5 years (range 28-84 years). The mean duration from the time of 
SCI was 24.1 years (range 10-45 years). During follow-up 47 participants (20%)
had at least one episode of renal calculi and 32 (14%) had at least one episode
of bladder calculi. The risk of first renal and bladder calculus was highest
within the first 6 months post-injury. The cumulative proportion of calculi-free 
participants 45 years post-injury was 62% for renal calculi and 85% for bladder
calculi. For participants who did not develop renal calculi within the first 2
years post-injury, the risk of having a renal calculus within the next 43 years
was 34%. For bladder calculi the corresponding risk of having a bladder calculus 
within the next 43 years was 5%. No significant differences were found regarding 
the bladder-emptying method and either renal or bladder calculi, only a
non-significant trend that more participants with bladder calculi used indwelling
catheters. Participants with renal or bladder calculi were not statistically
significantly different from the remainder of the study group regarding gender,
para- or tetraplegia or Frankel classification. CONCLUSIONS: The risk of
developing renal and bladder calculi was higher in the SCI population compared to
the normal population. Bladder calculi primarily occur early post-injury and
renal calculi appear both early post-injury and years later. Therefore, it is
important to follow individuals with SCI regularly by means of urological
investigations from the time of the injury until death.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17454949 [PubMed - indexed for MEDLINE]

317: J Endourol. 2007 Apr;21(4):401-3.

Does previous open nephrolithotomy affect the outcome of percutaneous
nephrolithotomy?

Sofikerim M, Demirci D, Gülmez I, Karacagil M.

Department of Urology, Erciyes University, School of Medicine, Kayseri, Turkey.

PURPOSE: To determine the effects of previous open nephrolithotomy on the results
and morbidity of subsequent percutaneous nephrolithotomy (PCNL). PATIENTS AND
METHODS: Between March 2005 and January 2006, 89 patients underwent PCNL at our
institution. We compared the patients who had had previous open surgery on the
same kidney (group 1; n = 27) with those who had had no previous surgery (group
2; n = 62). The two groups did not differ significantly in age (45.4 v 44 years),
stone burden (361.3 mm(2) v 482.4 mm(2) ), stone number, or laterality. Operative
time, hospital stay, success rate, visual analog pain scores 8 hours after
surgery, analgesic doses (diclofenac sodium), and intraoperative and
postoperative complications were compared. RESULTS: There were no differences in 
operating time, postoperative analgesic doses, pain scores, intraoperative and
postoperative complications, the number of accesses, or the stone-free rate.
CONCLUSIONS: The morbidity and efficacy of PCNL are similar in patients who have 
had previous open nephrolithotomy and those having no previous surgery. Previous 
open surgery does not affect the success of PCNL.

PMID: 17451330 [PubMed - indexed for MEDLINE]

318: J Endourol. 2007 Apr;21(4):386-92.

Observations on intrarenal geometry of the lower-caliceal system in relation to
clearance of stone fragments after extracorporeal shockwave lithotripsy.

Leykamm L, Tiselius HG.

Department of Urology, Karolinska University Hospital (Huddinge), Sweden.

PURPOSE: To study the intrarenal geometry of the lower-caliceal system in
patients with and without residual fragments after extracorporeal shockwave
lithotripsy (SWL) and to formulate a summarizing mathematical expression of
relevant variables. PATIENTS AND METHOD: In a series of patients consecutively
treated by SWL, we analyzed the geometric anatomy in 47 patients with (group R)
and 47 without (group NR) residual fragments in long-term follow-up. A number of 
distances and angles previously described in the literature were measured, to
which was added the distance between the stone-bearing calix and the vertex of
the lower renal lip (CL) and the angle (delta) this line formed with a vertical
line. RESULTS: There were significant differences between the groups in terms of 
infundibular length (P = 0.009), CL (P = 0.0020), and lower-caliceal height, CH
(P = 0.0004). The calix width and the various angles did not differ significantly
between the groups. The quotient CH/CL was used to calculate cos delta, and a
summarizing expression (Index LC) was given the form CH(2)/CL which equals CH x
cos delta. This index was significantly different in groups R and NR (P =
0.0036). Approximately 4% of the patients in group NR, compared with 28 percent
in group R, had Index LC values >25. CONCLUSION: Index LC, as an expression of
the geometry of the lower-caliceal system, might be useful for simple description
of the lower-caliceal anatomy and supportive for decisions on the use of fragment
clearance-facilitating procedures or the selection of a more invasive approach
than SWL.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 17451327 [PubMed - indexed for MEDLINE]

319: Surg Laparosc Endosc Percutan Tech. 2007 Apr;17(2):124-8.

Minimally invasive percutaneous nephrolithotomy for staghorn calculi: a novel
single session approach via multiple 14-18Fr tracts.

Guohua Z, Zhong W, Li X, Wu K, Chen W, Lei M, He Z.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated
Hospital of Guangzhou Medical College, Guangzhou 510230, China. gzgyzgh@tom.com

OBJECTIVE: To report our experience with minimally invasive percutaneous
nephrolithotomy (MPCNL) (14-18Fr percutaneous tract) to treat staghorn calculi
via multiple percutaneous tracts in a single session procedure, and evaluate the 
feasibility and efficiency of this technique. PATIENTS AND METHODS: From March
2001 to November 2005, 100 patients with staghorn calculi were treated by MPCNL
via multiple percutaneous tracts. The size and location of the stone, operative
parameters, number of tracts, stone-free rate, operating time, hospital stay, and
complications were analyzed retrospectively. RESULTS: A total of 209 percutaneous
tracts were established in 100 renal units during 128 operations including 28
second-look procedures. The mean operating time was 107 minutes (range 43 to 130 
min) and the mean hospital stay was 9.4 days (range 6 to 13 d). The initial stone
clearance rate of 72% after the first session was improved to 93% after a
second-look procedure in 28 patients. The mean blood loss was 112 mL (range 64 to
483 mL), 3 patients required blood transfusion and 1 patient with branched renal 
arterial injury during puncture received a highly elective embolism. Seven
patients had a postoperative fever of 38.5 degrees C or greater, whereas 4
patients had mild hydropneumothorax. CONCLUSIONS: With the development of
instrument and increased experience, judiciously made multiple percutaneous
tracts in a single session MPCNL for treating staghorn calculi in selected cases 
is safe, feasible, and efficient with an acceptable morbidity.

PMID: 17450095 [PubMed - indexed for MEDLINE]

320: Urology. 2007 Apr;69(4):629-32.

How small can we go? Percutaneous nephrolithotomy using 6F nephroureteral
catheter.

Canales BK, Karlovsky ME, Monga M, Seidmon EJ.

Department of Urology, University of Minnesota School of Medicine, Minneapolis,
Minnesota 55455-0392, USA.

OBJECTIVES: To retrospectively examine our percutaneous nephrolithotomy pathway
to determine the efficacy of a 6F antegrade nephroureteral catheter (NUC).
METHODS: The records of 99 consecutive patients who underwent percutaneous
nephrolithotomy from 1998 to 2000 were reviewed. All patients were admitted the
day before percutaneous nephrolithotomy and underwent placement of a nephrostomy 
tube. The following day, after balloon dilation of the access tract and
performance of the procedure through a 30F sheath, an internal-external 6F NUC
was left in place. Nephrostograms were performed on postoperative day 1, and, if 
negative for extravasation or residual stones, the stent was removed. The
postoperative parameters included the length of stay, intravenous narcotic use,
complications, and time to removal of the indwelling stent. RESULTS: The average 
procedure time was 103 minutes (range 30 to 300), with a mean stone size of 1.7
cm. The average length of stay was 2.5 days, with postoperative intravenous
narcotic use lasting 1.7 days. Of the 99 NUCs placed, 82% were removed by
postoperative day 2. Eleven patients had either renal (n = 8) or ureteral (n = 3)
extravasation requiring prolonged stenting, and nine had residual stones
requiring a second-look procedure. Multivariate analysis demonstrated that
prolonged narcotic use, days with an indwelling stent, and longer procedure times
correlated significantly with a longer length of stay (P <0.001). The proportion 
of minor and major complications was 18% and 5%, respectively. CONCLUSIONS: The
results of our study have indicated that the 6F NUC minimizes postoperative
intravenous narcotic use and expedites both recovery and discharge. Because it is
the smallest nephroureteral catheter reported to date for this use, we recommend 
it be incorporated into prospective studies with validated pain questionnaires.

PMID: 17445638 [PubMed - indexed for MEDLINE]

321: Urology. 2007 Apr;69(4):620-4.

Comment in:
    Urology. 2008 Aug;72(2):466; author reply 466-7.

Do anatomic factors pose a significant risk in the formation of lower pole
stones?

Manikandan R, Gall Z, Gunendran T, Neilson D, Adeyoju A.

Department of Urology, Stepping Hill Hospital, Stockport, Cheshire, United
Kingdom. armanikan2000@gmail.com

OBJECTIVES: To determine whether various anatomic factors predispose to a lower
pole stone on one side compared with the other. METHODS: We analyzed the
intravenous urography pictures of 40 consecutive patients presenting with a
single lower pole stone. Measurements were taken of the infundibulopelvic angle
(IPA), ureteroinfundibular angle, infundibular width, pelvicaliceal height,
infundibular length, and pelvicaliceal angle of the affected and normal kidney.
The IPA was measured according to the methods of Sampaio, Bagley, and Elbahnasy. 
A comparison was made to determine whether any of these measurements predisposed 
one side to form stones. RESULTS: The mean age was 47 years (range 20 to 80). The
mean stone size was 9.2 mm (range 5 to 20). The mean IPA was 94.82 degrees
(Sampaio), 56.17 degrees (Bagley), 60.40 degrees (Elbahnasy), and 49.15 degrees
(Sampaio) on the affected kidney and 95.97 degrees (P = 0.66), 57.47 degrees (P =
0.57), 65.9 degrees (P = 0.04), and 54 degrees (P = 0.07) on the normal side. A
statistically significant difference was found only when we measured the IPA as
described by Elbahnasy. The mean infundibular width was 4.4 mm on both sides (P =
0.99). The caliceopelvic height was 21.6 mm on the affected side and 22.6 mm on
the normal side (P = 0.30). The infundibular length was 28.6 mm and 27.4 mm (P = 
0.16) and the caliceopelvic angle was 48 degrees and 47.6 degrees (P = 0.8) on
the affected and normal kidneys, respectively CONCLUSIONS: Lower pole anatomy as 
a risk factor for stones depends on the type of measurement used. A consensus
should be reached to define how exactly the IPA should be measured. Other
anatomic factors were not significantly different between the affected and normal
side in our study.

Publication Types: 
    Comparative Study

PMID: 17445636 [PubMed - indexed for MEDLINE]

322: Transplant Proc. 2007 Apr;39(3):761-2.

Management of calculi in a donor kidney.

Trivedi A, Patel S, Devra A, Rizvi J, Goel R, Modi P.

Department of Urology and Transplantation, Dr H.L. Trivedi Institute Of
Transplantation Sciences, Gulabben Rasiklal Doshi and Kamlaben Mafatlal Mehta
Institute Of Kidney Diseases & Research Center, Ahmedabad, Gujarat, India.

INTRODUCTION: We evaluated the safety and efficacy of ex vivo ureteroscopy
(ExURS) and extracorporeal shock wave lithotripsy (ESWL) as means of rendering a 
donated kidney stone-free in living related and deceased donor renal
transplantation. MATERIAL AND METHODS: Three cases with calculi in donor kidneys 
were managed; 1 was from a living related donor and 2 were from deceased donors. 
Immediately after cold perfusion, ExURS was performed with iced saline solution
in 2 cases. Access to the collecting system was via the ureteral stump. Calculi
were fragmented with pneumatic intracorporeal lithotripsy and fragments were
removed with forceps. Posttransplantation ESWL was given to 1 patient for
migration of a small lower caliceal calculus in the upper ureter in 1 allograft
of a dual-kidney transplantation. RESULTS: Access to the renal collecting system 
and stone fragmentation was technically successful in both cases. Indwelling
ureteral stents were kept during transplantation in all cases. There were no
intraoperative or postoperative ureteral complications. Following ESWL, stone was
fragmented and cleared on its own within a week. At mean follow up of 2.2 years
no new stone formed in any recipient or donor. CONCLUSIONS: ExURS was technically
feasible to render a stone-bearing kidney stone- free without compromising
ureteral integrity or renal allograft function. ESWL could be performed at a
later date.

Publication Types: 
    Case Reports

PMID: 17445593 [PubMed - indexed for MEDLINE]

323: J Endourol. 2007 Mar;21(3):343-6.

In-Vivo relation between CT attenuation value and shockwave fragmentation.

Hurtado F, Gutiérrez J, Castaño-Tostado E, Bustos J, Mues E, Del Sol Quintero M, 
Méndez A, Loske AM.

Nuevo Hospital Civil, Universidad de Guadalajara, Guadalajara, Jalisco, C.T.
44340 México.

PURPOSE: To use CT attenuation numbers as a means of determining the
susceptibility of an artificial stone to in-vivo fragmentation with
extracorporeal shockwave lithotripsy (SWL). MATERIALS AND METHODS: Four types of 
artificial kidney stones having different CT attenuation values were used. One
randomly selected stone was implanted in the renal pelvis of a kidney of 12 young
pigs and exposed in vivo to 2500 shockwaves (21 kV) using an electrohydraulic
lithotripter. Bilateral nephrectomy was performed after SWL. Fragments were
strained through a mesh with a 3.1-mm grid, and the debris left on the mesh was
dried and weighed. Fragmentation coefficients (FCs) were associated with CT
attenuation values using a statistical model. RESULTS: The relation between FC
and CT number was significant, indicating that as CT attenuation increases, FC is
reduced. Larger stone fragments were obtained from stones with higher CT numbers.
Initial stone weight was not a significant explanation for variations in FC.
CONCLUSION: The CT values could be helpful in selecting patients for SWL in the
future. However, other parameters such as stone porosity, shape, and roughness
also will have to be considered.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17444784 [PubMed - indexed for MEDLINE]

324: J Endourol. 2007 Mar;21(3):337-42.

Basket design as a factor in retention and release of calculi in vitro.

Zeltser IS, Bagley DH.

Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania,
USA.

PURPOSE: To compare stone retrieval and release from seven basket designs in
vitro. MATERIALS AND METHODS: We tested two tipped and one tipless NCompass
models, three other tipless Nitinol designs (NCircle, Sur-Catch, and Dimension), 
and the Segura Hemisphere for their ability to retrieve and release single beads 
8, 6, 5.6, and 5 mm diameter and multiple beads 3.6 mm diameter in both a
ureteral and a caliceal model in three separate attempts. RESULTS: In the
ureteral model, all baskets were successful in retrieving all sizes of single
beads. With multiple 3.6-mm beads, only the NCompass and Dimension designs were
able to retrieve at least two of three beads in all attempts. With the exception 
of the Segura Hemisphere, all designs were successful in releasing all bead
sizes. In the caliceal model, only the NCircle, Dimension, and tipless NCompass
models were able to retrieve all bead sizes in 100% of the trials. The tipped
NCompass and Hemisphere designs were unable to retrieve any beads in this model. 
The Sur-Catch basket was successful in the retrieval of large beads only. The
Dimension articulating design was the only basket able to release all bead sizes 
in all attempts. The tipless NCompass basket did not release any of the beads
once engaged. CONCLUSION: Nitinol basket designs show excellent retrieval and
release capabilities in the in-vitro ureteral model. The articulating Nitinol
basket has the best stone-releasing capability of all baskets tested.

PMID: 17444783 [PubMed - indexed for MEDLINE]

325: J Urol. 2007 May;177(5):1867-71.

Percutaneous nephrolithotomy in children: lessons learned in 5 years at a single 
institution.

Bilen CY, Koçak B, Kitirci G, Ozkaya O, Sarikaya S.

Department of Urology, Ondokuz Mayis University School of Medicine, Samsun,
Turkey. cybilen@yahoo.com

PURPOSE: We retrospectively compared morbidity and success rates in children who 
underwent percutaneous nephrolithotomy with 3 different sizes of instruments.
MATERIALS AND METHODS: Percutaneous nephrolithotomy was performed using adult
instruments via a 26Fr tract in 23 patients, using pediatric instruments via a
20Fr tract in 13 and using minimal access (14Fr) in 10. Percutaneous
nephrolithotomy was performed using general anesthesia with parenteral antibiotic
prophylaxis. Cystoscopy and retrograde pyelography were performed, and 5Fr to 6Fr
soft ureteral catheters were placed during each procedure initially. Percutaneous
access was established via fluoroscopic guidance with the patient in the prone
position. Pneumatic, ultrasonic and holmium laser lithotriptors were used for in 
situ lithotripsy. A 14Fr nephrostomy catheter was placed at the end of the
procedure in the 26Fr and 20Fr groups, and in the minimal access group the
ureteral stent was left indwelling in cases of atraumatic procedure with no
residual fragments. RESULTS: Mean patient age was 13.2, 5.9 and 6.3 years,
respectively, in the 26Fr, 20Fr and minimal access groups (p=0.000). Sex
distribution, previous surgery, stone size, surgery and fluoroscopy times, mean
hemoglobin decrease and hospitalization time did not differ between the groups.
However, blood transfusion rate was higher in groups 1 and 2. Stone-free rates
were 69.5%, 80% and 90%, respectively, in groups 1 to 3. Overall, adjuvant shock 
wave lithotripsy treatment was needed in 3 children. CONCLUSIONS: Smaller
instrument size to 20Fr did not significantly increase the operative time, and
resulted in the same success rates as the adult sized devices. However, low blood
transfusion rates were only reached in the minimal access percutaneous
nephrolithotomy group.

PMID: 17437838 [PubMed - indexed for MEDLINE]

326: BJU Int. 2007 Aug;100(2):392-5. Epub 2007 Apr 13.

Comment in:
    Nat Clin Pract Urol. 2008 Feb;5(2):76-7.

Is extracorporeal shock wave lithotripsy the preferred treatment option for
elderly patients with urinary stone? A multivariate analysis of the effect of
patient age on treatment outcome.

Ng CF, Wong A, Tolley D.

The Chinese University of Hong Kong, Hong Kong, PRC. ngcf@surgery.cuhk.edu.hk

OBJECTIVES: To investigate the effect of patient age on the stone-free rate (SFR)
in patients with urinary calculi treated by extracorporeal shockwave lithotripsy 
(ESWL). PATIENTS AND METHODS: In all, 2192 solitary radio-opaque urinary stones
of 5-15 mm were identified in adult patients receiving primary ESWL. Patients
were divided into three age groups, i.e. < or = 40, 41-60 and >60 years (579,
1026 and 587 patients, respectively). Multiple logistic regression was used to
assess the effect of age and other possible predicting factors (gender, stone
characteristics, e.g. side, site and size, and the type of lithotripter used) on 
the SFR at 3 months after treatment. RESULTS: The overall adjusted odds ratios
(95% confidence interval) for the SFR for those aged 41-60 and >60 years (taking 
those aged < or= 40 years as the reference) were 0.708 (0.573-0.875; P = 0.001)
and 0.643 (0.506-0.818; P < 0.001). However, if the patients were divided into
those with renal or ureteric stones, only the SFR of the former was affected by
age, and the adjusted odds ratios were 0.665 (0.512-0.864; P = 0.002) and 0.629
(0.470-0.841; P = 0.002), respectively. Ageing had no effect on the SFR for
ureteric stones. CONCLUSION: The SFR after ESWL for renal stones, but not
ureteric stones, was significantly lower in older patients. Further studies on
the effects of ageing on renal stone clearance after ESWL are needed to improve
stone management in the elderly population.

Publication Types: 
    Evaluation Studies

PMID: 17433030 [PubMed - indexed for MEDLINE]

327: Urol Res. 2007 Jun;35(3):111-7. Epub 2007 Apr 13.

Intestinal and renal handling of oxalate loads in normal individuals and stone
formers.

Knight J, Holmes RP, Assimos DG.

Department of Urology, Wake Forest University School of Medicine, Medical Center 
Blvd, Winston-Salem, NC 27157, USA. jknight@wfubmc.edu

The renal handling and intestinal absorption of dietary oxalate are believed to
be risk factors for calcium oxalate stone formation. In this study, we have
examined the time and dose effects of soluble oxalate loads on the intestinal
absorption and renal handling of oxalate in six stone formers (SF) and six normal
individuals (N) who consumed diets controlled in oxalate and other nutrients.
Urinary and plasma oxalate changes were monitored over 24 h after ingestion of 0,
2, 4, and 8 mmole oxalate loads, containing a mixture of (12)C- and
(13)C(2)-oxalate. There were significant time and dose dependent changes in
urinary oxalate excretion and secretion after these loads. However, there were no
significant differences between SF and N in both the intestinal absorption and
the renal handling of oxalate loads, as measured by the urinary excretion of
oxalate (P = 0.96) and the ratio of oxalate to creatinine clearance (P = 0.34).
(13)C(2)-oxalate absorption studies showed three of the subjects, two SF and one 
N, had enhanced absorption with the 8 mmole load. A clear difference in
absorption was demonstrated in these individuals during the 8-24 h interval,
suggesting that in these individuals there was greater oxalate absorption in the 
large intestine as compared to the other subjects. This enhanced absorption of
oxalate warrants further characterization.

Publication Types: 
    Controlled Clinical Trial
    Research Support, N.I.H., Extramural

PMID: 17431604 [PubMed - indexed for MEDLINE]

328: BJU Int. 2007 Mar;99(3):641-5.

Magnetic resonance imaging in the evaluation of pelvi-ureteric junction
obstruction: an all-in-one approach.

El-Nahas AR, Abou El-Ghar ME, Refae HF, Gad HM, El-Diasty TA.

Department of Urology, Urology and Nephrology Center, Mansoura University,
Mansoura, Egypt. ar_el_nahas@yahoo.com

OBJECTIVE: To study the ability of comprehensive magnetic resonance imaging (MRI)
to replace multiple imaging methods in the evaluation of patients with
pelvi-ureteric junction obstruction (PUJO). PATIENTS AND METHODS: Between May
2003 and November 2005, 46 consecutive patients (22 male and 24 females; mean age
31.6 years) with symptomatic primary PUJO were included. All had comprehensive
MRI, including MR urography (MRU), dynamic MRI and MR angiography (MRA).
Morphological results of MRU were compared with that of renal ultrasonography or 
intravenous urography, while the anatomical results of MRA were compared with the
operative findings. A correlation between MR clearance and radioisotope clearance
was done using linear regression analysis. RESULTS: MRU showed the morphology of 
the collecting system in all patients, and the ureter below the PUJ in 31 of 46
(67%), but renal stones were missed in three of 10 patients. MRA showed crossing 
vessels in 22 patients (48%). There was a strong correlation between MR clearance
and radioisotope clearance (r = 0.823, P < 0.001). From the MRI results, 35
patients (19 with crossing vessels and 16 with marked hydronephrosis) had
pyeloplasty and 11 had an endopyelotomy. Findings during pyeloplasty showed one
false-negative and one false-positive result of the preoperative MRI. Therefore, 
the sensitivity, specificity and accuracy of MRA were 95%, 94% and 94%,
respectively. The outcome was successful in 44 (96%) patients. One failure after 
pyeloplasty was managed with endopyelotomy and the other was treated with
pyeloplasty after endopyelotomy. CONCLUSION: Comprehensive MRI is a valuable and 
accurate single-imaging method for evaluating patients with PUJO.

Publication Types: 
    Evaluation Studies

PMID: 17407519 [PubMed - indexed for MEDLINE]

329: Urol Int. 2007;78(3):214-8.

Sixteen years of experience with stone management in horseshoe kidneys.

Viola D, Anagnostou T, Thompson TJ, Smith G, Moussa SA, Tolley DA.

The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, UK.
domeviol@inwind.it

INTRODUCTION: Horseshoe kidney is the commonest congenital renal fusion anomaly, 
and is often complicated by urolithiasis. We focus on our 16 years of experience 
with stone management in horseshoe kidneys. MATERIALS AND METHODS: We reviewed
the progress of 44 patients treated between 1987 and 2002. Shock wave lithotripsy
(SWL) was used in 25 patients; the average stone surface area was 91 (range
10-1,600) mm2 and average follow-up was 36.5 (range 1-91) months. 19 patients
underwent percutaneous nephrolithotomy (PCNL); the average stone surface area was
197 (range 6-2,400) mm2. Follow-up data are available for 8 patients and the
average follow-up was 42.3 (range 3-144) months. RESULTS: In the SWL group the
3-month stone-free rate (SFR) was only 31%. In the PCNL group the SFR was 75% on 
the postoperative day-1 KUB. Complications occurred in 9 patients. CONCLUSIONS:
Stone management in horseshoe kidneys is challenging: PCNL produces a higher SFR 
with minimal major complications and failed access. PCNL thus appears to be the
preferred management option in patients with urolithiasis in horseshoe kidneys.
Copyright 2007 S. Karger AG, Basel.

PMID: 17406129 [PubMed - indexed for MEDLINE]

330: Eur Urol. 2007 Aug;52(2):539-46. Epub 2007 Mar 28.

Comment in:
    Eur Urol. 2007 Aug;52(2):318-20.

Extracorporeal shock wave lithotripsy of lower calyx calculi: how much is
treatment outcome influenced by the anatomy of the collecting system?

Danuser H, Müller R, Descoeudres B, Dobry E, Studer UE.

Department of Urology, University of Bern, Bern, Switzerland.
hansjoerg.danuser@ksl.ch

OBJECTIVES: Extracorporeal shock wave lithotripsy (ESWL) of lower calyx stones
has been criticized because of the high incidence of residual fragments.
Controversial results have been reported regarding the stone-free rate after ESWL
depending on the influence of the collecting system anatomy on stone clearance.
Therefore we evaluated our stone-free rate after ESWL of lower calyx stones and
searched for correlations to various anatomic parameters of the collecting
system. METHODS: Ninety-six patients with isolated lower calyx stones treated
exclusively with ESWL (Dornier HM3) were evaluated 3 mo postoperatively. The
results were correlated with the following anatomic parameters of the collecting 
system as determined from the pretreatment intravenous urography: (1) lower
infundibulum width, (2) lower infundibulum length, (3) infundibulopelvic angle,
(4) volume of the collecting system. Follow-ups were performed 24 h after ESWL
with an abdominal plain film and 3 mo postoperatively with a urography or
abdominal plain X-ray together with renal ultrasound. RESULTS: Three months
postoperatively, 68% of all patients were stone free, including 69% of the
patients with stones initially < or =1 cm, and 67% of the patients with stones >1
cm. Stone-free patients compared with patients having residual fragments had no
significant differences in infundibulum width, infundibulum length,
infundibulopelvic angle, or collecting system volume. CONCLUSIONS: A stone-free
rate 3 mo after ESWL of 68% overall justifies ESWL as a possible treatment option
for lower calyx stones. Influence of the collecting system anatomy on
disintegrate clearance from the lower calyx could not be demonstrated.

PMID: 17400366 [PubMed - indexed for MEDLINE]

331: J Huazhong Univ Sci Technolog Med Sci. 2007 Feb;27(1):83-7.

A comparative study on several models of experimental renal calcium oxalate
stones formation in rats.

Liu J, Cao Z, Zhang Z, Zhou S, Ye Z.

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China. jhliu@tjh.tjmu.edu.cn

In order to compare the effects of several experimental renal calcium oxalate
stones formation models in rats and to find a simple and convenient model with
significant effect of calcium oxalate crystals deposition in the kidney, several 
rat models of renal calcium oxalate stones formation were induced by some
crystal-inducing drugs (CID) including ethylene glycol (EG), ammonium chloride
(AC), vitamin D(3)[1alpha(OH)VitD(3), alfacalcidol], calcium gluconate, ammonium 
oxalate, gentamicin sulfate, L-hydroxyproline. The rats were fed with drugs given
singly or unitedly. At the end of experiment, 24-h urines were collected and the 
serum creatinine (Cr), blood urea nitrogen (BUN), the extents of calcium oxalate 
crystal deposition in the renal tissue, urinary calcium and oxalate excretion
were measured. The serum Cr levels in the stone-forming groups were significantly
higher than those in the control group except for the group EG+L-hydroxyproline, 
group calcium gluconate and group oxalate. Blood BUN concentration was
significantly higher in rats fed with CID than that in control group except for
group EG+L-hydroxyproline and group ammonium oxalate plus calcium gluconate. In
the group of rats administered with EG plus Vitamin D(3), the deposition of
calcium oxalate crystal in the renal tissue and urinary calcium excretion were
significantly greater than other model groups. The effect of the model induced by
EG plus AC was similar to that in the group induced by EG plus Vitamin D(3). EG
plus Vitamin D(3) or EG plus AC could stably and significantly induced the rat
model of renal calcium oxalate stones formation.

Publication Types: 
    Comparative Study

PMID: 17393118 [PubMed - indexed for MEDLINE]

332: J Urol. 2007 Apr;177(4):1542-5.

The effect of frequency doubled double pulse Nd:YAG laser fiber proximity to the 
target stone on transient cavitation and acoustic emission.

Fuh E, Haleblian GE, Norris RD, Albala WD, Simmons N, Zhong P, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University 
Medical Center and Pratt School of Engineering, Duke University, Durham, North
Carolina 27710, USA.

PURPOSE: Scant information has been published describing the effect of laser
fiber distance from the stone target on the mechanism of calculus fragmentation. 
Using high speed photography and acoustic emission measurements we characterized 
the impact of laser fiber proximity on stone comminution. We evaluated the effect
of laser fiber distance from the stone target on resultant cavitation bubble
formation and shock wave generation. MATERIALS AND METHODS: Stone fragmentation
was assessed using a FREDDY (frequency doubled double pulse Nd:YAG) (World of
Medicine, Orlando, Florida) laser and a holmium laser. The FREDDY laser was
operated using a 420 microm fiber at an output energy of 120 and 160 mJ in single
and double pulse settings, and a pulse repetition rate of 1 Hz. The holmium laser
was operated using a 200 microm fiber at an output energy of 1 to 3 J and a pulse
repetition rate of 1 Hz. The surface of a 1 cm square BegoStone (Bego, Bremen,
Germany) attached to an X-Y-Z translational stage was aligned perpendicular to
the laser fiber, which was immersed in a Lucite tank filled with water at room
temperature. An Imacon 200 high speed camera was used to capture transient
cavitation bubbles at a framing rate of up to 1,000,000 frames per second.
Acoustic emission signals associated with shock waves generated during the rapid 
expansion and collapse of the cavitation bubble were measured using a 1 MHz
focused ultrasound transducer. RESULTS: At laser fiber distances of 3.0 mm or
less cavitation bubbles and shock waves were observed with the FREDDY laser. In
contrast to the holmium laser, the bubble size and shock wave intensity of the
FREDDY laser was inversely related to the fiber-to-stone distance over the range 
tested (0.5 to 3.0 mm). CONCLUSIONS: While bubble size was noted to increase with
a larger stone-to-fiber distance using the holmium laser, to consistently
generate cavitation bubbles and shock waves using the FREDDY laser the laser
fiber should be operated within 3.0 mm of the target stone. These findings have
significant implications during clinical laser stone fragmentation.

PMID: 17382775 [PubMed - indexed for MEDLINE]

333: J Urol. 2007 Apr;177(4):1363-5.

In vitro assessment of a novel dual probe ultrasonic intracorporeal lithotriptor.

Kim SC, Matlaga BR, Tinmouth WW, Kuo RL, Evan AP, McAteer JA, Williams JC Jr,
Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease and Department of Anatomy
and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
46202, USA. samckim@iupui.edu

PURPOSE: The Cyberwand (Cybersonics, Erie, Pennsylvania) is a novel
intracorporeal lithotrite that uses coaxial ultrasonic elements operating at 2
frequencies. We compared this device to the LithoClast(R) Ultra, which we
previously noted is the most efficient commercially available intracorporeal
lithotripsy device. MATERIALS AND METHODS: An in vitro test system was used to
assess the efficiency of stone penetration for the Cyberwand and the LithoClast
Ultra. The devices were mounted upright with the probe tip up in a modified
irrigation sheath. A gypsum artificial stone was centered on the probe tip and a 
mass was placed atop the stone to provide a constant force. The manufacturer
recommended setting was selected for the Cyberwand, while for the LithoClast
Ultra a pneumatic frequency of 12 Hz with an ultrasonic power setting of 100% was
selected, representing optimal settings in previous in vitro tests. The time
required for complete stone penetration was measured. Differences in mean stone
penetration times were compared using ANOVA. RESULTS: Mean +/- SD penetration
time for the Cyberwand was significantly shorter than for the LithoClast Ultra
(4.8 +/- 0.6 vs 8.1 +/- 0.6 seconds, p <0.0001). Neither device showed any
difficulties with overheating, occlusion or another malfunction. CONCLUSIONS:
Initial assessment using our hands-free in vitro test system, in which stone
penetration time is not affected by operator bias, suggests that the Cyberwand is
an efficient lithotrite. These promising results justify in vivo testing.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 17382733 [PubMed - indexed for MEDLINE]

334: AJR Am J Roentgenol. 2007 Apr;188(4):927-33.

Low-dose versus standard-dose CT protocol in patients with clinically suspected
renal colic.

Poletti PA, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE, Becker CD.

Department of Radiology, University Hospital Geneva, 24 rue Micheli-du-Crest-14, 
Geneva 1211, Switzerland. pierre-alexandre.poletti@hcuge.ch

OBJECTIVE: The purpose of our study was to compare a low-dose abdominal CT
protocol, delivering a dose of radiation close to the dose delivered by abdominal
radiography, with standard-dose unenhanced CT in patients with suspected renal
colic. MATERIALS AND METHODS: One hundred twenty-five patients (87 men, 38 women;
mean age, 45 years) who were admitted with suspected renal colic underwent both
abdominal low-dose CT (30 mAs) and standard-dose CT (180 mAs). Low-dose CT and
standard-dose CT were independently reviewed, in a delayed fashion, by two
radiologists for the characterization of renal and ureteral calculi (location,
size) and for indirect signs of renal colic (renal enlargement, pyeloureteral
dilatation, periureteral or renal stranding). Results reported for low-dose CT,
with regard to the patients' body mass indexes (BMIs), were compared with those
obtained with standard-dose CT (reference standard). The presence of non-urinary 
tract-related disorders was also assessed. Informed consent was obtained from all
patients. RESULTS: In patients with a BMI < 30, low-dose CT achieved 96%
sensitivity and 100% specificity for the detection of indirect signs of renal
colic and a sensitivity of 95% and a specificity of 97% for detecting ureteral
calculi. In patients with a BMI < 30, low-dose CT was 86% sensitive for detecting
ureteral calculi < 3 mm and 100% sensitive for detecting calculi > 3 mm. Low-dose
CT was 100% sensitive and specific for depicting non-urinary tract-related
disorders (n = 6). CONCLUSION: Low-dose CT achieves sensitivities and
specificities close to those of standard-dose CT in assessing the diagnosis of
renal colic, depicting ureteral calculi > 3 mm in patients with a BMI < 30, and
correctly identifying alternative diagnoses.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17377025 [PubMed - indexed for MEDLINE]

335: J Clin Ultrasound. 2007 Jun;35(5):256-61.

Accuracy of sonography for detecting renal stone: comparison with CT.

Ulusan S, Koc Z, Tokmak N.

Department of Radiology, Başkent University Adana Teaching and Medical Research
Center, 01250 Adana, Turkey.

PURPOSE: To determine the diagnostic accuracy values of sonography in the
detection of renal stones using noncontrast CT as the gold standard. In addition,
we correlated the accuracy of sonography with stone size, the kidney affected
(right versus left), and body mass index (BMI). METHODS: Fifty patients underwent
2 separate sonographic examinations performed by 2 radiologists. CT scans were
evaluated by another 2 radiologists, and the diagnosis was made by consensus. We 
compared the sonograms and CT scans and the sonographic detection of stones in
the left and right kidneys. All sonographic findings were correlated with the BMI
groups. RESULTS: The sensitivity of sonography for any stone in a patient was
52-57% for the right kidney (radiologist 1 and 2) and 32-39% for the left kidney 
(radiologist 1 and 2). The overall accuracy of sonography in detecting a stone in
the right kidney by radiologists 1 and 2 was 67% and 77%, respectively. The
corresponding accuracy values for the left kidney were 53% and 54%, respectively.
CONCLUSION: Sonography is of limited value for detecting renal stones. The
sonographic detection of a renal stone is dependent on the side of the kidney
involved but is independent of BMI.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 17373690 [PubMed - indexed for MEDLINE]

336: Int Urol Nephrol. 2007;39(3):727-30. Epub 2007 Mar 16.

Body mass index, body fat percentage, and the effect of body fat mass on SWL
success.

Akay AF, Gedik A, Tutus A, Sahin H, Bircan MK.

Department of Urology, Dicle University Faculty of Medicine, Dicle Universitesi
Tip Fak Uroloji AbD, 21280, Diyarbakir, Turkey. aliak@dicle.edu.tr

OBJECTIVES: In the present study, we investigated the effects of the Body Mass
Index (BMI), the Body Fat Percentage (BFP), and the Body Fat Mass (BFM) on
success of SWL, prospectively. PATIENTS AND METHODS: The BMI, BFP, BFM values of 
patients, who were treated by SWL due to upper urinary system stone disease
(pelvis renalis, upper ureter, kidney lower and upper calices) between January
and December 2005 in our hospital's urolithiasis center, were measured. Patients 
with stones smaller than 5 mm or larger than 20 mm and patients who had a stone
localized somewhere other than in the upper urinary system, were not included in 
the study. Patients evaluated to be clinically successful according to the SWL
were put in group 1, and the other patients who were not successful were included
in group 2. RESULTS: About 158 (97 male, 61 female) patients aged between 16 and 
92 (mean 36.69 (+/-13.22) years), put on SWL therapy due to presence of upper
urinary system stone disease, were included in the study. While the mean BMI was 
23.97 +/- 0.4 in group 1 and 25.98 +/- 0.5 (P = 0.02) in group 2, BFP was 23.85
+/- 0.8 in group 1 and 29.19 +/- 1.1 (P = 0.001) in group 2, and BFM was
determined to be 16.74 +/- 0.7 and 21.19 +/- 1.01 (P = 0.001) in group 2.
Regarding all the parameters (BMI, BFP, BFM), the statistical analyses carried
out between the groups showed significant differences. CONCLUSION: BFP and BFM
parameters are also important factors along with the BMI in providing a
successful SWL treatment. All the parameters should be considered regarding the
success of the treatment and the patients should be informed.

PMID: 17364222 [PubMed - indexed for MEDLINE]

337: Nepal Med Coll J. 2006 Dec;8(4):263-5.

Spectrum of stones composition: a chemical analysis of renal stones of patients
visiting NMCTH.

Risal S, Risal P, Pandeya DR, Adhikari D, Bhattachraya CS, Singh PP, Shrestha ML.

Department of Biochemistry, Nepal Medical College, G.P Box: 13344 Attarkhel,
Kathmandu. srisall@hotmail.com

A general observation of clinicians suggests that the prevalence ofurolithiasis
is fairly high in Kathmandu but so far no systematic study has been undertaken
here to explore the etiopathogenesis of disease in this region. In this
preliminary communication, we present herewith the qualitative composition of 47 
renal stones collected from surgical patients admitted to NMCTH over a period of 
13 months (July 2005 to July 2006). All stones were of mixed type. Calcium was
present in all stones. Oxalate, phosphate and uric acid were present in 95.7%,
87.2% and 34.0% patients respectively. The probable composition, as construed
from analysis, suggests that calcium oxalate stones are predominant. Strikingly, 
the prevalence was very high in e"20 yrs age group.

PMID: 17357646 [PubMed - indexed for MEDLINE]

338: J Acoust Soc Am. 2007 Feb;121(2):1190-202.

A mechanistic analysis of stone fracture in lithotripsy.

Sapozhnikov OA, Maxwell AD, MacConaghy B, Bailey MR.

Department of Acoustics, Physics Faculty, Moscow State University, Leninskie
Gory, Moscow, 119992, Russia.

In vitro experiments and an elastic wave model were used to analyze how stress is
induced in kidney stones by lithotripsy and to test the roles of individual
mechanisms-spallation, squeezing, and cavitation. Cylindrical U30 cement stones
were treated in an HM-3-style lithotripter. Baffles were used to block specific
waves responsible for spallation or squeezing. Stones with and without surface
cracks added to simulate cavitation damage were tested in glycerol (a cavitation 
suppressive medium). Each case was simulated using the elasticity equations for
an isotropic medium. The calculated location of maximum stress compared well with
the experimental observations of where stones fractured in two pieces. Higher
calculated maximum tensile stress correlated with fewer shock waves required for 
fracture. The highest calculated tensile stresses resulted from shear waves
initiated at the proximal corners and strengthened along the side surfaces of the
stone by the liquid-borne lithotripter shock wave. Peak tensile stress was in the
distal end of the stone where fracture occurred. Reflection of the longitudinal
wave from the distal face of the stone--spallation-produced lower stresses.
Surface cracks accelerated fragmentation when created near the location where the
maximum stress was predicted.

Publication Types: 
    In Vitro
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17348540 [PubMed - indexed for MEDLINE]

339: Urol Res. 2007 Apr;35(2):55-62. Epub 2007 Mar 8.

Tamm-Horsfall protein in recurrent calcium kidney stone formers with positive
family history: abnormalities in urinary excretion, molecular structure and
function.

Jaggi M, Nakagawa Y, Zipperle L, Hess B.

Renal Stone Clinic and Stone Research Laboratory, Policlinic of Internal
Medicine, University Hospital, Berne, Switzerland.

Tamm-Horsfall protein (THP) powerfully inhibits calcium oxalate crystal
aggregation, but structurally abnormal THPs from recurrent calcium stone formers 
may promote crystal aggregation. Therefore, increased urinary excretion of
abnormal THP might be of relevance in nephrolithiasis. We studied 44 recurrent
idiopathic calcium stone formers with a positive family history of stone disease 
(RCSF(fam)) and 34 age- and sex-matched healthy controls (C). Twenty-four-hour
urinary THP excretion was measured by enzyme linked immunosorbent assay.
Structural properties of individually purified THPs were obtained from analysis
of elution patterns from a Sepharose 4B column. Sialic acid (SA) contents of
native whole 24-h urines, crude salt precipitates of native urines and
individually purified THPs were measured. THP function was studied by measuring
inhibition of CaOx crystal aggregation in vitro (pH 5.7, 200 mM sodium chloride).
Twenty-four-hour urine excretion of THP was higher in RCSF(fam) (44.0 +/- 4.0
mg/day) than in C (30.9 +/- 2.2 mg/day, P = 0.015). Upon salt precipitation and
lyophilization, elution from a Sepharose 4B column revealed one major peak (peak 
A, cross-reacting with polyclonal anti-THP antibody) and a second minor peak
(peak B, not cross-reacting). THPs from RCSF(fam) eluted later than those from C 
(P = 0.021), and maximum width of THP peaks was higher in RCSF(fam )than in C (P 
= 0.024). SA content was higher in specimens from RCSF(fam) than from C, in
native 24-h urines (207.5 +/- 20.4 mg vs. 135.2 +/- 16.1 mg, P = 0.013) as well
as in crude salt precipitates of 24-h urines (10.4 +/- 0.5 mg vs. 7.4 +/- 0.9 mg,
P = 0.002) and in purified THPs (75.3 +/- 9.3 microg/mg vs. 48.8 +/- 9.8
microg/mg THP, P = 0.043). Finally, inhibition of calcium oxalate monohydrate
crystal aggregation by 40 mg/L of THP was lower in RCSF(fam) (6.1 +/- 5.5%, range
-62.0 to +84.2%) than in C (24.9 +/- 6.0%, range -39.8 to +82.7%), P = 0.022, and
only 25 out of 44 (57%) THPs from RCSF(fam )were inhibitory (positive inhibition 
value) vs. 25 out of 34 (74%) THPs from C, P < 0.05. In conclusion, severely
recurrent calcium stone formers with a positive family history excrete more THP
than healthy controls, and their THP molecules elute later from an analytical
column and contain more SA. Such increasingly aggregated THP molecules predispose
to exaggerated calcium oxalate crystal aggregation, an important prerequisite for
urinary stone formation.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17345077 [PubMed - indexed for MEDLINE]

340: Int Braz J Urol. 2007 Jan-Feb;33(1):19-22; discussion 23-4.

Comment in:
    Int Braz J Urol. 2007 Mar-Apr;33(2):266-7.

Percutaneous nephrolithotomy with and without retrograde pyelography: a
randomized clinical trial.

Tabibi A, Akhavizadegan H, Nouri-Mahdavi K, Najafi-Semnani M, Karbakhsh M,
Niroomand AR.

Section of Urology, Dr Labbafinejad Hospital, Shahid Beheshti University of
Medical Sciences, Tehran, Iran.

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).

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 17335594 [PubMed - indexed for MEDLINE]

341: Int Urol Nephrol. 2007;39(4):1001-4. Epub 2007 Mar 3.

Do hydronephrosis and extracorporeal shock wave lithotripsy affect carbohydrate
antigens?

Akgül T, Nuhoğlu B, Ayyildiz A, Balci U, Ayyildiz SN, Germiyanoğlu C.

Second Urology Clinic, Ministry of Health Ankara Training and Research Hospital, 
Ankara, Turkey. turgayakgul@gmail.com

OBJECTIVES: To investigate carbohydrate antigen (CA 19-9, CA 15-3, and CA 125)
levels in the patients who had hydronephrosis with renal stones and in whom
Extracorporeal shock wave lithotripsy (ESWL) was performed. MATERIALS AND
METHODS: This prospective study included 20 people with no known disease for
control group and 30 patients who had hydronephrosis with renal stones and in
whom ESWL was performed between January 2005 and January 2006. None of patients
had urinary infection and malignancy. The blood for carbohydrate antigens was
taken pre-ESWL and 30 min after ESWL in both groups. CA 19-9, CA 15-3, and CA 125
in the serum were tested with the electro-immunoassay method on the Roche E-170
apparatus with the original Roche kit. RESULTS: The CA 19-9 and CA 125 values in 
the patients group were found to be statistically significant when compared with 
the control group but the CA 15-3 was not found to be significant. However, CA
19-9, CA 15-3, and CA 125 values of post-ESWL were not statistically significant 
when compared with pre-ESWL group (P > 0.05). CONCLUSIONS: The average serum
values of CA 125 and CA 19-9 in patients were found to be significantly high.
However, serum values of CA 19-9, CA 15-3, and CA 125 were not affected by ESWL.

Publication Types: 
    Randomized Controlled Trial

PMID: 17334832 [PubMed - indexed for MEDLINE]

342: CJEM. 2006 Jul;8(4):285-8.

Perinephric abscess secondary to a staghorn calculus presenting as a subcutaneous
abscess.

Tsukagoshi D, Dinkovski B, Dasan S, Jethwa J.

Emergency Department, East Surrey Hospital, Redhill, Surrey, United Kingdom.
dhayashi@doctors.org.uk

Perinephric abscesses often present with flank pain and signs of sepsis, and are 
known to discharge to the skin. We report a case of a young patient presenting
with a 48-hour history of painful swelling in her right renal angle following a
urinary tract infection and no overt signs or symptoms of sepsis. Plain abdominal
films showed a perinephric abscess secondary to a staghorn calculus in the upper 
pole of the right kidney. On incision and drainage, 700 mL of pus was drained
freely. The patient recovered well but required partial nephrectomy. Subcutaneous
abscess as a result of intra-abdominal pathology is a recognized but rare
complication. This case illustrates that subcutaneous abscesses may have
underlying intra-abdominal pathology without overt signs of sepsis.

Publication Types: 
    Case Reports

PMID: 17324312 [PubMed - indexed for MEDLINE]

343: Int Urol Nephrol. 2008;40(2):477-82.

Haemodynamic, electrolyte and metabolic changes during percutaneous
nephrolithotomy.

Mohta M, Bhagchandani T, Tyagi A, Pendse M, Sethi AK.

Department of Anaesthesiology and Critical Care, University College of Medical
Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi 110095, India.
medhamohta@hotmail.com

OBJECTIVES: The objectives were to evaluate haemodynamic, electrolyte and
metabolic changes in patients undergoing percutaneous nephrolithotomy when normal
saline was used for irrigation; and to correlate these changes with irrigation
time, volume of irrigation fluid absorbed and number of percutaneous
interventions. METHODS: Twenty adults undergoing percutaneous nephrolithotomy
were studied. Heart rate, systolic and diastolic blood pressure, arterial blood
gases, electrolytes and temperature were monitored before, during and after
irrigation. Haemoglobin, urea and creatinine values were recorded before and 24 h
after the procedure. Durations of anaesthesia and irrigation; volumes of
irrigation fluid used and effluent fluid; and number of percutaneous
interventions during the procedure were also recorded. RESULTS: No significant
changes occurred in mean heart rate, systolic and diastolic blood pressure,
electrolytes, haemoglobin, urea and creatinine. There was a significant fall in
mean pH in postoperative period (P = 0.003) and bicarbonate values showed a
negative correlation with duration of irrigation. Number of percutaneous
interventions had positive correlations with duration of irrigation and volume of
irrigant fluid absorbed. CONCLUSIONS: No significant changes occurred in
haemodynamics and electrolytes, but there was a trend towards metabolic acidosis.
Arterial blood gases should be monitored during and after PCNL in cases with
prolonged irrigation time, repeated percutaneous interventions and patients
having compromised renal function and metabolic status.

PMID: 17318347 [PubMed - indexed for MEDLINE]

344: BJU Int. 2007 Jun;99(6):1467-71. Epub 2007 Feb 19.

Minimally invasive percutaneous nephrolithotomy for upper urinary tract calculi
in transplanted kidneys.

He Z, Li X, Chen L, Zeng G, Yuan J.

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated
Hospital of Guangzhou Medical College, Guangzhou, Guangdong, China.

OBJECTIVE: To report our experience with minimally invasive percutaneous
nephrolithotomy (mPCNL) for upper urinary tract (UUT) calculi in transplanted
kidneys. PATIENTS AND METHODS: Between August 2002 and June 2006, seven patients 
(mean age 40.7 years) with UUT stones in transplanted kidneys (including one
staghorn, two pelvic and four ureteric stones) were treated by mPCNL. A 16 F
peel-away sheath was placed as the percutaneous access port and a 8.5/11.5 F
nephroscope or a 8/9.8 F ureteroscope was used for manipulation. Every 2-3 months
during the follow-up, patients had their serum urea, creatinine and uric acid
measured, with urine culture and ultrasonography. RESULTS: All patients were
rendered stone-free at one mPCNL procedure, with no complications during or after
surgery. The mean (range) operative duration was 53 (20-100) min and the mean
haemoglobin decrease was 0.55 (0.2-1.2) g/dL. At a mean (range) follow-up of 23
(3-48) months renal allograft function was stable in all patients and no
recurrence of stone was detected. CONCLUSIONS: mPCNL is safe and effective for
managing calculi in transplanted kidneys, and it can be the initial therapy for
most cases of UUT stones in transplanted kidneys, except for simple and small
stones in the middle or lower calyx.

PMID: 17309551 [PubMed - indexed for MEDLINE]

345: J Acoust Soc Am. 2007 Jan;121(1):EL41-7.

The use of resonant scattering to identify stone fracture in shock wave
lithotripsy.

Owen NR, Bailey MR, Crum LA, Sapozhnikov OA, Trusov LA.

There is currently little feedback as to whether kidney stones have fractured
during shock wave lithotripsy. Resonant scattering of the lithotripter shock wave
was used here to differentiate intact and fractured stone models in water.
Scattering, including reflection and radiation due to reverberation from within
the stone, was calculated numerically with linear elasticity theory and agreed
well with measurements made with a focused receiver. Identification of fracture
was possible through frequency analysis, where scatter from fractured stones was 
characterized by higher energy in distinct bands. High-speed photography
concurrent with measurement indicated the effect was not due to cavitation.

Publication Types: 
    In Vitro
    Letter
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17297825 [PubMed - indexed for MEDLINE]

346: J Urol. 2007 Mar;177(3):979-82.

Changing gender prevalence of stone disease.

Scales CD Jr, Curtis LH, Norris RD, Springhart WP, Sur RL, Schulman KA, Preminger
GM.

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery,
Duke University Medical Center, Durham, North Carolina 27710, USA.

PURPOSE: Recent studies suggest that the incidence of renal stone formation has
been increasing and the male predominance of nephrolithiasis is decreasing, which
may be due to changes in diet and lifestyle. We examined changes in the
prevalence by gender of inpatient hospital discharges for urinary stone disease. 
MATERIALS AND METHODS: The Nationwide Inpatient Sample was used for analysis.
Discharges with an International Classification of Diseases, 9th revision,
Clinical Modification principal diagnosis of 592.0 (calculus of kidney) or 592.1 
(calculus of ureter) from 1997 to 2002 were included in the investigation.
RESULTS: An estimated mean+/-SE 1,013,621+/-19,310 discharges for stone disease
occurred from 1997 to 2002. Discharges for renal calculus increased by 18.9%
during the study period (p<0.001), while discharges for ureteral calculus
remained relatively constant. After adjusting for population changes discharges
for renal calculi increased by 14.2% (p=0.002). In females discharges for renal
calculi increased by 21.0% and discharges for ureteral calculi increased by 19.2%
(each p<0.001). After adjusting for population changes renal calculus and
ureteral calculus discharges in females increased by 22.0% (p=0.001) and 14.5%
(p=0.005), respectively. CONCLUSIONS: In this nationally representative sample
the population adjusted rate of discharges for stone disease in females
dramatically increased from 1997 to 2002. This alteration represents a change in 
the prevalence by gender of treated stone disease from a 1.7:1 to 1.3:1
male-to-female ratio. It may reflect variations in the underlying prevalence by
gender of stone disease. We speculate that the increasing incidence of
nephrolithiasis might be due to lifestyle associated risk factors, such as
obesity.

PMID: 17296391 [PubMed - indexed for MEDLINE]

347: Urol Res. 2007 Apr;35(2):101-5. Epub 2007 Feb 8.

Percutaneous nephrolithotomy in patients with normal versus impaired renal
function.

Yaycioglu O, Egilmez T, Gul U, Turunc T, Ozkardes H.

Department of Urology, Baskent University Faculty of Medicine, Ankara, Turkey.
yaycioglu@yahoo.com

This study aimed to compare the results of percutaneous nephrolithotomy (PCNL) in
patients with impaired renal function (IRF) and normal renal function (NRF).
Records of 300 consecutive patients who underwent PCNL from July 2002 to July
2005 were retrospectively reviewed. Nineteen patients (6.3%) had serum creatinine
values higher than 1.5 mg/dl before surgery (IRF Group). Nineteen gender and age 
matched patients with normal renal function were chosen as controls (NRF Group). 
The surgical parameters, outcome, and complication rates were compared. The
effect of PCNL on the renal function was assessed in patients with IRF. There
were 13 male and 6 female patients in both groups. In the IRF group, seven
patients had a solitary kidney and three had bilateral stones. Thus, PCNL was
performed on 22 kidneys. No patients in the NRF Group had solitary kidney or
bilateral stones and PCNL was performed on 19 kidneys. There were no
statistically significant differences between the two groups for success and
complication rates (P = 0.376 and P = 0.184, respectively). In a mean follow-up
of 15.6 months, mean serum creatinine decreased from 2.8 to 2.6 mg/dl (P = 0.273)
in patients of the IRF group. Similar stone clearance and complication rates were
obtained with PCNL in patients with impaired and normal renal function. Surgery
does not cause biochemical deterioration in patients with compromised renal
function before treatment.

Publication Types: 
    Comparative Study

PMID: 17287962 [PubMed - indexed for MEDLINE]

348: Curr Opin Urol. 2007 Mar;17(2):136-40.

Management of stones in calyceal diverticulum.

Gross AJ, Herrmann TR.

Department of Urology, Asklepios Klinik Barmbek, Hamburg, and Urology Clinic,
Medizinische Hochschule, Hannover, Germany. an.gross@asklepios.com

PURPOSE OF REVIEW: Congenital abnormities in urology are very common. These
abnormalities include calyceal diverticula, which are frequently diagnosed as an 
incidental finding. Once symptomatic, calyceal diverticula have to be located by 
accurate imaging and then treated in an appropriate manner. RECENT FINDINGS:
Possible methods of treatment in calyceal diverticula are generally the same as
in other abnormalities of the kidney: extracorporeal shock-wave lithotripsy,
endoscopic procedures, percutaneous procedures, laparoscopy and open surgery. It 
is important to find the exact location of the stone-bearing diverticulum and
various imaging techniques may be used for this purpose. Metabolic work-up
remains important. SUMMARY: There is a strong trend towards endoscopical and
laparoscopical treatment in renal abnormalities such as calyceal diverticula. A
combination of these two methods seems to be appropriate in some cases.

Publication Types: 
    Review

PMID: 17285025 [PubMed - indexed for MEDLINE]

349: Curr Opin Urol. 2007 Mar;17(2):109-13.

Limitations of extracorporeal shock wave lithotripsy.

Madaan S, Joyce AD.

Pyrah Department of Urology, St James University Hospital, Leeds, UK.

PURPOSE OF REVIEW: Extracorporeal shock wave lithotripsy (ESWL) is the preferred 
modality for the treatment of renal and upper ureteric calculi. The present
review focuses on the limitations of ESWL, where recent developments have tried
to identify patients who are unlikely to succeed with ESWL and where improvements
in shock wave delivery may increase successful stone fragmentation. RECENT
FINDINGS: Evaluation of patients prior to ESWL is especially important, and the
use of imaging in the decision process, with the use of computed tomography
attenuation values and skin-to-stone distance, can help improve our ability to
identify suitable patients for shock wave treatment. Continued research into the 
methods of shock wave delivery techniques and lithotripter designs will help
achieve better stone fragmentation rates with reduced side effects. SUMMARY: The 
importance of traditional factors in predicting ESWL success, such as stone size,
location, composition and renal anatomy, are well known. More recently, authors
have created nomograms to predict stone-free outcome after ESWL. Others have used
the information obtained from computed tomography to predict stone comminution.
In addition, modifications in shock wave delivery by altering shock rate and
voltage have been researched in an effort to improve shock wave efficacy.

Publication Types: 
    Review

PMID: 17285020 [PubMed - indexed for MEDLINE]

350: Surg Laparosc Endosc Percutan Tech. 2006 Dec;16(6):435-6.

Laparoscopic pyelolithotomy with intraperitoneal ultrasonic lithotripsy: report
of a novel minimally invasive technique for intracorporeal stone ablation.

Collins S, Marruffo F, Durak E, Hruby G, Bergman A, Gupta M, Landman J.

Department of Urology, Columbia University School of Medicine, New York, NY
10032, USA.

We present the case of a 71-year-old Hispanic woman with a 4-cm stone in the
renal pelvis of a kidney with thin parenchyma. Retrograde pyelography revealed a 
normal ureter and normal ureteropelvic junction. A ureteral stent was placed. Six
weeks after the stent was placed, a differential renal scan revealed 18% function
of the involved kidney. A percutaneous nephrolithotomy was not performed because 
of the thin parenchyma and intrarenal anatomy, which would have complicated
access. The patient underwent an uncomplicated laparoscopic pyelolithotomy. The
stone was placed into an Endocatch entrapment sack. The open end of the Endocatch
sack was brought through a trocar site, and a nephroscope and ultrasonic
lithotripter were deployed. The stone was fragmented and aspirated in the
standard manner, thereby avoiding the need to extend the 12-mm trocar incision
for stone extraction. The stone fragmentation and extraction time was 14 minutes.
The patient was stone-free and discharged home in the morning of the first
postoperative day without complications.

Publication Types: 
    Case Reports

PMID: 17277663 [PubMed - indexed for MEDLINE]

351: Am J Clin Pathol. 2007 Mar;127(3):465-8.

Castleman disease of the hyaline-vascular type confined to the kidney.

Mah NA, Peretsman SJ, Teigland CM, Banks PM.

Department of Urology, Carolinas Medical Center, Charlotte, NC, USA.

The case is a 38-year-old man in whom a solitary subcapsular left renal cortical 
mass was successfully resected. Comorbidities included a benign epididymal cyst
and a history of nephrolithiasis. Computed tomographic imaging demonstrated a
1.8-cm enhancing mass in the anterior midregion of the kidney. An open partial
nephrectomy was performed, and histopathologic examination established a
diagnosis of the hyaline-vascular type of Castleman disease (CD). The patient had
an uneventful postoperative course and has experienced no local or metastatic
recurrence in the 10 months since surgery. CD localized in the kidney is an
exceptionally rare occurrence but should be included in the complete differential
diagnosis of solitary renal cortical mass lesions.

Publication Types: 
    Case Reports

PMID: 17276946 [PubMed - indexed for MEDLINE]

352: Semin Nephrol. 2006 Nov;26(6):441-6.

Physiology of acid-base balance: links with kidney stone prevention.

Halperin ML, Cheema Dhadli S, Kamel KS.

Renal Division, St. Michael's Hospital, University of Toronto, Toronto, Ontario, 
Canada. mitchell.halperin@utoronto.ca

Two processes permit the urine pH and the medullary interstitial pH to remain in 
an "ideal range" to minimize the risk of forming kidney stones. First, a
medullary shunt for NH(3) maintains the urine pH near 6.0 to minimize uric acid
precipitation when distal H(+) secretion is high. Second, excreting dietary
alkali excreting alkali as a family of organic anions--including citrate--rather 
than as bicarbonate maintains the urine pH near 6.0 while urinary citrate
chelates ionized calcium, which minimizes CaHPO(4) precipitation. In patients
with idiopathic hypercalciuria and recurrent calcium oxalate stones, the initial 
nidus is a calcium phosphate precipitate on the basolateral membrane of the thin 
limb of the loop of Henle (Randall's plaque). Formation of this precipitate
requires medullary alkalinization; K(+) -depletion and augmented medullary
H(+)/K(+) -ATPase may be predisposing factors.

Publication Types: 
    Review

PMID: 17275581 [PubMed - indexed for MEDLINE]

353: Urol Res. 2007 Feb;35(1):35-40. Epub 2007 Feb 2.

The pathogenesis of calyceal diverticular calculi.

Matlaga BR, Miller NL, Terry C, Kim SC, Kuo RL, Coe FL, Evan AP, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, 1801 North Senate Boulevard, Suite 220, Indianapolis, IN 46202, USA.

Controversy exists over whether metabolic factors or urinary stasis predominate
in the pathogenesis of calyceal diverticular calculi. We performed a study to
better define the effects urinary stasis and metabolic abnormalities have in the 
pathogenesis of calyceal diverticular stones. Twenty-nine patients who underwent 
percutaneous treatment of calyceal diverticular calculi were studied. All
patients underwent 24 h urine collection to evaluate metabolic risk factors. In
three patients, urine was sampled directly from the diverticulum for metabolic
studies. The urinary stone risk parameters of the patients with calyceal
diverticular stones (Tic SF) were similar to those of a well-characterized cohort
of calcium oxalate stone formers (CaOx SF). When compared to a group of normal
people, the Tic SF and CaOx SF were significantly more hypercalciuric and their
urine was significantly more supersaturated with calcium oxalate. Urine aspirated
directly from the diverticulum had the lowest SSCaOx when compared to ipsilateral
and contralateral renal pelves. The urinary risk profiles of patients with
diverticular calculi are similar to those of CaOx SF, suggesting a metabolic
etiology of diverticular stones. However, the SS CaOx of urine aspirated directly
from the diverticula is significantly lower than that of the renal pelves; these 
data support the hypothesis that urinary stasis significantly contributes to the 
pathogenesis of calyceal diverticular calculi. Taken together, it seems likely
that calyceal diverticular calculi arise from a combination of metabolic
abnormalities and urinary stasis.

PMID: 17273836 [PubMed - indexed for MEDLINE]

354: Urology. 2007 Jan;69(1):170-2.

Expanding use of ureteral access sheath for stones larger than access sheath's
internal diameter.

Gur U, Holland R, Lask DM, Livne PM, Lifshitz DA.

Department of Urology, Rabin Medical Center-Golda Hospital and Tel Aviv
University Sackler School of Medicine, Petah Tikva, Israel. ugtm@bezeqint.net

The internal diameter of the ureteral access sheath limits the size of stones
that can be removed during flexible ureteroscopy. We describe a technique that
allows removal of larger stones, which are entrapped and removed en bloc with the
access sheath. This new technique was shown to be efficient and safe.

PMID: 17270643 [PubMed - indexed for MEDLINE]

355: Urology. 2007 Jan;69(1):22-5; discussion 25-6.

High-power holmium:yttrium-aluminum-garnet laser for percutaneous treatment of
large renal stones.

Jou YC, Shen CH, Cheng MC, Lin CT, Chen PC.

Department of Urology, Chiayi Christian Hospital, Chiayi, Taiwan.

OBJECTIVES: To assess the efficacy and safety of high-power
holmium-yttrium-aluminum-garnet (YAG) laser lithotripsy for percutaneous
nephrolithotomy in patients with large renal stones. METHODS: We retrospectively 
reviewed the charts of 87 patients who underwent 91 percutaneous nephrolithotomy 
procedures at our hospital from April 2004 to June 2005, during which a
holmium-YAG laser with a self-made fiber guider was used for lithotripsy. Of the 
91 procedures, 51 were performed with the maximal power output set at 3.0 J in
patients with a renal stone size of 3 cm or larger (group 1). The other 40
procedures were performed with the maximal power set at 2.0 J in patients with a 
renal stone size of less than 3 cm or with ureteral stones (group 2). RESULTS:
The average stone size was 5.4 cm in group 1, and the stone-free rate was 61.4%
after a single procedure. The average operation time was 108 minutes in group 1
and 93 minutes in group 2. The average postoperative hospital stay was 5.7 days
in group 1 and 5.9 days in group 2. Two patients in group 1 and one in group 2
required blood transfusions after the procedure. Seven patients (13.7%) in group 
1 and two (5.0%) in group 2 experienced a urinary tract infection after the
procedure. No statistically significant difference in procedure time,
postoperative hospital stay, blood transfusion rate, or postoperative urinary
tract infection rate was found between the two groups. CONCLUSIONS: The results
of our study have shown that using a high-power holmium-YAG laser is safe and
effective in the treatment of large renal stones.

PMID: 17270603 [PubMed - indexed for MEDLINE]

356: Br J Radiol. 2007 Jan;80(949):e1-3.

An unusual case of pneumoperitoneum: nephrocolic fistula due to a giant renal
staghorn calculus.

Alster C, Zantut LF, Lorenzi F, Marchini GS, Onofrio BJ, Nakashima AA, Gatto BE, 
Birolini D.

University of Sao Paolo, Sao Paolo, SP 05410-020, Brazil. alster@usp.br

Gastrointestinal perforations usually lead to pneumoperitoneum and peritonitis.
Rarely, if ever described, a complete giant staghorn renal stone might cause a
nephrocolic fistula with sigmoid impaction and perforation similar to gallstone
ileus. Few nephrointestinal fistulae have been described in the literature and
none of them were presented as an acute abdomen with pneumoperitoneum and
pneumoretroperitoneum. To our knowledge, this is the only case showing CT and
radiographic findings of a pathology not yet described in the literature. We
named the sigmoid perforation by a renal stone ileus "Lorenzi's syndrome" after
the physician who hypothesized this rare differential diagnosis based only on
history and clinical examination.

Publication Types: 
    Case Reports

PMID: 17267461 [PubMed - indexed for MEDLINE]

357: Am J Physiol Renal Physiol. 2007 May;292(5):F1396-403. Epub 2007 Jan 30.

Effect of urine fractionation on attachment of calcium oxalate crystals to renal 
epithelial cells: implications for studying renal calculogenesis.

Grover PK, Thurgood LA, Ryall RL.

Urology Unit, Department of Surgery, Flinders Medical Centre, and Flinders
University, South Australia, Australia. pk.Grover@flinders.edu.au

Our aim was to determine whether fractionation of human urine affects the
attachment of calcium oxalate monohydrate (COM) crystals to renal cells. Urine
collected from six healthy subjects was fractionated into sieved (S), centrifuged
(C), centrifuged and filtered (CF), or ultrafiltered (UF). Attachment of
[(14)C]COM crystals to Madin-Darby canine kidney (MDCK) cells was studied after
precoating the crystals or the cells with the urine fractions and by using the
same fractions as the binding medium. Protein content of the fractions and
precoated crystals was analyzed with SDS-PAGE and Western blotting. All urine
fractions inhibited crystal attachment. When fractions from the six urine samples
were used to precoat the cells, the median inhibitions of crystal adhesion (
approximately 40%) were not significantly different. Median inhibition after
preincubation of crystals was the same for the S, C, and CF fractions (
approximately 40%) but significantly greater than for the UF fraction (
approximately 28%). When fractions were used as the binding medium, median
inhibitions decreased from 64% in the S fraction to 47 (C), 42 (CF), and to 29%
(UF). SDS-PAGE analysis showed that centrifugation and filtration reduced the
amount of Tamm-Horsfall glycoprotein (THG), which was confirmed by Western
blotting. Human serum albumin, urinary prothrombin fragment 1, and osteopontin,
but not THG, were present in demineralized extracts of the precoated crystals.
Fractionation of human urine affects the attachment of COM crystals to MDCK
cells. Hence future studies investigating regulation of crystal-cell interactions
should be carried out in untreated urine as the binding medium.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17267387 [PubMed - indexed for MEDLINE]

358: Kidney Int. 2007 Apr;71(8):795-801. Epub 2007 Jan 31.

Comment in:
    Kidney Int. 2008 May;73(9):1094-5.

Renal histopathology of stone-forming patients with distal renal tubular
acidosis.

Evan AP, Lingeman J, Coe F, Shao Y, Miller N, Matlaga B, Phillips C, Sommer A,
Worcester E.

Department of Anatomy and Cell Biology, Indiana University, School of Medicine,
and Department of Urology, Methodist Hospital Institute for Kidney Stone Disease,
Indianapolis, Indiana 46223, USA. evan@anatomy.iupui.edu

To define the renal tissue changes in stone-forming patients with distal renal
tubular acidosis (dRTA), we performed intra-operative papillary and cortical
biopsies in five patients. The main abnormalities were plugging of inner
medullary collecting ducts (IMCD) and Bellini ducts (BD) with deposits of calcium
phosphate in the form of apatite; epithelial cell injury and loss was marked.
Plugged ducts were surrounded by interstitial fibrosis, but the fibrosis was
generalized, as well, and was a main feature of the histopathology even when
plugging was not present. In contrast, common idiopathic calcium oxalate stone
formers (SF) never manifest intra-tubule crystals or interstitial fibrosis.
Patients with brushite (calcium monohydrogen phosphate) stones and those with
cystine stones have many fewer IMCD and BD plugged with apatite (or cystine, in
cystinuria), and interstitial fibrosis is limited to the regions around plugged
ducts. Patients with dRTA often present a radiographic picture of
nephrocalcinosis. Our direct surgical observations reveal that these may be
surgically removable stones, especially in patients with well preserved renal
function. In all, dRTA SF have a more diffuse papillary renal disease than other 
SF thus studied, and are also unusual for the degree of interstitial fibrosis.

PMID: 17264873 [PubMed - indexed for MEDLINE]

359: J Endourol. 2007 Jan;21(1):44-9.

Supine percutaneous nephrolithotomy: Effective approach to high-risk and morbidly
obese patients.

Manohar T, Jain P, Desai M.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat,
India.

BACKGROUND AND PURPOSE: There are various concerns regarding percutaneous
nephrolithotomy (PCNL) in the prone position, especially in the morbidly obese
and patients with compromised cardiopulmonary status and stature deformity. We
present our experience with supine PCNL with special reference to its technique, 
indications, advantages, and disadvantages. PATIENTS AND METHODS: A series of 62 
patients underwent PCNL in the supine position, 57 under general anesthesia and 5
with epidural anesthesia. Their average age was 48 +/- 14.16 years, and the
average bulk of the stone was 316 +/- 275 mm2, with 11% of the patients having
staghorn stones and 19 both renal and upperureteral stones. The average body mass
index was 24.28 +/- 4.69, and 11% of the patients were morbidly obese. Nearly all
patients (93%) had an anesthesia risk of ASA grade 3 or above. Two patients had
hip ankylosis. All patients were placed in a modified dorsal lithotomy position
with a 45 degrees tilt to the contralateral side. Under ultrasound guidance, the 
desired calix was punctured in or near the posterior axillary line. RESULTS: The 
average hemoglobin drop was 1.62 +/- 1.03 gm/dL, but only 3% of the patients
required blood transfusion. None of the patients suffered visceral injury. Nearly
all (95%) of the patients were rendered free of stones by the initial PCNL with
or without ureteroscopy. CONCLUSION: Supine PCNL is an effective and safe
procedure in high-risk and obese patients and allows simultaneous management of
renal and ureteral stones.

PMID: 17263606 [PubMed - indexed for MEDLINE]

360: J Endourol. 2007 Jan;21(1):34-43.

How do increasing stone surface area and stone configuration affect overall
outcome of percutaneous nephrolithotomy?

Turna B, Umul M, Demiryoguran S, Altay B, Nazli O.

Department of Urology, Ege University Medical Faculty, Bornova, Izmir, Turkey.
burakturna@gmail.com

BACKGROUND AND PURPOSE: Studies reporting the outcome of percutaneous
nephrolithotomy (PCNL) in relation to stone burden and configuration are limited.
We analyzed our stone-free and complication rates of PCNL with regard to stone
surface area and configuration. PATIENTS AND METHODS: Data of 234 patients who
underwent PCNL were analyzed retrospectively. Patients were stratified into six
groups according to stone burden and into four groups in relation to stone
configuration. Groups were compared with respect to the number of tracts, success
of therapy, complications, requirement for secondary procedures, drop in
hematocrit, and blood transfusion requirement. RESULTS: The overall stone-free
rate was 78.6% with a complication rate of 34.6%. Stone-free rates decreased with
increasing stone size (P = 0.001) and with increasing caliceal component in
complex stones (P = 0.01). The total number of complications rose with increasing
stone surface area (P = 0.0001); however, stone distribution within the kidney
did not affect the complication rate (P = 0.2). The mean operative time rose with
increasing stone burden (P < 0.05) and increasing caliceal involvement by complex
stones (P < 0.01). The need for multiple tracts also rose with increasing stone
burden (P < 0.05). CONCLUSION: There is a decrease in the overall stone-free
rate, as well as an increase in the complication rate, the secondary procedure
rate, the mean operative time, and the need for multiple tracts, with increasing 
stone surface area with PCNL. With regard to stone configuration, there is a
decrease in the stone-free rate, as well as an increase in the operative time,
with increasing caliceal component in complex renal stones.

PMID: 17263605 [PubMed - indexed for MEDLINE]

361: J Endourol. 2007 Jan;21(1):23-7.

Efficacy and safety of a new-generation shockwave lithotripsy machine in the
treatment of single renal or ureteral stones: Experience with 2670 patients.

Egilmez T, Tekin MI, Gonen M, Kilinc F, Goren R, Ozkardes H.

Department of Urology, Adana Teaching and Medical Research Center, Baskent
University, Adana, Turkey.

PURPOSE: To review the treatment efficacy and to assess the complications
encountered in patients with single renal or ureteral calculi managed with a
new-generation SWL machine, the Siemens Lithostar Modularis Uro-Plus. PATIENTS
AND METHODS: The stone location, size, minimum and maximum energy used,
localization technique, number of shockwaves, fluoroscopy time, and number of
sessions were reviewed for 2670 patients. The medical records were consulted to
identify post-SWL secondary treatments in order to calculate the efficacy
quotient (EQ). RESULTS: The stone-free rate was 79%. Calculi in the renal pelvis 
and upper, middle, and lower ureter had success rates of 86%, 86%, 86%, and 85%, 
respectively (P < 0.05). Higher re-treatment rates were encountered for
midureteral stones (P < 0.05). The major complications were renal hematoma, acute
pyelonephritis, perirenal abscess, and acute pancreatitis. The overall EQ was
0.67. The EQ was higher for the renal pelvis (0.73) and upper ureter (0.71).
CONCLUSION: Our experience has shown that this new lithotripter is safe and
provides a 68% to 86% chance of stone clearance.

PMID: 17263603 [PubMed - indexed for MEDLINE]

362: J Endourol. 2007 Jan;21(1):18-22.

Is stone clearance after shockwave lithotripsy in patients with solitary
upper-caliceal stone influenced by anatomic differences in the pelvicaliceal
system?

Küpeli B, Acar C, Gürocak S, Güneri C, Karaoglan U, Bozkirli I.

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.
borakupeli@yahoo.com

PURPOSE: We investigated the effect of pelvicaliceal differences on stone
clearance after extracorporeal shockwave lithotripsy (SWL) in patients with
solitary upper-caliceal stones. PATIENTS AND METHODS: The clinical records of
patients with solitary upper-caliceal stones who underwent SWL between 1996 and
2004 were reviewed. After excluding patients with hydronephrosis, significant
anatomic abnormalities, non-calcium stones, metabolic abnormalities, recurrent
stone disease, multiple stones, and previous renal surgery, 42 patients with a
mean stone size of 153.47 mm2 (range 20-896 mm2) were enrolled in this study.
They were divided into three groups according to stone burden (group 1 < or =100 
mm2, group 2,101 mm2-200 mm2, and group 3 >200 mm2). Upper-pole infundibulopelvic
angle (IPA), infundibular length (IL), and infundibular width (IW) were measured 
from intravenous urograms. Results: Of the total, 29 patients (69%) were stone
free after SWL treatment. The differences in the upperpole IPA, IL, and IW of
stone-free patients and patients with residual stones were not statistically
significant (P = 0.85, P = 0.89, and P = 0.37, respectively). Again, there were
no statistically significant differences in terms of upper IPA, IW, and IL in
comparing the three groups divided by initial stone size. Conclusion:
Upper-caliceal anatomy does not exert a significant impact on stone clearance
after SWL for isolated upper-caliceal stones. To best of our knowledge, this is
the first study to investigate the effects of pelvicaliceal anatomy on SWL
treatment for upper-caliceal stones, so there is a need for further
investigations to confirm our findings.

PMID: 17263602 [PubMed - indexed for MEDLINE]

363: Eur Urol. 2007 Dec;52(6):1784-7. Epub 2007 Jan 16.

Multiorgan failure 17 years after initial stone therapy: forgotten ureteral stent
in a horseshoe kidney.

Pühse G, Piechota H, Scheffold C, Kloska S, Hertle L, Wülfing C.

Department of Urology, University of Münster, Münster, Germany.
puehse@uni-muenster.de

We report on the case of a 44-yr-old white man who was referred as an emergency
from a local hospital to the medical intensive care unit (ICU) at our institution
for progressive multiorgan failure of unknown cause. The CT scan of the abdomen
showed a horseshoe kidney with extensive stone formation in both kidneys and the 
urinary bladder. A massively calcified double pigtail ureteral stent could also
be seen in the left upper urinary tract. The stent had been placed prior to
extracorporeal shock wave lithotripsy (ESWL) therapy 17 years previously. Three
weeks later, after conservative treatment for heart failure and septic
complications, the massively enlarged hydronephrotic left part of the horseshoe
kidney was exposed and heminephroureterectomy was performed. Moreover, a
right-sided pyelotomy was performed. Midline vesicotomy allowed extraction of the
remaining bladder stone including the rest of the forgotten pigtail stent. The
patient recovered rapidly after surgery and was discharged after 2 wk with all
drains removed.

Publication Types: 
    Case Reports

PMID: 17240040 [PubMed - indexed for MEDLINE]

364: Saudi J Kidney Dis Transpl. 2007 Mar;18(1):47-53.

Percutaneous nephrolithotomy for complete staghorn renal stones.

Koko AH, Onuora VC, Al-Turkey MA, Al Moss M, Meabed AH, Al Jawani NA.

Department of Urology, Armed Forces Hospital, Dhahran, Saudi Arabia.
abdhkoko@hotmail.com

To evaluate the effectiveness of percutaneous nephrolithotomy (PNL) in the
management of patients with complete staghorn stones, a retrospective study was
conducted on 110 patients at the Riyadh Medical Complex, Riyadh, Kingdom of Saudi
Arabia. The study was performed between September 1990 and September 1999. 144
procedures were performed on 119 renal units including 22 units (18.5%) that
needed more than one sitting. Of them, 85 units (71.4%) were completely cleared
after PNL and 11 units (9.2%) were left with insignificant residual fragments (< 
4 mm). This gives a success rate of 78.6% for PNL as a monotherapy. Twelve
patients with significant residual fragments required Extracorporal Shock Wave
Lithotripsy (SWL) in addition to PNL. The overall success rate after PNL and SWL 
in 108 renal units was 89.4%. We found PNL useful in the management of patients
with complete staghorn stones, either as monotherapy or in combination with SWL. 
It was associated with little morbidity and the procedure can be instituted even 
in centers with limited facilities.

PMID: 17237891 [PubMed - indexed for MEDLINE]

365: J Urol. 2007 Feb;177(2):565-9.

Hyperoxaluria in kidney stone formers treated with modern bariatric surgery.

Asplin JR, Coe FL.

Litholink Corporation and the Section of Nephrology, University of Chicago,
Chicago, Illinois, USA. jasplin@litholink.com

PURPOSE: Nephrolithiasis and renal failure secondary to severe hyperoxaluria were
complications of jejunoileal bypass for obesity, leading to the discontinuation
of this procedure in the United States in 1980. Bariatric procedures currently in
use have not been adequately evaluated for this complication. MATERIALS AND
METHODS: We compared 24-hour urine chemistry studies of 132 patients with
nephrolithiasis who had undergone bariatric surgery with the urine chemistry
studies of patients who had undergone jejunoileal bypass, those with routine
kidney stones and normal subjects. The primary aim was to determine if
hyperoxaluria developed in patients who underwent bariatric surgery and had
kidney stones as had been seen with jejunoileal bypass. RESULTS: Patients who
have undergone modern bariatric surgery had an adjusted mean urine oxalate
excretion of 83 mg per day compared to 39 mg per day for routine kidney stone
formers and 34 mg per day for normal subjects (p <0.001 for both comparisons),
but not quite as high as that found in patients treated with jejunoileal bypass
(102 mg per day, p <0.001). Urine supersaturation of calcium oxalate, the main
driving force for calcium oxalate stone formation, was higher in patients treated
with bariatric surgery compared to routine kidney stone formers and normal
subjects (p <0.001 for both comparisons). CONCLUSIONS: Hyperoxaluria is the most 
significant abnormality of urine chemistry studies in patients with kidney stones
who have undergone bariatric surgery. Many of these patients have a degree of
hyperoxaluria that could lead to kidney failure. Further studies are required to 
determine the prevalence of this problem in patients who have undergone bariatric
surgery.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 17222634 [PubMed - indexed for MEDLINE]

366: J Endourol. 2006 Dec;20(12):1005-9.

Renal tract calculi: comparison of stone size on plain radiography and
noncontrast spiral CT scan.

Dundee P, Bouchier-Hayes D, Haxhimolla H, Dowling R, Costello A.

Department of Urology, Royal Melbourne Hospital, Parkville, Melbourne, Australia.
pdundee@amavic.com

BACKGROUND AND PURPOSE: Noncontrast spiral CT (NCCT) has emerged as the
investigation of choice in patients presenting with renal-tract calculi. As
management guidelines are based on stone size measured on plain radiography of
the kidneys, ureters, and bladder (KUB), it is important to assess the accuracy
of stone size measured on NCCT compared with KUB films. PATIENTS AND METHODS: The
NCCT and KUB studies obtained from 24 patients (27 stones) presenting to the
emergency department at a major metropolitan hospital were analyzed randomly and 
independently by two urologists and one uroradiologist. The NCCT scans were
assessed separately from the KUB films. Only size in greatest dimension and stone
location were recorded. RESULTS: The stone size was 2 to 38 mm on NCCT scans and 
2 to 46 mm on KUB films. The mean stone size was 6.773 +/- 6.146 mm and 7.747 +/-
7.866 mm, respectively (P = 0.0398; Student's t-test). Almost three fourths (70%)
of the stones were larger on KUB films than they were on NCCT scans, with a mean 
difference -0.974 mm (95% confidence interval -5.652, 3.703) for NCCT.
CONCLUSION: Spiral CT underestimates stone size by approximately 12% compared
with KUB films. This error may impact stone management as outlined in guidelines 
published by the American Urological Association, particularly for stones about 5
mm in greatest dimension. These patients may initially be managed conservatively 
when intervention would be more appropriate.

Publication Types: 
    Comparative Study

PMID: 17206892 [PubMed - indexed for MEDLINE]

367: Urol Res. 2007 Feb;35(1):41-8. Epub 2007 Jan 5.

Analysis of urinary calculi using an infrared microspectroscopic surface
reflectance imaging technique.

Anderson JC, Williams JC Jr, Evan AP, Condon KW, Sommer AJ.

Department of Chemistry and Biochemistry, Miami University, Oxford, OH 45056,
USA.

This investigation highlights the use of infrared microspectroscopy for the
morphological analysis of urinary stones. The research presented here has
utilized the reflectance mode of an infrared microscope for use in creating
chemically specific maps of cross-sectioned renal calculi surfaces, precisely
showing the placement of renal stone components in a calculus sample. The method 
has been applied to renal stones of both single and multiple components
consisting primarily of hydroxyapatite, calcium oxalate monohydrate and calcium
oxalate dihydrate. Factors discussed include the photometric accuracy of the
spectra obtained, a comparison of the surface reflectance method with existing
methods such as diffuse reflectance infrared Fourier transform spectroscopy
(DRIFTS) and attenuated total internal reflection (ATR) analysis, and the
influence of specular reflectance between polished and unpolished sample spectra.
Full spectral maps of cross-sectioned renal stones provided positive localization
of components using qualitatively accurate spectra similar in appearance to
DRIFTS spectra. Unlike ATR and DRIFTS spectra, surface reflectance spectra lack
photometric accuracy and are therefore not quantifiable; at present, however,
spectra are suitable for qualitative analysis. It was found that specular
reflectance increases minimally with a highly polished stone cross-section
surface, though qualitative data is not affected. Surface reflectance imaging of 
sections of renal stones is useful for determining the identity of stone
components while simultaneously providing precise locations of mineral components
within the stone using presently available instruments.

Publication Types: 
    Evaluation Studies
    Research Support, N.I.H., Extramural

PMID: 17205310 [PubMed - indexed for MEDLINE]

368: Int J Urol. 2007 Jan;14(1):60-6.

Chronic acid ingestion promotes renal stone formation in rats treated with
vitamin D3.

Okamoto N, Aruga S, Tomita K, Takeuchi T, Kitamura T.

Department of Urology, University of Tokyo, Tokyo, Japan.

OBJECTIVE: Although hypercalciuria, a well-established adverse effect of vitamin 
D3, can be a risk factor of renal stone formation, the risk of nephrolithiasis
has not been well defined. The consumption of a diet high in acid precursors is
often cited as a risk factor for the development of calcium-based kidney stones. 
In the present study, we investigated the effect of chronic acid ingestion on
kidney stone formation in rats treated with calcitriol (1-25[OH]2 D3). METHODS:
Control rats (C-C), calcitriol-treated rats (C-V; three treatments of 0.5 microg 
of calcitriol per week) and acid-ingested (water containing 0.21 mol/L NH4Cl),
calcitriol-treated (three treatments of 0.5 microg of calcitriol per week) rats
(A-V) were fed in metabolic cages. After 1 month, urine, blood, kidney and bone
samples were analyzed. RESULTS: The A-V rats exhibited elevated serum calcium
concentrations, urinary calcium and phosphate excretion, urinary type I collagen 
cross-linked N-peptide (NTx)/creatinine values, mRNA expression of osteopontin in
the kidney, and renal calcium contents as well as decreased bone mineral
densities, compared with the C-C and C-V rats. Urinary citrate excretion was
lower and NaDC-1 mRNA expression in the kidney was higher in the A-V rats than in
the C-C and C-V rats. Calcium phosphate kidney stones were found in the A-V rats.
CONCLUSIONS: The ingestion of NH4Cl, an acid precursor, promotes calcium
phosphate kidney stone formation in calcitriol-treated rats. The chronic intake
of a diet rich in acid precursors may be a risk factor for the development of
kidney stones in subjects who are being treated with calcitriol.

PMID: 17199862 [PubMed - indexed for MEDLINE]

369: Urol Int. 2007;78(1):91-2.

Giant renal calculus in a solitary functioning kidney.

Girgin C, Sezer A, Sahin O, Oder M, Dinçel C.

Izmir Ataturk Training Hospital, 1st Urology Department, Izmir, Turkey.
girgincengiz@hotmail.com

We report a case of giant renal calculus 230 x 140 mm in size and weighing 1,350 
g in a solitary functioning kidney treated by nephrolithotomy. A 47-year-old man 
presented with right lumbar pain, abdominal mass and microscopic hematuria.
Physical examination revealed a stony hard mass on the right side of the abdomen,
extending from the subcostal region to the iliac crest. A giant renal calculus in
his right kidney and atrophic nonfunctioning left kidney was diagnosed by
ultrasonography, IVP and CT scan. Right nephrolithotomy was performed. Analysis
revealed a calcium phosphate stone. This case is the largest and the heaviest
stone reported in the literature in a solitary functioning kidney.

Publication Types: 
    Case Reports

PMID: 17192742 [PubMed - indexed for MEDLINE]

370: Can J Urol. 2006 Dec;13(6):3358-63.

The efficacy of the Dornier Doli S lithotripter for renal stones.

Hoag CC, Taylor WN, Rowley VA.

Department of Urological Sciences, University of British Columbia, Vancouver,
British Columbia, Canada.

INTRODUCTION: There is little documentation of the efficacy of the Doli-S
lithotripter. This study investigated the outcome of ESWL with the Doli-S
lithotripter on previously untreated renal calculi. METHODS: Over a 12 month
period, 105 consecutive patients with renal stones, treated by a single urologist
were enrolled in the study. None of the stones were previously treated. Data
gathered included stone characteristics and treatment characteristics. Treatment 
was to an endpoint of either fluoroscopically successful fragmentation or to 2500
shockwaves. Patients were followed with KUBs, ultrasounds, or CT-KUBs to assess
residual stone burden. Treatment success was defined as complete clearing of the 
calculus, or residual fragments of less than 3 mm. RESULTS: One hundred five
patients were treated and 16 were lost to follow-up. One hundred nineteen stones 
in 89 patients were included in our analysis. Mean follow-up was 115 days. The
average stone size (expressed as mean of two measured stone dimensions) was 7.8
mm. After a single lithotripsy treatment, the overall treatment success rate was 
47.9%. The left kidney accounted for 58% of the treated stones. Treatment success
was greater for left renal stones than right-sided stones (55.1% versus 38.0%, p 
= 0.033). There was no significant difference in treatment success rates for
calyceal location of stones. Lower pole stones were treated successfully in 57.9%
of cases. Smaller stones (3 mm-10 mm) were more successfully treated than larger 
stones (10 mm-20 mm) (55.6% versus 24.1%, p = < 0.001). CONCLUSIONS: Success
rates for the Doli-S lithotripter for a single treatment of previously untreated 
renal stones ranged from 24%-58%, depending on stone size and location. These
rates are lower than success rates reported for other lithotripters. Inferior
pole calculi had a higher treatment success rate than previously reported.
Factors associated with treatment success included smaller stone size, left-sided
stones, and ease of fluoroscopic visualization.

PMID: 17187703 [PubMed - indexed for MEDLINE]

371: J Investig Med. 2006 Nov;54(7):412-24.

Cell biology of pathologic renal calcification: contribution of crystal
transcytosis, cell-mediated calcification, and nanoparticles.

Kumar V, Farell G, Yu S, Harrington S, Fitzpatrick L, Rzewuska E, Miller VM,
Lieske JC.

Division of Nephrology, Mayo Clinic College of Medicine, Rochester, MN, USA.

INTRODUCTION: The earliest lesion in the kidneys of idiopathic calcium oxalate
stone formers is deposition of calcium phosphate in the interstitium, termed a
Randall's plaque. Yet the cellular and molecular factors leading to their
formation are unknown. METHODS: The influence of urinary proteins on adhesion of 
preformed calcium oxalate crystals to rat continuous inner medullary collecting
duct (cIMCD) cells was studied in vitro, and cIMCD cells were also exposed to
calcifying media containing beta-glycerophosphate for up to 28 days. Renal tissue
was obtained from a stone-forming and non-stone-forming individual at the time of
nephrectomy. These nanoparticles, isolated from renal stones obtained at the time
of surgical resection, were analyzed and propagated in standard cell culture
medium. RESULTS: Urinary proteins influence crystal adhesion to renal epithelial 
cells, and this activity is abnormal in the urine of stone-forming patients.
cIMCD cells assumed an osteoblastic phenotype when exposed to the calcifying
medium, expressing two bone matrix proteins (osteopontin and bone sialoprotein)
that were also identified in the kidney of the stone-forming patient and
associated with crystal deposition. Nanoparticles were propagated from the
majority of renal stones. Isolates were susceptible to selected metabolic
inhibitors and antibiotics and contained conserved bacterial proteins and
deoxyribonucleic acid (DNA). CONCLUSIONS: These results suggest new paradigms for
Randall's plaque formation and idiopathic calcium oxalate stone disease. It seems
unlikely that these events are driven solely by physical chemistry; rather, they 
are critically influenced by specific proteins and cellular responses, and
understanding these events will provide clues toward novel therapeutic targets.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 17169263 [PubMed - indexed for MEDLINE]

372: Am J Kidney Dis. 2006 Dec;48(6):905-15.

Body size and 24-hour urine composition.

Taylor EN, Curhan GC.

Renal Division and Channing Laboratory, Department of Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
entaylor@partners.org

BACKGROUND: Greater body mass index (BMI) is a risk factor for kidney stones.
However, the relation between BMI and the urinary excretion of many lithogenic
factors remains unclear. METHODS: We studied urine pH, urine volume, and 24-hour 
urinary excretion of calcium, oxalate, citrate, uric acid, sodium, magnesium,
potassium, phosphate, and creatinine in stone-forming and non-stone-forming
participants in the Health Professionals Follow-Up Study (599 stone-forming and
404 non-stone-forming men), Nurses' Health Study (888 stone-forming and 398
non-stone-forming older women), and Nurses' Health Study II (689 stone-forming
and 295 non-stone-forming younger women). Each cohort was divided into quintiles 
of BMI. Tests of linear trend were conducted by 1-way analysis of variance.
Linear regression models were adjusted for age, history of stone disease, dietary
intake, and urinary factors. RESULTS: Participants with greater BMIs excreted
more urinary oxalate (P for trend <or= 0.04), uric acid (P < 0.001), sodium (P < 
0.001), and phosphate (P < 0.001) than participants with lower BMIs. There was an
inverse relation between BMI and urine pH (P <or= 0.02). Positive associations
between BMI and urinary calcium excretion in men and stone-forming younger women 
(P <or= 0.02) did not persist after adjustment for urinary sodium and phosphate
excretion. Because of differences in urinary volume and excretion of inhibitors
such as citrate, we observed no relation between BMI and urinary supersaturation 
of calcium oxalate. Urinary supersaturation of uric acid increased with BMI (P
<or= 0.01). CONCLUSION: Positive associations between BMI and urinary calcium
excretion likely are due to differences in animal protein and sodium intake. The 
greater incidence of kidney stones in the obese may be due to an increase in uric
acid nephrolithiasis.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17162145 [PubMed - indexed for MEDLINE]

373: J Urol. 2007 Jan;177(1):168-73; discussion173.

Combined electrohydraulic and holmium:YAG laser ureteroscopic nephrolithotripsy
of large (greater than 4 cm) renal calculi.

Mariani AJ.

Kaiser Medical Center, Honolulu, Hawaii 96819, USA. albert.mariani@kp.org

PURPOSE: Percutaneous nephrolithotripsy is standard treatment for renal calculi
larger than 2 cm. Modern flexible ureteroscopes and accessories using the
complimentary effects of electrohydraulic lithotripsy and holmium:YAG laser
lithotrites can treat large (greater than 4 cm) branched renal calculi in a
minimally invasive fashion with similar or superior results. This report is an
assessment of the safety and efficacy of ureteroscopic nephrolithotripsy
monotherapy for the management of large (greater than 4 cm) branched renal
calculi in the community setting. MATERIALS AND METHODS: A total of 16 patients
with 17 branched renal calculi ranging from 41 to 97 mm (mean 65) in length and
560 to 2,425 mm2 (mean 1,169) in area underwent staged ureteroscopic
nephrolithotripsy monotherapy. Obesity (body mass index greater than 30) was
present in 81% and 38% were morbidly obese (body mass index greater than 40). An 
infectious etiology was present in 81% and hard stone components were present in 
94%. All patients presented with hematuria, pain and/or recurrent urinary tract
infection. Lithotripsy was performed with a single deflection flexible
ureteroscope and predominantly electrohydraulic lithotripsy. Laser drilling was
used (in 4) to weaken hard stones before electrohydraulic lithotripsy. Low
intrarenal pressure was maintained by continuous bladder drainage and placement
of a stiff safety wire. Visibility was maintained using manual pulsatile
irrigation. RESULTS: All patients were rendered pain and infection-free. No
patient required a blood transfusion and there was no change in serum creatinine.
Mobile stone-free status was achieved in 15 of 17 renal units (88%) with a mean
of 2.4 stages and 36 of 40 (90%) procedures performed on an outpatient basis.
Operative time averaged 49 minutes per stage and 115 minutes per calculus. There 
were 3 patients admitted for fever and 1 patient (90 years old) admitted for
pneumonia 3 days postoperatively. There were also 3 patients with calculi larger 
than 75 mm who required ureteroscopic management of steinstrasse. CONCLUSIONS:
Staged ureteroscopic nephrolithotripsy of large renal calculi is feasible with
low morbidity and stone clearance rates that compare favorably with percutaneous 
nephrolithotripsy.

PMID: 17162030 [PubMed - indexed for MEDLINE]

374: J Urol. 2007 Jan;177(1):31-8.

The role of Randall's plaques in the pathogenesis of calcium stones.

Matlaga BR, Coe FL, Evan AP, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, International Kidney Stone Institute, Indianapolis, Indiana 46202,
USA.

PURPOSE: Knowledge of the inciting lesion in kidney stone formation has remained 
rudimentary until quite recently. Randall theorized that areas of apatite plaque 
on the renal papillae would be an ideal site for an overgrowth of calcium oxalate
to develop into a calculus. We reviewed in vivo data that have further defined
the role of Randall's plaques in stone disease. MATERIALS AND METHODS: We
examined a set of literature that tested 2 hypotheses, that is 1) Randall's
plaques are a specialized disease that begins as apatite in a unique region of
the kidney due to local driving forces and anatomy, and 2) stones that arise from
causes different from common calcium oxalate stones do not necessarily arise on
plaque. RESULTS: Intraoperative papillary and cortical biopsy specimens obtained 
during percutaneous nephrolithotomy from the kidneys of 3 types of stone formers 
(idiopathic calcium stone formers, patients with stones due to bariatric
procedures and brushite stone formers) showed unique histopathological findings. 
CONCLUSIONS: The metabolic and surgical pathological findings in 3 distinct
groups of stone formers demonstrate that the histology of the renal papillae from
a stone former is particular to the clinical setting.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 17161996 [PubMed - indexed for MEDLINE]

375: Eur Urol. 2007 Jul;52(1):199-204. Epub 2006 Dec 4.

Comment in:
    Eur Urol. 2007 Jul;52(1):204-5.

Outcome of percutaneous nephrolithotomy: effect of body mass index.

El-Assmy AM, Shokeir AA, El-Nahas AR, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany
HA.

Urology & Nephrology Center, Mansoura University, Mansoura, Egypt.

OBJECTIVE: The surgical management of renal and upper ureteral calculi presents
unique challenges in obese patients. We reviewed our recent experience with
percutaneous nephrolithotomy (PNL) in obese patients to determine the safety and 
outcome of this procedure in such group of patients. PATIENTS AND METHODS: The
surgical records of 1121 patients treated with PNL between 2000 and 2004 were
reviewed. Patients were stratified into four groups according to the World Health
Organization classification of body mass index (BMI): <25 (average), 25-29.9
(overweight), 30-39.9 (obese), and >40 kg/m(2) (morbidly obese). The outcomes of 
PNL in these four groups were compared. RESULTS: A total of 1287 procedures were 
performed on 1155 renal units (1.1 procedures per renal unit). The overall
stone-free rate was 85.1% and the mean hospital stay was 3.3+/-2.6 d. Major
complications were seen in 72 patients (6.4%). No statistically significant
differences were found in decrease in haemoglobin concentration, hospital stay,
and complication rate among the four study groups. The need for auxiliary
procedures and stone-free rates were comparable. CONCLUSIONS: PNL in obese and
morbidly obese patients yields a stone-free rate that is comparable to that
achieved in nonobese patients. The complication rate and length of hospital stay 
are also similar.

PMID: 17161525 [PubMed - indexed for MEDLINE]

376: Eur Urol. 2007 Jun;51(6):1688-93; discussion 1693-4. Epub 2006 Dec 4.

A prospective multivariate analysis of factors predicting stone disintegration by
extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast
computed tomography.

El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
ar_el_nahas@yahoo.com

OBJECTIVE: To assess the value of noncontrast computed tomography (NCCT) as a
possible predictor of renal stone disintegration by shock wave lithotripsy (SWL).
PATIENTS AND METHODS: The study included 120 consecutive patients (71 males, 49
females; mean age: 42.6 yr) with a solitary renal stone of 0.5-2.5 cm in length. 
NCCT was performed using a multidetector row CT scanner at 120 KV and 240 mA,
with 1.25-mm collimation. A bone window was used to measure stone attenuation
values. SWL was performed with an electromagnetic lithotripter. Failure of
disintegration was defined as no fragmentation of the stone after three sessions.
The impact of patients' sex, age, and body mass index (BMI) and the stones'
laterality, location, volume, mean attenuation value, and the skin-to-stone
distance on disintegration were evaluated by univariate and multivariate
analyses. RESULTS: Failure of disintegration was observed in 15 patients (12.5%).
BMI and stone density >1000 HU were the significant independent predictors of
failure (p=0.04 and 0.02, respectively). The success rate of extracorporeal SWL
at 3 mo was 87.5% (105 of 120 patients); 90 patients were stone free and 15 had
residual fragments<4 mm. The only significant predictor of residual fragments was
stone density (p<0.001). CONCLUSIONS: Obesity and increased stone density as
detected by NCCT are significant predictors of failure to fragment renal stones
by SWL. An alternative treatment should be devised for obese patients with stone 
density>1000 HU.

PMID: 17161522 [PubMed - indexed for MEDLINE]

377: Carbohydr Res. 2007 Jan 15;342(1):79-86. Epub 2006 Nov 7.

Electrophoretic separation and characterization of urinary glycosaminoglycans and
their roles in urolithiasis.

Gohel MD, Shum DK, Tam PC.

Department of Health Technology and Informatics, The Hong Kong Polytechnic
University, Hung Hom, Kowloon, Hong Kong, China. danny.gohel@polyu.edu.hk
<danny.gohel@polyu.edu.hk>

Urinary polyanions recovered from the urine samples of kidney stone-formers and
normal controls were subjected to preparative agarose gel electrophoresis, which 
yielded fractions 1-5 in a decreasing order of mobility. In both groups,
chondroitin sulfates were identified in the fast-moving fractions and heparan
sulfates in the slow-moving fractions. Furthermore, two types of heparan sulfates
were identified based on their electrophoretic mobility: slow-moving and
fast-moving. The fractionated urinary polyanions were then tested in an in vitro 
calcium oxalate crystallization assay and compared at the same uronic acid
concentration, whereby, the chondroitin sulfates of stone-formers and heparan
sulfates of normals enhanced crystal nucleation. Fraction 5 of the normals,
containing glycoproteins (14-97 kDa) and associated glycosaminoglycans, were
found to effectively inhibit crystallization. Papainization of this fraction in
stone-formers revealed crystal-suppressive effects of glycoproteins, which was
not seen in similar fractions of normals. It was concluded that glycoproteins
could modulate the crystal-enhancing glycosaminoglycans such as chondroitin
sulfates of stone-formers but not in normals. The differing crystallization
activities of electrophoretic fraction 1 of normals and stone-formers revealed
the presence of another class of glycosaminoglycan-hyaluronan. Hence, in the
natural milieu, different macromolecules combine to have an overall outcome in
the crystallization of calcium oxalate.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17145044 [PubMed - indexed for MEDLINE]

378: J Endourol. 2006 Nov;20(11):885-90.

Calcium oxalate calculi found attached to the renal papilla: Preliminary evidence
for early mechanisms in stone formation.

Williams JC Jr, Matlaga BR, Kim SC, Jackson ME, Sommer AJ, McAteer JA, Lingeman
JE, Evan AP.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46202-5120, USA. williams@anatomy.iupui.edu

BACKGROUND: Calculi are commonly found attached to the renal papilla in calcium
oxalate (CaOx) stone formers, but the mechanisms by which stones form in this
manner are not well established. MATERIALS AND METHODS: Data are presented from
three attached stones collected from different patients. Stone morphology and
composition were determined using micro computed tomography (CT) and infrared
microspectrometry. RESULTS: One of the stones was composed of CaOx with a
peripheral region of apatite, such as might have come from a Randall's plaque.
Another stone was covered with large CaOx crystals but contained at least two
layers of apatite, with no apatite regions exposed at the surface. The third
stone contained CaOx with inclusions of apatite and more apatite on its surface, 
along with a substantial volume of poorly mineralized material that could not be 
identified. CONCLUSIONS: The complexity of these stones and their differing
morphologies do not by themselves allow inference of the mechanism of stone
formation. Future work will require the careful documentation of attached stones 
on the papilla, as well as study of the papilla after the stone has been removed,
before it can be determined whether such diverse CaOx stones originate from the
same or different underlying etiologies.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 17144856 [PubMed - indexed for MEDLINE]

379: J Endourol. 2006 Nov;20(11):875-9.

Effect of potassium citrate therapy on stone recurrence and regrowth after
extracorporeal shockwave lithotripsy in children.

Sarica K, Erturhan S, Yurtseven C, Yagci F.

Department of Urology, Memorial Hospital, Istanbul, Turkey.
ksarica@memorial.com.tr

BACKGROUND AND PURPOSE: Stone disease in children may cause functional and
morphologic changes in the urinary tract during longer-term follow-up. Prevention
of stone recurrence will be possible only with careful metabolic evaluation and
appropriate management. The possible preventive effects of potassium citrate
therapy on true stone recurrence, as well as regrowth rates after shockwave
lithotripsy (SWL), were evaluated in children treated for renal stones. PATIENTS 
AND METHODS: Following assessment of the efficacy of SWL, 96 children (72 male,
53 female aged 4 to 14 years with a mean of 6.6 years) were evaluated for the
effects of potassium citrate on residual fragments as well as true new stone
formation during long-term follow-up. All children had calcium-containing stones 
with normal renal morphology and function without any urinary-tract infection.
Depending on the outcome of treatment, patients with and without residual stones 
were allocated independently to Group I (N = 52) and Group II (N = 44), which
were matched for sex and age. Group I was given oral potassium citrate 1 mEq/kg
daily for 12 months; the remaining children served as controls. Follow-up ranged 
from 12 to 36.6 months, with a mean of 24.4 months. Follow-up results for at
least a year with respect to the stone recurrence or stone growth rates were
recorded in both groups. RESULTS: Stone-free children undergoing no specific
therapy had significant new stone formation compared with the group receiving
potassium citrate on a regular basis (34.6% and 7.6%, respectively). Children
with residual fragments receiving no specific preventive measure also showed
significant new stone formation, along with enlargement of the fragments.
CONCLUSION: In addition to stone removal, treatment of pediatric urolithiasis
requires a thorough metabolic evaluation. Depending on the abnormalities, each
patient should be advised on adequate drinking to increase the urine volume in
accordance with body size. Although children with hypocitraturia may well benefit
from therapeutic agents that raise the urine citrate concentration, our results
did clearly show that all children bearing residual fragments should be counseled
on adequate fluid intake along potassium citrate treatment to prevent stone
regrowth or formation during long-term follow-up.

PMID: 17144854 [PubMed - indexed for MEDLINE]

380: J Endourol. 2006 Nov;20(11):870-4.

Predictors of clinical significance of residual fragments after extracorporeal
shockwave lithotripsy for renal stones.

El-Nahas AR, El-Assmy AM, Madbouly K, Sheir KZ.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
ar_el_nahas@yahoo.com

PURPOSE: To determine the predictors of the clinical outcome of residual
fragments after extracorporeal shockwave lithotripsy (SWL). PATIENTS AND METHODS:
During the last 10 years, residual fragments < or =5 mm were present in 99 male
and 55 female patients (mean age 43.1 years) for >3 months after SWL for renal
stones. Follow-up with history, urine examination, and non-contrast CT scanning
was carried out every 6 months or when symptoms developed. Clinically
insignificant residual fragments were diagnosed in patients who became stone free
or had asymptomatic fragments of the same size during follow-up. A clinically
significant outcome was considered to have occurred in patients requiring
secondary intervention for regrowth of the fragments or medical treatment for
frequent symptomatic episodes. Univariate (Kaplan-Meier) and multivariate
(Cox-regression) analyses were performed to determine significant predictors of
the outcome. The mean follow-up was 31 months (range 6-80 months). RESULTS:
Stone-free status, regrowth of fragments, and persistence of fragments of the
same size were present in 21 (13.6%), 52 (33.8%), and 81 (52.6%) patients,
respectively. A clinically significant outcome was documented in 75 patients
(48.7%) as percutaneous nephrolithotomy was needed in 2, repeat SWL in 50, and
medical treatment for symptomatic episodes in 23 patients. Significant
independent predictors of a clinically significant outcome were fragment size >
or =4 mm and history of recurrent stone disease (P < 0.001). CONCLUSION: The term
"clinically insignificant residual fragments" is not appropriate for all patients
with post-SWL fragments, as 48.7% of patients had fragments that became
clinically significant. Fragments of 4 to 5 mm and recurrent stone disease
predicted clinical significance.

PMID: 17144853 [PubMed - indexed for MEDLINE]

381: J Endourol. 2006 Nov;20(11):863-9.

A new integrated ultrasound system for shockwave lithotripsy.

Bohris C, Jensen H, Bayer T, Liong ML.

Dornier MedTech Systems, Wessling, Germany. cbohris@dornier.com

BACKGROUND AND PURPOSE: Inline ultrasound monitoring requires good image quality 
for accurate stone localization, as well as low shockwave shadowing and a robust 
transducer. In general, conventional transducers designed for another purpose,
such as abdominal scanning, are employed. The distance between the transducer and
the SWL focus can be varied by a mechanical drive. The drawback is reduced
fragmentation at short distances and poor imaging at long distances. This paper
introduces a new approach using a specially designed transducer without a
mechanical drive. MATERIALS AND METHODS: A transducer prototype with optimized
beam focusing (B-K Medical, Herlev, Denmark) was integrated into a modified
Compact Delta II therapy head (Dornier MedTech, Wessling, Germany). Image quality
was tested at two clinical sites, where 40 kidney and 14 ureteral stones were
treated. The shockwave was characterized by model stone tests and fiberoptic
hydrophone measurements. RESULTS: Both kidney and ureteral stone treatments could
be monitored reliably. Despite the long distance to the SWL focus, the transducer
could be operated with relatively high frequencies (3.5-6 MHz), so that high
image resolution was obtained. Model stone tests yielded the same fragmentation
as the standard Compact Delta II without a transducer. CONCLUSIONS: This study
shows that the concept of an integrated transducer distant from the shockwave
focus is feasible. Transducer elevation, which is accompanied by shockwave
shadowing and early transducer failure, is avoided by employing a dedicated
transducer design.

Publication Types: 
    Multicenter Study

PMID: 17144852 [PubMed - indexed for MEDLINE]

382: Urol Int. 2006;77(4):340-6.

Impact of percutaneous access point number and location on complication and
success rates in percutaneous nephrolithotomy.

Muslumanoglu AY, Tefekli A, Karadag MA, Tok A, Sari E, Berberoglu Y.

Department of Urology, Haseki Teaching and Research Hospital, Haseki, Istanbul,
Turkey.

OBJECTIVES: Percutaneous nephrolithotomy (PNL) is sometimes associated with
complications, especially in patients with complex stones. Herein, we review our 
experience with PNL to determine the impact of percutaneous access number and
location on success and complication rates. PATIENTS AND METHODS: During a 2-year
period, a total of 275 patients with a mean age of 42.3 +/- 14.8 (range: 13-75)
years underwent PNL. Stones were classified as simple in 51.6%, and complex
(staghorn calculi or renal pelvis stones coexisting with caliceal stones) in
48.4%. Percutaneous access was done under C-armed fluoroscopy and the tract was
formed with a high-pressure balloon dilation system. One single percutaneous
access was sufficient in 210 (76.4%), while 2 accesses were utilized in 44 (16%),
and > or =3 accesses in 21 cases (7.6%). Supracostal access was performed in 23
(8.4%) patients. RESULTS: An overall success rate of 94.9% was achieved. Stone
location, but not the access point location, was the major determinant for
success, which was 99.3 and 90.2% in patients with simple and complex stones,
respectively (p < 0.01). Significant complications included bleeding
necessitating blood transfusion in 28 (10.2%), and hydropneumothorax in 2 (0.7%) 
patients. Bleeding was observed in 39.1 and 7.5% of patients managed with
supracostal access, and subcostal access, respectively (p < 0.01). An increased
number of access points significantly augmented the risk for bleeding. Bleeding
was encountered in 7.6% of patients managed with 1 percutaneous access point, and
in 18.5% of cases managed with > or =2 access points (p < 0.05).
Hydropneumothorax occurred in patients with supracostal access. CONCLUSION:
Supracostal access as well as multiple punctures may be needed especially in the 
management of complex stones, and the need for multiple access points and
supracostal access significantly increases complication rates. Copyright (c) 2006
S. Karger AG, Basel.

PMID: 17135785 [PubMed - indexed for MEDLINE]

383: Front Biosci. 2007 Jan 1;12:2580-7.

Phytate acts as an inhibitor in formation of renal calculi.

Grases F, Isern B, Sanchis P, Perello J, Torres JJ, Costa-Bauza A.

Laboratory of Renal Lithiasis Research, University Institute of Health Sciences
Research (IUNICS), University of Balearic Islands, Palma of Mallorca, Spain.
fgrases@uib.es

The aim of this study was to assess the inhibitory action of phytate in formation
of renal calculi. Hypertension (induced by nicotine) combined with hypercalcemia 
(induced by D vitamin) was used to induce calcification in renal tissue in male
Wistar rats that were fed a purified phytate free diet. Phytate non-treated rats 
developed significant calcium deposits in kidneys and papillae, as well as in
kidney tubules and vessels, whereas calcium deposits were absent in control and
phytate treated rats. Fragments of hydroxyapatite (HAP) calculi exhibited the
capacity to induce the growth of calcium salts on their surfaces. Presence of 1.5
mg/L of phytate in the synthetic urine inhibited the formation of calcium oxalate
monohydrate on HAP renal calculi in normocalciuric conditions. The findings show 
that the action of phytate as a crystallization inhibitor takes place both in the
intrapapillary tissue and urine.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17127264 [PubMed - indexed for MEDLINE]

384: Arq Bras Endocrinol Metabol. 2006 Aug;50(4):823-31.

Renal stone disease: Causes, evaluation and medical treatment.

Heilberg IP, Schor N.

Division of Nephrology, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

The purpose of the present review is to provide an update about the most common
risk factors or medical conditions associated with renal stone formation, the
current methods available for metabolic investigation, dietary recommendations
and medical treatment. Laboratory investigation of hypercalciuria,
hyperuricosuria, hyperoxaluria, cystinuria, hypocitraturia, renal tubular
acidosis, urinary tract infection and reduction of urinary volume is based on the
results of 24-hr urine collection and a spot urine for urinary sediment, culture 
and pH. Blood analysis for creatinine, calcium and uric acid must be obtained.
Bone mineral density has to be determined mainly among hypercalciurics and
primary hyperparathyroidism has to be ruled out. Current knowledge does not
support calcium restriction recommendation because it can lead to secondary
hyperoxaluria and bone demineralization. Reduction of animal protein and salt
intake, higher fluid intake and potassium consumption should be implemented.
Medical treatments involve the use of thiazides, allopurinol, potassium citrate
or other drugs according to the metabolic disturbances. The correction of those
metabolic abnormalities is the basic tool for prevention or reduction of
recurrent stone formation.

Publication Types: 
    Review

PMID: 17117307 [PubMed - indexed for MEDLINE]

385: Urology. 2006 Nov;68(5):956-9.

Extracorporeal renal lithotripsy: evolution of residual lithiasis treated with
thiazides.

Arrabal-Martín M, Fernández-Rodríguez A, Arrabal-Polo MA, García-Ruiz MJ,
Zuluaga-Gómez A.

Department of Urology, Hospital Universitario San Cecilio, Granada, Spain.
arrabalm@supercable.es

OBJECTIVES: To analyze the evolution of residual lithiasis after renal
extracorporeal shock wave lithotripsy (ESWL) and to show the prolonged efficacy
of thiazides in the treatment of residual lithiasis in patients with calcium
lithiasis. METHODS: We performed a longitudinal, analytical, 36-month study in
100 patients with residual calcium lithiasis after ESWL randomly distributed into
two groups: 50 patients treated with placebo (controls, group 1) and 50 treated
with hydrochlorothiazide, 50 mg/24 hr (group 2). All patients in both groups
underwent imaging studies (simple radiography of the urinary tract and renal
ultrasonography) and a metabolic urinary study. RESULTS: The percentage of global
expulsion of lithiasis during the follow-up period was significantly greater
(chi-square exponent = 19.938, P = 0.001) in the patients treated with thiazides 
(72%) than in the control group (36%), although a large number of patients in
this group underwent new ESWL sessions. During the follow-up period, we performed
ESWL on 42% of the patients in group 1 and 18% of group 2, a statistically
significant difference (chi-square exponent = 6.881, P = 0.032). CONCLUSIONS: The
results of our study have shown that residual lithiasis progresses in 58% of
patients undergoing observation, and new ESWL sessions will be necessary in 42%. 
We observed a significant relationship between the presence of a urinary
lithogenic pattern and the progression of the residual lithiasis. The
administration of thiazides stabilizes or reduces the growth of residual
lithiasis and favors its spontaneous elimination, thus reducing the need for new 
sessions of ESWL. This effect of thiazides is highly significant in patients
presenting with hypercalciuria.

Publication Types: 
    Randomized Controlled Trial

PMID: 17113886 [PubMed - indexed for MEDLINE]

386: Nephrol Dial Transplant. 2007 Feb;22(2):424-31. Epub 2006 Nov 14.

Studies to identify the basis for an alkaline urine pH in patients with calcium
hydrogen phosphate kidney stones.

Kamel KS, Shafiee MA, Cheema-Dhadli S, Halperin ML.

University of Toronto, St. Michael's Hospital, Division of Nephrology, 61 Queen
Street, Toronto, Ontario M5B 1A6, Canada. kamel.kamel@utoronto.ca

BACKGROUND: Patients with CaHPO(4) kidney stones belong to a diagnostic category 
that has a high urine pH as its common feature. Our objective was to provide a
new clinical approach to examine the basis for this high pH. METHODS: The study
group consisted of 26 CaHPO(4) stone formers and 28 normal volunteers. Urine was 
collected q2h plus an overnight sample to identify patients with a urine pH > 6.5
for 12/24 h. Urine ammonium (U(NH4)), sulphate (U(SO4)) and citrate were measured
and diet net alkali was calculated. RESULTS: Of the 26 patients, 13 had
persistently alkaline urine. In 7/13, U(NH4) (68 +/- 13 mEq/day) and U(SO4) (57
+/- 7 mEq/day) were both high. In 6/13 patients, U(NH4) was the usual 31 +/- 3
mEq/day; in 4/6, U(NH4)/U(SO4) was 0.9 +/- 0.1; the cause of the alkaline urine
pH seemed to be a dietary alkali load because the rise in urine pH was episodic
and coincided with a high net diet alkali load and peak citrate excretion rates. 
The remaining two patients had a high U(NH4)/U(SO4) (2.2 and 1.6). Citrate
excretion was very low in the male, but not in the female patient. CONCLUSIONS:
There are heterogeneous causes for a persistently high urine pH. Two of the
patients had a possible molecular basis: the lesion could be a low proximal
convoluted tubule cell pH in the male and an increased entry of NH(3) into the
late distal nephron in the female.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17107965 [PubMed - indexed for MEDLINE]

387: Arch Gynecol Obstet. 2007 Jun;275(6):481-7. Epub 2006 Nov 10.

Maternal kidney stones during pregnancy and adverse birth outcomes, particularly 
congenital abnormalities in the offspring.

Bánhidy F, Acs N, Puhó EH, Czeizel AE.

Second Department of Obstetrics and Gynecology, Semmelweis University, School of 
Medicine, Budapest, Hungary.

OBJECTIVE: The possible adverse birth outcomes, particularly congenital
abnormalities (CAs) in pregnant women with kidney stones (KS) previously have not
been evaluated; therefore, we decided to study this possible association.
METHODS: The population-based data set of the Hungarian Case-Control Surveillance
of CAs, 1980-1996, was used for this analysis. RESULTS: Of 22,843 newborns or
fetuses with CAs, 69 (0.30%) had mothers with KS during pregnancy. Of 38,151
matched control newborns without any abnormalities, 147 (0.39%) had KS during
pregnancy. KS were associated with an adjusted prevalence odds ratio (POR) with
95% CI of 0.8, 0.6-1.0 for CAs. A higher prevalence of maternal KS during the
first trimester of pregnancy was not found in any CA group. There was no higher
rate of preterm birth and low birthweight in the newborns of pregnant women with 
KS. CONCLUSIONS: There is no higher risk for adverse birth outcomes particularly 
CAs in the offspring of mothers with KS and related drug treatments during
pregnancy.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17096158 [PubMed - indexed for MEDLINE]

388: J Antimicrob Chemother. 2007 Jan;59(1):114-7. Epub 2006 Nov 9.

Influence of body temperature on indinavir crystallization under loop of Henle
conditions.

Salahuddin S, Kok DJ, Buchholz NN.

Department of Experimental Urology, Erasmus Medical Centre, Dr Molenwaterplein,
3010 GD, Rotterdam, The Netherlands.

OBJECTIVES: Indinavir is a protease inhibitor used in the therapy of HIV-1+
patients. It causes indinavir stone formation. It has been shown to precipitate
in the loop of Henle (LH) at plasma concentrations (conc[P]) of approximately 8
mg/L. Those experiments were performed at room temperature. Given the influence
of temperature on crystallization in general, and solubility of indinavir in
particular, we repeated the experiments under physiological (body) temperature
conditions. METHODS: Test solutions contained indinavir concentrations of 100-750
mg/L at ionic strengths varying from 0 to 800 mM simulating conditions in the
proximal tubule and the LH. Solutions were titrated with base (NaOH) to find the 
pH value where nucleation is initiated. Experiments were conducted at room
temperature (20 degrees C) and repeated under constantly monitored (body)
temperature (37 degrees C). RESULTS: Experiments at 20 degrees C confirmed our
previous results. At 37 degrees C, the relationship between pH and indinavir
concentration remained inversely proportional. Again, the LH was confirmed as the
most likely localization of crystallization. However, at 37 degrees C
precipitation occurred at a lower urinary concentration (100 versus 125 mg/L) and
within a lower pH range (6.67-7.26 versus 7.23-7.44). This lower urinary
concentration corresponds to a lower conc[P] [critical value (CV)] of 6.41 mg/L, 
as compared with 8.01 mg/L at 20 degrees C. CONCLUSIONS: The CV is even lower at 
37 degrees C than previously assumed. Plasma peak concentration above the CV of
6.4 mg/L will induce crystallization in the LH and should be avoided.

PMID: 17095526 [PubMed - indexed for MEDLINE]

389: J Endourol. 2006 Oct;20(10):761-5.

Simultaneous bilateral retrograde intrarenal surgery for stone disease in
patients with significant comorbidities.

Chung SY, Chon CH, Ng CS, Fuchs GJ.

Minimally Invasive Urology Institute, Cedars Sinai Medical Center, Los Angeles,
California, USA. chungsy@gmail.com

BACKGROUND AND PURPOSE: Advances in endoscopic equipment have allowed urologists 
to access stones in virtually any location in the upper tracts. Where clinically 
appropriate, this approach may represent the preferred treatment option,
regardless of stone size. We report the first description of simultaneous
bilateral retrograde intrarenal surgery (SB-RIRS) in patients with both
significant upper-tract stone burdens and comorbidities such as morbid obesity or
heart disease. PATIENTS AND METHODS: Between September 2003 and April 2004, three
men and one woman with an average of 62 years underwent a total of seven sessions
of SB-RIRS. All four patients were referred from other urologists after failing
prior treatments, including shockwave lithotripsy (five sessions) and RIRS (two
sessions). The average stone burden was 8.8 cm. The procedures were performed by 
two surgeons operating simultaneously using two sets of video/holmium laser
equipment. Flexible (7.5F) ureteroscopes were used to fragment and basket stone
debris without the use of ureteral access sheaths. RESULTS: Three patients
underwent a scheduled second-stage procedure to ensure adequate stone clearance. 
The average total and SB-RIRS-specific operative times were 256 and 131 minutes
for the initial procedure and 235 and 95 minutes for the second-stage procedure, 
respectively. No major complications were noted. CONCLUSION: Simultaneous
bilateral RIRS is an appropriate treatment option for stone patients with
significant comorbidities.

Publication Types: 
    Comparative Study

PMID: 17094751 [PubMed - indexed for MEDLINE]

390: J Endourol. 2006 Oct;20(10):753-60.

Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity
with single-tract procedures.

Hegarty NJ, Desai MM.

Stevan B. Streem Section of Endourology & Stone Disease, Glickman Urological
Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

PURPOSE: To compare the morbidity of percutaneous nephrolithotomy (PCNL)
requiring multiple percutaneous tracts with that of procedures requiring a single
tract for calculus clearance. PATIENTS AND METHODS: Data from 20 patients
undergoing PCNL through two or more percutaneous renal tracts over a 1-year
period were compared with a contemporary cohort of 20 patients undergoing PCNL
requiring a single tract. The mean stone size was 2157 mm(2) v 423 mm(2) (P <
0.0001), the baseline serum creatinine concentration was 1.67 mg/dL v 1.13 mg/dL 
(P < 0.05), and the baseline hemoglobin concentration was 11.8 g/dL v 13.4 g/dL
(P < 0.05) in the multiple- and single-tract groups, respectively. RESULTS: All
single-tract and 95% of multiple-tract patients were rendered stone free. The
mean drop in hemoglobin was similar in the two groups (2.3 g/dL for single tract 
v 2.1 g/dL for multiple tracts; P = 0.55). Complications occurred in two patients
in each group. Four multiple-tract patients required blood transfusion. The need 
for transfusion correlated with lower preoperative hemoglobin and higher
preoperative serum creatinine. There was a significant rise in serum creatinine
(1.67 mg/dL to 1.91 mg/dL; P < 0.05) and drop in creatinine clearance (76.9
mL/min to 67.2 mL/min; P < 0.05) in the multiple-tract group; this was more
pronounced in patients with existing renal insufficiency. No significant change
in renal function was seen in the single-tract group. CONCLUSIONS: Monotherapy
with PCNL utilizing multiple percutaneous tracts is highly effective in the
treatment of staghorn and other large-volume renal calculi. Blood loss and
complication rates with such an aggressive approach are comparable to those of
PCNL incorporating a single percutaneous tract for more straightforward calculi.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 17094750 [PubMed - indexed for MEDLINE]

391: J Endourol. 2006 Oct;20(10):713-6.

Forced versus minimal intravenous hydration in the management of acute renal
colic: a randomized trial.

Springhart WP, Marguet CG, Sur RL, Norris RD, Delvecchio FC, Young MD, Sprague P,
Gerardo CA, Albala DM, Preminger GM.

Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North 
Carolina, USA.

BACKGROUND AND PURPOSE: The management of acute renal colic is a problem commonly
encountered by both urologists and emergency medicine physicians. The classic
approach to managing uncomplicated acute renal colic involves hydration, along
with imaging and pain control. Previous studies have suggested that hydration has
a significant impact on patient comfort, as well as spontaneous stone passage.
This study evaluated the effects of maintenance v forced hydration and its effect
on the pain experienced from renal colic. PATIENTS AND METHODS: Forty male and 18
female patients with a mean age of 41 years suspected to have acute renal colic
were identified in the emergency department. After screening and informed
consent, the patients were enrolled in the study, and 43 patients were eventually
available for analysis. Patients received intravenous (IV) analgesia, imaging
with a noncontrast CT scan of abdomen and pelvis, and assignment to either forced
IV hydration with 2 L of normal saline over 2 hours (N = 20) or minimal IV
hydration at 20 mL of normal saline per hour (N = 23). A visual analog pain scale
was completed hourly for a total of 4 hours. Demographic information, laboratory 
and imaging results, narcotic use in morphine equivalents (ME), and pain scores
were recorded and compared. Spontaneous stone passage rates were also calculated 
by careful patient follow-up. Results were considered statistically significant
at p < 0.05. RESULTS: Stone size was equivalent in the two treatment groups (p > 
0.05). There was no difference in the narcotic requirement in ME (p = 0.644)
between the two groups. Similarly, there was no difference in hourly pain score
or stone-passage rates between the groups (p > 0.05). CONCLUSIONS: Treatment of
uncomplicated renal colic has traditionally included vigorous intravenous
hydration, as well as medications for the control of pain and nausea. Our data
suggest that maintenance intravenous fluids are as efficacious as forced
hydration with regard to patient pain perception and narcotic use. Moreover, it
appears the state of hydration has little impact on stone passage.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 17094744 [PubMed - indexed for MEDLINE]

392: J Urol. 2006 Dec;176(6 Pt 1):2483-7; discussion 2487.

Stressful life events and painful recurrent colic of renal lithiasis.

Diniz DH, Schor N, Blay SL.

Nephrology Division, Universidade Federal de São Paulo (UNIFESP), Escola Paulista
de Medicina, Rua Botucatu 740, 04023-900 São Paulo-SP-Brazil.
denise_diniz@uol.com.br

PURPOSE: There is strong evidence concerning the influence of life event stress
on the onset and course of painful acute episodes in primary care. However, few
studies have analyzed stressful life events in painful recurrent episodes of
renal stone disease. We evaluated the association between painful recurrent colic
of renal lithiasis and stressful life events. MATERIALS AND METHODS: We performed
this case-control study in a primary care setting. Study participants were 194
subjects (97 cases and 97 controls) matched according to age and gender. Cases
were outpatients with a confirmed diagnosis of nephrolithiasis. The control group
consisted of patients seen at the Ophthalmology Outpatient Clinic of the
University Hospital, reporting only refraction symptoms and presenting no chronic
or acute pathology. Main outcome measures reported were stressful life events as 
measured by the Social Readjustment Rating Scale. RESULTS: The mean Social
Readjustment Rating Scale of cases was significantly higher than controls at
257.56 (+/-193.81) vs 144 (+/-131.24), respectively. Logistic regression revealed
that belonging to the case group increased the chances of showing positive
results on the scale greater than or equal to 100 (OR 3.02, 95% CI 1.64-5.59) and
the chance of presenting results of 200 or greater was 2.87 (OR 2.87, 95% CI
1.58-5.22). CONCLUSIONS: Stressful life events were significantly greater among
cases than controls.

PMID: 17085135 [PubMed - indexed for MEDLINE]

393: Int J Urol. 2006 Nov;13(11):1445-7.

Development of multiple calculi in the duplex system ureterocele.

Nakane A, Hayashi Y, Kojima Y, Mizuno K, Kurokawa S, Kohri K.

Department of Nephro-urology, Nagoya City University, Graduate School of Medical 
Sciences, Nagoya, Japan. aki-nakane@ams.odn.ne.jp

A 61-year-old man presented complaining of pollakisuria and nocturia. A plain
radiograph of his kidney, ureter and bladder and intravenous urography revealed
numerous calculi in the upper kidney of his left renal pelvis and ureterocele. A 
transurethral incision of ureterocele (TUI-ureterocele) and extracorporeal shock 
wave lithotripsy were performed. On TUI-ureterocele, the many calculi were found 
to be almost the same size and spherical in form. The postoperative clinical
course was uneventful.

Publication Types: 
    Case Reports

PMID: 17083401 [PubMed - indexed for MEDLINE]

394: Am J Physiol Renal Physiol. 2006 Dec;291(6):F1123-31.

Molecular modulation of calcium oxalate crystallization.

De Yoreo JJ, Qiu SR, Hoyer JR.

Biosecurity and NaoSciences Laboratory, Department of Chemistry and Materials
Science, Lawrence Livermore National Laboratory, CA, USA.

Calcium oxalate monohydrate (COM) is the primary constituent of the majority of
renal stones. Osteopontin (OPN), an aspartic acid-rich urinary protein, and
citrate, a much smaller molecule, are potent inhibitors of COM crystallization at
levels present in normal urine. Current concepts of the role of site-specific
interactions in crystallization derived from studies of biomineralization are
reviewed to provide a context for understanding modulation of COM growth at a
molecular level. Results from in situ atomic force microscopy (AFM) analyses of
the effects of citrate and OPN on growth verified the critical role of
site-specific interactions between these growth modulators and individual steps
on COM crystal surfaces. Molecular modeling investigations of interactions of
citrate with steps and faces on COM crystal surfaces provided links between the
stereochemistry of interaction and the binding energy levels that underlie
mechanisms of growth modification and changes in overall crystal morphology. The 
combination of in situ AFM and molecular modeling provides new knowledge that
will aid rationale design of therapeutic agents for inhibition of stone
formation.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.
    Review

PMID: 17082348 [PubMed - indexed for MEDLINE]

395: Int Urol Nephrol. 2007;39(3):723-5. Epub 2006 Nov 2.

Standard percutaneous nephrolithotomy on a pelvic kidney without any ancillary
modalities.

Atmaca AF, Akbulut Z, Altinova S, Doğan B, Bayrak O, Balbay MD.

1st Urology Clinic, Ankara Ataturk Training and Research Hospital, 475. sokak
20/20 Cukurambar 06520, Cankaya, Ankara, Turkey. alifuatatmaca@yahoo.com

We are presenting a patient with two calculi in a right pelvic kidney managed by 
percutaneous nephrolithotomy with an access just above the iliac crest in the
prone position.

Publication Types: 
    Case Reports

PMID: 17080298 [PubMed - indexed for MEDLINE]

396: Can J Urol. 2006 Oct;13(5):3261-70.

Modified anatrophic nephrolithotomy: A useful treatment option for complete
complex staghorn calculi.

Ramakrishnan PA, Al-Bulushi YH, Medhat M, Nair P, Mawali SG, Sampige VP.

Department of Urology, Armed Forces Hospital, Muscat, Sultanate of Oman.

INTRODUCTION: Management of complete staghorn calculi represents a challenging
problem for urologists. We describe our technique and clinical experience with
modified anatrophic nephrolithotomy in patients harboring large, extensively
branched staghorn calculi. MATERIALS AND METHODS: From October 1996 to February
2005 twenty-six patients with complete staghorn calculi defined as filling the
entire collecting system or at least 80% of it, were treated employing a
modification of the classical anatrophic nephrolithotomy technique. The mean
patient age was 46 (range 16-70) years and the mean stone size was 3150 (range
1375-4800) mm2. Intra-operative data, complications and stone-free rates were
recorded. Long-term follow-up was completed in 22 patients with a mean duration
of 38 (range 12-96) months. Renal function was evaluated by 99mTc dimercapto
succinic acid renal scintigraphy before and 6 months after treatment. RESULTS:
The mean ischemia time was 36 (range 20-45) minutes, mean operative time was 195 
(range 170-235) minutes and the mean blood loss was 475 (range 300-750) ml.
Length of hospital stay averaged 8.8 days. One patient developed significant
hematuria requiring renal angiography and embolization of a pseudoaneurysm.
Overall, 22 patients (85%) were rendered stone-free at discharge while 23
patients (88%) were observed to be stone-free after 3 months. Long-term follow-up
demonstrated recurrent stone fragments less than 4 mm in three patients. Isotope 
studies revealed that renal function remained unchanged in 55%, improved in 32%
and became worse in the small number of remaining patients. CONCLUSIONS: Modified
anatrophic nephrolithotomy is a valuable treatment option for patients with
complete staghorn calculi. Because of its efficacy, safety and simplicity we
believe that the use of this surgical procedure is warranted in patients with a
large, extensively branched, complex renal stone burden.

PMID: 17076948 [PubMed - indexed for MEDLINE]

397: Urology. 2006 Oct;68(4):890.e13-5.

Gas-containing renal stones.

Rapoport MJ, Sadah AY.

Department of Urology, West Suburban Hospital, Oak Park, Illinois 60302, USA.

Emphysematous pyelonephritis is a rare, but potentially lethal, possible sequela 
of nephrolithiasis, occurring most commonly in diabetic patients. The diagnosis
of emphysematous pyelonephritis relies on the radiologic finding of gas in the
renal parenchyma. We present the case of a patient with sarcoidosis, diabetes,
and obstructing, gas-containing ureteral stones. Gas-containing renal stones are 
exceedingly rare, but have been linked to serious renal infections. The case
management and a brief review of the published reports follow. We propose that
gas-containing stones be considered evidence of emphysematous pyelonephritis in
certain clinical settings.

Publication Types: 
    Case Reports

PMID: 17070381 [PubMed - indexed for MEDLINE]

398: J Urol. 2006 Nov;176(5):2055-8; discussion 2058.

Does rate matter? The results of a randomized controlled trial of 60 versus 120
shocks per minute for shock wave lithotripsy of renal calculi.

Davenport K, Minervini A, Keoghane S, Parkin J, Keeley FX, Timoney AG.

Bristol Urological Institute, Bristol, UK. DrKimDav@aol.com

PURPOSE: In this study we prospectively compared 2 rates of shock wave delivery, 
60 and 120 shock waves per minute, to determine whether rate affects outcome with
the Dornier Lithotripter S, a lithotriptor with an electromagnetic shock wave
source, for renal calculi. MATERIALS AND METHODS: A total of 104 patients with
uncomplicated single renal calculus were randomized and treated. Following a
single treatment patients were reviewed at 3 months to determine outcome. A plain
abdominal x-ray was performed and the size of any residual fragments was noted.
Four patients were lost to followup, 1 in the 60 shock waves per minute group and
3 in the 120 shock waves per minute group. RESULTS: Of the 100 patients with
complete followup 49 were treated at 60 shock waves per minute and 51 at 120
shock waves per minute. There was no statistically significant difference between
mean stone area treated (p = 0.32) or additional analgesic use in the form of
patient controlled alfentanil (p = 0.82). A successful outcome was defined by
fragments smaller than 4 mm or stone-free status. At 60 shock waves per minute
59% of patients had a successful outcome compared with 61% at 120 shock waves per
minute (p = 0.87) following a single treatment. Post-treatment complications were
similar in both groups at 8% for 120 shock waves per minute and 10% for 60 shock 
waves per minute (p = 0.68). CONCLUSIONS: There was no significant difference in 
patient controlled analgesia use, complications or outcome between rates 60 and
120. Contrary to previous studies these results suggest that a slower rate of
shock wave delivery during extracorporeal shock wave lithotripsy for renal
calculi does not improve treatment efficacy with the Dornier Lithotripter S.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 17070254 [PubMed - indexed for MEDLINE]

399: Angiology. 2006 Oct-Nov;57(5):650-4.

Iliac arteries injury secondary to extracorporeal shock wave lithotripsy: a case 
report.

de Araújo Filho JD, Ciorlin E, de Araújo JD, Mauad T, Saldiva PH.

Instituto de Moléstias Cardiovasculares (IMC), São José do Rio Preto, São Paulo, 
Brazil.

The authors report a case of a 40-year-old woman who developed claudication of
the right limb 3 months after extracorporeal shock wave lithotripsy (ESWL) owing 
to a pyelic calculus. Patient had no previous vascular disease. Arteriography
revealed a 12-cm-long 80% stenosis of the right common, external, and internal
iliac arteries; the rest of the arterial tree had no detectable pathology.
Arterial complications related to ESWL have been reported before in patients with
aortic aneurysms or very intense calcifications. To the authors' knowledge this
is the first report of ESWL-induced injury in a patient without previous arterial
pathology.

Publication Types: 
    Case Reports

PMID: 17067991 [PubMed - indexed for MEDLINE]

400: Scand J Urol Nephrol. 2006;40(5):380-4.

Retrograde intrarenal stone surgery for extracorporeal shock-wave
lithotripsy-resistant kidney stones.

Jung H, Nørby B, Osther PJ.

Department of Urology, Fredericia and Kolding Hospitals, Fredericia, Denmark.
helenejung@hotmail.com

OBJECTIVE: The newer flexible ureteroscopes, 150-200-microm holmium YAG laser
fibres and superflexible Dormia baskets have made it possible to reach and treat 
stones in all parts of the kidney. The object of this evaluation was to study the
outcome of retrograde intrarenal stone surgery (RIRS) for extracorporeal
shock-wave lithotripsy (ESWL)-resistant kidney stones. MATERIAL AND METHODS: A
total of 38 consecutive patients (18 males, 20 females) participated in the
study. All patients had undergone ESWL prior to RIRS without success. In all
cases the stones could be reached with the endoscope. Calculi ranged in size from
3 to 20 mm (mean 9 mm). In 32 cases the stones were fragmented using a holmium
YAG laser and in six the stones could be extracted using zero-tip Dormia baskets 
without fragmentation. Sixteen patients had lower calyceal calculi and eight had 
an abnormal anatomy of the upper urinary tract. Intravenous pyelography was
performed 6-8 weeks after the treatment. RESULTS: In all cases the stones could
be reached and fragmented to some extent. After a single RIRS procedure, 22/38
patients (58%) were completely stone-free at follow-up, and four (11%) had
residual fragments < or = 4 mm in size that were expected to pass spontaneously. 
Of the remaining 12 patients, who initially had larger stones (mean 11.3 mm), the
residual fragments ranged in size from 5 to 15 mm. Three patients underwent an
additional RIRS procedure, after which they were all completely stone-free,
resulting in an overall success rate of 76%. There were no major complications.
CONCLUSIONS: RIRS is a safe procedure with a high success rate and a low
complication rate for ESWL-resistant renal stones. Patients with larger stones (>
10 mm), those with stones in the lower pole and those with an abnormal renal
anatomy may require more than one procedure.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17060084 [PubMed - indexed for MEDLINE]

401: Am J Kidney Dis. 2006 Nov;48(5):706-11.

Henle loop basement membrane as initial site for Randall plaque formation.

Sepe V, Adamo G, La Fianza A, Libetta C, Giuliano MG, Soccio G, Dal Canton A.

Unit of Nephrology, IRCCS Policlinico San Matteo, and University of Pavia, Pavia,
Italy. vsepe@libero.it

Since the early description of Randall plaques in 1937, studies of the
pathogenesis of stone formation mainly focused on the chemistry involving salt
precipitation and crystallization, rather than tubular and interstitial medullar 
mechanisms of calcium concentration and supersaturation. In 2003, Bushinsky
published a suggestive and inspiring sequence of events aimed to show that the
basement membrane of the thin limb of the loop of Henle can be the first site of 
nucleation, as recently shown by the impressive work by Evan et al. The aim of
this minireview is to verify the consistency of the Evan and Bushinsky theory
with the current literature in the field.

Publication Types: 
    Review

PMID: 17059989 [PubMed - indexed for MEDLINE]

402: J Med Assoc Thai. 2006 Aug;89 Suppl 2:S21-7.

High prevalence of indinavir-associated renal complications in Thai HIV-infected 
patients.

Avihingsanon A, Avihingsanon Y, Darnpornprasert P, Kerr S, Ungsedhapand C,
Duncombe C, Ubolyam S, Ruxrungtham K, Phanuphak P.

HIV-NAT study team, Thai Red Cross AIDS Research Centre.

BACKGROUND: Indinavir (IDV) is the protease inhibitor (PI) used most often in
resource-limited countries. The present study aimed to determine the prevalence
of IDV-associated renal complications as well as their clinical characteristics. 
MATERIAL AND METHOD: The authors reviewed all patients participating in cohorts
of indinavir-containing regimens at the HIV-NAT research center during the period
of indinavir treatment. Patients who had pre-existing renal diseases were
excluded. Renal toxicities included presence of urologic symptoms,
nephrolithiasis, abnormal urine sediments, crystalluria and loss of renal
function. Radiological studies of KUB system were reviewed as well. RESULTS:
Two-hundred and four patients treated with IDV were included. Median (IQR) follow
up period was 216 (150-312) weeks. One hundred and eighty patients were treated
with ritonavir-boosted regimens at some point, and 24 patients were treated only 
with unboosted regimens. Leukocyturia (51.9%) was the most common finding of
IDV-associated renal complications. Thirty-five percent of patients had urologic 
symptoms such as flank pain or dysuria. Almost half of the patients had
significant loss of renal function that was associated with prolonged use of IDV 
The most common radiological finding was nephrolithiasis. Less common, but of
greater clinical importance, are nephrocalcinosis or renal atrophy. CONCLUSION: A
high prevalence of IRC was found in Thai HIV-infected patients. As long as no
other cost-effective boosted PI regimens are available, strategies to prevent
irreversible loss of renal function are warranted.

PMID: 17044450 [PubMed - indexed for MEDLINE]

403: BJU Int. 2006 Nov;98(5):1094-9.

Heat-shock protein 25 ameliorates calcium oxalate crystal-mediated oxidative
stress in renal epithelial cells.

Patel AB, Robertson WG, Choong S, Hothersall JS.

Centre for Treatment and Prevention of Kidney Stone disease, Institute of
Urology, University College London, UK. a.b.patel@ucl.ac.uk

OBJECTIVE: To investigate whether the antioxidant protection attributed to small 
heat-shock proteins (sHSPs) affects calcium oxalate stone formation, a
pro-oxidant disease. MATERIALS AND METHODS: Canine distal tubular epithelial
cells (Madin-Darby canine kidney, MDCK cells) were grown as confluent monolayers.
Treatment regimens included control and HS-treated cells (37 degrees C and 42
degrees C for 1 h) with or without calcium oxalate monohydrate (COM) or free
oxalate treatment (28 microg/cm2) 16 h later. In digitonin-permeabilized cells,
O2- was measured by lucigenin-enhanced chemiluminescence over a 5-min period, to 
measure mitochondrial O2- production. Protein expression was assessed by sodium
dodecyl sulphate-polyacrylamide gel electrophoresis Western blot analysis using
specific antibodies. RESULTS: COM significantly increased O2- production in MDCK 
cells. HS treatment, which up-regulated HSP25 expression, significantly decreased
this O2- production (P < 0.05) but had no effect in control cells. In COM-treated
cells (20 h) there was a marked and significant down-regulation of both HSP 25,
HSP 70 and heme oxygenase-1 expression compared to cells treated with HS alone (P
< 0.05). Free oxalate had no effect on HSP 25 expression. CONCLUSIONS: The
results suggest that the COM-induced increase in mitochondrial O2- production in 
MDCK cells is ameliorated by HSP 25 up-regulation via HS. Specific COM inhibition
of HSP 25, HSP 70 and heme oxygenase-1 up-regulation suggests that COM-induced
reactive oxygen species damage is unable to benefit from HSP-associated
physiological resistance.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17034610 [PubMed - indexed for MEDLINE]

404: BJU Int. 2006 Nov;98(5):1075-9.

Comment in:
    BJU Int. 2007 Feb;99(2):466.

One week of ciprofloxacin before percutaneous nephrolithotomy significantly
reduces upper tract infection and urosepsis: a prospective controlled study.

Mariappan P, Smith G, Moussa SA, Tolley DA.

Western General Hospital, Urology, Edinburgh, UK. param.mariappan@nhs.net

OBJECTIVE: To evaluate whether 1 week of ciprofloxacin before percutaneous
nephrolithotomy (PCNL) in patients with stones of > or = 20 mm or pelvicalyceal
dilatation, reduces urosepsis, as we previously reported that such patients have 
four times the risk of urosepsis after PCNL. PATIENTS AND METHODS: Patients
undergoing PCNL, and who fulfilled strict selection criteria, were recruited
prospectively into a study which was conducted in two phases. The study methods
were similar to those previously described; patients with dilated pelvicalyceal
systems and/or stones of > or = 20 mm from phase 1 (previously published) acted
as controls. In the subsequent phase, the same selection criteria applied and
only those with stones of > or = 20 mm and/or dilated pelvicalyceal systems were 
given ciprofloxacin 250 mg twice daily for 1 week before PCNL and comprised the
treatment arm. Midstream urine samples, renal pelvic urine and fragmented stones 
were collected to assess culture and sensitivity. Systemic inflammatory response 
syndrome (SIRS) was used to define urosepsis after PCNL. The urologists
monitoring the patients after PCNL and conducting the analysis were all unaware
of the characteristics of the stones or intravenous urography findings before
PCNL. In all, 115 patients (54 in phase 1 and 61 in phase 2) were recruited, of
whom 46 in phase 1 and 52 in phase 2 had stones of > or = 20 mm and/or a dilated 
pelvicalyceal system, and became the control and treatment arms, respectively.
RESULTS: The patient demographics were similar in both arms. There was three
times less risk of upper tract infection (relative risk 3.4, 95% confidence
interval 1.0-11.8, P = 0.04) and SIRS (2.9, 1.3-6.3, P = 0.004) in the patients
receiving ciprofloxacin (treatment arm). CONCLUSIONS: The administration of oral 
ciprofloxacin for 1 week before PCNL in patients with stones of > or = 20 mm or
dilated pelvicalyceal systems significantly reduced the risk of urosepsis.

Publication Types: 
    Clinical Trial, Phase I
    Clinical Trial, Phase II
    Randomized Controlled Trial

PMID: 17034608 [PubMed - indexed for MEDLINE]

405: Am J Physiol Renal Physiol. 2006 Nov;291(5):F1061-9.

Pathophysiological correlates of two unique renal tubule lesions in rats with
intestinal resection.

Worcester E, Evan A, Bledsoe S, Lyon M, Chuang M, Orvieto M, Gerber G, Coe F.

Nephrology Section/MC 5100, Univ. of Chicago, 5841 South Maryland Ave., Chicago, 
IL 60637, USA. eworcest@medicine.bsd.uchicago.edu

Rats with small bowel resection fed a high-oxalate diet develop extensive
deposition of calcium oxalate (CaOx) and calcium phosphate crystals in the kidney
after 4 mo. To explore the earliest sites of renal crystal deposition, rats
received either small bowel resection or transection and were then fed either
standard chow or a high-oxalate diet; perfusion-fixed renal tissue from five rats
in each group was examined by light microscopy at 2, 4, 8, and 12 wk. Rats fed
the high-oxalate diet developed birefringent microcrystals at the brush border of
proximal tubule cells, with or without cell damage; the lesion was most common in
rats with both resection and a high-oxalate diet (10/19 with the lesion) and was 
significantly correlated with urine oxalate excretion (P < 0.001). Rats with
bowel resection fed normal chow had mild hyperoxaluria but high urine CaOx
supersaturation; four of these rats developed birefringent crystal deposition
with tubule plugging in inner medullary collecting ducts (IMCD). Two rats fed a
high-oxalate diet also developed this lesion, which was correlated with CaOx
supersaturation, but not oxalate excretion. Tissue was examined under oil
immersion, and tiny birefringent crystals were noted on the apical surface of
IMCD cells only in animals with IMCD crystal plugging. In one animal, IMCD
crystals were both birefringent and nonbirefringent, suggesting a mix of CaOx and
calcium phosphate. Overall, these animals demonstrate two distinct sites and
mechanisms of renal crystal deposition and may help elucidate renal lesions seen 
in humans with enteric hyperoxaluria and stones.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 17028259 [PubMed - indexed for MEDLINE]

406: J Clin Endocrinol Metab. 2007 Jan;92(1):277-83. Epub 2006 Oct 3.

Primary hyperparathyroidism and the presence of kidney stones are associated with
different haplotypes of the calcium-sensing receptor.

Scillitani A, Guarnieri V, Battista C, De Geronimo S, Muscarella LA, Chiodini I, 
Cignarelli M, Minisola S, Bertoldo F, Francucci CM, Malavolta N, Piovesan A,
Mascia ML, Muscarella S, Hendy GN, D'Agruma L, Cole DE.

Units of Endocrinology, Hospital Casa Sollievo della Sofferenza, Instituto di
Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo (Foggia), Italy.
alscill@tin.it

INTRODUCTION: Three single-nucleotide polymorphisms in the calcium-sensing
receptor gene (CASR) encoding the missense substitutions A986S, R990G, and Q1011E
have been associated with normal variation in extracellular calcium homeostasis, 
both individually and in haplotype combination. The aim of this study was to
examine haplotype associations in primary hyperparathyroidism (PHPT). PATIENTS
AND METHODS: Patients with sporadic PHPT (n = 237) were recruited from endocrine 
clinics and healthy controls (n = 433) from a blood donor clinic, and levels of
serum calcium, albumin, and PTH were measured. In PHPT patients, urinary
calcium/creatinine clearances and bone mineral density at spine and femoral neck 
were measured and the presence of kidney stones and vertebral fractures
identified. The CASR single-nucleotide polymorphisms were haplotyped by
allele-specific sequencing. RESULTS: Four haplotypes (ARQ, SRQ, AGQ, and ARE) of 
eight were observed, in keeping with significant linkage disequilibrium, but
haplotype frequencies did not show significant Hardy-Weinberg disequilibrium. The
SRQ haplotype was more common in PHPT (125 of 474 alleles) than in controls (170 
of 866 alleles, P = 0.006) and showed a significant (P = 0.006) gene-dosage
effect. There was no significant association between haplotype and bone mineral
density or fractures, but association with kidney stones was significant (P =
0.0007). In the stone-forming subgroup, the SRQ haplotype was underrepresented
and AGQ overrepresented. Patients bearing the AGQ haplotype had an odds ratio of 
3.8 (95% confidence interval, 1.30-11.3) for presentation with renal stones
compared with the rest. CONCLUSION: Our data indicate that the CASR SRQ haplotype
is significantly associated with PHPT in our population. Within the PHPT patient 
population, the AGQ haplotype is significantly associated with kidney stones.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 17018660 [PubMed - indexed for MEDLINE]

407: Int J Urol. 2006 Oct;13(10):1347-9.

Analysis of a 1-year-old cystinuric patient with recurrent renal stones.

Tanzer F, Ozgur A, Bardakci F, Cankorkmaz L, Ayan S.

Department of Pediatrics, Cumhuriyet University, Sivas, Turkey.
ftanzer@cumhuriyet.edu.tr

Cystinuria is a hereditary disorder of cystine and dibasic amino acids (lysine,
arginine, ornithine) transport across the luminal membrane of renal tubules and
intestine, resulting in recurrent nephrolithiasis. Cystine stones frequently
occur in the second or third decade of life with an occasional occurrence in
infancy and in old age. Herein is presented the case of a 1-year-old girl with
cystinuria and recurrent urolithiasis; the genetic basis of the disease was
investigated by mutational analysis of the SLC3A1 gene. The data show that the
present patient has an increased cystine (923.08 microg/mL) level and was
heterozygote for M467T mutation.

Publication Types: 
    Case Reports

PMID: 17010017 [PubMed - indexed for MEDLINE]

408: J Endourol. 2006 Sep;20(9):639-41.

Case report: laparoscopic heminephrectomy in a horseshoe kidney using bipolar
energy.

Patankar S, Dobhada S, Bhansali M.

Department of Urology, King George's Medical University, Lucknow UP, India.
suresh_iou@yahoo.com

Aberrant vasculature, functional parenchyma in the isthmus, and abnormal location
are all unique features of horseshoe kidney that present technical challenges to 
laparoscopic management of disease. A 52-year-old man presented with a large
renal calculus in a poorly functioning left moiety of a horseshoe kidney and
underwent laparoscopic heminephrectomy. The ismthus, which had 2.5 to 3.0 cm of
functioning parenchyma, was divided using the PlasmaKinetic Superpulse Generator 
(Gyrus). No additional hemostatic measure was required. The total operative time 
was 140 minutes with an estimated blood loss of 160 mL. At follow-up, the right
moiety and remaining isthmus exhibited normal function with no extravasation.

Publication Types: 
    Case Reports

PMID: 16999615 [PubMed - indexed for MEDLINE]

409: J Endourol. 2006 Sep;20(9):620-1.

Guidewire-assisted infundibular tilt: a technique for access into another calix
during percutaneous nephrolithotomy.

Dalela D, Goel A, Shankhwar SN, Ahuja M, Singh V, Bhandari M.

Department of Urology, King George's Medical University, Lucknow UP, India.

Sometimes, during percutaneous nephrolithotomy, a stone fragment migrates into a 
parallel calix, necessitating a separate puncture. We describe a simple technique
for removing such fragments. This technique is especially useful for patients who
have moderate to severe hydronephrosis where the intercaliceal parenchyma is
thin.

PMID: 16999611 [PubMed - indexed for MEDLINE]

410: J Endourol. 2006 Sep;20(9):607-11.

Reducing shock number dramatically decreases lesion size in a juvenile kidney
model.

Connors BA, Evan AP, Blomgren PM, Willis LR, Handa RK, Lifshitz DA, Lingeman JE, 
Ying J.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46202, USA. connors@anatomy.iupui.edu

BACKGROUND AND PURPOSE: Adult stone patients are treated with several thousand
lithotripter shockwaves (SWs) in order to pulverize a kidney stone. This typical 
clinical dose assures that the stone will be fractured completely. However, this 
same dose induces damage to the kidney, especially pediatric-size kidneys. If
increasing SW number is known to increase renal injury and functional impairment,
will reducing SW number below typical treatment levels significantly decrease
kidney damage and hemodynamic changes? MATERIALS AND METHODS: To address this
question, one kidney in each of nine juvenile pigs (6-7 weeks old) was treated
with 1000 SWs at 24 kV directed at a lower-pole calix with an unmodified HM-3
lithotripter. Parenchymal-lesion size was determined by sectioning the entire
kidney and quantitating the amount of hemorrhage in each slice. Renal function
was determined before and after SW treatment by inulin clearance,
paraaminohippurate (PAH) extraction, and PAH clearance. The resulting morphologic
and functional changes were then compared with those of kidneys that had been
treated with a typical clinical dose of 2000 SWs (data previously published; J Am
Soc Nephrol 2000;11:310). Eleven pigs were utilized as sham-treated controls.
RESULTS: Limiting SW number to 1000 significantly reduced the size of the lesion 
(by 95%) and reduced the degree of functional change (glomerular filtration rate 
by 38%, PAH extraction by 73%, renal plasma flow by 46%) compared with kidneys
receiving 2000 SWs (an adult dose). CONCLUSIONS: These data support the idea that
SW number should be reduced to the lowest number that fractures kidney stones in 
order to minimize renal injury and functional impairment.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16999608 [PubMed - indexed for MEDLINE]

411: J Endourol. 2006 Sep;20(9):603-6.

Progressive increase of lithotripter output produces better in-vivo stone
comminution.

Maloney ME, Marguet CG, Zhou Y, Kang DE, Sung JC, Springhart WP, Madden J, Zhong 
P, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urology, Duke University, Durham, 
North Carolina 27710, USA.

BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) has become a first-line
intervention for treatment of nephrolithiasis. However, few studies have examined
the effects of modifications in the method of shockwave energy administration on 
comminution efficiency. We propose that a gradual increase in output voltage will
produce superior stone fragmentation in comparison with a constant or a
decreasing output voltage by optimizing the stress wave and cavitation erosion
forces on renal calculi. MATERIALS AND METHODS: BegoStone phantoms were implanted
in the renal pelvis of 11 pigs that underwent SWL at a pulse repetition rate of 1
Hz. Animals in the increasing strategy group (N = 4) were subjected to 18, 20,
and 22 kV for 600, 600, and 800 shocks, respectively. The second group (N = 4)
received a decreasing strategy of 22, 20, and 18 kV for 800, 600, and 600 shocks,
respectively. The third group (N = 3) received all 2000 shocks at 20 kV,
mimicking the clinical protocol. RESULTS: A progressively decreasing strategy and
constant output voltage produced a mean comminution efficiency, or percentage of 
stone fragments <2 mm, of 89.0% +/- 3.3% and 87.6% +/- 1.7%, respectively. The
mean comminution efficiency was improved to 96.5% +/- 1.4% by using the
increasing strategy (P = 0.01). CONCLUSIONS: A progressive increase in
lithotripter output voltage during SWL can produce greater stone fragmentation
than protocols employing constant or decreasing output voltage.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16999607 [PubMed - indexed for MEDLINE]

412: Am J Kidney Dis. 2006 Oct;48(4):555-63.

Biochemical and stone-risk profiles with topiramate treatment.

Welch BJ, Graybeal D, Moe OW, Maalouf NM, Sakhaee K.

Department of Internal Medicine, University of Texas Southwestern Medical Center,
Dallas, TX 75390, USA.

BACKGROUND: Topiramate is a novel neuromodulatory agent commonly prescribed for
the treatment of seizure disorders and for migraine headache prophylaxis. Calcium
phosphate kidney stones have been observed with topiramate treatment, but a
comprehensive elucidation of stone-risk profile was not reported previously. This
study explores the relationship between topiramate treatment and propensity for
kidney stone formation. METHODS: Thirty-two topiramate-treated subjects and 50
healthy volunteers participated in a cross-sectional study in which serum
chemistry test and 24-hour urine collection results were evaluated for stone
risk. Furthermore, a short-term longitudinal study was conducted in 7 patients to
assess stone risk before and 3 months after topiramate treatment. RESULTS: Serum 
bicarbonate levels were lower with topiramate treatment. Urinary pH, urinary
bicarbonate excretion, and fractional excretion of bicarbonate increased, whereas
urinary citrate excretion was significantly lower (737 +/- 329 versus 278 +/- 226
mg/d; P < 0.001). Net acid excretion did not change. The relative saturation
ratio for brushite increased with topiramate treatment (3.14 +/- 1.69 versus 1.27
+/- 1.26; P < 0.001) because of urinary alkalinization and decreased urinary
citrate levels. Urinary saturation of undissociated uric acid decreased (41 +/-
52 versus 76 +/- 60 mg/d; P < 0.001). CONCLUSION: Treatment with topiramate
causes systemic metabolic acidosis, markedly lower urinary citrate excretion, and
increased urinary pH. These changes increase the propensity to form calcium
phosphate stones.

Publication Types: 
    Clinical Trial
    Research Support, N.I.H., Extramural

PMID: 16997051 [PubMed - indexed for MEDLINE]

413: Am J Kidney Dis. 2006 Oct;48(4):546-54.

Causes of hypocitraturia in recurrent calcium stone formers: focusing on urinary 
potassium excretion.

Domrongkitchaiporn S, Stitchantrakul W, Kochakarn W.

Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand. rasdr@mahidol.ac.th

BACKGROUND: Multiple factors associated with hypocitraturia have been identified.
However, limited studies addressing the causal relationship to hypocitraturia are
available. We therefore conducted this study to determine factors associated with
hypocitraturia and show their causal relationship in recurrent calcium stone
formers. METHODS: Dietary review and 24-hour urine samples were obtained from all
recurrent calcium stone formers referred for metabolic workup in the stone
clinic. One month of oral potassium chloride supplementation was prescribed to
stone formers to determine the causal relationship between urinary potassium and 
citrate levels. RESULTS: Eighty-three subjects, 44 men and 39 women, were
recruited to participate in this study. Hypocitraturia (citrate < 300 mg/d [<1.43
mmol/d]) was found in 50.6% of subjects. Four independent urinary variables
associated with hypocitraturia were identified, including potassium level, net
gastrointestinal alkaline absorption, calcium level, and titratable acid. Urinary
potassium level was the strongest predictor of urinary citrate level.
Hypocitraturic subjects also had lower fruit intake compared with subjects with
high urinary citrate levels. Potassium chloride supplementation to a subgroup of 
this population (n = 58) resulted in a significant increase in urinary citrate
excretion (350.73 +/- 27.25 versus 304.15 +/- 30.00 mg/d [1.67 +/- 0.13 versus
1.45 +/- 0.14 mmol/d]; P < 0.02), but no alteration in fractional excretion of
citrate (19.7% +/- 2.7% versus 23.1% +/- 2.4%; P > 0.05). CONCLUSION:
Hypocitraturia was found to be a common risk factor associated with recurrent
calcium stone formation and low urinary potassium level, low alkaline absorption,
low urinary calcium level, and high titratable acid excretion. Hypocitraturia is 
predominantly of dietary origin. Estimation of fruit intake should be included in
the metabolic evaluation for recurrent calcium stone formation.

Publication Types: 
    Evaluation Studies

PMID: 16997050 [PubMed - indexed for MEDLINE]

414: Urology. 2006 Sep;68(3):500-4. Epub 2006 Sep 18.

Percutaneous treatment of large upper tract stones after urinary diversion.

el-Nahas AR, Eraky I, el-Assmy AM, Shoma AM, el-Kenawy MR, Abdel-Latif M, Mosbah 
A, Abol-Enein H, Shaaban AA, Mohsen T, el-Kappany HA.

Department of Urology, Urology and Nephrology Center, Mansoura University,
Mansoura, Egypt.

OBJECTIVES: To present our experience in percutaneous management of large upper
tract stones after urinary diversion. METHODS: From October 1984 to March 2005,
20 percutaneous nephrolithotomy and 4 antegrade ureteroscopy procedures were
performed in 17 men and 7 women, with a mean age of 53.5 years. The urinary
diversions were an ileal W neobladder, hemi-Kock pouch, ileal conduit, and rectal
bladder in 10, 7, 4, and 3 patients, respectively. The median interval between
diversion and stone management was 1.5 years. Success was defined as a
stone-free, nonobstructed renal unit at 3 months after the intervention.
Follow-up was performed every 6 months with intravenous urography or noncontrast 
computed tomography for diagnosis of stone recurrence and evaluation of renal
morphology. RESULTS: Renal punctures were guided with ultrasonography in 18
patients (75%) and fluoroscopy in 6 patients. One intraoperative complication
(4.16%) and two postoperative complications (8.3%) occurred. All patients with
ureteral stones became stone free after one procedure. Auxiliary procedures were 
needed in 5 patients after percutaneous nephrolithotomy; 2 patients required a
second session and 3 needed extracorporeal shock wave lithotripsy. The overall
success rate was 87.5% (21 patients). One patient with treatment failure
underwent open surgery, and two with small residual fragments were followed up.
Long-term follow-up data were available for 15 patients. The stone recurrence
rate was 33.3% (5 patients) after a median follow-up of 40 months (range 14 to
132). Recurrent stones were treated with extracorporeal shock wave lithotripsy.
CONCLUSIONS: The results of our study have demonstrated that percutaneous
treatment of large upper tract stones after urinary diversion offers a high
success rate with minimal morbidity. However, regular follow-up after treatment
is recommended.

PMID: 16979745 [PubMed - indexed for MEDLINE]

415: Urology. 2006 Sep;68(3):489-93; discussion 493-4. Epub 2006 Sep 18.

Closing the tract of mini-percutaneous nephrolithotomy with gelatine matrix
hemostatic sealant can replace nephrostomy tube placement.

Nagele U, Schilling D, Anastasiadis AG, Corvin S, Seibold J, Kuczyk M, Stenzl A, 
Sievert KD.

Department of Urology, University of Tuebingen, Tuebingen, Germany.
udo.nagele@med.uni-tuebingen.de

OBJECTIVES: To investigate the outcomes using gelatine matrix hemostatic sealant 
to close the tract after mini-percutaneous nephrolithotomy (mini-PCNL), resulting
in a tubeless setting. METHODS: After complete stone removal after mini-PCNL, a
double-J ureteral stent was placed in an antegrade manner. After withdrawing the 
17F Amplatz sheet from the collecting system under direct vision without
irrigation, the urothelium collapsed. While retracting the sheet further, the
gelatine matrix hemostatic sealant was injected. The skin incision was closed
with glue. An ultrasound examination was performed on the first postoperative day
to exclude the presence of urine extravasation. RESULTS: Mini-PCNL was performed 
in 11 patients, either as a primary, small stone, single-access procedure or as a
second-look mini-PCNL because of small residual fragments after extracorporeal
shock wave lithotripsy. The time to seal the mini-PCNL tract through the kidney
parenchyma was 2 to 5 minutes. The mean operative time was 79 minutes. In the
first 5 cases, intravenous urography was performed in addition to ultrasonography
and demonstrated an intact collecting system. The subsequent procedures
demonstrated similar findings, with the exception of 1 case of temporary
paravasation. In all other patients, the catheter was removed on the first
postoperative day. Ten of 11 patients had an uneventful follow-up until removal
of the double-J catheter. No major complications were observed. CONCLUSIONS:
Closing the tract of the mini-PCNL with gelatine matrix hemostatic sealant is a
safe and fast alternative and provides the option of discharging the patient in
good condition without the commonly used nephrostomy tube.

PMID: 16979734 [PubMed - indexed for MEDLINE]

416: Urol Res. 2006 Dec;34(6):365-72.

Chinese herbal medicines and their efficacy in treating renal stones.

Gohel MD, Wong SP.

Department of Health Technology and Informatics, The Hong Kong Polytechnic
University, Hung Hom, Kowloon, Hong Kong. danny.gohel@polyu.edu.hk

In herbal treatment of kidney stones, antilithics are used to "dissolve" the
stones or aid their passing to guard against further retention. Diuretic action
is also needed to increase the amount of fluid going through the kidneys and
flush out the deposits. Previous clinical studies have shown that herbal
medicines and their concoctions could be used to inhibit calcium oxalate
crystallization. However, the pharmacodynamics and in-vitro effects of such
medicines have not been established. Five Chinese herbal medicines were selected 
based on their usefulness in treating stone disease. A 96-well plate
oxalate-induced turbidity in artificial urine was used to evaluate the efficacies
of the different herbal medicines on calcium oxalate crystallization. The
metastable limit was determined and the nucleation rate was derived from 12-min
time-course measurement of turbidity at 405 nm. Phase-contrast microscopy was
used to visualize the crystals. The results showed that with increasing
concentrations of herbal extracts, smaller calcium oxalate crystal sizes were
observed. Overall, the five herbal medicinal extracts tested were able to promote
nucleation of calcium oxalate crystals while at the same time decreasing the
size. This in-vitro crystallization confirms that prophylaxis of renal stones
could be achieved by reducing overall supersaturation through promotion of small 
crystal nucleates and concomitant pharmacological diuretic action of herbal
medicines. Clinical studies will provide more definitive conclusions.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16972062 [PubMed - indexed for MEDLINE]

417: J Pak Med Assoc. 2006 Aug;56(8):381-3.

Laparoscopic assisted percutaneous nephrolithotomy (PCNL) in ectopic pelvic
kidney.

Aquil S, Rana M, Zaidi Z.

The Kidney Centre Postgraduate Training Institute, Karachi.

We report the case of a patient with pain and an abdominal palpable mass whose
tests showed a right pelvic kidney with a 4-cm stone in the renal pelvis. We
describe the successful management through laparoscopic assisted percutaneous
nephrolithotomy (PCNL) in ectopic pelvic kidney, stressing that this method is a 
minimally invasive therapeutic option in such cases.

Publication Types: 
    Case Reports

PMID: 16967794 [PubMed - indexed for MEDLINE]

418: Ultrasound Med Biol. 2006 Sep;32(9):1383-97.

Cloud cavitation control for lithotripsy using high intensity focused ultrasound.

Ikeda T, Yoshizawa S, Tosaki M, Allen JS, Takagi S, Ohta N, Kitamura T, Matsumoto
Y.

Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan.
teichiro@fel.t.u-tokyo.ac.jp

Cloud cavitation is potentially the most destructive form of cavitation. When the
cloud cavitation is acoustically forced into a collapse, it has the potential to 
concentrate a very high pressure, more than 100 times the acoustic pressure, at
its center. We experimentally investigate a method to control the collapse of
high intensity focused ultrasound (HIFU)-induced cloud cavitation to fragment
kidney stones. Our study examines a novel two-frequency wave designed to control 
the cloud cavitation (cavitation control [C-C] waveform); a high-frequency
ultrasound pulse (1 to 4 MHz) to create the cloud cavitation and a low-frequency 
trailing pulse (545 kHz) following the high-frequency pulse to force the cloud
into collapse. High-speed photography has revealed that a localized distribution 
of the cloud cavitation can be produced within 1 mm on the solid surface by the
high-frequency pulse. The low-frequency ultrasound was irradiated to the
high-frequency-induced cloud cavitation. A subsequent shock wave emitted from the
cloud cavitation was observed both in the shadowgraph photography and the remote 
hydrophone measurement. Furthermore, in vitro erosion tests of model and natural 
stones were conducted. In the case of model stones, the erosion rate of the C-C
waveform showed a distinct advantage with the combined high- and low-frequency
waves over either wave alone. Natural stones were eroded and most of the
resulting fragments were less than 1 mm in diameter. The results show that the
control of the cloud cavitation has untapped potential for the lithotripsy
applications upon further optimization of the ultrasound parameters and
complementary in vivo studies.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16965979 [PubMed - indexed for MEDLINE]

419: Nutr J. 2006 Sep 6;5:23.

Renal lithiasis and nutrition.

Grases F, Costa-Bauza A, Prieto RM.

Laboratory of Renal Lithiasis Research, Universitary Institute of Health Sciences
Research (IUNICS), University of Balearic Islands, E-07122 Palma de Mallorca,
Spain. fgrases@uib.es

Renal lithiasis is a multifactorial disease. An important number of etiologic
factors can be adequately modified trough diet, since it must be considered that 
the urine composition is directly related to diet. In fact, the change of
inappropriate habitual diet patterns should be the main measure to prevent kidney
stones. In this paper, the relation between different dietary factors (liquid
intake, pH, calcium, phosphate, oxalate, citrate, phytate, urate and vitamins)
and each type of renal stone (calcium oxalate monohydrate papillary, calcium
oxalate monohydrate unattached, calcium oxalate dihydrate, calcium oxalate
dihydrate/hydroxyapatite, hydroxyapatite, struvite infectious, brushite, uric
acid, calcium oxalate/uric acid and cystine) is discussed.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 16956397 [PubMed - indexed for MEDLINE]

420: J Urol. 2006 Oct;176(4 Pt 1):1570-3.

Retrograde proximal rigid ureteroscopy and pyeloscopy in prepubertal children:
safe and effective.

Lesani OA, Palmer JS.

Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case
Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.

PURPOSE: Traditionally, rigid ureteroscopy in adults has been reserved for distal
ureteral procedures, due to the risk of injury associated with proximal
ureteroscopy. However, the safety of proximal rigid ureteroscopy in prepubertal
children is not well established. MATERIALS AND METHODS: We retrospectively
evaluated all prepubertal children (12 years old and younger) who underwent
attempted rigid proximal ureteroscopy and pyeloscopy. The indications for
ureteroscopy were treatment of ureteral and/or renal pelvic calculi, and
evaluation of hematuria. All patients were evaluated postoperatively with renal
and bladder ultrasonography and abdominal radiography (if stone was visible
before treatment). RESULTS: A total of 24 consecutive children 3.4 to 12 years
old underwent 24 ureteropyeloscopic procedures. Of these children 20 (83%)
successfully underwent 20 rigid ureteroscopic and pyeloscopic procedures.
However, 4 procedures (17%) were converted from rigid to flexible endoscopy to
perform 4 successful ureteropyeloscopies. The indications for ureteroscopy were
treatment of ureteral and/or renal pelvic calculi in 22 patients and evaluation
of hematuria in 2. Followup was 0.6 to 3.6 years (mean 1.9) for the patients
undergoing rigid ureteropyeloscopy. All children with calculi were rendered
stone-free based on direct visualization by complete ureteroscopy and pyeloscopy 
of the affected system. No complications occurred during any of the procedures.
CONCLUSIONS: Proximal rigid ureteroscopy and pyeloscopy can be safely applied
toward treatment of proximal ureteral and renal pelvic calculi as well as
diagnostic ureteropyeloscopy in prepubertal children. The technique has several
advantages compared to flexible ureteroscopy.

PMID: 16952683 [PubMed - indexed for MEDLINE]

421: J Urol. 2006 Oct;176(4 Pt 1):1453-6; discussion 1456-7.

Comment in:
    J Urol. 2006 Oct;176(4 Pt 1):1280-1.

Preoperative nomograms for predicting stone-free rate after extracorporeal shock 
wave lithotripsy.

Kanao K, Nakashima J, Nakagawa K, Asakura H, Miyajima A, Oya M, Ohigashi T, Murai
M.

Department of Urology, Keio University School of Medicine, Tokyo, Japan.
cev14660@nyc.odn.ne.jp

PURPOSE: Extracorporeal shock wave lithotripsy is currently accepted as a first
line treatment modality for urolithiasis. In obtaining informed consent it is
important to inform patients of the stone-free rate with extracorporeal shock
wave lithotripsy before surgery. The present study was performed to develop
preoperative nomograms for predicting stone-free rates after extracorporeal shock
wave lithotripsy. MATERIALS AND METHODS: A total of 435 patients with 507 urinary
stones were treated with extracorporeal shock wave lithotripsy with a Dornier
Lithotripter D. Patient age, sex, body mass index, number of stone(s) in each
treatment, stone length, side and location were evaluated before extracorporeal
shock wave lithotripsy, and treatment efficacies were evaluated at 3 months after
each session. The treated stones were divided into 2 groups, those in cases that 
were stone-free with a single extracorporeal shock wave lithotripsy session and
those in all other cases. Multivariate analysis was performed using a logistic
regression model. The nomograms were developed by repeating the analysis on 200
bootstrap samples. RESULTS: Stone length, location and number were identified as 
significant variables on multivariate analysis, and a logistic regression model
was developed using these variables. The nomograms predicting stone-free rate at 
3 months after single extracorporeal shock wave lithotripsy treatment were
finally developed from 200 bootstrap samples. In these nomograms the stone-free
probability was highest for solitary proximal ureteral stones less than 5 mm in
size (93.8%) and lowest for multiple caliceal stones greater than 21 mm (10.5%). 
CONCLUSIONS: This study demonstrated that stone size, location and number are
significant predictors of extracorporeal shock wave lithotripsy outcome. We have 
developed nomograms for predicting the stone-free rate of extracorporeal shock
wave lithotripsy, which is useful for counseling patients with urolithiasis
before surgery.

PMID: 16952658 [PubMed - indexed for MEDLINE]

422: Pediatr Nephrol. 2006 Dec;21(12):1901-3. Epub 2006 Sep 1.

Idiopathic hypercalciuria in infants with renal stones.

Ammenti A, Neri E, Agistri R, Beseghi U, Bacchini E.

Department of Pediatrics, University of Parma, Parma, Italy.

In children older than 2 years, hypercalciuria is the most common metabolic cause
of renal stones. In infants, its prevalence is not well established. Since 1990, 
we observed five infants in whom renal stones or microcalculi were diagnosed
between the age of 5 and 19 months. One of them was lost to follow up. In the
present report, we describe the four patients who underwent metabolic evaluation 
and in whom idiopathic hypercalciuria (IH) was diagnosed. We conclude that IH is 
a frequent cause of microcalculi and renal stones in infants, and a screen for
this condition is warranted in this age group.

PMID: 16947030 [PubMed - indexed for MEDLINE]

423: Eur Urol. 2007 Mar;51(3):810-4; discussion 815. Epub 2006 Aug 11.

Miniperc? No, thank you!

Giusti G, Piccinelli A, Taverna G, Benetti A, Pasini L, Corinti M, Teppa A,
Zandegiacomo de Zorzi S, Graziotti P.

Department of Urology, Istituto Clinico Humanitas, IRCCS, via Manzoni 56, 20089
Rozzano, Milan, Italy. guido.giusti@humanitas.it

OBJECTIVES: The aim of this retrospective study was to evaluate the results of
our miniperc series through comparison with results from standard percutaneous
nephrolithotomy (PNL) and tubeless PNL series in the treatment of stones <2 cm in
diameter. PATIENTS AND METHODS: A total of 134 percutaneous treatments were
performed for renal stones <2 cm in diameter. Among the treatments, 40 were
minipercs, 67 were standard PNLs, and 27 were tubeless PNLs. RESULTS: Miniperc
operative time was longer than that of standard PNL (155.5 vs 106.6 min,
respectively) and tubeless PNL (95.9 min). Conversely, there was an advantage for
miniperc over standard PNL in terms of a significantly reduced hematocrit drop
(4.49% vs 6.31%). No miniperc patients required blood transfusions, whereas two
did in the standard PNL group and one in the tubeless PNL group. There was no
statistical difference in terms of the amount of analgesics between the standard 
PNL and miniperc groups, although this difference was statistically significant
between the miniperc and tubeless PNL groups (73.8 vs 41.1mg, respectively).
Hospitalization for the miniperc group was shorter than that required by the
standard PNL group (3.05 vs 5.07 days), but tubeless PNL offered the best result 
(2.18 days). The stone-free rate was 100% in the tubeless PNL group, 94% in the
standard PNL group, and 77.5% in the miniperc group. CONCLUSIONS: Our
retrospective study failed to demonstrate significant advantages of the miniperc 
technique. As such, we no longer perform miniperc but instead use tubeless PNL
when possible.

Publication Types: 
    Comparative Study

PMID: 16938385 [PubMed - indexed for MEDLINE]

424: Arch Ital Urol Androl. 2006 Jun;78(2):71-4.

Infundibulotomy and percutaneous removal of stones in calyceal diverticula: case 
report and review of therapeutic options.

Pecoraro G, Motta L, Olivo G, Frigo M.

Urology Unit, Isola della Scala Hospital, ASL 22 Bussolengo (VR), Italy.

The authors describe the use of a percutaneous approach for treating secondary
calyceal diverticular stones. This disease was once managed with open surgery,
but today minimally invasive techniques are preferred such as percutaneous
nephrostolithotomy (PCNL), ureteroscopic stone removal (URS), laparoscopy,
extracorporeal shock wave lithotripsy (ESWL), with PCNL representing the gold
standard. Various percutaneous techniques are described for treating both calculi
and the diverticulum. The first essential step is a careful preoperative
morphological assessment of the diverticulum in order to plan the most suitable
treatment modality.

Publication Types: 
    Case Reports

PMID: 16929608 [PubMed - indexed for MEDLINE]

425: Surg Obes Relat Dis. 2005 Sep-Oct;1(5):481-5. Epub 2005 Aug 26.

Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially
serious and unappreciated complications of Roux-en-Y gastric bypass.

Nelson WK, Houghton SG, Milliner DS, Lieske JC, Sarr MG.

Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota 55905,
USA.

BACKGROUND: Neither the presence nor prevalence of enteric hyperoxaluria has been
recognized after Roux-en-Y gastric bypass (RYGBP). We have noted a high rate of
oxalate nephrolithiasis and even 2 patients with oxalate nephropathy in this
patient population postoperatively. Our aim was to determine the frequency of the
occurrence and effects of enteric hyperoxaluria after RYGBP. METHODS:
Retrospective review of all patients at our institution diagnosed with calcium
oxalate nephrolithiasis or oxalate nephropathy after standard (n = 14) or distal 
(n = 9) RYGBP. The mean postoperative follow-up was 55 months. RESULTS: A total
of 23 patients (14 men and 9 women; mean age 45 years; mean preoperative body
mass index 55 kg/m(2)) developed enteric hyperoxaluria after RYGBP, defined by
the presence of oxalate nephropathy (n = 2) or calcium oxalate nephrolithiasis (n
= 21) and increased 24-hour excretion of urinary oxalate and/or calcium oxalate
supersaturation. Enteric hyperoxaluria was recognized after a mean weight loss of
46 kg at 29 months (range 2-85) after RYGBP. Two patients developed renal failure
and required chronic hemodialysis. Of the 21 patients with nephrolithiasis, 14
had no history of nephrolithiasis preoperatively, and 19 of 21 required
lithotripsy or other intervention. Of the 23 patients, 20 tested had increased
oxalate excretion, and 14 of 15 tested had high urine calcium oxalate
supersaturation. CONCLUSION: Enteric hyperoxaluria, nephrolithiasis, and oxalate 
nephropathy must be considered with the other risks of RYGBP. Efforts should be
made to identify factors that predispose patients to developing hyperoxaluria.

PMID: 16925274 [PubMed - indexed for MEDLINE]

426: Nutr Rev. 2006 Jul;64(7 Pt 1):301-12.

Dietary therapy in idiopathic nephrolithiasis.

Borghi L, Meschi T, Maggiore U, Prati B.

Dipartimento di Scienze Cliniche, Università di Parma, Italy.
loris.borghi@unipr.it

Like other diseases striking predominantly the affluent societies, idiopathic
nephrolithiasis is increasing in rich countries and appears to be closely related
to dietary habits. In this review we summarize the latest evidence about the
efficacy of dietary treatment for idiopathic calcium and uric acid stones,
dealing especially with its effect on the urinary stone risk factors, stone
recurrences, and clinical limitations. After a short introduction on epidemiology
and pathogenesis, we review the role of the most important foods and nutrients in
stone formation and protection: water and other fluids, proteins, carbohydrates, 
fats, salt, milk and dairy products, fruits and vegetables, and vitamins. The
final part of the paper will provide practical guidelines for pursuing an
anti-lithogenic diet in idiopathic calcium and uric acid stones.

Publication Types: 
    Review

PMID: 16910218 [PubMed - indexed for MEDLINE]

427: Int J Urol. 2006 Aug;13(8):1141-3.

Laparoscopic management of a retained heavily encrusted ureteral stent.

Bhansali M, Patankar S, Dobhada S.

Institute of Urology, Pune, Maharashtra, India.
mannish_bhansali2001@rediffmail.com

The indwelling ureteral stent is a fundamental part of today's urologic practice.
Since its introduction in 1978, many improvements have been made in stent design 
and composition to minimize patient discomfort. As a consequence, the patient can
forget about the stent. A known and well-documented complication of this
situation is encrustations of the ureteral stent which causes significant
morbidity to the patient, and at times, they are very difficult to manage.
Reports in the literature describe techniques that require several procedures and
anaesthetic sessions to effect stent extraction. Here, we report the one-sitting 
laparoscopic management of a heavily encrusted and stuck DJ stent, with minimal
morbidity and very short hospital stay. Laparoscopic management of this common
urologic problem has not been reported before. A comprehensive discussion is also
presented regarding the management of such problems and their prevention.

Publication Types: 
    Case Reports

PMID: 16903950 [PubMed - indexed for MEDLINE]

428: Int J Urol. 2006 Aug;13(8):1109-11.

Atypical findings in a patient with a renal milky stone including a cake of
stone.

Uesugi T, Ichikawa T.

Juzen General Hospital, Urology, Niihama-shi, Ehime-ken, Japan.

A 54-year-old woman was admitted to our department with the diagnosis of a renal 
calculus. She exhibited dull left flank pain. A plain film revealed a round
opaque calcific density in the left kidney in the supine and the upright
position. There was no connection between the calcification and the renal
collecting system by retrograde pyelography. Computed tomography in the supine
position showed a rounded calcification in the left renal parenchyma without a
semilunar configuration. She was diagnosed with left renal calyceal diverticula
calculi. She underwent a surgical intervention which found a renal milky stone
including a 10-mm. diameter stone. The examination of the fluid and the stone
material disclosed three components: calcium phosphate, calcium oxalate and
calcium carbonate. The present case is interesting because its characteristics
differ from the common features of renal milky stone.

Publication Types: 
    Case Reports

PMID: 16903938 [PubMed - indexed for MEDLINE]

429: J Endourol. 2006 Aug;20(8):560-4.

Variability of protein content in calcium oxalate monohydrate stones.

Williams JC Jr, Zarse CA, Jackson ME, Witzmann FA, McAteer JA.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46202-5120, USA. williams@anatomy.iupui.du

BACKGROUND AND PURPOSE: Urinary stones are heterogeneous in their fragility to
lithotripter shockwaves. As a first step in gaining a better understanding of the
role of matrix in stone fragility, we measured extractible protein in calcium
oxalate monohydrate (COM) stones that were extensively characterized by
micro-computed tomography (micro CT). MATERIALS AND METHODS: Stones were scanned 
using micro CT (Scanco mCT20, 34 microm). They were ground, and the protein
extracted using four methods: 0.25M EDTA, 2% SDS reducing buffer, 9M urea buffer,
and 10% acetic acid. Protein was measured using NanoOrange. The SDS extracts were
also examined using polyacrylamide electrophoresis (PAGE). RESULTs: Extracted
protein was highest with the SDS or urea methods (0.28% +/- 0.13% and 0.24% +/-
0.11%, respectively) and lower using the EDTA method (0.17% +/- 0.05%; P < 0.02).
Acetic acid extracted little protein (0.006 +/- 0.002%; P < 0.001). Individual
stones were significantly different in extractability of protein by the different
methods, and SDS-PAGE revealed different protein patterns for individual stones. 
Extracted protein did not correlate with X-ray-lucent void percentage, which
ranged from 0.06% to 2.8% of stone volume, or with apatite content. CONCLUSIONS: 
Extractible stone-matrix protein differs for individual COM stones, and yield is 
dependent on the extraction method. The presence of X-ray-lucent voids or minor
amounts of apatite in stones did not correlate with protein content. The amounts 
of protein recovered were much lower than reported by Boyce, showing that these
methods extracted only a fraction of the protein bound up in the stones. The
results suggest that none of the methods tested will be useful for helping to
answer the question of whether matrix content differs among stones of differing
fragility to lithotripter shockwaves.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16903815 [PubMed - indexed for MEDLINE]

430: J Endourol. 2006 Aug;20(8):556-9.

Retrograde intrarenal surgery as second-line therapy yields a lower success rate.

Holland R, Margel D, Livne PM, Lask DM, Lifshitz DA.

Minimally Invasive Urology, Rabin Medical Center, Petach Tikva, Israel.

BACKGROUND AND PURPOSE: Retrograde intrarenal surgery (RIRS) is a recent addition
to the treatment options for renal calculi. Therefore, the indications, as well
as the predictors of success, are still being studied. Herein, we report a
retrospective comparison of RIRS performed as the primary treatment and as
second-line therapy, mostly after shockwave lithotripsy (SWL) failure. PATIENTS
AND METHODS: Between October 2001 and August 2004, 93 patients underwent RIRS
(11% of all ureteroscopies), all by the same surgeon. Patients were divided into 
two groups: group 1 (n = 42) consisted of patients undergoing RIRS as a
first-line modality and group 2 (n = 51) of those having RIRS as secondline
therapy. The indications for RIRS in group 1 were renal calculi with prior
placement of a double-J stent (30%), renal + ureteral stone (25%), pushback of
ureteral stone during ureteroscopy (22%), a radiolucent stone (8%), coagulopathy,
and abnormal renal anatomy. In group 2, the patients were initially treated by
SWL (92%) or percutaneous nephrolithotomy. The groups did not differ
significantly in demographic characteristics, mean stone size (9.5 and 8.7 mm,
respectively), or stone location (in both 60% in the lower pole). The variables
analyzed were operating time, complications, length of hospitalization, and
stone-free rate. RESULTS: The overall stone-free rate was 73%. However, the
stone-free rate was significantly higher in group 1 than in group 2: 80% v 67%,
respectively. A higher complication rate and longer hospitalization were noted in
group 2, although the difference was not statistically significant. CONCLUSIONS: 
When RIRS is performed after failed SWL, it has a lower success rate and may be
associated with a higher morbidity rate than if it is performed as first-line
therapy. These results suggest that the success rate of RIRS may be influenced by
the same negative factors that reduce SWL success. Therefore, if a patient fails 
SWL, careful consideration should be given to the best second-line therapy
comparing RIRS with percutaneous stone removal.

PMID: 16903814 [PubMed - indexed for MEDLINE]

431: J Endourol. 2006 Aug;20(8):547-51.

Percutaneous nephrolithotomy for complex caliceal calculi and staghorn stones in 
children less than 5 years of age.

Manohar T, Ganpule AP, Shrivastav P, Desai M.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat,
India.

BACKGROUND AND PURPOSE: Treatment of children with staghorn and complex caliceal 
calculi is one of the most challenging problems in urology. We present our
experience with percutaneous nephrolithotomy (PCNL) monotherapy for staghorn and 
complex caliceal calculi in children less than 5 years of age. PATIENTS AND
METHODS: Between 1991 and 2004, 27 boys and 9 girls aged 11 months to 4.5 years
underwent PCNL for staghorn (33%) or complex caliceal (67%) calculi. The average 
bulk of the stones was 140.17 +/- 42.16 mm(2) (range 61-253 mm(2)). Staging of
the procedure was preferred in children with renal insufficiency, urinary-tract
infection, fragmentation time >60 minutes, or a stone burden requiring more than 
two tracts. Essential steps of the technique were a dynamic contrast study to
select the appropriate-size Amplatz sheath and ultrasound guidance for renal
access. RESULTS: The average operative time was 72.11 +/- 28.86 minutes. The
stone-free rate was 86%, the mean hemoglobin drop was 2.2 +/- 0.95 g/dL, and the 
mean hospital stay was 3.5 days. Less than half of the patients (42%) were
treated in a single stage, the remainder requiring multiple procedures. Only 39% 
could be treated with a single tract. There was statistically significant
increase in the blood loss in patients requiring multiple tracts (P = 0.008);
however, staging the procedure did not increase the blood loss (P = 0.06).
CONCLUSION: Percutaneous nephrolithotomy is safe and effective in children less
than 5 years of age. Staging the procedure, instrument modification, the timed
"multi mini-perc" technique, and ultrasound-guided access help in achieving
maximum stone clearance with minimal morbidity.

PMID: 16903812 [PubMed - indexed for MEDLINE]

432: J Endourol. 2006 Aug;20(8):542-6.

Spondyloarthropathy: an independent risk factor for kidney stones.

Canales BK, Leonard SM, Singh JA, Orzano IM, Zimmermann B, Weiland D, Monga M,
Krug HE.

Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
55455-0392, USA.

PURPOSE: To better stratify risk and to verify previous prevalence reports, we
conducted a retrospective cohort study comparing the lifetime incidence of
nephrolithiasis in patients with spondyloarthropathies (SpA) and rheumatoid
arthritis (RA). PATIENTS AND METHODS: Patients with SpA or rheumatoid
factor-positive RA were identified from the rheumatology clinics of two Veterans 
Affairs hospitals and the University of Minnesota. Among them, 168 were confirmed
to meet the American College of Rheumatology criteria and gave informed consent
to participation. They were sent a survey regarding their rheumatologic
diagnosis, coexistent conditions, medications, and history of kidney stones. Of
the total, 143 patients responded and met the criteria for analysis. Rheumatoid
arthritis patients were age and sex matched with SpA patients as controls.
RESULTS: Populations were similar in all categories except that RA patients were 
more likely to have used prednisone (P < 0.001), bisphosphonates (P < 0.001), and
calcium supplementation (P = 0.03). Kidney stones were reported by 23 (29.11%) of
the 79 SpA patients compared with 8 (12.5%) of the 64 RA patients (chi (2) =
5.75; P = 0.025). Subgroup analysis of self-reporting stone history in 85
patients was found to be reliable on imaging review (sensitivity 82%; specificity
100%). CONCLUSIONS: Self-reporting of kidney stones by patients is a reliable
measure. Despite adjusting for medication use and matching two similar arthritic 
populations, patients with SpA had a higher incidence of kidney stones than those
with RA. This finding suggests that SpA is an independent risk factor for
nephrolithiasis. Future studies will evaluate urinary risk factors and
polymorphisms in the ANKH gene that may predispose to stone formation in this
high-risk group.

PMID: 16903811 [PubMed - indexed for MEDLINE]

433: J Endourol. 2006 Aug;20(8):537-41.

Why stones break better at slow shockwave rates than at fast rates: in vitro
study with a research electrohydraulic lithotripter.

Pishchalnikov YA, McAteer JA, Williams JC Jr, Pishchalnikova IV, Vonderhaar RJ.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46202-5120, USA. yura@anatomy.iupui.edu

BACKGROUND AND PURPOSE: Stones break better when the rate of shockwave (SW)
delivery is slowed. It has been hypothesized that the greater cavitation
accompanying a fast rate shields pulse propagation, thus interfering with the
delivery of SW energy to the stone. We tested this idea by correlating waveforms 
measured at the SW focus with cavitation viewed using high-speed imaging.
MATERIALS AND METHODS: A series of U30 gypsum stones held in a 2-mm mesh basket
were exposed to 200 SWs at 30 or 120 SW/min from a research electrohydraulic
lithotripter (HM3 clone). Waveforms were collected using a fiberoptic probe
hydrophone. High-speed imaging was used to observe cavitation bubbles in the
water and at the stone surface. Results: Stone breakage was significantly better 
at 30 SW/min than at 120 SW/min. The rate had little effect on SW parameters in
the water free field. In the presence of particulates released from stones, the
positive pressure of the SW remained unaffected, but the trailing tensile phase
of the pulse was significantly reduced at 120 SW/min. CONCLUSIONS: Cavitation
bubbles do not persist between SWs. Thus, mature bubbles from one pulse do not
interfere with the next pulse, even at 120 SW/min. However, cavitation nuclei
carried by fine particles released from stones can persist between pulses. These 
nuclei have little effect on the compressive wave but seed cavitation under the
influence of the tensile wave. Bubble growth draws energy from the
negative-pressure phase of the SW, reducing its amplitude. This likely affects
the dynamics of cavitation bubble clusters at the stone surface, reducing the
effectiveness of bubble action in stone comminution.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16903810 [PubMed - indexed for MEDLINE]

434: Saudi J Kidney Dis Transpl. 2006 Jun;17(2):208-12.

Acute renal infarction secondary to atrial fibrillation - mimicking renal stone
picture.

Salih SB, Al Durihim H, Al Jizeeri A, Al Maziad G.

Department of Medicine, King Abulaziz Cardiac Center, King Fahad National Guard
Hospital, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.

Acute renal infarction presents in a similar clinical picture to that of a renal 
stone. We report a 55-year-old Saudi female, known to have atrial fibrillation
secondary to mitral stenosis due to rheumatic heart disease. She presented with a
two day history of right flank pain that was treated initially as a renal stone. 
Further investigations confirmed her as a case of renal infarction. Renal
infarction is under-diagnosed because the similarity of its presentation to renal
stone. Renal infarction should be considered in the differential diagnosis of
loin pain, particularly in a patient with atrial fibrillation.

Publication Types: 
    Case Reports

PMID: 16903629 [PubMed - indexed for MEDLINE]

435: J Pak Med Assoc. 2006 Jul;56(7):302-5.

The efficacy of conventional PCNL and two modifications to standard procedure.

Basiri A, Ahmadnia H, Moghaddam SM.

Urology Nephrology Research Center (UNRC), Labbafi Nejad Hospital, Shahid
Beheshti University of Medical Science, Tehran, Iran.

OBJECTIVE: To compare the efficacy of conventional Percutaneous Nephrolithotomy
(PCNL) with two of its modified procedures. METHODS: A randomized controlled
trial, was performed on 60 patients undergoing PCNL. Cases of renal stone
regardless of stone size and configuration, having pre-operative negative urine
culture, no coagulopathy, and no visible residual stone in intra-operative
fluoroscopy, were included. They were randomly divided into 3 groups of 20 cases 
each with nephrostomy tube (NT) and temporary ureteral catheter (TU) in group A, 
only TU in group B and only indwelling ureteral catheter (IU) in group C. Mean
age of cases were 43.2 (25-70), 40.1 (25-73), and 44 (25-70) years in groups A , 
B and C, respectively (P = 0.6). Procedures were performed under general
anaesthesia, using standard techniques for access and lithotomy. Forty-eight
hours, 2 weeks and 3 months after PCNL, plain X-ray abdomen, ultrasonography and 
IVP were performed for each case. RESULTS: Only one case in group A had urinary
leakage after removal of nephrostomy tube. No cases in the other two groups
encountered this problem. There was no haemorrhagic episode. Ultrasonic
evaluation showed mild residue in 3, 1 and 1 cases of groups A, B and C,
respectively (P = 0.2). No collective fluid was found in these groups. IVP showed
dilatation without obstruction in 3 subjects of group A and none in group B or C 
(P = 0.03). CONCLUSION: Tubeless PCNL seems to be accompanied by better outcome. 
So, further evaluation on more patients seems necessary.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 16900709 [PubMed - indexed for MEDLINE]

436: Urol Res. 2006 Oct;34(5):329-37. Epub 2006 Aug 4.

Preservation of urine samples for metabolic evaluation of stone-forming patients.

Ferraz RR, Baxmann AC, Ferreira LG, Nishiura JL, Siliano PR, Gomes SA, Moreira
SR, Heilberg IP.

Nephrology Division, Universidade Federal de São Paulo, Rua: Botucatu, 740 Vila
Clementino, São Paulo, SP 04023-900, Brazil.

Metabolic evaluation of stone-forming (SF) patients is based on the determination
of calcium, oxalate, citrate, uric acid and other parameters in 24-h urine
samples under a random diet. A reliable measurement of urinary oxalate requires
the collection of urine in a receptacle containing acid preservative. However,
urinary uric acid cannot be determined in the same sample under this condition.
Therefore, we tested the hypothesis that the addition of preservatives (acid or
alkali) after urine collection would not modify the results of those lithogenic
parameters. Thirty-four healthy subjects (HS) were submitted to two
non-consecutive collections of 24-h urine. The first sample was collected in a
receptacle containing hydrochloric acid (HCl 6 N) and the second in a dry plastic
container, with HCl being added as soon as the urine sample was received at the
laboratory. Additionally, 34 HS and 34 SF patients collected a spot urine sample 
that was divided into four aliquots, one containing HCl, another containing
sodium bicarbonate (NaHCO(3 )5 g/l), and two others in which these two
preservative agents were added 24 h later. Urinary oxalate, calcium, magnesium,
citrate, creatinine and uric acid were determined. Urinary parameters were also
evaluated in the presence of calcium oxalate or uric acid crystals. Mean values
of all urinary parameters obtained from previously acidified 24-h urine samples
did not differ from those where acid was added after urine collection. The same
was true for spot urine samples, with the exception of urinary citrate that
presented a slight albeit significant change of 5.9% between samples in HS and
3.1% in SF. Uric acid was also not different between pre- and post-alkalinized
spot urine samples. The presence of crystals did not alter these results. We
concluded that post-delivery acidification or alkalinization of urine samples
does not modify the measured levels of urinary oxalate, calcium, magnesium,
creatinine and uric acid, and that the change on citrate was not relevant, hence 
allowing all parameters to be determined in a single urine sample, thus avoiding 
the inconvenience and cost of multiple 24-h urine sample collections.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16896690 [PubMed - indexed for MEDLINE]

437: Mil Med. 2006 Jul;171(7):684-6.

Case management study Walter Reed Army Medical Center. A 37-year-old soldier with
right flank pain.

Bernet V, Shumway NM, Bunin JL.

Department of Medicine, Walter Reed Army Medical Center, 6900 Georgia Avenue,
Washington, DC 20307, USA.

The objective of this study was to discuss the appropriate diagnostic and
treatment approach to an active duty patient presenting with recurrent kidney
stones. A 37-year-old active duty infantryman, stationed in Iraq, was evacuated
by air to Waiter Reed Army Medical Center for workup of recurrent kidney stones
and hypercalcemia. A diagnosis was made and the definitive treatment was
performed. During this report, we will illustrate the various aspects of
diagnosis that are involved with the workup of kidney stones and hypercalcemia as
well as discuss the available treatment options. Relevant military issues include
proceeding with the initial management regimen and recognition of appropriate
reasons for initiation of referral consultation.

Publication Types: 
    Case Reports

PMID: 16895141 [PubMed - indexed for MEDLINE]

438: J Urol. 2006 Sep;176(3):1020-2.

Can Phyllanthus niruri affect the efficacy of extracorporeal shock wave
lithotripsy for renal stones? A randomized, prospective, long-term study.

Micali S, Sighinolfi MC, Celia A, De Stefani S, Grande M, Cicero AF, Bianchi G.

Division of Urology, Policlinico di Modena, University of Modena, Via del Pozzo
71, 41100 Modena, Italy. micali.salvatore@unimo.it

PURPOSE: Phyllanthus niruri is a plant used in Brazilian folk medicine for the
treatment of urolithiasis. We assessed the efficacy of P. niruri after
extracorporeal shock wave lithotripsy for renal stones. MATERIALS AND METHODS: We
prospectively evaluated 150 patients with renal stones that were as large as 25
mm and composed of calcium oxalate. All patients received 1 to 3 extracorporeal
shock wave lithotripsy sessions by Dornier Lithotriptor S. After treatment 78 of 
150 patients (52%) underwent therapy with Uriston, a P. niruri extract (2 gm
daily) for at least 3 months (group 1). Otherwise 72 of 150 patients (48%) were
used as a control group (group 2). No significant difference in stone size
between the 2 groups was found. Stone clearance was assessed after 30, 60, 90 and
180 days by abdominal x-ray and ultrasound scan. RESULTS: Stone-free rate
(stone-free defined as the absence of any stone or residual fragments less than 3
mm) was 93.5% in group 1 and 83.3% in group 2 (p = 0.48) at the end point of the 
followup (180 days). For lower caliceal stones (56 patients) the stone-free rate 
was 93.7% in the treatment group and 70.8% in the control group (p = 0.01).
Re-treatment need for group 1 was 39.7% and for group 2 it was 43.3% (p = 0.2).
No side effects were recorded with extracorporeal shock wave lithotripsy or P.
niruri therapy. CONCLUSIONS: Regular self-administration of P. niruri after
extracorporeal shock wave lithotripsy for renal stones results in an increased
stone-free rate that appears statistically significant for lower caliceal
location. Its efficacy and the absolute lack of side effects make this therapy
suitable to improve overall outcomes after extracorporeal shock wave lithotripsy 
for lower pole stones.

Publication Types: 
    Randomized Controlled Trial

PMID: 16890682 [PubMed - indexed for MEDLINE]

439: Urol Int. 2006;77(2):179-81.

Shock wave lithotripsy in solitary functioning kidneys: is prophylactic stenting 
necessary?

Kumar S, Sakthivel A, Chacko KN, Kekre NS, Ganesh G.

Department of Urology, Christian Medical College, Vellore, India.
uro2@cmcvellore.ac.in

OBJECTIVE: To assess the safety of shock wave lithotripsy (SWL) without
prophylactic stents in solitary functioning kidneys. PATIENTS AND METHODS:
Sixteen solitary functioning kidneys with 23 renal stones with a size of <15 mm
were treated with SWL as the primary modality. All patients were counseled about 
the possibility of obstruction, and treatment was offered to those who consented.
The safety of SWL was assessed by the need for interventions and the
posttreatment renal function. RESULTS: In 14 patients lithotripsy was uneventful.
The duration of treatment ranged from 5 to 35 days. One patient with a 15-mm
pelvic calculus presented with anuria which resolved before intervention. In 1
patient fragmentation failed, and percutaneous nephrolithotomy was performed.
CONCLUSIONS: In solitary functioning kidneys, SWL is safe without prophylactic
stents in properly selected and closely monitored patients. Avoiding stents
decreases costs, duration of treatment, and stent-related morbidity without
unduly compromising safety.

PMID: 16888427 [PubMed - indexed for MEDLINE]

440: J Am Assoc Lab Anim Sci. 2006 Jul;45(4):64-7.

Urolithiasis and transitional cell carcinoma of the bladder in a Wistar rat.

Dontas IA, Khaldi L.

Laboratory of Experimental surgery and surgical Research, School of Medicine,
University of Athens, Greece. idontas@med.uoa.gr

Urolithiasis and carcinoma of the urinary bladder are generally uncommon in rats.
In particular, spontaneous urolithiasis and carcinoma of the bladder in young
rats has not yet been reported. Our case concerns the unexpected finding of
urolithiasis of the bladder and left kidney of an apparently healthy 4-mo-old
male Wistar rat. The bladder was filled with 28 white, round to oval calculi of
various sizes. The kidney presented a single unevenly shaped calculus in the
pelvis. Histology revealed, in addition to urolithiasis, a grade II papillary
transitional cell carcinoma of the bladder, with muscle invasion and neoplastic
extension to the left renal pelvic epithelium. No previous experimental procedure
or dietetic manipulation had occurred, which could be held responsible for these 
findings. These unusual findings indicate that, unknown to researchers,
unapparent factors can affect the health status of even relatively young
experimental animals. Asymptomatic disease, such as the unknown presence of a
tumor, potentially can affect many parameters and thus influence research
results.

Publication Types: 
    Case Reports

PMID: 16884183 [PubMed - indexed for MEDLINE]

441: Acta Anaesthesiol Scand. 2006 Aug;50(7):798-803.

Low-dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy: the
suitability and impact of adding intrathecal fentanyl.

Atallah MM, Shorrab AA, Abdel Mageed YM, Demian AD.

Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt.
atallah_36@hotmail.com

BACKGROUND: Unilateral spinal anaesthesia has been used for lower limb surgery
with a stable cardiovascular state and a short recovery unit stay. We sought to
test the suitability of low-dose bupivacaine spinal anaesthesia for percutaneous 
nephrolithotomy, a procedure hitherto performed under general anaesthesia.
Furthermore, we hypothesized that adding intrathecal fentanyl to bupivacaine may 
improve the quality of anaesthesia. METHODS: We randomly allocated, through
computer-generated randomization, 108 patients subjected to percutaneous
nephrolithotomy to receive either 7.5 mg of hyperbaric bupivacaine 5 mg/ml alone 
or with the addition of 10 microg of fentanyl. Drugs were given at the L(2)-L(3) 
interspace with the patient in the lateral decubitus position. The patients
remained in this position for 10 min, after which the sensory and motor blocks
were assessed. Intra-operative analgesic supplementation, when deemed necessary, 
was achieved with intravenous fentanyl boluses (25 microg). RESULTS: The sensory 
and motor blocks after intrathecal bupivacaine and bupivacaine-fentanyl were
similar. Sensory block, in both groups, reached the fifth and eighth thoracic
dermatomes on the operative and non-operative sides, respectively. Deep motor
block occurred on the operative side in all patients and in nearly 50% of
patients on the non-operative side. The patients in the bupivacaine-fentanyl
group required less intra-operative and post-operative analgesics, and both
patients and endoscopists were better satisfied. CONCLUSION: This study
demonstrated, for the first time, that intrathecal low-dose bupivacaine and
fentanyl offers a reliable neuraxial block for patients subjected to percutaneous
nephrolithotomy, with stable haemodynamics, good post-operative analgesia and
acceptable patient and endoscopist satisfaction.

Publication Types: 
    Randomized Controlled Trial

PMID: 16879461 [PubMed - indexed for MEDLINE]

442: J Am Soc Nephrol. 2006 Sep;17(9):2567-75. Epub 2006 Jul 19.

High urinary calcium excretion and genetic susceptibility to hypertension and
kidney stone disease.

Mente A, Honey RJ, McLaughlin JM, Bull SB, Logan AG.

Department of Medicine, Division of Nephrology, Mount Sinai Hospital, Room 435,
600 University Avenue, Toronto, Ont M5G1X5, Canada.

Increased urinary calcium excretion commonly is found in patients with
hypertension and kidney stone disease (KSD). This study investigated the
aggregation of hypertension and KSD in families of patients with KSD and
hypercalciuria and explored whether obesity, excessive weight gain, and diabetes,
commonly related conditions, also aggregate in these families. Consecutive
patients with KSD, aged 18 to 50 yr, were recruited from a population-based
Kidney Stone Center, and a 24-h urine sample was collected. The first-degree
relatives of eligible patients (n = 333) and their spouse were interviewed by
telephone to collect demographic and health information. Familial aggregation was
assessed using generalized estimating equations. Multivariate-adjusted odds
ratios (OR) revealed significant associations between hypercalciuria in patients 
and hypertension (OR 2.9; 95% confidence interval 1.4 to 6.2) and KSD (OR 1.9;
95% confidence interval 1.03 to 3.5) in first-degree relatives, specifically in
siblings. No significant associations were found in parents or spouses or in
patients with hyperuricosuria. Similarly, no aggregation with other conditions
was observed. In an independent study of siblings of hypercalciuric patients with
KSD, the adjusted mean fasting urinary calcium/creatinine ratio was significantly
higher in the hypertensive siblings compared with normotensive siblings (0.60 +/-
0.32 versus 0.46 +/- 0.28 mmol/mmol; P < 0.05), and both sibling groups had
significantly higher values than the unselected study participants (P < 0.001).
Urinary sodium/creatinine and uric acid/creatinine ratios were not different
among the groups. Although an environmental effect cannot be excluded fully, our 
findings suggest that the disturbance in calcium metabolism in hypertension and
KSD has a genetic basis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16855017 [PubMed - indexed for MEDLINE]

443: Kidney Int. 2006 Sep;70(5):914-23. Epub 2006 Jul 19.

Modeling of hyperoxaluric calcium oxalate nephrolithiasis: experimental induction
of hyperoxaluria by hydroxy-L-proline.

Khan SR, Glenton PA, Byer KJ.

Department of Pathology and Laboratory Medicine, College of Medicine, University 
of Florida, Gainesville, Florida 32610-0275, USA. khan@pathology.ufl.edu

A number of animal models have been developed to investigate calcium oxalate
(CaOx) nephrolithiasis. Ethylene glycol (EG)-induced hyperoxaluria in rats is
most common, but is criticized because EG and some of its metabolites are
nephrotoxic and EG causes metabolic acidosis. Both oxalate (Ox) and CaOx crystals
are also injurious to renal epithelial cells. Thus, it is difficult to
distinguish the effects of EG and its metabolites from those induced by Ox and
CaOx crystals. This study was performed to investigate hydroxy-L-proline (HLP), a
common ingredient of many diets, as a hyperoxaluria-inducing agent. In rats, HLP 
has been shown to induce CaOx nephrolithiasis in only hypercalciuric conditions. 
Five percent HLP mixed with chow was given to male Sprague-Dawley rats for 63
days, resulting in hyperoxaluria, CaOx crystalluria, and nephrolithiasis. Crystal
deposits were surrounded by ED-1-positive inflammatory cells. Cell injury and
death was followed by regeneration, as suggested by an increase in proliferating 
cell nuclear antigen-positive cells. Both osteopontin (OPN) and CD44 were
upregulated. Staining for CD44 and OPN was intense in cells lining the tubules
that contained crystals. Along with a rise in urinary Ox and lactate
dehydrogenase, there were significant increases in 8-isoprostane and hydrogen
peroxide excretion, indicating that the oxidative stress induced cell injury.
Thus, HLP-induced hyperoxaluria alone can induce CaOx nephrolithiasis in rats.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16850024 [PubMed - indexed for MEDLINE]

444: Eur Urol. 2007 Jan;51(1):224-7; discussion 228. Epub 2006 Jun 30.

Feasibility of percutaneous nephrolithotomy under assisted local anaesthesia: a
prospective study on selected patients with upper urinary tract obstruction.

Aravantinos E, Karatzas A, Gravas S, Tzortzis V, Melekos M.

Department of Urology, University Hospital of Larissa, Feidiou 6-8, 412 21
Larissa, Greece.

OBJECTIVE: To evaluate the feasibility of performing percutaneous nephrolithotomy
(PCNL) under local anaesthesia in selected patients. METHODS: Twenty-four
patients with unilateral renal obstruction due to pelvic stones > or =2.0 cm were
enrolled in our study. First a percutaneous nephrostomy to decompress the
obstructed kidney was performed using local anaesthesia (lignocaine). A 16-Fr
nephrostomy tube was left in place for 1 wk, and then the second stage was
carried out. After having infiltrated the tract and the renal parenchyma with
lignocaine, dilatation of the nephrostomy tract was performed. Subsequently, PCNL
was done using a 24-Fr rigid nephroscope and a ballistic lithotripter. All
patients were premedicated with pethidine HCl intramuscularly 30 min before the
beginning of both stages. Diazepam was given (0.1mg/kg orally) to patients before
the second stage. Pain scores were collected using 10-cm linear visual analogue
scale (VAS) after the completion of both procedures. RESULTS: The procedure was
well tolerated. One patient needed further treatment with midazolam during PCNL. 
The mean VAS score was 38 mm (range: 17-60 mm) for the first stage and 36 mm
(13-69 mm) for the second stage. The mean operative time, including both stages, 
was 127 min (85-155 min). No anaesthesia-related complications occurred.
CONCLUSION: Our study indicates that PCNL under assisted local anaesthesia is
safe and effective in selected patients.

PMID: 16842905 [PubMed - indexed for MEDLINE]

445: Kidney Int. 2006 Sep;70(5):835-9. Epub 2006 Jul 12.

Diet and fluid prescription in stone disease.

Taylor EN, Curhan GC.

Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard
Medical School, Boston, Massachusetts 02115, USA. entaylor@partners.org

Dietary factors play an important role in kidney stone formation, and dietary
modification can reduce the risk of stone recurrence. Because stone recurrence
rates may be as high as 30-50% after 5 years, individualized dietary intervention
to prevent stone recurrence should be offered to every patient willing to
participate in a diagnostic work-up and to adhere to treatment recommendations.
The necessity of prescribing medical therapy to select patients does not obviate 
the need for an effective dietary and/or fluid prescription. In this review, we
summarize specific dietary and fluid recommendations, and emphasize several key
concepts. First, risk factors for stone formation vary by age and sex. Second,
recommendations should be tailored to the individual patient based on urinary
profile and stone type. Third, it is essential that the patient perform follow-up
measurements to evaluate the impact of dietary recommendations. Fourth, it is
important to distinguish stone passage from new stone formation. If a patient
implements dietary changes and then passes a pre-existing stone, this does not
mean that the intervention was not effective. Finally, because of the relative
paucity of randomized trials, observational studies provide the basis for many
clinical recommendations. Adequate fluid intake and appropriate dietary
modifications may substantially reduce the morbidity and costs associated with
recurrent nephrolithiasis.

Publication Types: 
    Review

PMID: 16837923 [PubMed - indexed for MEDLINE]

446: Int Urol Nephrol. 2007;39(2):357-60. Epub 2006 Jul 12.

Milk of calcium cyst mimicking renal calculi: a case report.

Gürel S, Metin A, Gürel K, Semerciöz A.

Department of Radiology, Abant Izzet Baysal University School of Medicine, Bolu, 
Turkey.

A milk of calcium cyst mimicking renal stone in a 51-year-old man was presented
to remind the possibility of milk of calcium when a well-defined round density
was observed on the renal shadow of the plain abdomen film and the importance of 
graphics or CT scans taken in different positions to see the changes in the
calcium gravidation to prevent unnecessary surgical interventions due to
misdiagnosis.

Publication Types: 
    Case Reports

PMID: 16835729 [PubMed - indexed for MEDLINE]

447: Urol Clin North Am. 2006 Aug;33(3):353-64.

Imaging for percutaneous renal access and management of renal calculi.

Park S, Pearle MS.

University of Washington School of Medicine, Seattle, WA, USA.

Percutaneous renal stone surgery requires detailed imaging to define stone burden
and delineate the anatomy of the kidney and nearby organs. It is also essential
to carry out safe percutaneous access and to assess postoperative outcomes. The
emergence of CT as the imaging modality of choice for detecting renal calculi and
the ability of CT urography with or without three-dimensional reconstruction to
delineate the collecting system makes this the most versatile and sensitive
imaging modality for pre- and postoperative evaluation. At present, intravenous
urogram continues to play an important role in the evaluation of patients
considered for percutaneous nephrostolithotomy. Fluoroscopy re-mains the mainstay
of intraoperative imaging, although ultrasound is a useful alternative. Selection
and application of appropriate imaging modalities for patients undergoing
per-cutaneous nephrostolithotomy enhances the safety and success of the
procedure.

Publication Types: 
    Review

PMID: 16829270 [PubMed - indexed for MEDLINE]

448: Nephrol Dial Transplant. 2006 Sep;21(9):2452-63. Epub 2006 Jul 5.

Phenotypic and genetic heterogeneity in Dent's disease--the results of an Italian
collaborative study.

Tosetto E, Ghiggeri GM, Emma F, Barbano G, Carrea A, Vezzoli G, Torregrossa R,
Cara M, Ripanti G, Ammenti A, Peruzzi L, Murer L, Ratsch IM, Citron L, Gambaro G,
D'angelo A, Anglani F.

Division of Nephrology, Department of Medical and Surgical Sciences, University
of Padua, via Giustiniani, 2 35128 Padova, Italy. enrica.tosetto@unipd.it

BACKGROUND: Dent's disease is an inherited tubulopathy caused by CLCN5 gene
mutations. While a typical phenotype characterized by low-molecular-weight (LMW) 
proteinuria, hypercalciuria, nephrocalcinosis, nephrolithiasis, rickets and
progressive renal failure in various combinations often enables a clinical
diagnosis, less severe sub-clinical cases may go under-diagnosed. METHODS: By
single-strand conformation polymorphism analysis and direct sequencing, we
screened 40 male patients from 40 unrelated families for CLCN5 gene mutations.
Twenty-four of these patients had the prominent features of Dent's disease,
including LMW proteinuria, hypercalciuria and nephrocalcinosis. RESULTS: We
identified 24 mutations in the CLCN5 gene in 21/24 patients with a typical
phenotype and in 3/16 patients with a partial clinical picture of Dent's disease.
Overall, 10 novel CLCN5 mutations were identified (E6fsX11, W58fsX97, 267 del E, 
Y272C, N340K, F444fsX448, W547X, Q600X, IVS3 +2 G>C and IVS3 -1 G>A), extending
the number of mutations identified so far from 75 to 85. The CLCN5 coding
sequence was normal in three patients. In the group with an incomplete Dent's
disease phenotype, we detected two intronic mutations and one silent substitution
leading to the up regulation of an alternatively spliced isoform. CONCLUSIONS:
Our data confirm the genetic heterogeneity of Dent's disease. In most classic
cases, the clinical diagnosis is confirmed by genetic tests.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16822791 [PubMed - indexed for MEDLINE]

449: BMC Urol. 2006 Jul 5;6:16.

Factors affecting calcium oxalate dihydrate fragmented calculi regrowth.

Costa-Bauzá A, Perelló J, Isern B, Sanchis P, Grases F.

Laboratory of Renal Lithiasis Research, University Institute of Health Sciences
Research (IUNICS), University of Balearic Islands, 07122 Palma of Mallorca,
Spain. dqufgfo@ps.uib.es

BACKGROUND: The use of extracorporeal shock wave lithotripsy (ESWL) to treat
calcium oxalate dihydrate (COD) renal calculi gives excellent fragmentation
results. However, the retention of post-ESWL fragments within the kidney remains 
an important health problem. This study examined the effect of various urinary
conditions and crystallization inhibitors on the regrowth of spontaneously-passed
post-ESWL COD calculi fragments. METHODS: Post-ESWL COD calculi fragments were
incubated in chambers containing synthetic urine varying in pH and calcium
concentration: pH = 5.5 normocalciuria (3.75 mM), pH = 5.5 hypercalciuria (6.25
mM), pH = 6.5 normocalciuria (3.75 mM) or pH = 6.5 hypercalciuria (6.25 mM).
Fragment growth was evaluated by measuring increases in weight. Fragment growth
was standardized by calculating the relative mass increase. RESULTS: Calcium
oxalate monohydrate (COM) crystals formed on COD renal calculi fragments under
all conditions. Under pH = 5.5 normocalciuria conditions, only COM crystals
formed (growth rate = 0.22 +/- 0.04 microg/mg x h). Under pH = 5.5 hypercalciuria
and under pH = 6.5 normocalciuria conditions, COM crystals and a small number of 
new COD crystals formed (growth rate = 0.32 +/- 0.03 microg/mg x h and 0.35 +/-
0.05 microg/mg x h, respectively). Under pH = 6.5 hypercalciuria conditions,
large amounts of COD, COM, hydroxyapatite and brushite crystals formed (growth
rate = 3.87 +/- 0. 34 microg/mg x h). A study of three crystallization inhibitors
demonstrated that phytate completely inhibited fragment growth (2.27 microM at pH
= 5.5 and 4.55 microM at pH = 6.5, both under hypercalciuria conditions), while
69.0 microM pyrophosphate caused an 87% reduction in mass under pH = 6.5
hypercalciuria conditions. In contrast, 5.29 mM citrate did not inhibit fragment 
mass increase under pH = 6.5 hypercalciuria conditions. CONCLUSION: The growth
rate of COD calculi fragments under pH = 6.5 hypercalciuria conditions was
approximately ten times that observed under the other three conditions. This
observation suggests COD calculi residual fragments in the kidneys together with 
hypercalciuria and high urinary pH values may be a risk factor for stone growth. 
The study also showed the effectiveness of specific crystallization inhibitors in
slowing calculi fragment growth.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16822299 [PubMed - indexed for MEDLINE]

450: FEBS J. 2006 Jul;273(13):3024-37.

Sialylation of urinary prothrombin fragment 1 is implicated as a contributory
factor in the risk of calcium oxalate kidney stone formation.

Webber D, Radcliffe CM, Royle L, Tobiasen G, Merry AH, Rodgers AL, Sturrock ED,
Wormald MR, Harvey DJ, Dwek RA, Rudd PM.

Department of Chemistry, University of Cape Town, South Africa.

Urinary glycoproteins are important inhibitors of calcium oxalate crystallization
and adhesion of crystals to renal cells, both of which are key mechanisms in
kidney stone formation. This has been attributed to glycosylation of the
proteins. In South Africa, the black population rarely form stones (incidence <
1%) compared with the white population (incidence 12-15%). A previous study
involving urinary prothrombin fragment 1 from both populations demonstrated
superior inhibitory activity associated with the protein from the black group. In
the present study, we compared N-linked and O-linked oligosaccharides released
from urinary prothrombin fragment 1 isolated from the urine of healthy and
stone-forming subjects in both populations to elucidate the relationship between 
glycosylation and calcium oxalate stone pathogenesis. The O-glycans of both
control groups and the N-glycans of the black control samples were significantly 
more sialylated than those of the white stone-formers. This demonstrates a
possible association between low-percentage sialylation and kidney stone disease 
and provides a potential diagnostic method for a predisposition to kidney stones 
that could lead to the implementation of a preventative regimen. These results
indicate that sialylated glycoforms of urinary prothrombin fragment 1 afford
protection against calcium oxalate stone formation, possibly by coating the
surface of calcium oxalate crystals. This provides a rationale for the
established roles of urinary prothrombin fragment 1, namely reducing the
potential for crystal aggregation and inhibiting crystal-cell adhesion by masking
the interaction of the calcium ions on the crystal surface with the renal cell
surface along the nephron.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16817853 [PubMed - indexed for MEDLINE]

451: J Urol. 2006 Aug;176(2):706-10.

Comment in:
    Nat Clin Pract Urol. 2007 Feb;4(2):70-1.

Treatment of renal stones in children: a comparison between percutaneous
nephrolithotomy and shock wave lithotripsy.

Shokeir AA, Sheir KZ, El-Nahas AR, El-Assmy AM, Eassa W, El-Kappany HA.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
ahmedshokeir@hotmail.com

PURPOSE: We compared the results of percutaneous nephrolithotomy and shock wave
lithotripsy for the treatment of 1 to 2 cm renal stones in children. MATERIALS
AND METHODS: The study included 166 children with renal stones 1 to 2 cm. A total
of 75 patients (82 kidneys) were treated with percutaneous nephrolithotomy and 91
(93 kidneys) were treated with shock wave lithotripsy. Mean followup was 31 +/-
10 months (range 6 to 84). Both groups were compared regarding stone-free rate,
re-treatment rate, complications and incidence of stone recurrence. RESULTS: Both
groups were comparable regarding preoperative characteristics. Of the units
treated with percutaneous nephrolithotomy 4 (4.9%) were associated with minor
complications. Stone-free rate after a single session of percutaneous
nephrolithotomy was 86.6% (71 units), and the remaining 11 kidneys with residual 
stones were successfully treated with repeat percutaneous nephrolithotomy in 7
and shock wave lithotripsy in 4. Therefore, a total of 78 units (95%) were
stone-free after percutaneous nephrolithotomy monotherapy, and the overall
stone-free rate at 3 months was 100%. Of the patients undergoing shock wave
lithotripsy 1 (1.1%) had development of steinstrasse and was successfully treated
with ureteroscopy. The overall re-treatment rate after shock wave lithotripsy was
55%. A total of 79 units (84.9%) were stone-free after shock wave lithotripsy
monotherapy, whereas 7 (7.5%) with no gross response to treatment were treated
with percutaneous nephrolithotomy and 7 with insignificant stones less than 4 mm 
were followed. Therefore, the overall stone-free rate at 3 months was 92.5%. The 
differences in stone-free rates and re-treatment rates significantly favored
percutaneous nephrolithotomy, while the incidence of complications and stone
recurrence at last followup were not significantly different between the groups. 
CONCLUSIONS: For treatment of 1 to 2 cm renal stones in children percutaneous
nephrolithotomy is better than shock wave lithotripsy, yielding higher stone-free
and lower re-treatment rates.

Publication Types: 
    Comparative Study

PMID: 16813924 [PubMed - indexed for MEDLINE]

452: J Urol. 2006 Aug;176(2):600-3; discussion 603.

Renal function in patients with nephrolithiasis.

Worcester EM, Parks JH, Evan AP, Coe FL.

Nephrology Section, University of Chicago, Illinois, USA.
eworcest@medicine.bsd.uchicago.edu

PURPOSE: We describe kidney function, as measured by creatinine clearance in
stone formers, and classified by type of stone formed and systemic etiologies of 
stone formation. MATERIALS AND METHODS: The mean of 3 pretreatment 24-hour
creatinine clearance measurements in each of 1,856 stone formers and creatinine
clearance in 153 normal individuals were used. Clearance was adjusted for patient
sex, age and body weight using general linear modeling. RESULTS: As a group, all 
stone formers had decreased clearance adjusted for age, sex and body weight
compared to that in normal individuals. Although clearance was particularly low
in cystine and struvite stone formers, they were below normal in even common CaOx
stone formers. CONCLUSIONS: As a rule, patients with kidney stones do not have
normal kidney function. In clinical management all efforts must be made to
minimize renal injury, balancing the risks of obstruction from stones against
those of urological procedures.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16813897 [PubMed - indexed for MEDLINE]

453: Can J Urol. 2006 Jun;13(3):3153-5.

Percutaneous nephrolithotomy under conscious sedation in morbidly obese patients.

Kanaroglou A, Razvi H.

Division of Urology, Department of Surgery, The University of Western Ontario,
London, Ontario, Canada.

Two morbidly obese males weighing 159 kg and 184 kg underwent percutaneous
nephrolithotomy (PCNL) for large, symptomatic renal stones. To avoid anesthetic
complications and cardiorespiratory compromise in the prone position, the
procedures were performed under IV sedation with local anesthesia. The risks of
PCNL in this patient population are reviewed, and the technique employed to
mitigate the risks in these two cases is described.

Publication Types: 
    Case Reports

PMID: 16813707 [PubMed - indexed for MEDLINE]

454: Int Braz J Urol. 2006 May-Jun;32(3):287-92; discussion 292-4.

The impact of pelvicaliceal anatomical variation between the stone-bearing and
normal contralateral kidney on stone formation in adult patients with lower
caliceal stones.

Kupeli B, Tunc L, Acar C, Gurocak S, Alkibay T, Guneri C, Bozkirli I.

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.
borakupeli@yahoo.com

OBJECTIVE: We aimed to investigate the effect of pelvicaliceal anatomical
differences on the etiology of lower caliceal stones. MATERIALS AND METHODS:
Records of adult patients between January 1996 and December 2005 with solitary
lower caliceal stone were reviewed. After exclusion of patients with
hydronephrosis, major renal anatomic anomalies, non-calcium stones, history of
recurrent stone disease and previous renal surgery, 78 patients were enrolled
into the study. Lower pole infundibulopelvic angle (IPA), infundibulovertebral
angle (IVA), infundibular length (IL), width (IW), number of minor calices and
cortical thickness of the lower pole together with other caliceal variables
obtained from the whole pelvicaliceal anatomy of both stone-bearing and
contralateral normal kidneys were measured from intravenous pyelogram of the
patients. Total pelvicaliceal volume was also calculated by a previously
described formula for both kidneys. RESULTS: There were statistically significant
difference between two kidneys in terms of IW (p < 0.001) and IL (p = 0.002) of
the upper calyx, IW (p = 0.001) and IVA (p < 0.001) of the lower calyx),
pelvicaliceal volume (p < 0.001), IPA of middle calyx (p = 0.006) and cortical
thickness over the lower pole (p < 0.001). However there was no difference
between stone-bearing and contralateral normal kidneys in terms of lower pole IPA
(p = 0.864) and IL (p = 0.568). CONCLUSION: Pelvicaliceal volume but not lower
caliceal properties seem to be a risk factor for stone formation in lower calyx.

PMID: 16813671 [PubMed - indexed for MEDLINE]

455: Scand J Urol Nephrol. 2006;40(3):215-20.

Epidemiology of kidney stones in Iceland: a population-based study.

Indridason OS, Birgisson S, Edvardsson VO, Sigvaldason H, Sigfusson N, Palsson R.

Division of Nephrology, Department of Medicine, Children's Medical Center,
Landspitali University Hospital, Reykjavik, Iceland.

OBJECTIVE: The prevalence of kidney stones varies greatly between ethnic groups
and geographic locations, ranging from 8% to 19% in males and from 3% to 5% in
females in Western countries. The aim of this study was to examine the
epidemiology of kidney stones in Iceland. MATERIAL AND METHODS: Data were derived
from the Reykjavik Study, a population-based cohort study carried out between
1967 and 1991. All subjects answered a thorough questionnaire concerning their
medical history at each visit. The lifetime prevalence of kidney stones was
calculated based on the answer to the question "Have you ever been diagnosed with
a kidney stone?" at each person's first visit. Incidence was calculated based on 
answers from subjects who had made two or more visits. Prevalence and incidence
were age-standardized to the truncated world population. Family history of kidney
stones was also evaluated. RESULTS: A total of 9039 men aged 33-80 years and 9619
women aged 33-81 years participated. Of these, 423 males and 307 females had a
history of kidney stones (p=0.001). Prevalence increased significantly with age
for both genders. Men aged 30-34 years had a prevalence of 2.9%, compared to 8.8%
for those aged 65-69 years, whereas corresponding values for women were 2.5% and 
5.0%. The age-standardized prevalence for the 30-79 years age group was 4.3% for 
men and 3.0% for women. No significant increase in prevalence was observed over
time. The incidence was 562 per 100 000 per year among men and increased
significantly with age. The incidence among women was 197 per 100 000 per year
and did not differ between age groups. A family history of nephrolithiasis was
present in 25% of subjects with a history of kidney stones, and in 4% of those
without. CONCLUSIONS: The incidence and prevalence of kidney stones in Icelandic 
women are similar to those that have been reported in other Western countries.
The prevalence among men is lower that in neighboring countries but the incidence
is similar. A strong family history of kidney stones suggests a genetic
predisposition.

PMID: 16809263 [PubMed - indexed for MEDLINE]

456: Scand J Urol Nephrol. 2006;40(3):187-91.

Influence of hypercalcic and/or hyperoxalic diet on calcium oxalate renal stone
formation in rats.

Mourad B, Fadwa N, Mounir T, Abdelhamid E, Mohamed Fadhel N, Rachid S.

04/UR/09-03 Faculté de Médecine de Monastir, Tunisia. bardaouimourad@yahoo.fr

OBJECTIVE: To test whether increasing dietary calcium intake prevents calcium
oxalate stone formation when the diet is oxalate-rich. Material and methods. Four
groups, eight rats in each, were subjected to a lithogenic diet by the addition
of 0.5% ethylene glycol to drinking water for 3 weeks. The first group, used as a
control, simultaneously received a standard diet. The second group was
supplemented with calcium at 500 mg/100 g of diet and the third group with
oxalate at 3 g/100 g of diet. The diet given to the last group was supplemented
with similar doses of calcium and oxalate. One day before the end of treatment,
each animal was placed in a metabolic cage to collect 24-h urine samples and
determine urinary parameters. The kidneys were removed to determine calcium
oxalate deposits and for histological examination. RESULTS: The number of calcium
oxalate crystals in renal tissue was highest in the oxalate group and calcium
oxalate deposits were also found to be elevated in this group. Hyperoxaluria and 
hypocitraturia, induced by a oxalate-rich diet, seemed to be the major causes
contributing to aggravated renal stone formation. The protective effect of
dietary calcium supplementation, which was clear in the calcium + oxalate group, 
was probably due to intestinal binding of oxalate by calcium, thereby reducing
urinary oxalate excretion. CONCLUSION: Increased dietary calcium intake can
prevent calcium oxalate stone formation only when the diet is oxalate-rich.

PMID: 16809257 [PubMed - indexed for MEDLINE]

457: Kidney Int. 2006 Aug;70(4):699-710.

Erratum in:
    Kidney Int. 2007 Apr;71(7):712.

Vitamin E attenuates crystal formation in rat kidneys: roles of renal tubular
cell death and crystallization inhibitors.

Huang HS, Chen J, Chen CF, Ma MC.

Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.

We previously reported that oxidative stress and renal tubular damage occur in
chronic hyperoxaluric rats. However, the in vivo responses of renal epithelial
cells after vitamin E administration and their correlations with calcium oxalate 
(CaOx) crystal formation have not been evaluated. Male Wistar rats received 0.75%
ethylene glycol (EG) for 7, 21, or 42 days to induce CaOx deposition (EG group). 
Another group of EG-treated rats received 200 mg kg(-1) of vitamin E
intraperitoneally (EG+E group) to evaluate its effect on hyperoxaluria. Urinary
electrolytes and biochemistry and levels of lipid peroxides and enzymes were
examined, together with serum vitamin E levels. Levels of the tubular markers,
alpha and mu glutathione S-transferase, proliferating cell nuclear antigen
(PCNA), osteopontinin (OPN), and Tamm-Horsfall protein (THP) were also measured, 
and TUNEL staining was performed to examine the viability of the tubular
epithelium. There were no significant differences between the two age-matched
controls either untreated or given vitamin E. Compared to untreated controls,
tubular cell death was increased at all time points in EG rats with a gradual
increase in CaOx crystals, whereas the number of PCNA-positive cells was only
significantly increased on day 21. In EG+E rats, tubular cell death was decreased
compared to the EG group, and cell proliferation was seen at all time points,
while CaOx crystal deposition was decreased, but hyperoxaluria, urinary lipid
peroxides, and enzymuria were unaffected. Vitamin E supplement prevented the loss
of OPN and THP in renal tissues by EG and the reduction in their levels in the
urine. The beneficial effect of vitamin E in reducing CaOx accumulation is due to
attenuation of tubular cell death and enhancement of the defensive roles of OPN
and THP.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16807540 [PubMed - indexed for MEDLINE]

458: Urology. 2006 Jul;68(1):24-7. Epub 2006 Jun 27.

Can prilocaine infiltration alone be the most minimally invasive approach in
terms of anesthesia during extracorporeal shock wave lithotripsy?

Yilmaz E, Batislam E, Basar M, Tuglu D, Yuvanc E.

Department of Urology, University of Kirikkale Faculty of Medicine, Kirikkale,
Turkey. erdaly69@mynet.com

OBJECTIVES: To evaluate the analgesic effect and utility of prilocaine
infiltration alone for minimal morbidity during extracorporeal shock wave
lithotripsy. METHODS: A total of 114 patients with kidney stones, aged 18 to 69
years, were randomly separated into two groups. The 58 patients in group 1
received intramuscular diclophenac 30 minutes before extracorporeal shock wave
lithotripsy, and the 56 patients in group 2 received prilocaine infiltration into
the 30 cm2 area below the 12th rib right before the session. A visual analog
scale (0 to 100 mm) was used to evaluate pain. RESULTS: The visual analog scale
scores for group 2 were statistically lower at 1, 10, and 20 minutes compared
with the scores for group 1 (P = 0.006, P = 0.005, and P = 0.006, respectively). 
However, no difference was detected at the end of the procedure. The requirement 
for additional analgesic was less in group 2 (P = 0.007). CONCLUSIONS: Prilocaine
infiltration alone can be used for analgesic purposes efficiently and safely
during extracorporeal shock wave lithotripsy with minimal morbidity.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 16806420 [PubMed - indexed for MEDLINE]

459: Urology. 2006 Jul;68(1):33-7. Epub 2006 Jun 27.

Role of volume and attenuation value histogram of urinary stone on noncontrast
helical computed tomography as predictor of fragility by extracorporeal shock
wave lithotripsy.

Yoshida S, Hayashi T, Ikeda J, Yoshinaga A, Ohno R, Ishii N, Okada T, Osada H,
Honda N, Yamada T.

Department of Urology, Saitama Medical Center, Saitama Medical School, Kawagoe,
Saitama, Japan. soichiroyoshida2000@yahoo.co.jp

OBJECTIVES: To test, for the first time, the predictive capability of the total
stone volume (TSV) and the attenuation value histogram. Recently, the mean
attenuation value (MAV) of urinary stones has been recognized as a predictor of
fragility by extracorporeal shock wave lithotripsy. However, properties other
than MAV, including the TSV and the heterogeneity of attenuation value histogram,
may also be related to fragility. METHODS: A total of 62 renal and proximal
ureteral radiopaque stones treated with extracorporeal shock wave lithotripsy
were included in this prospective study. Stones less than 5 mm or greater than 20
mm were excluded. Attenuation value histograms were graphed from the data from
noncontrast helical computed tomography scans. The TSV, MAV, and hump existence
(HE) on the histogram were also calculated. These parameters were compared
between the treatment success and treatment failure groups. RESULTS: Of the 62
stones, 6 were excluded, 39 were in the success group, and 17 in the failure
group. Of the 56 stones, 16 had a hump and 40 did not on the attenuation value
histograms. The TSV, MAV, and HE were significantly different statistically
between the two groups (P <0.001), with an accuracy of 82.1%, 83.9%, and 91.1%,
respectively. Also, HE was the only independent predictor of success or failure
of extracorporeal shock wave lithotripsy on multivariate analysis (P = 0.0073).
CONCLUSIONS: Our results have suggested that TSV, MAV, and HE are good predictors
of stone fragility. The treatment modality of the stone should be selected
according to the HE, which is a practical, simple, and predictive index.

PMID: 16806419 [PubMed - indexed for MEDLINE]

460: J Am Soc Nephrol. 2006 Aug;17(8):2213-9. Epub 2006 Jun 21.

Mild tubular damage induces calcium oxalate crystalluria in a model of subtle
hyperoxaluria: Evidence that a second hit is necessary for renal lithogenesis.

Gambaro G, Valente ML, Zanetti E, Della Barbera M, Del Prete D, D'Angelo A,
Trevisan A.

Department of Biomedical and Surgical Sciences, Division of Nephrology,
University of Verona, Verona, Italy. giovanni.gambaro@univr.it

Environment and diet have a major role in calcium nephrolithiasis by affecting
urine saturation, but this is not enough to cause lithogenesis; the crystals must
adhere to the tubular epithelium (TE), but it is hard to say how environment and 
nutrition may be involved in this step. The hypothesis that TE damage (known to
enhance crystal attachment) is lithogenic in mild hyperoxaluria was tested. Mild 
hyperoxaluria was induced in male Wistar rats using ethylene glycol (EG; 0.5% in 
water) for 21 d, and TE damage was induced by intraperitoneal administration of
hexachloro-1:3-butadiene (HCBD; an industrial nephrotoxin) at 10, 25, and 50
mg/kg body wt on days 7 and 14. These EG and HCBD concentrations were chosen to
span from suboptimal to very low doses as far as effects on crystalluria and TE
damage are concerned. Enzymuria, proteinuria, oxaluria, crystalluria, and renal
pathology were investigated. All HCBD dosages induced crystalluria in mildly
hyperoxaluric rats, but no intrarenal crystals were found. EG alone induced very 
mild hyperoxaluria but no damage to the renal tubule observable on transmission
electron microscopy, and it did not cause crystalluria or intrarenal crystals.
HCBD with the concomitant administration of EG caused apoptosis of the TE at the 
two highest dosages after the second injection. Apoptosis did not correlate with 
crystalluria. A TE toxin is needed for crystallogenesis to occur in borderline
metabolic conditions. It may take more than just a metabolic predisposition for
calcium nephrolithiasis to occur, and the second hit could come from an
environmental pollutant such as HCBD.

PMID: 16790510 [PubMed - indexed for MEDLINE]

461: Aviat Space Environ Med. 2006 Jun;77(6):649-53.

Renal lithiasis: addressing the risks of austere desert deployments.

Cramer JS, Forrest K.

Department of Family Medicine, SUNY at Buffalo, SUNY Clinical Center, NY 14215,
USA. cramerjs@msn.com

INTRODUCTION: Renal lithiasis affects approximately 5% of the general population,
with higher risks for men and increasing risks with increasing age. The forward
deployment of the Air Force into austere desert environments with integration of 
the active duty, Reserves, and Guard presents increasing risks to mission
accomplishment with the increased risk of developing renal lithiasis. METHODS:
This paper describes seven cases of presumed renal lithiasis in a deployed desert
setting in Air Force personnel on flying status. Their status and the location of
the base acted as a focus for a review of the literature on kidney stone
causation, prevention, diagnosis, and management. RESULTS/DISCUSSION: A review of
the literature revealed that current military recommendations to hydrate in the
field may not be sufficient for the primary prevention of kidney stones. Beverage
choice may prove more useful for prevention. Situations precipitating voluntary
dehydration need to be prevented. Although there are superior ways to diagnose
renal lithiasis, in the deployed setting patient history and physical examination
are usually the only available means. Ultrasound is a viable diagnostic option
for use in the deployed setting based on its portability, affordability, and ease
of use. Additions to the standard management of renal lithiasis, such as
subcutaneous Lidocaine and heat may have value in the deployed setting if the
supply of narcotics is limited. CONCLUSION: In the deployed setting, hydration
choices, the addition of portable ultrasound to the diagnostic process, and pain 
management with nontraditional therapies need to be explored.

PMID: 16780245 [PubMed - indexed for MEDLINE]

462: Urology. 2006 Jul;68(1):28-32. Epub 2006 Jun 13.

Five-year clinical experience with the Dornier Delta lithotriptor.

White W, Klein F.

Department of Urology, University of Tennessee Medical Center, Knoxville,
Knoxville, Tennessee 37920, USA. wwhite@mc.utmck.edu

OBJECTIVES: Multiple studies support the clinical value of extracorporeal shock
wave lithotripsy (ESWL) in the treatment of symptomatic urolithiasis. Although
prior investigations have examined such efficacy among several commercially
available lithotriptors, no published data exist to support the efficacy of the
Dornier Delta lithotriptor. METHODS: A retrospective review of 4621 patients with
urolithiasis treated with the Dornier Delta lithotriptor from 1999 through 2004
was undertaken. Data were obtained regarding stone location, stone size,
shockwave usage, total success rate, and complications. RESULTS: From January 1, 
1999 through December 31, 2004, 4621 patients with 7347 stones were treated with 
the Dornier Delta lithotriptor. Of these stones, 74.38% were located in the
kidney, and 25.62% were confined to the ureter. Of renal stones, 22.8% were in
the renal pelvis, whereas upper, middle, and lower pole stones constituted 16.3%,
23.3%, and 37.6%, respectively. Of ureteral stones, 72.2% were in the proximal
ureter, compared with 14.2% and 13.6% in the mid- and distal ureter,
respectively. The majority of stones were less than 1 cm (65.7%). The average
number of shocks was 2037. Average shockwave intensity was 5.5 (out of 6).
Average treatment time was 23.8 minutes. Of those patients that completed
follow-up, 85.1% achieved total success, with 58.5% being stone free and 26.6%
having fragments less than 4 mm. The efficiency quotient was 0.51. CONCLUSIONS:
Treatment of renal and/or ureteral stones in selected patients with the Dornier
Delta lithotriptor is appropriate. The total success rate and efficiency quotient
is consistent with that of other available lithotriptors.

PMID: 16777194 [PubMed - indexed for MEDLINE]

463: Curr Opin Nephrol Hypertens. 2006 Jul;15(4):430-6.

Control of potassium excretion: a Paleolithic perspective.

Halperin ML, Cheema-Dhadli S, Lin SH, Kamel KS.

Renal Division, St. Michael's Hospital, University of Toronto, Toronto, Ontario, 
Canada. mitchell.halperin@utoronto.ca

PURPOSE OF REVIEW: Regulation of potassium (K) excretion was examined in an
experimental setting that reflects the dietary conditions for humans in
Paleolithic times (high, episodic intake of K with organic anions; low intake of 
NaCl), because this is when major control mechanisms were likely to have
developed. RECENT FINDINGS: The major control of K secretion in this setting is
to regulate the number of luminal K channels in the cortical collecting duct.
Following a KCl load, the K concentration in the medullary interstitial
compartment rose; the likely source of this medullary K was its absorption by the
H/K-ATPase in the inner medullary collecting duct. As a result of the higher
medullary K concentration, the absorption of Na and Cl was inhibited in the loop 
of Henle, and this led to an increased distal delivery of a sufficient quantity
of Na to raise K excretion markedly, while avoiding a large natriuresis. In
addition, because K in the diet was accompanied by 'future' bicarbonate, a role
for bicarbonate in the control of K secretion via 'selecting' whether aldosterone
would be a NaCl-conserving or a kaliuretic hormone is discussed. SUMMARY: This
way of examining the control of K excretion provides new insights into clinical
disorders with an abnormal plasma K concentration secondary to altered K
excretion, and also into the pathophysiology of calcium-containing kidney stones.

Publication Types: 
    Review

PMID: 16775458 [PubMed - indexed for MEDLINE]

464: Curr Opin Nephrol Hypertens. 2006 Jul;15(4):403-18.

Genetic hypercalciuric stone-forming rats.

Bushinsky DA, Frick KK, Nehrke K.

Division of Nephrology, Department of Medicine, University of Rochester School of
Medicine, Rochester, New York 14642, USA. David_Bushinsky@urmc.rochester.edu

PURPOSE OF REVIEW: We will describe the pathophysiology of hypercalciuria and the
mechanism of the resultant stone formation in a rat model and draw parallels to
human hypercalciuria and stone formation. RECENT FINDINGS: Through inbreeding we 
have established a strain of rats that excrete 8-10 times more urinary calcium
than control rats. These genetic hypercalciuric rats absorb more dietary calcium 
at lower 1,25-dihydroxyvitamin D3 levels. Elevated urinary calcium excretion on a
low-calcium diet indicated a defect in renal calcium reabsorption and/or an
increase in bone resorption. Bone from hypercalciuric rats released more calcium 
when exposed to 1,25-dihydroxyvitamin D3. Bisphosphonate significantly reduced
urinary calcium excretion in rats fed a low-calcium diet. Clearance studies
showed a primary defect in renal calcium reabsorption. The intestine, bone and
kidneys of the hypercalciuric rats had increased numbers of vitamin D receptors. 
When hydroxyproline is added to their diet they form calcium oxalate stones, the 
most common stone type in humans. Increased numbers of vitamin D receptors may
cause hypercalciuria in these rats and humans. SUMMARY: Understanding the
mechanism of hypercalciuria and stone formation in this animal model will help
clinicians devise effective treatment strategies for preventing recurrent stone
formation in humans.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Review

PMID: 16775455 [PubMed - indexed for MEDLINE]

465: Curr Opin Nephrol Hypertens. 2006 Jul;15(4):394-402.

Bone disease in idiopathic hypercalciuria.

Heilberg IP, Weisinger JR.

Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil.

PURPOSE OF REVIEW: Decreased bone mineral density and increased prevalence of
bone fractures have been found in patients with idiopathic hypercalciuria. The
purpose of this review is to summarize the recent published evidence that
supports a potential role of the bone, and its link to the kidney and intestine, 
in the pathogenesis of idiopathic hypercalciuria. The effects of hypercalciuria
on bone and the implications for treatment are also reviewed. RECENT FINDINGS:
Evidence suggests that the incidence of a first fracture in kidney stone patients
is fourfold higher than the control population. Support for the role of bone in
the pathophysiology of hypercalciuria has been corroborated. New studies have
detailed the effects of several cytokines - increased number and sensitivity of
vitamin D receptors, and increased acid production - upon the bone acting cells. 
Similarly, recent clinical and experimental studies have suggested that genetic
factors confer a predisposition to the formation of renal calcium stones and bone
demineralization. SUMMARY: Whether hypercalciuria is the result of a primary bone
disorder, a consequence of a persisting negative calcium balance or a combination
of both still remains to be determined. Nevertheless, bone status must be
evaluated and followed up in patients with idiopathic hypercalciuria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16775454 [PubMed - indexed for MEDLINE]

466: Curr Opin Nephrol Hypertens. 2006 Jul;15(4):386-93.

Role of crystal surface adhesion in kidney stone disease.

Wesson JA, Ward MD.

Department of Medicine/Nephrology, The Medical College of Wisconsin, Milwaukee,
Wisconsin 53295, USA. jwesson@mcw.edu

PURPOSE OF REVIEW: Atomic force microscopy has been used recently to characterize
the adhesion force between selected calcium oxalate crystal surfaces and
biologically relevant chemical groups attached to the atomic force microscopy
probe tip. These measurements have permitted comparisons of the adhesion
properties of different, well defined crystal faces, as well as determination of 
the influence of solution-phase macromolecules on adhesion. These studies have
produced new insight into the specific chemical interactions that regulate kidney
stone formation. RECENT FINDINGS: The adhesion force measurements have
demonstrated that the large hexagonal (100) face of calcium oxalate monohydrate
is the most adhesive. In contrast, the large (101) face of calcium oxalate
dihydrate is the least adhesive. Carboxylate and amidinium groups on the atomic
force microscopy tip exhibit equivalently large adhesion at a given crystal face,
implicating specific binding to crystal surface lattice ions. Solution-phase
macromolecules modulate adhesion in a face-selective manner, dependent on their
chemical structures. SUMMARY: The low adhesion force for calcium oxalate
dihydrate predicts a decreased ability of these crystals to aggregate or attach
to cells, and correlates with the relative absence of calcium oxalate dihydrate
in kidney stones. These measurements provide new understanding of the
macromolecular regulation of crystal aggregation and attachment to cells in stone
formation.

Publication Types: 
    Review

PMID: 16775453 [PubMed - indexed for MEDLINE]

467: Curr Opin Nephrol Hypertens. 2006 Jul;15(4):374-80.

Protein regulation of intrarenal crystallization.

Kumar V, Lieske JC.

Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo
Clinic College of Medicine, Rochester, Minnesota 55905, USA.

PURPOSE OF REVIEW: In this review we discuss the key role renal proteins appear
to play during initiation and growth of renal stones. RECENT FINDINGS: Specific
macromolecules have been identified in urine that can regulate crystal
nucleation, growth, aggregation, and adhesion to renal cells. Many are
incorporated into the matrix of crystals while they grow, including urinary
prothrombin fragment 1, thereby increasing crystal susceptibility to degradation 
by cellular proteases. None of these macromolecular inhibitors appears to be
quantitatively decreased in the urine of stone formers, although functional
deficiencies thought due to abnormal glycosylation have been implicated,
especially in the case of Tamm Horsfall protein. Increasing information is
available on the nature and expression of crystal binding molecules on the renal 
cell surface, and they appear to be maximally expressed in response to stressful 
stimuli. Studies that employ atomic force microscopy and knockout mice are now
being used to further clarify macromolecule-crystal interactions. SUMMARY: The
exact series of events that transform supersaturation to crystal formation and
renal stones are poorly defined. Multiple anchored and soluble renal proteins
potentially modulate or even regulate these events. A combination of proteomics
and molecular biology seems likely to unravel these critical mediators in the
coming years.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 16775451 [PubMed - indexed for MEDLINE]

468: J Am Soc Nephrol. 2006 Jul;17(7):2026-33. Epub 2006 Jun 14.

Type 2 diabetes increases the risk for uric acid stones.

Daudon M, Traxer O, Conort P, Lacour B, Jungers P.

Assitance Publique-Hôpitaux de Paris, Laboratoire de Biochimie A, Hôpital
Necker-Enfants Malades, Paris Cedex 15, France. michel.daudon@nck.aphp.fr

An increased prevalence of nephrolithiasis has been reported in patients with
diabetes. Because insulin resistance, characteristic of the metabolic syndrome
and type 2 diabetes, results in lower urine pH through impaired kidney
ammoniagenesis and because a low urine pH is the main factor of uric acid (UA)
stone formation, it was hypothesized that type 2 diabetes should favor the
formation of UA stones. Therefore, the distribution of the main stone components 
was analyzed in a series of 2464 calculi from 272 (11%) patients with type 2
diabetes and 2192 without type 2 diabetes. The proportion of UA stones was 35.7% 
in patients with type 2 diabetes and 11.3% in patients without type 2 diabetes (P
< 0.0001). Reciprocally, the proportion of patients with type 2 diabetes was
significantly higher among UA than among calcium stone formers (27.8 versus 6.9%;
P < 0.0001). Stepwise regression analysis identified type 2 diabetes as the
strongest factor that was independently associated with the risk for UA stones
(odds ratio 6.9; 95% confidence interval 5.5 to 8.8). The proper influence of
type 2 diabetes was the most apparent in women and in patients in the lowest age 
and body mass index classes. In conclusion, in view of the strong association
between type 2 diabetes and UA stone formation, it is proposed that UA
nephrolithiasis may be added to the conditions that potentially are associated
with insulin resistance. Accordingly, it is suggested that patients with UA
stones, especially if overweight, should be screened for the presence of type 2
diabetes or components of the metabolic syndrome.

PMID: 16775030 [PubMed - indexed for MEDLINE]

469: World J Urol. 2006 Jun;24(2):198-201. Epub 2006 May 16.

Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility
study.

Badani KK, Hemal AK, Fumo M, Kaul S, Shrivastava A, Rajendram AK, Yusoff NA,
Sundram M, Woo S, Peabody JO, Mohamed SR, Menon M.

Vattikuti Urology Institute, Henry Ford Hospital, K-9 Urology, 2799 W. Grand
Blvd, Detroit, MI 48202, USA. Kbadani1@hfhs.org

Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for staghorn 
renal calculi. Many reports suggest that laparoscopy can be an alternative
treatment for large renal stones. We wished to evaluate the role and feasibility 
of laparoscopic extended pyelolithotomy (REP) for treatment of staghorn calculi. 
Thirteen patients underwent REP for treatment of staghorn calculi over a 12-day
period. Twelve patients had partial staghorn stones and one had a complete
staghorn stone. All patients had pre-operative and post-operative imaging
including KUB and computed tomography. All procedures were completed robotically 
without conversion to laparoscopy or open surgery. Mean operative time was 158
min and mean robotic console time was 108 min. Complete stone removal was
accomplished in all patients except the one with a complete staghorn calculus.
Estimated blood loss was 100 cc, and no patient required post-operative
transfusion. REP is an effective treatment alternative to PCNL in some patients
with staghorn calculi. However, patients with complete staghorn stones are not
suitable candidates for this particular technique.

PMID: 16758250 [PubMed - indexed for MEDLINE]

470: J Urol. 2006 Jul;176(1):242-6; discussion 246.

Comment in:
    J Urol. 2006 Jul;176(1):14.

Regionalization of percutaneous nephrolithotomy: evidence for the increasing
burden of care on tertiary centers.

Morris DS, Taub DA, Wei JT, Dunn RL, Wolf JS Jr, Hollenbeck BK.

Department of Urology, University of Michigan Health System, 1500 East Medical
Center Drive, Ann Arbor, MI 48109, USA.

PURPOSE: The regionalization of procedures to specialized medical centers has
been suggested as a means to improve the quality of care for select high risk
procedures. Prior work has demonstrated the spontaneous regionalization of high
risk procedures to tertiary centers. Similar concentration of complex, low risk
procedures (e.g. percutaneous nephrolithotomy) to these centers would underscore 
the increasing burden of care placed on these hospitals. MATERIALS AND METHODS:
We used the Nationwide Inpatient Sample to identify 12,948 patients who underwent
percutaneous nephrolithotomy for stones between 1988 and 2002. Regionalization
was measured based on the 6 structural hospital qualities of teaching status,
urban location, bed capacity, hospital throughput (all diagnoses), annual
percutaneous nephrolithotomy volume and for-profit status. Logistic regression
was used to determine the propensity of percutaneous nephrolithotomy to
concentrate to these medical centers. RESULTS: Compared to procedures performed
between 1988 and 1990, patients were more likely to undergo percutaneous
nephrolithotomy at teaching (OR 1.6, 95% CI 1.3-1.9), high percutaneous
nephrolithotomy volume (OR 1.7, 95% CI 1.6-1.9), large bed capacity (OR 1.2, 95% 
CI 1.1-1.3) and high throughput hospitals (OR 1.4, 95% CI 1.3-1.4) in the years
2000 to 2002. CONCLUSIONS: Percutaneous nephrolithotomy, a technically complex
but low risk procedure, has spontaneously regionalized to tertiary centers,
suggesting the migration of complex surgical care to these centers. The impact of
this increasing burden of care on tertiary centers is unclear but may be
problematic in the current reimbursement environment.

PMID: 16753409 [PubMed - indexed for MEDLINE]

471: J Urol. 2006 Jul;176(1):142-5.

Comment in:
    J Urol. 2006 Jul;176(1):14.

Access related complications during percutaneous nephrolithotomy: urology versus 
radiology at a single academic institution.

Watterson JD, Soon S, Jana K.

Division of Urology, University of Ottawa General Campus, The Ottawa Hospital,
501 Smyth Road, Ottawa, Ontario, Canada. jwatterson@ottawahospital.on.ca

PURPOSE: A recent survey revealed that only 11% of urologists performing
percutaneous nephrolithotomy routinely obtained percutaneous access themselves.
Reasons for this trend may include lack of training, comfort level and perceived 
need for radiological involvement. In this study we evaluated percutaneous access
for percutaneous nephrolithotomy obtained by interventional radiologists or a
urologist at a single academic institution, and compared access trends and
complications. MATERIALS AND METHODS: Two cohorts of patients who had undergone
percutaneous nephrolithotomy between 1999 and 2003 were reviewed. Percutaneous
access was performed by a group of interventional radiologists (group 1) or a
urologist (group 2). An access difficulty score was calculated using patient,
stone and procedural variables. Primary outcome measures of percutaneous access
complications such as bleeding, failure of access, pneumothorax or other organ
injury were compared between groups. Secondary outcome measures of stone-free
rates were also compared. RESULTS: In groups 1 and 2, 54 and 49 patients were
identified with a total number of tracts of 54 and 60, respectively. Both groups 
had similar rates of supracostal access. Mean access difficulty scores were
similar between groups. Access related complications were significantly higher in
the radiology access group (15 vs 5). Stone-free rates were significantly better 
in the urology access group (86% vs 61%). CONCLUSIONS: Despite similar access
difficulty between groups, access related complications were less and stone-free 
rates were improved during urologist acquired percutaneous access. Urologists
instructed in percutaneous access may be able to provide improved stone-free
rates during percutaneous nephrolithotomy while minimizing access related
complications.

Publication Types: 
    Comparative Study

PMID: 16753389 [PubMed - indexed for MEDLINE]

472: J Urol. 2006 Jul;176(1):127-31.

Renal stone risk in a simulated microgravity environment: impact of treadmill
exercise with lower body negative pressure.

Monga M, Macias B, Groppo E, Kostelec M, Hargens A.

Department of Urologic Surgery, University of Minnesota, 1420 Delaware Street,
Minneapolis, MN 55455, USA. endourol@yahoo.com

PURPOSE: Prolonged exposure to microgravity during spaceflight causes metabolic
changes that increase the risk of renal stone formation. Studies during the
Gemini, Apollo, Skylab and Shuttle missions demonstrated alterations in renal
function, fluid homeostasis and bone resorption that result in increased urinary 
supersaturation of calcium oxalate, brushite, sodium urate and uric acid.
Developing countermeasures to increased urinary supersaturation is an important
priority as the duration of space missions increases. MATERIALS AND METHODS: A
total of 11 sets of identical twins remained on 6-degree head down, tilt bed rest
for 30 days to simulate prolonged microgravity. One twin per pair was randomly
selected to exercise while supine in a lower body negative pressure chamber 6
days weekly for 40 minutes, followed by 5 minutes of resting lower body negative 
pressure at 50 mm Hg. The other twin served as a nonexercise control. Pressure in
the exercise lower body negative pressure chamber (52 to 63 mm Hg) was adjusted
to produce footward forces equivalent to those for upright running on Earth at
1.0 to 1.2 x body weight. Pre-bed rest urinary stone risk profiles were done
elsewhere after 5 days of a standardized diet, consisting of 170 mEq sodium,
1,000 mg calcium, 0.8 gm/kg animal protein and 2,500 kcal, and then throughout
the bed rest and recovery phases of the protocol. RESULTS: A significant increase
in urinary calcium after just 1 week of bed rest was noted in the nonexercise
control group (p = 0.001). However, no such increase was noted in the exercise
group. Brushite supersaturation increased significantly from bed rest in each
group, although the increase was significantly higher in the nonexercise control 
group than in the exercise group (p = 0.006). Calcium oxalate supersaturation
increased during bed rest in the exercise group (p = 0.004). It trended toward a 
higher level in the nonexercise control group, although this did not achieve
significance (p = 0.055) Mean urine volume +/- SD was significantly higher in the
nonexercise control group than in the exercise group at bed rest week 2 and at
week 3 (2.01 +/- 0.21 vs 1.63 0.18 l and 2.03 +/- 0.22 vs 1.81 +/- 0.20,
respectively). Urinary pH was significantly higher in the nonexercise control
group than in the exercise group at week 1 and week 3 (6.62 +/- 0.7 vs 6.49 +/-
0.5 and 6.58 +/- 0.6 vs 6.49 +/- 0.8, respectively, p = 0.01). CONCLUSIONS: Bed
rest significantly alters the urinary environment to favor calculous formation.
Lower body negative pressure chamber treadmill exercise offers some protection
against increases in stone risk during simulated microgravity, particularly with 
regard to the risks of hypercalciuria and brushite stone formation. The use of
lower body negative pressure to augment aerobic exercise in space may decrease
the risk of stone formation in astronauts. Adjunct measures, including aggressive
hydration and alkalinization therapy, should be considered.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.
    Twin Study

PMID: 16753386 [PubMed - indexed for MEDLINE]

473: Urology. 2006 Jun;67(6):1159-63.

Is pelvicaliceal anatomy a risk factor for stone formation in patients with
solitary upper caliceal stone?

Acar C, Küpeli B, Gürocak S, Alkibay T, Güneri C, Ozkan S, Bozkirli I.

Department of Urology, School of Medicine, Gazi University, Ankara, Turkey.

OBJECTIVES: To investigate the effect of pelvicaliceal anatomy on stone formation
in patients with solitary upper caliceal stones. METHODS: The records of patients
with solitary upper caliceal stones between 1996 and 2004 were reviewed. After
the exclusion of patients with hydronephrosis, major anatomic abnormalities,
noncalcium stones, metabolic abnormalities, history of recurrent stone disease,
multiple stones, and previous renal surgery, 42 patients (24 male, 18 female) and
42 healthy subjects (22 male, 20 female) with normal results on intravenous
pyelography (IVP) were enrolled into the study. With a previously described
formula, upper pole infundibulopelvic angle (IPA), infundibular length (IL) and
width (IW), and pelvicaliceal volume of the stone-bearing and contralateral
normal kidney of patients and bilateral normal kidneys of healthy subjects were
measured from IVP. RESULTS: Forty-two stone-bearing and 126 normal kidneys (42
contralateral, 84 healthy) were assessed. The mean stone size was 153.47 mm2
(range, 20 to 896 mm2). There were no statistically significant differences in
terms of upper caliceal specifications between stone-bearing and normal kidneys. 
The mean (+/- standard deviation) pelvicaliceal volume of 42 stone-bearing and
126 normal kidneys was 2455.2 +/- 1380.2 mm3 and 1845.7 +/- 1454.8 mm3,
respectively (P = 0.019). These values were 2114 +/- 2081.5 mm3 (P = 0.34) and
1709.5 +/- 989.1 mm3 (P = 0.001) for contralateral normal kidneys (n = 42) and
normal kidneys of healthy subjects (n = 84), respectively. CONCLUSIONS:
Explanation of the etiology of the upper caliceal stone by the anatomic features 
is very difficult, and these caliceal anatomic variables (IPA, IL, IW) seem not
to be a significant risk factor for stone formation in the upper calyx.

PMID: 16750255 [PubMed - indexed for MEDLINE]

474: J Nephrol. 2006 Mar-Apr;19 Suppl 9:S53-61.

Hypercalciuria from acid load: renal mechanisms.

Moe OW, Huang CL.

Charles and Jane Pak Center of Mineral Metabolism and Clinical Research,
University of Texas Southwestern Medical Center, Dallas, TX, USA.
Orson.Moe@UTSouthwestern.edu

Excessive acid load is considered a risk factor for both Nephrolithiasis and
osteoporosis. The mechanisms by which acid confer the risk involves multiple
organs, and is highly complex and incompletely understood. At least one component
of the acid effect is due to renal leak of calcium. This article summarizes the
effect of acid on renal handling of calcium in the proximal tubule, thick
ascending limb, and distal convoluted tubule.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 16736442 [PubMed - indexed for MEDLINE]

475: J Endourol. 2006 May;20(5):356-61.

Effects of green tea on urinary stone formation: an in vivo and in vitro study.

Jeong BC, Kim BS, Kim JI, Kim HH.

Department of Urology, Seoul National University College of Medicine and Clinical
Research Institute, Seoul National University Hospital, Seoul, Korea.

PURPOSE: We evaluated whether epigallocatechin gallate (EGCG), a main constituent
of green tea polyphenols, could protect against cellular toxicity by oxalate and 
whether green tea supplementation attenuates the development of nephrolithiasis
in an animal model. MATERIALS AND METHODS: Cells of the NRK-52E line were
incubated with different concentrations of oxalate with and without EGCG, and
toxicity and malondialdehyde assays were done to investigate the cytotoxic effect
of oxalate and the anti-oxalate effect of EGCG.. In a second series of
experiments, male Sprague-Dawley rats were divided into three groups. Group 1
animals (controls) were fed regular chow and drank water ad libitum; group 2
animals were fed chow containing 3% sodium oxalate with the administration of
gentamicin (40 mg/kg) and drank water ad libitum; group 3 animals were fed the
same diet as group 2 with gentamicin administration and drank only green tea.
Rats were killed 4 weeks later after a 24-hour urine collection, and the kidneys 
were removed for morphologic examination. RESULTS: As oxalate concentrations
increased, the number of surviving cells decreased, and the formation of free
radicals increased. The administration of EGCG inhibited free-radical production 
induced by oxalate. Green tea supplementation decreased the excretion of urinary 
oxalate and the activities of urinary gammaglutamyltranspeptidase and
N-acetylglucosaminidase. The number of crystals within kidneys in group 3 was
significantly lower than in group 2. CONCLUSIONS: Green tea has an inhibitory
effect on urinary stone formation, and the antioxidative action of EGCG is
considered to be involved.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 16724910 [PubMed - indexed for MEDLINE]

476: J Endourol. 2006 May;20(5):296-9.

Endoscopic lithotripsy and the FREDDY laser: initial experience.

Dubosq F, Pasqui F, Girard F, Beley S, Lesaux N, Gattegno B, Thibault P, Traxer
O.

Urology Department, Tenon Hospital, Paris, France.

BACKGROUND AND PURPOSE: The frequency-doubled double-pulse neodymium:YAG (FREDDY)
laser has been developed for endoscopic lithotripsy and combines the
characteristics of solid and dye lasers with a thin flexible optical fiber
enabling it to be used with flexible ureterorenoscopy. Furthermore, it is less
expensive and easier to maintain than other lasers. Our goal was to evaluate its 
efficacy and role in the ureteroscopic treatment of urinary stones. PATIENTS AND 
METHODS: We used a FREDDY laser in 26 patients (29 stones). For 4 stone cases,
this was the first line of treatment; for the remaining cases, this was the
second line of treatment, following SWL in 23 cases and nephrolithotomy in 2
cases. The mean stone size was 9 mm, with a range of 6 to 15 mm. There were 13
renal and 16 ureteral stones. The absence of residual fragments at 3-month
postoperative radiography was considered to reflect successful treatment.
RESULTS: Twenty-six stones were treated with satisfactory results. Within 3
months, 18 patients were stone free (69%), and 72.4% of the stones (21/29) had
been treated completely. Fragments of 8 stones still remained in 8 patients. Of
these stones, 5 were >10 mm and persisted at 3 months. Fragmentation was
ineffective for 2 cystine stones and poor for 1 calcium oxalate monohydrate
stone. Hospitalization, on average, was 1.5 days with a range of 1 to 3 days. A
ureteral perforation was observed in the case of an impacted ureteral stone.
CONCLUSIONS: Because of the wavelengths used, endoscopic FREDDY laser lithotripsy
is an effective and harmless method. This laser can be used as a therapeutic tool
because of its moderate cost and ability to be used with flexible
ureterorenoscopy. However, it is important to be aware of the FREDDY laser's
limited fragmentation capabilities for cystine stones and its inability to treat 
tissue lesions such as urinary-tract stenosis and tumors.

PMID: 16724897 [PubMed - indexed for MEDLINE]

477: J Endourol. 2006 May;20(5):293-5.

Comment in:
    J Endourol. 2006 Jun;20(6):444.

Use of Surgicel for sealing nephrostomy tract after totally tubeless percutaneous
nephrolithotomy.

Aghamir SM, Khazaeli MH, Meisami A.

Department of Urology, Sina Hospital, Tehran, Iran.

BACKGROUND AND PURPOSE: Fibrin glue and gelatin matrix have been used to seal
nephrostomy tracts to reduce bleeding and extravasation after tubeless
percutaneous nephrolithotomy (PCNL). In this study, Surgicel (oxidized cellulose)
was used to seal the nephrostomy tract after totally tubeless PNL. PATIENTS AND
METHODS: Twenty patients with kidney calculi were treated with totally tubeless
PNL. According to randomization, at the conclusion of surgery, the nephrostomy
tracts were sealed with Surgicel in ten patients and left unsealed in the other
ten. Postoperatively, the two groups were compared with respect to hematocrit
changes and extravasation as detected by abdominal ultrasonography and
wound-dressing inspection. RESULTS: There was statistically significant decrease 
in the hematocrit in both the study (P = 0.017) and the control (P = 0.003)
group. When the two groups were compared with respect to the decrease in
hematocrit, no statistically significant difference was seen (P = 0.241).
Similarly, extravasation from the nephrostomy tract was not significantly
different in the two groups. CONCLUSION: Sealing the nephrostomy tract with
Surgicel after totally tubeless PNL did not decrease bleeding or extravasation
from the tract.

Publication Types: 
    Randomized Controlled Trial

PMID: 16724896 [PubMed - indexed for MEDLINE]

478: J Endourol. 2006 May;20(5):289-92.

Success in treating renal calculi with single-access, single-event percutaneous
nephrolithotomy: is a routine "second look" necessary?

Davol PE, Wood C, Fulmer B.

Department of Surgery, Division of Urology, Geisinger Medical Center, Danville,
Pennsylvania 17822, USA. pedavol1@geisinger.edu

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is an effective
procedure for the treatment of large renal calculi. An important consideration
for patients undergoing PCNL is the management of any residual stone burden,
which may include "second-look" nephroscopy. The utility of this practice is
unproven, and we present our data on a series of patients in which second-look
procedures were not performed. PATIENTS AND METHODS: We retrospectively reviewed 
the records of 43 consecutive patients undergoing a total of 45 procedures by a
single surgeon at a tertiary-care center. Patients were considered stone free if 
no calculi were evident by either plain film or noncontrast CT scan. Statistical 
analysis was used to look for correlations between radiographic stone clearance
and various patient and stone characteristics. Results: Of these procedures, 15% 
had immediate postoperative evidence of residual fragments. At a mean follow-up
of 8 months, 32.5% had residual or recurrent stone. There were statistically
significant correlations between both patient age and stone size and the risk of 
recurrent or residual stone. CONCLUSIONS: In our study, PCNL was effective for
the single-stage treatment of large renal calculi. Aggressive stone clearance
obviated the need for routine second-look nephroscopy. Factors leading to an
increased risk of residual or recurrent calculi included the presence of a
staghorn calculus and younger patient age. The excellent stone-free rates
achieved suggest that routine second-look nephroscopy may not be necessary for
the majority of patients undergoing PCNL.

PMID: 16724895 [PubMed - indexed for MEDLINE]

479: Kidney Int. 2006 Jun;69(12):2227-35. Epub 2006 May 17.

Renal crystal deposits and histopathology in patients with cystine stones.

Evan AP, Coe FL, Lingeman JE, Shao Y, Matlaga BR, Kim SC, Bledsoe SB, Sommer AJ, 
Grynpas M, Phillips CL, Worcester EM.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46220, USA. evan@anatomy.iupui.edu

We have biopsied the papillae of patients who have cystine stones asking if this 
stone type is associated with specific tissue changes. We studied seven cystine
stone formers (SF) treated with percutaneous nephrolithotomy using digital video 
imaging of renal papillae for mapping and obtained papillary biopsies. Biopsies
were analyzed by routine light and electron microscopy, infrared spectroscopy,
electron diffraction, and micro-CT. Many ducts of Bellini (BD) had an enlarged
ostium, and all such were plugged with cystine crystals, and had injured or
absent lining cells with a surrounding interstitium that was inflamed to
fibrotic. Crystal plugs often projected into the urinary space. Many inner
medullary collecting ducts (IMCD) were dilated with or without crystal plugging. 
Apatite crystals were identified in the lumens of loops of Henle and IMCD.
Abundance of interstitial Randall's plaque was equivalent in amount to that of
non-SF. In the cortex, glomerular obsolescence and interstitial fibrosis exceeded
normal. Cystine crystallizes in BD with the probable result of cell injury,
interstitial reaction, nephron obstruction, and with the potential of inducing
cortical change and loss of IMCD tubular fluid pH regulation, resulting in
apatite formation. The pattern of IMCD dilation, and loss of medullary structures
is most compatible with such obstruction, either from BD lumen plugs or urinary
tract obstruction from stones themselves.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16710357 [PubMed - indexed for MEDLINE]

480: J Am Soc Nephrol. 2006 Jun;17(6):1673-87. Epub 2006 May 17.

Crystal retention in renal stone disease: a crucial role for the
glycosaminoglycan hyaluronan?

Verkoelen CF.

Department of Urology, Sector Kidney Stones, Erasmus MC, Rotterdam, The
Netherlands. cverkoelen@erasmusmc.nl

The mechanisms that are involved in renal stone disease are not entirely clear.
In this article, the various concepts that have been proposed during the past
century are reviewed briefly and integrated into current insights. Much attention
is dedicated to hyaluronan (HA), an extremely large glycosaminoglycan that may
play a central role in renal stone disease. The precipitation of poorly soluble
calcium salts (crystal formation) in the kidney is the inevitable consequence of 
producing concentrated urine. HA is a major constituent of the extracellular
matrix in the renal medullary interstitium and the pericellular matrix of
mitogen/stress-activated renal tubular cells. HA is an excellent crystal-binding 
molecule because of its size, negative ionic charge, and ability to form hydrated
gel-like matrices. Crystal binding to HA leads to crystal retention in the renal 
tubules (nephrocalcinosis) and to the formation of calcified plaques in the renal
interstitium (Randall's plaques). It remains to be determined whether one or both
forms of renal crystal retention are involved in the development of kidney stones
(nephrolithiasis).

Publication Types: 
    Review

PMID: 16707562 [PubMed - indexed for MEDLINE]

481: Int Surg. 2006 Jan-Feb;91(1):9-11.

Ureteral stents and their current use.

Haritopoulos K, Hakim N.

St Mary's Hospital, Paddington, London, United Kingdom.

Stents in urology have been used for a long time in the management of
nephro-ureterolithiasis. However, the indications for stent insertion have
increased during the last few years and they are now used both diagnostically and
therapeutically in a variety of cases. A brief history of the name is presented
along with a review of the indications and the complications of stent usage.

PMID: 16706095 [PubMed - indexed for MEDLINE]

482: Urology. 2006 May;67(5):1084.e9-11.

Xanthine urolithiasis.

Pais VM Jr, Lowe G, Lallas CD, Preminger GM, Assimos DG.

Department of Urology, Wake Forest University School of Medicine, Winston-Salem, 
North Carolina 27157, USA.

Xanthine calculi are uncommonly encountered stones. When they occur, they
typically do so in association with inborn metabolic disorders such as hereditary
xanthinuria or Lesch-Nyhan syndrome. They may also occur in association with
states of profound hyperuricemia such as myeloproliferative disease after
treatment with allopurinol. If the underlying disorder is not addressed, a high
risk of stone recurrence exists. Therefore, to raise clinical awareness, we
reviewed and report our experience in the treatment of patients with these
stones, discussing the underlying pathophysiology and approach to treatment.

PMID: 16698380 [PubMed - indexed for MEDLINE]

483: Urology. 2006 May;67(5):1084.e13-4.

Renal calculi presenting as hyperhidrosis in patient with spinal cord injury.

Borawski KM, Sur RL, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery,
Duke University Medical Center, Durham, North Carolina 27710, USA.

Renal calculi in the spinal cord injury population present a diagnostic dilemma
for urologists. However, 7% of all patients with spinal cord injury will develop 
renal calculi. Undiagnosed stone disease can lead to significant morbidity and
mortality in this population. This case demonstrates the subtlety of the
presenting symptoms of renal calculi in the patient with spinal cord injury.

Publication Types: 
    Case Reports

PMID: 16698376 [PubMed - indexed for MEDLINE]

484: J Urol. 2006 Jun;175(6):2129-33; discussion 2133-4.

Ureteroscopic laser lithotripsy for upper urinary tract calculi with active
fragment extraction and computerized tomography followup.

Portis AJ, Rygwall R, Holtz C, Pshon N, Laliberte M.

Metropolitan Urologic Specialists, PA, USA.

PURPOSE: Management of fragments generated by ureteroscopic laser lithotripsy
remains controversial. In this study we explored the impact of active fragment
extraction after ureteroscopic laser lithotripsy on stone clearance. MATERIALS
AND METHODS: A total of 69 patients with 3 or less upper urinary tract calculi (5
to 15 mm) demonstrated on preoperative CT were prospectively evaluated. Stones
were translocated to a dependent upper pole calix where laser lithotripsy was
performed. An attempt was made to clear all fragments using tipless stone
baskets. One month after surgery stone clearance was evaluated exclusively with
noncontrast spiral CT. RESULTS: In 58 patients undergoing surgery on protocol,
average stone burden was 9.4 +/- 3.4 mm and was significantly smaller in 44
patients with stones in a solitary location (8.5 +/- 2.9 mm) than in 14 patients 
with stones in multiple locations (12.3 +/- 3.2 mm, p <0.001). Primary stone
location was categorized as renal nonlower pole (in 16), renal lower pole (in 19)
and proximal ureter (in 23). Average operative time (43.7 +/- 18.4 minutes) was
unaffected by stone location or multiplicity after controlling for stone size (p 
>0.05). Stone clearance rates were not affected by stone location or
multiplicity, with overall success rates of 54%, 84% and 95% at fragment
thresholds of 0, 2 and 4 mm, respectively (p >0.05). CONCLUSIONS: Ureteroscopic
laser lithotripsy with active fragment extraction was time efficient and highly
effective. Sensitive postoperative imaging reveals the challenge of achieving a
true stone-free state. We were unable to demonstrate an impact of stone location 
on stone-free rates.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 16697818 [PubMed - indexed for MEDLINE]

485: J Chin Med Assoc. 2006 Apr;69(4):162-5.

Gelatin packing of intracortical tract after percutaneous nephrostomy lithotripsy
for decreasing bleeding and urine leakage.

Yu DS.

Division of Urology, Department of Surgery, Tri-Service General Hospital, and
National Defense Medical Center, National Defense University, Taipei, Taiwan,
ROC. yuds@ms21.hinet.net

BACKGROUND: Percutaneous nephrostomy is almost a daily routine procedure in
clinical urologic practice. Tract bleeding and urine leakage along the
percutaneous tract is a common event and bothersome to both patients and the
surgeon. Herein we introduce a simple technique of gelatin packing for stopping
subsequent bleeding and urine leakage immediately after a percutaneous
nephrostomy lithotripsy (PCNL) procedure. METHODS: PCNL, using a tubeless
technique, was performed in 15 patients with renal calculi. In all cases, stones 
were removed using grasping forceps after the stones were disintegrated with a
lithoclast. In all patients, a retrograde internal ureteral stent was put in
place before the PCNL procedure, as was a Foley catheter for bladder drainage. A 
gelatin patch sealant was placed in the nephrostomy cortical tract under
nephroscopic vision, immediately after the PCNL procedure. Another 15 patients,
treated using a standard PCNL with tube drainage post-PCNL, were enrolled as a
control group. RESULTS: The stone burden, mean operative time, and stone-free
rate (67% versus 73%, p = 0.33) were not statistically different between the 2
groups. In the 15 patients who received tubeless PCNL treatment, there were no
severe complications related to the gelatin packing in the nephrostomy tract, and
no significant bleeding or urine leakage occurred after the packing. The
necessity for blood transfusion was much lower in the tubeless group as compared 
with the tube-drainage group (6.6% versus 26.7%; 0.2 +/- 0.1 units versus 0.9 +/-
0.5 units, p = 0.013). Tubeless patients began ambulation and were discharged
from the hospital earlier (3.4 days versus 5.1 days, p = 0.035) than those in the
tube-drainage group. Analgesic requirement was significantly less with the
gelatin sealant technique when compared with the tube drainage group (85 +/- 20
mg versus 185 +/- 25 mg, p = 0.008). CONCLUSION: Gelatin sealant packing is an
alternative, available, and feasible method for preventing bleeding and urine
leakage postoperatively in selected patients receiving tubeless PCNL.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16689197 [PubMed - indexed for MEDLINE]

486: Kidney Int. 2006 Jun;69(12):2261-7. Epub 2006 May 10.

NPT2a gene variation in calcium nephrolithiasis with renal phosphate leak.

Lapointe JY, Tessier J, Paquette Y, Wallendorff B, Coady MJ, Pichette V,
Bonnardeaux A.

Department of Physics, Université de Montréal, Montreal, Quebec, Canada.

A decrease in renal phosphate reabsorption with mild hypophosphatemia (phosphate 
leak) is found in some hypercalciuric stone-formers. The NPT2a gene encodes a
sodium-phosphate cotransporter, located in the proximal tubule, responsible for
reclaiming most of the filtered phosphate load in a rate-limiting manner. To
determine whether genetic variation of the NPT2a gene is associated with
phosphate leak and hypercalciuria in a cohort of 98 pedigrees with multiple
hypercalciuric stone-formers, we sequenced the entire cDNA coding region of 28
probands, whose tubular reabsorption of phosphate normalized for the glomerular
filtration rate (TmP/GFR) was 0.7 mmol/l or lower. We performed
genotype/phenotype correlations for each genetic variant in the entire cohort and
expressed NPT2a variant RNAs in Xenopus laevis oocytes to test for cotransporter 
functionality. We identified several variants in the coding region including an
in-frame 21 bp deletion truncating the N-terminal cytoplasmic tail of the protein
(91del7), as well as other single-nucleotide polymorphisms that were
non-synonymous (A133V and H568Y) or synonymous. Levels of TmP/GFR and urine
calcium excretion were similar in heterozygote carriers of NPT2a variants
compared to the wild-type (wt) homozygotes. The transport activity of the H568Y
mutants was identical to the wt, whereas the N-terminal-truncated version and the
91del7 and A133V mutants presented minor kinetic changes and a reduction in the
expression level. Although genetic variants of NPT2a are not rare, they do not
seem to be associated with clinically significant renal phosphate or calcium
handling anomalies in a large cohort of hypercalciuric stone-forming pedigrees.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16688119 [PubMed - indexed for MEDLINE]

487: Acad Radiol. 2006 Jun;13(6):759-63.

Virtual pyeloscopy using volumetric depth peeling.

Fielding JR, Borland D, Lee KH, Clarke JP, Wallen E, Pruthi R, Taylor RM.

Department of Radiology, University of North Carolina at Chapel Hill, 27599, USA.
julia_fielding@med.unc.edu

RATIONALE AND OBJECTIVES: The aim of the study is to test a new volume-rendering 
method, volumetric depth peeling (VDP), for use in virtual pyeloscopy. MATERIALS 
AND METHODS: VDP was applied to axial contrast-enhanced source computed
tomographic (CT) images and coronal reformatted maximum intensity projections of 
three contrast-filled gloves containing objects of varying density. Similar
renderings were performed on CT urograms performed to evaluate hematuria (n =
20). Renderings were assessed for anatomic appearance of ureters and specific
calyces in comparison with source images. RESULTS: Objects of soft-tissue and
calcific density ranging in size from 4 to 20 mm were identified by using VDP
within the glove phantoms. Normal and deformed renal calyces were well visualized
by using VDP; however, two stones were not identified. The minimal ureteral width
that could be visualized was 3 mm. CONCLUSION: VDP may be a useful technique for 
virtual pyeloscopy providing that a robust and user-friendly computer interface
can be developed.

PMID: 16679279 [PubMed - indexed for MEDLINE]

488: J Colloid Interface Sci. 2006 Aug 1;300(1):131-40. Epub 2006 Apr 4.

Adhesion force between calcium oxalate monohydrate crystal and kidney epithelial 
cells and possible relevance for kidney stone formation.

Rabinovich YI, Esayanur M, Daosukho S, Byer KJ, El-Shall HE, Khan SR.

University of Florida, PO Box 6135, Gainesville, FL 32611-6135, USA.
yrabinovich@erc.ufl.edu

AFM interaction force measurements have been performed between calcium oxalate
monohydrate crystal (COM) colloidal probes and monolayers of renal epithelial
cells (on a polymer substrate) in artificial urine (AU) solutions. The adhesion
force was measured for the COM/MDCK cell interaction, while no adhesion force was
found for the COM/LLC-PK(1) cell interaction. Long-range repulsive forces for
both lines of cells were measured in the range of 2-3 mum. After removal of the
cell from the substrate by the AU flow, the basal membrane (BM), with a thickness
of 100-200 nm, remained on the substrate. In this case, the shorter-range
repulsive forces were found on the extending (approaching) portion of
force/indentation curves. Similar to the COM/MDCK cell interaction, the
retracting portions of curves for COM/basal membranes have shown the existence of
the attractive force of adhesion for the interaction of COM with a BM of MDCK
cells, while no adhesion was found for COM/BM LLC-PK(1) cells interaction. No
adhesion force was found for the interaction of a BM (of any cells) with the
silicon nitride tip. Besides the hydrodynamic reasons, the adhesion difference
between LLC-PK(1) and MDCK cells possibly explains the preferential deposition of
crystals only in collecting ducts (lined with MDCK-type cells) and the lack of
the crystal deposition in the proximal tubules (lined with LLC-PK(1)-type cells).
Previous treatments of cells with oxalate alone increased the adhesion force
COM/BM MDCK; however, even after oxalate treatment there was small or no adhesion
between COM and BM LLC-PK(1) cells. Note that the adhesion force for COM/BM MDCK 
is practically independent of the probe velocity, i.e., does not have the viscous
origin. Evaluation of the adhesion energy shows that this force should be related
to the ionic or hydrogen bonds of samples.

PMID: 16677664 [PubMed - indexed for MEDLINE]

489: Kidney Int. 2006 Jul;70(1):79-87. Epub 2006 May 3.

Kidney-specific upregulation of vitamin D3 target genes in ClC-5 KO mice.

Maritzen T, Rickheit G, Schmitt A, Jentsch TJ.

Zentrum für Molekulare Neurobiologie Hamburg, ZMNH, Universität Hamburg, Hamburg,
Germany.

Mutations in ClC-5 cause Dent's disease, a disorder associated with low molecular
weight proteinuria, hyperphosphaturia, and kidney stones. ClC-5 is a
Cl(-)/H(+)-exchanger predominantly expressed in the kidney, where it facilitates 
the acidification of proximal tubular endosomes. The reduction in proximal
tubular endocytosis resulting from a lack of ClC-5 raises the luminal
concentration of filtered proteins and peptides like parathyroid hormone (PTH).
The increase in PTH may explain the hyperphosphaturia observed in Dent's disease.
Expression profiling, quantitative reverse transcriptase-polymerase chain
reaction (qRT-PCR), and hormone measurements were used to investigate whether the
disruption of ClC-5 affects other signalling pathways. Although the upregulation 
of 25(OH)(2)-vitamin D(3) 1alpha-hydroxylase and downregulation of vitamin D(3)
24-hydroxylase suggested an increased formation of 1,25(OH)(2)-vitamin D(3), the 
concentration of this active metabolite was reduced in the serum of ClC-5
knockout (KO) mice. However, target genes of 1,25(OH)(2)-vitamin D(3) were
upregulated in KO kidneys. Expression analysis of intestine and bone revealed
that the upregulation of 1,25(OH)(2)-vitamin D(3) target genes was kidney
intrinsic and not systemic. In spite of reduced serum levels of
1,25(OH)(2)-vitamin D(3) in ClC-5 KO mice, 1,25(OH)(2)-vitamin D(3) is increased 
in later nephron segments as a consequence of impaired proximal tubular
endocytosis. This leads to a kidney-specific stimulation of 1,25(OH)(2)-vitamin
D(3) target genes that may contribute to the pathogenesis of Dent's disease. The 
activation of genes in distal nephron segments by hormones that are normally
endocytosed in the proximal tubule may extend to other pathways like those
activated by retinoic acid.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16672909 [PubMed - indexed for MEDLINE]

490: J Phys Chem B. 2006 May 11;110(18):9085-9.

How does bovine serum albumin prevent the formation of kidney stone? A kinetics
study.

Liu J, Jiang H, Liu XY.

Department of Physics, National University of Singapore, 2 Science Drive 3,
Singapore 117542.

To attain a better understanding of the crystallization of calcium oxalate
crystals under the influence of the protein bovine serum albumin, we examined not
only the nucleation kinetics but also the structural synergy between the
biomineral and the biosubstrate. It follows that during the crystallization
process of calcium oxalate crystals bovine serum albumin inhibits the nucleation 
of calcium oxalate by increasing the kink kinetics barrier. The results of
scanning electron microscopy and X-ray diffraction show, however, that bovine
serum albumin promotes the formation of calcium oxalate dihydrate. Apart from
this, bovine serum albumin facilitates the ordered calcium oxalate crystal
assembly by suppressing the supersaturation-driven interfacial structure
mismatch. The physics questions behind the mentioned effects have been addressed 
from the kinetics point of view. This may explain why bovine serum albumin plays 
an important role in suppressing urine stone formation.

PMID: 16671718 [PubMed - indexed for MEDLINE]

491: Virchows Arch. 2006 Jul;449(1):62-8. Epub 2006 May 3.

Normocalcemic primary hyperparathyroidism in patients with recurrent kidney
stones: pathological analysis of parathyroid glands.

Yang AH, Hsu CW, Chen JY, Tseng LM, Won GS, Lee CH.

Division of Ultrastructural and Molecular Pathology, Department of Pathology,
Taipei Veterans General Hospital, Taipei, Taiwan.

The lack of overt elevation of serum calcium concentration in some patients
suffering from primary hyperparathyroidism is an intriguing clinical phenomenon. 
Previous studies have substantiated abnormal parathyroid tissue in these
patients, but the extent and mode of derangements remained largely undefined. The
parathyroid tissues from patients of normocalcemic primary hyperparathyroidism
(NCPHPT) and those having normal parathyroid glands, hypercalcemic primary
hyperplasia, secondary hyperplasia, and adenoma were compared by undertaking
quantitative immunohistochemistry analysis on tissue microarray. The statistic
results suggested that the parathyroid tissue of NCPHPT approximates more to
normal gland than to its counterpart in other groups of parathyroid proliferative
diseases in terms of the lack of significant alterations of calcium-sensing
receptor (CaSR), chromogranin A (CGA), parathyroid hormone (PTH), and
proliferation index (Ki67). On the other hand, the depressed vitamin D receptor
(VitDR) and elevated cyclin D1 (CyD1) of NCPHPT indicated the inherent functional
abnormalities in parathyroid cells. Our results imply that inherent functional
disengagement may exist between CaSR and CyD1 or between CaSR and VitDR or both
in parathyroid cells of symptomatic NCPHPT. Lack of enhanced release of CGA and
PTH and discordance between proliferative activity and CyD1 expression in
parathyroid cells may further hinder the development of hypercalcemia.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16670929 [PubMed - indexed for MEDLINE]

492: Am J Physiol Renal Physiol. 2006 Oct;291(4):F731-40. Epub 2006 May 2.

Renal oxidative vulnerability due to changes in mitochondrial-glutathione and
energy homeostasis in a rat model of calcium oxalate urolithiasis.

Meimaridou E, Lobos E, Hothersall JS.

Centre for Prevention and Treatment of Urinary Stones, Institute of Urology and
Nephrology, University College London, London, United Kingdom.

Calcium oxalate monohydrate (COM) crystals are the commonest component of kidney 
stones. Oxalate and COM crystals in renal cells are thought to contribute to
pathology via prooxidant events. Using an in vivo rat model of crystalluria
induced by hyperoxaluria plus hypercalciuria [ethylene glycol (EG) plus
1,25-dihydroxycholecalciferol (DHC)], we measured glutathione and energy
homeostasis of kidney mitochondria. Hyperoxaluria or hypercalciuria without
crystalluria was also investigated. After 1-3 wk of treatment, kidney
cryosections were analyzed by light microscopy. In kidney subcellular fractions, 
glutathione and antioxidant enzymes were measured. In mitochondria, oxygen
consumption and superoxide formation as well as cytochrome c content were
measured. EG plus DHC treatment increased formation of renal birefringent
crystal. Histology revealed increased renal tubular pathology characterized by
obstruction, distension, and interstitial inflammation. Crystalluria at all time 
points led to oxidative stress manifest as decreased cytosolic and mitochondrial 
glutathione and increased activity of the antioxidant enzymes glutathione
reductase and -peroxidase (mitochondria) and glucose-6-phosphate dehydrogenase
(cytosol). These changes were followed by a significant decrease in mitochondrial
cytochrome c content at 2-3 wk, suggesting the involvement of apoptosis in the
renal pathology. Mitochondrial oxygen consumption was severely impaired in the
crystalluria group without increased mitochondrial superoxide formation. Some of 
these changes were also evident in hyperoxaluria at week 1 but were absent at
later times and in all calciuric groups. Our data indicate that impaired electron
flow did not cause superoxide formation; however, mitochondrial dysfunction
contributes to pathological events when tubular crystal-cell interactions are
uncontrolled, as in kidney stones disease.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16670437 [PubMed - indexed for MEDLINE]

493: J Endourol. 2006 Apr;20(4):248-51.

Lower-caliceal stone clearance index to predict clearance of stone after SWL.

Desai MR, Raghunath SK, Manohar T, Prajay S.

Department of Urology, Muljibhai Patel Urological Hospital, Gujarat, India.
mrdesai@mpuh.org

BACKGROUND AND PURPOSE: There is no uniform consensus regarding the anatomic
factors that influence the clearance rate of caliceal stones after SWL, as
different authors have studied various independent factors separately. We
correlated both favorable and unfavorable factors into a formula to predict the
clearance rate. PATIENTS AND METHODS: A series of 56 consecutive patients (37
male, 19 female) with isolated lower-caliceal single stones (right 29, left 27)
treated with SWL using the Dornier Compact Delta lithotripter were analyzed
retrospectively. Of these, 40 patients had soft stones, and 16 patients had hard 
stones. The first stone-free rate (SFR) according to plain films and
ultrasonography was analyzed by stone size, and a stone clearance index (SCI)
formula was applied to see if there was any change in the SFR, especially for
stones >2 cm. RESULTS: The formula, which correlated well with the clearance, is 
SCI = [(IVA x IW x stone type)/IH] - (stone size in mm(2)/10). Nearly all (90%)
of the patients with an SCI of >0 cleared their stones within 3 months, and 87%
of the patients with an SCI <0 cleared their stones after 3 months. Positive and 
negative predictive values were 93.33% and 76.9%, respectively. The accuracy of
the correlation is 85.71%. CONCLUSIONS: The success of SWL for lower-caliceal
stones can be predicted easily using the SCI. Stones of >200 mm(2) (>2 cm)
surface area may still be suitable for SWL if the SCI is positive, whereas
alternative treatment modalities should be considered if the SCI is a low
negative value (<-7).

PMID: 16646650 [PubMed - indexed for MEDLINE]

494: Int J Urol. 2006 Mar;13(3):252-6.

Role of uric acid in different types of calcium oxalate renal calculi.

Grases F, Sanchis P, Perelló J, Costa-Bauzá A.

Laboratory of Renal Lithiasis Research, Institute of Health Sciences Research
(IUNICS), University of Balearic Islands, Mallorca, Spain. fgrases@uib.es

AIM: The presence of uric acid in the beginning zone of different types of 'pure'
calcium oxalate renal calculi was evaluated with the aim of establishing the
degree of participation of uric acid crystals in the formation of such calculi.
METHODS: The core or fragment of different types of 'pure' calcium oxalate renal 
calculi was detached, pulverized and uric acid extracted. Uric acid was
determined using a high-performance liquid chromatography/mass spectrometry
method. RESULTS: In calcium oxalate monohydrate (COM) papillary calculi with a
core constituted by COM crystals and organic matter, 0.030+/-0.007% uric acid was
found in the core. In COM papillary calculi with a core constituted by
hydroxyapatite, 0.031+/-0.008% uric acid was found in the core. In COM unattached
calculi (formed in renal cavities) with the core mainly formed by COM crystals
and organic matter, 0.24+/-0.09% uric acid was found in the core. In COM
unattached calculi with the core formed by uric acid identifiable by scanning
electron microscopy (SEM) coupled to X-ray microanalysis, 20.8+/-7.8% uric acid
was found in the core. In calcium oxalate dihydrate (COD) unattached calculi
containing little amounts of organic matter, 0.012+/-0.004% uric acid was found. 
In COD unattached calculi containing little amounts of organic matter and
hydroxyapatite, 0.0030+/-0.0004% of uric acid was found. CONCLUSIONS: From these 
results it can be deduced that uric acid can play an important role as inducer
(heterogeneous nucleant) of COM unattached calculi with the core formed by uric
acid identifiable by SEM coupled to X-ray microanalysis (these calculi constitute
the 1.2% of all calculi) and in COM unattached calculi with the core mainly
formed by COM crystals and organic matter (these calculi constitute the 10.8% of 
all calculi).

Publication Types: 
    Comparative Study
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 16643619 [PubMed - indexed for MEDLINE]

495: BJU Int. 2006 May;97(5):1053-6.

Metabolic abnormalities associated with calyceal diverticular stones.

Auge BK, Maloney ME, Mathias BJ, Pietrow PK, Preminger GM.

Department of Urology, Naval Medical Center, San Diego, CA, USA.

OBJECTIVE: To review the metabolic analyses of patients with calyceal
diverticular stones who had surgical treatment of their calculi and to examine
the effect of selective medical therapy on stone recurrence, as recent reports
suggest that metabolic abnormalities contribute to stone development. PATIENTS
AND METHODS: In all, 37 patients who had endoscopic treatment of symptomatic
calyceal diverticular calculi were retrospectively reviewed. Stone composition
and initial 24-h urine collections (24-h urinary volumes, pH, calcium, sodium,
uric acid, oxalate, citrate, and the number of abnormalities/patient per
collection) were compared with 20 randomly selected stone-forming patients
(controls) with no known anatomical abnormalities. Stone formation rates before
and after the start of medical therapy were calculated in the patients available 
for follow-up. RESULTS: Twelve of the diverticulum patients (five men and seven
women) had complete 24-h urine collections, all of whom had at least one
metabolic abnormality. Seven patients had hypercalciuria, four had
hyperuricosuria and three had mild hyperoxaluria. The most common abnormality was
a low urine volume; 11 of the 12 patients had urine volumes of <2000 mL/day
(range 350-1950). Ten patients had hypocitraturia in at least one of the two 24-h
urine samples; seven had low urinary citrate levels (172-553 mg/day) on both
samples. The findings were similar in the control group. The diverticulum
patients had 3.1 abnormalities/patient, and the controls had 2.9
abnormalities/patient (P > 0.05). No patients had gouty diathesis and none
developed cystine stones. Stone analyses were similar in the two groups; both
developed either calcium oxalate or mixed calcium oxalate/calcium phosphate
stones. Six patients were followed for a mean of 23.1 months while on selective
medical therapy; only one passed any additional stones, thought to be existing
calculi, for a remission rate of five of six (83%). CONCLUSIONS: All patients
with symptomatic calyceal diverticular stones who had comprehensive metabolic
evaluation had metabolic abnormalities. There were similar abnormalities in the
control random stone-formers. The abnormalities were corrected with selective
medical therapy, as shown by the high remission rate. We recommend that, for
patients with symptomatic calyceal diverticular calculi, a metabolic evaluation
should be considered to determine stone forming risk factors.

PMID: 16643491 [PubMed - indexed for MEDLINE]

496: J Acoust Soc Am. 2006 Apr;119(4):1929-32.

Quantitative measurements of acoustic emissions from cavitation at the surface of
a stone in response to a lithotripter shock wave.

Chitnis PV, Cleveland RO.

Department of Aerospace and Mechanical Engineering, Boston University, 110
Cummington Street, Boston, Massachusetts 02215, USA.

Measurements are presented of acoustic emissions from cavitation collapses on the
surface of a synthetic kidney stone in response to shock waves (SWs) from an
electrohydraulic lithotripter. A fiber optic probe hydrophone was used for
pressure measurements, and passive cavitation detection was used to identify
acoustic emissions from bubble collapse. At a lithotripter charging voltage of 20
kV, the focused SW incident on the stone surface resulted in a peak pressure of
43 +/- 6 MPa compared to 23 +/- 4 MPa in the free field. The focused SW incident 
upon the stone appeared to be enhanced due to the acoustic emissions from the
forced cavitation collapse of the preexisting bubbles. The peak pressure of the
acoustic emission from a bubble collapse was 34 +/- 15 MPa, that is, the same
magnitude as the SWs incident on the stone. These data indicate that stresses
induced by focused SWs and cavitation collapses are similar in magnitude thus
likely play a similar role in stone fragmentation.

Publication Types: 
    In Vitro
    Research Support, N.I.H., Extramural

PMID: 16642802 [PubMed - indexed for MEDLINE]

497: Kidney Int. 2006 Jul;70(1):71-8. Epub 2006 Apr 26.

Dual roles of brushite crystals in calcium oxalate crystallization provide
physicochemical mechanisms underlying renal stone formation.

Tang R, Nancollas GH, Giocondi JL, Hoyer JR, Orme CA.

Department of Chemistry, The State University of New York at Buffalo, Buffalo,
New York 14260, USA.

Calcium oxalate monohydrate (COM) crystals are the major mineral component of
most kidney stones, and thus have an important role in chronic human disease.
However, the physicochemical mechanisms leading to calcium oxalate (CaOx) stone
disease are only partially defined. As spontaneous precipitation of CaOx is rare 
under renal conditions, an alternative pathway for CaOx crystallization seems
necessary to resolve this central issue. We performed kinetic studies using the
dual constant composition method to simultaneously analyze the crystallization of
COM and brushite, the form of calcium phosphate that is most readily formed in
the typical slightly acidic urinary milieu. These studies were supported by
parallel analysis by scanning electron and atomic force microscopy. In these
studies, mineralization of a thermodynamically stable phase (COM) was induced by 
the presence of brushite, a more readily precipitated inorganic phase.
Furthermore, once formed, the COM crystals grew at the expense of brushite
crystals causing the dissolution of the brushite crystals. These studies show
that brushite may play crucial roles in the formation of COM crystals. The
definition of these two roles for brushite thereby provides physicochemical
explanations for the initiation of COM crystallization and also for the relative 
paucity of calcium phosphate detected in the majority of CaOx renal stones.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16641926 [PubMed - indexed for MEDLINE]

498: Urology. 2006 May;67(5):1066-8. Epub 2006 Apr 25.

Use of Stone Cone minimizes stone migration during percutaneous nephrolithotomy.

Springhart WP, Tan YH, Albala DM, Perelman J, Teichman JM, Preminger GM.

Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North 
Carolina 27710, USA.

We describe a simple and effective method using the Stone Cone to prevent
migration of stone fragments into the ureter during percutaneous nephrolithotomy.
This maneuver may reduce the need for antegrade ureteroscopy to remove residual
fragments, thereby saving time and obviating the need for placement of an
occlusion balloon.

PMID: 16635514 [PubMed - indexed for MEDLINE]

499: Urol Res. 2006 Aug;34(4):265-70. Epub 2006 Apr 22.

Prevention of nephrolithiasis by Lactobacillus in stone-forming rats: a
preliminary study.

Kwak C, Jeong BC, Ku JH, Kim HH, Lee JJ, Huh CS, Baek YJ, Lee SE.

Department of Urology, Seoul National University College of Medicine, Clinical
Research Institute, Seoul National University Hospital, Seoul, Korea.

Hyperoxaluria is a risk factor for renal stones. It appears to be sustained by
increased dietary load or increased intestinal absorption. The aim of this study 
was to evaluate whether oral administration of lactobacilli could prevent
urolithiasis in stone-forming rats. Oxalate-degrading activities of lactobacilli 
were evaluated by measuring the oxalate level in a culture medium after
inoculation with lactobacilli. Only the strains of Lactobacillus having
oxalate-degrading activity were used. Sprague-Dawley rats were fed a powdered
standard diet containing 3% sodium oxalate and/or received 100 mg/kg of celecoxib
for the first 8 days by gavage, before or after the beginning of this experiment 
(groups with previous treatment or with co-treatment). Rats were sacrificed after
4 weeks and kidneys were harvested for the assay of crystal formation under a
dissecting microscope. Twenty-four-hour urine collections were performed before
kidney harvest. Only two strains, Lactobacillus casei HY2743 and L. casei HY7201 
out of 31 strains of Lactobacillus were able to degrade oxalate. In both groups
of co-treatment and previous treatment with L. casei HY2743 and L. casei HY7201, 
urine oxalate excretion decreased compared to the group without lactobacilli. The
dissecting microscope examination of kidneys in the rats in two previous
treatment groups and the co-treatment group with L. casei HY7201 showed less
abundant crystals than control groups. Our results show that lactobacilli may be 
used as a potential therapeutic strategy in the prevention of urinary stones.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16633809 [PubMed - indexed for MEDLINE]

500: Am J Physiol Renal Physiol. 2006 Sep;291(3):F530-6. Epub 2006 Apr 18.

Urine protein markers distinguish stone-forming from non-stone-forming relatives 
of calcium stone formers.

Bergsland KJ, Kelly JK, Coe BJ, Coe FL.

Litholink Corp., 2250 W. Campbell Park Dr., Chicago, IL 60612, USA.
kbergsland@litholink.com

We have investigated urine protein inhibitors of calcium oxalate crystallization 
to determine whether variations in these proteins are associated with kidney
stone disease and whether protein measurements improve the identification of
stone formers compared with conventional risk factors (RF). Using Western
blotting, we studied variations in the electrophoretic mobility patterns and
relative abundances of crystallization-inhibitory proteins in urine from 50
stone-forming (SF) and 50 non-stone-forming (NS) first-degree relatives of
calcium SF patients, matched by gender and age. Standard urine chemistry stone
risk measurements were also made. Multivariate discriminant analysis was used to 
test the association of these proteins with nephrolithiasis. Differences in form 
and abundance of several urine proteins including inter-alpha-trypsin inhibitor
(ITI), prothrombin fragment 1 (PF1), CD59, and calgranulin B (calB) were found to
be associated with stone formation. By multivariate discriminant analysis,
measurements of forms of PF1, ITI, and calB in men and ITI and CD59 in women,
classified 84% of men and 76% of women correctly by stone status. In contrast,
standard urine chemistry RF identified only 70% of men correctly and failed to
distinguish female SF from NS. Thus a small subset of protein measurements
distinguished SF from NS far better than conventional RF in a population of
relatives of calcium SF, illustrating the significant association of these
proteins with stone disease. Variations in these proteins may serve as markers of
stone disease activity or vulnerability to recurrence and may provide new
insights into mechanisms of stone formation.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16622176 [PubMed - indexed for MEDLINE]

501: Kidney Int. 2006 Apr;69(8):1313-8.

Comment in:
    Kidney Int. 2007 Jan;71(1):83; author reply 83-4.    Kidney Int. 2007 Jan;71(1):83; author reply 83-4.

Randall's plaque: pathogenesis and role in calcium oxalate nephrolithiasis.

Evan A, Lingeman J, Coe FL, Worcester E.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, 46220, USA. evan@anatomy.iupui.edu

The purpose of these studies was to test the hypothesis that Randall's plaque
develops in unique anatomical sites of the kidney and their formation is
conditioned by specific stone-forming pathophysiologies. We performed
intraoperative papillary biopsies from kidneys of idiopathic-calcium oxalate
(CaOx), intestinal bypass for obesity, brushite (BR) and cystine stone formers
(SF) during percutaneous nephrolithotomy. Tissues were examined by infrared
analysis and light and electron microscopy. Our analysis revealed a distinct
pattern of mineral deposition and papillary pathology for each type of SF. CaOx
SF had interstitial apatite crystals beginning at thin loops of Henle. These
deposits termed Randall's plaque are thought to serve as sites for stone
attachment. No tubular injury was noted. Intestinal bypass patients possessed
intraluminal apatite deposits in inner medullary collecting ducts (IMCD) with
associated cell injury. BR SF showed the most severe form of cortical and
medullary changes with sites of Randall's plaque, and yellowish intraluminal
deposits of apatite in IMCD. Cystine SF had plugging of ducts of Bellini with
cystine crystals and apatite deposits in IMCD and loops of Henle. Intratubular
sites of crystalline deposits were always associated to adjacent regions of
interstitial fibrosis. The metabolic, anatomic, and surgical pathologic findings 
in four distinct groups of SF clearly show that 'the histology of the renal
papilla from a stone former, is particular to the clinical setting'. We believe
our approach to studying stone disease will provide insights into the
pathogenesis of stone formation for each type of SF that will lead to improved
clinical treatment.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 16614720 [PubMed - indexed for MEDLINE]

502: J Am Soc Nephrol. 2006 May;17(5):1292-304. Epub 2006 Apr 12.

Isolation and confirmation of a calcium excretion quantitative trait locus on
chromosome 1 in genetic hypercalciuric stone-forming congenic rats.

Hoopes RR Jr, Middleton FA, Sen S, Hueber PA, Reid R, Bushinsky DA, Scheinman SJ.

Department of Medicine, SUNY Upstate Medical University, 750 E. Adams Street,
Syracuse, NY 13210, USA. hoopesr@mail.upstate.edu

Hypercalciuria is the most common risk factor for kidney stones and has a
substantial genetic component. The genetic hypercalciuric stone-forming (GHS) rat
model displays complex changes in physiology involving intestine, bone, and
kidney and overexpression of the vitamin D receptor, thereby reproducing the
human phenotype of idiopathic hypercalciuria. Through quantitative trait locus
(QTL) mapping of rats that were bred from GHS female rats and normocalciuric
Wistar Kyoto (WKY) male rats, loci that are linked to hypercalciuria and account 
for a 6 to eight-fold phenotypic difference between the GHS and WKY progenitors
were mapped. GHS x WKY rats were backcrossed to breed for congenic rats with the 
chromosome 1 QTL HC1 on a normocalciuric WKY background. Ten generations of
backcrosses produced N10F1 rats, which were intercrossed to produce rats that
were homozygous for GHS loci in the HC1 region between markers D1Mit2 and
D1Mit32. On a high-calcium diet (1.2% calcium), significantly different levels of
calcium excretion were found between male congenic (1.67 +/- 0.71 mg/24 h) and
male WKY control rats (0.78 +/- 0.19 mg/24 h) and between female congenic (3.11
+/- 0.90 mg/24 h) and female WKY controls (2.11 +/- 0.50 mg/24 h); the congenics 
preserve the calcium excretion phenotype of the GHS parent strain. Microarray
expression analyses of the congenic rats, compared with WKY rats, showed that of 
the top 100 most changed genes, twice as many as were statistically expected
mapped to chromosome 1. Of these, there is a clear bias in gene expression change
for genes in the region of the HC1. Of >1100 gene groups analyzed, one third of
the 50 most differentially expressed gene groups have direct or secondary action 
on calcium metabolism or transport. This is the first QTL for hypercalciuria to
be isolated in a congenic animal.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16611718 [PubMed - indexed for MEDLINE]

503: Scand J Urol Nephrol. 2006;40(2):119-24.

Immediate versus deferred radiological investigation after acute renal colic: a
prospective randomized study.

Lindqvist K, Hellström M, Holmberg G, Peeker R, Grenabo L.

Department of Urology, Sahlgrenska University Hospital, Göteborg University,
Göteborg, Sweden. klas.lindqvist@vgregion.se

OBJECTIVE: The timing of radiological assessment after acute renal colic is
controversial. The aim of this study was to investigate the value of immediate
versus deferred radiological imaging and to compare morbidity rates after an
attack of acute renal colic. MATERIAL AND METHODS: Between September 2001 and
December 2002 all 686 patients with acute renal colic attending our university
hospital were registered. Of these, 172 patients rendered pain-free after
analgesic injection were randomized to either immediate or deferred radiological 
investigation. All patients received a questionnaire encompassing questions on
consumption of analgesics, impact of symptoms on normal daily activity (including
working ability), need for additional emergency department visits and
hospitalization. Stone treatments were registered. RESULTS: The incidence of
renal colic was 0.9/1,000 inhabitants per year. In total, 74% of all patients
became pain-free after analgesic injection. Morbidity was low among the
randomized patients, and did not differ between the immediate or deferred
radiological investigation groups. In both groups, the duration of impairment of 
normal daily activities and analgesic consumption was a median of 2 days. In the 
immediate group, 14% needed another emergency visit and 4% were hospitalized.
Corresponding figures for the deferred group were 15% and 7%. In the immediate
group, 17% had stone treatment, compared with 8% in the deferred group.
CONCLUSION: For most patients with acute renal colic, parenteral analgesia
resulted in complete symptom resolution. When initial medical treatment was
successful, patient morbidity was low. In these patients, immediate radiological 
imaging did not lead to reduced morbidity compared with radiological imaging
after 2-3 weeks.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16608809 [PubMed - indexed for MEDLINE]

504: J Urol. 2006 May;175(5):1742-7.

Comment in:
    Eur Urol. 2007 Jan;51(1):281-2.

Diabetes mellitus and hypertension associated with shock wave lithotripsy of
renal and proximal ureteral stones at 19 years of followup.

Krambeck AE, Gettman MT, Rohlinger AL, Lohse CM, Patterson DE, Segura JW.

Department of Urology, Mayo Clinic College of Medicine, Rochester, Minnesota
55905, USA. Krambeck.amy@mayo.edu

PURPOSE: SWL has revolutionized the management of nephrolithiasis and it is a
preferred treatment for uncomplicated renal and proximal ureteral calculi. Since 
its introduction in 1982, conflicting reports of early adverse effects have been 
published. However, to our knowledge the long-term medical effects associated
with SWL are unknown. We evaluated these adverse medical effects associated with 
SWL for renal and proximal ureteral stones. MATERIALS AND METHODS: Chart review
identified 630 patients treated with SWL at our institution in 1985.
Questionnaires were sent to 578 patients who were alive in 2004. The response
rate was 58.9%. Respondents were matched by age, sex and year of presentation to 
a cohort of patients with nephrolithiasis who were treated nonsurgically.
RESULTS: At 19 years of followup hypertension was more prevalent in the SWL group
(OR 1.47, 95% CI 1.03, 2.10, p = 0.034). The development of hypertension was
related to bilateral treatment (p = 0.033). In the SWL group diabetes mellitus
developed in 16.8% of patients. Patients treated with SWL were more likely to
have diabetes mellitus than controls (OR 3.23, 95% CI 1.73 to 6.02, p <0.001).
Multivariate analysis controlling for change in body mass index showed a
persistent risk of diabetes mellitus in the SWL group (OR 3.75, 95% CI 1.56 to
9.02, p = 0.003). Diabetes mellitus was related to the number of administered
shocks and treatment intensity (p = 0.005 and 0.007). CONCLUSIONS: At 19 years of
followup SWL for renal and proximal ureteral stones was associated with the
development of hypertension and diabetes mellitus. The incidence of these
conditions was significantly higher than in a cohort of conservatively treated
patients with nephrolithiasis.

PMID: 16600747 [PubMed - indexed for MEDLINE]

505: J Urol. 2006 May;175(5):1737-41; discussion 1741.

Comment in:
    J Urol. 2007 Jan;177(1):405.

Transcutaneous electrical nerve stimulation: an effective treatment for pain
caused by renal colic in emergency care.

Mora B, Giorni E, Dobrovits M, Barker R, Lang T, Gore C, Kober A.

Department of Anesthesia and Intensive Care, University of Vienna, Vienna,
Austria.

PURPOSE: Acute renal colic is one of the most anguishing forms of pain in humans.
We hypothesized that TENS is an effective pain treatment in patients with acute
renal colic. MATERIALS AND METHODS: A total of 100 patients with acute flank pain
and suspected renal colic consented to participate in our study. Paramedic 1
recorded baseline parameters at the emergency site and at the end of
transportation. Paramedic 2 performed TENS in patients randomly assigned to G1
with actual TENS or to G2 with sham TENS. Pain and anxiety were measured using
paper based visual analog scales on a scale of 0 to 100 mm. RESULTS: Of 100
screened patients 73 had renal colic, including 39 in G1 and 34 in G2. There was 
no significant difference with regard to potentially influencing factors, such as
patient age, sex, weight, height, blood pressure and heart rate, pain, nausea and
anxiety between the groups before treatment. G1 showed a significant mean pain
decrease +/- SD of more than 50% (85.7 +/- 10.5 to 33.3 +/- 16.0 mm, p <0.01). G2
showed no variation in mean pain scores (85.8 +/- 18.0 to 82.6 +/- 14.3 mm). G1
showed changes in the mean anxiety score (69.0 +/- 8.4 to 37.7 +/- 15.1 mm, p
<0.01), nausea score (90.7 +/- 9.2 to 44.9 +/- 22.0 mm) and heart rate (92 +/- 10
to 64 +/- 8 bpm), while G2 showed nonsignificant changes. CONCLUSIONS: This trial
shows that local TENS is a rapid and effective treatment for renal colic pain. We
found TENS to be a good nondrug therapy under the difficult circumstances of out 
of hospital rescue.

Publication Types: 
    Randomized Controlled Trial

PMID: 16600745 [PubMed - indexed for MEDLINE]

506: J Urol. 2006 May;175(5):1725-30; discussion 1730.

Alternate or additional findings to stone disease on unenhanced computerized
tomography for acute flank pain can impact management.

Hoppe H, Studer R, Kessler TM, Vock P, Studer UE, Thoeny HC.

Institute of Diagnostic Radiology, University of Bern, Bern, Switzerland.

PURPOSE: We evaluated the incidence and clinical relevance of alternate or
additional findings on unenhanced CT in patients with acute flank pain and
suspected urinary calculi. MATERIALS AND METHODS: A consecutive series of 1,500
patients underwent unenhanced CT due to acute flank pain. The absence or presence
of urinary tract calculi and their localization were recorded. Alternate or
additional CT findings were classified according to whether they required
immediate or deferred treatment, or were of little or no clinical importance.
RESULTS: Of the 1,500 patients 1,035 (69%) had urinary tract calculi, including
309 (30%) with nephrolithiasis, 377 (36%) with ureterolithiasis and 349 (34%)
with the 2 conditions. Urolithiasis alone was found in 331 of these patients
(32%) and additional pathological conditions were noted in 704 (68%). Of all
patients 1,064 (71%) had other or additional CT findings. Of all patients 207
(14%) had nonstone related CT findings requiring immediate or deferred treatment,
464 (31%) had pathological conditions of little clinical importance and 393 (26%)
had pathological conditions of no clinical relevance. CT was normal in 105 of all
patients (7%). CONCLUSIONS: Unenhanced CT in patients with acute flank pain
allows the accurate diagnosis of urinary stone disease and it can also provide
further important information leading to emergency or deferred treatment in a
substantial number of patients.

PMID: 16600742 [PubMed - indexed for MEDLINE]

507: J Urol. 2006 May;175(5):1720-4; discussion 1724.

Comment in:
    J Urol. 2006 May;175(5):1602-3.

Endoscopic evidence of calculus attachment to Randall's plaque.

Matlaga BR, Williams JC Jr, Kim SC, Kuo RL, Evan AP, Bledsoe SB, Coe FL,
Worcester EM, Munch LC, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, Indianapolis, Indiana 46202, USA.

PURPOSE: It has been proposed that calcium oxalate calculi begin as small stones 
attached to the renal papillae at sites of Randall's plaque. However, no study
has investigated the prevalence of attached stones in calcium oxalate stone
formers or the relationship between stone attachment site and Randall's plaque.
In this study we used endoscopic examination of renal papillae in stone formers
undergoing percutaneous nephrolithotomy to investigate both issues. MATERIALS AND
METHODS: Idiopathic calcium oxalate stone formers undergoing PNL for stone
removal were enrolled in this study. Multiple papillae were examined and images
were recorded by digital video. The presence or absence of papillary plaque and
attached stones was noted, as was the site of stone attachment. RESULTS: In 23
patients, 24 kidneys and 172 renal papillae were examined. All kidneys were found
to have papillary plaque and 11 of the patients had attached stones. Most
papillae (91%) contained plaque. CONCLUSIONS: The prevalence of attached stones
in calcium oxalate stone formers (48%) is greater than that previously reported
for the general population. Attachment appears to be on Randall's plaque. The
high prevalence of attached stones and the appearance of the attachment site are 
consistent with a mechanism of calcium oxalate stone formation in which stones
begin as plaque overgrowth.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16600740 [PubMed - indexed for MEDLINE]

508: J Urol. 2006 May;175(5):1716-9; discussion 1719.

Comment in:
    J Urol. 2006 May;175(5):1602-3.

Changing composition of renal calculi in patients with neurogenic bladder.

Matlaga BR, Kim SC, Watkins SL, Kuo RL, Munch LC, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, Indianapolis, Indiana 46202, USA.

PURPOSE: Renal calculi are a significant source of morbidity for patients with
neurogenic bladder. Calculi from patients with NB have traditionally been
composed primarily of struvite and carbonate apatite secondary to chronic
urea-splitting bacteriuria. In the current era there have been great improvements
in the urological rehabilitation of patients with NB. We defined the composition 
of renal calculi in a contemporary cohort of patients with NB due to spinal cord 
injury or myelomeningocele who underwent percutaneous nephrolithotomy. MATERIALS 
AND METHODS: We performed a retrospective evaluation of all patients with NB due 
to SCI or MM who underwent PNL between January 2002 and January 2005. RESULTS: A 
total of 32 patients with NB (14 with SCI, 18 with MM) underwent PNL in this
period. Stones were infectious in etiology in 37.5% (12 struvite/carbonate
apatite) and metabolic in 62.5% (1 uric acid, 2 calcium oxalate monohydrate, 2
brushite, 6 hydroxyapatite, 9 mixed hydroxyapatite/calcium oxalate). All patients
with struvite calculi were infected with urea-splitting bacteria on preoperative 
urine culture. CONCLUSIONS: Patients with neurogenic bladder are traditionally
thought to harbor infection related calculi. These data demonstrate that many
contemporary patients will be found to have calculi of a metabolic etiology.
Although patients with NB still have renal calculi, advances in urological
treatment may have affected the composition of their calculi, as metabolic stones
are becoming more commonly identified. When metabolic components are identified, 
stone activity may be attenuated with appropriate metabolic evaluation,
pharmacological therapies and dietary modifications.

PMID: 16600738 [PubMed - indexed for MEDLINE]

509: J Am Soc Nephrol. 2006 May;17(5):1422-8. Epub 2006 Apr 5.

Urine composition in type 2 diabetes: predisposition to uric acid
nephrolithiasis.

Cameron MA, Maalouf NM, Adams-Huet B, Moe OW, Sakhaee K.

Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, 5323
Harry Hines Boulevard, Dallas, TX 75390-8885, USA.
maryann.cameron@utsouthwestern.edu

Type 2 diabetes is a risk factor for nephrolithiasis in general and has been
associated with uric acid stones in particular. The purpose of this study was to 
identify the metabolic features that place patients with type 2 diabetes at
increased risk for uric acid nephrolithiasis. Three groups of individuals were
recruited for this outpatient study: patients who have type 2 diabetes and are
not stone formers (n = 24), patients who do not have diabetes and are uric acid
stone formers (UASF; n = 8), and normal volunteers (NV; n = 59). Participants
provided a fasting blood sample and a single 24-h urine collection for stone risk
analysis. Twenty-four-hour urine volume and total uric acid did not differ among 
the three groups. Patients with type 2 diabetes and UASF had lower 24-h urine pH 
than NV. Urine pH inversely correlated with both body weight and 24-h urine
sulfate in all groups. Urine pH remained significantly lower in patients with
type 2 diabetes and UASF than NV after adjustment for weight and urine sulfate (P
< 0.01). For a given urine sulfate, urine net acid excretion tended to be higher 
in patients with type 2 diabetes versus NV. With increasing urine sulfate, NV and
patients with type 2 diabetes had a similar rise in urine ammonium, whereas in
UASF, ammonium excretion remained unchanged. The main risk factor for uric acid
nephrolithiasis in patients with type 2 diabetes is a low urine pH. Higher body
mass and increased acid intake can contribute to but cannot entirely account for 
the lower urine pH in patients with type 2 diabetes.

Publication Types: 
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16597681 [PubMed - indexed for MEDLINE]

510: Nephrol Dial Transplant. 2006 Jul;21(7):1870-5. Epub 2006 Apr 4.

Factors increasing the risk for stone formation in adult patients with cystic
fibrosis.

Terribile M, Capuano M, Cangiano G, Carnovale V, Ferrara P, Petrarulo M,
Marangella M.

Department of Nephrology and Renal Stone Centre, Pellgrini Hospital Napoli,
Italy. maurizio.terribile@fastwebnet.it

BACKGROUND: Patients with cystic fibrosis (CF) are at high risk of
nephrolithiasis (NL), but controversy still exists in terms of causes, including 
low urine output, hypercalciuria, hyperoxaluria, hyperuricosuria and
hypocitraturia. Moreover, heterozygotes (H-CF), which may exhibit altered renal
concentrating and diluting ability, have never studied so far. We, therefore,
evaluated the metabolic and physicochemical data of adult CF and H-CF patients,
comparing them to controls (C). METHODS: Twenty-nine CF patients (16 females,
aged 28.4 +/- 7.1 years), 20 H-CF (12 females, aged 58.6 +/- 6.3 years) and 30 C 
(19 females, aged 39.1 +/- 11.5 years) underwent kidney ultrasound and metabolic 
evaluation to assess stone risk profile. RESULTS: There was a 21% prevalence of
NL in CF vs 15% in H-CF. The CF group had elevated uric acid, but no other
serological differences compared with the H-CF and C group. Conversely, the
citrate and oxalate content in the urine differed significantly, being lower and 
higher, respectively. These changes held after correction for urine creatinine.
Consequently, urine specimens were more supersaturated with calcium oxalate,
despite exhibiting no differences for other relevant constituents. Uric acid
increased only after normalization for the body weight and urine creatinine.
Lower urine volume and more acidic pH produced mild supersaturation with uric
acid in samples from CF, while urine from both H-CF and C remained
undersaturated. H-CF had only minor increases in both urine oxalate and calcium
oxalate supersaturation. CONCLUSIONS: This study confirms a high prevalence of
kidney stones among CF patients associated with supersaturated urine. Their
longer survival justifies diets and/or medications aimed at reducing the risk of 
forming stones.

PMID: 16595587 [PubMed - indexed for MEDLINE]

511: Urology. 2006 Apr;67(4):812-6. Epub 2006 Mar 29.

Pediatric kidney stones: long-term outcomes.

Schwarz RD, Dwyer NT.

IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
robert.schwarz@iwk.nshealth.ca

OBJECTIVES: To determine the specific risks for recurrent stone disease and which
initial evaluations resulted in an effective reduction of risk, we undertook a
long-term follow-up study of children who had experienced upper tract urinary
stones. METHODS: Identified patients were contacted and interviewed using a
structured questionnaire. The patient data were subcategorized and analyzed.
RESULTS: The results demonstrated that our population had a recurrence rate
similar to the reported adult stone recurrence rates. No evidence was found of
impaired growth or development. Our population of noncircumcised boys did not
demonstrate a high risk of struvite stones. Surgical techniques have evolved.
Anatomic and metabolic factors were not a predictor of an adverse risk of
recurrence. Cystinuria may carry extra risk, although our numbers were not
sufficient to be sure. CONCLUSIONS: Extensive metabolic screening of children
with upper tract urinary stones is not supported by the data from our patients.
Testing for cystinuria is justified. The principles of screening and surveillance
should match the recommended care of adults with stone formation.

PMID: 16566973 [PubMed - indexed for MEDLINE]

512: Kidney Int. 2006 May;69(9):1586-92.

Effect of cinacalcet on urine calcium excretion and supersaturation in genetic
hypercalciuric stone-forming rats.

Bushinsky DA, Laplante K, Asplin JR.

Nephrology Division, Department of Medicine, University of Rochester School of
Medicine, Rochester, New York, USA. David_Bushinsky@URMC.Rochester.edu

Idiopathic hypercalciuria is the most common metabolic abnormality in patients
with nephrolithiasis. Through successive inbreeding, we have developed a strain
of rats whose urine calcium (UCa) excretion is approximately 8-10-fold greater
than that of control rats and who spontaneously form kidney stones. We have
termed these rats genetic hypercalciuric stone-forming (GHS) rats. The physiology
of the hypercalciuria in the GHS rats closely parallels that of man. We have
recently shown that the GHS rat kidneys have an increased number of receptors for
calcium (CaR) compared to Sprague-Dawley rats, the strain of rats originally bred
to develop the GHS rats. Calcimimetics, such as cinacalcet (Cin), increase the
sensitivity of the CaR to Ca. The effects of Cin on UCa are complex and difficult
to predict. We tested the hypothesis that Cin would alter urinary (U) Ca and
supersaturation with respect to calcium hydrogen phosphate (CaHPO(4)) and calcium
oxalate (CaOx). GHS or control rats were fed a normal Ca diet (0.6% Ca) for 28
days with Cin (30 mg/kg/24 h) added to the diet of half of each group for the
last 14 days. The protocol was then repeated while the rats were fed a low Ca
(0.02% Ca) diet. We found that Cin led to a marked reduction in circulating
parathyroid hormone and a modest reduction in serum Ca. Cin did not alter UCa
when the GHS rats were fed the normal Ca diet but lowered UCa when they were fed 
the low Ca diet. However, Cin did not alter U supersaturation with respect to
either CaOx or CaHPO(4) on either diet. If these findings in GHS rats can be
confirmed in man, it suggests that Cin would not be an effective agent in the
treatment of human idiopathic hypercalciuria and resultant stone formation.

Publication Types: 
    Research Support, N.I.H., Extramural

PMID: 16557225 [PubMed - indexed for MEDLINE]

513: Urol Res. 2006 Apr;34(2):92-5. Epub 2006 Jan 28.

The riddle of kidney stone disease: lessons from Africa.

Rodgers A.

Department of Chemistry, University of Cape Town, Cape Town, 7701, South Africa. 
allenr@science.uct.ac.za

Urolithiasis has not been extensively researched in the African continent due to 
a general lack of facilities and resources. Consideration of the few published
papers indicates that there are some regions where the occurrence of stones is
extremely rare. South Africa is unique in two respects. Firstly, it has both
stone-prone and stone-free population groups and secondly, it is an African
country in which a fair amount of research has been conducted in this field.
These studies have shown that routine urine parameters cannot explain stone
rarity, but that structural differences of inhibitory urinary proteins appear to 
be important. Similarly, the studies have demonstrated that common dietary
components cannot necessarily be correlated with urine composition, particularly 
oxaluria, nor can they necessarily explain stone rarity, but that the role of
oxalate-degrading bacteria has the potential to offer explanatory insights. By
investigating the factors influencing stone rarity, those affecting stone
formation have been concomitantly scrutinized. As a result, it is suggested that 
a paradigm shift from a focus on pathology to one on physiology is needed in
urolithiasis research in general.

Publication Types: 
    Review

PMID: 16555110 [PubMed - indexed for MEDLINE]

514: Surg Laparosc Endosc Percutan Tech. 2006 Feb;16(1):47-8.

Colonic perforation complicating percutaneous nephrolithotomy.

Nouira Y, Nouira K, Kallel Y, Feki W, Horchani A.

Department of Urology, La Rabta Hospital, Tunis, Tunisia. nouirayassine@gnet.tn

A case of colonic perforation complicating percutaneous nephrolithotomy in a
64-year-old woman is reported. Nonoperative management was successful with the
creation of a controlled colocutaneous fistula by pulling the nephrostomy tube
back from the kidney to the colon and the use of an elemental diet and
antibiotics. Internal urinary drainage was not necessary.

Publication Types: 
    Case Reports

PMID: 16552381 [PubMed - indexed for MEDLINE]

515: Korean J Radiol. 2006 Jan-Mar;7(1):50-6.

The "mini-perc" technique of percutaneous nephrolithotomy with a 14-Fr peel-away 
sheath: 3-year results in 72 patients.

Sung YM, Choo SW, Jeon SS, Shin SW, Park KB, Do YS.

Department of Radiology and Center for Imaging Science, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul, Korea.

OBJECTIVE: To assess the efficacy and safety of a "mini-perc" technique of
percutaneous nephrolithotomy using a 14-Fr peel-away sheath for the removal of
pyelocaliceal stones, and to determine appropriate inclusion criteria. MATERIALS 
AND METHODS: From July 1999 to June 2002, the medical records and radiographic
images of 72 patients who underwent the "mini-perc" technique of percutaneous
nephrolithotomy with a 14-Fr peel-away sheath, were reviewed to determine
clinical history, stone characteristics, immediate stone free rate, final stone
free rate after additional procedures, complications, and hospital stay. We also 
analyzed the effect of the longest stone diameter, the cumulative longest
diameter of stones, the cumulative stone burden, and the stone density on the
immediate stone free rate using a Fisher exact test. RESULTS: The only major
complication, arterial bleeding, occurred in a patient with Child A liver
cirrhosis and was successfully treated by embolization with coils and a gelatin
sponge. The immediate stone free rate was 80.6 %, which was significantly
influenced by stone diameter but not stone density. The mean hospital stay after 
the procedure was 3.97 days. CONCLUSION: The "mini-perc" technique of
percutaneous nephrolithotomy, which uses the 14-Fr peel-away sheath, is a safe
and effective modality for treating renal calculi.

Publication Types: 
    Clinical Trial

PMID: 16549956 [PubMed - indexed for MEDLINE]

516: J Endourol. 2006 Mar;20(3):194-8.

Initial experience with hemostatic fibrin glue as adjuvant during tubeless
percutaneous nephrolithotomy.

Shah HN, Kausik V, Hedge S, Shah JN, Bansal MB.

R.G. Stone Urological Research Institute, Mumbai, India.
drhemendrashah@yahoo.co.in

PURPOSE: To report our initial experience with hemostatic fibrin glue as an
adjuvant during tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND
METHODS: Seventeen consecutive patients underwent tubeless PCNL with injection of
2 mL of Tisseel Vapor Heated Sealant (Baxter AG, Vienna, Austria) into the
percutaneous tracts at the conclusion of the procedure. The perioperative
outcomes of these patients were compared retrospectively with those of a control 
group of 25 consecutive patients who underwent tubeless PCNL without the use of
fibrin glue. The safety and efficacy of the new approach was evaluated by
comparing operative time, hemoglobin drop, transfusion requirement, length of
hospitalization, postoperative pain, analgesic use, and postoperative
complications in the two groups. RESULTS: There was no difference in the mean
drop in hemoglobin, transfusion requirement, or complications in the two groups. 
However, patients undergoing Tisseel tubeless PCNL required less analgesia
postoperatively (P=0.05), and they were discharged an average of 7 hours earlier 
than the patients in the control group. There were no major postoperative
complications. CONCLUSIONS: Use of fibrin glue was safe and was associated with
less analgesic requirement and a shorter hospital stay. Randomized studies are
needed to evaluate its clinical role in the future.

Publication Types: 
    Comparative Study

PMID: 16548728 [PubMed - indexed for MEDLINE]

517: J Endourol. 2006 Mar;20(3):175-8.

Pre-percutaneous nephrolithotomy opacification for caliceal diverticular calculi.

Matlaga BR, Kim SC, Watkins SL, Munch LC, Chan BW, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, Indiana Kidney Stone Institute, Indianapolis, Indiana 46202, USA.

Caliceal diverticula harbor calculi in as many as 50% of cases. Such stones
rarely pass spontaneously. Various stone-removal techniques have been used, with 
percutaneous techniques generally having the best results. In patients with
nonradiopaque stones or in whom the diverticulum does not opacify when contrast
is instilled retrograde or by intravenous urogram, contrast can be instilled
directly into the cavity with CT or ultrasound guidance. Three such cases are
described, with good results.

Publication Types: 
    Case Reports
    Review

PMID: 16548723 [PubMed - indexed for MEDLINE]

518: BJU Int. 2006 Apr;97(4):790-3.

Risk factors for urinary stone formation in men with spinal cord injury: a
17-year follow-up study.

Ku JH, Jung TY, Lee JK, Park WH, Shim HB.

Department of Urology, Seoul Veterans Hospital, 6-2 Doonchon-2-dong, Kangdong-gu,
Seoul 134-791, Korea.

OBJECTIVE: To establish hazard ratios for risk of urinary stone formation in men 
with chronic spinal cord injury. PATIENTS AND METHODS: In all, 140 men injured
before 1987 were eligible for this investigation and were followed yearly from
January 1987 and December 2003. RESULTS: Over the 17 years, 39 patients (28%) and
21 (15%) were diagnosed with bladder and renal stones for a total of 59 and 25
episodes, respectively. In multivariate analysis, bladder stone was more common
in patients injured when aged > or = 24 years than in those injured when aged <24
years (odds ratio 2.5; 95% confidence interval 1.1-5.7; P = 0.03). In another
model, patients with complete injury had a greater risk of renal stone formation 
than those with incomplete injury (4.1, 1.3-12.9; P = 0.016). Renal stone was
more common for patients with urethral catheterization than for those voiding
spontaneously (5.7, 1.3-24.6, P = 0.021) and for patients with bladder stone than
for those without (4.7, 1.5-15.1; P = 0.01). CONCLUSION: Injury characteristics
are important for the development of urinary stone in chronic traumatic spinal
cord injury. In addition, the present findings suggest that in men who cannot use
intermittent catheterization or when the bladder cannot empty spontaneously,
suprapubic cystostomy is better than urethral catheterization to avoid renal
stone formation.

PMID: 16536775 [PubMed - indexed for MEDLINE]

519: J Med Assoc Thai. 2005 Oct;88(10):1426-9.

Percutaneous nephrolithotomy (PCNL) in kidneys with fusion and rotation
anomalies.

Lojanapiwat B.

Division of Urology, Department of Surgery, Chiang Mai University, Chiang Mai
50200, Thailand.

OBJECTIVES: Fusion and rotation anomalies are among the most common anomalies of 
the kidneys especially the horseshoe kidneys that have abnormal mixtures of
malrotation, ectopia and fusion. Percutaneous nephrolithotomy (PCNL) in horseshoe
kidney and malrotation kidney is challenging. We report PCNL in 10 horseshoe
kidneys and 4 kidneys with congenital malrotation. MATERIAL AND METHOD: PCNL was 
done in 14 kidneys of 12 patients who had horseshoe kidneys (6 patients) and
malrotation kidneys (4 patients). Two patients with horseshoe kidney had
bilateral calculi. One patient had simultaneous PCNL. Upper pole access was done 
in 12 kidneys under fluoroscopic guidance with modified PCNL technique. Tubeless 
PCNL was done in 7 kidneys. RESULTS: Stone-free rate was 86% and the fragment of 
stones less than 4 mm was 14%. Only minimal pleural effusion was found in one
patient that no intervention was needed. Average hospital stay was 3.3 days.
CONCLUSION: Percutaneous nephrolithotomy (PCNL) in horseshoe kidney and
malrotation kidney is effective and a safe method in wish only a minor modified
technique is needed. Upper pole access was used in most of the cases. No
increasing of the complications of PCNL in horseshoe kidneys and malrotion
kidneys is found comparing to the same procedure done in the normal kidney.

PMID: 16519390 [PubMed - indexed for MEDLINE]

520: Urol Res. 2006 Jun;34(3):215-21. Epub 2006 Mar 4.

Factors affecting the success rate of extracorporeal shock wave lithotripsy for
renal calculi in children.

Tan MO, Kirac M, Onaran M, Karaoglan U, Deniz N, Bozkirli I.

Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey.
mozgurtan@yahoo.com

The aim of the study was to analyse factors affecting the success rate of
extracorporeal shock wave lithotripsy (ESWL) in children with renal calculi. We
performed a retrospective analysis reviewing records of 85 (40 female, 45 male)
children (89 renal units) subjected to ESWL for treatment of renal calculi during
1990-2005 in our department. As 4 patients had bilateral calculi and 19 children 
(21 renal units) had renal stones at more than one different site, each location 
was analysed separately for convenience. The mean age of the patients was
10.3+/-4.6 (2-16) years. The stone-free rates for renal pelvis, lower, middle and
upper caliceal calculi were 70, 62, 50 and 73%, respectively. A higher rate (33%)
of insignificant fragments (< or = 4 mm) was noted for lower pole calculi.
Increased stone diameter (P=0.0001) and burden (P=0.04) were found as the most
significant factors that adversely affect the stone-free rate for pelvis renalis 
calculi, whereas an acutely oriented infundibulum and/or a long lower
infundibulum (P=0.005) were unfavourable factors for clearance of lower caliceal 
stones. The stone-free rate in children with multiple calculi was 48%, while 29% 
of the renal units had retained fragments. ESWL is a good initial option for
treatment of most of the renal calculi < 2 cm except in the presence of
unfavourable lower caliceal anatomy. Increased stone burden, multiple stones,
staghorn calculi, narrow lower infundibulopelvic angle and long lower
infundibulum are factors that adversely affect the clearance rate.

PMID: 16518619 [PubMed - indexed for MEDLINE]

521: Kidney Int. 2006 Feb;69(4):760-4.

Renal stone epidemiology in Rochester, Minnesota: an update.

Lieske JC, Peña de la Vega LS, Slezak JM, Bergstralh EJ, Leibson CL, Ho KL,
Gettman MT.

Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo
Clinic, Rochester, Minnesota 55905, USA. Lieske.John@mayo.edu

Studies in Western countries have suggested an increasing incidence of
nephrolithiasis (NL) in the latter part of the 20th century. Therefore, we
updated NL epidemiology data for the Rochester population over the years
1970-2000. All Rochester residents with any diagnostic code that could be linked 
to NL in the years of 1970, 1980, 1990, and 2000 were identified, and the records
reviewed to determine if they met the criteria for a symptomatic kidney stone as 
defined in a previous Rochester, MN study. Age-adjusted incidence (+/-s.e.) of
new onset symptomatic stone disease for men was 155.1 (+/-28.5) and 105.0
(+/-16.8) per 100,000 per year in 1970 and 2000, respectively. For women, the
corresponding rates were 43.2 (+/-14.0) and 68.4 (+/-12.3) per 100,000 per year, 
respectively. On average, rates for women increased by about 1.9% per year
(P=0.064), whereas rates for men declined by 1.7% per year (P=0.019). The overall
man to woman ratio decreased from 3.1 to 1.3 during the 30 years (P=0.006).
Incident stone rates were highest for men aged 60-69 years, whereas for women,
they plateaued after age 30. Therefore, since 1970 overall NL incidence rates in 
Rochester have remained relatively flat. However, NL rates for men have declined,
whereas rates for women appear to be increasing. The reasons remain to be
determined.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 16518332 [PubMed - indexed for MEDLINE]

522: J Urol. 2006 Apr;175(4):1370-3; discussion 1373-4.

Does a slower treatment rate impact the efficacy of extracorporeal shock wave
lithotripsy for solitary kidney or ureteral stones?

Chacko J, Moore M, Sankey N, Chandhoke PS.

Departments of Surgery and Medicine, University of Colorado Health Sciences
Center and Kidney Stone Center of the Rocky Mountains, Denver, Colorado, USA.

PURPOSE: We compared the efficacy of an SR (70 to 80 shocks per minute) and an FR
(120 shocks per minute) for ESWL for solitary stones less than 2 cm located in
the kidney or proximal ureter. MATERIALS AND METHODS: A total of 349 patients
with a solitary, radiopaque kidney or ureteral stone underwent ESWL on a DoLi(R) 
50 lithotriptor. Patients were grouped based on stone size, stone location and
whether SR or FR treatment was performed. Of the 349 patients 135 had a renal
stone between 1and 2 cm, 137 had a renal stone less than 1 cm and 77 had a
proximal ureteral stone with a surface area of between 30 and 90 mm. SFRs were
determined at approximately 1 month by plain x-ray of the kidneys, ureters and
bladder. RESULTS: In comparison to the FR groups SR groups required fewer shocks 
and had significantly lower power indexes. Of patients with renal stones between 
1 and 2 cm 24 of 52 (46%) in the FR group were stone-free compared to 56 of 83
(67%) in the SR group (p <0.05). For stones with a surface area of 30 to 90 mm
located in the kidney or proximal ureter there was a trend toward an improved SFR
in the SR group but differences between the SR and FR groups were not
statistically significant. CONCLUSIONS: For solitary renal stones between 1 and 2
cm an SR results in a better treatment outcome than an FR for ESWL. However, when
stone size is less than 1 cm, SFR differences in the SR and FR treatment groups
become less significant.

Publication Types: 
    Comparative Study

PMID: 16515999 [PubMed - indexed for MEDLINE]

523: J Endourol. 2006 Feb;20(2):157-60.

Association of urokinase gene 3'-UTR polymorphism with calcium oxalate
nephrolithiasis.

Mittal RD, Bid HK, Kumar A, Bhandari M.

Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
rmittl@sgpgi.ac.in

PURPOSE: Urokinase might play a role in the formation of kidney stones. The aim
of this study was to investigate the role of the urokinase gene in calcium
oxalate nephrolithiasis. SUBJECTS AND METHODS: A control group of 150 healthy
individuals having no history of stone formation (mean age 40 +/- 11.5 years) and
a group of 130 patients (mean age 40.5 +/- 10.5 years) with recurrent calcium
oxalate stones were examined. The C/T polymorphism of the urokinase gene was
detected using polymerase chain reaction (PCR)-based restriction analysis.
RESULTS: A marginally significant difference (P = 0.035) was found in the
distribution of the urokinase gene 3' untranslated region (UTR) C/T polymorphism 
between patients with stones and controls. The odds ratio for the risk of the T
allele in stone patients was 1.006 (95% CI 0.63-1.62). CONCLUSION: The T allele
of 3' UTR of the urokinase gene may not be associated with a higher risk of stone
formation.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16509805 [PubMed - indexed for MEDLINE]

524: J Endourol. 2006 Feb;20(2):102-6.

Effect of percutaneous nephrolithotripsy on renal function: assessment with
quantitative SPECT of (99m)Tc-DMSA renal scintigraphy.

Moskovitz B, Halachmi S, Sopov V, Burbara J, Horev N, Groshar D, Nativ O.

Department of Urology, Bnai Zion Medical Center, Technion, Institute of
Technology, Haifa, Israel. boaz.moskovitz@b-zion.org.il

PURPOSE: To measure the effect of PCNL on global and regional renal function
using quantitative single-photon emission CT (SPECT) measurement of
Tc-dimercaptosuccinic acid (DMSA) uptake by the kidneys (QDMSA). PATIENTS AND
METHODS: A series of 47 male and 41 female patients with a mean age of 47 +/- 16 
years were studied by sequential QDMSA examinations before and 1.5 to 24 months
after PCNL. Among the 67 patients (76%) in whom PCNL was performed using upper-
or lower-pole access, the function of the affected and nonaffected poles of the
treated kidney was calculated separately. RESULTS: There was no statistically
significant difference in the uptake by the treated kidneys before versus after
PCNL (11.9% +/- 5% v 11.6% +/- 5%; t = 0.9; P = 0.368). The total functional
volume of the treated kidney was slightly decreased, from 235 cc +/- 62 cc to 224
cc +/- 59 cc (t = 2.7; P = 0.011). The percent of the injected isotope dose per
cubic centimeter of tissue of the treated kidney was not affected (0.051 +/- 0.02
v 0.053 +/- 0.02; t = 0.86; P = 0.296). Regional assessment revealed a
statistically significant decrease in the functional volume at the PCNL port of
entry (91 cc +/- 30 cc v 82 cc +/- 27 cc; t = 2.64; P = 0.013). Regarding the
percent of the injected dose per cubic centimeter of renal tissue, no
statistically significant difference was found between the area of the kidney
that underwent PCNL and the untreated area of the same kidney (0.049 +/- 0.02 v
0.05 +/- 0.02; t = 0.693; P = 0.494). The function of the contralateral kidneys
remained unchanged (13.4% +/- 5.2% v 13.6% +/- 4.8%; t = 0.68; P = 0.5).
CONCLUSIONS: Despite the statistically significant decrease in the functional
volume of the surgically treated region, neither total percent uptake nor percent
of injected dose were reduced significantly. Further studies with long-term
follow-up of treated kidneys are required.

Publication Types: 
    Comparative Study

PMID: 16509791 [PubMed - indexed for MEDLINE]

525: Urology. 2006 Mar;67(3):513-7. Epub 2006 Feb 28.

Percutaneous nephrolithotomy for ectopic kidneys: over, around, or through.

Matlaga BR, Kim SC, Watkins SL, Kuo RL, Munch LC, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, Kidney Stone Institute, Indianapolis, Indiana, USA.

OBJECTIVES: The treatment of patients with complex urolithiasis in ectopic
kidneys can be challenging. Because the location of an ectopic kidney can vary,
each case requires a unique and, at times, unconventional approach. We reviewed
the techniques we have developed to treat such patients, including
laparoscopic-assisted tubeless, transhepatic, and transiliac percutaneous
nephrolithotomy (PNL). METHODS: We performed a retrospective analysis of all
patients with congenital pelvic kidneys who underwent PNL at our institution. Six
patients underwent laparoscopic-assisted PNL, one underwent transiliac PNL, and
one underwent transhepatic PNL. All laparoscopic-assisted procedures were
performed tubeless, with an internalized ureteral stent placed at the conclusion 
of the procedure. RESULTS: All patients underwent successful PNL. On computed
tomography, performed on the morning of postoperative day 1, all patients who
underwent laparoscopic-assisted PNL were stone free. The patients who underwent
transiliac PNL and transhepatic PNL required secondary procedures to attain a
stone-free status. The mean length of hospitalization was 3 days for the
laparoscopic-assisted cohort, 1 day for the transhepatic patient, and 3 days for 
the transiliac patient. CONCLUSIONS: For the patient with a large or complex
stone burden in an ectopic kidney, laparoscopic-assisted PNL is the optimal
treatment. Performing such a procedure tubeless may be associated with a reduced 
hospital stay. For those patients with a hostile peritoneal cavity owing to prior
surgical exploration, consideration should be given to a more individualized
approach.

PMID: 16504255 [PubMed - indexed for MEDLINE]

526: Cardiovasc Intervent Radiol. 2006 May-Jun;29(3):443-5.

Aortic stent-graft infection following septic complications of a kidney stone.

van den Berg HR, Leijdekkers VJ, Vahl A.

Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, HA, The
Netherlands. h.r.vandenberg@erasmusmc.nl

A 73-year-old man was treated because of a renal pelvis blowout of the left
kidney for which he received a nephrostomy catheter without antibiotic
prophylaxis. Almost a year previously this patient had undergone endovascular
repair of a symptomatic infrarenal abdominal aorta aneurysm. Four weeks after the
diagnosis and treatment of the ruptured renal pelvis, a new computed tomography
scan and ultrasound-guided fine needle aspiration confirmed the diagnosis of
infected aortic stent-graft. An extra-anatomic axillo-uniiliac bypass and graft
excision was performed. Two weeks after discharge the patient returned to the
hospital with an occlusion of his left renal artery and died of renal failure.
This is the first time an infected aortic stent-graft after a renal pelvis
blowout has been reported. Although infections of aortic stent-grafts occur
rarely, one should be aware of the possibility in aortic stent-graft patients
undergoing abdominal procedures without antibiotic prophylaxis.

Publication Types: 
    Case Reports

PMID: 16502167 [PubMed - indexed for MEDLINE]

527: Int Urol Nephrol. 2006;38(1):87-92.

Diagnostic and treatment patterns for renal colic in US emergency departments.

Brown J.

Department of Emergency Medicine, George Washington University, Washington DC
20037, USA. jbrown@mfa.gwu.edu

PURPOSE: To describe the epidemiology, imaging and treatment patterns of acute
renal colic in US emergency departments. MATERIALS AND METHODS: Data on 25,622
visits representing 108 million emergency department visits were obtained from
the 2000 National Hospital Ambulatory Medical Care Survey. Demographic and
clinical information are presented descriptively. RESULTS: There were a total of 
259 records representing 1,139,257 visits with a primary ED diagnosis of renal
calculus or colic. The majority of patients are young males, presenting with
moderate to severe flank pain. Patients received an average of two medications
from a pharmacopoeia of several dozen. The most commonly used medications were
ketorolac, promthiazine and morphine. Antibiotics were prescribed in over 20% of 
cases. Just under half of all patients had a radiographic test, and a similar
number had one or more blood tests. Fewer than 10% were admitted. CONCLUSIONS:
Renal colic is a common emergency department presentation and but there is
widespread variation in the type of ancillary testing obtained. Patients may not 
obtain those radiological tests required to ensure prompt urological follow-up.
Further work should be aimed at developing protocols for the emergent management 
of patients with renal colic.

PMID: 16502058 [PubMed - indexed for MEDLINE]

528: Int Urol Nephrol. 2006;38(1):79-85.

Renal anatomical factors for the lower calyceal stone formation.

Gozen AS, Kilic AS, Aktoz T, Akdere H.

Department of Urology, Trakya University School of Medicine, Edirne, Turkey.
asgozen@yahoo.com

PURPOSE: The pathogenesis of urolithiasis is mainly explained with metabolic
disorders. However metabolic disorders alone are not sufficient to explain this
pathology. In the present study the anatomical differences in the lower calyceal 
stone formers were examined on both the stone forming and contralateral normal
side. The objective was to assess the effect of lower pole renal anatomy on the
lower calyceal stone formation. MATERIALS AND METHODS: Between July 1999 and July
2004 39 patients with non-obstructed solitary lower pole stones were studied.
Mean age was 47.02 years. The anatomic factors were determined on intravenous
urograms (IVU). The renal length and width and the number of major and minor
calices were noted. Lower pole infundibular calyceal length (ICL) and width (IW),
lower infundibular length-to-width ratio were measured. The
infundibulo-ureteropelvic angle (IUPA) was measured by two methods using the
angle between infundibular and ureteral axes (IUPA-1), and between infundibular
and ureteropelvic axes (IUPA-2). We examined a new parameter: Renal longitudinal 
axis-infundibulum angle (RIA) for renal stone formation. RIA was determined
between two axes, including the axis connecting the central point of the pelvis
opposite the margins of inferior and superior renal sinus to midpoint of renal
axis and the longitudinal renal axis (Figure 2). The data of the stone forming
and non-stone forming contralateral side were compared. Statistical analysis was 
performed by paired-t-test. RESULTS: The IUPA-1 of the stone forming side was
more acute than the non-stone forming side, in 77% of cases. The UIPA-2 of the
stone forming side was more acute than the non-stone forming side, in 72% of
cases. The differences with both methods between the stone forming and
contralateral normal side were statistically significant (p < 0.05). Mean ICL of 
stone forming side was 30.20 mm whereas it was 25.51 mm in non-stone forming
contralateral side. The difference between mean ICL values was statistically
significant (p < 0.05). The mean infundibular length-to-width ratio was 8.55 +/- 
3.25 on the stone forming side and 7.09 +/- 2.90 on the non-stone forming
contralateral side. The difference between two groups was statistically
significant (p < 0.05). The differences in RIA, infundibular width (IW), renal
length, renal width and the number of major and minor calyces between stone
forming and non-stone forming contralateral side were not statistically
significant. CONCLUSION: Anatomical disorders of lower pole collecting system may
be considered as factors contributing to stone formation. IUPA (1 and 2), ICL and
ICL-to-IW ratio are significantly differing factors that might predispose to
lower calyceal stone formation.

PMID: 16502057 [PubMed - indexed for MEDLINE]

529: Int Urol Nephrol. 2006;38(1):75-8.

Laparoscopic assisted percutaneous nephrolithotomy (PCNL) in ectopic kidneys: two
different techniques.

Goel R, Yadav R, Gupta NP, Aron M.

Department of Urology, All India Institute of Medical Sciences, 110 029, New
Delhi, India.

Two patients presented with calculi in ectopic kidneys. Complete clearance of
calculi was achieved by laparoscopic assisted percutaneous nephrolithotomy
(PCNL), by different but related techniques. In one patient with prior history of
open pyelolithotomy, the anterior surface of the kidney was exposed by mobilizing
the overlying sigmoid colon laparoscopically and the percutaneous tract was
established into the desired calyx under combined laparoscopic and fluoroscopic
control. In the second patient, the tract was established between the major
mesenteric vessels without any mobilization of the bowel. Herein, we outline the 
nuances of these two related techniques, and the indications and
contraindications for their use for laparoscopic assisted PCNL in ectopic
kidneys.

Publication Types: 
    Case Reports

PMID: 16502056 [PubMed - indexed for MEDLINE]

530: Int Urol Nephrol. 2006;38(1):69-73.

Simple radiological indicators for staghorn calculi response to ESWL.

Murshidi MS.

Department of Urology, Jordan University Hospital, 11942, Amman, Jordan.
mujalli_mhailan@hotmail.com

OBJECTIVE: To evaluate staghorn calculi response to ESWL using simple
radiological indicators which are stone size, stone homogeneity, and stone
density. PATIENTS AND METHODS: This is a prospective study of 60 patients with
staghorn calculi where the majority had ESWL. The relationship between response
and size, homogeneity and density is studied. RESULTS: Single staghorn calculus
less than 4 cm, heterogeneous with stone density similar to bone or a little
denser than bone has best response to ESWL. CONCLUSION: ESWL is useful as first
line therapy for staghorn calculi less than 4 cm, heterogeneous with similar
density to bone or a little denser than bone.

PMID: 16502055 [PubMed - indexed for MEDLINE]

531: Int Urol Nephrol. 2006;38(1):63-7.

Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in 
the treatment of renal stones.

Al-Ansari A, As-Sadiq K, Al-Said S, Younis N, Jaleel OA, Shokeir AA.

Urology Department, Hamad Medical Corporation, Doha, Qatar.

OBJECTIVES: To evaluate the factors that affect the success rate of
extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones.
PATIENTS AND METHODS: Between January 2000 and December 2003, 427 patients with
single or multiple renal stones (< 30 mm, largest diameter) underwent ESWL
monotherapy using Storz SL 20 lithotriptor. The results of treatment were
evaluated after 3 months of follow-up. Treatment success was defined as complete 
clearance of the stones or presence of clinically insignificant residual
fragments < 4 mm. The success rate was correlated with the characteristics of the
patients, conditions of the urinary tract and stone features. RESULTS: At 3-month
follow-up, the overall success rate was 333/427 (78%). Repeat treatment was
needed in 226 patients (53.1%). Post-ESWL auxiliary procedures were required in
36 patients (8.4%). Post-ESWL complications were recorded in 16 patients (3.7%). 
Of the 10 prognostic factors studied, 5 had a significant impact on the success
rate, namely: renal morphology, congenital anomalies, stone size, stone site and 
number of treated stones. Other factors including age, sex, nationality, stone
nature (de novo or recurrent) and ureteric stenting had no significant impact on 
the success rate. CONCLUSIONS: The success rate of ESWL for the treatment of
renal stones could be predicted by stone size, location and number, radiological 
renal features and congenital renal anomalies.

PMID: 16502054 [PubMed - indexed for MEDLINE]

532: Neurourol Urodyn. 2006;25(3):252-8.

Changes in nitric oxide production in the rat kidney due to CaOx nephrolithiasis.

Huang HS, Ma MC, Chen CF, Chen J.

Department of Urology, National Taiwan University Hospital, Fu-Jen Catholic
University, Taipei, Taiwan.

AIMS: The aim of the study was to test the hypothesis that the renal nitric oxide
(NO) system is involved in the animal model of nephrolithiasis by evaluating the 
relationship between nitric oxide synthase (NOS) and oxidative stress. METHODS:
Deposition of renal calculi was induced by adding 0.75% ethylene glycol (EG) to
the drinking water of male Wistar rats. After 42 days of treatment, urinary
biochemistry and urinary levels of oxalate, NO metabolites (nitrate and nitrite),
cGMP, and lipid peroxides, and markers for renal damage and oxidative stress in
the kidney were examined. In the second part of the experiment, two diuretic
stimuli (intrarenal infusion of l-arginine or saline loading) were applied to
test the renal NO system response. Finally, levels of three isoforms of NOS in
renal tissues were evaluated by immunostaining. RESULTS: In the EG-treated rats, 
increased urinary excretion of enzymes and lipid peroxides and increased
nitrotyrosine levels and oxidative injury markers in the kidneys indicated that
peroxynitrite formation occurred during oxidative stress, while the 24-hr urinary
excretion of NO metabolites and cGMP remained unchanged. In contrast to control
rats, urinary excretion and NO metabolites and cGMP excretion were unresponsive
to intrarenal l-arginine infusion; in response to saline loading, an increase in 
these factors was seen, but the increase was only 50% of that seen in the
identically treated control group. A significant decrease in eNOS expression and 
increase in iNOS expression were observed in the renal medulla of the EG-treated 
group, whereas expression of nNOS was not affected. CONCLUSIONS: Although basal
renal NO production remained unchanged, excessive peroxynitrite formation in the 
kidney was noted in this model. A decreased response of the NOS system was noted 
when diuretic stimuli were applied. How the imbalance between eNOS and iNOS
expression influences CaOx stone formation requires detailed evaluation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16496394 [PubMed - indexed for MEDLINE]

533: Urol Res. 2006 Aug;34(4):283-7. Epub 2006 Feb 15.

Assessing the efficiency of extracorporeal shockwave lithotripsy for stones in
renal units with impaired function: a prospective controlled study.

Srivastava A, Sinha T, Karan SC, Sandhu AS, Gupta SK, Sethi GS, Talwar R, Narang 
V, Adlakha N, Agarwal A.

Department of Urology, Army Hospital (Research & Referral), Delhi Cantt, 110010, 
Delhi, India. annand_srivastava@yahoo.com

The objective was to determine the efficiency of extracorporeal shockwave
lithotripsy (ESWL) in clearing stones from renal units with impaired function.
Thirty-five patients with poorly functioning kidneys determined by intravenous
urogram and 99mtechnetium diethylene triamine pentacetic acid renal dynamic scan 
underwent ESWL. Stone clearance was assessed at 3 months and compared with that
in normally functioning kidneys. The study group was divided into two subgroups. 
Those with split glomerular filtration rate (GFR) of the concerned kidney between
10 and 20 ml/min were in group 1. Group 2 consisted of patients with split GFR
between 20 and 30 ml/min. A control group (group 3) was formed from patients with
urolithiasis and normally functioning kidneys. The overall retreatment rate was
84.4%. The overall stone clearance rate in the study group was 34.2% while it was
57.7% in the control group. The stone clearance rate in group 2 was 40%. The
difference in stone clearance rate between the study and control groups was
statistically significant (P=0.023) but that between group 2 and the control
group was not (P=0.159). The incidence of steinstrasse between the study group 2 
and control group was not statistically significant (P=0.408). The clearance rate
for ureteral stones was comparable in all the three groups. The stone-free rate
and rate of steinstrasse for renal stones in kidneys with moderately impaired
function were comparable to normally functioning kidneys. However, kidneys with
severely impaired function had poor results. The clearance rate for ureteral
stones was not influenced by the impairment of renal function.

Publication Types: 
    Controlled Clinical Trial

PMID: 16479390 [PubMed - indexed for MEDLINE]

534: Curr Opin Urol. 2006 Mar;16(2):100-5.

Management of stones in patients with anomalously sited kidneys.

Gross AJ, Fisher M.

Abteilung für Urologie, AK Barmbek, Hamburg, Germany. an.gross@asklepios.com

PURPOSE OF REVIEW: Congenital abnormities in urology are very common. Horseshoe, 
malrotated and ectopic kidneys, as well as duplex systems, are the most frequent 
in this respect. The combination of both abnormalities and stones is of clinical 
importance. The question is asked if standard procedures for stones apply also to
stones in abnormal kidneys. RECENT FINDINGS: In general, open surgery,
extracorporeal shock-wave lithotripsy, percutaneous procedures, endoscopic
procedures and laparoscopy are possible procedures in both normal and abnormal
kidneys. The importance of ureteric pelvic junction obstruction has to be taken
into account and a metabolic work-up remains important. SUMMARY: The trend for
treatment of stones in abnormal kidneys goes towards endoscopical and
laparoscopical procedures, whereas a combination of both seems to be appropriate 
in many cases.

Publication Types: 
    Review

PMID: 16479212 [PubMed - indexed for MEDLINE]

535: Urol Res. 2006 Apr;34(2):146-50. Epub 2006 Feb 14.

Stone analysis.

Schubert G.

Vivantes Klinikum im Friedrichshain, Institute of Laboratory Diagnostics, Urinary
Stone Laboratory, Landsberger Allee 49, 10249, Berlin, Germany.
gernot.schubert@vivantes.de

The definition and the frequencies of the components of urinary stones are
presented on the basis of more than 110,000 analyses. The stone morphologies are 
described. The methods of stone analysis X-ray diffraction, infrared spectroscopy
and polarization microscopy and the most recent developments are presented. The
benefits and disadvantages of different methods are compared. The results of ring
trials show that the X-ray diffraction method is the best method with regard to
correctness.

Publication Types: 
    Comparative Study
    Review

PMID: 16477427 [PubMed - indexed for MEDLINE]

536: Mol Cell Biochem. 2006 Mar;284(1-2):95-101. Epub 2006 Feb 14.

Oxalate mediated nephronal impairment and its inhibition by c-phycocyanin: a
study on urolithic rats.

Farooq SM, Ebrahim AS, Subramhanya KH, Sakthivel R, Rajesh NG, Varalakshmi P.

Department of Medical Biochemistry, Dr. A.L.M. Postgraduate Institute of Basic
Medical, Sciences, University of Madras, Taramani, Chennai, 600 113, India.

The assumption of oxidative stress as a mechanism in oxalate induced renal damage
suggests that antioxidants might play a beneficial role against oxalate toxicity.
An in vivo model was used to investigate the effect of C-phycocyanin (from
aquatic micro algae; Spirulina spp.), a known antioxidant, against calcium
oxalate urolithiasis. Hyperoxaluria was induced in two of the 4 groups of Wistar 
albino rats (n = 6 in each) by intraperitoneally injecting sodium oxalate (70
mg/kg body weight). A pretreatment of phycocyanin (100 mg/kg body weight) as a
single oral dosage was given, one hour prior to oxalate challenge. An untreated
control and drug control (phycocyanin alone) were employed. Phycocyanin
administration resulted in a significant improvement (p < 0.001) in the thiol
content of renal tissue and RBC lysate via increasing glutathione and reducing
malondialdehyde levels in the plasma of oxalate induced rats (p < 0.001),
indicating phycocyanin's antioxidant effect on oxalate mediated oxidative stress.
Administering phycocyanin after oxalate treatment significantly increased
catalase and glucose-6-phosphate dehydrogenase activity (p < 0.001) in RBC lysate
suggesting phycocyanin as a free radical quencher. Assessing calcium oxalate
crystal retention in renal tissue using polarization microscopy and renal
ultrastructure by electron microscopy reveals normal features in phycocyanin--
pretreated groups. Thus the study presents positive pharmacological implications 
of phycocyanin against oxalate mediated nephronal impairment and warrants further
work to tap this potential aquatic resource for its medicinal application.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16477383 [PubMed - indexed for MEDLINE]

537: Nat Clin Pract Urol. 2005 Jul;2(7):351-4; quiz 355.

Bilateral kidney stones with ureteropelvic junction obstruction.

Soylu A, Uğraş YM, Güneş A, Baydinç C.

Department of Urology, Inönü University Medical Faculty, Turgut Ozal Medical
Center, Malatya, Turkey. asoylu@inonu.edu.tr

BACKGROUND: A 56-year-old male with bilateral flank pain was admitted following
diagnosis of bilateral kidney stone disease. He had previously undergone four
separate pyelolithotomy sessions (two per kidney), the latest being 14 years
prior. At presentation the patient had two stones in the right kidney and seven
in the left kidney. The right renal pelvis was dilated, indicating obstruction of
the ureteropelvic junction. INVESTIGATIONS: Plain radiography, ultrasonography,
intravenous pyelography, retrograde ureteropyelography and spiral tomography.
DIAGNOSIS: Bilateral kidney stones and obstruction of the right ureteropelvic
junction. MANAGEMENT: Bilateral percutaneous nephrolithotomy and simultaneous
right endopyelotomy; intraoperative antegrade nephrogram; preoperative and
postoperative measurement of hemoglobin, blood urea nitrogen and creatinine;
postoperative nephrostograms, plain X-ray, diuretic renogram and intravenous
pyelography.

Publication Types: 
    Case Reports

PMID: 16474788 [PubMed - indexed for MEDLINE]

538: J Urol. 2006 Mar;175(3 Pt 1):1080-2; discussion 1082.

Ureteral access sheath for the management of pediatric renal and ureteral stones:
a single center experience.

Singh A, Shah G, Young J, Sheridan M, Haas G, Upadhyay J.

Department of Urology, Upstate Medical University, Syracuse, New York 13210, USA.

PURPOSE: Ureteral access sheaths were developed to facilitate difficult
ureteroscopic access in adults. We report our use of the ureteral access sheath
during standard ureteroscopic procedures in the pediatric stone population.
MATERIALS AND METHODS: Eight patients underwent flexible ureteroscopy and holmium
laser lithotripsy for symptomatic renal and ureteral calculi between October 2003
and October 2004. Average patient age was 9.3 years (range 4 to 13). There were 4
males and 4 females. Five of 8 patients had bilateral stones and underwent
bilateral endoscopic stone treatment at the same operation. A 14Fr 20 cm Flexor
ureteral access sheath was used for dilation and access of the ureter. Flexible
pediatric ureteroscope was used to enter the ureter and collecting system for
stone retrieval and fragmentation. RESULTS: All patients were rendered stone-free
in a single operative setting. Average operative time was 99 minutes (range 65 to
130). Average total stone burden for the group was 9 +/- 3 mm. All patients
received stents after the procedure. There were no perioperative complications.
All patients were followed with renal-bladder ultrasound and plain x-ray. All
patients were stone-free at a mean followup of 10 months (median 11).
CONCLUSIONS: Routine use of a ureteral access sheath in children facilitates
flexible ureteroscopy with lithotripsy of multiple renal and proximal ureteral
stones. The procedure is safe and time efficient, and is associated with minimal 
morbidity. Larger prospective studies in children with longer followup are
warranted.

PMID: 16469623 [PubMed - indexed for MEDLINE]

539: Urol Res. 2006 Apr;34(2):108-11. Epub 2006 Feb 7.

Management of lower pole renal calculi: shock wave lithotripsy versus
percutaneous nephrolithotomy versus flexible ureteroscopy.

Preminger GM.

The Comprehensive Kidney Stone Center, The Division of Urology, Department of
Surgery, Duke University Medical Center, Durham, NC, USA.
glenn.preminger@duke.edu

Current ureteroscopic intracorporeal lithotripsy devices and stone retrieval
technology allow for the treatment of calculi located throughout the intra-renal 
collecting system. Difficulty accessing lower pole calculi, especially when the
holmium laser fiber is utilized, is often encountered. Herein we review our
experience where lower pole renal calculi were ureteroscopically managed by
holmium laser fragmentation, either in situ, or by first displacing the stone
into a less dependent position with the aid of a nitinol stone retrieval device. 
Lower pole stones less than 20 mm can be primarily treated by ureteroscopic means
in patients: that are obese; have a bleeding diathesis; with stones resistant to 
shockwave lithotripsy (SWL); with complicated intra-renal anatomy; or as a
salvage procedure after failed SWL. Lower pole calculi are fragmented with a 200 
microm holmium laser fiber via a 7.5 F flexible ureteroscope. For those patients 
where the laser fiber reduced ureteroscopic deflection, precluding re-entry into 
the lower pole calyx, a 1.9 F nitinol basket is used to displace the lower pole
calculus into a more favorable position, thus allowing for easier fragmentation. 
A nitinol device passed into the lower pole, through the ureteroscope, for stone 
displacement cause only a minimal loss of deflection and no significant impact on
irrigation. Eighty-five percent of patients were stone free by IVP or CT scan
performed at 3 months. Ureteroscopic management of lower pole calculi is a
reasonable alternative to SWL or percutaneous nephrolithotomy (PNL) in patients
with low volume stone disease. If the stone cannot be fragmented in situ, nitinol
basket or grasper retrieval, through a fully deflected ureteroscope, allows for
repositioning of the stone into a less dependant position, thus facilitating
stone fragmentation.

Publication Types: 
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial

PMID: 16463145 [PubMed - indexed for MEDLINE]

540: Urol Res. 2006 Jun;34(3):222-4. Epub 2006 Feb 7.

Right renal stone on the trajectory of upper left ureter.

Ceylan K, Arslan H, Etlik O, Bayrakli H, Yilmaz Y.

Medical Faculty, Urology, Yüzüncü Yýl University, Van, Turkey.
drceylan26@yahoo.com

We report a 52-year-old woman with a right renal pelvic stone, mimicking a left
upper ureteral stone in a kidney-ureter-bladder film. Computed tomography
detected the exact anatomical location of the stone, which was not possible by
intravenous urography and ultrasonography. In this study, we discuss diagnostic
modalities of the urinary calculi in the light of the literature.

Publication Types: 
    Case Reports

PMID: 16463144 [PubMed - indexed for MEDLINE]

541: Urol Res. 2006 Jun;34(3):184-9. Epub 2006 Feb 4.

The effect of calcium channel blockers on stone regrowth and recurrence after
shock wave lithotripsy.

Sarica K, Inal Y, Erturhan S, Yağci F.

Department of Urology, Memorial Hospital, Istanbul, Turkey.
kemalsarica@superonline.com

We evaluated the possible effects of a calcium entry blocking agent "verapamil"
on new stone formation and/or regrowth of residual fragments after shock wave
lithotripsy (SWL) during long-term follow-up (>30 months) and compared the
results with the success rates of adequate fluid intake. A total of 70 patients
treated with SWL were randomly divided into three different groups, in the first 
two of which the patients received different preventive measures with respect to 
stone recurrence and/or regrowth. While 25 patients received a calcium channel
blocking agent, verapamil hydrochloride, beginning 3 days before SWL and
continued 4 weeks after the procedure, an additional 25 patients were put in an
enforced fluid intake program and the remaining 20 patients received no specific 
medication and/or measure apart from close follow-up. Patients were followed
regularly with respect to the clearance/regrowth of the residual fragments and
that of new stone formation during long-term follow-up (within a mean follow-up
of 30.4 months). The overall stone recurrence rate was 14% (10/70). Of the
patients who became stone free (12/25, 48%) in group I, only one patient (1/12,
8.3%) showed a new stone formation during long-term follow-up. The figure was 40%
(4/10) in group II patients and 55% (5/9) in group III patients receiving no
specific medication. Regarding the residual stone fragments (<5 mm) after SWL,
again high fluid intake was found to be the most effective on stone regrowth
rates (2/13, 15.3%). Patients treated with verapamil also had acceptable regrowth
rates (3/15, 20%). Finally, verapamil treatment significantly improved the
clearance of residual fragments; while 7 out of 15 patients with residual
fragments passed these particles successfully, (46.5%) in this group; these
figures were 46% (6/13) and 18% (2/13) in the remaining groups. Residual
fragments located in lower calyces demonstrated a poor clearance rate with higher
regrowth rates. Verapamil administration was found to be effective enough to
limit the regrowth of residual fragments and also to facilitate residual fragment
clearance after SWL. Patients receiving this medication seemed to pass the
retained fragments easily in a shorter time than the others.

Publication Types: 
    Randomized Controlled Trial

PMID: 16463053 [PubMed - indexed for MEDLINE]

542: Urology. 2006 Feb;67(2):392-3.

Ungated extracorporeal shock wave lithotripsy in children: an initial series.

Rhee K, Palmer JS.

Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case
Western Reserve University School of Medicine, Cleveland, Ohio, USA.

OBJECTIVES: Ungated extracorporeal shock wave lithotripsy (ESWL) is associated
with cardiac arrhythmias in adults. However, the incidence of arrhythmias in
children undergoing ungated ESWL has not been established. Therefore, we report
on the safety and efficacy of ungated ESWL of renal calculi in children. METHODS:
We evaluated all patients younger than 18 years of age who were undergoing
ungated ESWL of renal calculi. All patients were monitored for arrhythmias, along
with other standard monitoring, by the anesthesiologist. RESULTS: Eight
consecutive children (three boys and five girls) between 3.5 and 17 years of age 
(median 13.5) underwent 10 ESWL procedures for renal calculi. Of the 10 stones, 9
were located in the left kidney and 1 was located in the right kidney. The stone 
size ranged from 5 to 19 mm. Six patients underwent 3000 shocks and 2 patients
underwent 800 and 2200 shocks. All patients underwent lithotripsy with a gradual 
incremental energy increase from 17 to 24 kV, except for 1 child (maximum of 18
kV) because of the patient's age (3.5 years). No patient had cardiac arrhythmias 
or other intraoperative complications. No patient required conversion to gated
ESWL. The overall stone-free rate was 90.0% as determined by abdominal
radiography and renal/bladder ultrasonography. CONCLUSIONS: The results of this
initial series suggest that ungated ESWL is safe and efficacious in patients
younger than 18 years of age. Additional studies are warranted to evaluate
further the use of ungated ESWL in the pediatric population.

PMID: 16461092 [PubMed - indexed for MEDLINE]

543: Urol Res. 2006 Apr;34(2):157-61. Epub 2006 Feb 3.

Is prevention of stone recurrence financially worthwhile?

Robertson WG.

Head of Urinary Stone Management, Institute of Urology and Nephrology, 48 Riding 
House Street, W1W 7EY, London, UK. w.robertson@ucl.ac.uk

This review shows that the cost of relying solely on minimally-invasive
urological procedures for removing stones when patients return with recurrent
stones is considerable and is significantly greater that that incurred by
screening already proven recurrent stone-formers to identify the risk factors
that are causing their stones and then instituting prophylactic measures to
prevent stone recurrence. In the UK, at 1998 prices (when the original survey was
carried out) for every stone episode prevented, there is a potential saving of
almost 2,000 pound to the local Health Authority concerned. In spite of this,
many Health Authorities have taken the liberty to discontinue comprehensive stone
screening within the past 20 years under the mistaken supposition that
minimally-invasive techniques for removing stones have "solved the stone
problem". At UCLH in London where such a comprehensive scheme has been in place
for the past 8 years, savings of up to 250,000 pound per year can be made by
identifying the particular lifestyle as well as the epidemiological, metabolic
and nutritional risk factors involved in a given patient and then instituting
appropriate measures to prevent further stones.

Publication Types: 
    Review

PMID: 16456694 [PubMed - indexed for MEDLINE]

544: J Am Soc Nephrol. 2006 Mar;17(3):663-73. Epub 2006 Feb 1.

Prevention of lithotripsy-induced renal injury by pretreating kidneys with
low-energy shock waves.

Willis LR, Evan AP, Connors BA, Handa RK, Blomgren PM, Lingeman JE.

Department of Pharmacology and Toxicology, Indiana University School of Medicine,
and Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, IN
46202, USA. willisl@iupui.edu

Lithotripsy shock waves (SW) to one renal pole damage that pole but protect the
opposite pole from the damage inflicted by another, immediate application of SW. 
This study investigated whether the protection (1) occurs when the first
treatment causes no injury, (2) is caused by SW or injury, (3) exhibits a
threshold, and (4) occurs when the same pole receives both treatments. Six- to
7-wk-old anesthetized female pigs were studied. The following groups were
studied: group 1 (n=4), 2000 SW at 12 kV to one pole and 2000 SW at 24 kV
(standard) to the opposite pole; group 2 (n=6), same as group 1 except 500 12-kV 
SW pretreatment; group 3 (n=8), 500 12-kV, 2000 standard SW, all to the same
pole; and group 4 (n=8), same as group 3 except 100 12-kV SW pretreatment.
Mean+/-SD lesion size in group 1, first pole treated, was 0.66+/-0.82% of
functional renal volume (FRV; P<0.05 versus 5.22+/-3.6% FRV with no pretreatment 
[NP]; 95% confidence interval [CI] -7.0 to -2.1) and 0.50+/-0.68% FRV in the
opposite pole after 2000 standard SW (P<0.05 versus NP; 95% CI -9.4 to -0.08).
Mean lesion size (first pole) in group 2 was 0.020+/-0.028% FRV (P<0.01 versus
NP; 95% CI -9.2 to -1.2) and 0.43+/-0.54% FRV in the opposite pole after 2000
standard SW (P<0.05 versus NP; 95% CI -8.8 to -0.82). Same-pole SW (groups 3 and 
4) also protected. Mean lesion sizes were 0.28+/-0.33% (P<0.01 versus NP; 95% CI 
-8.0 to -1.9) in group 3 and 0.39+/-0.48% FRV (P<0.01 versus NP; 95% CI -8.2 to
-1.7) in group 4. It is concluded that the pretreatment protocol substantially
limits the renal injury that normally is caused by SWL and occurs when the
pretreatment and standard SW are applied to the same pole. The threshold for the 
protection may be <100 SW.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural

PMID: 16452495 [PubMed - indexed for MEDLINE]

545: Scand J Urol Nephrol. 2006;40(1):35-44.

Effect of acute acid loading on acid-base and calcium metabolism.

Osther PJ.

Department of Urology, Centre for Kidney Stones and Endourology, Fredericia and
Kolding Hospitals, Fredericia, Denmark. palle.osther@dadlnet.dk

OBJECTIVE: To investigate the acid-base and calcium metabolic responses to acute 
non-carbonic acid loading in idiopathic calcium stone-formers and healthy males
using a quantitative organ physiological approach. MATERIAL AND METHODS: Five-h
ammonium chloride loading studies were performed in 12 male recurrent idiopathic 
calcium stone-formers and 12 matched healthy men using a randomized,
placebo-controlled, cross-over design. Arterialized capillary blood, serum and
urine were collected hourly for measurement of electrolytes, ionized calcium,
magnesium, phosphate, parathyroid hormone and acid-base status. Concentrations of
non-metabolizable base (NB) and acid (NA) were calculated from measured
concentrations of non-metabolizable ions. RESULTS: The extracellular acid-base
status in the stone-formers during basal conditions and acid loading was
comparable to the levels in the healthy controls. The stone-formers tended to
have lower renal excretion rates of NA during acid loading; however, for a given 
degree of non-carbonic acidosis, controls and stone-formers excreted
approximately the same amount of NA in the urine, suggesting that the capacity of
tubular regeneration of NB was comparable in the two groups. Acid loading
resulted in significantly increased concentrations of ionized calcium in serum in
both controls and stone-formers. The increase in serum ionized calcium in
response to acid loading was, however, significantly higher in the calcium
stone-formers than in the healthy individuals. Acid loading resulted in massive
calciuria in both groups, with significantly higher urinary calcium excretion
rates in the stone-formers compared to the healthy subjects. Renal excretion
rates of NA correlated significantly with renal calcium excretion rates in both
groups. However, the stone-formers excreted significantly more calcium in the
urine at a given rate of renal NA excretion. CONCLUSIONS: The hypercalciuric and 
hypercalcaemic responses to loading with non-carbonic acid are more pronounced in
recurrent idiopathic calcium stone-formers than in healthy individuals. Acid
loading (i.e. protein ingestion) may contribute to disturbed bone metabolism in
idiopathic calcium nephrolithiasis as well as calcium stone formation.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 16452054 [PubMed - indexed for MEDLINE]

546: Lancet. 2006 Jan 28;367(9507):333-44.

Kidney stones: pathophysiology and medical management.

Moe OW.

Charles and Jane Pak Center of Mineral Metabolism and Clinical Research and
Department of Internal Medicine University of Texas Southwestern Medical Center, 
Dallas, TX 75390, USA. orson.moe@utsouthwestern.edu

The formation of stones in the urinary tract stems from a wide range of
underlying disorders. That clinicians look for the underlying causes for
nephrolithiasis is imperative to direct management. There are many advances in
genetics, pathophysiology, diagnostic imaging, medical treatment, medical
prevention, and surgical intervention of nephrolithiasis. Here, I provide a brief
general background and focus mainly on pathophysiology and medical treatment of
kidney stones. Although important advances have been made in understanding
nephrolithiasis from single gene defects, the understanding of polygenetic causes
of kidney stones is still largely elusive. A substantial proportion of data that 
resulted in new methods of treatment and prevention, which can be empirical or
definitive, has focused on urinary luminal chemical composition of the
precipitating solutes. Manipulation of inhibitors and epithelial factors is
important and needs further investigation. Advances in the management of
nephrolithiasis depend on combined efforts of clinicians and scientists to
understand the pathophysiology.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.
    Review

PMID: 16443041 [PubMed - indexed for MEDLINE]

547: Urol Nurs. 2005 Dec;25(6):451-7.

The role of diet in the prevention of common kidney stones.

Krieg C.

Methodist Urology, Indianapolis, IN, USA.

Current dietary recommendations for patients who form kidney stones are
discussed. Focusing on the most common kidney stone types, calcium oxalate and
uric acid, the rationale for dietary changes are described based on the renal and
urine physiology.

Publication Types: 
    Review

PMID: 16438250 [PubMed - indexed for MEDLINE]

548: Urol Nurs. 2005 Dec;25(6):427-48, 475, 449.

Urolithiasis/nephrolithiasis: what's it all about?

Colella J, Kochis E, Galli B, Munver R.

The Prostate Institute of The Cancer Center at Hackensack University Medical
Center, Hackensack, NJ, USA. USA.

Urolithiasis (urinary tract calculi or stones) and nephrolithiasis (kidney
calculi or stones) are well-documented common occurrences in the general
population of the United States. The etiology of this disorder is multifactorial 
and is strongly related to dietary lifestyle habits or practices. Proper
management of calculi that occur along the urinary tract includes investigation
into causative factors in an effort to prevent recurrences. Urinary calculi or
stones are the most common cause of acute ureteral obstruction. Approximately 1
in 1,000 adults in the United States are hospitalized annually for treatment of
urinary tract stones, resulting in medical costs of approximately dollar 2
billion per year (Ramello, Vitale, & Marangella, 2000; Tanagho & McAninch, 2004).

Publication Types: 
    Review

PMID: 16438249 [PubMed - indexed for MEDLINE]

549: Urol Res. 2006 Jun;34(3):178-83. Epub 2006 Jan 25.

Long-term effects of percutaneous nephrolithotomy on renal morphology and
arterial vascular resistance as evaluated by color Doppler ultrasonography:
preliminary report.

Kiliç S, Altinok T, Altunoluk B, Erdoğan O, Oğuz F.

Department of Urology, Turgut Ozal Medical Center, Inonu University School of
Medicine, Elaziğ yolu 15. km., 44315, Malatya, Turkey. skilic@inonu.edu.tr

We evaluated the long-term effects of percutaneous nephrolithotomy (PNL) on renal
morphology and vascular resistance. Parenchyma thickness, echogenicity and
resistive index (RI) of upper, middle and lower poles of operated and
contralateral kidneys of 41 patients with 82 renal units who underwent unilateral
PNL with single pole access between 2000 and 2002 were examined separately by
color Doppler ultrasonography. Mean patient age and duration between PNL and
evaluation time were 38.29+/-11.53 years and 46.44+/-10.9 months, respectively.
In operated kidney, mean RI, parenchyma thickness and echogenicity of the access 
pole were not statistically different than those of the adjacent two poles
(0.608+/-0.053 vs. 0.608+/-0.052 for RI, P=0.895; 11.46+/-2.58 vs. 11.41+/-2.68
mm for parenchyma thickness, P=0.838; 0.049+/-0.31 vs. 0.073+/-0.33 for
parenchyma echogenicity, P=0.160, respectively). Although mean RI and parenchyma 
thickness of access pole were statistically significantly different than the mean
values of contralateral kidney (0.562+/-0.032 and 14.31+/-1.37 mm, respectively),
no statistical difference was found between mean parenchyma echogenicities of
both of them (echogenicity of contralateral kidney was 0, P=0.317). No
significant difference was found between the average echogenicities of the three 
poles of the operated and contralateral kidneys (0.063+/-0.32 vs. 0, P=0.080). In
14 patients RI decreased from 0.694+/-0.058 to 0.602+/-0.056 in operated kidney
(P=0.001) and from 0.604+/-0.06 to 0.559+/-0.031 in contralateral kidney
(P=0.018) following PNL. It seems that PNL does not cause renal scarring, renal
parenchymal loss or increase in renal vascular resistance in the long term.
However, prospective studies must be performed for more definitive conclusions.

PMID: 16435138 [PubMed - indexed for MEDLINE]

550: BJU Int. 2006 Feb;97(2):359-63.

Paediatric percutaneous nephrolithotomy: setting new frontiers.

Samad L, Aquil S, Zaidi Z.

Paediatric Urology, The Kidney Centre Postgraduate Training Institute, Karachi,
Pakistan. zzaidi@cyber.net.pk

OBJECTIVE: To assess the safety and outcome of paediatric percutaneous
nephrolithotomy (PCNL) for atypical cases and compare the results with 'standard'
unilateral paediatric PCNL. PATIENTS AND METHODS: We retrospectively reviewed
children who had had a PCNL between December 1997 and December 2004. Patients
were grouped as follows: group 1, aged >5-16 years with normal anatomy and normal
renal function undergoing unilateral PCNL or staged bilateral PCNL; group 2, < or
= 5 years with normal anatomy and renal function undergoing unilateral PCNL;
group 3, undergoing bilateral simultaneous PCNL; group 4, impaired renal function
in addition to renal stone disease; group 5, renal anatomical abnormality with
calculi in the same kidney. Demographics, stone profile, procedure and outcome
indicators were analysed for each group. RESULTS: In all, 188 consecutive PCNLs
in 169 children were included (mean age 3.3-10.3 years, mean stone burden
19.1-33.3 mm in the five groups). The mean duration of PCNL was 69-115 min. Stone
clearance was satisfactory with single tract access in 90-100% of patients.
Transient postoperative fever was the commonest complication (12.5-51%) followed 
by hyponatraemia and hypokalaemia. Blood transfusion was required in 0-7.7%. The 
mean stone clearance rates were 47-90% in the five groups; additional
extracorporeal shockwave lithotripsy increased the cumulative clearance rates to 
90-100%. CONCLUSION: PCNL is safe for treating renal stones, with excellent
results and minimal complications. Comparable results are achieved in the very
young child, children with anatomically abnormal kidneys, children with impaired 
renal function and children with bilateral renal stones undergoing simultaneous
bilateral PCNL. Hence none of these factors should be considered as relative
contraindications.

Publication Types: 
    Evaluation Studies

PMID: 16430647 [PubMed - indexed for MEDLINE]

551: Asian J Surg. 2006 Jan;29(1):36-9.

Shock wave lithotripsy for uric acid stones.

Sun XZ, Zhang ZW.

Department of Urology, Affiliated Drum Tower Hospital, Nanjing University,
Zhongshan Road 321, Nanjing, Jiangsu Province, China. sunxizhao@sohu.com

OBJECTIVE: To report our experience of extracorporeal shock wave lithotripsy
(SWL) for patients with uric acid stones. METHODS: From December 1987 to December
2003, a total of 443 patients with uric acid stones in the kidney or ureter
accepted SWL using ultrasound-guided lithotripters together with alkali therapy. 
Among them, 168 patients with an average stone burden of 9.1 mm were treated
using an EDAP LT-01 piezoelectric lithotripter. The other patients, with an
average stone burden of 9.6 mm, were treated using a Dornier Compact S
electromagnetic lithotripter. RESULTS: The average duration of treatment using
the EDAP LT-01 device was 52.1 minutes with a pulse frequency of 1.25-2.5 shocks 
per second at 100% power. The average treatment parameters on the Dornier Compact
S device were 3,196 shocks at 14.8 kV. For the EDAP LT-01, the 3-month stone-free
rate was 86.4%, with a retreatment rate of 24.2%. For the Dornier Compact S, the 
3-month stone-free rate was 90.3%, with a retreatment rate of 29.0%. Auxiliary
therapy with the push-back technique was needed in 0.45% of patients with upper
ureteral stones that could not be localized using ultrasound. The treatment
results were best for stones smaller than 20 mm. No anaesthesia was required for 
any patient. CONCLUSION: SWL with ultrasound localization for uric acid stones is
safe and effective. The combination of SWL with urine alkalization may further
improve the stone-free rate.

PMID: 16428097 [PubMed - indexed for MEDLINE]

552: J Endourol. 2006 Jan;20(1):17-20.

Previous open nephrolithotomy: does it affect percutaneous nephrolithotomy
techniques and outcome?

Lojanapiwat B.

Division of Urology, Department Surgery, Chiang Mai University, Chiangmai,
Thailand. blojanap@mail.med.cmu.ac.th

BACKGROUND AND PURPOSE: The consequences of open nephrolithotomy are scar tissue 
around the kidney and in the retroperitoneum and distortion of the pelvicaliceal 
anatomy that may affect the techniques and outcome of percutaneous
nephrolithotomy (PCNL). We compared the results and complications of patients
undergoing PCNL who had and had not previously undergone open nephrolithotomy.
PATIENTS AND METHODS: A total of 178 calculi in 175 patients who had previously
had open nephrolithotomy (group I) and 178 calculi in 175 patients who had never 
had a renal operation (group II) were treated with PCNL. The average time between
open nephrolithotomy and PCNL was 8.5 years (range 4 months-22 years). In both
groups, PCNL was done by a standard technique with serial Amplatz dilator
enlargement of the tract to 30F. Upper-pole access under fluoroscopic guidance
was done in most patients. The operative time, success rate, hospital stay, and
complications in the two groups were compared. RESULTS: The stone-free rates were
80.3% and 82.6% in groups I and II, respectively, and the rate of residual
fragments < or =4 mm was 14.6% and 8.4%. The operative time, success rate,
hospital stay, and complications did not differ significantly in the two groups. 
CONCLUSION: Percutaneous nephrolithotomy is effective and safe in patients who
have previously had open nephrolithotomy with no more complications than are seen
with PCNL of kidneys that have not been operated on.

Publication Types: 
    Comparative Study

PMID: 16426125 [PubMed - indexed for MEDLINE]

553: Urol Res. 2006 Feb;34(1):53-7. Epub 2006 Jan 20.

Lithogenesis: induction of renal calcifications by nanobacteria.

Shiekh FA, Khullar M, Singh SK.

Department of Experimental Medicine and Biotechnology, Postgraduate Institute of 
Medical Education and Research, 160012, Chandigarh, India.

Nanobacteria have been isolated from kidney stones and it has been suggested that
they may act as a nucleus for the initiation of the renal stones. In the present 
study, we examine their role in biocrystallization and their in vivo effects on
kidney pathology. Calcium oxalate monohydrate (COM) assay was carried out in the 
presence of nanobacteria to study biocrystallization. Wistar rats were given an
intravenous injection of nanobacteria and the kidneys were examined for
pathological changes. The COM assay showed accelerated biocrystallization of
(14)C-oxalate in the presence of nanobacteria, indicating them to be efficient
candidates for biomineralization. Histopathological studies revealed bacteria
induced renal tubular calcifications and various manifestations of infection. Our
studies confirm that nanobacteria may be involved in the pathogenesis of renal
tubular calcification.

PMID: 16425019 [PubMed - indexed for MEDLINE]

554: Urol Res. 2006 Apr;34(2):102-7. Epub 2006 Jan 14.

Lithiasis in cystic kidney disease and malformations of the urinary tract.

Gambaro G, Fabris A, Puliatta D, Lupo A.

Divisione di Nefrologia, Dipartimento di Scienze Biomediche e Chirurgiche,
Università di Verona, Ospedale Maggiore, P.le Stefani 1, 37126, Verona, Italy.
giovanni.gambaro@univr.it

The prevalence of renal stones in renal cystic and malformative conditions
exceeds the prevalence of renal stones in the general population, suggesting that
the above-mentioned cystic and malformative disorders favor stone formation.
Urinary stasis is generally assumed to play a major part in the pathogenesis of
the nephrolithiasis associated with distorted renal anatomy due to a delayed
washout of crystals and risk of urinary infections. However metabolic factors are
also important in the pathogenesis of stones in these conditions. Indeed,
metabolic abnormalities have been observed in the majority of stone-forming
patients with conditions such as horseshoe kidney and ureteropelvic junction
obstruction. Five different models of stone formation can be identified,
depending on stone composition, risk of infection stones, and pathogenesis of
renal cystic and malformative conditions. A proper metabolic evaluation should be
conducted to diagnose specific, treatable metabolic disorders, thereby reducing
the frequency of recurrent stone disease in these conditions as well.

Publication Types: 
    Review

PMID: 16416113 [PubMed - indexed for MEDLINE]

555: Urol Res. 2006 Feb;34(1):61-3. Epub 2006 Jan 14.

Family history may be misleading in the diagnosis of Dent's disease.

Anglani F, Bernich P, Tosetto E, Cara M, Lupo A, Nalesso F, D'Angelo A, Gambaro
G.

Department of Medical and Surgical Sciences, Laboratory of Molecular Biology,
University of Padova, Padova, Italy.

The rare Dent's disease manifests with medullary nephrocalcinosis,
nephrolithiasis, hypercalciuria, low molecular weight proteinuria and other
tubular dysfunctions, rickets or osteomalacia, and renal failure, in various
combinations. It is a recessive X-linked condition. Clinicians consider family
history a fundamental pointer to its diagnosis, but this is not invariably the
case as clearly pointed out by the two reported cases.

Publication Types: 
    Case Reports

PMID: 16416111 [PubMed - indexed for MEDLINE]

556: Urology. 2006 Jan;67(1):170-4; discussion 174-5.

Efficacy of extracorporeal shock wave lithotripsy for isolated lower caliceal
stones in children compared with stones in other renal locations.

Demirkesen O, Onal B, Tansu N, Altintaş R, Yalçin V, Oner A.

Department of Urology, University of Istanbul Cerrahpasa School of Medicine,
Istanbul, Turkey.

OBJECTIVES: To evaluate the efficacy of extracorporeal shock wave lithotripsy
(ESWL) monotherapy for isolated lower caliceal calculi in a pediatric age group
and compare it with that for isolated middle/upper caliceal and renal pelvic
calculi. METHODS: We retrospectively reviewed the data of 151 renal units in 126 
children treated with ESWL for isolated caliceal and renal pelvic stones from
March 1992 to February 2004. The stones were localized in the lower, middle/upper
calices, and renal pelvis in 50, 26, and 75 renal units, respectively. The
results were compared with respect to renal location and stone burden. RESULTS:
The median patient age was 8 years (range 1 to 16). The median stone burden in
the lower and middle/upper caliceal groups was significantly lower than in the
renal pelvis group at 0.6, 0.6, and 1 cm2, respectively (P = 0.002). The overall 
stone-free rate was 62% for lower calices, 65.3% for middle/upper calices, and
80% for renal pelvis stones. For the group with a stone size greater than 2 cm2, 
the stone-free rate decreased to 33% in both lower and middle/upper calices;
however, it was almost the same in the renal pelvis (81.8%). A highly significant
relation was found between the stone burden and number of sessions (P < 0.001),
but none between the stone burden and stone-free rate. CONCLUSIONS: In our study,
ESWL was equally effective for stones in all locations. We recommend ESWL as the 
primary treatment of choice for stones less than 2.0 cm2 in all caliceal
locations. For the management of caliceal stones greater than 2.0 cm2,
prospective randomized trials comparing ESWL and percutaneous nephrolithotomy are
necessary.

Publication Types: 
    Comparative Study

PMID: 16413356 [PubMed - indexed for MEDLINE]

557: Urology. 2006 Jan;67(1):30-4.

Nephrostomy tube-free percutaneous nephrolithotomy for patients with large stones
and staghorn stones.

Jou YC, Cheng MC, Lin CT, Chen PC, Shen JH.

Department of Urology, Chiayi Christian Hospital, Chiayi, Taiwan.
b729@cych.org.tw

OBJECTIVES: To perform a retrospective study to assess the outcome and safety of 
64 nephrostomy tube-free percutaneous nephrolithotomies (PCNLs) in 62 patients
with calculi 3 cm or greater. METHODS: Between March 2001 and June 2004, 365
consecutive patients underwent 389 PCNLs at our hospital. Electrocauterization of
the access tract was performed at the end of the operation in every patient. No
nephrostomy tube was inserted in the patient if a bloodless tract had been
obtained. Of the 389 PCNLs, 154 were performed in patients with a stone size of 3
cm or greater. Of these 154 PCNLs, 64 were performed with the nephrostomy
tube-free modification (group 1) and 90 were performed with insertion of the
nephrostomy tube after the operation (group 2). The hospital course and
complications were evaluated in both groups. RESULTS: No statistically
significant differences in age, stone size, urinary tract infection rate, or
blood transfusion rate were found between those with and without insertion of the
nephrostomy tube. Fourteen patients in group 1 had complete staghorn stones. A
shorter operative time, lower analgesic requirement, and shorter postoperative
hospital stay were noted in the group with the nephrostomy tube-free modification
(group 1). CONCLUSIONS: With adequate homeostasis, nephrostomy tube-free PCNL can
be performed in patients with complicated urolithiasis without any increase in
morbidity.

PMID: 16413327 [PubMed - indexed for MEDLINE]

558: Urology. 2006 Jan;67(1):26-9.

Clinical implication of routine stone culture in percutaneous nephrolithotomy--a 
prospective study.

Margel D, Ehrlich Y, Brown N, Lask D, Livne PM, Lifshitz DA.

Institute of Urology, Rabin Medical Center, Golda Campus, Petach Tikva, Israel.
sdmargel@bezeqint.net

OBJECTIVES: To evaluate the correlation between preoperative urine culture (UC)
and intraoperative stone culture (SC) and the impact of SC findings on clinical
decisions. METHODS: UC and intraoperative fragmented SC were prospectively
obtained in all patients undergoing percutaneous nephrolithotomy between January 
2004 and March 2005. Patients with a positive UC received a full course of
antibiotics before surgery. All postoperative systemic inflammatory response
syndrome (SIRS) events were recorded, as was the antibiotic regimen used and any 
changes in antibiotic treatment secondary to the SC results. RESULTS: The study
group consisted of 75 consecutive patients. Of these 75 patients, 33 (49%) had
sterile UC and SC results. Both urine and renal stones were colonized in 17
patients (24%); in 6 of them, the UC and SC showed different pathogens. A
colonized SC associated with a sterile UC was found in 19 patients (25%). The
calculated UC sensitivity, specificity, and positive and negative predictive
value for the detection of stone colonization was 30%, 94%, and 84% and 58%,
respectively. Seventeen patients (22%) had postoperative SIRS. In 13 of them, a
change in antibiotic treatment was made according to the SC findings. On
univariate analysis, the incidence of SIRS was not related to the length of the
operation, stone-free rate, or supracostal or infracostal access. The relative
risk of SIRS when the SC was positive was 3.6. CONCLUSIONS: Renal calculi
pathogens are one of the predisposing factors for infectious events; however,
preoperative UC often fails to grow stone-colonizing bacteria. Intraoperative SC 
may be essential in directing the antibiotic regimen postoperatively and should
be routinely used.

PMID: 16413326 [PubMed - indexed for MEDLINE]

559: Urol Res. 2006 Apr;34(2):134-8. Epub 2006 Jan 13.

Acid-base metabolism: implications for kidney stones formation.

Hess B.

Internal Medicine and Nephrology, Klinik Im Park, Bellariastrasse 38, 8038,
Zurich, Switzerland. bernhard.hess@hirslanden.ch

The physiology and pathophysiology of renal H+ ion excretion and urinary buffer
systems are reviewed. The main focus is on the two major conditions related to
acid-base metabolism that cause kidney stone formation, i.e., distal renal
tubular acidosis (dRTA) and abnormally low urine pH with subsequent uric acid
stone formation. Both the entities can be seen on the background of disturbances 
of the major urinary buffer system, NH3+ <--> NH4+. On the one hand, reduced
distal tubular secretion of H+ ions results in an abnormally high urinary pH and 
either incomplete or complete dRTA. On the other hand, reduced
production/availability of NH4+ is the cause of an abnormally low urinary pH,
which predisposes to uric acid stone formation. Most recent research indicates
that the latter abnormality may be a renal manifestation of the increasingly
prevalent metabolic syndrome. Despite opposite deviations from normal urinary pH 
values, both the dRTA and uric acid stone formation due to low urinary pH require
the same treatment, i.e., alkali. In the dRTA, alkali is needed for improving the
body's buffer capacity, whereas the goal of alkali treatment in uric acid stone
formers is to increase the urinary pH to 6.2-6.8 in order to minimize uric acid
crystallization.

Publication Types: 
    Review

PMID: 16411127 [PubMed - indexed for MEDLINE]

560: J Urol. 2006 Feb;175(2):580-4; discussion 584.

Use of lower pole nephrostomy drainage following endorenal surgery through an
upper pole access.

Kim SC, Ng JC, Matlaga BR, Lifshitz DA, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana,
USA.

PURPOSE: PNL via an UP puncture is efficient for treating complex stone disease. 
Access via the UP can provide better visualization, allowing greater stone
clearance with a rigid instrument due to its more favorable alignment with the
axis of the intrarenal collecting system. However, the presence of a NT through
the upper pole tract, especially with a supracostal puncture, can generate
significant patient discomfort. We reviewed our experience with a technique using
tubeless UP access for PNL with concomitant placement of a NT via a LP calix.
MATERIALS AND METHODS: We performed a retrospective review of our experience
using tubeless UP access for PNL with concomitant placement of an LP NT for
postoperative drainage. Patient demographics, the number and location of
accesses, stone size, stone-free rates, concurrent/additional procedures and
complications were recorded. RESULTS: A total of 63 tubeless UP accesses were
performed in 62 patients undergoing PNL, including unilateral access in 61 and
bilateral access in 1. Supracostal UP punctures were used in 58 patients,
including 40 above the 12th, 17 above the 11th and 1 above the 10th rib. Each
patient underwent at least 2 accesses and 3 had 3 or more accesses placed. LP
access was nondilated in 37 patients and dilated in 26. Of the patients 56.6%
were stone-free after a single procedure, increasing to 96.2% following secondary
procedures. Three of the 62 patients (4.8%) required transfusion, 3 (4.8%)
required intervention for pleural morbidity and 1 (1.6%) required a stent for a
nonsealing upper pole access. CONCLUSIONS: Tubeless UP access provides maximal
efficiency for stone clearance during PNL, while minimizing the morbidity of an
intercostal tube.

PMID: 16407000 [PubMed - indexed for MEDLINE]

561: J Urol. 2006 Feb;175(2):575-9.

External validation of outcome prediction model for ureteral/renal calculi.

Parekattil SJ, Kumar U, Hegarty NJ, Williams C, Allen T, Teloken P, Leitão VA,
Netto NR, Haber GP, Ballereau C, Villers A, Streem SB, White MD, Moran ME.

Cleveland Clinic Foundation, Cleveland, Ohio, USA. sijo_p@hotmail.com

PURPOSE: We externally validated a previously designed neural network model to
predict outcome and duration of passage for ureteral/renal calculi. The model was
also evaluated using a 6 mm largest stone dimension cutoff in predicting stone
outcome. MATERIALS AND METHODS: The model was previously designed on 301 patients
at Albany Medical Center (free shareware from www.uroengineering.com). The model 
had a prediction accuracy of 86% for passage outcome and 87% for passage
duration. In this study we tested the model on a separate 384 patients from 6
different external institutions to assess the prediction accuracy. All patients
had a single renal/ureteral calculus by evaluation in an emergency room setting
or by primary physicians and were then referred for further treatment. Model
accuracy was also compared to using a 6 mm largest stone dimension cutoff in
predicting the need for intervention. RESULTS: Testing on the 384 patients from
all 6 external institutions revealed an outcome prediction accuracy of 88%. The
area under the ROC curve was 0.9. Using a 6 mm stone size cutoff provided 79%
(ROC 0.8) accuracy. The model duration of passage prediction accuracy was 80%
(133 patients passed the stone, area under ROC of 0.8). CONCLUSIONS: The model
provided high stone outcome prediction accuracy (ROC of 0.9 and 0.8) at the 6
external institutions, comparable to that of the design institution. The model
provided higher accuracy than using only the largest stone dimension as a cutoff.
Increasing experience will further assess the model's accuracy.

Publication Types: 
    Comparative Study
    Multicenter Study
    Validation Studies

PMID: 16406999 [PubMed - indexed for MEDLINE]

562: J Urol. 2006 Jan;175(1):270-5; discussion 275.

Pelvicaliceal anatomical variation between stone bearing and normal contralateral
kidneys--does it have an impact on stone formation in pediatric patients with a
solitary lower caliceal stone?

Gurocak S, Kupeli B, Acar C, Guneri C, Tan MO, Bozkirli I.

Department of Urology, Gazi University School of Medicine, Ankara, Turkey.

PURPOSE: We aimed to investigate the probable effect of pelvicaliceal anatomical 
differences between stone bearing and normal contralateral kidneys on the
etiology of stone formation in children with a solitary lower pole caliceal
stone. MATERIALS AND METHODS: We reviewed the clinical records of 25 pediatric
patients who underwent SWL for a solitary lower caliceal stone and 15 healthy
pediatric patients who served as controls. Lower pole IPA, IL and IW, together
with other caliceal variables obtained from the pelvicaliceal anatomy of the
stone bearing and contralateral normal kidneys of patients with urolithiasis, and
both kidneys of the control group were measured based on excretory urography.
Also, total pelvicaliceal volume for both kidneys was calculated. RESULTS: Mean
LIPAs of stone bearing kidneys compared to the normal contralateral kidneys was
more acute, equal and wider in 52%, 16% and 32% of the patients, respectively.
Mean pelvicaliceal volumes of the stone forming and normal kidneys were 1,553.8
mm(3) (range 242 to 7,107) and 581.0 mm(3) (90 to 2,662), respectively, and there
was statistical significance only in pelvicaliceal volumes between the stone
bearing and contralateral normal kidneys (p <0.001). CONCLUSIONS: Our results
reveal that IPA, IL and IW of calices do not have an effect on stone formation in
pediatric patients. However, large pelvicaliceal volume seems to be a significant
risk factor for stone formation in the lower calix, probably because it creates
abnormal urodynamic and morphological features, especially when accompanied by
other metabolic abnormalities.

Publication Types: 
    Comparative Study

PMID: 16406924 [PubMed - indexed for MEDLINE]

563: J Urol. 2006 Jan;175(1):162-5; discussion 165-6.

Erratum in:
    J Urol. 2006 Mar;175(3 Pt 1):1176.

Intraoperative fragment detection during percutaneous nephrolithotomy: evaluation
of high magnification rotational fluoroscopy combined with aggressive
nephroscopy.

Portis AJ, Laliberte MA, Drake S, Holtz C, Rosenberg MS, Bretzke CA.

Metropolitan Urologic Specialists P. A., St. Paul, Minnesota, USA.
aportis@metro-urology.com

PURPOSE: Percutaneous nephrolithotomy effectively treats large volume renal
calculi but relies on postoperative imaging to judge success. We evaluated the
effectiveness of maximizing intraoperative imaging through combined high
resolution fluoroscopy and flexible nephroscopy. MATERIALS AND METHODS:
Percutaneous nephrolithotomy was performed cooperatively with a radiologist in an
interventional radiology suite equipped with a ceiling mounted, high resolution
C-arm. Aggressive rigid and flexible nephroscopy was performed. At the conclusion
patients were prospectively classified as radiologically and/or endoscopically
stone-free. Postoperative noncontrast CT allowed fragment classification as
stone-free, 2 mm or less, 2 to 4 mm and greater than 4 mm. RESULTS: The average
stone dimension +/- SEM was 579 +/- 77 mm(2) in 25 consecutive renal units. CT
demonstrated that 15 renal units (60%) were stone-free after the primary
procedure, while 2 (8%), 5 (20%) and 3 (12%) had fragments 2 or less, 2 to 4 and 
greater than 4 mm, respectively. Of 21 renal units considered endoscopically and 
fluoroscopically stone-free postoperative CT demonstrated that 6 had residual
fragments, of which all were less than 4 mm. All 4 renal units not considered
radiologically and endoscopically stone-free had fragments on CT. Intraoperative 
fluoroscopy after nephroscopy demonstrated fragments in 36% of renal units, of
which after further nephroscopy 78% were stone-free on CT. The sensitivity of
intraoperative imaging with reference to the gold standard of postoperative CT
was 40%, 38% and 100% at thresholds of 0, 2 and 4 mm, respectively. Specificity
was 100%, 94% and 95%, respectively. CONCLUSIONS: Flexible nephroscopy combined
with high magnification rotational fluoroscopy allows sensitive and specific
intraoperative detection of residual fragments, enabling immediate removal or the
planning of necessary second look nephroscopy.

PMID: 16406897 [PubMed - indexed for MEDLINE]

564: J Urol. 2006 Jan;175(1):156-61.

A novel single step percutaneous access sheath: the initial human experience.

Baldwin DD, Maynes LJ, Desai PJ, Jellison FC, Tsai CK, Barker GR.

Division of Urology, Loma Linda University Medical Center, Loma Linda,
California, USA.

PURPOSE: A novel 1-step percutaneous access sheath NS has been developed that
allows the insertion of a dilating balloon and renal access sheath in a single
step. We present the initial human experience with this sheath. MATERIALS AND
METHODS: We performed a retrospective chart and database review of the initial 30
consecutive patients undergoing percutaneous nephrostolithotomy using the NS.
Data collected included patient demographics, operative and recovery parameters, 
and complications. RESULTS: Mean patient age was 50.4 years (range 11 to 81),
mean body mass index was 31.63 kg/m(2) (range 17.1 to 65) and mean preoperative
stone area was 6.23 cm(2) (range 1 to 14.6). Six and 3 patients had full and
partial staghorn calculi, respectively. Access was achieved via the upper pole in
16 patients, middle pole in 7 and lower pole in 7. Mean operative time was 114.8 
minutes (range 61 to 237). Mean estimated blood loss was 145.5 cc (range 10 to
500) and mean postoperative hospital stay was 4.89 days (range 2 to 14). A total 
of 23 patients (76.7%) had no residual calculi on postoperative computerized
tomography, 5 (16.7%) had residual fragments 4 mm or less and 2 (6.7%) had
residual stone fragments greater than 4 mm. There were no complications related
to the NS. CONCLUSIONS: The NS is safe, easy to use and has potential advantages 
compared to currently available renal access sheaths.

PMID: 16406896 [PubMed - indexed for MEDLINE]

565: Urol Res. 2006 Apr;34(2):86-91. Epub 2006 Jan 11.

Renal tubular damage/dysfunction: key to the formation of kidney stones.

Khan SR.

Department of Pathology and Center for the Study of Lithiasis, College of
Medicine, University of Florida, Gainesville, FL, USA. khan@pathology.ufl.edu

Supersaturation is the driving force behind crystal formation in the kidneys. It 
can, however, result only in the formation of crystals which can be harmlessly
expelled. For stone formation, crystals must form in the kidneys and be retained 
there, which is indeed a rare occurrence. Crystalluria is common while stone
formation is not. Only pathological changes in the kidneys including renal injury
and dysfunction can accomplish crystal retention. Lethal epithelial cellular
injury promotes crystal nucleation, aggregation and retention. Sub-lethal injury 
or dysfunctional cells may produce ineffective crystallization modulators and
localized areas of supersaturation in the interstitium. The former will affect
crystallization in the urine while the latter may cause precipitation in the
interstitium and development of Randall's plaques.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 16404622 [PubMed - indexed for MEDLINE]

566: Urol Res. 2006 Apr;34(2):131-3. Epub 2006 Jan 11.

Impact of dietary habits on stone incidence.

Siener R.

Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn,
Germany. Roswitha.Siener@ukb.uni-bonn.de

Changes in dietary habits and lifestyle are suggested to contribute markedly to
the rise in the prevalence and incidence of urolithiasis during the past decades.
Insufficient fluid intake and diets rich in animal protein are considered to be
important determinants of stone formation. Overweight and associated dietary
pattern additionally contribute to the increasing incidence and prevalence of
stone disease. Reduction of overweight through extreme fasting or high-protein
weight-loss diets, e.g. Atkins diet, also appear to affect stone formation.
Although there is evidence that changes in dietary habits can reduce urinary risk
factors and the risk of stone formation, further randomized controlled clinical
trials are necessary to evaluate long-term effects of dietary interventions on
stone disease.

Publication Types: 
    Review

PMID: 16404621 [PubMed - indexed for MEDLINE]

567: BMC Urol. 2006 Jan 8;6:1.

Laparoscopic nephrectomy for giant staghorn calculus with non-functioning
kidneys: is associated unsuspected urothelial carcinoma responsible for
conversion? Report of 2 cases.

Shah HN, Jain P, Chibber PJ.

Department of Urology, R. G. Stone Urological Research Institute, Mumbai, India. 
drhemendrashah@yahoo.co.in

BACKGROUND: Neglected renal stones remain a major cause of morbidity in
developing countries. They not only result in functional impairment of affected
kidney, but also act as an important predisposing factor for development of
urothelial neoplasms. It is not uncommon to miss an associated urothelial tumor
in a patient of nephrolithiasis preoperatively. CASE PRESENTATION: In last 3
years, we came across two patients with giant staghorn calculus and poorly
functioning kidneys who underwent laparoscopic nephrectomy. In view of
significant perirenal adhesions & loss of normal tissue planes both these
patients were electively converted to open surgery. The pathological examination 
of specimen revealed an unsuspected urothelial carcinoma in both these patients. 
The summary of our cases and review of literature is presented. CONCLUSION: It is
important to keep a differential diagnosis of associated urothelial malignancy in
mind in patient presenting with long standing renal calculi. The exact role of a 
computerized tomography and cytology in preoperative workup for detection of
possible associated malignancy in such condition is yet to be defined. Similarly 
if laparoscopic dissection appears difficult during nephrectomy for a renal
calculus with non-functional kidney, keeping a possibility of associated
urothelial malignancy in mind it is advisable to dissect in a plane outside
gerotas fascia as for radical nephrectomy.

Publication Types: 
    Case Reports
    Review

PMID: 16398940 [PubMed - indexed for MEDLINE]

568: Urol Res. 2006 Feb;34(1):58-60. Epub 2006 Jan 6.

An unusual patient with kidney stones composed of 1-methyluric acid.

Davies PM, Fairbanks LD, Safranow K, Bending MR, Simmonds HA.

Purine Research Unit, 5th Floor Thomas Guy House, Guy's Hospital, SE1 9RT, London
Bridge, UK.

An unusual case with kidney stones composed mainly of 1-methyluric acid is
described. The patient, a Caucasian male of Celtic descent, reportedly drank at
least eight cups of coffee per day and had a long history of rheumatoid
arthritis, gouty attacks and renal colics--the latter attributed to
nephrocalcinosis and analgesic nephropathy. He was treated with allopurinol. At
54 years, a bilateral nephrolithotomy was performed. Stone samples were analysed 
by thermogravimetry and infrared spectroscopy and reported to be 12-25% calcium
oxalate, the remainder being organic uric acid-like material. Analysis of the
extracts by HPLC confirmed that the organic material contained 67% of
1-methyluric acid and 33% of uric acid. Possible mechanisms leading to the
precipitation of 1-methyluric acid from urine are discussed. We conclude that the
high caffeine intake resulted in extremely elevated urinary concentrations of
1-methyluric acid favouring the formation of 1-methyluric acid stones.

Publication Types: 
    Case Reports

PMID: 16397778 [PubMed - indexed for MEDLINE]

569: Urol Res. 2006 Apr;34(2):118-21. Epub 2006 Jan 6.

The use of risk indices: do they predict recurrence? Yes, they (at least some)
do.

Laube N, Pullmann M.

Division of Experimental Urology, Department of Urology, University of Bonn,
Sigmund-Freud-Strasse 25, 53105, Bonn, Germany. norbert.laube@ukb.uni-bonn.de

A suitable and advisedly used risk index is an effective tool for improving
prevention, therapy monitoring and classification of almost unmanageable amounts 
of analysis data and diagnoses. In contrast to statistically founded indices,
causality-based risk indices can provide a fundamental insight into the
mechanisms of the underlying pathology. However, understanding of stone formation
as the result of many linked and often non-linear individual processes must be
further improved. Only in this way can risk indices be optimized or better ones
be developed. We are confident that, with consistent research efforts, science
will be able to predict recurrence of stone formation more accurately within the 
next couple of years.

Publication Types: 
    Review

PMID: 16397777 [PubMed - indexed for MEDLINE]

570: Urol Res. 2006 Apr;34(2):122-5. Epub 2006 Jan 6.

The use of risk indices: do they predict recurrence?

Sutton RA.

University of British Columbia, 3254 West 20th Avenue, Vancouver, BC, Canada,
V6L1H9. roger.sutton@shaw.ca

A risk index which would reliably predict the likelihood of stone recurrence in
the patient with renal calculi would help the clinician to select appropriate
preventative therapy. However, none of the indices developed to date combines
easy applicability in usual clinical settings with sufficient predictive power to
be useful to the clinician in making treatment decisions.

PMID: 16397776 [PubMed - indexed for MEDLINE]

571: Curr Pharm Des. 2005;11(32):4153-9.

Uric acid and the kidney: urate transport, stone disease and progressive renal
failure.

Capasso G, Jaeger P, Robertson WG, Unwin RJ.

Research Center for Cardiovascular Diseases, Second University of Naples, Naples,
Italy.

In this brief review and update, we try to cover recent developments in our
understanding of uric acid transport by the kidney, the contribution of uric acid
to renal stone disease, its potential role in progressive renal failure and, most
recently, the novel and as yet unexplained link between the urinary glycoprotein 
Tamm-Horsfall protein (uromodulin) and hyperuricaemia and two inherited forms of 
renal disease with chronic renal failure.

Publication Types: 
    Review

PMID: 16375737 [PubMed - indexed for MEDLINE]

572: Nephron Physiol. 2006;103(1):p53-62. Epub 2005 Dec 21.

Expression profiling of crystal-induced injury in human kidney epithelial cells.

Liang L, Chen J, Vittal R, Selvanayagam ZE, McAteer JA, Deng L, Tischfield J,
Chin KV, Sahota A.

Department of Genetics, Rutgers University, Piscataway, NJ 08854, USA.

BACKGROUND: Deposition of crystals within tubular lumens is a feature of many
kidney stone diseases, including crystals of calcium oxalate monohydrate (COM) in
primary hyperoxaluria and of 2,8-dihydroxyadenine (DHA) in adenine
phosphoribosyltransferase deficiency. Crystals are injurious to renal epithelial 
cells, but the molecular bases of cell injury have not been well characterized.
METHODS: We used a cDNA microarray to identify the time-dependent changes in gene
expression associated with the interaction of COM or DHA crystals with primary
cultures of normal human kidney cortical epithelial cells. RESULTS: We observed
gene expression changes that were common to both crystal types, as well as a
number of crystal-specific responses. A subset of genes known to be aberrantly
expressed in kidney tissue from stone formers also showed an altered expression
in COM- or DHA-treated normal human kidney cortical epithelial cells.
CONCLUSIONS: Our results show that cultured epithelial cells exposed to COM or
DHA crystals demonstrate cellular responses that may be physiologically relevant,
thus suggesting that this experimental system may be useful for elucidating the
mechanisms of crystal-induced renal cell injury. Copyright 2006 S. Karger AG,
Basel.

Publication Types: 
    Comparative Study

PMID: 16374038 [PubMed - indexed for MEDLINE]

573: J Comput Assist Tomogr. 2006 Jan-Feb;30(1):44-50.

Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to
detect renal and ureteral calculi?

Kluner C, Hein PA, Gralla O, Hein E, Hamm B, Romano V, Rogalla P.

Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte,
Berlin, Germany. claudia.kluner@charite.de

The objective of this study was to evaluate the diagnostic yield of multislice CT
using a radiation dose equivalent to that of conventional abdominal x-ray (KUB). 
One hundred forty-two patients were prospectively examined with ultrasound and a 
radically dose-reduced CT protocol (120 kV, 6.9 eff. mAs). Number and size of
calculi, presence of urinary obstruction, and alternative diagnoses were recorded
and confirmed by stone removal/discharge or by clinical and imaging follow-up.
The mean effective whole-body dose was 0.5 mSv in men and 0.7 mSv in women. The
sensitivity and specificity in detecting patients with calculi was 97% and 95%
for CT and 67% and 90% for ultrasound. Urinary obstruction was similarly
assessed, whereas CT identified significantly more alternative diagnoses than
ultrasound (P<0.001). With regard to published data for standard-dose CT, the
present CT protocol seems to be comparable in its diagnostic yield in assessing
patients with calculi, and its radiation dose is equivalent to that of KUB.

Publication Types: 
    Comparative Study

PMID: 16365571 [PubMed - indexed for MEDLINE]

574: Int Urol Nephrol. 2005;37(4):685-9.

Extracorporeal shock wave lithotripsy in L-shaped kidneys: report of two cases.

Tokgöz H, Sen I, Tan MO, Onaran M, Biri H, Bozkirli I.

Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey.

The L-shaped or tandem kidney is a type of crossed ectopia with fusion in which
the crossed kidney assumes a transverse position during its attachment to the
inferior pole of the other kidney. Calculus formation is a well-known sequel of
congenital abnormalities of the urinary tract and we like to present two patients
harbouring calculi in L-shaped kidneys treated by extracorporeal shock wave
lithotripsy (ESWL). The first patient had a calculus in renal pelvis of the
transverse kidney. The second case had multiple calculi in renal pelvis and
calices of the vertically positioned kidney. After three sessions, first patient 
was stone free, whereas no fragmentation in the second case. As a conclusion,
ESWL might be an option for L-shaped kidneys.

Publication Types: 
    Case Reports

PMID: 16362579 [PubMed - indexed for MEDLINE]

575: Urology. 2005 Dec;66(6):1160-4.

Comment in:
    Urology. 2008 Feb;71(2):354; author reply 355.

Optimal frequency in extracorporeal shock wave lithotripsy: prospective
randomized study.

Yilmaz E, Batislam E, Basar M, Tuglu D, Mert C, Basar H.

Department of Urology, University of Kirikkale Faculty of Medicine, Kirikkale,
Turkey. erdaly69@mynet.com

OBJECTIVES: To determine the optimal frequency of extracorporeal shock wave
lithotripsy of urolithiasis, in terms of efficacy and duration, by comparing
three different shock wave frequencies. METHODS: A total of 170 patients between 
the ages of 18 and 69 years with radiopaque kidney stones were included in the
study. The patients were randomly separated into three groups. Group 1 (56
patients) received 120 shock waves per minute, group 2 (57 patients) received 90 
shock waves per minute, and group 3 (57 patients) received 60 shock waves per
minute. The duration, analgesic or sedative requirement, and complications were
recorded for each treatment. All patients were evaluated in terms of successful
treatment by radiography of the kidneys, ureters, and bladder and abdominal
ultrasonography 10 days after the single-session therapy. RESULTS: No
statistically significant difference was observed in patients according to age,
sex, stone size, side, composition, location in the kidney, total energy level,
or number of shocks. The successful therapy rate in groups 2 and 3 was
prominently greater compared with that for group 1, and the difference was
statistically significant (P = 0.032 between groups 1 and 2 and P = 0.015 between
groups 1 and 3). The analgesic or sedative requirement in groups 2 and 3 was
lower than that in group 1, and the difference was statistically significant (P =
0.003 between groups 1 and 2 and P = 0.001 between groups 1 and 3). The duration 
was longer in group 3 than in groups 1 and 2, and the difference was
statistically significant (P = 0.000 between groups 1 and 3 and P = 0.009 between
groups 2 and 3). CONCLUSIONS: The results of our study have shown that the
optimal frequency during extracorporeal shock wave lithotripsy is 90 shock waves 
per minute in terms of duration, efficacy, and analgesic and sedative requirement
at the same total energy level.

Publication Types: 
    Randomized Controlled Trial

PMID: 16360432 [PubMed - indexed for MEDLINE]

576: Expert Rev Med Devices. 2006 Jan;3(1):73-80.

Medical devices used for ureteroscopy for renal calculi.

Weiland D, Canales BK, Monga M.

University of Minnesota, Department of Urologic Surgery, 420 Delaware St SE, MMC 
394, Minneapolis, MN 55455, USA. endourol@yahoo.com

Urinary stone disease is a problem as old as human civilization. In this article,
a brief history of stone disease and the current status of urinary stone disease 
treatment will be discussed. This review will focus primarily on the newest
technology and devices associated with flexible ureteropyeloscopy for the
treatment of upper tract urinary stones. In addition to defining the cutting-edge
technology that is newly available, this review will glimpse at what technologic 
advances are expected in the near future. Reference articles that do a good job
of defining the current state of flexible ureteropyeloscopy technology and
urinary stone disease treatment will be highlighted, along with a reiteration of 
the major points of the article.

Publication Types: 
    Review

PMID: 16359254 [PubMed - indexed for MEDLINE]

577: J Endourol. 2005 Dec;19(10):1161-4.

Percutaneous nephrolithotomy in patients who previously underwent open
nephrolithotomy.

Margel D, Lifshitz DA, Kugel V, Dorfmann D, Lask D, Livne PM.

Minimally Invasive Urology, Rabin Medical Center-Golda Campus, Petach Tikva,
Israel. sdmargel@bezeqint.net

BACKGROUND AND PURPOSE: Open stone surgery nowdays is rare. However, some
patients who are treated today have in the past undergone open nephrolithotomy.
The aim of this study was to determine the possible impact of open
nephrolithotomy on the efficacy and morbidity of subsequent percutaneous
nephrolithotomy (PCNL). PATIENTS AND METHODS: We reviewed the files of all 167
patients undergoing PCNL at our institution between December 2000 and December
2003. The same surgeon performed all of the procedures. We compared 21 patients
undergoing PCNL after open nephrolithotomy to the same kidney with all other
patients undergoing PCNL. The groups did not differ in terms of age or stone
burden (mean size, number of stones, percentage with staghorn calculi). The
outcomes measured were operating time, necessity for secondary procedures,
stonefree rate, and intraoperative and postoperative complications. RESULTS: The 
operating time (203+/-92 v 177+/-52 minutes) and percentage of secondary
procedures (29% v 12%) were significantly higher in patients who had previously
undergone open stone surgery. However, the stone-free rate (95% v 93%),
intraoperative complication rate (10% v 9%), and postoperative complication rate 
(10% v 11%) did not differ significantly. CONCLUSIONS: A PCNL in a patient with a
history of open nephrolithotomy may take longer and lead to a higher percentage
of auxiliary procedures, probably because of scar tissue and anatomic changes in 
the kidney. However, the morbidity and efficacy of PCNL appear to remain the same
in these patients.

Publication Types: 
    Comparative Study

PMID: 16359205 [PubMed - indexed for MEDLINE]

578: J Endourol. 2005 Dec;19(10):1157-60.

Sir William Osler's perceptions of urolithiasis and the case of the indigo
calculus.

Moran ME, Das S, Rosenberg SA.

Capital District Urologic Surgeons, Albany, New York 12208, USA.
memoran2@juno.com

BACKGROUND: Sir William Osler published his textbook, The Principles and Practice
of Medicine, in 1892. It became the definitive treatise on a wide variety of
diseases. The section on nephrolithiasis clearly presents the etiology,
pathology, symptoms, diagnosis, and treatments. What remains a mystery is the
mention, under rare forms of human stones, of a type called "indigo." MATERIALS
AND METHODS: A search of Index Medicus starting from 1909 backward to its
inception in 1879 was performed for key words "indigo," "calculus," "renal" or
"bladder stones" and "indicanuria." Twelve textbooks of urology published before 
1940 were scrutinized for references to indigo calculi. RESULTS: Only two
references to indigo were found, both related to its use for treating
constipation (1887 and 1891). Of the 12 textbooks, only 4 make passing reference 
to "indigo stones." They all mention that such calculi are very rare, but direct 
references to cases are lacking. One textbook references a study of blue stones
from Egyptian mummies. CONCLUSION: It is unlikely that Osler's reference to an
indigo calculus was taken lightly during his writing of The Principles and
Practice of Medicine. The case of the indigo calculus is fascinating and perhaps 
enlightening if only for the source of Osler's intrigue.

Publication Types: 
    Biography
    Historical Article

Personal Name as Subject: 
    Osler W

PMID: 16359204 [PubMed - indexed for MEDLINE]

579: Methods Find Exp Clin Pharmacol. 2005 Nov;27(9):633-8.

Antilithiatic effect of Asparagus racemosus Willd on ethylene glycol-induced
lithiasis in male albino Wistar rats.

Christina AJ, Ashok K, Packialakshmi M, Tobin GC, Preethi J, Murugesh N.

Department of Pharmacology, K.M. College of Pharmacy, Tamil Nadu, India.
kmcp@sancharnet.in

The ethanolic extract of Asparagus racemosus Willd. was evaluated for its
inhibitory potential on lithiasis (stone formation), induced by oral
administration of 0.75% ethylene glycolated water to adult male albino Wistar
rats for 28 days. The ionic chemistry of urine was altered by ethylene glycol,
which elevated the urinary concentration of crucial ions viz. calcium, oxalate,
and phosphate, thereby contributing to renal stone formation. The ethanolic
extract, however, significantly (p < 0.05) reduced the elevated level of these
ions in urine. Also, it elevated the urinary concentration of magnesium, which is
considered as one of the inhibitors of crystallization. The high serum creatinine
level observed in ethylene glycol-treated rats was also reduced, following
treatment with the extract. The histopathological findings also showed signs of
improvement after treatment with the extract. All these observations provided the
basis for the conclusion that this plant extract inhibits stone formation induced
by ethylene glycol treatment.

PMID: 16357948 [PubMed - indexed for MEDLINE]

580: J Clin Endocrinol Metab. 2006 Mar;91(3):959-63. Epub 2005 Dec 13.

Fibroblast growth factor 23 is increased in calcium nephrolithiasis with
hypophosphatemia and renal phosphate leak.

Rendina D, Mossetti G, De Filippo G, Cioffi M, Strazzullo P.

Department of Clinical and Experimental Medicine, Università Federico II, Via S. 
Pansini, 5-80131 Naples, Italy.

CONTEXT: Nephrolithiasis affects about 10% of the population in industrialized
countries, with calcium salts composing more than 80% of renal stones. A
significant percentage of patients with calcium nephrolithiasis and normal
parathyroid function show hypophosphatemia and reduced renal phosphate
reabsorption (i.e. a renal phosphate leak). OBJECTIVES: The objective of the
study was to compare serum levels of fibroblast growth factor 23 (FGF23), a
regulator of phosphate homeostasis, in 110 recurrent stone formers with or
without renal phosphate leak, six patients affected by X-linked hypophosphatemic 
rickets, five patients affected by oncogenic osteomalacia, and 60 unrelated
healthy controls. DESIGN: This was a prospective interventional study. METHODS:
Renal phosphate leak was identified based on the occurrence of idiopathic
hypophosphatemia [serum phosphate concentration < 2.50 mg/dl (<0.80 mmol/liter)] 
and reduced renal threshold phosphate concentration [<2.2 mg/liter (<0.70
mmol/liter)]. RESULTS: In 22 stone formers with renal phosphate leak, serum FGF23
concentration was significantly higher as compared with 88 stone formers without 
renal phosphate leak and with controls [83.3 (65.6-101.1) vs. 32.1 (26.8-37.4)
and 24.5 (19.8-29.1) reference units (RU)/ml, respectively]. Stone formers with
renal phosphate leak showed lower FGF23, compared with patients with oncogenic
osteomalacia and X-linked hypophosphatemic rickets [572.3 (235.9-908.7) RU/ml].
Among stone formers and controls, serum FGF23 concentration displayed a strong
inverse association with serum phosphate (r = -0.784, P = 0.009) and the rate of 
tubular phosphate reabsorption (r = -0.791, P = 0.008). CONCLUSIONS: In our study
population, renal phosphate leak affected 20% of stone formers and was strongly
associated with increased serum FGF23 concentration.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16352682 [PubMed - indexed for MEDLINE]

581: Int J Urol. 2005 Nov;12(11):1001-4.

Renal matrix stones in an emphysematous pyelonephritis.

Okochi H, Iiyama T, Kasahara K, Moriki T, Inoue K, Shuin T.

Department of Urology, Kochi Medical School, Kochi, Japan.

A 74-year-old-woman was referred to our hospital for further examination. Her
chief complaint had been a high-grade fever, but she was seen at our hospital
without fever. Plain fi lm of kidney, ureter and bladder drip infusion
pyelography and abdominal computed tomography (CT) showed a gas shadow
surrounding calcifications in the right renal pelvis. We diagnosed right
emphysematous pyelonephritis. Since changes in the CT findings were not
remarkable for 2 weeks, we performed laparoscopic right nephrectomy, even though 
her condition had not worsened. The renal pelvis contained brownish and clayish
matter. We report here this rare case of renal matrix stones.

Publication Types: 
    Case Reports

PMID: 16351660 [PubMed - indexed for MEDLINE]

582: Urol Int. 2005;75(4):327-32.

Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi.

Aron M, Yadav R, Goel R, Kolla SB, Gautam G, Hemal AK, Gupta NP.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
monisharon@hotmail.com

INTRODUCTION: The treatment of large complete staghorn calculi requires a
sandwich combination of percutaneous nephrolithotomy (PCNL) and shockwave
lithotripsy (SWL) or sometimes open surgery. Many urologists hesitate to place
more than 2-3 tracts during PCNL because of the belief that this may increase
complications. We present data to support multi-tract PCNL for large (surface
area >3,000 mm(2)) complete staghorn calculi. PATIENTS AND METHODS: From July
1998 to October 2003, 121 renal units (103 patients) with large complete staghorn
renal calculi were treated with PCNL. All procedures were performed in the prone 
position after retrograde ureteral catheterization. Fluoroscopy-guided punctures 
were made by the urologist followed by track dilation to 34 french. When multiple
tracts were anticipated all punctures were usually made at the outset and
preplaced wires were put into the collecting system or down the ureter. Stones
were fragmented and removed using a combination of pneumatic lithotripsy and
suction. Postoperative stone clearance was documented on X-ray KUB. RESULTS: 121 
renal units of 103 patients (15 women and 88 men, mean age 43 years) were
treated. Six patients had associated bladder calculi that were treated
simultaneously. The stone surface area was 3,089-6,012 (mean 4,800) mm(2). 10
patients (9.7%) had renal insufficiency with a mean (range) serum creatinine of
3.0 (1.5-5.5) mg/dl. The number of tracts required per patient were 2 tracts in
11, 3 tracts in 68, 4 tracts in 39, and 5 tracts in 3, giving a total of 397
tracts in 121 renal units, over a total of 140 procedures (including second-look 
procedures in 19 renal units). The points of entry of these tracts were 121 upper
calyx (30.4%), 178 middle calyx (44.8%), and 98 lower calyx (24.6%). All 121
units had one upper polar access tract of which 92 (76%) were supracostal.
Complications were blood transfusion (n = 18), pseudoaneurysm (n = 2), fever (n =
22), septic shock (n = 1) and hydrothorax (n = 3). PCNL monotherapy achieved an
84% complete clearance rate that improved to 94% with SWL in 8 renal units with
small residual fragments. Stone compositions were calcium oxalate (91%), uric
acid (2%) and mixed (7%). CONCLUSION: Aggressive PCNL monotherapy using multiple 
tracts is safe and effective, and should be the first option for massive renal
staghorn calculi.

Publication Types: 
    Comparative Study
    Multicenter Study

PMID: 16327300 [PubMed - indexed for MEDLINE]

583: Urol Int. 2005;75(4):322-6.

Management of pelvic stones larger than 20 mm: laparoscopic transperitoneal
pyelolithotomy or percutaneous nephrolithotomy?

Meria P, Milcent S, Desgrandchamps F, Mongiat-Artus P, Duclos JM, Teillac P.

Department of Urology, St-Louis Hospital, Paris, France.

Large pelvic stones are frequently managed with percutaneous nephrolithotomy
(PCNL) but laparoscopic transperitoneal pyelolithotomy (LTP) can be an
alternative. We compared PCNL and LTP for the treatment of pelvic stones >20 mm
in diameter. PATIENTS AND METHODS: Between November 1999 and November 2004, 16
consecutive patients, mean age 42, with a single pelvic stone >20 x 10 mm (group 
I), underwent LTP as first-line treatment or after shockwave lithotripsy failure.
They were compared with a similar population of 16 consecutive patients, mean age
45 (group II), who underwent PCNL for the same indication and were assessed
retrospectively. We evaluated operative characteristics, complications, and
results for each technique. RESULTS: There was no difference between the two
groups regarding the characteristics of patients and stones. Operative time
duration was significantly longer in group I (129 vs. 75 min; p = 0.001) and
conversion was required in 2 patients (12%). The main postoperative complications
were urinary leakage (2 patients, 12%) in group I and bleeding (3 patients, 18%) 
in group II, but only 1 required blood transfusion. Mean hospital stay was
respectively 6.5 and 5.6 days in groups I and II (p = 0.17). Stone-free rates
were assessed at 3 months and were not different between group I and group II (88
vs. 82%). CONCLUSIONS: The operative time of LTP is longer and the results of
both techniques are comparable but postoperative morbidity is different. Specific
indications of each technique must be determined although PCNL remains the gold
standard for most large pelvic stones.

Publication Types: 
    Comparative Study

PMID: 16327299 [PubMed - indexed for MEDLINE]

584: Nephrol Dial Transplant. 2006 Mar;21(3):701-6. Epub 2005 Dec 2.

Evidence against a contribution of conventional urine risk factors to de novo
ESRD renal stones.

Stankus N, Worcester E, Hammes M, Coe FL.

Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
nstankus@medicine.bsd.uchicago.edu

BACKGROUND: The authors measured urine and blood stone risk factors in
African-American (AA) haemodialysis (HD) patients with new onset of stones during
dialysis. METHODS: Patients with nephrolithiasis (NL) newly manifested during
dialysis were matched by age, sex and urine output and dialysis duration to AA HD
patients without history or symptoms of stones. Two 24 h urine and serum samples 
were collected and analysed for conventional stone risk factors. RESULTS: Three
percent of the patients formed new stones while on HD; none had formed stones
prior to end-stage renal disease. Newly onset NL patients had higher urine
citrate and lower serum potassium levels than HD patients without stones.
CONCLUSION: Usual stone risk factors did not correlate with new stones during
dialysis.

Publication Types: 
    Comparative Study

PMID: 16326738 [PubMed - indexed for MEDLINE]

585: Int J Urol. 2005 Oct;12(10):859-63.

Kidney stone disease and risk factors for coronary heart disease.

Hamano S, Nakatsu H, Suzuki N, Tomioka S, Tanaka M, Murakami S.

Department of Urology, Asahi General Hospital, Asahi-city, Chiba, Japan.
shammer@d3.dion.ne.jp

BACKGROUND: We conducted a case-control study to examine the impact of coronal
heart disease (CHD) risk factors on calcium oxalate (CaOX) stone formation.
METHODS: Variables included body mass index (BMI), current alcohol use, smoking
habit, hypertension, hypercholesterolemia, diabetes mellitus, and hyperuricemia. 
Data suf fi cient for analysis were obtained for 181 CaOX stone formers and 187
controls. RESULTS: Seven of 181 stone formers (3.9%) had a history of CHD
compared with none of 187 control subjects (P = 0.007). In univariate logistic
regression analysis, smoking habit (OR 4.41, 95% CI 2.85-6.84, P < 0.0001),
hypertension (OR 4.24, 95% CI 2.61-6.91, P < 0.0001), hypercholesterolemia (OR
3.03, 95% CI 1.77-5.20, P < 0.0001) and BMI (OR 1.10, 95% CI 1.04-1.17, P =
0.007) reached statistical signi fi cance. In a multivariate logistic regression 
analysis, smoking habit (OR 4.29, 95% CI 2.68-6.86, P < 0.0001), hypertension (OR
3.57, 95% CI 2.11-6.07, P < 0.0001), and hypercholesterolemia (OR 2.74, 95% CI
1.51-5.00, P = 0.001) reached statistical signi fi cance, while BMI (OR 1.06, 95%
CI 0.99-1.12, P = 0.09) did not. CONCLUSIONS: CaOX stone formers are signi fi
cantly associated with several CHD risk factors, including smoking habit,
hypertension, hypercholesterolemia, and obesity.

Publication Types: 
    Comparative Study

PMID: 16323977 [PubMed - indexed for MEDLINE]

586: J Clin Invest. 2005 Dec;115(12):3613-22. Epub 2005 Nov 23.

Identification of human urinary trefoil factor 1 as a novel calcium oxalate
crystal growth inhibitor.

Chutipongtanate S, Nakagawa Y, Sritippayawan S, Pittayamateekul J,
Parichatikanond P, Westley BR, May FE, Malasit P, Thongboonkerd V.

Medical Molecular Biology Unit, Office for Research and Development, Siriraj
Hospital, Mahidol University, Bangkok, Thailand.

Previous research on proteins that inhibit kidney stone formation has identified 
a relatively small number of well-characterized inhibitors. Identification of
additional stone inhibitors would increase understanding of the pathogenesis and 
pathophysiology of nephrolithiasis. We have combined conventional biochemical
methods with recent advances in mass spectrometry (MS) to identify a novel
calcium oxalate (CaOx) crystal growth inhibitor in normal human urine. Anionic
proteins were isolated by DEAE adsorption and separated by HiLoad 16/60 Superdex 
75 gel filtration. A fraction with potent inhibitory activity against CaOx
crystal growth was isolated and purified by anion exchange chromatography. The
protein in 2 subfractions that retained inhibitory activity was identified by
matrix-assisted laser desorption/ionization-time-of-flight MS and electrospray
ionization-quadrupole-time-of-flight tandem MS as human trefoil factor 1 (TFF1). 
Western blot analysis confirmed the mass spectrometric protein identification.
Functional studies of urinary TFF1 demonstrated that its inhibitory potency was
similar to that of nephrocalcin. The inhibitory activity of urinary TFF1 was dose
dependent and was inhibited by TFF1 antisera. Anti-C-terminal antibody was
particularly effective, consistent with our proposed model in which the 4
C-terminal glutamic residues of TFF1 interact with calcium ions to prevent CaOx
crystal growth. Concentrations and relative amounts of TFF1 in the urine of
patients with idiopathic CaOx kidney stone were significantly less (2.5-fold for 
the concentrations and 5- to 22-fold for the relative amounts) than those found
in controls. These data indicate that TFF1 is a novel potent CaOx crystal growth 
inhibitor with a potential pathophysiological role in nephrolithiasis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16308573 [PubMed - indexed for MEDLINE]

587: J Pak Med Assoc. 2005 Sep;55(9):387-9.

Xanthogranulomatous pyelonephritis due to calculi: report of 63 cases and review 
of literature.

Nawaz H, Khan S, Hussain I, Ahmed S, Khan M, Niazi N.

Department of Urology, Bolan Medical College, Quetta.

OBJECTIVE: To examine the relationship between clinical history and results of
renal investigations in patients with xanthogranulomatous pyelonephritis.
METHODS: A retrospective review was conducted on 63 cases presenting with
histopathological diagnosis of xanthogranulomatous pyelonephritis between 1995 to
2002, at the department of Urology, Bolan Medical College and Sandeman Provincial
Teaching Hospital Quetta. RESULTS: There were 26 males and 37 females having an
average follow up of two years. Positive findings on examination and
investigations at presentation were fever and flank pain in 59 (93.6%) patients
and pyuria in 34 (53.9%) patients. All the patients had renal and ureteric
calculi with no or severe reduction in the function of the affected kidney on
DTPA scan. Hypertrophy of the contra lateral kidney was seen in 56 (88.8%)
patients. CONCLUSION: Xanthogranulomatous pyelonephritis is a common entity in
this part of the world. Late referral leads to loss of the kidney. Pre-operative 
diagnosis of the condition is desirable and if surgery is mandatory then all
infected tissues have to be removed.

PMID: 16302473 [PubMed - indexed for MEDLINE]

588: BJU Int. 2005 Dec;96(9):1365-8.

Comment in:
    BJU Int. 2006 Mar;97(3):653-4.

Concomitant management of renal calculi and pelvi-ureteric junction obstruction
with robotic laparoscopic surgery.

Atug F, Castle EP, Burgess SV, Thomas R.

Department of Urology, Center for Minimally Invasive Urologic Surgery, Tulane
University Health Sciences Center, New Orleans, LA 70112, USA.

OBJECTIVE: To present technical recommendations for robotic-assisted laparoscopic
pyeloplasty (RALP) and stone extraction, as patients with kidney stones proximal 
to a pelvi-ureteric junction obstruction (PUJO) present a technical challenge,
and have traditionally been managed with open surgery or percutaneous antegrade
endopyelotomy. PATIENTS AND METHODS: From November 2002 to April 2005, 55
patients had RALP for PUJO; eight of these had concomitant renal calculi. Stone
burden and location were assessed with a preoperative radiological examination.
Before completing the PUJO repair, one robot working arm (cephalad one) was
temporarily undocked to allow passage of a flexible nephroscope into the renal
pelvis and collecting systems under direct vision. Stones were extracted with
graspers or basket catheters and removed via the port. The surgical-assistant
port in the subxiphoid area was used to introduce laparoscopic suction and other 
instruments. RESULTS: The Anderson-Hynes dismembered pyeloplasty was the
preferred reconstructive technique in all patients. Operations were completed
robotically with no conversions to open surgery. All patients were rendered
stone-free, confirmed by imaging, and there were no intraoperative or delayed
complications during a mean (range) follow-up of 12.3 (4-22) months. The mean
operative time was 275.8 min, 61.7 min longer than in patients who did not have
concomitant stone removal. CONCLUSIONS: Concurrent stone extraction and PUJO
repair can be successful with RALP. Operative times are longer than in patients
with isolated PUJO repair, but this is to be expected as there is an additional
procedure.

PMID: 16287459 [PubMed - indexed for MEDLINE]

589: Urology. 2005 Nov;66(5):953-7.

One-step percutaneous nephrolithotomy sheath versus standard two-step technique.

Pathak AS, Bellman GC.

Department of Urology, Kaiser Permanente, Los Angeles, California 90027, USA.

OBJECTIVES: Advances in technique and equipment have allowed urologists to
perform percutaneous stone removal with increasing efficacy and decreasing
complications. The procedure of choice for large renal calculi is percutaneous
nephrolithotomy. At our institution, percutaneous access is achieved by a
two-step process using either Amplatz dilators or placement of a high-pressure
balloon catheter for tract dilation, followed by advancement of a sheath over the
balloon. A novel device, the Pathway Access Sheath (PAS) has been developed that 
allows for balloon tract dilation and percutaneous access sheath placement in one
simple step. METHODS: Our study population consisted of 21 patients, who were
randomized to one of two arms. Of the 21 patients, 10 underwent standard two-step
access using a high-pressure balloon catheter and 11 underwent percutaneous
nephrolithotomy using the novel PAS. We compared the insertion time, blood loss, 
and cost between the two techniques. RESULTS: The average insertion time was
shorter in the PAS group (3 minutes) compared with the high-pressure balloon
catheter (5 minutes, 42 seconds); a difference that was statistically significant
(P <0.01). The estimated blood loss and cost were similar between the two groups.
The increased sheath flexibility of the PAS was noted to be an advantage in some 
patients. CONCLUSIONS: The results of our study have shown that a novel
single-step renal access device is safe and efficacious and results in a shorter 
insertion time for percutaneous nephrolithotomy. Blood loss was less in the PAS
group as well, although the difference was not statistically significant.
Additional studies will establish whether this device will provide a new standard
of obtaining renal access.

Publication Types: 
    Comparative Study
    Randomized Controlled Trial

PMID: 16286102 [PubMed - indexed for MEDLINE]

590: Urology. 2005 Nov;66(5):941-4.

Shock wave lithotripsy success determined by skin-to-stone distance on computed
tomography.

Pareek G, Hedican SP, Lee FT Jr, Nakada SY.

Division of Urology, Department of Surgery, University of Wisconsin Medical
School, Madison, Wisconsin 53792, USA.

OBJECTIVES: To evaluate whether the skin-to-stone distance (SSD), body mass index
(BMI), and Hounsfield unit (HU) density can be used as independent predictors of 
stone-free (SF) status after shock wave lithotripsy (SWL) of lower pole kidney
stones. No studies have evaluated the SSD by non-contrast-enhanced computed
tomography (NCCT) as a predictor of SWL success. Studies have suggested that the 
BMI and HU density of urinary calculi on NCCT may predict the SF rate after SWL. 
METHODS: The radiographs of 64 patients treated with SWL (DoliS lithotripter)
from March 2000 to April 2004 with lower pole kidney stones measuring 0.5 to 1.5 
cm on NCCT were reviewed. The average SSD was calculated by measuring three
distances from the center of the stone to the skin (0 degrees, 45 degrees, and 90
degrees angles) on NCCT. The BMI and HU density were determined, and chemical
analysis was performed on all stones. Radiographic assessment of the kidneys,
ureter, and bladder at 6 weeks categorized patients into the SF or residual stone
group. Logistic regression was fit, using SSD, BMI, and HU density as predictors,
to assess the SF rates after SWL. RESULTS: Of 64 patients, 30 were SF and 34 had 
residual stones. The mean SSD was 8.12 +/- 1.74 cm for the SF group versus 11.53 
+/- 1.89 cm for the residual stone group (P <0.01). Logistic regression analysis 
revealed only SSD to be a significant predictor of outcome (odds ratio 0.32, 95% 
confidence interval 0.29 to 0.35, P <0.01). An SSD greater than 10 cm predicted
treatment failure. CONCLUSIONS: The SSD may predict the outcome after SWL of
lower pole kidney stones. SWL in patients with an SSD greater than 10 cm is
likely to fail. The use of the SSD may be transferable to the treatment of all
urinary stones, regardless of location.

PMID: 16286099 [PubMed - indexed for MEDLINE]

591: Urol Res. 2005 Nov;33(5):380-2. Epub 2005 Nov 13.

A new animal model of hyperoxaluria and nephrolithiasis in rats with small bowel 
resection.

Worcester EM, Chuang M, Laven B, Orvieto M, Coe FL, Evan AP, Gerber GS.

Nephrology Section, MC 5100, Department of Medicine, University of Chicago,
Chicago, IL 60637, USA. eworcest@medicine.bsd.uchicago.edu

An association between small bowel resection and stone disease has been noted,
which is primarily due to increased gut oxalate absorption and resulting
excretion by the kidney. In order to better understand the factors affecting both
oxalate absorption and renal excretion, and the resulting renal lesions, we have 
developed a rodent model of small bowel resection and hyperoxaluria. Using this
model, we have studied the renal histology in animals with hyperoxaluria over
time spans from 2 weeks to 7 months. The initial lesion appears to be crystal
formation along the brush border of the proximal tubule, with eventual crystal
deposition in collecting ducts and papillary interstitium, and eventual tubule
obstruction, interstitial inflammation and fibrosis. Crystal formation appears to
dissociate from urinary supersaturation. We hypothesize that oxalate transporters
in the proximal tubule may increase local saturations, leading to crystal
formation at this site initially. Further studies are required to better
characterize the causes and consequences of hyperoxaluria in this animal model.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 16284881 [PubMed - indexed for MEDLINE]

592: Urol Res. 2005 Nov;33(5):398-402. Epub 2005 Nov 13.

Quantitation of stone burden: imaging advances.

Vrtiska TJ.

Department of Radiology, Mayo Clinic College of Medicine, 200 First Street, SW,
Rochester, MN 55905, USA. vrtiska.terri@mayo.edu

The accurate diagnosis and quantitation of nephrolithiasis in patients with
primary hyperoxaluria (PH) often directly impacts the medical and surgical
management for individuals with both symptomatic and asymptomatic calculi.
Traditionally, depiction of the size, location and appearance of urinary calculi 
has been provided by kidney, ureter and bladder plain film radiographs with or
without tomography. Given advances in imaging technology there is a shift from
conventional radiographs to cross-sectional imaging technology, namely unenhanced
computed tomography (CT), CT urography, ultrasound and magnetic resonance
imaging. These diagnostic techniques provide differing advantages and
disadvantages for imaging stone disease. This review outlines imaging advances in
the accurate diagnosis and quantitation of patients with metabolically active
stone disease such as PH.

Publication Types: 
    Review

PMID: 16284880 [PubMed - indexed for MEDLINE]

593: J Acoust Soc Am. 2005 Oct;118(4):2667-76.

Modeling elastic wave propagation in kidney stones with application to shock wave
lithotripsy.

Cleveland RO, Sapozhnikov OA.

Department of Aerospace and Mechanical Engineering, Boston University, 110
Cummington Street, Boston, Massachusetts 02215, USA. robinc@bu.edu

A time-domain finite-difference solution to the equations of linear elasticity
was used to model the propagation of lithotripsy waves in kidney stones. The
model was used to determine the loading on the stone (principal stresses and
strains and maximum shear stresses and strains) due to the impact of lithotripsy 
shock waves. The simulations show that the peak loading induced in kidney stones 
is generated by constructive interference from shear waves launched from the
outer edge of the stone with other waves in the stone. Notably the shear wave
induced loads were significantly larger than the loads generated by the classic
Hopkinson or spall effect. For simulations where the diameter of the focal spot
of the lithotripter was smaller than that of the stone the loading decreased by
more than 50%. The constructive interference was also sensitive to shock rise
time and it was found that the peak tensile stress reduced by 30% as rise time
increased from 25 to 150 ns. These results demonstrate that shear waves likely
play a critical role in stone comminution and that lithotripters with large focal
widths and short rise times should be effective at generating high stresses
inside kidney stones.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 16266186 [PubMed - indexed for MEDLINE]

594: J Endourol. 2005 Oct;19(8):968-72.

Percutaneous nephrolithotomy for complete staghorn calculi in preschool children.

Aron M, Yadav R, Goel R, Hemal AK, Gupta NP.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
monisharon@hotmail.com

BACKGROUND AND PURPOSE: To evaluate the safety and efficacy of percutaneous
nephrolithotomy (PCNL) for the management of complete staghorn calculi in
children <or=5 years old. PATIENTS AND METHODS: The charts of 19 preschool
children (15 boys, 4 girls) aged 20 months to 5 years (mean 4.2 years) with
complete staghorn calculi who underwent PCNL at our center over a 3-year period
were reviewed. The mean stone burden was 972 mm2 (range 870-1210 mm2). All
procedures were performed with the patient in the prone position after retrograde
catheterization with a 5F ureteral catheter. Fluoroscopyguided punctures were
made by the urologist followed by track dilation to 24F. A 19F sheathless
nephroscope passed through an Amplatz sheath was used in all cases. Flexible
nephroscopy was used as an adjunct where necessary. Postoperative stone clearance
was documented by plain film or, for radiolucent calculi, ultrasonography.
RESULTS: The majority of children (68%; N = 13) required two tracts, while five
children (26%) required only one tract and one child required three. Complete
clearance with PCNL monotherapy was achieved in 17 patients (89%), which
increased to 94.7% with adjunctive shockwave lithotripsy. Stone analysis revealed
struvite in 1, uric acid in 3, and calcium oxalate monohydrate in 15 patients.
CONCLUSION: In preschool children, PCNL for complete staghorn calculi is a safe
and effective method for maximal stone clearance.

PMID: 16253060 [PubMed - indexed for MEDLINE]

595: Am J Physiol Renal Physiol. 2006 Apr;290(4):F838-43. Epub 2005 Oct 25.

Erratum in:
    Am J Physiol Renal Physiol. 2006 Jul;291(1):F254-5.

Longitudinal study of urinary excretion of phosphate, calcium, and uric acid in
mutant NHERF-1 null mice.

Weinman EJ, Mohanlal V, Stoycheff N, Wang F, Steplock D, Shenolikar S, Cunningham
R.

Department of Medicine, University of Maryland School of Medicine, Baltimore
21202, USA. eweinman@medicine.umaryland.edu

NHERF-1 binds numerous renal protein targets, including the proximal tubule
transporters Na(+)/H(+) exchanger 3 (NHE3) and Na(+)-phosphate cotransporter 2a
(Npt2a). Young NHERF-1(-/-) male mice display defective targeting of Npt2a to
apical membranes in the renal proximal tubule and manifest hypophosphatemia and
increased urinary excretion of phosphate. The present studies describe the
changes in the urinary excretion of phosphate, calcium, uric acid, and sodium in 
male and female wild-type and NHERF-1 null mice over a time period from 12 to 54 
wk of age. Young male and female NHERF-1(-/-) mice demonstrated increased urinary
excretion of phosphate and urine phosphate/creatinine ratios. There was an
age-related decline in the phosphate/creatinine ratio in mutant mice such that
there were no differences between wild-type and NHERF-1(-/-) by 24 to 30 wk of
age despite the continued presence of hypophosphatemia. Male and female NHERF-1
null mice also demonstrate increased urine calcium/creatinine and uric
acid/creatinine ratios compared with wild-type controls. These studies indicate
defects in the renal tubule transport of phosphate, calcium, and uric acid in
NHERF-1(-/-) male and female mice that could account for the increased deposition
of calcium in the papilla of null mice.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16249272 [PubMed - indexed for MEDLINE]

596: J Hum Genet. 2006;51(1):25-30. Epub 2005 Oct 25.

Dent's disease and prevalence of renal stones in dialysis patients in
Northeastern Italy.

Tosetto E, Graziotto R, Artifoni L, Nachtigal J, Cascone C, Conz P, Piva M,
Dell'Aquila R, De Paoli Vitali E, Citron L, Nalesso F, Antonello A, Vertolli U,
Zagatti R, Lupo A, D'Angelo A, Anglani F, Gambaro G.

Laboratory of Molecular Biology, Department of Medical and Surgical Sciences,
Division of Nephrology, University of Padova, Padova, Italy.

Dent's disease (DD) involves nephrocalcinosis, urolithiasis, hypercalciuria, LMW 
proteinuria, and renal failure in various combinations. Males are affected. It is
caused by mutations in the chloride channel CLCN5 gene. It has been suggested
that DD is underdiagnosed, occurring in less overt forms, apparently without
family history. A possible approach to this problem is to search for CLCN5
mutations in patients who may have a high prevalence of mutations: end-stage
renal disease (ESRD) patients with previous calcium, struvite, or radio-opaque
(CSR) stones. We looked for CLCN5 mutations in 25 males with ESRD-CSR stones
selected from all of the patients (1,901 individuals, of which 1,179 were males) 
of 15 dialysis units in the Veneto region. One DD patient had a new DD mutation
(1070 G > T) in exon 7. The new polymorphism IVS11-67 C > T was detected in
intron 11 in one patient and one control. We also found 28 females with ESRD and 
stone history, and seven more males with ESRD and non-CSR stones. The prevalence 
of stone formers among dialysis patients in our region was 3.2%, much lower than 
the prevalence observed in older studies. Struvite stones continue to play a
major role in causing stone-associated ESRD .

PMID: 16247550 [PubMed - indexed for MEDLINE]

597: BJU Int. 2005 Nov;96(7):1097-100.

Simultaneous combined use of flexible ureteroscopy and percutaneous
nephrolithotomy to reduce the number of access tracts in the management of
complex renal calculi.

Marguet CG, Springhart WP, Tan YH, Patel A, Undre S, Albala DM, Preminger GM.

Department of Urology, Duke University Medical Center, Durham, NC 27710, USA.

OBJECTIVE: To present early experience in managing complex renal calculi using a 
combined ureteroscopic and percutaneous approach, as complex and branched renal
calculi often require multiple access tracts during percutaneous nephrolithotomy 
(PNL), and the combined use of flexible ureteroscopy and PNL has the potential to
reduce the inherent morbidity of several tracts. PATIENTS AND METHODS: The study 
included seven patients (mean age 54 years) with multiple, branched, large-volume
renal calculi suitable for management with PNL. Preoperative data, including
patient demographics, stone location and stone surface area, were recorded. After
informed consent, the patients underwent combined PNL and ureteroscopy in one
session. Intraoperative data, including the location of PNL puncture sites,
operative duration and complications, were analysed. Stone-free rates were
determined by follow-up imaging at 3 months. RESULTS: All patients had either two
or more stones in separate locations in the collecting system, or staghorn stones
involving multiple calyces. The mean stone burden was 666 mm(2). All patients had
only one percutaneous access tract. The mean operative duration was 142 min and
the mean blood loss 79 mL. Two patients had small residual stones (< 3 mm), that 
required ureteroscopic intervention as they failed to pass spontaneously by 3
months after the initial combined procedure. The convalescence was similar to
that in our current PNL practice; imaging showed that five of the patients were
stone-free. CONCLUSIONS: Combined PNL and ureteroscopic management can
effectively reduce the number of percutaneous access tracts which would otherwise
be required for managing complex and branched renal calculi, as stones in an
unfavourable location relative to the access tract can be relocated and
fragmented within easy reach of the single nephrostomy tract. This manoeuvre
reduces potential patient morbidity and blood loss but with no significant effect
on stone-free rates and operative durations.

PMID: 16225535 [PubMed - indexed for MEDLINE]

598: J Urol. 2005 Nov;174(5):1844-6; discussion 1846.

Jejunoileal bypass reversal: effect on renal function, metabolic parameters and
stone formation.

Dhar NB, Grundfest S, Jones JS, Streem SB.

Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
44195, USA. dharn@ccf.org

PURPOSE: While the effect of jejunoileal bypass (JIB) reversal has been well
studied regarding hepatic function, there is little information regarding the
effect of reversal on renal function and even less data regarding the metabolic
urinary stone environment. We evaluated the results of JIB reversal on renal
function, the urinary stone milieu and the clinical development of recurrent
calculi in affected patients. MATERIALS AND METHODS: From 1995 to 2003, 4 female 
patients with a mean age of 48.2 years underwent JIB reversal primarily for
refractory stone disease. The clinical and metabolic courses prior to and
following bypass reversal were reviewed specifically to evaluate renal function, 
serum and urinary metabolic stone profiles, and clinical stone formation.
RESULTS: At initial presentation following JIB all 4 patients had significantly
increased 24-hour urinary oxalate (range 80 to 160 mg, mean 112.5, normal less
than 50) and significantly low 24-hour urinary citrate (range 5 to 62 mg, mean
21.5, normal greater than 320). Following reversal 24-hour urinary oxalate
normalized to between 31 and 36 mg (mean 33.75). However, 24-hour urinary citrate
continued to be low (range 215 to 248 mg, mean 226.5). After JIB reversal all 4
patients continued to have new stones until the commencement of urinary
alkalization, following which only 1 had 1 calculus, which occurred 47 months
after reversal. After JIB mean serum creatinine was 1.48 mg/dl (range 0.8 to 1.9)
and mean urinary creatinine excretion was 0.91 mg per hour (range 0.69 to 1.15). 
After JIB reversal mean serum creatinine was 1.28 mg/dl (range 0.6 to 2.0) and
mean urinary creatinine excretion was 1.0 mg per hour (range 0.85 to 1.10).
CONCLUSIONS: JIB reversal normalizes 24-hour urinary oxalate. While urinary
citrate improves, it continues to be low and such patients are at high risk for
recurrent stone formation. However, in this setting appropriate replacement
therapy has a significant and positive impact on that propensity.

PMID: 16217311 [PubMed - indexed for MEDLINE]

599: Eur Urol. 2005 Nov;48(5):832-7. Epub 2005 Sep 15.

"Angular percutaneous renal access". Multiple tracts through a single incision
for staghorn calculous treatment in a single session.

Liatsikos EN, Kapoor R, Lee B, Jabbour M, Barbalias G, Smith AD.

Department of Urology, University of Patras, School of Medicine, Rio, Patras 26
500, Greece. Liatsikos@yahoo.com

PURPOSE: We herein describe the technique of a single subcostal skin incision
with multiple angular punctures to approach the superior, middle and lower pole
of the kidney for the management of staghorn calculi. MATERIALS AND METHOD: One
hundred patients with staghorn calculi were managed between January 1997 and June
2000. The superior calyx was approached by a subcostal triangulation technique
and the middle and lower calyces were approached by angular punctures. Correct
advancement of the needle was monitored by biplane fluoroscopy. Maximum effort
was made for complete stone clearance in a single session. RESULTS:: 87% patients
were rendered stone free in a single session. The average number of tract
dilation per renal unit was 2.4 with an average anesthesia time of 110 minutes
and the average blood loss of 450 ml. The average hospital stay duration was 4.6 
days. The secondary procedures required were 0.11 per patient and the
complication rate totalled 7% with one case of excessive hemorrhage requiring
embolization. CONCLUSIONS: We therefore propose the triangulation technique as a 
safe and appealing method for the percutaneous management of staghorn calculi.

PMID: 16203078 [PubMed - indexed for MEDLINE]

600: J Clin Invest. 2005 Oct;115(10):2598-608.

Kidney stone disease.

Coe FL, Evan A, Worcester E.

Renal Section, University of Chicago, Chicago, Illinois 60637, USA.
f-coe@uchicago.edu

About 5% of American women and 12% of men will develop a kidney stone at some
time in their life, and prevalence has been rising in both sexes. Approximately
80% of stones are composed of calcium oxalate (CaOx) and calcium phosphate (CaP);
10% of struvite (magnesium ammonium phosphate produced during infection with
bacteria that possess the enzyme urease), 9% of uric acid (UA); and the remaining
1% are composed of cystine or ammonium acid urate or are diagnosed as
drug-related stones. Stones ultimately arise because of an unwanted phase change 
of these substances from liquid to solid state. Here we focus on the mechanisms
of pathogenesis involved in CaOx, CaP, UA, and cystine stone formation, including
recent developments in our understanding of related changes in human kidney
tissue and of underlying genetic causes, in addition to current therapeutics.

Publication Types: 
    Review

PMID: 16200192 [PubMed - indexed for MEDLINE]

601: J Endourol. 2005 Sep;19(7):768-73.

Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale
study at a single institution.

Abe T, Akakura K, Kawaguchi M, Ueda T, Ichikawa T, Ito H, Nozumi K, Suzuki K.

Department of Urology, Graduate School of Medicine, Chiba University, Chiba,
Japan. rt968@f8.dion.ne.jp

PURPOSE: We investigated the risk factors having an impact on the achievement of 
stone-free status and on the success rate, as well as on the likelihood of
recurrence, in patients undergoing shockwave lithotripsy. PATIENTS AND METHODS:
We evaluated the characteristics and outcomes of 3023 patients (3254 renal units)
with upper urinary-tract stones who underwent SWL at the Funabashi Clinic over a 
13-year period. We assessed the stone-free and success rates for 2844 patients
(3061 renal units) 3 months post-SWL. We also determined the recurrence rate for 
the 1078 patients (1139 renal units) who had achieved stone-free status at that
time. RESULTS: Overall, stone-free status was achieved in 65.1% of patients, and 
the success rate was 85.7%. There were significant differences in the stone-free 
rates depending on patient age, history of urolithiasis, and presence of pyuria
before SWL, as well as the number, location, size, and composition of the stones.
Stones recurred in 326 of 1139 renal units (28.6%) during a mean follow-up of 36 
months. The recurrence rates were 7.5%, 24.1%, and 33.0% after 1, 3, 5 years,
respectively. Multiple stones, a history of urolithiasis, and stones located in
the kidney or both kidneys plus the ureter significantly influenced recurrence.
Multivariate analysis demonstrated that multiple stones were most significantly
related to recurrence. CONCLUSION: Treatment with SWL has a low morbidity and
high effectiveness. The number and location of stones and a history of
urolithiasis significantly influence recurrence. Further studies of prophylactic 
therapy are required, especially for patients with these factors.

PMID: 16190825 [PubMed - indexed for MEDLINE]

602: Kidney Int. 2005 Oct;68(4):1808-14.

Direct and indirect costs of nephrolithiasis in an employed population:
opportunity for disease management?

Saigal CS, Joyce G, Timilsina AR; Urologic Diseases in America Project.

Department of Urology, University of California, Los Angeles, California 90095,
USA. csaigal@ucla.edu

BACKGROUND: More than 5% of the United States population has been diagnosed with 
nephrolithiasis and about one half of (first-time) stone formers will have a
recurrence within 5 years. The prevalence of nephrolithiasis is concentrated
among working age adults, yet little prior work has examined the economic burden 
of the disease on employers and their employees. We sought to estimate the direct
and indirect costs of nephrolithiasis for working age adults (18-64) with
employer-provided insurance. METHODS: This was an observational study using
retrospective claims data. Detailed medical and pharmacy claims from 25 large
employers and absentee data from a subset of firms were used to estimate the
direct and indirect costs associated with nephrolithiasis in a privately insured,
non-elderly population. Multivariate regression models were used to predict
health care expenditures for persons with and without the condition, controlling 
for differences in patient (health status) and plan characteristics. RESULTS:
More than 1% of working-age adults were treated for nephrolithiasis in 2000.
Prevalence was considerably higher among men and employees age 55 to 64. About
one third of employees treated for nephrolithiasis in 2000 missed work due to the
condition, with an average work loss for the entire treated population of 19
hours per person. Conditional on receiving treatment, the incremental costs of
nephrolithiasis were 3,494 US dollars per person in 2000. CONCLUSION: The direct 
and indirect costs of nephrolithiaisis are substantial among working-age adults. 
Interventions that prevent recurrence among known stone formers may be a
cost-effective component of disease management programs.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16164658 [PubMed - indexed for MEDLINE]

603: Kidney Int. 2005 Oct;68(4):1660-9.

Oxalate is toxic to renal tubular cells only at supraphysiologic concentrations.

Schepers MS, van Ballegooijen ES, Bangma CH, Verkoelen CF.

Department of Urology, Erasmus Medical Center Rotterdam, Rotterdam, The
Netherlands.

BACKGROUND: Oxalate-induced tissue damage may play an initiating role in the
pathophysiology of calcium oxalate nephrolithiasis. The concentration of oxalate 
is higher in the renal collecting ducts ( approximately 0.1 to 0.5 mmol/L) than
in the proximal tubule ( approximately 0.002 to 0.1 mmol/L). In the present
investigation, we studied the damaging effect of oxalate to renal proximal and
collecting tubule cells in culture. METHODS: Studies were performed with the
renal proximal tubular cell lines, LLC-PK1 and Madin Darby canine kidney II
(MDCK-II), and the renal collecting duct cell lines, rat renal cortical
collecting duct (RCCD1) and MDCK-I. Confluent monolayers cultured on permeable
growth substrates in a two-compartment culture system were apically exposed for
24 hours to relatively low (0.2, 0.5, and 1.0 mmol/L) and high (5 and 10 mmol/L) 
oxalate concentrations, after which several cellular responses were studied,
including monolayer morphology (confocal microscopy), transepithelial electrical 
resistances (TER), prostaglandin E(2) (PGE(2)) secretion, lactate dehydrogenase
(LDH) release, DNA synthesis ([(3)H]-thymidine incorporation), total cell
numbers, reactive oxygen species (H(2)O(2)) generation, apoptotic (annexin V and 
DNA fragmentation), and necrotic (propidium iodide influx) cell death. RESULTS:
Visible morphologic alterations were observed only at high oxalate
concentrations. TER was concentration-dependently decreased by high, but not by
low, oxalate. Elevated levels of PGE(2), LDH, and H(2)O(2) were measured in both 
cell types after exposure to high, but not to low oxalate. Exposure to high
oxalate resulted in elevated levels of DNA synthesis with decreasing total cell
numbers. High, but not low, oxalate induced necrotic cell death without signs of 
programmed cell death. CONCLUSION: This study shows that oxalate is toxic to
renal tubular cells, but only at supraphysiologic concentrations.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16164643 [PubMed - indexed for MEDLINE]

604: Kidney Int. 2005 Oct;68(4):1543-53.

Crystals cause acute necrotic cell death in renal proximal tubule cells, but not 
in collecting tubule cells.

Schepers MS, van Ballegooijen ES, Bangma CH, Verkoelen CF.

Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.

BACKGROUND: The interaction between renal tubular cells and crystals generated in
the tubular fluid could play an initiating role in the pathophysiology of calcium
oxalate nephrolithiasis. Crystals are expected to form in the renal collecting
ducts, but not in the proximal tubule. In the present investigation, we studied
the damaging effect of calcium oxalate crystals on renal proximal and collecting 
tubule cells in culture. METHODS: Studies were performed with the renal proximal 
tubular cell lines, porcine proximal tubular cells (LLC-PK(1)) and Madin-Darby
canine kidney II (MDCK-II) and the renal collecting duct cell lines, RCCD(1) and 
MDCK-I. Confluent monolayers cultured on permeable growth substrates in a
two-compartment culture system were apically exposed to calcium oxalate
monohydrate crystals, after which several cellular responses were studied,
including monolayer morphology (confocal microscopy), transepithelial electrical 
resistances (TER), prostaglandin E(2) (PGE(2)) secretion, DNA synthesis
([(3)H]-thymidine), total cell numbers, reactive oxygen species [hydrogen
peroxide (H(2)O(2))] generation, apoptotic (annexin V and DNA fragmentation), and
necrotic (propidium iodide influx) cell death. RESULTS: Crystals were rapidly
taken up by proximal tubular cells and induced a biphasic response. Within 24
hours approximately half of the cell-associated crystals were released back into 
the apical fluid (early response). Over the next 2 weeks half of the remaining
internalized crystals were eliminated (late response). The early response was
characterized by morphologic disorder, increased synthesis of PGE(2), H(2)O(2),
and DNA and the release of crystal-containing cells from the monolayers. These
released cells appeared to be necrotic, but not apoptotic cells. Scrape-injured
monolayers generated even higher levels of H(2)O(2) than those generated in
response to crystals. During the late response, crystals were gradually removed
from the monolayers without inflammation-mediated cell death. Crystals did not
bind to, were not taken up by, and did not cause marked responses in collecting
tubule cells. CONCLUSION: This study shows that calcium oxalate crystals cause
acute inflammation-mediated necrotic cell death in renal proximal tubular cells, 
but not in collecting tubule cells. The crystal-induced generation of reactive
oxygen species by renal tubular cells is a general response to tissue damage and 
the increased levels of DNA synthesis seem to reflect regeneration rather than
growth stimulation. As long as the renal collecting ducts are not obstructed with
crystals, these results do not support an important role for crystal-induced
tissue injury in the pathophysiology of calcium oxalate nephrolithiasis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16164631 [PubMed - indexed for MEDLINE]

605: Kaohsiung J Med Sci. 2005 Aug;21(8):358-64.

Impact of lower pole anatomy on stone clearance after shock wave lithotripsy.

Juan YS, Chuang SM, Wu WJ, Shen JT, Wang CJ, Huang CH.

Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan.

This study retrospectively analyzed patients treated with shock wave ithotripsy
(SWL) for lower calyceal stones, to determine the influence of the lower pole
anatomy and stone size in predicting the clearance of fragments. Between June
2000 and March 2002, we reviewed excretory urography (IVU) of 59 patients with
isolated lower pole stones treated with SWL. A total of 44 men and 15 women, with
an age ranging between 23 and 78 years (mean, 55 years), were included in the
study. The patients were divided into two groups, either a stone-free group or
residual-stone group. After SWL, overall stone rate was 57.6%, and clearance for 
stones less than 10 mm in diameter was 64.5%, whereas clearance was 50% for
stones between 10 and 20 mm in diameter. Intrarenal anatomy on IVU, such as
infundibular width and infundibulopelvi-ureteric angle showed no significant
difference between the stone-free and residual-stone groups. Our analysis showed 
that three significant variables were relevant to stone clearance: infundibular
length, stone size and stone burden. We conclude that SWL is the best treatment
for lower pole kidney stones 10 mm or less in diameter, showing lower
complication and acceptable stone-free rates.

PMID: 16158878 [PubMed - indexed for MEDLINE]

606: BJU Int. 2005 Oct;96(6):879-83.

Comment in:
    BJU Int. 2006 Apr;97(4):868.

Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review
of previous reports.

Shah HN, Kausik VB, Hegde SS, Shah JN, Bansal MB.

R. G. Stone Urological Research Centre, Mumbai, Maharashtra, India.
drhememdrashah@yahoo.co.in

OBJECTIVE: To evaluate the status of tubeless percutaneous nephrolithotomy (PCNL)
in managing renal and upper ureteric calculi, from initial experience and a
review of previous reports. PATIENTS AND METHODS: From September 2004 to December
2004, 46 patients were scheduled for tubeless PCNL in a prospective study.
Patients with solitary kidney, or undergoing bilateral simultaneous PCNL or
requiring a supracostal access were also enrolled. Patients needing more than
three percutaneous access tracts, or with significant bleeding or a significant
residual stone burden necessitating a staged second-look nephroscopy were
excluded. At the end of the procedure, a JJ ureteric stent was placed antegradely
and a nephrostomy tube avoided. The patients' demographic data, the outcomes
during and after surgery, complications, success rate, and stent-related
morbidity were analysed. Previous reports were reviewed to evaluate the current
status of tubeless PCNL. RESULTS: Of the 46 patients initially considered only 40
(45 renal units) were assessed. The mean stone size in these patients was 33 mm
and 23 patients had multiple stones. Three patients had a serum creatinine level 
of >2 mg/dL (>177 micromol/L). Five patients had successful bilateral
simultaneous tubeless PCNL. In all, 51 tracts were required in 45 renal units, 30
of which were supracostal. The mean decrease in haemoglobin was 1.2 g/dL and two 
patients required a blood transfusion after PCNL. There was no urine leakage or
formation of urinoma after surgery, and no major chest complications in patients 
requiring a supracostal access tract, except for one with hydrothorax, managed
conservatively. The mean hospital stay was 26 h and analgesic requirement 40.6 mg
of diclofenac. Stones were completely cleared in 87% of renal units and 9% had
residual fragments of < 5 mm. Two patients required extracorporeal lithotripsy
for residual calculi. In all, 30% of patients had bothersome stent-related
symptoms and 60% needed analgesics and/or antispasmodics to treat them.
CONCLUSION: Tubeless PCNL was safe and effective even in patients with a solitary
kidney, or with three renal access tracts or supracostal access, or with deranged
renal values and in those requiring bilateral simultaneous PCNL. The literature
review suggested a need for prospective, randomized studies to evaluate the role 
of fibrin sealant and/or cauterization of the nephrostomy tract in tubeless PCNL.

Publication Types: 
    Evaluation Studies

PMID: 16153222 [PubMed - indexed for MEDLINE]

607: BJU Int. 2005 Oct;96(6):875-8.

Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience
from over 300 cases.

Osman M, Wendt-Nordahl G, Heger K, Michel MS, Alken P, Knoll T.

Department of Urology, Mannheim University Hospital, Germany.

OBJECTIVE: To report our experience with over 300 patients treated with
percutaneous nephrolithotomy (PNL), for although PNL was established as a
treatment in the 1970s, its use diminished with the introduction of
extracorporeal shockwave lithotripsy (ESWL); clinical experience with ESWL showed
its limitations, and the role of PNL for treating urolithiasis was redefined,
which with improvements in instruments and lithotripsy technology has expanded
the capability of percutaneous stone disintegration. PATIENTS AND METHODS: The
study included 315 patients (156 males, 159 females, aged 13-85 years) treated
with PNL in our department between 1987 and 2002. The mean (range) stone diameter
was 27 (7-52) mm. The kidney was punctured under ultrasonography guidance via a
lower-pole calyx whenever possible. The working channel was dilated using an
Alken dilator under X-ray control. If necessary, a flexible renoscope was used.
Ultrasonic, pneumatic and laser probes were used for lithotripsy. RESULTS: Four
weeks after treatment the total stone-free rate was 96.5%; 45.7% of all patients 
were primarily stone-free, 21.3% had clinically insignificant residual stones
that passed spontaneously within 4 weeks after PNL, and 33% of the patients
needed auxiliary measures (a second PNL, ESWL, ureterorenoscopy). Overall, the
early complication rate was 50.8%, the most common complications being transient 
fever (27.6%), clinically insignificant bleeding (7.6%) or both (3.2%); 3.5% of
the patients developed urinary tract infections (with no signs of urosepsis),
3.2% had renal colic and 2.9% upper urinary tract obstruction. One patient (0.3%)
developed acute pancreatitis after PNL; one died from urosepsis and one needed
selective angiographic embolization of the punctured kidney due to bleeding. No
patient required transfusions and there were no injuries to neighbouring organs. 
CONCLUSIONS: These results show that PNL causes no significant blood loss or
major complications in almost all patients. Two aspects may especially reduce the
potential complications: ultrasonography-guided renal puncture and using PNL in
an experienced centre. PNL is a highly efficient procedure that provides fast and
safe stone removal.

Publication Types: 
    Evaluation Studies

PMID: 16153221 [PubMed - indexed for MEDLINE]

608: J Urol. 2005 Oct;174(4 Pt 1):1468-70; discussion 1470-1.

Cystine: helical computerized tomography characterization of rough and smooth
calculi in vitro.

Kim SC, Hatt EK, Lingeman JE, Nadler RB, McAteer JA, Williams JC Jr.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, Indianapolis, Indiana 46202, USA.

PURPOSE: The classification of cystine stones into rough and smooth varieties has
been suggested as an aid to choosing treatment for these difficult stones. Since 
the surface of stones is difficult to visualize preoperatively, we tested the
hypothesis that the surface morphology of cystine stones correlates with their
internal structure, as viewed by helical computerized tomography (CT). MATERIALS 
AND METHODS: Cystine stones were examined visually and categorized into rough (15
stones) and smooth (16 stones) subpopulations of similar size. Each stone was
scanned in a helical CT scanner (GE Quad Scanner) to assess radiological
characteristics and to measure attenuation values. Scans were also performed
using a microCT 20 high resolution laboratory scanner (Scanco Medical AG,
Bassersdorf, Switzerland) at 34 microm voxel size and the percent of internal
voids was determined. RESULTS: Mean helical CT attenuation values +/- SD for
rough stones were lower than for smooth stones (702 +/- 206 vs 921 +/- 51 HU, p
<0.002) and the radiological appearance of rough stones suggested radiolucent
voids. Internal voids in rough stones were confirmed using micro CT. Rough
cystine stones contained a higher percent of internal voids (0.30% vs 0.06%, p
<0.0001). CONCLUSIONS: Rough cystine stones can be distinguished from smooth
stones using helical CT in vitro, suggesting that it may be possible to
distinguish these stones preoperatively. Since rough cystine stones have been
reported to be susceptible to shock wave lithotripsy, the identification of this 
morphology of cystine stones in the patient using attenuation values and
appearance on helical CT could be valuable for planning treatment.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16145473 [PubMed - indexed for MEDLINE]

609: Urology. 2005 Sep;66(3):510-3.

Extracorporeal shock wave lithotripsy of upper urinary tract calculi in patients 
with cystectomy and urinary diversion.

El-Assmy A, El-Nahas AR, Mohsen T, Eraky I, El-Kenawy MR, Shaban AA, Sheir KZ.

Department of Urology, Urology and Nephrology Center, Mansoura University,
Mansoura, Egypt. amaea73@link.net

OBJECTIVES: To present our experience with extracorporeal shock wave lithotripsy 
(ESWL) in the management of upper urinary tract calculi in patients with urinary 
diversion. METHODS: Between March 1989 and June 2004, 27 patients with radical
cystectomy and urinary diversion were treated using ESWL for upper urinary tract 
calculi using the Dornier MFL 5000 lithotripter. The mean length of the stones
was 11 +/- 3.1 mm and the mean width was 8.8 +/- 3.5 mm. The follow-up protocol
included plain abdominal x-ray and renal ultrasonography every 2 weeks until
complete stone clearance. All follow-up data were collected and analyzed after 3 
months. Success was defined as the absence of residual stones or the presence of 
insignificant gravel less than 4 mm. RESULTS: Retreatment was required in 12
patients (44.4%). Failure to disintegrate the stones was recorded in 2 cases
(7.4%) and significant residual stones were recorded in 1 (3.7%). Post-ESWL renal
obstruction was observed in 2 cases (7.4%). Secondary procedures were needed in 5
cases (18.5%). Two percutaneous nephrolithotomy and one antegrade ureteroscopy
were performed for treatment of ESWL failure. One open ureterolithotomy and one
antegrade ureteroscopy were performed for treatment of post-ESWL renal
obstruction. Thus, the overall success rate of ESWL monotherapy in the treatment 
of upper urinary tract stones was 81.5% (22 of 27). CONCLUSIONS: ESWL monotherapy
proved to be a valuable option in the treatment of upper tract lithiasis in
patients with urinary diversion. However, it may cause renal obstruction, and
antegrade endoscopic maneuvers should be available.

PMID: 16140067 [PubMed - indexed for MEDLINE]

610: Urology. 2005 Sep;66(3):500-4.

Safety and efficacy of bilateral simultaneous tubeless percutaneous
nephrolithotomy.

Shah HN, Kausik VB, Hegde SS, Shah JN, Bansal MB.

R. G. Stone Urological Research Institute, Ahimsa Marg, Khar (W), Mumbai, India. 
drhemendrashah@yahoo.co.in

OBJECTIVES: To evaluate the feasibility and safety of bilateral simultaneous
tubeless percutaneous nephrolithotomy (PCNL). METHODS: From August 2004 to
January 2005, 10 patients underwent bilateral simultaneous tubeless PCNL.
Patients needing more than two percutaneous tracts, having significant
intraoperative bleeding, or a residual stone burden were excluded from the study 
group. The outcome of these 10 patients was compared with a control group of 10
patients who had previously undergone bilateral simultaneous PCNL with routine
placement of a nephrostomy tube. RESULTS: The two groups had comparable
demographic data, except for a greater stone burden in the right renal units in
patients undergoing standard PCNL. The study and control groups needed a total of
22 and 23 tracts, respectively. The difference in the mean drop in hemoglobin,
transfusion requirement, and complication rate between the two groups was not
statistically significant. Patients undergoing tubeless PCNL required less
analgesia (P = 0.001) and were discharged 20 hours earlier (40 versus 60 hours)
than those in the control group. However, the difference in mean hospital stay
was not statistically significant owing to the small sample size. Complete stone 
clearance was achieved in 80% of the renal units in the study group and 75% of
the renal units in the control group. Three renal units in the tubeless group and
four in the standard PCNL group had less than 5-mm residual fragments.
CONCLUSIONS: Bilateral simultaneous tubeless PCNL appears to be a feasible, safe,
and effective procedure offering potential advantages of decreased analgesic
requirement and hospital stay without increasing the complications. Additional
clinical studies with a larger number of patients are required to confirm these
potential benefits.

Publication Types: 
    Clinical Trial

PMID: 16140065 [PubMed - indexed for MEDLINE]

611: Clin Chim Acta. 2006 Feb;364(1-2):267-74. Epub 2005 Sep 1.

Epitaxial deposition of calcium oxalate on uric acid rich stone matrix is induced
by a 29 kDa protein.

Srinivasan S, Kalaiselvi P, Varalakshmi P.

Department of Medical Biochemistry, Dr. A.L. Mudaliar, Post Graduate Institute of
Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, India.
srini@musc.edu

BACKGROUND: Association of macromolecules particularly the role of proteins in
urolithiasis has been studied for last few centuries, but still a complete
profile of stone matrix proteins that mediate co-precipitation of uric acid and
calcium oxalate has not been characterized. We isolated and characterize proteins
from uric acid rich stone matrix, which have oxalate binding activity. METHODS:
Matrix proteins were isolated from uric acid rich stone matrix using EDTA as a
demineralizing agent. The radiolabelled solubilized proteins were fractionated
with increasing ionic concentration by DEAE cellulose column chromatography to
identify the oxalate binding protein. It was purified using Sephadex G-200 column
chromatography. Amino acid composition was determined and monoclonal antibody was
produced against the oxalate binding uric acid rich stone matrix protein. Urinary
uric acid binding proteins were isolated from stone formers urine, their oxalate 
binding activity assayed and cross reactivity with the produced monoclonal
antibody were checked using ELISA and Western blotting. RESULTS: Matrix on DEAE
column chromatography elution yielded 3 protein peaks and they were named as
fraction I, II and III among which fraction I had higher oxalate binding activity
which was further purified with Sephadex G-200 column which yielded 2 protein
peaks designated as Ia and Ib. Fraction Ib with molecular weight 29 kDa exhibited
the maximum oxalate binding activity. Forty percent of this 29 kDa protein is
comprised of basic amino acids. Monoclonal antibody (IgG1) was produced against
the 29 kDa stone matrix protein. Urinary uric acid binding proteins were isolated
from stone formers, 4 protein peaks were obtained named as fraction I to IV.
Among them, fraction IV having molecular weight of approximately 29 kDa cross
reacted up to 85.6% with 29 kDa stone matrix protein. Moreover, urinary 29 kDa
protein exhibited oxalate binding activity of 94.16 +/- 6.08 pmol/mg protein at
pH 5.5. CONCLUSION: The 29 kDa protein isolated from uric acid rich stone matrix 
and urine are one and the same, thereby insinuating that 29 kDa protein might
play a major role in epitaxial deposition of calcium oxalate over uric acid core,
consequently favoring the lithogenic events like uric acid and calcium oxalate
nucleation, aggregation and retention.

PMID: 16139257 [PubMed - indexed for MEDLINE]

612: Pediatr Nephrol. 2005 Nov;20(11):1587-92. Epub 2005 Aug 23.

Nephrolithiasis in children.

Cameron MA, Sakhaee K, Moe OW.

Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and
Department of Internal Medicine, University of Texas Southwestern Medical Center,
5323 Harry Hines Blvd, Dallas, TX 75390-8885, USA.
Maryann.Cameron@UTSouthwestern.edu

A metabolic etiology is the most common cause for pediatric kidney stones.
Appropriate evaluation of affected children should include assessment of stone
type, if available, and assessment of predisposing factors in all cases. This
review discusses the metabolic disorders that lead to nephrolithiasis with
respect to the development of calcium, uric acid, struvite, and cystine stones.
Environmental and hereditary factors are summarized to provide a guide in the
evaluation of pediatric stone formers.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

PMID: 16133066 [PubMed - indexed for MEDLINE]

613: Int Urol Nephrol. 2005;37(1):35-7.

"Ambulatory PCNL" (tubeless PCNL under regional anesthesia) -- a preliminary
report of 10 cases.

Singh I, Kumar A, Kumar P.

Division of Urology, Department of Surgery and Anesthesiology, University College
of Medical Sciences, University of Delhi, Delhi-95, India.
iqbalsinghp@yahoo.co.uk

AIM: We report the technique, safety, outcome and efficacy of "tubeless
percutaneous nephrolithotomy (PCNL) performed under regional anesthesia" in
selected cases. METHODS: Patients satisfying the entry criteria for the regional 
block (spinal low-dose anesthesia with low-dose Bupivacaine plus Fentanyl) and
tubeless procedure were subjected to a tubeless spinal PCNL The patients were
followed up the next day for an ultrasonography and an x-ray of the KUB region.
RESULTS: All the ten patients were discharged uneventfully the next day (mean
hospital stay-40 h). No blood transfusion and postoperative analgesics (mean post
op visual analogue pain score was 2.4) were required. The mean time to return of 
S(1) sensation, motor block and walking were 183,118 and 196.6 min respectively. 
There was complete stone clearance in all the cases with a mean collection of
14.5 cc was seen on the post op ultrasound. CONCLUSIONS: The present cases were
reported to highlight that in a select group of patients tubeless PCNL under
regional block is technically feasible and viable option. Regional block has the 
advantage of avoidance of general anesthesia and anaphylaxis due to use of
multiple drugs. Tubeless PCNL has the advantage of avoidance of nephrostomy tube 
related postoperative pain discomfort and urosepsis. This synergistically (spinal
+ tubeless PCNL) speeds up the recovery, shortens the length of hospitalization
and the analgesic requirement.

PMID: 16132756 [PubMed - indexed for MEDLINE]

614: Int Urol Nephrol. 2005;37(1):9-11.

Extracorporeal shock wave lithotripsy of renal pelvis stones with PCK stonelith
lithotripter.

Ozgür A, Yalm Iker N.

School of Medicine, Department of Urology, Marmara University, Tophanelioglu cd. 
13/15, 34662 Altunizade, Istanbul, Turkey. aozgur2000@yahoo.com

Shock wave lithotripsy (SWL) has made a revolution in the treatment of
urolithiasis. It is a safe procedure with a lower morbidity than open surgery or 
percutaneous nefrolithotomy (PCN). In this article, we analyze our results of SWL
with PCK Stonelith-V5 Lithotripter for the renal pelvis localized stones. About
97 patients with radiopaque stone localized in the renal pelvis were treated with
PCK lithotripter from January 2001 to March 2003. The study group was divided
into two groups according to their stone size. The stone size was < or = 10 mm in
the first group and 11-20 mm in the second group. 56(57) patients were male and
41 (43) were female. Age range was 7-68 (mean 44) years. The overall success
rates of SWL for the treatment of renal pelvic stones in our study group was 35
and 62.2 for stones 10 mm or less and 11-20 mm, respectively. Since the focal
zone is 7.7 x 30 mm, the stones can easily get out of the focal zone area with
respiration and as a result, the success rate is decreased. So, general
anesthesia can be preferred for the treatment of stones < or =10 mm with the PCK 
Stonelith Lithotripter.

PMID: 16132749 [PubMed - indexed for MEDLINE]

615: Int Urol Nephrol. 2005;37(1):5-8.

Percutaneous endoscopic treatment for calyceal diverticular calculi.

Okumura A, Murakami K, Yoshida M, Nagakawa O, Fuse H.

Department of Urology, Faculty of Medicine, Toyama Medical and Pharmaceutical
University, 2630 Sugitani, Toyama 930-0194, Japan. okumura@kamiichi-hosp.jp

A 29-year-old man complaining of gross hematuria was referred to our department. 
DIP demonstrated calyceal diverticular calculi of the left kidney. The patient
requested ESWL, but the stone had not been discharged after two treatments. He
then underwent PNL with dilation of the narrow neck of the calyceal diverticulum 
under fluoroscope. The neck of the diverticulum was dilated using an amplats
dilator. Three months after the surgery, DIP demonstrated that the diverticulum
was completely free from calculi and the size of the diverticulum was reduced. He
was doing well 24 months after the operation. Calyceal diverticular calculi
should be managed not only with ESWL and PNL but also with dilation of the narrow
neck of the calyceal diverticulum.

Publication Types: 
    Case Reports

PMID: 16132748 [PubMed - indexed for MEDLINE]

616: Int Urol Nephrol. 2005;37(1):1-3.

Percutaneous nephrolithotomy in early pregnancy.

Tóth C, Tóth G, Varga A, Flaskó T, Salah MA.

Department of Urology, Medical and Health Science Center, University of Debrecen,
Nagyerdei krt. 98., 4032 Debrecen, Hungary.

We report on an 11-weeks pregnant woman, who under went a percutaneous
nephrolithotomy without the use of X-rays during the procedure due to 8-mm left
upper ureteric stone. In the available literature, we didn't find any reported
case about percutaneous stone removal without the use of X-rays.

Publication Types: 
    Case Reports

PMID: 16132747 [PubMed - indexed for MEDLINE]

617: Urol Int. 2005;75(2):97-101.

Fatty acids and idiopathic calcium nephrolithiasis.

Baggio B, Budakovic A.

Department of Medical-Surgical Sciences, Division of Nephrology, University of
Padua, Italy. bruno.baggio@unipd.it

Clinical and experimental investigations seem to underline the important role of 
fatty acids in the pathogenesis of hypercalciuria, a well-known risk factor for
lithogenesis. To evaluate the relationships between the previously reported
increase in plasma phospholipid arachidonic acid level and the factors
responsible for calcium metabolism in idiopathic calcium nephrolithiasis, a
best-fit model was constructed. This new statistical application shows a causal
relationship between plasma phospholipid arachidonic acid content, intestinal
calcium absorption, biochemical markers of bone turnover, urinary calcium
excretion and bone mineral density at the lumbar spine. This model suggests that 
a defect in the phospholipid fatty acid composition could represent the primary
event responsible for the mosaic of metabolic and clinical alterations that are
distinctive features of renal stone formers, such as kidney, intestine, and bone 
calcium metabolism, and several forms of idiopathic hypercalciuria. Copyright (c)
2005 S. Karger AG, Basel.

Publication Types: 
    Review

PMID: 16123560 [PubMed - indexed for MEDLINE]

618: Scand J Urol Nephrol. 2005;39(3):226-9.

Radiographic anatomical factors do not predict clearance of lower caliceal
calculus by shock-wave lithotripsy.

Viswaroop B, Devasia A, Gnanaraj L, Chacko N, Kekre N, Gopalakrishnan G.

Department of Urology, Christian Medical College, Vellore, India.

OBJECTIVE: Use of shock-wave lithotripsy (SWL) for lower caliceal calculus is
associated with a relatively high rate of residual fragments. Various
radiographic anatomical factors of the lower calix predicting the outcome of
lithotripsy have been described and have generated considerable discussion. We
aimed to reassess the role of these factors in predicting clearance of lower
caliceal stones by SWL. MATERIAL AND METHODS: Between January 1998 and December
2001, 148 patients underwent SWL for solitary lower caliceal stones using a
Dornier Compact S lithotripter. The infundibular length, infundibular width,
caliceopelvic height and infundibulopelvic angle were measured. Success was
defined as either complete clearance or clearance with insignificant residual
fragments <4 mm in size at 3 months follow-up. The results were analysed using
the chi2 test and logistic regression analysis. RESULTS: Complete clearance was
seen in 69% of cases and clearance with residual fragments <4 mm in size at 3
months was seen in 5%. The overall clearance rate at 3 months was 74%.
Infundibular length, infundibular width, caliceopelvic height and stone size were
not found to be statistically significant in predicting clearance. None of the
patients had an infundibulopelvic angle of >90 degrees. Contrary to most previous
studies, univariate and multivariate analysis revealed that an infundibulopelvic 
angle of <70 degrees was statistically significant in predicting clearance in the
stone-free group. CONCLUSIONS: The use of radiographic anatomical factors to
predict clearance of lower caliceal stones following SWL is an attractive
concept. However, based on this study, we feel that these factors do not merit
the attention they have attracted. In routine practice, regardless of the
radiological anatomy, SWL continues to be the initial treatment option, given its
non-invasive nature and ease of administration.

PMID: 16118095 [PubMed - indexed for MEDLINE]

619: Scand J Urol Nephrol. 2005;39(3):194-9.

Factors affecting the regrowth of renal stones in vitro: a contribution to the
understanding of renal stone development.

Costa-Bauzá A, Isern B, Perelló J, Sanchis P, Grases F.

Laboratory of Renal Lithiasis Research, Faculty of Sciences, University of the
Balearic Islands, Palma de Mallorca, Spain.

OBJECTIVE: The exact mechanism of renal stone formation is still not totally
understood. Thus, the role of crystallization inhibitors at different stages of
stone development, the influence of preexisting solid particles and the effects
of variations in urine composition require further clarification. The aim of this
paper is to clarify some of these questions by studying the regrowth achieved by 
real spontaneously passed post-extracorporeal shock wave lithotripsy (post-ESWL) 
fragments of calcium oxalate monohydrate (COM) renal calculi. MATERIAL AND
METHODS: An in vitro system was used to study the regrowth of post-ESWL fragments
of COM calculi, which was defined as the relative increase in weight of the
fragments. RESULTS: It was found that new columnar zones of COM crystals were
formed under normal calcium and oxalate urinary conditions and no calcium
phosphates were observed, in spite of the urinary pH being >6. The presence of
3.03 microM phytate totally blocked these crystal growth processes. When
hypercalciuric urine was used at a pH of 6.5, large brushite crystals and zones
totally covered by hydroxyapatite were observed for short periods, and zones
containing calcium oxalate dihydrate crystals could be observed for longer
periods. In such cases, 9.09 microM phytate totally blocked the growth processes,
69.0 microM pyrophosphate caused a reduction in calculi growth of 93% and 5.35 mM
citrate caused no inhibitory effects. CONCLUSION: The results show that when
crystallization inhibitors were absent, the growth of calcium oxalate calculi
fragments took place even under normal urine conditions, clearly demonstrating
the importance of crystallization inhibitors in avoiding or delaying calculi
development.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 16118089 [PubMed - indexed for MEDLINE]

620: Clin Nephrol. 2005 Aug;64(2):151-4.

Nephrolithiasis and hematuria--sometimes a stony road to diagnosis.

Sellin L, Quack I, Weiner SM, Waldherr R, Henning B, Hofebauer S, Rump LC.

Department of Nephrology, Marienhospital Herne, Hospital of the University of
Bochum, Herne, Germany.

We report a case of a young man with a history of kidney stones. Occurrence of
gross hematuria several months after the extracorporeal shock wave, lithotripsy
(ESWL) treatment lead to hospitalization. By ultrasound and abdominal CT scan,
the urologist could exclude post-renal causes of the gross hematuria and acute
renal failure. After transfer to a department of nephrology hemodialysis was
started, an immediate kidney biopsy was performed and prednisolone was
administered on the same day. The kidney biopsy revealed an anti-glomerular
basement membrane (GBM) disease. The renal function did not recover and the
patient remained on hemodialysis. In the literature it has been hypothesized that
ESWL-treated patients are prone to develop anti-GBM disease by liberation of
glomerular basement antigen through the ESWL high energy shock waves. An
additional hypothesis considering the higher susceptibility for anti-GBM disease 
among certain HLA-tissue types is discussed with regard to our case.
Unfortunately, the prolonged track to diagnosis and delayed immunosuppressive
treatment could not prevent poor clinical outcome. Although anti-GBM disease is a
rather rare disease, it should be included as a differential diagnosis for
hematuria--especially months after ESWL treatment. Otherwise early diagnosis may 
be missed and as in our patient immunosuppressive treatment will remain
unsuccessful to recover renal function.

Publication Types: 
    Case Reports

PMID: 16114792 [PubMed - indexed for MEDLINE]

621: Am J Kidney Dis. 2005 Aug;46(2):263-9.

Nephrolithiasis and increased blood pressure among females with high body mass
index.

Gillen DL, Coe FL, Worcester EM.

Department of Statistics, University of California, Irvine, CA 92697-1250, USA.
dgillen@uci.edu

BACKGROUND: We hypothesized that one reason for the heterogeneity in previously
reported links between kidney stones and blood pressure (BP) was the differential
effects of nephrolithiasis among subgroups of individuals. In particular, we
hypothesized that the association between stone history and BP may vary with
respect to sex and body size. METHODS: Data from the Third National Health and
Nutrition Examination Survey were used to estimate the association between
history of stone disease and odds of prior diagnosis of hypertension and mean
difference in systolic BP, diastolic BP, and pulse pressure. Nine hundred
nineteen persons with a history of stones and 19,120 persons without stones were 
available for analysis. RESULTS: In women, it was estimated that stone formers
(SFs) experienced a 69% increase in odds of self-reported hypertension (95%
confidence interval [CI], 1.33 to 2.17; P < 0.001). No significant difference was
found in men. The estimated difference in mean systolic and diastolic BP
comparing SFs with non-SFs increased with body mass index in both sexes, but was 
more pronounced in women. Mean systolic BPs in women SFs in quintiles 4 and 5 of 
body mass index were 7.62 mm Hg (95% CI, 1.04 to 14.2; P = 0.024) and 4.36 mm Hg 
(95% CI, 0.30 to 8.42; P = 0.036) greater than those in similar women non-SFs,
respectively. CONCLUSION: Our findings not only support the link between kidney
stone disease and BP, but also suggest that overweight women SFs may be at
significantly increased risk for hypertension.

Publication Types: 
    Comparative Study

PMID: 16112044 [PubMed - indexed for MEDLINE]

622: Kidney Int. 2005 Sep;68(3):1244-9.

Use of a probiotic to decrease enteric hyperoxaluria.

Lieske JC, Goldfarb DS, De Simone C, Regnier C.

Division of Nephrology and Hypertension, Mayo Clinic, Mayo Hyperoxaluria Center, 
and Mayo Complementary and Integrative Medicine Program, Rochester, Minnesota
55905, USA. Lieske.John@mayo.edu

BACKGROUND: Patients with inflammatory bowel disease have a 10- to 100-fold
increased risk of nephrolithiasis, with enteric hyperoxaluria being the major
risk factor for these and other patients with fat malabsorptive states.
Endogenous components of the intestinal microflora can potentially limit dietary 
oxalate absorption. METHODS: Ten patients were studied with chronic fat
malabsorption, calcium oxalate stones, and hyperoxaluria thought to be caused by 
jejunoileal bypass (1) and Roux-en-Y gastric bypass surgery for obesity (4),
dumping syndrome secondary to gastrectomy (2), celiac sprue (1), chronic
pancreatitis (1), and ulcerative colitis in remission (1). For 3 months, patients
received increasing doses of a lactic acid bacteria mixture (Oxadrop), VSL
Pharmaceuticals), followed by a washout month. Twenty-four-hour urine collections
were performed at baseline and after each month. RESULTS: Mean urinary oxalate
excretion fell by 19% after 1 month (1 dose per day, P < 0.05), and oxalate
excretion remained reduced by 24% during the second month (2 doses per day, P <
0.05). During the third month on 3 doses per day oxalate excretion increased
slightly, so that the mean was close to the baseline established off treatment.
Urinary oxalate again fell 20% from baseline during the washout period. Calcium
oxalate supersaturation was reduced while on Oxadrop, largely due to the decrease
in oxalate excretion, although mean changes did not reach statistical
significance. CONCLUSION: Manipulation of gastrointestinal (GI) flora can
influence urinary oxalate excretion to reduce urinary supersaturation levels.
These changes could have a salutary effect on stone formation rates. Further
studies will be needed to establish the optimal dosing regimen.

Publication Types: 
    Clinical Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16105057 [PubMed - indexed for MEDLINE]

623: Kidney Int. 2005 Sep;68(3):1230-5.

Diabetes mellitus and the risk of nephrolithiasis.

Taylor EN, Stampfer MJ, Curhan GC.

Channing Laboratory, and Renal Division, Department of Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
entaylor@partners.org

BACKGROUND: Insulin resistance is a central feature of type 2 diabetes mellitus
(DM) and may increase the risk of kidney stone formation. Existing
cross-sectional data on the association between DM and nephrolithiasis are
limited, and no prospective study to date has evaluated the relation between DM
and the risk of kidney stones. METHODS: To evaluate the relation between DM and
prevalent kidney stones, we conducted a cross-sectional study of 3 large cohorts 
including over 200,000 participants: the Nurses' Health Study I (older women),
the Nurses' Health Study II (younger women), and the Health Professionals
Follow-up Study (men). We then prospectively studied the association between DM
and incident nephrolithiasis over a combined 44 years of follow-up. Because
insulin resistance can precede the diagnosis of DM by decades, we also
prospectively examined the relation between kidney stones and the diagnosis of
incident DM. Multivariate regression models adjusted for age, body mass index,
thiazide diuretic use, fluid intake, and dietary factors. RESULTS: At baseline,
the multivariate relative risk of prevalent stone disease in individuals with DM 
compared to individuals without was 1.38 (95% CI 1.06-1.79) in older women, 1.67 
(95% CI 1.28-2.20) in younger women, and 1.31 (95% CI 1.11-1.54) in men.
Prospectively, the multivariate relative risk of incident kidney stone formation 
in participants with DM compared to participants without was 1.29 (95% CI
1.05-1.58) in older women, 1.60 (95% CI 1.16-2.21) in younger women, and 0.81
(95% CI 0.59-1.09) in men. The multivariate relative risk of incident DM in
participants with a history of kidney stones compared to participants without was
1.33 (95% CI 1.18-1.50) in older women, 1.48 (95% CI 1.14-1.91) in younger women,
and 1.49 (95% CI 1.29-1.72) in men. CONCLUSION: DM is a risk factor for the
development of kidney stones. Additional studies are needed to determine if the
increased risk of DM in stone formers is due to subclinical insulin resistance.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16105055 [PubMed - indexed for MEDLINE]

624: Kidney Int. 2005 Sep;68(3):966-71.

Comment in:
    Kidney Int. 2006 Mar;69(5):943.

Segregation of urine calcium excretion in families ascertained for
nephrolithiasis: evidence for a major gene.

Loredo-Osti JC, Roslin NM, Tessier J, Fujiwara TM, Morgan K, Bonnardeaux A.

Department of Human Genetics, McGill University, Montréal, Canada.

BACKGROUND: The quantitative genetics of urine calcium excretion has not been
established. It is a trait of interest because hypercalciuria is commonly found
in subjects with nephrolithiasis. The aim of this study was to model the
segregation of this trait in a sample of French-Canadian families ascertained
through a stone former. METHODS: Major gene, polygenic, and mixed models were fit
to 24-hour urine calcium excretion from 567 individuals in 221 nuclear families, 
while simultaneously taking into account gender, age at examination, body mass
index (BMI), and the use of thiazide drugs. The nuclear families were extracted
from 154 pedigrees, some of which were four generations, with at least two
siblings with a history of calcium stones. RESULTS: All the proposed genetic
models fit the data significantly better than the null model. The most
parsimonious model was the mixed codominant/polygenic model but it was
statistically indistinguishable from the single-gene codominant model. In both of
these models the heritability attributable to the major gene was estimated to be 
0.58. CONCLUSION: Our results suggest that a major gene with a relatively large
effect on variation in urine calcium excretion is segregating in French-Canadian 
families with stone formers. This implies that the power of quantitative trait
segregation analysis of urine calcium excretion may be increased in these
families, and results indicate that it should be feasible to genetically map the 
quantitative trait locus.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 16105027 [PubMed - indexed for MEDLINE]

625: Kidney Int. 2005 Sep;68(3):938-47.

Aprt/Opn double knockout mice: osteopontin is a modifier of kidney stone disease 
severity.

Vernon HJ, Osborne C, Tzortzaki EG, Yang M, Chen J, Rittling SR, Denhardt DT,
Buyske S, Bledsoe SB, Evan AP, Fairbanks L, Simmonds HA, Tischfield JA, Sahota A.

Department of Genetics, Rutgers University, Piscataway, New Jersey 08854-8082,
USA.

BACKGROUND: Osteopontin (OPN) is reported to have two distinct functions in
kidney disease: Promotion of inflammation at sites of tissue injury, and
inhibition of calcium oxalate monohydrate stone formation. However, many of the
studies supporting these functions were carried out in animal models of acute
renal injury or in cultured cells; thus, the role of OPN in chronic renal disease
is not well defined. We examined the role of OPN in adenine
phosphoribosyltransferase (Aprt) knockout mice, in which inflammation and
formation of 2,8-dihydroxyadenine (DHA) kidney stones are prominent features, by 
generating Aprt/Opn double knockout mice. METHODS: We characterized the
phenotypes of six- and 12-week-old Aprt-/- Opn-/-, Aprt-/- Opn+/+, Aprt+/+
Opn-/-, and Aprt+/+ Opn+/+ male and female mice using biochemical, histologic,
immunohistochemical, and in situ hybridization techniques. RESULTS: At 6 weeks of
age, there was no difference in phenotype between double knockout and Aprt
knockout mice. At 12 weeks, there was increased adenine and DHA excretion, renal 
crystal deposition, and inflammation in double knockout versus Aprt knockout male
mice. Double knockout and Aprt knockout female mice at 12 weeks had less
pathology than their male counterparts, but kidneys from double knockout females 
showed more inflammation compared with Aprt knockout females; both genotypes had 
similar levels of DHA crystal deposition. CONCLUSION: We conclude that (1) OPN is
a major inhibitor of DHA crystal deposition and inflammation in male mice; and
(2) OPN is a major modifier of the inflammatory response but not of crystal
deposition in female mice. Thus, separate mechanisms appear responsible for the
tissue changes seen in DKO males versus females.

PMID: 16105024 [PubMed - indexed for MEDLINE]

626: Magnes Res. 2005 Jun;18(2):123-6.

Magnesium therapy for nephrolithiasis.

Massey L.

Food Science and Human Nutrition, Washington State University, PO Box 1495,
Spokane WA 99210-1495, USA. massey@wsu.edu

PURPOSE:Critically evaluate the experimental evidence and clinical trial outcomes
as the basis for use of magnesium (Mg) supplements as therapy for calcium oxalate
nephrolithiasis. MATERIALS AND METHODS: Literature search of MedLine and Web of
Science through January 2005; articles cited in papers found by searches.
RESULTS: Magnesium inhibits calcium oxalate crystallization in human urine and
model systems. Magnesium also inhibits absorption of dietary oxalate from the gut
lumen. Three early trials of Mg oxide (MgO) and Mg hydroxide (Mg(OH)2) reported
lower rates of recurrent stone formation. However in a double-blind, randomized, 
placebo-controlled trial with more carefully selected patients, there was no
significant difference between recurrence rates with 650 or 1300 mg MgO daily and
the placebo. Another trial reported 391 mg (21 meq) Mg daily as a mixed salt, Mg 
potassium citrate, reduced calcium stone recurrence by 90%, similar to potassium 
citrate, but with better gastrointestinal tolerance. The failure of MgO and
Mg(OH)2 as sole therapy may be related to poor absorption and low rates of Mg
deficiency in the patient populations tested. CONCLUSIONS: Clinical trial
evidence does not justify the use of MgO or Mg(OH)2 as a sole therapy for calcium
oxalate kidney stones in a general patient population. However, the addition of
magnesium to potassium citrate therapy improves outcomes. Clinical trials should 
focus on patients who are likely to be Mg deficient.

Publication Types: 
    Review

PMID: 16100850 [PubMed - indexed for MEDLINE]

627: J Urol. 2005 Sep;174(3):1088-90.

Renal pelvis cuff pyeloplasty for ureteropelvic junction obstruction for the high
inserting ureter: an initial experience.

Palmer LS, Proano JM, Palmer JS.

Division of Pediatric Urology, Schneider Children's Hospital, North Shore-Long
Island Jewish Health System, New Hyde Park, New York, USA.

PURPOSE: Ureteropelvic junction (UPJ) obstruction can result from a high
inserting ureter without intrinsic ureteral obstruction. We describe our initial 
experience using a renal pelvis cuff pyeloplasty technique to treat this cause of
UPJ obstruction. MATERIALS AND METHODS: We reviewed our experience regarding all 
children who underwent renal pelvis cuff pyeloplasty. All patients had Society
for Fetal Urology grade 3 to 4 hydronephrosis on ultrasonography and radiographic
confirmation of UPJ obstruction by diuretic mercaptoacetyltriglycine renography. 
Pyeloplasty was performed through a flank incision. A circumferential incision
was made of the renal pelvis proximal to the insertion site of the ureter into
the renal pelvis. Next, a catheter was passed through the UPJ to ensure uniform
patency. The cuff of pelvis with the attached ureter was then sutured to the
dependent portion of the pelvis. Postoperative resolution of the obstruction was 
evaluated by ultrasonography and mercaptoacetyltriglycine renography. RESULTS: A 
total of 11 children (6 boys and 5 girls) underwent renal cuff pyeloplasty for
UPJ obstruction due to a high inserting ureter. Median patient age was 6 months
(range 2.5 months to 2.4 years) and median followup was 11 months (8 months to
3.4 years). All patients were discharged home within 2 days postoperatively. No
intraoperative or postoperative complications were noted. All patients exhibited 
resolution of UPJ obstruction on followup radiographs. CONCLUSIONS: Renal pelvis 
cuff pyeloplasty is a surgical technique for UPJ obstruction resulting from a
high inserting ureter without intrinsic ureteral obstruction. The procedure was
straightforward with good results and without complications in this initial
experience.

PMID: 16094065 [PubMed - indexed for MEDLINE]

628: J Urol. 2005 Sep;174(3):1072-4.

Pediatric ureteroscopic stone management.

Thomas JC, DeMarco RT, Donohoe JM, Adams MC, Brock JW 3rd, Pope JC 4th.

Division of Pediatric Urology, Vanderbilt Children's Hospital, Nashville,
Tennessee 37232-2765, USA.

PURPOSE: We reviewed our experience of 5 years using ureteroscopy with laser
lithotripsy to treat stone disease in prepubertal children. MATERIALS AND
METHODS: A retrospective review was performed of all ureteroscopic procedures
performed in prepubertal children. RESULTS: A total of 33 ureteroscopic
procedures were performed in 29 prepubertal children (15 males and 14 females) 5 
to 144 months old (mean age 94 months, including 3 patients 24 months or
younger). Stones were located in the renal pelvis in 1 case (3%), proximal ureter
in 3 (9%), mid ureter in 5 (15%) and distal ureter in 24 (73%). Stone size ranged
from 3 to 14 mm (mean 6). Eight patients required balloon dilation of the
ureteral orifice. Followup ranged from 1 to 66 months (mean 11). Stone-free rate 
after initial ureteroscopy and laser lithotripsy was 88%, with all distal and mid
ureteral stones (3 to 9 mm, mean 5) successfully treated. Three patients with
proximal ureteral stones 7 to 14 mm in diameter (mean 10.3) required a secondary 
procedure (repeat ureteroscopy in 2 and shock wave lithotripsy in 1) to become
stone-free. One patient with cystinuria and a renal pelvic stone measuring 14 mm 
required shock wave lithotripsy and percutaneous nephrostolithotomy. There were
no major complications of ureteroscopy but there was 1 case of extravasation at
the ureterovesical junction after balloon dilation that was managed with stent
placement. CONCLUSIONS: Although more patients and longer followup are needed,
ureteroscopy with laser lithotripsy is an excellent first line treatment for
children with stones in whom conservative therapy fails, especially those with
distal and mid ureteral stones. Patients with a stone burden of 10 mm or greater,
especially in the proximal ureter, likely will require a secondary procedure to
become stone-free.

PMID: 16094060 [PubMed - indexed for MEDLINE]

629: J Urol. 2005 Sep;174(3):943-7; discussion 947.

Comment in:
    J Urol. 2006 Apr;175(4):1576; author reply 1576-7.

Dietary oxalate loads and renal oxalate handling.

Holmes RP, Ambrosius WT, Assimos DG.

Department of Urology, Wake Forest University School of Medicine, Winston-Salem, 
North Carolina 27157, USA. rholmes@wfubmc.edu

PURPOSE: Dietary oxalate makes a significant contribution to urinary oxalate
excretion and, thus, may have a role in calcium oxalate kidney stone formation.
Studies have indicated that the ingestion of oxalate rich foods results in
transient increases in plasma oxalate concentrations and urinary oxalate
excretion. We examined changes in plasma and urinary oxalate following oral
crystalline oxalate loading under controlled dietary conditions to further define
the renal handling of oxalate by normal adults. MATERIALS AND METHODS: Six normal
adult subjects consumed controlled diets of known oxalate content for 1 week
before ingesting loads of 0, 2, 4 and 8 mmol of oxalate. Urinary and plasma
changes were measured to assess renal oxalate handling. Urinary excretion of
proximal tubule derived enzymes and isoprostanes was monitored to assess for
renal injury and oxidative stress. RESULTS: Time and dose dependent changes in
plasma oxalate, urinary oxalate and in the clearance ratio of
oxalate-to-creatinine were observed. A significant correlation (r=0.43, p <0.001)
between the oxalate-to-creatinine clearance ratio and plasma oxalate levels was
identified. No changes in urinary markers of oxidative stress or renal injury
were observed following the 8 mmol oxalate load. CONCLUSIONS: Oxalate is rapidly 
absorbed and cleared by the kidney by filtration and secretion following an oral 
oxalate load. Renal oxalate secretion has a significant role in the renal
handling of an oral oxalate load. There is no evidence of acute renal injury or
oxidative stress with oral oxalate loads in these experimental conditions.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 16094002 [PubMed - indexed for MEDLINE]

630: J Biomed Mater Res B Appl Biomater. 2005 Nov;75(2):351-8.

Fatigue of kidney stones with heterogeneous microstructure subjected to
shock-wave lithotripsy.

Zohdi TI, Szeri AJ.

Department of Mechanical Engineering, University of California, Berkeley,
California 94720, USA.

In this article a theoretical framework is developed for the mechanics of kidney 
stones with an isotropic, random microstructure--such as those comprised of
cystine or struvite. The approach is based on a micromechanical description of
kidney stones comprised of crystals in a binding matrix. Stress concentration
functions are developed to determine load sharing of the particle phase and the
binding matrix phase. Measurements have shown the inclusions to be considerably
harder than the binder; consequently, loading of a stone leads to higher stresses
in the inclusions than in the binder. As an illustration of the theory, the
fatigue of kidney stones subject to shock-wave lithotripsy is considered. Stress 
concentration functions are used to construct fatigue-life estimates for each
phase, as a function of the volume fraction and of the mechanical properties of
the constituents, as well as the loading from SWL. The failure of the binding
matrix, or of the particulate phase, is determined explicitly in a model for the 
accumulation of distributed damage. The theory can be used to assess the
importance of microscale heterogeneity on the comminution of renal calculi, and
to estimate the number of cycles to failure in terms of measurable material
properties. Copyright (c) 2005 Wiley Periodicals, Inc.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16088905 [PubMed - indexed for MEDLINE]

631: Clin Nutr. 2005 Dec;24(6):932-42. Epub 2005 Aug 8.

Credentials of Spirulina diet on stability and flux related properties on the
biomineralization process during oxalate mediated renal calcification in rats.

Farooq SM, Ebrahim AS, Asokan D, Sakthivel R, Savitha S, Rajesh NG, Varalakshmi
P.

Department of Medical Biochemistry, Dr. A.L.M. Postgraduate Institute of Basic
Medical Sciences, University of Madras, Taramani, Chennai-600 113, India.

BACKGROUND: High Spirulina diet is a potential risk factor for nephrolithiasis
since it has the capacity to increase urinary oxalate and uric acid level,
facilitating lithogenesis. Our aim was to identify the effect of Spirulina diet
during hyperoxaluric condition in Wistar albino rats. METHODS: The animals were
divided into four groups: control (Gl, n=6); ethylene glycol (EG) induced (G2,
n=6); EG+Spirulina (G3, n=6); Spirulina alone (G4, n=6). EG at 0.75% was
administered to G2 and G3 through drinking water for 4 weeks and Spirulina 1500
mg/kg feed was administered to G3 and G4. RESULTS: Urinary parameters like
oxalate, uric acid, calcium, urea, and creatinine (P<0.001) were found increased 
after Spirulina diet under hyperoxaluric conditions compared to the same without 
Spirulina diet. Similarly the BUN, plasma contents of uric acid, urea, creatinine
(P<0.001) were found to be raised in G3. The renal and RBC GSH levels, as
estimated by HPLC, seemed decreased when compared to G2. CONCLUSIONS: The present
study shows that free radicals aid in the progression of nephrolithiasis. The
crystal deposition was found to be high in the renal cells of G3 than G2 and TEM 
revealed damage in renal cell of G3 implying that the disease deteriorates by
free radical injury. In contrast the Spirulina diet alone (G4) did not induce any
features relating to stone forming condition suggesting that free radical release
might have been suppressed due to enrichment of dietary antioxidants and
vitamins. Thus the present investigation demonstrates that during hyperoxaluric
conditions the Spirulina diet must possibly be avoided and can be considered in
normal subjects checked for family history of renal stone deposition.

PMID: 16084629 [PubMed - indexed for MEDLINE]

632: Urol Res. 2005 Nov;33(5):383-9. Epub 2005 Aug 3.

Insights on the pathology of kidney stone formation.

Evan AP, Coe FL, Lingeman JE, Worcester E.

Department of Anatomy and Cell Biology, Indiana University, School of Medicine,
Indianapolis, IN, USA. evan@anatomy.iupui.edu

The purpose of these studies was to test the hypothesis that Randall's plaque
develops in unique anatomical sites of the kidney and that its formation is
conditioned by specific stone-forming pathophysiologies. To test this hypothesis,
we performed intraoperative mapping studies with biopsies of papilla from the
kidneys of 15 idiopathic calcium oxalate (CaOx) stone formers, four intestinal
bypass for obesity patients and ten brushite stone formers, and obtained
papillary specimens from four non-stone formers after nephrectomy. Both light and
electron microscopic examination of tissue changes along with infrared and
electron diffraction analyses of mineral composition were performed. Distinct
patterns of mineral deposition and papillary pathology were discovered in each of
the three different stone forming groups. CaOx stone formers had predictable
sites of interstitial apatite crystals beginning at the thin loops of Henle and
spreading to the urothelium. These plaque areas are termed Randall's plaque and
are thought to serve as sites for stone attachment. The papilla and medullary
tubules appeared normal. The intestinal bypass patients only had intraluminal
sites of crystalline material in the medullary collecting ducts. The brushite
stone formers had the most severe form of cortical and medullary changes with
sites of Randall's plaque, and yellowish intraluminal deposits in medullary
collecting ducts. All deposits were determined to be apatite. The metabolic and
surgical pathologic finding in three distinct groups of stone formers clearly
shows that "the histology of the renal papilla from a stone former is particular 
to the clinical setting". It is observations like these that we believe will
provide the insights to allow the stone community to generate better clinical
treatments for kidney stone disease, as we understand the pathogenesis of stone
formation for each type of stone former.

Publication Types: 
    Research Support, N.I.H., Extramural
    Review

PMID: 16078085 [PubMed - indexed for MEDLINE]

633: Urol Res. 2005 Aug;33(4):247-53. Epub 2005 Aug 3.

Bone mineral content in calcium renal stone formers.

Trinchieri A.

Urology Unit, Ospedale A. Manzoni, Via dell'Eremo 9/11, 23800 Lecco, Italy.
a.trinchieri@ospedale.lecco.it

Idiopathic renal calcium stone disease often presents with reduced bone mineral
content. Investigations using non-invasive methods for the measurement of bone
mineral content (single and dual-photon absorptiometry, dual-energy x-ray
absorptiometry, quantitative computed tomodensitometry) show a slight decrease in
skeletal mineral content of idiopathic renal stone formers (RSFs).The alterations
in bone mineral content in RSFs have different explanations:
prostaglandin-mediated bone resorption, subtle metabolic acidosis and 1-25
vitamin D disorders. Bone mineral content is worsened by insufficient dietary
calcium leading to a negative calcium balance.

Publication Types: 
    Review

PMID: 16078084 [PubMed - indexed for MEDLINE]

634: Phys Med Biol. 2005 Aug 21;50(16):3907-25. Epub 2005 Aug 2.

Laboratory coherent-scatter analysis of intact urinary stones with crystalline
composition: a tomographic approach.

Davidson MT, Batchelar DL, Velupillai S, Denstedt JD, Cunningham IA.

Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A
5K8, Canada. mdavid@imaging.robarts.ca

Knowledge of urinary stone composition and structure provides important insights 
in guiding treatment and preventing recurrence. No current method can
successfully provide information relating structure and composition of intact
stones. We are developing a tomographic technique that uses measures of
coherently scattered diagnostic x-rays to yield stone composition.
Coherent-scatter (CS) properties depend on molecular structure and are,
therefore, sensitive to material composition. Powdered, amorphous or
polycrystalline materials with no significant orientation produce circularly
symmetric CS patterns. However, in materials with preferred crystallite
orientation, like urinary stones, bright spots in CS patterns are observed. This 
compromises a composition analysis based on comparing CS measurements from
calculi to a library of CS signatures from powdered chemicals. We show that a
computed tomographic reconstruction of CS measurements using filtered
backprojection (CSCT) effectively eliminates bright spots and yields CS patterns 
equivalent to powdered materials. This allows for direct comparison with a
powdered chemical reference library to establish composition. Validation is
achieved through a tomographic CS analysis of an aluminium (Al) rod phantom. Much
like calculi, CS patterns from a solid polycrystalline Al rod exhibit diffraction
spots, absent in the ring-like Al powder CS pattern. We show that the
reconstructed Al CS cross-section is equivalent to its powdered counterpart and
results in clearly defined composition images. The potential of CSCT to identify 
stone composition is demonstrated through images of intact stones deemed
chemically pure by infrared spectroscopy. Computed tomographic reconstruction of 
CS signals allowed the generation of composition maps, showing the distribution
of stone components. These images provide strong evidence that current laboratory
techniques risk missing critical stone components due to inadequate sampling.
This is of particular importance since follow-up treatments are based on these
composition analyses. CS analysis can distinguish common stone components and can
provide topographic composition maps of intact stones. Such details offer
invaluable clinical information regarding stone formation, treatment and
follow-up, and thus support the development of CS analysis as a laboratory stone 
analysis technique.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 16077235 [PubMed - indexed for MEDLINE]

635: J Chromatogr B Analyt Technol Biomed Life Sci. 2005 Sep 25;824(1-2):175-80.

Determination of uric acid in urine, saliva and calcium oxalate renal calculi by 
high-performance liquid chromatography/mass spectrometry.

Perelló J, Sanchis P, Grases F.

Laboratory of Renal Lithiasis Research, Faculty of Sciences, Universitary
Institute of Health Sciences Research (IUNICS), University of Balearic Islands,
Ctra. Valldemossa, Km 7.5, 07122 Palma of Mallorca, Spain.

A very simple and direct method for determination of uric acid, in various
biological matrices, based on high-performance liquid chromatography and mass
spectrometry is described. Chromatographic separations were performed with a
stationary phase Zorbax Sax Column, an anion exchange resin, with 50% sodium
citrate 1 mM at pH 6.5 and 50% acetonitrile as mobile phase delivered at a flow
rate of 1 ml/min. The detector counted negative ions by monitoring m/z 167.1,
which corresponds to the urate anion. The method does not use an internal
standard but quality control samples were used. Intra-day precision ranged
between 1.1 and 1.5%, whereas inter-day precision was between 1.3 and 2.8% (n=5) 
working with some selected standards. Recovery tests of added standard have been 
successfully performed in urine and saliva samples, thus showing an appropriate
accuracy of the method. The limit of quantitation found was 70 microg/l.
Different urine and saliva samples were analyzed using an alternative analytical 
methodology based on an enzymatic reaction and photometric detection at 520 nm,
resulting both methods comparable at a 95% confidence level. The method has been 
also applied to the determination of trace amounts of uric acid in the core of
some selected calcium oxalate renal calculi.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 16061429 [PubMed - indexed for MEDLINE]

636: J Endourol. 2005 Jul-Aug;19(6):722-3.

Management of renal-vein perforation during a challenging percutaneous
nephrolithotomy.

Shaw G, Wah TM, Kellett MJ, Choong SK.

Institute of Urology, University College London, London, United Kingdom.
gregshaw@doctors.org.uk

A 54-year-old man with complex urinary anatomy as the result of previous surgery 
sustained a renal-vein injury during percutaneous nephrolithotomy for a staghorn 
calculus with a blood loss of 1.5 L. He was managed with antibiotics, bed rest,
heparin, and a 28F nephrostomy catheter, which was withdrawn gradually as the
tract sealed. This case highlights the importance of early diagnosis of this
complication and the possibility of conservative management.

Publication Types: 
    Case Reports

PMID: 16053363 [PubMed - indexed for MEDLINE]

637: J Endourol. 2005 Jul-Aug;19(6):719-21.

Percutaneous nephrolithotomy to remove a cartridge detonating cap mimicking a
renal pelvic stone 12 years after renal trauma.

Bissas A, Dellis A, Bafaloukas N, Sopilidis O, Livadas K, Skolarikos A.

2nd Department of Urology, University of Athens, Sismanoglio Hospital, Athens,
Greece.

Complications of gunshot injuries of the kidney usually present in the early
postoperative period. We describe a case of a cartridge's plastic detonating cap 
retained in the renal pelvis of a young male patient for 12 years. Renal colic
was the cause of admission. This missile's part was mimicking a renal stone on
both an intravenous urogram and a CT scan. The nature of the "stone" was
identified during a percutaneous nephrolithotomy procedure during which the
foreign body was removed.

Publication Types: 
    Case Reports

PMID: 16053362 [PubMed - indexed for MEDLINE]

638: J Endourol. 2005 Jul-Aug;19(6):608-13; discussion 613.

Laparoscopy-assisted transperitoneal percutaneous nephrolithotomy for renal
caliceal diverticular calculi.

Wong C, Zimmerman RA.

Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma
City, Oklahoma 73104, USA. carson-wong@ouhsc.edu

BACKGROUND AND PURPOSE: There are a variety of options for the management of
symptomatic calculi in caliceal diverticula, each with utility in particular
situations. Herein, we describe a laparoscopy-assisted transperitoneal
percutaneous nephrolithotomy (PCNL) technique to address the unusual combination 
of an anterior caliceal diverticulum together with multiple branched calculi
having segments both within and proximal to the diverticulum. TECHNIQUE: With the
patient in a modified lithotomy position, standard transperitoneal laparoscopy
was performed utilizing three 10-mm trocars. After mobilization of the colon
medially, the cystic diverticulum was opened. An additional 12-mm trocar was
placed to allow transperitoneal PCNL within the diverticulum. Rigid nephroscopy, 
holmium laser lithotripsy, and stone extraction were performed, including laser
enlargement of the diverticular neck and removal of the stone burden proximal to 
the neck. A double-pigtail ureteral stent and Jackson-Pratt drain were placed.
RESULTS: This procedure was successful in the only patient in whom it has been
used to date. As far as we know, this is the first report of laparoscopy-assisted
transperitoneal PCNL for the management of caliceal diverticular calculi.
CONCLUSION: Laparoscopy-assisted transperitoneal PCNL is a safe and effective
alternative for the management of symptomatic stones in anterior cystic caliceal 
diverticula with a narrow neck and complex branched calculi.

PMID: 16053346 [PubMed - indexed for MEDLINE]

639: BJU Int. 2005 Aug;96(3):385-9.

Multimodal management of urolithiasis in renal transplantation.

Challacombe B, Dasgupta P, Tiptaft R, Glass J, Koffman G, Goldsmith D, Khan MS.

Department of Urology, Guy's and St Thomas' Hospitals, London, UK.
benchallacombe@hotmail.com

OBJECTIVE: To report the largest single series of renal transplant patients
(adults and children) with urolithiasis, assess the risk factors associated with 
urolithiasis in renal transplant recipients, and report the outcome of the
multimodal management by endourological and open procedures. PATIENTS AND
METHODS: The records of all patients undergoing renal transplantation between
1977 and 2003 were reviewed. In all, 2085 patients had a renal transplant at our 
centre and 21 (17 adults and four children) developed urinary tract calculi.
Their mode of presentation, investigations, treatments, complications and
outcomes were recorded. Investigations included one or more of the following;
ultrasonography (US), plain abdominal X-ray, intravenous urography, nephrostogram
and computed tomography. Management of these calculi involved extracorporeal
shock wave lithotripsy (ESWL), flexible ureteroscopy and in situ lithotripsy,
percutaneous nephrolithotomy (PCNL), open pyelolithotomy and open
cystolitholapaxy. RESULTS: Thirteen patients had renal calculi, seven had
ureteric calculi and one had bladder calculi. The incidence of urolithiasis was
21/2085 (1.01%) in the series. Urolithiasis was incidentally discovered on
routine US in six patients, six presented with oliguria or anuria, including one 
with acute renal failure, four with a painful graft, three with haematuria, one
with sepsis secondary to obstruction and infection and in one, urolithiasis was
found after failure to remove a stent. Ten patients (63%) had an identifiable
metabolic cause for urolithiasis, two by obstruction, two stent-related, one
secondary to infection and in six no cause was identifiable. Thirteen required
more than one treatment method; 13 (69%) were treated by ESWL, eight of whom
required multiple sessions; eight required ureteric stent insertion before a
second procedure and four required a nephrostomy tube to relieve obstruction. Two
patients had flexible ureteroscopy and stone extraction, three had a PCNL and one
had open cystolithotomy. PCNL failed in one patient who subsequently had
successful open pyelolithotomy. All patients were rendered stone-free when
different treatments were combined. CONCLUSIONS: The incidence of urolithiasis in
renal transplant patients is low. There is a high incidence of metabolic causes
and therefore renal transplant patients with urolithiasis should undergo
comprehensive metabolic screening. Management of these patients requires a
multidisciplinary approach by renal physicians, transplant surgeons and
urologists.

PMID: 16042735 [PubMed - indexed for MEDLINE]

640: BJU Int. 2005 Aug;96(3):379-84.

Comment in:
    BJU Int. 2005 Dec;96(9):1423.

Outcome from percutaneous nephrolithotomy in patients with spinal cord injury,
using a single-stage dilator for access.

Lawrentschuk N, Pan D, Grills R, Rogerson J, Angus D, Webb DR, Bolton DM.

University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg,
Victoria, Australia.

OBJECTIVE: To present our experience of percutaneous nephrolithotomy (PCNL) for
treating urolithiasis in patients with spinal cord injury (SCI) using a
single-stage dilator for percutaneous access. PATIENTS AND METHODS: A prospective
database of patients with SCI having PCNL using the single-stage dilator was
assessed, analysing patient data, stone-free rates, morbidity and the follow-up
outcome. RESULTS: In all, 26 patients had 54 PCNLs on 32 kidneys; 20 had
unilateral and six bilateral stone disease; there were many staghorn calculi
(24/54). Major complications occurred in three of 54 PCNLs (6%). The complete
stone-clearance rate was 87% for PCNL alone, rising to 29 of 32 kidneys (91%) or 
24 of 26 patients (92%) with adjuvant procedures. A further three kidneys
required no further treatment and were monitored, having residual fragments of < 
or = 2 mm. CONCLUSIONS: PCNL has a high success rate and acceptable complication 
rate compared to extracorporeal shock-wave lithotripsy, and remains a valid
first-line treatment option for kidney stones in patients with SCI.

Publication Types: 
    Comparative Study

PMID: 16042734 [PubMed - indexed for MEDLINE]

641: Urology. 2005 Aug;66(2):252-5.

Effect of ureteral access sheath on stone-free rates in patients undergoing
ureteroscopic management of renal calculi.

L'esperance JO, Ekeruo WO, Scales CD Jr, Marguet CG, Springhart WP, Maloney ME,
Albala DM, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery,
Duke University Medical Center, Durham, North Carolina 27710, USA.

OBJECTIVES: To evaluate the effect of ureteral access sheaths (UASs) on
stone-free rates (SFRs) during ureteroscopic treatment of renal calculi. Several 
advantages of UASs during flexible ureteroscopy have been documented. However, no
study has evaluated their impact on SFRs. METHODS: We retrospectively reviewed
all ureteroscopic cases for the management of renal stones performed at our Stone
Center. Data were stratified according to the use or lack of use of the UAS. The 
groups were stratified by stone location within the kidney. Stone-free status was
determined at 2 months postoperatively by either intravenous urography with
tomograms or noncontrast renal computed tomography in patients with contrast
allergies. RESULTS: A total of 256 ureteroscopic procedures for the removal of
renal calculi were performed between 1997 and 2003 (173 with UAS and 83 without).
The groups were similar in age, sex, and stone burden. Stents were placed in
nearly 80% of patients. The lower renal pole represented the most common
presenting location. Stone displacement with a ureteroscopic basket for efficient
fragmentation was necessary in 34%. The overall SFR in the UAS group and non-UAS 
group was 79% and 67%, respectively (P = 0.042). The SFRs were improved for
calculi in all portions of the kidney. CONCLUSIONS: In addition to facilitating
ureteroscopic access, reducing costs, and lowering intrarenal pressures, the
results of the current study suggest that UASs improve SFRs during the management
of renal calculi. It is now our current practice to use the UAS routinely during 
ureteroscopic treatment of renal and upper ureteral calculi.

PMID: 16040093 [PubMed - indexed for MEDLINE]

642: Urol Int. 2005;75(1):17-20.

Urothelial cancer of the renal pelvis in percutaneous nephrolithotomy patients.

Katz R, Gofrit ON, Golijanin D, Landau EH, Shapiro A, Pode D, Meretyk S.

Department of Urology, Hadassah and Hebrew University Hospital, Jerusalem,
Israel. rank@cc.huji.ac.il

INTRODUCTION: The association between staghorn calculus of the kidney
long-standing and urothelial tumors of the renal pelvis is well documented. We
describe 3 patients with urothelial cancer in a kidney who underwent percutaneous
nephrolithotomy (PCNL). PATIENTS AND METHODS: Retrospective analysis of our
series of more than 500 PCNLs revealed 3 patients in whom urothelial cancer of
the renal pelvis was diagnosed during or following percutaneous stone removal.
Preoperative assessment included IVP, renal sonography and renal scan using DTPA 
in all 3 patients, and CT in 2 patients. Imaging did not raise the suspicion of a
neoplastic lesion. RESULTS: All patients had a long history of urolithiasis and
urinary infections. No patient was diagnosed preoperatively. One patient was
diagnosed postoperatively, when a CT demonstrated a renal lesion. The second
patient underwent simple nephrectomy due to a non-functioning kidney, and the
tumor was found on pathological analysis. In the third patient, biopsies were
taken from a suspicious-looking tissue in the renal pelvis during the PCNL
session. All patients had transitional cell carcinoma: 1 associated with
sarcomatoid features and 1 with squamous carcinoma. They all died from metastatic
disease 2-19 months after the diagnosis of urothelial cancer. CONCLUSIONS: The
preoperative diagnosis of urothelial cancer in patients with staghorn stones is
difficult due to the existing stone and inflammation. Since the prognosis of
urothelial cancer is extremely poor, biopsies of the renal pelvis, obtained
directly through the nephroscope during the PCNL session, may be the only key for
early diagnosis and treatment. A high index of suspicion should be raised when
patients suffering from infected staghorn calculi are encountered, and such
intraoperative biopsies should be considered. 2005 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 16037702 [PubMed - indexed for MEDLINE]

643: Scand J Urol Nephrol. 2005;39(2):173-5.

Nephrolithiasis as primary symptom in sarcoidosis.

Darabi K, Torres G, Chewaproug D.

Department of Medicine, Albert Einstein Medical Center, Philadelphia,
Pennsylvania, USA. kamrandarabi@yahoo.com

A 30-year-old black woman presented with a 1-year history of repeated episodes of
worsening weight loss and fatigue. Physical examination showed no skin lesions
and a chest roentgenogram was normal. Workup showed no obvious cause of recurrent
renal stones. Finally, the detection of lymphadenopathy led to the diagnosis of
extrapulmonary sarcoidosis. Up to 4% of all cases of sarcoidosis may present with
urolithiasis only. Renal stones may be more common in severe cases of
sarcoidosis, which affect blacks most frequently. Although not generally
recommended for diagnostic purposes in sarcoidosis, in this case determination of
the angiotensin-converting enzyme level was helpful in making the correct
diagnosis. It is important that physicians are aware of the possibility that
sarcoidosis may present as urolithiasis, even in the presence of a negative chest
roentgenogram.

PMID: 16019774 [PubMed - indexed for MEDLINE]

644: J Nephrol. 2005 May-Jun;18(3):262-6.

Prevalence of fasting hypercalciuria associated with increased citraturia in the 
ambulatory evaluation of nephrolithiasis.

Damasio B, Massarino F, Durand F, Banchero R, Bottino P, De Franchis V,
Carmignani G, Cannella G.

Division of Nephrology, San Martino Hospital, Genoa, Italy.
beatrice.damasio@libero.it

BACKGROUND: Nephrolithiasis is a common, high costing pathology of the urinary
tract. The most common urinary abnormalities are fasting hypercalciuria,
hypercalciuria and hypocitraturia. This study aimed to identify the principal
urinary abnormalities in our patients. METHODS: Ninety-eight patients (pts) (43
females, 55 males) with recurrent calcium nephrolithiasis underwent metabolic
evaluation. In two 24-hr urine collections the following parameters were
evaluated: calcium, phosphate, sodium, potassium, chloride, magnesium, citrate,
oxalate, uric acid, creatinine (Cr), urea, ammonium and pH; blood measurement of 
calcium, phosphate, sodium, potassium, chloride, magnesium, uric acid, Cr, urea, 
acid-base balance ionized calcium and intact parathyroid hormone (iPTH) were also
performed. A first morning voided urine sample was collected for measuring the
urinary cross-links and fasting calciuria. The tubular threshold of phosphate
(TmP) was calculated according to Walton and Bijovet. Metabolic evaluation was
repeated in 63/98 pts after 7 days on a low calcium diet. RESULTS: The most
common urinary abnormalities were fasting hypercalciuria in 51/96 pts (53.1%),
hypercalciuria in 33/97 pts (34%) and hypocitraturia in 29/98 pts (29%); 24/33
pts (73%) with hypercalciuria had fasting hypercalciuria. Hypercalciuria was
partially corrected on the calcium-restricted diet, while fasting hypercalciuria 
was not. Urine citrate levels were significantly higher in patients with fasting 
hypercalciuria. CONCLUSIONS: Fasting hypercalciuria was the most frequent urinary
abnormality and it was not corrected with a calcium-restricted diet. In fasting
hypercalciuric patients, increased bone resorption activity could be responsible 
for higher citraturia levels.

Publication Types: 
    Comparative Study

PMID: 16013013 [PubMed - indexed for MEDLINE]

645: J Urol. 2005 Aug;174(2):595-9.

Shock wave lithotripsy at 60 or 120 shocks per minute: a randomized, double-blind
trial.

Pace KT, Ghiculete D, Harju M, Honey RJ; University of Toronto Lithotripsy
Associates.

Division of Urology, Department of Surgery, St. Michael's Hospital, University of
Toronto, Toronto, Ontario, Canada. kenneth.pace@utoronto.ca

PURPOSE: The rate of shock wave administration is a factor in the per shock
efficiency of shock wave lithotripsy (SWL). Experimental evidence suggests that
decreasing shock wave frequency from 120 shocks per minute results in improved
stone fragmentation. To our knowledge this study is the first to examine the
effect of decreased shock wave frequency in patients with renal stones. MATERIALS
AND METHODS: Patients with previously untreated radiopaque stones in the renal
collecting system were randomized to SWL at 60 or 120 shocks per minute. They
were followed at 2 weeks and 3 months. The primary outcome was the success rate, 
defined as stone-free status or asymptomatic fragments less than 5 mm 3 months
after treatment. RESULTS: A total of 220 patients were randomized, including 111 
to 60 shocks per minute and 109 to 120 shocks per minute. The 2 groups were
comparable in regard to age, sex, body mass index, stent status and initial stone
area. The success rate was higher for 60 shocks per minute (75% vs 61%, p =
0.027). Patients with larger stones (stone area 100 mm or greater) experienced a 
greater benefit with treatment at 60 shocks per minute. The success rate was 71% 
for 60 shocks per minute vs 32% (p = 0.002) and the stone-free rate was 60% vs
28% (p = 0.015). Repeat SWL was required in 32% of patients treated with 120
shocks per minute vs 18% (p = 0.018). Fewer shocks were required with 60 shocks
per minute (2,423 vs 2,906, p <0.001) but treatment time was longer (40.6 vs 24.2
minutes, p <0.001). There was a trend toward fewer complications with 60 shocks
per minute (p = 0.079). CONCLUSIONS: SWL treatment at 60 shocks per minute yields
better outcomes than at 120 shocks per minute, particularly for stones 100 mm or 
greater, without any increase in morbidity and with an acceptable increase in
treatment time.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 16006908 [PubMed - indexed for MEDLINE]

646: Clin Chem Lab Med. 2005;43(6):585-9.

Effects of urine dilution on quantity, size and aggregation of calcium oxalate
crystals induced in vitro by an oxalate load.

Guerra A, Allegri F, Meschi T, Adorni G, Prati B, Nouvenne A, Novarini A,
Maggiore U, Fiaccadori E, Borghi L.

Department of Clinical Sciences, University of Parma, Parma, Italy.

Increasing urinary volume is an important tool in the prevention of calcium renal
stones. However, the mechanism of how it actually works is only partially
understood. This study aimed at assessing how urine dilution affects urinary
calcium oxalate crystallization. A total of 16 male idiopathic calcium oxalate
(CaOx) stone-formers and 12 normal male subjects were studied and 4 h urine
samples were taken twice, under low (undiluted urine) and high hydration
conditions (diluted urine). An equal oxalate load (1.3 mmol/L) was added to both 
types of urine and the crystallization parameters were assessed. In both
stone-formers and normal subjects, the crystallization processes were
significantly (p<0.05 or less) more marked in the undiluted urine than in the
diluted urine in terms of: a) total quantity of calcium oxalate dihydrate (COD)
and calcium oxalate monohydrate (COM) crystals; b) total quantity of crystalline 
aggregates; and c) aggregation index (i.e., ratio between the area occupied by
crystalline aggregates and the area occupied by all the crystals present). The
comparison between stone-formers and normal subjects showed that the greatest
difference was for the size of COD crystals, which were larger in the urine of
the stone-formers. A further important finding was an inverse relationship
between changes in urinary volume and in the aggregation index (r = -0.53, p =
0.004). In conclusion, urine dilution considerably reduces crystallization
phenomena induced in vitro by an oxalate load in both calcium stone-formers and
normal subjects.

PMID: 16006253 [PubMed - indexed for MEDLINE]

647: Eur Urol. 2005 Aug;48(2):296-302; discussion 302. Epub 2005 Mar 9.

Predictive factors of lower calyceal stone clearance after Extracorporeal
Shockwave Lithotripsy (ESWL): a focus on the infundibulopelvic anatomy.

Ghoneim IA, Ziada AM, Elkatib SE.

Department of Urology, Kasr El-Aini Faculty of Medicine, Cairo University,
Elmanial, Cairo, Egypt.

INTRODUCTION: Controversy exists as to whether ESWL is suitable for lower pole
renal stones, given the dependent position of the lower calyces. This study aims 
to test the effect of lower pole anatomy, namely lower polar infundibulo-pelvic
angle, infundibular length and width, on clearance of fragments after ESWL.
PATIENTS AND METHODS: We conducted a retrospective study of 205 renal units with 
single lower pole stones of not more than 25 mm in their greatest diameter that
were treated by ESWL alone. Exclusion criteria included multiple stones, patients
requiring stenting or percutaneous drainage for various reasons. Pretreatment IVU
was used to measure lower polar dimensions. Post treatment ultrasonography and
KUB were used to assess clearance of fragments. RESULTS: The right kidney was
involved in 68% and the left in 42% of cases. Average number of sessions was 1.6 
with an average 3277 shockwaves per session. 134 patients (65.3%) required one
session, 41 requiring 2 sessions (20%), 18 requiring 3 sessions (8.7%), 6
requiring 4 sessions (2.9%) and 8 requiring 5 sessions (3.9%). Complete clearance
was attained in 141 cases, while 64 cases had residual fragments, 20 were
asymptomatic and required no further management. The lower pole
infundibulo-pelvic angle (LIP-A) was the most significant factor in clearance (p 
value 0.00001). Infundibular length (IL) was also statistically significant (p
value 0.039). CONCLUSION: Lower pole anatomy has a significant impact on ESWL
results. LIP-A not less than 70 degrees and an infundibular length of < 50 mm is 
preferable to achieve favorable outcome.

PMID: 16005376 [PubMed - indexed for MEDLINE]

648: Int Arch Occup Environ Health. 2005 Sep;78(8):670-2. Epub 2005 Oct 12.

Nephrolithiasis in a worker with cadmium exposure in the past.

Trevisan A, Gardin C.

Department of Environmental Medicine and Public Health, University of Padova, Via
Giustiniani 2, 35128, Padova, Italy. andrea.trevisan@unipd.it

OBJECTIVES: A clinical case regarding a cadmium-exposed worker is described.
CLINICAL CASE: The subject during the work as welder (male, 42-years-old at the
time of the first investigation) developed a Fanconi-like syndrome due to high
exposure to cadmium fumes. Ten years after exposure removal, the subject showed
clinical and laboratory evidence of nephrolithiasis (calcium phosphate stones).
CONCLUSIONS: The clinical case confirms the possibility of nephrolithiasis in
cadmium-exposed workers and suggests that susceptible subjects may develop kidney
stones after lesion of the tubular cells.

Publication Types: 
    Case Reports

PMID: 16001205 [PubMed - indexed for MEDLINE]

649: Urology. 2005 Jul;66(1):24-8.

Tamsulosin treatment increases clinical success rate of single extracorporeal
shock wave lithotripsy of renal stones.

Gravina GL, Costa AM, Ronchi P, Galatioto GP, Angelucci A, Castellani D, Narcisi 
F, Vicentini C.

Department of Surgery, University of L'Aquila, L'Aquila, Italy.
giovanniluca.gravina@poste.it

OBJECTIVES: To design a randomized, no-treatment, controlled, prospective study
to determine whether the administration of tamsulosin, as adjunctive medical
therapy, increases the efficacy of one extracorporeal shock wave lithotripsy
(ESWL) session to treat renal stones and decreases the use of analgesic drugs
after the procedure. METHODS: A total of 130 patients underwent a single ESWL
session to treat solitary radiopaque renal stones 4 to 20 mm in diameter. After
treatment, all patients were randomly assigned to receive our standard medical
therapy alone (controls) or in association with 0.4 mg tamsulosin daily for a
maximum of 12 weeks. All 130 patients were followed up for 3 months or until an
alternative treatment was given. RESULTS: Of the 130 patients, 78.5% of those
receiving tamsulosin and 60% of controls had achieved clinical success at 3
months (P = 0.037). When we stratified patients according to stone size, for
those with a stone size larger than 10 mm, the success rate was significantly
greater in the tamsulosin group (P = 0.028). Renoureteral colic occurred in 76.9%
of patients treated with standard therapy but in only 26.1% of those receiving
tamsulosin (P < 0.001). The mean cumulative diclofenac dose was 375 mg per
patient in the tamsulosin group and 675 mg per patient in the control group (P < 
0.001). CONCLUSIONS: The results of our study have demonstrated that tamsulosin
therapy, as an adjunctive medical therapy after ESWL, is more effective than
lithotripsy alone for the treatment of patients with large renal stones and is
equally safe. In addition, our results also indicated that adjunctive treatment
with tamsulosin could decrease the use of analgesic drugs after ESWL.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15992885 [PubMed - indexed for MEDLINE]

650: Urology. 2005 Jul;66(1):38-40.

Vascular complications after percutaneous nephrolithotomy: are there any
predictive factors?

Srivastava A, Singh KJ, Suri A, Dubey D, Kumar A, Kapoor R, Mandhani A, Jain S.

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow, India. anees@sgpgi.ac.in

OBJECTIVES: To evaluate the severe hemorrhagic complications of percutaneous
nephrolithotomy (PNL) and their management and to analyze the predictive factors.
METHODS: We retrospectively analyzed the data of 1854 patients who had undergone 
PNL for removal of renal calculi at our institute between 1993 and 2003. All
patients were resuscitated with intravenous fluids and blood transfusions.
Patients in whom bleeding did not respond to conservative means underwent
angiography and subsequent embolization. Multivariate analyses were done to
determine the various factors responsible for the occurrence of these lesions.
RESULTS: Of the 1854 patients, 27 (1.4%), with a mean age of 38.6 years (range 19
to 63) required angiography and/or embolization for bleeding control. The mean
time to the onset of hemorrhage was 8 days (range 2 to 18). Renal arteriography
revealed pseudoaneurysm in 13, arteriovenous fistula in 6, a combination of both 
in 4, lumbar artery injury in 1, and no lesion in 3 patients. In 22 patients,
successful embolization of the offending vessel was achieved and in 2 the
hematuria recurred. These 2 patients underwent repeat angiography and
embolization of the lesion. Metallic coils were used in 13, Gelfoam in 5, and
coils and Gelfoam in 8 patients. On multivariate analysis, only stone size was
the significant factor predicting for the occurrence of these vascular
complications. CONCLUSIONS: Severe hematuria is a rare complication of PNL that
can be successfully managed with angioembolization. Our results indicated that
stone size significantly predicted for the occurrence of lesions in patients
undergoing PNL for symptomatic stone disease.

PMID: 15992882 [PubMed - indexed for MEDLINE]

651: J Nutr. 2005 Jul;135(7):1673-7.

Ascorbate increases human oxaluria and kidney stone risk.

Massey LK, Liebman M, Kynast-Gales SA.

Department of Food Science and Human Nutrition, Washington State University,
Spokane, WA, USA. massey@wsu.edu

Currently, the recommended upper limit for ascorbic acid (AA) intake is 2000
mg/d. However, because AA is endogenously converted to oxalate and appears to
increase the absorption of dietary oxalate, supplementation may increase the risk
of kidney stones. The effect of AA supplementation on urinary oxalate was studied
in a randomized, crossover, controlled design in which subjects consumed a
controlled diet in a university metabolic unit. Stoneformers (n = 29; SF) and
age- and gender-matched non-stoneformers (n = 19; NSF) consumed 1000 mg AA twice 
each day with each morning and evening meal for 6 d (treatment A), and no AA for 
6 d (treatment N) in random order. After 5 d of adaptation to a low-oxalate diet,
participants lived for 24 h in a metabolic unit, during which they were given 136
mg oxalate, including 18 mg 13C2 oxalic acid, 2 h before breakfast; they then
consumed a controlled very low-oxalate diet for 24 h. Of the 48 participants, 19 
(12 stoneformers, 7 non-stoneformers) were identified as responders, defined by
an increase in 24-h total oxalate excretion > 10% after treatment A compared with
N. Responders had a greater 24-h Tiselius Risk Index (TRI) with AA
supplementation (1.10 +/- 0.66 treatment A vs. 0.76 +/- 0.42 treatment N) because
of a 31% increase in the percentage of oxalate absorption (10.5 +/- 3.2%
treatment A vs. 8.0 +/- 2.4% treatment N) and a 39% increase in endogenous
oxalate synthesis with treatment A than during treatment N (544 +/- 131 A vs. 391
+/- 71 micromol/d N). The 1000 mg AA twice each day increased urinary oxalate and
TRI for calcium oxalate kidney stones in 40% of participants, both stoneformers
and non-stoneformers.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15987848 [PubMed - indexed for MEDLINE]

652: Int J Urol. 2005 Jun;12(6):525-32.

Impact of anatomical pielocaliceal topography in the treatment of renal lower
calyces stones with extracorporeal shock wave lithotripsy.

Ruggera L, Beltrami P, Ballario R, Cavalleri S, Cazzoletti L, Artibani W.

Department and Clinic of Urology, University of Verona, Verona, Italy.
lorenzoruggera@yahoo.it

AIM: There is wide consensus that the lowest success rate of extracorporeal shock
wave lithotripsy (ESWL) is in the complete clearance of renal stones located in
the lower calyces. We assess the effectiveness of extracorporeal shock wave
lithotripsy monotherapy for lower pole renal calculi to determine the
relationship between the spatial anatomy of lower pole and the outcome of ESWL.
METHODS: We evaluated 107 patients who were treated for solitary lower pole renal
stones less than 20 mm in diameter with ESWL. The spatial anatomy of the lower
pole, as defined by the lower infundibulopelvic angle, infundibular length and
infundibular width, was measured by preoperative intravenous pyelography, while
the stone location and size were determined by using abdominal plain X-ray. All
patients were followed up at 1 and 3 months with abdominal plain X-ray and
ultrasonography. RESULTS: Only 62 patients (58%) became stone free, while 45
(42%) retained residual fragments. A small lower infundibulopelvic angle, a long 
infundibular length and a tight infundibular width are unfavorable for stone
clearance after ESWL. CONCLUSIONS: ESWL is the treatment of choice for most renal
and ureteral stones. However, stone clearance from the lower pole following ESWL 
is poor and significantly affected by the inferior pole collecting system
anatomy. Therefore, we believe it is important to evaluate these anatomical
factors when deciding on the best treatment for lower pole renal calculi.

PMID: 15985072 [PubMed - indexed for MEDLINE]

653: Clin Exp Rheumatol. 2005 May-Jun;23(3):389-92.

Increased frequency of ultrasonographic findings suggestive of renal stones in
patients with ankylosing spondylitis.

Korkmaz C, Ozcan A, Akçar N.

Division of Rheumatology, Department of Internal Medicine, Osmangazi University
Medical Faculty, Eskisehir, Turkey. ckorkmaz@ogu.edu.tr

OBJECTIVE: To determine the frequency of hypercalciuria and renal stones in
ankylosing spondylitis (AS) sufferers. METHODS: This study involved 83
consecutive AS patients (21 female, 62 male; mean age 36.7 yr), 72 consecutive
Behcet's disease (BD) patients (29 female, 43 male; mean age 37.7 yr) as disease 
control and 92 healthy control (HC) (26 female, 66 male; mean age 32.9 yr.)
Twenty-four hour urine analyses for urinary calcium and uric acid levels were
performed in each patient. Likewise, blood samples for erythrocyte sedimentation 
rate (ESR), C-reactive protein (CRP), parathyroid hormone (PTH), calcium and uric
acid evaluation were taken. Renal ultrasonography to evaluate the presence of
renal stone was performed in patients with AS, as well as in the BD patients and 
HC individuals after a fasting period of 12 hours. RESULTS: 20 of the 80 (25%)
patients with AS were diagnosed with renal stones. Only 4/72 (5.5%) BD patients, 
and 3/98 (3.3%) HC individuals had renal stones by ultrasonography. AS patients
had a significantly higher frequency of renal stones compared with BD (p < 0.001)
and HC (p < 0.0001). AS patients with renal stones were much older and their
disease duration was much longer in comparison with AS patients without renal
stones. Ultrasonographic and laboratory findings did not correlate. The number of
AS patients with hypercalciuria who had renal stones was higher than that of AS
patients who did not have renal stones (p < 0.01). There was a negative
correlation between acute phase response and spinal mobility. CONCLUSION: Renal
stone prevalence was found to increase in AS patients. The likelihood of renal
stone formation was also found to increase with the extension of the disease
duration of AS sufferers.

PMID: 15971429 [PubMed - indexed for MEDLINE]

654: Transplant Proc. 2005 Jun;37(5):2104-6.

Management of coralliform lithiasis on renal allograft with bricker-type
ureterointestinal anastomosis.

Tanneau Y, Vidart A, Sibert L, Grise P, Pfister C.

Department of Urology, Rouen University Hospital-Charles Nicolle, 1 rue de
Germont, 76031 Rouen Cedex, France.

PURPOSE: The authors report the management of a coralliform lithiasis that
occurred in a renal allograft in association with a Bricker ureterointestinal
anastomosis for urinary diversion. MATERIALS AND METHODS: A 58-year-old patient
with a significant previous urological history, ie, surgery for childhood
incomplete bladder extrophy, trans-ileal Bricker type ureterostomy, and in the
end a renal allograft, presented with hematuria and septicemia. Complete
radiological examination revealed an obstructive upper tract coralliform
lithiasis in the transplanted kidney. A percutaneous nephrolithotomy also was
performed for surgical treatment. RESULTS: On postoperative day 2, a urinary
fistula was observed at the nephrostomy orifice. The Bricker ureterointestinal
anastomosis was located at the same level as the nephrostomy orifice, which
maintained upper urinary high pressures as well as the fistula. CONCLUSIONS:
Possible preexistent lithiasis in a donor kidney should not be overlooked. In the
management of kidney stones larger than 3 cm, percutaneous nephrolithotomy
remains the "gold standard" procedure even in cases of external urinary
diversion. We proposed an original management of the previously described
postoperative complication using a hyperpression drainage tube device in
association with a JJ stent.

Publication Types: 
    Case Reports

PMID: 15964351 [PubMed - indexed for MEDLINE]

655: BJU Int. 2005 Jul;96(1):117-26.

Vitamin E therapy prevents hyperoxaluria-induced calcium oxalate crystal
deposition in the kidney by improving renal tissue antioxidant status.

Thamilselvan S, Menon M.

Department of Urology, Ste 2D/34, Henry Ford Health System, One Ford Place,
Detroit, MI-48202, USA. STHAMIL1@HFHS.ORG

OBJECTIVE: To determine whether vitamin E prevents hyperoxaluria-induced stone
formation, using a new animal model of calcium oxalate stone disease, as our
previous in- vitro and in-vivo studies showed that oxalate and hyperoxaluria
induce free-radical generation, which results in peroxidative injury to renal
tubular cells. MATERIALS AND METHODS: Ethylene glycol (EG) was administered at
150 mg/day by gavage for 3 weeks to rats fed on diets with adequate (group 1),
excess (group 2) or deficient (group 3) vitamin E. Several indicators of
peroxidation, free radicals and enzymatic activity were then assessed. RESULTS:
EG treatment in group 1 lead to increased lipid peroxidation, protein thiol,
excretion of urinary enzymes, oxalate and decreases in urinary calcium,
antioxidant enzymes and altered glutathione redox balance. Although renal
function was not altered, there was increased water intake, urine volume and
lowered urinary pH in these rats. These changes were more intense, with extensive
calcium-oxalate crystal deposition, in rats in group 3, and prevented in rats in 
group 2, except for urinary oxalate levels, which remained high.
Histopathological examination showed that there was no deposition of calcium
oxalate crystals in rats in group 2. CONCLUSION: This is the first study to
demonstrate in-vivo evidence that hyperoxaluria-induced peroxidative injury
induces individual calcium oxalate crystal attachment in the renal tubules. In
addition, excess vitamin E completely prevented calcium oxalate deposition, by
preventing peroxidative injury and restoring renal tissue antioxidants and
glutathione redox balance. Therefore, vitamin E therapy might provide protection 
against the deposition of calcium oxalate stones in the kidney of humans.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15963133 [PubMed - indexed for MEDLINE]

656: Braz J Med Biol Res. 2005 Apr;38(4):577-82. Epub 2005 Apr 13.

Effect of an isotonic rehydration sports drink and exercise on urolithiasis in
rats.

Abreu NP, Bergamaschi CT, di Marco GS, Razvickas CV, Schor N.

Disciplina de Fisiologia Cardiovascular e Respiratória, Departamento de
Farmacologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.

The objective of the present study was to evaluate the role of physical exercise 
as well as the influence of hydration with an isotonic sports drink on renal
function in male Wistar rats. Four groups were studied over a period of 42 days: 
1) control (N = 9); 2) physical exercise (Exe, N = 7); 3) isotonic drink (Drink, 
N = 8); 4) physical exercise + isotonic drink (Exe + Drink, N = 8). Physical
exercise consisted of running on a motor-driven treadmill for 1 h/day, at 20
m/min, 5 days a week. The isotonic sports drink was a commercial solution used by
athletes for rehydration after physical activity, 2 ml administered by gavage
twice a day. Urine cultures were performed in all animals. Twenty-four-hour urine
samples were collected in metabolic cages at the beginning and at the end of the 
protocol period. Urinary and plasma parameters (sodium, potassium, urea,
creatinine, calcium) did not differ among groups. However, an amorphous material 
was observed in the bladders of animals in the Exe + Drink and Drink groups.
Characterization of the material by Western blot revealed the presence of
Tamm-Horsfall protein and angiotensin converting enzyme. Physical exercise and
the isotonic drink did not change the plasma or urinary parameters measured.
However, the isotonic drink induced the formation of intravesical matrix,
suggesting a potential lithogenic risk.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15962183 [PubMed - indexed for MEDLINE]

657: Kidney Int. 2005 Jul;68(1):145-54.

Apatite plaque particles in inner medulla of kidneys of calcium oxalate stone
formers: osteopontin localization.

Evan AP, Coe FL, Rittling SR, Bledsoe SM, Shao Y, Lingeman JE, Worcester EM.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46220, USA. evan@anatomy.iupui.edu

BACKGROUND: We have previously shown that interstitial plaque particles appear
first in the basement membranes of thin loops of Henle and then in the
interstitial space. However, it is not known if the plaque in the basement
membrane of thin loops of Henle is of the same or different form than the
interstitial plaque. Thus our purpose here is to detail the structure of the
interstitial and membrane-bound plaque and explore the relationship of plaque
apatite to osteopontin, a well-known crystal-associated urine protein. METHODS:
Deep papillary biopsy tissue was studied from all 15 calcium oxalate stone
formers and four nonforming subjects that we previously reported on [Evan et al, 
J Clin Ivest, 2003]. Routine light and transmission electron microscopy (TEM) as 
well as light microscopy and TEM immunohistochemical localization of osteopontin 
antibody were performed on all 19 subjects. RESULTS: In the basement membrane,
plaque particles are individual and appear laminated with alternating light
regions of crystal and electron-dense organic layers. In the interstitium,
individual particles are not abundant but are instead aggregated to form regions 
of attached particles and in some regions what appears to be a fusion or
syncytium in which crystal islands float in an organic sea. By light microscopy
immunohistochemistry, osteopontin was localized to cells of the loops of Henle
and collecting ducts as well as on sites of plaque. By immunoelectron microscopy,
osteopontin immunogold label was found mainly on the surfaces of apatite crystal 
phase, at the junction of the crystal/organic layers. A similar immunogold
labeling pattern was seen in the particles forming the syncytial islands of
interstitial plaque. CONCLUSION: If indeed we accept the hypothesis that apatite 
plaque may be an anchored site on which calcium oxalate stones form and grow, the
present work makes clear that it is unlikely that the surface of plaque presented
to the final urine will be apatite crystal per se. However, our findings clearly 
show osteopontin is one of the crystal-associated urine proteins involved in the 
formation of the organic layers of the plaque particles.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15954903 [PubMed - indexed for MEDLINE]

658: Int J Urol. 2005 Apr;12(4):335-9.

Analysis of bone mineral density in urolithiasis patients.

Tsuji H, Umekawa T, Kurita T, Uemura H, Iguchi M, Kin K, Kushida K.

Department of Urology, Kinki University School of Medicine, Ohnohigashi
Osakasayama Osaka, Japan. tsujihidenori@hotmail.com

BACKGROUND: The association between hypercalciuria and bone mineral density (BMD)
has been already recognized. The aim of the present study is to relate BMD to age
and sex and to evaluate the calcium metabolism and hypercalciuria-defined dietary
or non-dietary category in patients with urolithiasis. METHODS: The BMI of the
L2-L4 lumbar vertebrae was measured in 310 renal stone patients (191 men and 119 
women). Percent age matched score (%AMS), which is the percent ratio of measured 
BMD to the mean BMD of age-matched control subjects, was utilized for the
appraisal of BMD. Low BMD groups were defined by lower than 90% of %AMS. RESULTS:
Low BMD was observed in 27.7% of urinary stone patients, which was not a
significant difference to that of control subjects (23.5%) who were measured in
the health examination. In male patients with urolithiasis, the frequency of
patients in whom BMD had been apt to decrease since youth was high, but there was
not a proven significant difference among the three age groups (20-39 years old, 
40-59 years old and 60 years old or older). In contrast, for female stone
patients, the frequency of low BMD markedly increased in patients aged 40 years
or older, when menopause occurs. Furthermore, in female stone patients with
hypercalciuria, the frequency of reduced BMD reached more than 40%. When the
cause was non-dietary hypercalciuria (classified mainly on the daily amount of
urinary calcium excretion after ingestion of calculus test diet), the frequency
of reduced BMD reached 65% (P < 0.01). CONCLUSIONS: In case female stone patients
with non-dietary hypercalciuria become menopausal, not only the risk of recurrent
lithiasis increases, but the possibility of developing osteopenia in the future
also increases. Appropriate treatments for prophylactic effects on urolithiasis
or osteopenia should be considered, as judged from BMD, diet, sex, urinary
calcium excretion and other factors synthetically.

Publication Types: 
    Comparative Study

PMID: 15948718 [PubMed - indexed for MEDLINE]

659: Minerva Urol Nefrol. 2005 Mar;57(1):17-22.

Ureteroscopic treatment of upper tract urinary calculi.

Dimarco DS, Chow GK, Gettman MT, Segura JW.

Department of Urology, Mayo Clinic, Rochester, MN 55901, USA.

Ureteroscopic treatment of upper urinary tract calculi is continuously evolving. 
Initial reports were limited to the treatment of distal ureteral stones. These
cases had mixed success, and compared to modern ureteroscopy, had significant
associated morbidity. The entire urinary tract can now be safely accessed via
ureteroscopy almost always. Improvements in ureteroscope technology have
certainly made this possible. These advances include smaller steerable scopes and
sharper optics and video. The enhanced view of the upper urinary tract in
combination with advances in lithotripsy, in particular, the holmium laser, has
resulted in increased treatment success and reduced procedure related morbidity. 
This review describes the advances in ureteroscopic technology and provides data 
regarding treatment success and associated complications.

Publication Types: 
    Review

PMID: 15944518 [PubMed - indexed for MEDLINE]

660: Minerva Urol Nefrol. 2005 Mar;57(1):9-16.

Metabolic abnormalities and the medical management of calcium oxalate
nephrolithiasis.

Chandhoke PS.

Department of Surgery (Urology) and Medicine (Renal Diseases), University of
Colorado, Health Sciences Center, Denver, CO 80262, USA. pj.chandhoke@uchsc.edu

The lifetime prevalence of urolithiasis is approximately 12% for men and 7% for
women in the United States and seems to be increasing; the cost of managing
kidney stones continues to escalate. The most common kidney stones continue to be
composed primarily of calcium and are an admixture of phosphate and oxalate. Of
these, calcium oxalate stones are the most predominant. This review will focus
only on the pathogenesis and medical management of calcium oxalate stones.

Publication Types: 
    Review

PMID: 15944517 [PubMed - indexed for MEDLINE]

661: Urol Res. 2005 Aug;33(4):297-300. Epub 2005 Jun 4.

Pelvi-calyceal height, a predictor of success when treating lower pole stones
with extracorporeal shockwave lithotripsy.

Symes A, Shaw G, Corry D, Choong S.

Stone Unit, Institute of Urology, University College London, London W1W 7EY, UK. 
andysymes@mac.com

Extra corporeal shockwave lithotripsy (ESWL) is the treatment of choice for the
majority of renal stones, however, it has the lowest success rate in complete
clearance of stones located in the lower pole. We assess whether pelvi-calyceal
height is a useful measurement in predicting successful stone clearance from the 
lower pole. A total of 105 patients with a solitary lower pole calculus of less
than 20 mm treated with ESWL were reviewed. Stone size, location and
pelvi-calyceal height were measured by intravenous urogram. Success was defined
as complete stone clearance. Fifty-four patients (51.4%) had successful
treatments, with the remaining 51 (48.6%) having incomplete stone clearance
(including two patients in whom treatment had no effect). There was a
statistically significant difference (P<0.0001) in pelvi-calyceal height between 
the two groups. Mean pelvi-calyceal height in patients with complete stone
clearance was 15.1 mm (SD=3.9) compared with 22.9 mm (SD=5.2) for those with
incomplete clearance. Pelvi-calyceal height is a useful predictor of success when
treating lower pole renal stones with ESWL.

PMID: 15937708 [PubMed - indexed for MEDLINE]

662: Ultrasound Med Biol. 2005 Jun;31(6):827-39.

Cavitation cluster dynamics in shock-wave lithotripsy: part 1. Free field.

Arora M, Junge L, Ohl CD.

Department of Applied Physics, Physics of Fluids, University of Twente, Enschede,
The Netherlands.

The spatiotemporal dynamics of cavitation bubble growth and collapse in
shock-wave lithotripsy in a free field was studied experimentally. The
lithotripter was equipped with two independently triggerable layers of
piezoceramics. The front and back layers generated positive pressure amplitudes
of 30 MPa and 15 MPa, respectively, and -10 MPa negative amplitude. The time
interval between the launch of the shock waves was varied from 0 and 0.1 s,
covering the regimens of pulse-modification (regimen A, delay 0 to 4 micros),
shock wave-cavitation cluster interaction (B, 4 micros to 64 micros) and shock
wave-gas bubble interaction (C, 256 micros to 0.1 s). The time-integrated
cavitation activity was most strongly influenced in regimen A and, in regimen B, 
the spatial distribution of bubbles was altered, whereas enhancement of
cavitation activity was observed in regimen C. Quantitative measurements of the
spatial- and time-integrated void fractions were obtained with a photographic and
light-scattering technique. The preconditions for a reproducible experiment are
explained, with the existence of two distinct types of cavitation nuclei, small
particles suspended in the liquid and residuals of bubbles from prior cavitation 
clusters.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15936498 [PubMed - indexed for MEDLINE]

663: J Am Soc Nephrol. 2005 Jul;16(7):1904-8. Epub 2005 Jun 1.

Crystal surface adhesion explains the pathological activity of calcium oxalate
hydrates in kidney stone formation.

Sheng X, Ward MD, Wesson JA.

Department of Chemical Engineering and Materials Science, University of
Minnesota, 421 Washington Avenue SE, Minneapolis, MN 55455, USA.

Renal tubular fluid in the distal nephron of the kidney is supersaturated with
calcium oxalate (CaOx), which crystallizes in the tubules as either calcium
oxalate monohydrate (COM) or calcium oxalate dihydrate (COD). Kidney stones are
aggregates, most commonly containing microcrystals of COM as the primary
inorganic constituent. Stones also contain small amounts of embedded proteins,
which are thought to play an adhesive role in these aggregates, and they often
are found attached to the tip of renal papilla, presumably through adhesive
contacts. Voided urine, however, often contains COD in the form of single
micron-sized crystals. This suggests that COD formation protects against stone
disease because of its reduced capacity to form stable aggregates and strong
adhesion contacts to renal epithelial cells. Using atomic force microscopy
configured with tips modified with biologically relevant functional groups, we
have compared the adhesion strengths of the morphologically important faces of
COM and COD. These measurements provide direct experimental evidence, at the near
molecular level, for poorer adhesion at COD crystal faces, which explains the
benign character of COD and has implications for resolving one of the mysteries
of kidney stone formation.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 15930089 [PubMed - indexed for MEDLINE]

664: Exp Clin Endocrinol Diabetes. 2005 May;113(5):257-61.

Is there any connection between the presence of kidney stones in primary
hyperparathyroidism and the location of an underlying adenoma?

Csupor E, Toth E, Meszaros S, Ferencz V, Szucs J, Lakatos P, Horányi J, Perner F,
Horvath C.

Health Service, Budavar Local Authorities, Budapest, Hungary. ecsupor@freemail.hu

The majority of the patients with primary hyperparathyroidism (pHPT) recurrently 
produce kidney stones, while the rest have other clinical manifestations. The aim
of this study was to examine the possibility of an association between the
presence of kidney stones and the location of an underlying adenoma. This was a
retrospective evaluation of the records of 91 patients (10 males, 81 females,
mean age: 61.9 years [20 - 70 yrs]) operated for primary hyperparathyroidism
between 1995 and 2000. One patient was excluded due to carcinoma. Kidney stones
were found in 55 cases and other clinical symptoms in 35 cases. In 50 of the 55
patients (91 %) with kidney stones, the adenoma was located in the left inferior 
parathyroid gland (chi2 = 67.5, p < 0.00,001), while in 24 of the 35 patients (69
%) without kidney stones, the adenoma was in the right inferior parathyroid gland
(chi2 = 43.9, p < 0.0001). These results suggest that the location of the adenoma
may influence the presence of kidney stones in pHPT. It is proposed that the
biologic effects of parathyroid hormone could differ depending on which of the
four parathyroid glands it was secreted in, or the four glands may produce
different biologically active fragments.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15926110 [PubMed - indexed for MEDLINE]

665: Urol Res. 2005 Jun;33(3):223-30. Epub 2005 May 28.

International comparison of cost effectiveness of medical management strategies
for nephrolithiasis.

Lotan Y, Cadeddu JA, Pearle MS.

Department of Urology, The University of Texas Southwestern Medical Center, 5323 
Harry Hines Blvd., Dallas, TX 75390, USA. Yair.lotan@utsouthwestern.edu

Although medical therapy is known to reduce the risk of kidney stone recurrence, 
the cost effectiveness of medical prophylaxis is controversial. We evaluated
medical treatment strategies including dietary measures (conservative), empiric
medical therapy (empiric) or directed medical therapy (directed) based on
comprehensive metabolic evaluation (CME) for patients with recurrent kidney
stones, and compared the costs of these strategies using cost data from ten
different countries. We previously established rates of stone formation in
recurrent stone-formers, risk reduction of medical therapy, sensitivity of CME
and rates of spontaneous stone passage from a comprehensive literature search
(Lotan et al. 2004 J Urol 172: 2275). The costs of medication, surgical therapy, 
emergency room visits and CME for ten different countries were obtained from a
published report of an international cost survey (Chandhoke 2002 J Urol 168: 937)
as well as from our own county hospital in the US. Medication costs in the US
were obtained from two national pharmacy chains. A decision tree model was
created to compare the costs of different treatment strategies assuming cost
accrual for metabolic evaluation, medical therapy and surgery or emergency room
visits. For medical therapy, we assumed the distribution of medication use
described in the published report, consisting of potassium citrate (60%),
thiazide (30%) and allopurinol (10%). A nearly 20-fold difference in the costs of
shock-wave lithotripsy, ureteroscopy and medication was found among different
countries. From the model (US dollars/patient/year), conservative therapy alone
was the most cost effective approach followed by empiric and directed medical
therapy in all countries except in the UK. In the UK, the cost of drug therapy
(estimated at dollar 29/patient/year) resulted in empiric therapy being the most 
cost effective strategy for recurrent stone formers. The low likelihood of
surgical intervention, as well as the low relative cost of surgery to medication,
contributed to the higher cost of empiric and directed medical therapy
strategies. Of note, despite the higher cost, drug treatment strategies were
associated with significantly lower stone recurrence rates. We found that drug
treatment strategies are more costly than conservative treatment but produce good
control of stone formation. In all but one country (UK), dietary therapy was the 
most cost effective approach due to the relatively low cost of surgery compared
with medication. The differential resource allocation to different components of 
a healthcare system (i.e. subsidized medication versus surgical treatment) in
different countries determines the cost effectiveness of various treatment
strategies.

Publication Types: 
    Comparative Study

PMID: 15924256 [PubMed - indexed for MEDLINE]

666: Urol Res. 2005 Jun;33(3):244-6. Epub 2005 May 29.

Nephrolithiasis complicating treatment of diabetes insipidus.

Mehandru S, Goldfarb DS.

Kidney Stone Prevention Program, New York VA Medical Center, New York, USA.

A decrease in urine volume is considered the therapeutic goal of the treatment of
central diabetes insipidus (DI) with desmopressin (dDAVP). A low urine volume is 
a risk factor for kidney stone formation. This is the first report of
nephrolithiasis in association with DI. It is likely that successful therapy with
dDAVP and the patient's own purposeful decreased fluid intake contributed to
calcium oxalate stone formation. Prevention of stone recurrence requires an
increase in urine volume. The patient's compliance with this recommendation led
to an episode of acute hyponatremia, a well-known complication of dDAVP therapy. 
The challenge of the management of stones in the setting of DI requires balancing
the conflicting goals of both decreasing and increasing urine volume.

Publication Types: 
    Case Reports

PMID: 15924254 [PubMed - indexed for MEDLINE]

667: Urology. 2005 Jun;65(6):1070-4.

Randomized controlled study of mechanical percussion, diuresis, and inversion
therapy to assist passage of lower pole renal calculi after shock wave
lithotripsy.

Chiong E, Hwee ST, Kay LM, Liang S, Kamaraj R, Esuvaranathan K.

Department of Surgery, National University of Singapore, Singapore.
surce@nus.edu.sg

OBJECTIVES: To determine whether mechanical percussion, diuresis, and inversion
(PDI) therapy after shock wave lithotripsy (SWL) improves the clearance rates of 
lower pole renal stones. METHODS: In this single-blind study, 108 patients who
underwent SWL treatment for lower pole renal stones with a total diameter of 2 cm
or less were prospectively randomized into two groups. One group (n = 49)
received SWL only and the other group (n = 59) received a median of four sessions
of PDI therapy (range 1 to 12), 1 to 2 weeks after each SWL session. PDI therapy 
was performed as follows. Patients drank 500 mL of water 30 minutes before
therapy; they then lay in a prone Trendelenburg position on a 45 degrees -angle
couch, and received continuous 10-minute manual mechanical percussion applied
over the flank. Stone clearance was documented with plain abdominal radiography, 
with additional imaging, if indicated, 1 and 3 months after initial SWL therapy. 
RESULTS: The patients from both groups were comparable in terms of total stone
diameter, infundibular neck diameter, infundibular length, caliceal height,
infundibular-pelvic angles, infundibular-ureteral angles, infundibular-vertebral 
angles, lower pole cortical thickness, and caliceal number. All patients
underwent a maximum of four SWL treatments. For all assessable patients, the
radiologically documented complete stone clearance rate at 3 months for the
SWL-alone group was 35.4% and for the SWL plus PDI group was 62.5% (chi-square
test, P = 0.006). CONCLUSIONS: PDI therapy is a valuable adjunct in assisting
passage of lower pole renal stone fragments after SWL therapy.

Publication Types: 
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15922429 [PubMed - indexed for MEDLINE]

668: Anaesthesia. 2005 Jun;60(6):602-4.

Comment in:
    Anaesthesia. 2005 Sep;60(9):931-2.    Anaesthesia. 2005 Sep;60(9):932.

Radial nerve injury after general anaesthesia in the lateral decubitus position.

Tuncali BE, Tuncali B, Kuvaki B, Cinar O, Doğan A, Elar Z.

Department of Anaesthesiology and Reanimation, Dokuz Eylul University, Izmir,
Turkey. binnur.tuncali@deu.edu.tr

A 43-year-old female patient underwent pyelolithotomy in the left lateral
decubitus position. Her upper right arm was placed on a padded armboard. Surgery 
lasted for 240 min. Postoperatively, she complained of numbness of the dorsal
part of her right hand and wrist drop. Neurological examination revealed
hypoaesthesia of the dermatome of the right forearm and hand innervated by the
radial nerve. Electromyography revealed advanced axonal degeneration of the
radial nerve below the level of the elbow. Treatment with diclofenac, vitamin B
and physiotherapy was started. Her symptoms improved gradually and at the 60th
postoperative day, motor weakness had completely resolved. In order to prevent
peri-operative nerve injury, careful positioning of every patient on the
operating table with proper padding is essential, with attention paid to
time-dependent risks. If an injury occurs, diagnosis and treatment should be
started as rapidly as possible.

Publication Types: 
    Case Reports

PMID: 15918832 [PubMed - indexed for MEDLINE]

669: Urol Res. 2005 Jun;33(3):191-3. Epub 2005 May 26.

Comment in:
    Urol Res. 2006 Feb;34(1):64; discussion 65-6.

Ex vivo training model for percutaneous renal surgery.

Strohmaier WL, Giese A.

Department of Urology and Paediatric Urology, Klinikum Coburg, Ketschendorfer
Str. 33, 96450 Coburg, Germany. walter.strohmaier@klinikum.coburg.de

Percutaneous endourological procedures require an advanced level of skills. To
facilitate training in the proper technique, simulators are helpful.
Non-biological models, useful for learning the basic steps, do not represent the 
clinical situation in an ideal way. Recently, we developed a porcine urinary
tract model for ureteroscopy. Proceeding from this experience, we developed a
further ex vivo model for training percutaneous endourological procedures. The
kidney with the ureter is dissected off of the retroperitoneal organ package of
freshly slaughtered pigs. It is embedded in silicon. The renal pelvis can be
filled with saline to simulate hydronephrosis, stones can be implanted for
percutaneous nephrolithotomy. This ex vivo model allows training of all
percutaneous endourological procedures (e.g. percutaneous nephrostomy,
percutaneous lithotomy, endopyelotomy). It is an ideal way to train these
techniques, being superior to non-biological models in terms of "tissue feeling" 
for anatomic relations, and the great variety of procedures that can be trained. 
Nevertheless, it is readily available and inexpensive.

PMID: 15918072 [PubMed - indexed for MEDLINE]

670: Southeast Asian J Trop Med Public Health. 2004 Dec;35(4):1028-33.

Effects of calcium supplements on the risk of renal stone formation in a
population with low oxalate intake.

Stitchantrakul W, Sopassathit W, Prapaipanich S, Domrongkitchaiporn S.

research Center, Mahidol University, Bangkok.

It has been speculated that calcium supplement in subjects with low oxalate
intake might increase the risk of calcium stone formation due to an increase in
calcium absorption without a significant reduction in oxalate absorption. There
have been no human studies addressing specifically the effects of taking calcium 
supplements in populations whose dietary oxalate is low. This study was conducted
to determine the effects of calcium supplements on the risk of calcium stone
formation in a population with low oxalate intake. Thirty-two healthy male navy
privates, 22.7 +/- 1.9 (mean +/- SD) years old, who had oxalate intake of less
than 1 mmol/day, a serum creatinine of less than 150 micromol/l, and no history
of renal stones, participated in the study. Dietary oxalate was controlled to be 
under 1 mmol/day throughout the study. Twenty-four hour urine collections for the
determination of urinary constituents were obtained at baseline and after taking 
calcium supplements. Detection of calcium oxalate was performed to assess the
risk of calcium oxalate stone formation. The urinary excretion of calcium was
significantly elevated above baseline values while taking the calcium supplements
(3.48 +/- 2.13 vs 5.17 +/- 2.61 mmol/d, p < 0.05) and urinary oxalate was
significantly decreased when the subjects took calcium supplements compared to
the corresponding baseline value (0.13 +/- 0.05 vs 0.17 +/- 0.07 mmol/d, p =
0.01). Urinary citrate was significantly elevated when the subjects took calcium 
supplements compared to the baseline (0.83 +/- 0.57 vs 0.64 +/- 0.39 mmol/d, p = 
0.03). There was no significant alteration in the activity products of calcium
oxalate while taking the calcium supplements (0.54 +/- 0.25 vs 0.57 +/- 0.22, p =
0.54). The effect of calcium supplements with meals, for the reduction of the
risk of calcium stone formation, was unchanged, even in a population whose
oxalate intake is rather low. Taking calcium supplements resulted in a reduction 
in urinary oxalates and an elevation in urinary citrates. Both alterations in
urinary constituents counterbalanced the elevation in urinary calcium which
resulted from the calcium supplements.

Publication Types: 
    Clinical Trial

PMID: 15916110 [PubMed - indexed for MEDLINE]

671: Cell Biochem Funct. 2006 Sep-Oct;24(5):467-9.

The effects of extracorporeal shock wave lithotripsy on antioxidant enzymes in
erythrocytes.

Aksoy Y, Malkoc I, Atmaca AF, Aksoy H, Altinkaynak K, Akcay F.

Department of Urology, School of Medicine, Atatürk University, Erzurum, Turkey.
aksoyyilmaz@yahoo.com

The effects of extracorporeal shock wave lithotripsy (ESWL) on patients
undergoing ESWL for renal stone treatment have been studied using activities of
glucose-6-phosphate dehydrogenase (G6PDH), superoxide dismutase (SOD) and
catalase (CAT), and levels of malondialdehyde (MDA) in the erythrocyte
haemolysate. The study included 23 patients (eight women, 15 men with an age
range of 23-57 years). Blood samples were taken 5 min before ESWL, in addition to
1 h and 5 days after termination of treatment. Enzyme activities and MDA levels
in erythrocytes were measured spectrophotometrically. When compared with the
values obtained before ESWL, erythrocyte G6PDH (p = 0.015), SOD (p = 0.036) and
CAT (p = 0.01) activities were found to be significantly reduced at the first
hour after ESWL. On the fifth day after ESWL, erythrocyte enzyme activities were 
normalized to the values obtained before ESWL. Although there was a significant
difference between values before and 1 h after ESWL (p = 0.003), no difference
was detected between 1 h after ESWL and 5 days after ESWL (p > 0.05) in terms of 
MDA values. The findings of the present study revealed that erythrocyte lipid
peroxidation might be induced and antioxidative defence mechanism may be
transiently impaired by ESWL.

PMID: 15912571 [PubMed - indexed for MEDLINE]

672: Pediatr Nephrol. 2005 Jul;20(7):940-4. Epub 2005 May 24.

Comment in:
    Pediatr Nephrol. 2006 Sep;21(9):1331-2.

High incidence of kidney stones in Icelandic children.

Edvardsson V, Elidottir H, Indridason OS, Palsson R.

Department of Pediatrics, Landspitali University Hospital, Hringbraut, 101
Reykjavik, Iceland.

All children less than 18 years of age who were diagnosed with a first episode of
kidney stones at pediatric referral centers in Iceland during the years 1995-2000
were studied retrospectively. The diagnosis was based on clinical features and
results of imaging studies. Patients were invited for evaluation at the end of
the study period. Twenty-six patients (15 females, 11 males), median age 9.4
(range 0.2-14.9) years, experienced 34 episodes of kidney stones. The annual
incidence was 5.6 and 6.3 per 100,000 children less than 18 and 16 years of age, 
respectively. Abdominal pain was the most common symptom (N=17; 69%) and
urinalysis revealed hematuria in 21 patients (80.8%), sterile pyuria in 17 (65%),
and 2,8-dihydroxyadeninuria in two. Six patients (23%) had positive urine
cultures at the time of diagnosis and five (20%) had urinary tract anomalies.
Family history of kidney stones was positive in one third of patients. Metabolic 
risk factors for stone formation were identified in 22 of 23 patients (96%) who
underwent evaluation. Hypercalciuria, the most common metabolic risk factor, was 
identified in 18 patients (78%). Stones passed spontaneously in nine patients
(35%) and six patients had recurrent stone episodes. The incidence of kidney
stones in Icelandic children is high compared with other Western populations,
affecting females more than males. Underlying metabolic risk factors were
identified in most patients.

PMID: 15912382 [PubMed - indexed for MEDLINE]

673: J Endourol. 2005 May;19(4):464-8.

Combined ureterorenoscopy and shockwave lithotripsy for large renal stone burden:
an alternative to percutaneous nephrolithotomy?

Hafron J, Fogarty JD, Boczko J, Hoenig DM.

Department of Urology, Montefiore Medical Center/Albert Einstein College of
Medicine, Bronx, New York 10461, USA.

PURPOSE: To investigate the feasibility and initial outcomes of a combination of 
ureterorenoscopy (URS) using holmium laser lithotripsy and extracorporeal
shockwave lithotripsy (SWL) in a single outpatient session for the treatment of
large renal stone burdens in patients refusing or unsuitable for percutaneous
nephrolithotomy (PCNL). PATIENTS AND METHODS: Fourteen patients with a mean age
of 52.7 years (range 34-81 years) having a mean stone burden of 847 mm2 (range 58
mm2-1850 mm2) were treated with combined URS laser lithotripsy and SWL as an
alternative to PCNL. The SWL (mean 2800 shockwaves) was performed using the Storz
Modulith SL-X, and flexible URS with holmium laser lithotripsy was performed
either during or following SWL. RESULTS: Ninety-three percent of the patients
(13/14) were treated successfully on an outpatient basis. Two patients were
rendered stone free after the initial procedure alone (14%). Overall, including
secondary outpatient treatment with a second session of URS alone (N = 7) URS and
SWL (N = 1), SWL (N = 1), or oral alkalinization therapy (N = 1), the stone-free 
rate was 76.9% (10/13). One patient was excluded secondary to death from
unrelated causes after the initial procedure, and the success rate (residual
fragments <4 mm) was 84.6% (11/13). The two treatment failures included one
patient who required a third URS procedure and one patient who developed
urosepsis necessitating nephrostomy-tube placement who underwent subsequent PCNL.
CONCLUSIONS: In comparison with traditional approaches using PCNL and second-look
nephroscopy, single-session combined URS and SWL with a second outpatient
procedure may offer equivalent results with decreased morbidity in carefully
selected patients.

Publication Types: 
    Evaluation Studies

PMID: 15910257 [PubMed - indexed for MEDLINE]

674: J Endourol. 2005 May;19(4):461-3.

Three-dimensional planning of percutaneous renal stone surgery in a horseshoe
kidney using 16-slice CT and volume-rendered movies.

Ghani KR, Rintoul M, Patel U, Anson K.

Department of Urology, St George's Hospital, London, UK.

Percutaneous management of calculi within horseshoe kidneys can be difficult
because of the abnormal renal anatomy. We report our use of 16-slice CT scans to 
obtain three-dimensional (3D) volume-rendered (VR) movies of the pelvicaliceal
system and stone for planning percutaneous renal stone surgery. The movie is
formatted onto a disc, which can be played on a personal computer without
additional software. This technique allows user-friendly 3D planning in the
operating theatre. Unlike conventional two-dimensional images, the 3D VR movie
provides a global appreciation for planning.

PMID: 15910256 [PubMed - indexed for MEDLINE]

675: BMC Urol. 2005 May 22;5:9.

New chemolysis for urological calcium phosphate calculi - a study in vitro.

Xiang-bo Z, Zhi-ping W, Jian-min D, Jian-zhong L, Bao-liang M.

School of Life Sciences, LanZhou University, LanZhou, 730030, China.
zhangxb4@tom.com

BACKGROUND: Advances in techniques have left very few indications for open
surgical extraction of urinary stones currently. These advances notwithstanding, 
the search continues for medical approaches to urinary stone management. In this 
study, we perform an in vitro study analyzing the efficiency and prospect of two 
new complex solutions in urological calcium phosphate calculi dissolution.
METHODS: Eighteen stones composed mainly of calcium phosphates were taken from
patients who underwent kidney stone surgery. These stones were large enough
(weight range 0.514-0.928 g) to be fragmented and matched equally into six
groups. Chemolysis of phosphate stones was done with six different solvents and
was repeated 3 times with 6 stones for each solution. At 24, 48 and 72 h,
reduction in weight, percentage weight change, and dissolution rate; the
dissolution rates at pH 5.0, 7.0 and 8.5 for each solution, using different
cations (Na+, K+ or Ca2+), according to different dilutions (1:1, 1:2, 1:3, 1:4) 
of S1 and S2 were simultaneously determined. RESULTS: Calcium phosphate calculi
were poorly dissolved by Phys and Art, and they had a low dissolution rate in pH 
8.5 EDTA. The most effective solutions were S1, S2 and R, with 72 h mean
dissolution rates: 5.75 +/- 0.44 mg/hr (S1), 5.2 +/- 0.63 mg/hr (S2), 4.55 +/-
0.46 mg/hr (R) (x +/- s, p < 0.01 R, S1 and S2 vs Phys, Art and EDTA; p < 0.05,
S1 vs R, LSD-test). The mean percentage weight loss at 72 h was: 52.1 +/- 15.75 %
(S1), 44.4 +/- 7.37 % (S2) and 40.5 +/- 3.67 % (R) ( x +/- s, p < 0.01 R, S1 and 
S2 vs Phys, Art and EDTA, LSD-test). Diluted twice, S1 and S2 had even better
effectiveness than their initial solution. The additive of Na+, K+ or Ca2+
greatly reduced the dissolution rates of S1, S2. CONCLUSION: Our data indicate
that test solutions S1 and S2 are effective solvents in the chemolysis of calcium
phosphate stones. At twice dilutions, these solutions are even more useful in the
treatment of stone disease.

Publication Types: 
    Comparative Study
    In Vitro

PMID: 15907215 [PubMed - indexed for MEDLINE]

676: Urol Res. 2005 Jun;33(3):203-5. Epub 2005 May 14.

Filling cystoureterography facilitates stone visualization in patients with
previously inserted double-J ureteral stents.

Kravchick SG, Shumalinsky D, Jeshurun-Koren M, Stepnov E, Cytron S.

Barzilai Medical Center, Department of Urology, Asdod, Israel.
cambell@netvision.il

In our study, we assessed the ability of a filling cystogram to induce
vesicoureteral reflux (VUR) and to evaluate its role in stone targeting during
ESWL in the presence of a double-J ureteral stent (JJ-S). Filling
cystoureterography was performed during ESWL in 17 patients with previously
inserted 4.7 F JJ-S. The examination ended with stone localization. In every
procedure, 3,500 shock waves were delivered with an energy range of 18-23 kV.
Patients were evaluated 4 weeks after ESWL. A stone-free result was defined as no
evidence of calculi in the first or second visits. Because contrast material was 
employed in this study, we also evaluated its possible interference with the
results of lithotripsy. All radiolucent or poorly calcified stones were
successfully localized. In four patients, rhythmic suprapubic manual pressure was
performed to initiate VUR. Reflux was low grade in 35% and high grade in 65% of
renal units. The efficiency quotient reached 59%. In vitro artificial stones were
successfully disintegrated both in water and solutions of Ultravist. In the
presence of a JJ-S, filling cystography can easily localize radiolucent stones
during SWL. No special catheters or stents are required for this technique.
Ultravist in particular does not affect the results of ESWL unfavorably.

PMID: 15895220 [PubMed - indexed for MEDLINE]

677: BJU Int. 2005 Jun;95(9):1285-8.

Comment in:
    BJU Int. 2005 Sep;96(4):685.    BJU Int. 2005 Sep;96(4):685-6.

Role of computed tomography with no contrast medium enhancement in predicting the
outcome of extracorporeal shock wave lithotripsy for urinary calculi.

Gupta NP, Ansari MS, Kesarvani P, Kapoor A, Mukhopadhyay S.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

OBJECTIVE: To evaluate the usefulness of urinary calculi attenuation values from 
non-contrast computed tomography (NCCT) in predicting the outcome of treatment by
extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS: We evaluated 
112 patients with solitary renal and upper ureteric calculi of 0.5-2 cm
undergoing ESWL. All patients had NCCT at 120 kV and 240 mA on a spiral CT
scanner. During each ESWL session 3000 shock waves were given to a maximum of 3.0
kV. A final X-ray of the kidney, ureters and bladder was taken 12 weeks after the
last ESWL session. Fragments of < or = 5 mm were regarded as clinically
insignificant residual fragments (CIRF). The calculi retrieved were analysed by
X-ray diffraction and the results assessed by comparing the mean density (as
measured in Hounsfield units, HU) with the number of ESWL sessions and clearance.
RESULTS: In all, 82 (76%) patients had complete clearance of stones and 26 (24%) 
had CIRF. There was a linear relationship between the calculus density and number
of ESWL sessions required. Of patients with calculi of < or = 750 HU, 41 (80%)
needed three or fewer ESWL sessions and 45 (88%) had complete clearance. Of
patients with calculi of > 750 HU, 41 (72%) required three or more ESWL sessions,
and 37 (65%) had complete clearance. The best outcome was in patients with
calculus diameters of < 1.1 cm and mean densities of < or = 750 HU; 34 (83%)
needed three or fewer ESWL sessions, and the clearance rate was 90%. The worst
outcome was in patients with calculus densities of > 750 HU and diameters of >
1.1 cm; 23 (77%) needed three or more ESWL sessions and the clearance rate was
only 60%. The calculus density was a stronger predictor of outcome than size
alone. CONCLUSIONS: The use of NCCT for determining the attenuation values of
urinary calculi before ESWL might help to predict the treatment outcome, and so
might help in planning alternative treatment in patients with a likelihood of a
poor outcome from ESWL.

Publication Types: 
    Evaluation Studies

PMID: 15892818 [PubMed - indexed for MEDLINE]

678: BJU Int. 2005 Jun;95(9):1280-4.

Comment in:
    BJU Int. 2005 Oct;96(6):916-7.

Planning percutaneous nephrolithotomy using multidetector computed tomography
urography, multiplanar reconstruction and three-dimensional reformatting.

Thiruchelvam N, Mostafid H, Ubhayakar G.

Departments of Urology and Radiology, North Hampshire Hospital, Basingstoke, UK. 
n.t@talk21.com

OBJECTIVE: To assess a modified technique of multidetector computed tomographic
urography (CTU) which can reproducibly and accurately map the pelvicalyceal
system (PCS) and complex renal calculi, as such information is essential in
choosing the optimal percutaneous approach into the PCS for safe and successful
percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Ten consecutive
patients with renal calculi underwent a modified four-detector multislice CTU
with frusemide, abdominal compression and subsequent injection with contrast
medium. After unenhanced CT of the abdomen, a high-resolution contrast-enhanced
scan was taken through the kidneys in the pyelographic phase. Data were analysed 
using multiplanar reconstruction and three-dimensional (3D) reformatting.
RESULTS: In 10 CTUs there were three staghorn, two diverticular, 25 calyceal, two
infundibular and two renal pelvic calculi; nine showed posterior calyces and good
infundibular anatomy, and provided a good map of the PCS. Seven patients had
PCNL, with the remaining three having either primary extracorporeal shock wave
lithotripsy or conservative management. CTU detected stones in all patients and
accurately located their relation to the PCS. With reconstructed images,
subjectively the 3D imaging provided an advantage over conventional imaging in
optimizing nephrostomy placement. CONCLUSION: CTU with this protocol and
post-processing techniques enables an accurate and confident, reproducible
prediction of the site, number and size of stones in complex pelvicalyceal
anatomy, optimal site(s) for placing the percutaneous track, and potential
hazards when placing the track, with no significant increase in the patient's
radiation burden. 3D CTU should become the standard imaging method for planning
PCNL in selected patients.

Publication Types: 
    Evaluation Studies

PMID: 15892817 [PubMed - indexed for MEDLINE]

679: J Endocrinol Invest. 2005 Feb;28(2):122-8.

Risk factors associated to kidney stones in primary hyperparathyroidism.

Corbetta S, Baccarelli A, Aroldi A, Vicentini L, Fogazzi GB, Eller-Vainicher C,
Ponticelli C, Beck-Peccoz P, Spada A.

Institute of Endocrine Sciences, Fondazione Ospedale Maggiore IRCCS, University
of Milan, Milan, Italy. sabrina.corbetta@unimi.it

Nephrolithiasis is the most important clinical manifestation of primary
hyperparathyroidism (PHPT), although nowadays this disorder is often
asymptomatic. Clinical or biochemical differences between PHPT patients with and 
without nephrolithiasis have not been clearly identified in most of the previous 
studies. The aim of the study was to investigate clinical and biochemical
parameters in kidney stone former (SF) and non-stone former (NSF) patients with
PHPT in order to identify potential risk factors. Serum and plasma samples from
55 consecutive patients (43 females, 12 males) with PHPT were collected after
overnight fasting; 24-h urine collection and a fresh sample of urine for sediment
analysis were obtained from all patients. Clinical data were recorded in all. Out
of 55 patients, 22 had kidney stones, which were symptomatic in 73%. SFs showed
circulating PTH, total and ionized calcium, 1,25 dihydroxyvitamin D3, urinary
calcium excretion and 24-h urine oxalate levels significantly higher than NSFs.
Hypercalciuria was often concomitant with massive quantities of calcium oxalate
crystals in urine sediment. Hypercalciuria and relatively high oxaluria were
associated with stone formation with an odds ratio (OR) of 4.0 and 7.0,
respectively, which rose to 33.5 when they coexisted. Hypomagnesuria and
hypocitraturia were common in at least one third of all PHPT patients, but they
were not associated to an increased OR. As expected, they were positively
correlated with urine calcium excretion, suggesting that calcium, magnesium and
citrate are commonly regulated at renal level. In conclusion, hypercalciuria,
higher oxalate excretion and severe PHPT are associated with kidney stones in
PHPT.

PMID: 15887857 [PubMed - indexed for MEDLINE]

680: Urology. 2005 May;65(5):858-61.

High kidney stone risk in men working in steel industry at hot temperatures.

Atan L, Andreoni C, Ortiz V, Silva EK, Pitta R, Atan F, Srougi M.

Urological Institute, Volta Redonda, Rio de Janeiro, Brazil.

OBJECTIVES: To study the incidence of urinary lithiasis and metabolic alterations
among male employees from a steel industry who were exposed to high temperatures 
in the work environment. METHODS: A retrospective cross-sectional study was
performed and consisted of two stages. First, the incidence of urolithiasis among
the industry's 10,326 employees was assessed. These employees were divided into
two group's: group 1 (n = 1289) consisted of the hot-area workers (temperature
greater than 45 degrees C) and group 2 (n = 9037) consisted of those working in
areas at room temperature. In the second stage, 59 workers without urolithiasis
who underwent a metabolic evaluation were divided into two group's: group 3 (n = 
34) consisted of hot-area workers and group 4 (n = 25) consisted of those working
in areas at room temperature. Evaluations were made of calcium, creatinine, and
uric acid in serum; in the 24-hour urine samples, we assessed the volume,
calcium, uric acid, citrate, and oxalate. RESULTS: Of the 10,326 workers, 181
(1.75%) had presented with at least one episode of urinary stones. Of these, 103 
were among the hot-area workers (8.0%) and 78 among the room-temperature workers 
(0.9%; P <0.001). The metabolic evaluation showed that the hot-area group (group 
3), compared with the room-temperature group (group 4), presented more frequently
with hypocitraturia (55.8% versus 28%, P = 0.03) and low urinary volume (79.4%
versus 48%, P = 0.01). CONCLUSIONS: Workers exposed to high temperatures
presented with a ninefold risk of lithiasis. Hypocitraturia and low urine volumes
were the metabolic alterations observed.

PMID: 15882711 [PubMed - indexed for MEDLINE]

681: J Urol. 2005 Jun;173(6):2175-7.

Can the Bonn Risk Index be replaced by a simple measurement of the urinary
concentration of free calcium ions?

Laube N, Hergarten S.

Division of Experimental Urology, Department of Urology and Geodynamics,
University of Bonn, Bonn, Germany. norbert.laube@ukb-bonn.de

PURPOSE: It has been shown that a strong hyperbolic relationship exists between
the urinary concentration of free Ca ions ([Ca]) and the amount of ammonium
oxalate (Ox) that must be titrated in a standardized procedure to a urine sample 
to induce CaOx crystallization. The ratio of [Ca] to (Ox) is termed the Bonn Risk
Index (BRI). Most data plot around a hyperbola described by the formula, [Ca] x
(Ox) = constant. Due to the high relationship between [Ca] and (Ox) one may argue
that determining only 1 of the 2 BRI parameters, preferably [Ca], is sufficient
to describe the urine crystallization risk. MATERIALS AND METHODS: Based on 195
urine samples taken from CaOx stone formers and healthy subjects we compared the 
sensitivity and specificity of BRI, and its corresponding [Ca] value by
calculating ROC curves. Furthermore, ROC curves of the established risk indexes, 
namely the model value of urinary supersaturation and the model value of the
urine activity product, are presented. RESULTS: Our results clearly demonstrate
that 1) BRI has the highest sensitivity and specificity of the tested indexes, 2)
(Ox) cannot be reliably predicted from [Ca] and 3) determining [Ca] alone
revealed a meaningful first estimate of urine CaOx crystallization risk according
to BRI. CONCLUSIONS: To avail ourselves of the high quality of BRI in patient
treatment the additional determination of (Ox) is required.

PMID: 15879882 [PubMed - indexed for MEDLINE]

682: J Urol. 2005 Jun;173(6):2017-21.

Comparison of flexible ureteroscopes: deflection, irrigant flow and optical
characteristics.

Abdelshehid C, Ahlering MT, Chou D, Park HK, Basillote J, Lee D, Kim I, Eichel L,
Protsenko D, Wong B, McDougall E, Clayman RV.

Department of Urology, University of California, Irvine, Irvine, California, USA.

PURPOSE: We measured and compared the deflection, irrigation flow rates,
distortion, resolution and light transmission of new generation flexible
ureteroscopes. MATERIALS AND METHODS: Multiple characteristics of 5 flexible
ureteroscopes (ACMI DUR-8 Elite, Olympus URF-P3, Storz 11278AU1 [Flex-X], Wolf
7330.072 and Wolf 7325.172) commonly available in the market were measured and
compared. Measured data included active deflection, irrigation flow rates and
optical characteristics. Each ureteroscope was evaluated with an empty working
channel and with various accessories. Optical characteristics, specifically
resolution and distortion, were measured using test targets (Edmund Optics,
Barrington, New Jersey). Light transmission was also measured from the
ureteroscope tip at 50% and 100% intensity. All 5 flexible ureteroscopes were
tested in a laboratory setting using a Storz OR 1 system to capture the images.
RESULTS: For all 5 ureteroscopes the angle of deflection was most impaired by a
365 microm laser fiber probe and least impaired by a 2.2Fr nitinol basket. Among 
all 5 ureteroscopes irrigation flow rate was most impaired with a 3.0Fr basket
and least impaired with 200 microm laser fiber. The Wolf 7325.172 had the highest
observed resolution of 25.39 lines per mm and the Wolf 7330.072 had the lowest
distortion at 11.9%. The Karl Storz Flex-X and the ACMI DUR-8 Elite had the
highest light output at 374 and 364 mV, respectively. CONCLUSIONS: The various
flexible ureteroscopes differ with regard to flow rates as well as degree of
deflection with either an empty or an occupied working channel. The Wolf flexible
ureteroscope with a slightly larger working channel and a fused quartz bundle
provided for superior flow and better optical performance. However, the greatest 
amount of tip deflection and highest light output were found in the ACMI and Karl
Storz flexible ureteroscopes.

Publication Types: 
    Comparative Study

PMID: 15879808 [PubMed - indexed for MEDLINE]

683: J Urol. 2005 Jun;173(6):2013-6.

Is newer always better? A comparative study of 3 lithotriptor generations.

Gerber R, Studer UE, Danuser H.

Department of Urology, University of Bern, Bern, Switzerland.
rolf.gerber@hirslanden.ch

PURPOSE: At a single center we compared the efficacy of 3 generations of
lithotriptors using identical protocol inclusion and followup criteria but with
different modes of anesthesia. MATERIALS AND METHODS: We compared stone
disintegration and dilatation of the pyelocaliceal system achieved in a
prospective, randomized trial comparing the original HM3 (Dornier Medtech,
Kennesaw, Georgia) and Lithostar Plus (LSP) lithotriptors, and a matched,
consecutive series of 107 treatments with the Modulith SLX. Stone disintegration 
and dilatation of the pyelocaliceal system were evaluated by abdominal plain
x-ray and renal ultrasonography 1 day and 3 months after treatment. RESULTS: A
total of 82 treatments with the HM3, 75 with the LSP and 107 with the SLX were
analyzed, matched for stone burden and location within the pyelocaliceal system. 
On postoperative day 1, 91%, 65% and 48% patients treated with the HM3, LSP and
SLX, respectively, were stone-free or had fragments that were 2 mm or less (HM3
vs LSP p <0.001, HM3 vs SLX p <0.001 and LSP vs SLX p = 0.015). Three to 5 mm
fragments were found in 7%, 21% and 35% of patients (p = 0.006, <0.001 and 0.06),
and fragments 6 mm or greater were found in 1%, 14% and 15% (p = 0.002, <0.001
and 0.1, respectively). The re-treatment rate was 4% in the HM3 group, 13% in the
LSP group and 38% in the SLX group (HM3 vs LSP p = 0.05, HM3 vs SLX p <0.001 and 
LSP vs SLX p <0.001). Obstructive pyelonephritis occurred in 1% of the HM3 group,
8% of the LSP group and 5% of the SLX group (HM3 vs LSP p = 0.02, HM3 vs SLX p = 
0.12 and LSP vs SLX p = 0.4). All re-treatments except those in 5 patients were
performed with the HM3. Therefore, the 3-month stone-free rate was comparable in 
all 3 groups (HM3 87%, LSP 80% and SLX 81%). CONCLUSIONS: This study indicates
that the HM3 lithotriptor disintegrates caliceal and renal pelvic stones better
than the LSP and SLX machines, resulting in fewer complications and
re-treatments. Disintegration with the LSP machine was also superior to that of
the SLX with a need for fewer re-treatments.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15879807 [PubMed - indexed for MEDLINE]

684: J Urol. 2005 Jun;173(6):2005-9.

Republished in:
    J Urol. 2008 May;179(5 Suppl):S69-73.

Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy
for lower pole caliceal calculi 1 cm or less.

Pearle MS, Lingeman JE, Leveillee R, Kuo R, Preminger GM, Nadler RB, Macaluso J, 
Monga M, Kumar U, Dushinski J, Albala DM, Wolf JS Jr, Assimos D, Fabrizio M,
Munch LC, Nakada SY, Auge B, Honey J, Ogan K, Pattaras J, McDougall EM, Averch
TD, Turk T, Pietrow P, Watkins S.

Department of Urology, University of Texas Southwestern Medical Center, Dallas,
Texas, USA. margaret.pearle@utsouthwestern.edu

PURPOSE: The optimal management of lower pole renal calculi is controversial. We 
compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of
patients with small lower pole stones in a prospective, randomized, multicenter
trial. MATERIALS AND METHODS: A total of 78 patients with 1 cm or less isolated
lower pole stones were randomized to SWL or URS. The primary outcome measure was 
stone-free rate on noncontrast computerized tomography at 3 months. Secondary
outcome parameters were length of stay, complication rates, need for secondary
procedures and patient derived quality of life measures. RESULTS: A total of 67
patients randomized to SWL (32) or URS (35) completed treatment. The 2 groups
were comparable with respect to age, sex, body mass index, side treated and stone
surface area. Operative time was significantly shorter for SWL than URS (66 vs 90
minutes). At 3 months of followup 26 and 32 patients who underwent SWL and URS
had radiographic followup that demonstrated a stone-free rate of 35% and 50%,
respectively (p not significant). Intraoperative complications occurred in 1 SWL 
case (unable to target stone) and in 7 URS cases (failed access in 5 and
perforation in 2), while postoperative complications occurred in 7 SWL and 7 URS 
cases. Patient derived quality of life measures favored SWL. CONCLUSIONS: This
study failed to demonstrate a statistically significant difference in stone-free 
rates between SWL and URS for the treatment of small lower pole renal calculi.
However, SWL was associated with greater patient acceptance and shorter
convalescence.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15879805 [PubMed - indexed for MEDLINE]

685: J Urol. 2005 Jun;173(6):2001-4.

Ethnic background has minimal impact on the etiology of nephrolithiasis.

Maloney ME, Springhart WP, Ekeruo WO, Young MD, Enemchukwu CU, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery,
Duke University Medical Center, Durham, North Carolina, USA.

PURPOSE: Nephrolithiasis disproportionately affects white patients. However,
recent studies propose an increase in the incidence of stone disease in nonwhite 
populations. We compared the metabolic risk factors of ethnically disparate stone
formers from the same geographic region. MATERIALS AND METHODS: A retrospective
review of 1,141 patients identified 98 (9%) nonwhite stone formers. Of these
individuals 60 underwent a comprehensive metabolic evaluation, comprising 44
black, 8 Asian and 8 Hispanic patients. A similar sex and age matched group of 66
white stone forming patients were also identified for comparative analysis. Stone
analyses were recorded when available. Urinary metabolic abnormalities were
defined as low urine volume-urine volume less than 2,000 cc, gouty diathesis-pH
5.5 or less (normal level 5.5 to 6.5), hypercalciuria-calcium greater than 200
mg, hyperoxaluria-oxalate greater than 45 mg, hyperuricosuria-uric acid greater
than 600 mg, hypocitraturia-citrate less than 600 mg and purine gluttony-sulfate 
greater than 20 mg. RESULTS: The incidence of metabolic abnormalities was
surprisingly similar between the white and nonwhite stone formers. Whites have a 
higher prevalence of hypercalciuria compared with nonwhites (67% vs 25%,
respectively, p <0.01). This comparison persisted when the white group was
compared with individual ethnic groups (25% in each group). Whites also displayed
a higher mean urinary calcium level (233 mg) than their nonwhite counterparts
overall (146 mg), specifically with respect to blacks (146 mg, p <0.01). Asians
had higher urine volumes with respect to whites and blacks (p <0.01) and,
therefore, a decreased prevalence of low urine volumes (37.5% vs 74.2% and 79.5%,
respectively). Hypocitraturia, hyperuricosuria, hyperoxaluria, gouty diathesis
and high sulfate levels were equally represented among all ethnic groups.
CONCLUSIONS: Although there appears to be a predominance of stone disease among
whites, all racial groups demonstrated a remarkable similarity in the incidence
of underlying metabolic abnormalities. These results suggest that dietary and
environmental factors may be as important as ethnicity in the etiology of stone
disease.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15879804 [PubMed - indexed for MEDLINE]

686: Int Braz J Urol. 2005 Mar-Apr;31(2):111-6.

Retroperitoneoscopy for treatment of renal and ureteral stones.

Soares RS, Romanelli P, Sandoval MA, Salim MM, Tavora JE, Abelha DL Jr.

Section of Urology, Hospital da Previdência dos Servidores do Estado de Minas
Gerais, Belo Horizonte, Minas Gerais, Brazil. quintelarod@yahoo.com

OBJECTIVE: To assess the efficacy of retroperitoneoscopy for treating stones in
the renal pelvis and proximal ureter. MATERIALS AND METHODS: In the period from
August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary
stones were performed on 34 patients. Fifteen patients (42%) had stones in the
renal pelvis, and in 2 cases, there were associated stones in the upper caliceal 
group. Twenty patients (58%) had ureteral stones, all of them located above the
iliac vessel. Twenty-five patients (71%) had previously undergone at least one
session of extracorporeal lithotripsy and 8 patients (26%) also underwent
ureteroscopy to attempt to remove the stone. Eight patients underwent
retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm
with a mean of 2.1 cm. RESULTS: Retroperitoneoscopy was performed by lumbar
approach with initial access conducted by open technique and creation of space by
digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3
additional working ports placed under visualization. Following identification,
the urinary tract was opened with a laparoscopic scalpel and the stone was
removed intact. The urinary tract was closed with absorbable 4-0 suture and a
Penrose drain was left in the retroperitoneum. In 17 patients (49%), a double-J
stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes
with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days). The
mean length of retroperitoneal urinary drainage was 3 days (1-10 days). There
were minor complications in 6 (17.6%) patients and 1 case of conversion due to
technical difficulty. Thirty-three patients (94%) became stone free. CONCLUSION: 
Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of
urinary stones.

Publication Types: 
    Clinical Trial

PMID: 15877829 [PubMed - indexed for MEDLINE]

687: Int Braz J Urol. 2005 Mar-Apr;31(2):105-10.

Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal
stones in morbidly obese patients.

Mezentsev VA.

Department of Urology, Moscow Regional Scientific Research Clinical Institute,
Moscow, Russia. vitalimezentsev@hotmail.com

INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually
associated with higher morbidity and mortality compared to non-obese patients. In
morbidly obese patients, since the kidney and stone are at a considerable
distance from the skin (compared to non-obese patients) difficulty may be found
in positioning the patient so that the stone is situated at the focal point of
the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of
extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal
pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients.
MATERIALS AND METHODS: Using various aids, such as mobile overtable module,
extended shock pathway and abdominal compression 37 patients with body mass index
more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation
lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm.
Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall 
stone free rate at 3 months of 73% was achieved. The mean number of treatments
per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No 
complications, such as subcapsular haematoma or acute pyelonephritis were
recorded. The most effective (87% success rate) and cost-efficient treatment was 
in the patients with pelvic stones. The treatment of the patients with low
caliceal stones was effective in 60% only. The cost of the treatment of the
patients with low calyceal stones was in 1.8 times higher than in the patients
with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens
Lithostar-plus is the most effective and cost-efficient in morbidly obese
patients with pelvic stones sized between 6 and 20 mm. 87% success rate was
achieved. The increased distance from the skin surface to the stone in those
patients does not decrease the success rate provided the stone is positioned in
the focal point or within 3 cm of it on the extended shock pathway. ESWL should
not be considered as the first line of treatment in the morbidly obese patients
with low caliceal stones where the stone was positioned more than 1 cm from the
focal point on the extended shock pathway.

PMID: 15877828 [PubMed - indexed for MEDLINE]

688: J Endourol. 2005 Apr;19(3):353-9.

Role of laparoscopy in management of renal stones: single-center experience and
review of literature.

Nambirajan T, Jeschke S, Albqami N, Abukora F, Leeb K, Janetschek G.

Department of Urology, Elisabethinen Hospital, Linz, Austria.

BACKGROUND AND PURPOSE: Laparoscopy can be an alternative modality in the
management of renal stones. We present our experience with laparoscopic renal
stone surgery. PATIENTS AND METHODS: Eighteen patients (4 males, 14 females) with
mean age of 51 years (range 18-86 years) underwent 19 laparoscopic procedures.
The mean stone number and size, excluding five patients who had
nephrectomy/heminephrectomy, were 1.9 (range 1-5) and 1.3 cm (range 0.5-4.5 cm), 
respectively. Three patients with ureteropelvic junction obstruction underwent
pyeloplasty and concomitant pyelolithotomy. Three patients with upper-pole
caliceal-diverticular stones had nephrolithotomy and fulguration of the
diverticular mucosa. Three patients with stones and hydrocalix with scarred
cortex had partial nephrectomy, two under cold and one under warm ischemia. Five 
patients, including one with a horseshoe kidney (who had one procedure on each
kidney), had pyelolithotomy as an alternative to percutaneous nephrolithotomy.
Patients with stones in a nonfunctioning kidney underwent nephrectomy (three
patients) or heminephrectomy (one patient). RESULTS: All procedures were
completed laparoscopically. The operative time was variable depending on the
complexity of the procedures, from 115 minutes for Fengerplasty to 315 minutes
for partial nephrectomy under cold ischemia (mean 178 minutes). The estimated
blood loss was 53.2 mL (range 20-120 ml), and none of the patients received a
blood transfusion. Complete stone clearance was achieved in 93% of the
procedures. The mean hospital stay was 10.5 days (range 5-35 days). Three
patients needed temporary pigtail-catheter drainage for obstruction after
pyelolithotomy. One patient with a solitary kidney and infected staghorn calculus
had prolonged urinary leak, which stopped with conservative management. One
nephrectomy for nephrocutaneous fistula was complicated by a late colonic
perforation necessitating colostomy. CONCLUSION: Laparoscopic surgery is
effective for complex renal stones and allows for adjunctive procedures. It can
also be an alternative to percutaneous nephrolithotomy. It complements other
minimally invasive procedures, and a need for open stone surgery should be rare
in the future.

Publication Types: 
    Comparative Study
    Review

PMID: 15865527 [PubMed - indexed for MEDLINE]

689: J Endourol. 2005 Apr;19(3):348-52.

Using and choosing a nephrostomy tube after percutaneous nephrolithotomy for
large or complex stone disease: a treatment strategy.

Kim SC, Tinmouth WW, Kuo RL, Paterson RF, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, 1801 N. Senate Boulevard #220, Indianapolis, IN 46202, USA.
samckim@iupui.edu

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is a well-accepted
technique for removal of large or complex renal calculi. However, little
attention has been paid to strategies for nephrostomy tube (NT) selection. We
reviewed the reasons for selecting three types of NT after PCNL for large or
complex stone disease. PATIENTS AND METHODS: A series of 106 consecutive renal
units undergoing PCNL for stone burdens >2 cm by a single surgeon (JEL) were
reviewed. Noncontrast CT (NCCT) was carried out on postoperative day 1, and
secondary procedures were performed if fragments remained. The NTs studied were
8.5F and 10F Cope loops (CP), 20F reentry Malecot catheters (REM), and 20F circle
loops (CL). Patient demographics, access site and number, complications, and
stone type were examined. "Stone free" was defined as a negative NCCT or negative
second-look PCNL. RESULTS: A total of 134 accesses were created in 106 renal
units: 35 upper, 7 mid, and 92 lower; however, only 111 NTs were placed: 85 CP
(76.6%), 19 REM (17.1%), and 7 CL (6.3%). Sixteen accesses were performed
tubeless; all but two were in the upper pole. All 16 of these renal units had a
concomitant NT placed in the lower pole. Multiple sites were accessed in 21
patients; 7 of these patients had CL placed. Five of ten patients with
spinal-cord injury had REM/CL placed. Nineteen REM were placed: 10 for drainage
of infection, and 9 for difficult anatomy. All renal units were rendered stone
free: 31.1% with a single procedure and 95.6% with one or two procedures. There
were no difficulties with drainage or access for secondary PCNL regardless of the
NT employed. Complications included two hydrothoraces, one arteriovenous fistula,
and one ureteral perforation. Three of four renal units in patients requiring
transfusions underwent bilateral PCNL, and at least one renal unit required
multiple accesses. Of kidneys with infection stones, 57.1% required REM or CL;
only 12.0% of nonstruvite stones necessitated REM or CL. CONCLUSIONS: All
patients having PCNL done for complex stone disease should have an NT placed;
however, small (8.5F-10F) CP suffice in most cases and can provide greater
patient comfort. To minimize pleural morbidity, tubeless upper-pole access should
be considered if the kidney is judged to be stone free at the conclusion of PCNL.
Circle loops are useful when multiple accesses are necessary, whereas REM are
appropriate if access is difficult, gross residual stone remains, or pain is not 
an issue (i.e., spinal-cord injury).

Publication Types: 
    Comparative Study

PMID: 15865526 [PubMed - indexed for MEDLINE]

690: J Endourol. 2005 Apr;19(3):283-6.

Gender Differences among Hispanics and Caucasians in symptomatic presentation of 
kidney and ureteral stones.

Dall'era JE, Kim F, Chandhoke PS.

Department of Surgery (Urology), University of Colorado Health Sciences Center,
4200 E. 9th Avenue, Box C-319, Denver, CO 80262, USA.

PURPOSE: We determined gender differences in the symptomatic presentation of
kidney and ureteral stones among the Hispanic population and compared it with
presentation in the Caucasian population. PATIENTS AND METHODS: A retrospective
chart review was performed on 443 patients seen in our Emergency Department or
Urgent Care Center for symptomatic kidney or ureteral stones over a 5-year
period. Demographic information was obtained, including sex, race, age, location 
of stone, stone size, and type of urologic intervention. Of the 443 patients, 263
(59%) were Hispanic, and 180 (41%) were Caucasian. RESULTS: The male-to-female
ratio of the symptomatic patients with kidney stones was 1.48 for both Hispanic
and Caucasian patients. The male-to-female ratio for ureteral stones was 1.06 and
2.48 for the Hispanic and Caucasian patients, respectively (P < 0.05). The rate
of urologic intervention was similar among Caucasian males and females and
Hispanic females (approximately 33%) but significantly lower among Hispanic males
(18%). CONCLUSIONS: The relative symptomatic presentation of ureteral stones of
men and women among the Hispanic population is nearly 1:1, whereas the ratio in
Caucasian men and women approaches the previously reported 2.5:1. No significant 
racial or sex differences were noted in the symptomatic presentation of kidney
stones. In comparison with Hispanic men, Hispanic women undergo significantly
more urologic interventions for symptomatic urolithiasis.

Publication Types: 
    Comparative Study

PMID: 15865513 [PubMed - indexed for MEDLINE]

691: J Endourol. 2005 Apr;19(3):279-82.

Defining the learning curve for percutaneous nephrolithotomy.

Allen D, O'Brien T, Tiptaft R, Glass J.

Department of Urology, Guy's Hospital, Guy's and St. Thomas' NHS Trust, Guy House
1st Floor, St. Thomas Street, London SE1 9RT, England, UK. darrell34a@hotmail.com

PURPOSE: To define the learning curve for percutaneous nephrolithotomy (PCNL)
using three potential surrogate markers of surgical expertise. MATERIALS AND
METHODS: The learning curve of an endourologist with no previous experience at
performing solo PCNL was studied. Three putative parameters of expertise were
reviewed, namely, operating time, fluoroscopic screening time, and radiation
dose. Operations were analyzed in cohorts of 15 to determine when a plateau was
reached for all three variables. Comparison was then made with the results of a
surgeon who had performed more than 1600 PCNLs. Stone type and stone clearance
rate were also noted. RESULTS: The mean operating time of the novice surgeon fell
to a plateau of 92 minutes after 60 cases, but screening time and radiation dose 
did not plateau until case 115, when values of 231 seconds and 406 cGy/cm2 were
recorded, respectively. The senior surgeon had a mean operating time of 98
minutes and screening parameters equivalent to those of the novice surgeon after 
115 cases. The complexity of the stones tackled grew with increasing experience, 
although stone-free rates remained constant. CONCLUSIONS: This study of the
learning curve of a single surgeon suggests that competence at performing PCNL is
reached after 60 cases and excellence after 115. Radiation parameters are a
valuable tool in the assessment of operative competence.

Publication Types: 
    Comparative Study

PMID: 15865512 [PubMed - indexed for MEDLINE]

692: Urol Res. 2005 Jun;33(3):206-12. Epub 2005 Apr 28.

Regulation by macromolecules of calcium oxalate crystal aggregation in stone
formers.

Wesson JA, Ganne V, Beshensky AM, Kleinman JG.

Department of Medicine/Nephrology, Veterans Affairs Medical Center and Medical
College of Wisconsin, 5000 W National Avenue (111 K), Milwaukee, WI 53295, USA.

Based on the structure of kidney stones, it is likely that they form as
aggregations of preformed crystals, mostly calcium oxalate monohydrate (COM). In 
this study, we examined the ability of a macromolecular mixture isolated from the
urine of normal individuals and stone formers to inhibit aggregation of preformed
COM seed crystals in a simple ionic solution using measurements of changes in the
particle size distribution (PSD) of preformed COM crystal aggregates. We also
examined the effect in this assay of a number of synthetic homopolymers,
naturally occurring urine macromolecules, and binary mixtures thereof. The
macromolecular mixtures from urine of normals and most stone formers reduced the 
degree of aggregation of the seed crystals, whereas 22% of stone former urine
macromolecules either did not disaggregate or actually promoted further
aggregation. Stone formers within one family shared this property, but a
non-stone forming sibling did not. Polyanions, either synthetic or naturally
occurring, induced disaggregation to an extent similar to that exhibited by
normal urine macromolecules, while polycations had no effect on the PSD. However,
mixing a polyanion, either poly-aspartate or osteopontin, with the polycation
poly-arginine, changed their behavior from disaggregation to aggregation
promotion. The disaggregating behavior of normal urinary macromolecules provides 
a defense against aggregation, but a minority of stone forming individuals lacks 
this defense, which may contribute to stone formation.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15864572 [PubMed - indexed for MEDLINE]

693: Biochim Biophys Acta. 2005 May 25;1723(1-3):175-83. Epub 2005 Mar 24.

The association of different urinary proteins with calcium oxalate hydromorphs.
Evidence for non-specific interactions.

Walton RC, Kavanagh JP, Heywood BR, Rao PN.

Faculty of Life Sciences, 3.614 Stopford Building, University of Manchester,
Manchester, M13 9PT, UK. rachel.c.walton@manchester.ac.uk

It has been proposed that various urinary proteins interact specifically with
different calcium oxalate hydromorphs and these interactions have important
implications regarding the understanding of the onset and progress of kidney
stone disease. Calcium oxalate monohydrate and dihydrate crystals were grown and 
characterised thoroughly to establish sample purity. These crystals were then
incubated in artificial urine samples containing isolated urinary macromolecules.
Crystal growth was prevented by saturating the incubation mix with calcium
oxalate, and this was confirmed through electron microscopy and calcium
measurements of the incubation mix. The surface interactions between the
different calcium oxalate hydrates and urinary proteins were investigated by the 
use of Western blots and immunoassays. The same proteins, notably albumin,
Tamm-Horsfall protein, osteopontin and prothrombin fragment 1, associated with
both hydrates. There was a trend for more protein to associate with calcium
oxalate dihydrate, and greater quantities of different proteins associated with
both hydrates when Tamm-Horsfall protein was removed from the incubation mix.
There is no evidence from this study to indicate that particular proteins
interact with specific calcium oxalate hydrates, which in turn suggests that
these protein-mineral interactions are likely to be mediated through non-specific
charge interactions.

PMID: 15863356 [PubMed - indexed for MEDLINE]

694: Ann Nutr Metab. 2005 Mar-Apr;49(2):132-8. Epub 2005 Apr 28.

Effect of hyperprotidic diet associated or not with hypercalcic diet on calcium
oxalate stone formation in rat.

Sakly R, Bardaoui M, Neffati F, Moussa A, Zakhama A, Najjar MF, Hammami M.

UR/0839, Faculté de Médecine, Monastir, Tunisia. rachid_sakly@yahoo.fr

The aim of this study was to determine whether protein, administered alone or
simultaneously with a hypercalcic diet, was able to aggravate calcium oxalate
stone formation in rats. Thirty-two male Wistar rats were randomly divided into
four groups of 8 rats each and assigned a calcium oxalate lithogenic diet added
to their drinking water for 3 weeks. One group, used as reference, received a
standard diet prepared in our laboratory. The second was assigned the same diet
but supplemented with 7.5 g animal proteins/100 g diet. The third received a diet
containing 500 mg calcium more than the standard group. The diet given to the
last group was supplemented with calcium and protein at the same doses indicated 
previously. One day before the end of treatment, each animal was placed in a
metabolic cage to collect 24-hour urine samples and determine urinary creatinine,
urea, calcium, magnesium, phosphate, uric acid, citric acid and oxalate levels.
Immediately thereafter, aortic blood was collected to determine the same
parameters as in urine. The kidneys were also removed to determine calcium
oxalate deposits. Our results showed an increased 24-hour urinary excretion of
calcium, oxalate and uric acid and decreased urinary citric acid excretion only
in groups that received protein supplementation. At the same time, calcium
oxalate deposits were found significantly higher in hyperprotidic diets than
reference or calcium-supplemented groups. According to these findings, glomerular
filtration, fractional excretion of urea and reabsorption of water, calcium and
magnesium were found significantly lower in hyperprotidic diets compared to other
groups. These results demonstrate that proteins could seriously aggravate calcium
oxalate stones and cause renal disturbances. Copyright (c) 2005 S. Karger AG,
Basel.

Publication Types: 
    Comparative Study

PMID: 15860912 [PubMed - indexed for MEDLINE]

695: Pediatr Nephrol. 2005 Jun;20(6):773-6. Epub 2005 Apr 26.

Association of vitamin-D and calcitonin receptor gene polymorphism in paediatric 
nephrolithiasis.

Bid HK, Chaudhary H, Mittal RD.

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow, Uttar Pradesh, India.

We investigated the role of vitamin-D receptor gene (VDR) and calcitonin receptor
(CTR) gene polymorphism in childhood nephrolithiasis in the north Indian
population. A control group of 60 healthy paediatric individuals (age range 4-16 
years) and 50 paediatric patients (age range 2-14 years) with kidney stones were 
examined. Polymorphism in both genes (VDR and CTR) was detected by using
PCR-based restriction analysis. There was a statistically significant difference 
between the two groups for the genotypes of the VDR gene Fok-I polymorphism (P
=0.007) and the CTR gene (P =0.048) polymorphism. The odds ratio (95% Confidence 
Interval) for the C allele in those at risk of stone disease was 1.83 (0.82-4.09)
in VDR gene polymorphism and 1.99 (0.90-4.39) in the case of CTR gene
polymorphism. Our results suggest that the effects of VDR (Fok-I) and CTR gene
polymorphism contribute to the understanding of the pathogenesis of urinary
calculi. It is also suggestive of a potential candidate gene in the search for
genetic causes of paediatric calcium oxalate nephrolithiasis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15856322 [PubMed - indexed for MEDLINE]

696: Ultrasound Obstet Gynecol. 2005 May;25(5):517-8.

Antenatal diagnosis of fetal renal calculus.

Rhodes C, Churchill D, Hulton SA.

Department of Obstetrics and Gynaecology, Birmingham Heartlands Hospital,
Birmingham, UK. cathyrhodes@doctors.org.uk

Pediatric urolithiasis is commonly associated with structural renal tract
anomalies and metabolic disorders. Antenatal diagnosis of renal calculi is
extremely rare, with only one report in the literature. We present a case of
renal stone formation diagnosed at 34 weeks' gestation on ultrasound examination.

Publication Types: 
    Case Reports

PMID: 15846765 [PubMed - indexed for MEDLINE]

697: Kidney Int. 2005 May;67(5):1934-43.

Serial crystalluria determination and the risk of recurrence in calcium stone
formers.

Daudon M, Hennequin C, Boujelben G, Lacour B, Jungers P.

Department of Biochemistry A, Necker Hosptial, Paris, France.
michel.daudon@nck.ap-hop-paris.fr

BACKGROUND: Urinary crystal precipitation is the necessary initial step in kidney
stone formation. However, clinical relevance of crystalluria in the evaluation of
stone formers is disputed. METHODS: We serially determined crystalluria in
first-voided morning urine samples, together with full 24-hour urine
biochemistry, in 181 patients with idiopathic calcium nephrolithiasis who had
formed at least one calcium-oxalate stone and were followed for at least 3 years 
under our care. All stone events which occurred prior to referral, then after
entry in the study were recorded. RESULTS: As compared with 109 patients who had 
no evidence of stone recurrence during follow-up, the 72 patients who experienced
>/= one recurrent stone event had a lower daily urine volume (1.74 +/- 0.06 vs.
2.26 +/- 0.05 L/day (mean +/- SEM) (P < 0.0001), higher urine calcium and oxalate
concentrations, and daily calcium excretion, and they had more frequent
crystalluria (68% vs. 23% of urine samples) (P < 0.0001). By multivariate Cox
regression analysis, the hazard ratio for stone recurrence was 0.32 (95% CI
0.16-0.62) for 1 L increase in daily urine volume, 1.12 (1.09-1.24) for 1 mmol/L 
increase in urine calcium concentration, 1.24 (1.02-1.50) for 0.1 mmol/L increase
in urine oxalate concentration and 27.8 (10.2-75.6) for crystalluria index.
CONCLUSION: These data provide evidence that crystalluria, when repeatedly found 
in early morning urine samples, is highly predictive of the risk of stone
recurrence in calcium stone formers. Serial search for crystalluria, a simple and
cheap method, may be proposed as a useful tool for the monitoring of calcium
stone formers, in addition to urine biochemistry.

PMID: 15840041 [PubMed - indexed for MEDLINE]

698: Urology. 2005 Apr;65(4):778-81.

Use of mobile extracorporeal shock wave lithotripter: experience in a pediatric
institution.

Defoor W, Dharamsi N, Smith P, Sekhon D, Colombo J, Riden D, Reddy P, Sheldon C, 
Minevich E.

Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center,
Cincinnati, Ohio 45229-3039, USA. bob.defoor@cchmc.org

OBJECTIVES: To present our results of the past 3 years using a mobile
lithotripter in a pediatric institution. The low incidence of pediatric urinary
calculi, along with the high cost of lithotripsy units, has limited the use of
extracorporeal shock wave lithotripsy in pediatric institutions. METHODS: A
retrospective cohort study was performed of all children who had undergone
extracorporeal shock wave lithotripsy at two institutions from 1999 to 2003. All 
patients were treated with a Dornier Compact Delta mobile lithotriptor with a
universal urologic table. RESULTS: A total of 88 patients (38 males and 50
females) underwent a total of 119 outpatient treatments. The mean patient age was
12 years, and the mean follow-up was 20 months. The mean stone size was 6 mm. An 
average of 1600 shocks per procedure was performed. Overall, 68% were stone free 
after one treatment, and 74% were stone free after one or two treatments. Of the 
patients with a solitary stone, 72% were stone free after one treatment and 78%
were after one or two treatments. Fifteen patients had multiple stones treated
simultaneously on the same side. Of these, 47% were stone free after one
treatment and 53% after one or two treatments. Two patients subsequently required
ureteroscopy and laser lithotripsy for obstructing ureteral calculi. CONCLUSIONS:
The results of our study have shown that the new-generation mobile lithotripter
is safe and effective in treating pediatric nephrolithiasis. The success rate was
greater for solitary stones than for multiple stones treated at the same setting.
Additional endoscopic procedures can be performed simultaneously on the same
table.

Publication Types: 
    Multicenter Study

PMID: 15833527 [PubMed - indexed for MEDLINE]

699: Urology. 2005 Apr;65(4):659-62; discussion 662-3.

Comparative study of percutaneous access for staghorn calculi.

Netto NR Jr, Ikonomidis J, Ikari O, Claro JA.

Division of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
nrnetto@uol.com.br

OBJECTIVES: To compare the success and complication rates of staghorn calculi
treated through the upper pole calix, lower/middle calices, and multiple access. 
METHODS: Between January 1995 and December 2000, the records of 119 patients with
staghorn calculi who underwent percutaneous nephrolithotomy were retrospectively 
reviewed. The mean stone burden was 6.9 cm. Of the 119 patients, 16 (13.4%) had
upper pole access, 70 (58.8%) lower or middle calix access, and 33 (27.7%)
multiple renal access. RESULTS: The stone-free rate was 80.0% for those in the
lower/middle, 87.5% for those in the upper pole, and 84.8% for those in the
multiple access group. Single access was performed in 72.3% and multiple access
tracts in 27.7% of patients. The average operative time was 86.8 minutes in the
upper pole, 139.1 minutes in the lower/middle pole, and 134.9 minutes in the
multiple access groups. Extracorporeal shock wave lithotripsy was used in 4.2% of
patients. The overall complication rate was 28.5% (25% in the upper pole, 21.4%
in the lower/middle, and 45.4% in the multiple access group). Thoracic
complications (pneumothorax and hydrothorax) occurred in 2 patients (1.7%), but
only 1 patient had undergone supracostal access. Bleeding requiring blood
transfusion was significantly greater in the multiple access group. The average
hospital stay was 3.0 days for all patients. CONCLUSIONS: The success of
percutaneous treatment of patients with staghorn calculi is highly related to
optimal kidney access. The supracostal and multiple access approaches can be
used, with a slight increase in the incidence of acceptable complications.

PMID: 15833502 [PubMed - indexed for MEDLINE]

700: Int J Urol. 2005 Mar;12(3):290-8.

Study of a rat model for calcium oxalate crystal formation without severe renal
damage in selected conditions.

Yamaguchi S, Wiessner JH, Hasegawa AT, Hung LY, Mandel GS, Mandel NS.

Department of Medicine, Medical College of Wisconsin and the Department of
Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.
syama@asahikawa-med.ac.jp

BACKGROUND: Although nephrotoxic in high doses, ethylene glycol (EG) has been
used with ammonium chloride (NH(4)Cl) or vitamin D(3) to study calcium oxalate
stone formation in rat models. In the present study we used EG alone or with
NH(4)Cl to study hyperoxaluria, crystaluria, and crystal attachment to renal
epithelial cells in rats with minimal renal damage. METHODS: Six-week-old male
Sprague-Dawley (SD) rats were given food and special drinking water. In
experiment 1 the drinking water contained 1.0% NH(4)Cl plus four different
concentrations of EG (0.8%, 0.4%, 0.2%, 0.1%). In experiment 2 the drinking water
contained EG alone (0.8%, 0.4%, 0.2%, 0.1%). Urine was collected for 24 h before 
the rats were sacrificed. In experiment 1 the rats were sacrificed 5-13 days
after starting the special water. In experiment 2 the rats were sacrificed 7-21
days after starting the special water. Bladder urine was also obtained. Blood and
urine were tested for calcium, phosphorus, and creatinine. In addition, urine was
tested for pH, oxalate and N-acetyl-beta-D glucosaminidase (NAG). Kidney sections
were stained with hematoxylin-eosin, von Kossa and Pizzolato stain. Crystal
morphology was determined using polarizing microscopy, and composition was
determined using high-resolution X-ray powder diffraction. RESULTS: Experiment 1:
Aggravation of renal function, an increase in urinary oxalate and NAG excretion, 
and crystals observed in the kidneys all correlated with EG concentration and
length of drinking time. In bladder urine, calcium oxalate monohydrate (COM)
crystals exceeded calcium oxalate dihydrate (COD) crystals. Experiment 2: Renal
function remained unchanged. Oxalate excretion increased and NAG increased
slightly. Crystals occurred only in the papillary tip region. Crystals in bladder
urine were mostly COD. CONCLUSION: In the current rat model, calcium oxalate
crystaluria could be induced without severe renal damage in selected cases.
Either and/or both COM and COD might form and interact with kidney epithelium. We
propose different experimental conditions to study the various phases of calcium 
oxalate stone formation in young male SD rats.

Publication Types: 
    Evaluation Studies
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15828958 [PubMed - indexed for MEDLINE]

701: Curr Biol. 2005 Apr 12;15(7):667-71.

Defective skeletogenesis with kidney stone formation in dwarf zebrafish mutant
for trpm7.

Elizondo MR, Arduini BL, Paulsen J, MacDonald EL, Sabel JL, Henion PD, Cornell
RA, Parichy DM.

Section of Integrative Biology, Institute for Cellular and Molecular Biology,
University of Texas at Austin, 1 University Station C0930, Austin, Texas 78712,
USA.

Development of the adult form requires coordinated growth and patterning of
multiple traits in response to local gene activity as well as to global endocrine
and physiological effectors. An excellent example of such coordination is the
skeleton. Skeletal development depends on the differentiation and morphogenesis
of multiple cell types to generate elements with distinct forms and functions
throughout the body. We show that zebrafish touchtone/nutria mutants exhibit
severe growth retardation and gross alterations in skeletal development in
addition to embryonic melanophore and touch-response defects. These alterations
include accelerated endochondral ossification but delayed intramembranous
ossification, as well as skeletal deformities. We show that the touchtone/nutria 
phenotype results from mutations in trpm7, which encodes a transient receptor
potential (TRP) family member that functions as both a cation channel and kinase.
We find trpm7 expression in the mesonephric kidney and show that mutants develop 
kidney stones, indicating renal dysfunction. These results identify a requirement
for trpm7 in growth and skeletogenesis and highlight the potential of forward
genetic approaches to uncover physiological mechanisms contributing to the
development of adult form.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15823540 [PubMed - indexed for MEDLINE]

702: J Med Assoc Thai. 2004 Dec;87(12):1506-12.

Changes in erythrocyte contents of potassium, sodium and magnesium and Na, K-pump
activity after the administration of potassium and magnesium salts.

Sriboonlue P, Jaipakdee S, Jirakulsomchok D, Mairiang E, Tosukhowong P,
Prasongwatana V, Savok S.

Department Biochemistry, Faculty Medicine, Khon Kaen University, Khon Kaen 40002,
Thailand.

Low potassium and magnesium status and decreased Na, K-pump activity is an
endemic condition among rural Northeast Thais. The authors examined the effect of
supplementing potassium and magnesium on erythrocyte potassium, sodium and
magnesium content and on Na, K-pump activity. Rural Northeast Thai renal stone
patients (62) were recruited, divided into four groups and supplemented for one
month with potassium chloride (Group1, n = 16), potassium-sodium citrate (Group2,
n = 15), chelated magnesium (Group 3, n =16) and potassium-magnesium citrate
(Group 4, n =15) in order to achieve 40 mmol potassium, 10 mmol magnesium and 60 
mmol citrate daily. After supplementation with potassium (Groups 1, 2 and 4),
plasma potassium and Na, K-pump activity rose significantly in Groups 1, 2 and 4,
but erythrocyte potassium rose only in Groups 2 and 4. When supplementing
elemental magnesium (Groups 3 and 4), the chelated magnesium caused a significant
increase in plasma potassium, erythrocyte potassium, sodium and magnesium without
a significant increase in Na, K-pump activity. By contrast, potassium-magnesium
citrate caused a significant increase in erythrocyte potassium and magnesium and 
Na, K-pump activity, but depressed erythrocyte sodium. These results suggest the 
forms of potassium and /or magnesium salts being supplemented should be
considered because they affect erythrocyte potassium, sodium and magnesium
content and Na, K-pump activity differently.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15822549 [PubMed - indexed for MEDLINE]

703: Urol Res. 2005 May;33(2):105-15.

Nephrolithiasis and nephrocalcinosis in rats with small bowel resection.

O'Connor RC, Worcester EM, Evan AP, Meehan S, Kuznetsov D, Laven B, Sommer AJ,
Bledsoe SB, Parks JH, Coe FL, Grynpas M, Gerber GS.

Department of Urology, University of Chicago, Chicago, IL, USA.

Intestinal resection (IR) may lead to hyperoxaluria and nephrolithiasis. A rat
model of IR was developed, in which kidney stones form. We describe the urine
chemistries and histopathologic features. Rats underwent resection of 40-45 cm of
distal ileum (n=16) or sham resection (SR) (n=8), and were then fed a 1% Na
oxalate, 0.02% Ca diet. After 1 week on the diet, 24 h urine samples were
obtained for stone chemistries. At 4-7 months after surgery, kidneys were
examined grossly and by light microscopy. The extent and location of
crystallization was assessed by polarized light. Histochemistry and infrared
spectroscopy were used to determine crystal composition. IR rats had higher urine
oxalate excretion (P<0.01) and concentration (P<0.001) than SR rats, and lower
urine citrate excretion; only IR rats formed kidney stones (12/15 surviving
rats). Tissue calcification was found only in kidneys from IR rats, located in
the cortex (83% of kidneys), medulla (73%) and papillary tip (47%). Crystals,
composed of CaOx, apatite, and calcium carbonate, filled collecting duct lumens, 
and were associated with tubular obstruction, and interstitial inflammation.
Crystals in the papillary interstitium incited inflammation with tubular
destruction and development of progressive papillary erosion. This new rat model 
of nephrolithiasis and nephrocalcinosis resembles the pattern of urinary
abnormalities and tissue calcification that may be seen in humans with small
bowel resection. The model allows further studies of the mechanisms of renal
crystal formation, and possible therapeutic interventions.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15815943 [PubMed - indexed for MEDLINE]

704: Eur Radiol. 2005 Nov;15(11):2238-43. Epub 2005 Apr 2.

Comment in:
    Eur Radiol. 2006 Mar;16(3):759; author reply 760-1.

Predictions of outcomes of renal stones after extracorporeal shock wave
lithotripsy from stone characteristics determined by unenhanced helical computed 
tomography: a multivariate analysis.

Wang LJ, Wong YC, Chuang CK, Chu SH, Chen CS, See LC, Chiang YJ.

Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung
University, Taipei, Taiwan, Republic of China. ljw33db@adm.cgmh.org.tw

The aim of our study is to analyze the relationships between the characteristics 
of renal stones determined by unenhanced helical computed tomography (UHCT) and
their outcomes after extracorporeal shock wave lithotripsy (ESWL) as well as to
predict ESWL outcomes of renal stones by their UHCT characteristics with the use 
of multivariate analysis. During a 7-month period, 80 adult patients with renal
stones underwent ESWL as well as UHCT both before and 3 months after ESWL. Of the
80 patients, 42 patients were classified as ESWL successes and 38 as ESWL
failures based on their post-ESWL UHCT findings. For pre-ESWL UHCT, a stone
number of more than 2 (P=0.0236), a maximal stone size of greater than 12 mm
(P<0.0001), a stone burden of more than 700 mm3 (P<0.0001), a maximal stone
density of more than 900 HU (P=0.0008) and nonround/oval stones (P=0.0007) were
associated with ESWL failure outcomes. Multivariate analysis demonstrated that a 
stone burden of more than 700 mm3 (P=0.0003), the presence of nonround/oval
stones (P=0.0072) and a maximal stone density of more than 900 HU (P=0.0430) were
statistically significant predictors of a failure outcome for ESWL. Thus, the
analysis of stone characteristics of renal stones by UHCT is helpful in selecting
appropriate patients undergoing ESWL for favorable outcomes and reduces the
overall costs of the treatment of renal stones.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15806362 [PubMed - indexed for MEDLINE]

705: J Endourol. 2004 Dec;18(10):971-5.

Simultaneous holmium laser enucleation of prostate and upper-tract endourologic
stone procedures.

Kim SC, Tinmouth WW, Kuo RL, Paterson RF, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease and Indiana University
School of Medicine, Indianapolis, Indiana, USA. samckim@iupui.edu

BACKGROUND AND PURPOSE: The holmium laser is a versatile urologic tool. Its
unique cutting and coagulating properties allow multiple procedures, such as
stone fragmentation and laser enucleation of the prostate (HoLEP), to be
performed with a single set-up. This paper reviews our experience with
simultaneous HoLEP and endourologic upper-tract stone procedures. PATIENTS AND
METHODS: We retrospectively reviewed all 11 patients (12 renal units) treated
with the combined approach of HoLEP and an upper-tract endourologic procedure for
stone disease. All patients initially underwent HoLEP, followed immediately by
percutaneous nephrolithotomy (PCNL)(N=2), ureteroscopy (URS)(N=8), or both (N=1).
The mean stone diameter was 34.7 mm for PCNL and 6.7 mm for URS. Outcome data and
complications were recorded. RESULTS: The mean preoperative and postoperative
American Urological Association Symptom Scores were 21.8 and 6.3, respectively.
The mean prostatic specimen weight was 118 g (range 21-376 g), and the mean
hospital stay was 1.4 days. For 10 patients with available prostatic specific
antigen (PSA) data, the mean preoperative and postoperative values were 6.2 and
0.9 ng/mL, respectively. All patients were catheter free at discharge. All three 
PCNL patients were rendered stone free; all four URS patients who had
radiographic follow-up were stone free. There were no short- or long-term
complications, and no transfusions were necessary. CONCLUSIONS: Simultaneous
HoLEP and laser lithotripsy are feasible, emphasizing the unique capabilities of 
the holmium laser. The hemostasis offered by HoLEP allows safe removal of
prostatic tissue and urinary calculi, obviating multiple procedures.

PMID: 15801364 [PubMed - indexed for MEDLINE]

706: J Endourol. 2005 Mar;19(2):177-82.

Genetic and dietary factors in urinary citrate excretion.

Shah O, Assimos DG, Holmes RP.

Department of Urology, Wake Forest University Health Sciences Center,
Winston-Salem, North Carolina 27157, USA. oshah@wfubmc.edu

BACKGROUND AND PURPOSE: Hypocitraturia, an important risk factor for calcium
oxalate nephrolithiasis, is the result of numerous factors. We studied citrate
excretion by patients with and without stones consuming normal and controlled
formula diets. SUBJECTS AND METHODS: Subjects with and without a history of
calcium oxalate stones (N = 101 per group) provided two or three 24-hour urine
specimens during consumption of self-selected diets. Data also were collected on 
subsets of subjects consuming formula (Ensure) diets. Citrate was determined
using the citrate lyase method of Petrarulo and associates, and values for
multiple specimens were averaged. The data were adjusted for creatinine excretion
and examined on a per-day basis. RESULTS: The mean citrate excretion of the
non-stone formers was slightly but not significantly higher than that of the
stone formers (442 +/- 217 versus 378 +/- 153 mg/g of creatinine). All
statistical analyses revealed highly significant differences between, but not
within, individuals, a result compatible with a genetic influence. In the normal 
population, 5% of subjects had a citrate excretion <200 mg/g of creatinine,
whereas this result was seen in 34% of the stone-forming subjects. When the
subjects consumed a formula diet, women in both groups had much higher citrate
excretion than when on a self-selected diet, but little difference was seen in
the men. The patterns of citrate recovery suggest low, intermediate, and high
excretors. In the normal population, 15% of subjects excreted <340 mg/g of
creatinine, whereas this was true of 43% of the stone-forming subjects. Analysis 
of six families suggested three excretor phenotypes, with a codominant pattern of
inheritance. CONCLUSION: These findings imply a genetic influence on citrate
excretion, as has already been demonstrated for calcium excretion. Further
studies of genetic influences on calcium oxalate stone formation are warranted.

PMID: 15798414 [PubMed - indexed for MEDLINE]

707: J Endourol. 2005 Mar;19(2):167-9.

Effect of urine specific gravity on effectiveness of shockwave lithotripsy.

Li CC, Finley DS, Uribe C, Eichel L, Lee DI, McDougall EM, Clayman RV.

Department of Urology, University of California, Irvine, CA, USA.

PURPOSE: To determine the effect of urine specific gravity (SG) and radiographic 
contrast medium on the efficiency of extracorporeal shockwave lithotripsy (SWL)
fragmentation using a previously published in vitro model. MATERIALS AND METHODS:
Artificial kidney stones (BegoStone [BEGO USA, Smithfield, RI]) of a standard
size (10 x 10 mm) and weight (mean 1.90 g; range 1.89-1.91 g) were randomly
allotted to one of four test media with differing SG: group 1: synthetic urine,
SG 1.003; group 2: synthetic urine, SG 1.040; group 3: 50% radiographic contrast 
(Cysto-Conray II, Mallinckrodt Inc., Hazelwood, MO), 50% synthetic urine, SG
1.069; and group 4: 100% contrast, SG 1.121. The stones were placed in cups made 
of 2.2-mm screen mesh and exposed to 500 shockwaves at 20 KV from a spark-gap
lithotripter (Econolith 2000; Medispec, Germantown, MD). The stone fragmentation 
rate (i.e., percent fragmentation) was determined by dividing the dry residual
stone weight by the prelithotripsy dry weight (X 100). RESULTS: The mean
fragmentation rate for the four groups was 31.7%, 37.6%, 31.8%, and 27.2%,
respectively. Statistical significance was not achieved (P = 0.1). CONCLUSION:
Stone breakage tends to be more effective when urine SG is about 1.040 than at
higher or lower values. Hence, the recommendation for an overnight fast prior to 
SWL is well founded. Introduction of contrast medium may inhibit stone breakage
because it increases the specific gravity.

PMID: 15798412 [PubMed - indexed for MEDLINE]

708: J Endourol. 2005 Mar;19(2):136-9.

Incidental detection of purulent fluid in kidney at percutaneous nephrolithotomy 
for branched renal calculi.

Aron M, Goel R, Gupta NP, Seth A.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
monisharon@hotmail.com

BACKGROUND AND PURPOSE: Some patients undergoing percutaneous nephrolithotomy
(PCNL) have purulent fluid in the pelvicaliceal system at the time of puncture,
although preoperative features are not suggestive of infection. We report the
management and outcome of 19 such patients. PATIENTS AND METHODS: Among the 639
patients who underwent PCNL at our center from July 2000 to October 2003, 19 had 
purulent fluid in the kidney at initial puncture. The preoperative findings,
operative details, hospital course, and final outcome in these patients were
analyzed. Twelve patients had stone removal at the first sitting (option 1),
while seven had a nephrostomy tube placed initially with stone removal deferred
for 3 to 7 days (option 2). RESULTS: With option 1, stones were cleared with one 
to three tracts in 45 to 120 minutes. Seven patients recovered smoothly, three
had transient fever, while one had grade I and another had grade II sepsis. The
purulent fluid grew E. coli in two cases and Proteus or Serratia in one case each
and was sterile in eight. With option 2, stones were cleared using one to three
tracts in 60 to 100 minutes. The fluid grew E. coli or Klebsiella in one case
each and was sterile in five. Three patients had a smooth recovery, two had
transient fever, one had grade I sepsis, and another had grade II sepsis. Risk
factors for sepsis, irrespective of the option, were a recent history of febrile 
urinary-tract infection, borderline elevation of total leukocyte count, thick or 
foul pus as opposed to mere turbidity, the use of a single tube or tract or
delayed creation of second tracts, and operating time >90 minutes. CONCLUSIONS:
Despite normal preoperative urine and blood values, one may find purulence on
puncture during PCNL, which is not always infected. If any one or more of the
above risk factors is present, it is safer to drain the kidney initially, making 
sure that all blocked calices are drained, inserting multiple tubes if necessary.

PMID: 15798405 [PubMed - indexed for MEDLINE]

709: JSLS. 2005 Jan-Mar;9(1):97-101.

Retroperitoneal pyelolithotomy for management of renal calculi.

Chander J, Suryavanshi M, Lal P, Singh L, Ramteke VK.

Maulana Azad Medical College and Association, Lok Nayak Hospital, New Delhi,
India. drjchander@hotmail.com

OBJECTIVE: We evaluated the role of retroperitoneoscopic pyelolithotomy in the
management of renal calculi. METHODS: Fifty-six cases (male, 27; female, 29) of
solitary or multiple renal calculi were evaluated in the study. There were 46
patients with a single calculus, 4 patients with a staghorn calculus, and 6 with 
a caliceal calculus. Retroperitoneoscopic pyelolithotomy was carried out after
creating a retroperitoneal space with the balloon dissection method.
Pneumoretroperitoneum was maintained by carbon dioxide insufflation. RESULTS:
Stone clearance was achieved in all cases barring 2 cases of caliceal calculi
that were converted to the open procedure. The postoperative hospital stay
averaged 4 days. Patients were ambulatory within 24 hours and back to work within
7 days on average. Complications encountered were peritoneal rent, subcutaneous
emphysema, and superficial wound infection. The postoperative analgesic
requirement averaged 100 mg of diclofenac (2 tablets). CONCLUSIONS:
Retroperitoneoscopic pyelolithotomy is a safe, simple, and effective minimally
invasive procedure and is a feasible option that can be recommended for
management of renal calculi.

PMID: 15791981 [PubMed - indexed for MEDLINE]

710: Int Urol Nephrol. 2004;36(4):587-9.

Absence or decreased endogenous thiosulfaturia: a cause of recurrent calcium
nephrolithiasis.

Yatzidis H.

University of Athens, School of Medicine, Laboratory for Experimental Surgery and
Surgical Research, Greece. iyatzidi@med.uoa.gr

In two earlier publications we reported excellent therapeutic results in patients
with recurrent calcium nephrolithiasis, using oral or intravenous i.v. sodium
thiosulfate on the one hand, and on treatment of tumorus-soft periarticular
tissues calcifications on the other. Thus, we considered useful to measure
endogenous thiosulfaturia, using a specific HPLC method, in 25 healthy adult
males and 25 patients with recurrent calcium nephrolithiasis. Healthy adult males
excreted between 11 and 16 microM/24 hour of endogenous thiosulfate, while
patients with recurrent calcium nephrolithiasis excreted significantly lower
amounts of 6 and 10 microM/24 hour, except one patient, who did not excrete
endogenous thiosulfate, reflecting probably a genetic abnormality. Thiosulfate is
a unique agent for treatment of recurrent calcium nephrolithiasis as well as some
other abnormal calcium depositions. Two doses of 5 mM sodium thiosulfate daily
are therapeutically sufficient.

PMID: 15787343 [PubMed - indexed for MEDLINE]

711: Int Urol Nephrol. 2004;36(3):445-9.

Gestational urinary hyperthiosulfaturia protects hypercalciuric normal pregnant
women from nephrolithiasis.

Yatzidis H.

University of Athens, School of Medicine, Laboratory for Experimental Surgery and
Surgical Research, Greece. iyatzidi@med.uoa.gr

Urinary calcium excretion increases by 1-2-fold during gestation in normal,
uncomplicated pregnant women. Hypercalciuria occurs in all trimesters and
elevates urine supersaturation with regards to calcium oxalate. However,
crystalluria has not been a frequent clinical finding and stone formation is not 
a common complication of pregnancy. To elucidate this discrepancy we measured
various chemical entities (i.e. calcium, oxalate, uric acid, phosphorous,
magnesium, citrate, sulfate and thiosulfate) in urine at the end of each
trimester of 25 pregnant women. Twenty-five healthy women served as controls. Our
observations show that endogenous thiosulfate, a natural component of urine,
increased considerably during pregnancy to approximately 36, 38 and 40 microM/24 
hour at the end of each three trimesters. One month after delivery, endogenous
thiosulfaturia and hypercalciuria, in parallel, returned to initial normal
values. Consequently, it seems that gestational hyperthiosulfaturia protects
hypercalciuric normal pregnant women from the risk of nephrolithiasis.

PMID: 15783122 [PubMed - indexed for MEDLINE]

712: Int Urol Nephrol. 2004;36(3):317-8.

Per urethra insertion of a through-and-through safety guide wire using a
dual-lumen ureteral catheter during percutaneous nephrolithotripsy.

Greenstein A, Sofer M, Mabjeesh NJ, Kaver I, Matzkin H.

Department of Urology, Tel Aviv Sourasky Medical Center, Sackler Faculty of
Medicine, Tel-Aviv University, Tel Aviv, Israel. surge04@post.tau.ac.il

BACKGROUND: The second ("safety") of two guide wires is commonly inserted
antegradely in percutaneous nephrolithotripsy (PCNL). We describe the retrograde 
insertion of a through-and-through safety guide wire during PCNL. METHODS: After 
inserting a percutaneous nephrostomy 1 day earlier, a guide wire was introduced
through the nephrostomy tube to the bladder and pulled out through the urethral
meatus via a cystoscope and grasper. The tube was removed, leaving the wire
positioned from the flank to the meatus. A dual-lumen catheter was introduced
retrogradely through the urethra over the wire, up to the nephrostomy incision.
The safety guide wire was introduced retrogradely through the catheter's other
port. RESULTS: This procedure succeeded in 9 of 10 patients: the exception was
very obese and the catheter was too short to reach the incision in the flank.
CONCLUSION: Using a dual-lumen catheter allows quick and simple retrograde
insertion of a safety guide wire during PCNL.

PMID: 15783093 [PubMed - indexed for MEDLINE]

713: Urology. 2005 Mar;65(3):572-4.

Simultaneous bilateral retrograde intrarenal surgery for bilateral complex upper 
tract stone disease.

Chon CH, Chung SY, Ng CS, Fuchs GJ.

Endourology Institute, Cedars Sinai Medical Center, Los Angeles, California
90048, USA. chonster@yahoo.com

Recent advances in retrograde endoscopy have greatly expanded the role of
minimally invasive surgery in addressing upper tract stone disease. In an attempt
to decrease patient morbidity further, we present our initial experience with
simultaneous bilateral retrograde intrarenal surgery in a patient with complex
bilateral upper tract stones.

Publication Types: 
    Case Reports

PMID: 15780379 [PubMed - indexed for MEDLINE]

714: Urology. 2005 Mar;65(3):454-8.

Percutaneous nephrolithotomy with holmium: Yttrium-aluminum-garnet laser and
fiber guider--report of 349 cases.

Jou YC, Shen JH, Cheng MC, Lin CT, Chen PC.

Department of Urology, Chiayi Christian Hospital, Chiayi, Taiwan.
b729@cych.org.tw

OBJECTIVES: To assess the efficacy and safety of holmium:yttrium-aluminum-garnet 
(YAG) laser lithotripsy for percutaneous nephrolithotomy in a cohort of 349
consecutive procedures. METHODS: We retrospectively reviewed the charts of 334
patients who had undergone 349 percutaneous nephrolithotomy (PCNL) procedures
conducted at our hospital from January 2001 to March 2004 in which the
holmium:YAG laser with a self-made fiber guider was used for lithotripsy.
RESULTS: The average patient age was 54.1 years, and the average stone size was
3.3 +/- 1.8 cm. The average operative time was 99 +/- 38 minutes, and the average
postoperative hospital stay was 4.0 +/- 2.3 days. The overall stone-free rate was
83.7%. The postoperative urinary tract infection rate was 7.2%. The postoperative
transfusion rate was 2.0%. The holmium:YAG laser was effective against all kinds 
of stones, but sometimes it was time consuming to use the holmium:YAG laser to
disintegrate a very large stone. Thirteen PCNLs (3.7%) to treat large complete
staghorn stones were performed in combination with a pneumatic lithotriptor. Of
the 349 procedures, 152 (43.6%) had bloodless tracts afterward, and all 152
procedures had been performed with the nephrostomy tube-free modification.
CONCLUSIONS: The holmium:YAG laser is an effective and safe lithotriptor for most
percutaneous stone surgery. However, in patients with a very large stone burden, 
the combination of this technology with another, more powerful, intracorporeal
lithotriptor may be necessary.

PMID: 15780354 [PubMed - indexed for MEDLINE]

715: Physiology (Bethesda). 2005 Apr;20:125-33.

Molecular physiology of urate transport.

Hediger MA, Johnson RJ, Miyazaki H, Endou H.

Membrane Biology Program and Renal Division, Brigham and Women's Hospital and
Harvard Medical School, Boston, Massachusetts, USA. mhediger@rics.bwh.harvard.edu

Humans excrete uric acid as the final breakdown product of unwanted purine
nucleotides. Urate scavenges potential harmful radicals in our body. However, in 
conjunction with genetic or environmental (especially dietary) factors, urate may
cause gout, nephrolitiasis, hypertension, and vascular disease. Blood levels of
urate are maintained by the balance between generation and excretion. Excretion
requires specialized transporters located in renal proximal tubule cells,
intestinal epithelial cells, and vascular smooth muscle cells. The recently
identified human urate transporters URAT1, MRP4, OAT1, and OAT3 are thought to
play central roles in homeostasis and may prove interesting targets for future
drug development.

Publication Types: 
    Review

PMID: 15772301 [PubMed - indexed for MEDLINE]

716: Radiology. 2005 May;235(2):523-9. Epub 2005 Mar 15.

Detection of urinary tract stones at low-radiation-dose CT with z-axis automatic 
tube current modulation: phantom and clinical studies.

Kalra MK, Maher MM, D'Souza RV, Rizzo S, Halpern EF, Blake MA, Saini S.

Division of Abdominal Imaging and Intervention, Department of Radiology,
Massachusetts General Hospital and Harvard Medical School, White 270-E, 55 Fruit 
Street, Boston, MA 02114, USA. mannudeep_k_kalra@yahoo.com

PURPOSE: To evaluate depiction of urinary tract calculi at computed tomography
(CT) with a z-axis modulation technique at various noise indexes to reduce
radiation dose and preserve image quality. MATERIALS AND METHODS: Sixteen
radiopaque kidney stones (2.5-19.2 mm in diameter) were embedded in the
collecting systems of two bovine kidneys immersed in a water bath. A kidney
phantom was made by placing the kidneys in an elliptical Plexiglas phantom (32 x 
20 x 20 cm) filled with physiologic saline. The phantom was scanned at
16-detector row CT with a fixed tube current (300 mA) and z-axis modulation at
noise indexes of 14, 20, 25, 35, and 50; remaining imaging parameters were held
constant. Two abdominal radiologists reviewed images from most to least noisy.
Images were evaluated for presence of stones and size, site, and attenuation
value of each stone. Readers also graded conspicuity and margins of each stone on
a five-point scale. In addition, follow-up studies of 22 patients (mean age, 46
years; range, 26-57 years; male-female ratio, 14:8) with kidney and ureteral
stones who underwent CT with z-axis modulation (noise index, 14 and 20) were
evaluated in the same manner. Statistical analysis was performed with the Student
t test, Wilcoxon signed rank test, and kappa test of interobserver agreement.
Institutional review board approval was obtained, and informed consent was not
needed. RESULTS: In the phantom study, all 16 stones were identified on images
obtained with a fixed tube current and z-axis modulation at noise indexes of 14, 
20, and 25 (with a reduction in radiation dose of up to 77% compared with that of
fixed tube current scanning). Three stones (<5 mm) were not visualized with
z-axis modulation at noise indexes of 35 and 50. No significant difference was
shown for conspicuity of kidney stones in 22 patients who underwent CT with
z-axis modulation (with a 43%-66% reduction in radiation dose) when compared with
results of previous fixed tube current studies (P > .05). CONCLUSION: Kidney
stones (< or =2.5 mm) can be adequately depicted with the z-axis modulation
technique, with a 56%-77% reduction in radiation dose. In patients with urinary
tract stones, the technique results in a 43%-66% reduction in radiation dose at
noise indexes of 14 and 20 without compromising stone depiction. (c) RSNA, 2005.

PMID: 15770037 [PubMed - indexed for MEDLINE]

717: Int Braz J Urol. 2005 Jan-Feb;31(1):3-8; discussion 9.

Is stone radiodensity a useful parameter for predicting outcome of extracorporeal
shockwave lithotripsy for stones < or = 2 cm?

Krishnamurthy MS, Ferucci PG, Sankey N, Chandhoke PS.

Department of Surgery (Urology), University of Colorado Health Sciences Center
and Kidney Stone Center of the Rocky Mountains, Denver, Colorado 80262, USA.

PURPOSE: Several factors determine the success of extracorporeal shockwave
lithotripsy (SWL) for kidney stones: stone size, stone location within the
collecting system, stone type, and the SWL machine used. It has been suggested
that stone radiodensity, as determined either by plain radiography or computed
tomography attenuation values, may be an independent predictor of SWL success. We
examined the outcome of SWL for solitary stones less than or equal to 2 cm
located within the renal pelvis, based on their radiodensity. MATERIAL AND
METHODS: 211 patients with solitary renal pelvic stones measuring less than or
equal to 2 cm were treated on a Dornier Doli 50 lithotriptor under general
anesthesia. The radiodensity of the stone was determined to be either less than, 
equal to, or greater than the radiodensity of the ipsilateral 12th rib.
Stone-free rates (SFR) were determined at 3 months by kidney, ureters and bladder
(KUB) plain X-rays. Patients requiring re-treatment or auxiliary procedures were 
considered failures of SWL. RESULTS: Follow-up SFR information was available in
all 211 patients. Stone composition was available in 158 (75%) treated patients, 
but no correlation was found between stone radiodensity and stone composition.
For stones < or = 10 mm within the renal pelvis, the SFRs were similar (71 to 74%
regardless of stone radiodensity). For stones between 11 and 20 mm, the SFR was
60% if the stone had a radiodensity > 12th rib compared to a SFR of 71% if the
stone radiodensity was < or = 12th rib. However, these differences in SFRs were
not statistically significant. CONCLUSIONS: On the Doli machine, stone
radiodensity alone does not predict lithotripsy treatment outcome for stones < or
= 1 cm within the renal pelvis. This parameter is probably only useful as the
stone size becomes larger than 1 cm, and should be used in conjunction with other
stone parameters to select appropriate therapy.

PMID: 15763001 [PubMed - indexed for MEDLINE]

718: J Urol. 2005 Apr;173(4):1194-8.

Comment in:
    J Urol. 2005 Nov;174(5):2069.

Percutaneous nephrolithotomy for caliceal diverticular calculi: a novel single
stage approach.

Kim SC, Kuo RL, Tinmouth WW, Watkins S, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, Indianapolis, Indiana, USA.

PURPOSE: Current percutaneous treatment of symptomatic caliceal diverticular
calculi involves renal access, stone removal, dilation of the diverticular
communication, fulguration of the cavity and placement of a nephrostomy tube. We 
reviewed the outcomes of patients undergoing a novel single stage percutaneous
nephrolithotomy technique for radiopaque caliceal diverticular stones that
eliminates ureteral catheterization and entry into the renal collecting system.
MATERIALS AND METHODS: A total of 21 patients (8 male and 13 female including 1
bilateral) with a mean age of 42.4 years underwent percutaneous nephrolithotomy
for caliceal diverticular stones from February 2001 to May 2003. Of the
diverticula 12 were upper pole, 4 were interpolar and 6 were lower pole.
Infracostal access was established by the urologist directly onto the radiopaque 
stones without the aid of a ureteral catheter. After balloon tract dilation a
30Fr Amplatz sheath was placed and following stone removal the diverticulum was
fulgurated. The infundibulum was neither cannulated nor dilated. A 20Fr red
rubber catheter or an 8.5Fr Cope loop was placed into the diverticulum.
Stone-free status was assessed by noncontrast computerized tomography on
postoperative day 1 (POD1). The drainage tube was removed if there was no urine
drainage and the kidney was stone-free. Excretory urography was performed at 3
months to evaluate diverticular resolution. RESULTS: Of 21 patients 20 were
discharged home tubeless on POD1 and 18 of 21 (85.7%) renal units were stone-
free on POD1 noncontrast computerized tomography. Mean operative time was 58.5
minutes and mean stone burden was 138.9 mm. Mean stone diameter was 11.6 mm and
mean diverticular diameter was 15.3 mm. Of 22 renal units 16 had followup
excretory urography. All diverticula decreased in size and 14 (87.5%) had
complete resolution. CONCLUSIONS: In patients with symptomatic radiopaque
caliceal diverticular stones, a single stage procedure without the need for
ureteral catheterization combined with direct infracostal diverticular puncture
allows for a rapid procedure with little morbidity.

PMID: 15758742 [PubMed - indexed for MEDLINE]

719: Radiology. 2005 May;235(2):530-6. Epub 2005 Mar 9.

Unenhanced multi-detector row CT in patients suspected of having urinary stone
disease: effect of section width on diagnosis.

Memarsadeghi M, Heinz-Peer G, Helbich TH, Schaefer-Prokop C, Kramer G, Scharitzer
M, Prokop M.

Department of Radiology, University of Vienna, General Hospital of Vienna,
Waehringer Guertel 18-20, A-1090 Vienna, Austria.
mazda.memarsadeghi@meduniwien.ac.at

PURPOSE: To assess prospectively the effect of section width in multi-detector
row computed tomographic (CT) evaluation of patients with acute flank pain who
are suspected of having or known to have urinary stone disease. MATERIALS AND
METHODS: This study was approved by the ethics committee of the authors'
university, and written informed consent was obtained from all patients. One
hundred forty-seven patients (age range, 11-101 years; mean, 51.4 years +/- 18.7 
[standard deviation]) suspected of having urinary stone disease underwent
unenhanced multi-detector row CT. CT was performed with four detector rows, a
section thickness of 1.0 mm, an effective tube current-time product of 100 mAs,
and a tube voltage of 120 kVp (CT dose index, 11.4 mGy). From these data, three
sets of transverse images were reconstructed with section widths of 1.5, 3.0, and
5.0 mm and approximately 50% of overlap each. Scans were evaluated in varying
random orders by two radiologists for the number, size, and location of uroliths 
and nephroliths and for the presence of phleboliths, renal cysts, and secondary
signs of obstruction. The significance of differences between the numbers of
detected calcifications and the numbers of associated abnormalities on the scans 
obtained with varying section widths was tested with the McNemar test at a P
level of less than .05. Spearman rho rank correlation coefficients were
calculated to assess the correlation between the presence of uroliths and the
presence of secondary signs. RESULTS: Uroliths were found in 72 of 147 (49.0%)
patients, and nephroliths were found in 16 patients (10.9%). There was no
significant difference between section widths of 1.5 and 3.0 mm with regard to
the number of detected stones (264 uroliths and 61 nephroliths for both
protocols). Transverse sections 5.0-mm wide revealed significantly fewer uroliths
(n = 231; P < .001) and nephroliths (n = 47; P < .016). The final diagnosis was
changed in four of 72 patients. All missed renal and ureteral stones measured
less than 3 mm in diameter. CONCLUSION: Overlapping 3-mm sections are sufficient 
for the detection of urinary stone disease. Small calculi (<3 mm) may be missed
on 5.0-mm-thick sections. (c) RSNA, 2005.

PMID: 15758192 [PubMed - indexed for MEDLINE]

720: J Eur Acad Dermatol Venereol. 2005 Mar;19(2):212-5.

Pseudoxanthoma elasticum and nephrolithiasis.

Fabre B, Bayle P, Bazex J, Durand D, Lamant L, Chassaing N.

Service de Dermatologie, CHU Purpan, 31059 Toulouse cedex, France.

We report the case of a 42-year-old man with pseudoxanthoma elasticum (PXE) and
recurrent bilateral nephrolithiasis. Diagnosis of PXE was made by yellow papules 
on the neck and ophthalmologic angioid streaks. This diagnosis was confirmed by a
skin biopsy (Von Kossa stain) and by genotyping analysis of ABCC6 (homozygous
mutation R1138Q). Nephrolithiasis was recurrent and biological investigations
showed hypophosphoraemia, hyperphosphaturia, hypercalciuria, normocalcaemia,
normal serum parathyroid hormone value, high 1,25-dihydroxy vitamin D value and a
renal calcium oxalate stone. ABCC6 encodes for MRP6, a multidrug resistant
protein strongly expressed in the liver and kidney. The substrates of the MRP6
remain unknown. As PXE is characterized by calcification of elastic fibres and
this patient presents important phosphocalcic anomalies, we discuss the possible 
implications of MRP6 in the phosphocalcic metabolism.

Publication Types: 
    Case Reports

PMID: 15752294 [PubMed - indexed for MEDLINE]

721: Nephrol Dial Transplant. 2005 May;20(5):909-14. Epub 2005 Mar 1.

Mapping a new suggestive gene locus for autosomal dominant nephrolithiasis to
chromosome 9q33.2-q34.2 by total genome search for linkage.

Wolf MT, Zalewski I, Martin FC, Ruf R, Müller D, Hennies HC, Schwarz S, Panther
F, Attanasio M, Acosta HG, Imm A, Lucke B, Utsch B, Otto E, Nurnberg P, Nieto VG,
Hildebrandt F.

Department of Pediatrics and Communicable Diseases, University of Michigan, 8220C
MSRB III, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0646, USA.

BACKGROUND: Nephrolithiasis is a complex, multifactorial disease resulting from
genetic and environmental interaction. The pathogenesis of nephrolithiasis is far
from being understood. So far, no gene locus for autosomal dominant
nephrolithiasis only has been described. We here identified a new suggestive gene
locus for autosomal dominant nephrolithiasis by a genome-wide search for linkage 
in a Spanish kindred with nephrolithiasis. METHODS: Clinical data, blood and
urine samples of 18 individuals from a Spanish kindred with nephrolithiasis were 
collected. We performed a genome-wide search for linkage using 380 polymorphic
microsatellite markers. RESULTS: Nephrolithiasis segregated in this Spanish
kindred in a pattern compatible with autosomal dominant inheritance. The total
genome search yielded the highest two-point LOD score of Z(max) = 1.99 (theta =
0) for marker D9S159 on chromosome 9q33.2-q34.2. Multipoint analysis of 24
polymorphic markers used for further fine mapping resulted in a LOD score of
Z(max) = 2.7 (theta = 0) for markers D9S1881-D9S164, thereby identifying a new
gene locus for autosomal dominant nephrolithiasis (NPL1). Two recombination
events define D9S1850 as the centromeric flanking marker and D9S1818 as the
telomeric flanking marker, restricting the NPL1 locus to a 14 Mb interval.
CONCLUSION: We here identified a new suggestive gene locus (NPL1) for autosomal
dominant nephrolithiasis. It is localized on chromosome 9q33.2-q34.2. The
identification of the responsible gene will provide new insights into the
molecular basis of nephrolithiasis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15741201 [PubMed - indexed for MEDLINE]

722: J Endourol. 2005 Jan-Feb;19(1):111-5.

Association of vitamin D receptor-gene (FokI) polymorphism with calcium oxalate
nephrolithiasis.

Bid HK, Kumar A, Kapoor R, Mittal RD.

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow, India.

BACKGROUND AND PURPOSE: Formation of kidney stones is still not understood but is
hypothesized to be associated with the vitamin D receptor gene (VDR). In order to
assess the eventual role of VDR start-codon FokI polymorphism in stone formation,
we evaluated the association between calcium stone disease and this polymorphism 
in a North Indian population. PATIENTS AND METHODS: A control group comprised of 
166 healthy individuals (age range 22-58 years) and a group of 138 patients with 
calcium oxalate stones (age range 21-72 years) were examined. The polymorphism
was detected using polymerase chain reaction-based restriction analysis. An
unexcisable length of 265 bp (CC) and two fragments of 169 bp and 96 bp (TT) were
obtained by FokI restriction digestion. RESULTS: There was a statistically
significant difference between the control and patient groups (X2 test, P<0.001) 
for the genotype of the VDR FokI start-codon polymorphism. The odds ratio (with
95% CI) for the C allele in those at risk of stone disease was 1.654 (1.041,
2.628). The VDR frequency distribution was also statistically significant
(P<0.001) in case of male sex. The frequency distribution for this genetic
polymorphism was not statistically different in normocalciuric and hypercalciuric
stone patients (P=0.355). CONCLUSION: The VDR FokI polymorphism may be a good
candidate for a marker for calcium oxalate-stone disease. These findings may
contribute a small piece to the understanding of the pathogenesis of urinary
calculi.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15735395 [PubMed - indexed for MEDLINE]

723: J Endourol. 2005 Jan-Feb;19(1):45-9.

Nephrolithiasis: "scope," shock or scalpel?

Skenazy J, Ercole B, Lee C, Best S, Fallon E, Monga M.

Veterans Administration Health Care Systems and the Department of Urologic
Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.

PURPOSE: To evaluate treatment preferences for complex urinary calculi. MATERIALS
AND METHODS: A questionnaire was sent to 174 members of the Minnesota Urological 
Society. Three case scenarios were presented: a 1.5-cm lower-pole calculus with
unfavorable anatomy, a 1.4-cm proximalureteral calculus, and a staghorn calculus.
The treatment options offered were extracorporeal shockwave lithotripsy (SWL),
ureteral stenting, ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and
open surgery. RESULTS: Our survey response rate was 49%. A PCNL for staghorn
calculi was more likely to be offered by urologists in metropolitan (100%;
P<0.001) and urban (100%; P=0.003) settings than rural settings (57%). Whereas
only 22% of urban and metropolitan urologists would offer anatrophic
nephrolithotomy, 43% of rural urologists would include this among their treatment
options. A PCNL was more likely to be offered by urologists trained after 1980
(100%) than by urologists trained before 1980 (81%; P=0.004). For a large
lower-pole calculus with unfavorable anatomy, urologists with >50% managed-care
practices were more likely (91%) than urologists with <50% managed-care practices
(65%) to select PCNL for such stones (P=0.034). Whereas 82% of metropolitan
urologists would select PCNL, 43% of rural urologists would consider SWL as
initial therapy. A URS was more likely to be offered by urologists trained after 
1980 (16%) than by urologists trained before 1980 (0; P=0.044). For a large
proximal-ureteral calculus, metropolitan urologists were most likely (64%) to use
stents initially (urban 28%; P=0.014; rural 14%; P=0.017). Rural urologists were 
more likely to offer SWL (100%) than were metro urologists (55%; P=0.024).
CONCLUSIONS: Initial therapy for nephrolithiasis differs significantly according 
to geographic location, year of residency completion, and the percentage of
managed-care patients in a urologist's practice. Future emphasis should be placed
on increasing the availability of endoscopic techniques in rural settings.

Publication Types: 
    Comparative Study

PMID: 15735382 [PubMed - indexed for MEDLINE]

724: J Endourol. 2005 Jan-Feb;19(1):5-10.

CT attenuation value and shockwave fragmentation.

Favela R, Gutierrez J, Bustos J, Castaño-Tostado E, Loske AM.

Nuevo Hospital Civil, Universidad de Guadalajara, Guadalajara, Jalisco, México.

PURPOSE: To evaluate whether, in principle, the mean CT attenuation values of
kidney stones could predict fragmentation by shockwaves. MATERIALS AND METHODS:
Four types of artificial kidney stones having different CT attenuation values
were tested. Artificial stones were weighed and exposed to 700 shockwaves at 21
kV at the focus of an electrohydraulic lithotripter. Fragments were strained
through meshes with 2x2-mm and 3.1x3.1-mm openings. The material left on the
meshes after shockwave exposure was dried and weighed on a precision scale. Half 
of all artificial stones were saturated by immersing them in water several days
before fragmentation. Fragmentation coefficients (i.e., percent weight loss) were
associated with CT attenuation values using a statistical model. RESULTS: Higher 
CT numbers resulted in lower fragmentation coefficients. Artificial stone weight 
was inversely proportional to the percent weight loss. Larger fragments were
obtained at lower fragmentation coefficients. Statistical analysis revealed that 
fragmentation can be predicted knowing the weight and the CT number of a stone
before shockwave application. CONCLUSION: Prediction of the number of shockwaves 
necessary for successful SWL could be possible. Our statistical model proved to
fit in vitro fragmentation of artificial stones; however, clinical application
requires further research.

Publication Types: 
    Comparative Study
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 15735374 [PubMed - indexed for MEDLINE]

725: Int J Urol. 2005 Feb;12(2):211-3.

Management of gestational nephrolithiasis in the presence of a bicornuate uterus 
and pelvic kidney.

Kavanagh DO, Fanning N, Heffernan E, Malone DE, Mulvin DM, Quinlan DM.

Department of Urology, St Vincent's University Hospital, Elm Park, Dublin 4,
Ireland. dara_kav@hotmail.com

A 39-year-old para 0(+1) woman with known nephrolithiasis within a left-sided
pelvic kidney presented with left-sided renal colic at 7 weeks gestation. She had
a previous miscarriage due to a bicornuate uterus. Ultrasound and magnetic
resonance urography confirmed an incomplete obstruction of the left upper renal
tract which was relieved by percutaneous nephrostomy. She presented again at 14
weeks with renal colic and minimal output. An ultrasound confirmed recurrent
hydronephrosis and a nephrostogram showed that the catheter had retracted almost 
completely from the collecting system. This was considered to be due to the
upward pressure of the enlarging uterus on the catheter, which had been fixed
externally to the skin. This problem was obviated by not securing the replacement
nephrostomy tube to the skin. She developed pre-eclamptic toxaemia and gave birth
at 35 weeks gestation by caesarean section. The calculus was later dissolved
using extra-corporeal shockwave lithotripsy.

Publication Types: 
    Case Reports

PMID: 15733119 [PubMed - indexed for MEDLINE]

726: Curr Opin Urol. 2005 Mar;15(2):127-31.

How significant are clinically insignificant residual fragments following
lithotripsy?

Tan YH, Wong M.

Department of Urology, Singapore General Hospital, Outram Road, Singapore
169-608, Singapore. gurtyh@sgh.com.sg

PURPOSE OF REVIEW: Extracorporeal shock-wave lithotripsy had revolutionized the
treatment of kidney stones. Residual fragments smaller than 4 or 5 mm which are
asymptomatic and likely to pass spontaneously are termed as clinically
insignificant residual fragments. This article reviews the current literature
with regards to the management of clinically insignificant residual fragments.
RECENT FINDINGS: However, the term is controversial because no consensus has been
reached regarding its exact definition or interval after extracorporeal
shock-wave lithotripsy to evaluate its presence. While most small residual stone 
fragments might be managed expectantly, a significant number of patients might
become symptomatic or require intervention. These so-called clinically
insignificant residual fragments have the potential to cause obstruction and are 
important risk factors for stone recurrence and re-growth. SUMMARY: Residual
fragments require close monitoring for stone growth, potential complications and 
subsequent intervention. Secondary procedures may be applied selectively to those
patients who have significant symptoms of obstruction associated with the
residual stone. Medical therapy might play an important role in the management of
residual fragments.

Publication Types: 
    Review

PMID: 15725937 [PubMed - indexed for MEDLINE]

727: Curr Opin Urol. 2005 Mar;15(2):119-26.

Developments in stone prevention.

Straub M, Hautmann RE.

Urolithiasis Research Group, Department of Urology and Pediatric Urology,
University of Ulm, Prittwitzstrasse 43, D-89075 Ulm, Germany.
michael.straub@medizin.uni-ulm.de

PURPOSE OF REVIEW: This review focuses on new developments in stone prevention.
Unfortunately, no major progress in this field has happened. There is a worldwide
lack of randomized and controlled trials, which could confirm our theoretical
assumptions and preventive concepts in stone disease. With these preconditions in
mind, this review presents the current knowledge of metabolic influences causing 
the symptom "stone" and the effective measures against it. RECENT FINDINGS:
Modern lifestyle, dietary habits and obesity emerge to be the promoters of
idiopathic stone disease. Cross-sectional studies showed significant correlations
between these factors and kidney stones with direct implications on our
preventive concepts: normalization of body mass index, adequate physical
activity, balanced nutrition and sufficient circadian fluid intake. Modern diets 
containing a lot of animal protein, refined carbohydrates and salt act on the
metabolism like an acid load. To overcome these disadvantageous effects, a
sufficient supply of potassium and alkali is required. Last but not least,
calcium should not be restricted. There is clear evidence from clinical and
experimental research that a normal or a high calcium supply is appropriate in
calcium stone disease. Only in absorptive hypercalciuria calcium restriction
remains beneficial in combination with thiazide and citrate therapy. SUMMARY: Up 
to 85% of all stone patients could anticipate lower risk of stone recurrence with
elementary reorientation of their lifestyle and dietary habits. Normalizing the
major risk factors is easy and cheap. About 15% of patients forming stones
require additional specific pharmacological prevention. The specific measures to 
avoid recurrence of the stone disease are precisely defined.

Publication Types: 
    Review

PMID: 15725936 [PubMed - indexed for MEDLINE]

728: Curr Opin Urol. 2005 Mar;15(2):107-12.

Endoscopic management of stones in children.

Desai M.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat
387-001, India. mrdesai@mpuh.org

PURPOSE OF REVIEW: Management of pediatric urolithiasis has evolved from open
surgery to minimally invasive techniques. With advancements in instrumentation,
endourological procedures are being performed more commonly in children. The
current article reviews the literature published from January 2003 to September
2004 regarding endoscopic management of stones in children. RECENT FINDINGS:
Whereas recent literature supports shock-wave lithotripsy as the preferred
treatment option for pediatric stones, it also confirms the safety of
percutaneous nephrolithotomy and ureteroscopy in all age groups. Retrograde
intrarenal surgery and laparoscopic surgery are newer additions to the
armamentarium of the endourologist but their role needs to be better defined.
SUMMARY: The majority of stones in children can be managed using minimally
invasive techniques. Proper treatment planning and use of appropriate
instrumentation are important to achieve optimal outcome.

Publication Types: 
    Review

PMID: 15725934 [PubMed - indexed for MEDLINE]

729: Curr Opin Urol. 2005 Mar;15(2):101-5.

Endoscopic stone surgery: minimizing the risk of post-operative sepsis.

Mariappan P, Tolley DA.

Department of Urology, Scottish Lithotriptor Centre, Western General Hospital,
Crewe Road South, Edinburgh EH4 2XU, Scotland, UK.
Param.Mariappan@luht.scot.nhs.uk

PURPOSE OF REVIEW: Urosepsis from manipulation of the urinary tract during stone 
surgery can be catastrophic despite antibiotic prophylaxis and sterile
pre-operative urine. We have reviewed recent literature with regards to
pathogenesis, predictors of infected stones and prevention of urosepsis. RECENT
FINDINGS: Bladder urine culture has been found to correlate poorly with infection
in the upper urinary tract, defined by either stone or pelvic urine culture. This
specimen, which has been the cornerstone in pre-operative preparation of
patients, does not predict urosepsis. Authors recommending routine stone culture 
found that the presence of infected stones is highly predictive of potential
sepsis. Terminology for systemic infection has been standardized and used in
recent literature to define urosepsis. SUMMARY: Recent studies have recommended
changes in the approach to the peri-operative management of stone surgery.
Predictors of potential sepsis have also been identified.

Publication Types: 
    Review

PMID: 15725933 [PubMed - indexed for MEDLINE]

730: Urol Res. 2005 Jun;33(3):194-8.

Calcium stone disease: a multiform reality.

Trinchieri A, Castelnuovo C, Lizzano R, Zanetti G.

Urology Unit, Lecco Hospital, Lecco, Italy. a.trinchieri@ospedale.lecco.it

In calcium renal stones, calcium oxalate and calcium phosphate in various crystal
forms and states of hydration can be identified. Calcium oxalate monohydrate
(COM) or whewellite and calcium oxalate dihydrate (COD) or weddellite are the
commonest constituents of calcium stones. Calcium oxalate stones may be pure or
mixed, usually with calcium phosphate or sometimes with uric acid or ammonium
urate. The aim of this study was to compare the clinical and urinary patterns of 
patients forming calcium stones of different composition according to infrared
spectroscopic analysis in order to obtain an insight into their etiology. The
stones of 84 consecutive calcium renal stone formers were examined by infrared
spectroscopy. In each patient, a blood sample was drawn and analysed for serum
biochemistry and a 24-h urine sample was collected and analysed for calcium,
phosphate, oxalate, citrate and other electrolytes. We classified 49 patients as 
calcium oxalate monohydrate (COM) stone formers, 32 as calcium oxalate dihydrate 
(COD) stone formers and three as apatite stone formers according to the main
component of their stones. Patients with COM stones were significantly older than
patients with COD stones (P < 0.002). Mean daily urinary calcium and urinary
saturation with respect to calcium oxalate were significantly lower in patients
with COM than in those with COD stones (P < 0.000). Patients with calcium oxalate
stones containing a urate component (< or = 10%) presented with higher saturation
(P < 0.012) with respect to uric acid in their urine (and lower with respect to
calcium oxalate and calcium phosphate, respectively P < 0.024 and P < 0.003) in
comparison with patients without a urate component in the stone. Patients with
calcium oxalate stones with a calcium phosphate component (> or = 15%) showed
higher (P < 0.0016) urinary saturation levels with respect to calcium phosphate
(and lower with respect to uric acid (P < 0.009), compared with patients forming 
stones without calcium phosphate or with a low calcium phosphate component.
Patients with calcium stones mixed with urate had a significantly lower urinary
pH (P < 0.002) and urinary calcium (P < 0.000), and patients with calcium
phosphate >15%, higher urinary pH (P < 0.004) and urinary calcium (P < 0.000). In
conclusion, in the evaluation of the individual stone patient, an accurate
analysis of the stone showing its exact composition and the eventual presence of 
minor components of the stone is mandatory in order to plan the correct
prophylactic treatment. Patients with "calcium stones" could require various
approaches dependent on the form and hydration of the calcium crystals in their
stones, and on the presence of "minor" crystalline components that could have
acted as epitaxial factors.

PMID: 15714335 [PubMed - indexed for MEDLINE]

731: Surg Laparosc Endosc Percutan Tech. 2005 Feb;15(1):41-3.

Laparoscopy-assisted percutaneous nephrolithotomy (PCNL) in previously operated
ectopic pelvic kidney.

Aron M, Gupta NP, Goel R, Ansari MS.

Department of Urology, All India Institute of Medical Sciences, New Delhi 110
029, India. monisharon@hotmail.com

A 35-year-old man with a left ectopic pelvic kidney and a prior history of open
pyelolithotomy presented with recurrent multiple stones in the pelvic kidney.
Complete clearance of calculi was achieved by laparoscopy-assisted PCNL
(percutaneous nephrolithotomy). To the best of our knowledge this is the first
report of laparoscopy-assisted PCNL in a previously operated ectopic pelvic
kidney.

Publication Types: 
    Case Reports

PMID: 15714158 [PubMed - indexed for MEDLINE]

732: J Urol. 2005 Mar;173(3):858-61.

Comment in:
    J Urol. 2006 Feb;175(2):789-90; author reply 790.

Time to development of symptomatic urinary calculi in a high risk environment.

Evans K, Costabile RA.

47th Combat Support Hospital, Fort Lewis, Washington, USA.
karen.evans@amedd.army.mil

PURPOSE: While seasonal variation of stone disease is well described, the time to
formation of urinary calculi is unknown. Because southwestern Asia is a high risk
environment for stone disease, the date of entry into this region is a definitive
beginning to a period of increased risk of urinary calculi. The recent influx of 
Department of Defense personnel into southwestern Asia provided the opportunity
to observe stone disease in a cohort of healthy personnel during a well-defined
period of increased risk of stone formation. MATERIALS AND METHODS: A database
was constructed for all patients presenting with symptomatic urinary calculi to a
single military hospital deployed to Kuwait from March through August 2003.
Patient demographics, stone characteristics and time to formation of symptomatic 
urinary calculi were evaluated. RESULTS: A total of 182 patients were diagnosed
with 218 symptomatic stones. Mean time to formation of symptomatic urinary
calculi was 93 days with a standard deviation of 42 days. CONCLUSIONS: This study
provides unprecedented information about the development of symptomatic urinary
calculi in a high risk environment. While unique aspects of the population,
environment and medical system created a singular opportunity to study stone
disease, the results of this study are applicable to the general population.

PMID: 15711293 [PubMed - indexed for MEDLINE]

733: Urology. 2005 Feb;65(2):380-3.

Retroperitoneoscopic management of caliceal diverticular calculi.

Wyler SF, Bachmann A, Jayet C, Casella R, Gasser TC, Sulser T.

Department of Urology, University Hospital of Basel, Basel, Switzerland.

INTRODUCTION: The management of caliceal diverticular calculi has changed from an
open surgical approach to endoscopic management. TECHNICAL CONSIDERATIONS:
Different minimally invasive treatment modalities, such as extracorporeal shock
wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, laparoscopy, and
retroperitoneoscopy, can be offered to the patient. We report on a
retroperitoneoscopic operative technique using endosonography for location and
performing nephrotomy with complete excision of the caliceal diverticulum and
ligation of the diverticular neck with an Endo-loop. CONCLUSIONS: The advantages 
of this minimally invasive technique include total excision of the diverticulum
with no risk of recurrence and easy and complete closure of the diverticular
neck.

Publication Types: 
    Case Reports

PMID: 15708058 [PubMed - indexed for MEDLINE]

734: Urology. 2005 Feb;65(2):265-9.

Ureteroscopic management of renal calculi in anomalous kidneys.

Weizer AZ, Springhart WP, Ekeruo WO, Matlaga BR, Tan YH, Assimos DG, Preminger
GM.

The Comprehensive Kidney Stone Center, The Division of Urology, Department of
Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.

OBJECTIVES: To review our experience with ureteroscopy in treating patients with 
renal calculi in anomalous kidneys and to evaluate the efficacy of this approach.
METHODS: Eight patients with renal calculi in anomalous kidneys who were managed 
by ureteroscopic procedures were identified. Demographic information,
preoperative stone burden, operative information (ureteroscope size, lithotrite
used, instruments used, duration of surgery, complications, stenting), follow-up 
imaging, and complications were obtained from the medical record. This
information was analyzed to determine the most frequently used instruments and
stone-free rates. RESULTS: Our cohort consisted of 4 patients with horseshoe
kidneys (HSK) and 4 patients with pelvic kidneys (PK) (6 male, 2 female, mean
age, 50.6 years). The average preoperative stone burden of the 11 treated calculi
was 1.4 cm, with 5 stones located in the renal pelvis, 2 in the upper pole, and 4
in lower pole calyces. A 7.5F flexible ureteroscope, holmium laser lithotripsy,
and nitinol baskets and graspers were used in all patients. Six patients had
complete clearance of the stone on postoperative imaging (75% HSK, 75% PK), with 
88% of patients asymptomatic after their procedure. No patients required
additional surgical intervention. CONCLUSIONS: Flexible ureteroscopy with holmium
laser lithotripsy and the use of nitinol baskets and graspers provides a
reasonable alternative to shock wave lithotripsy in the management of patients
harboring renal calculi in anomalous kidneys. In addition, ureteroscopy can be
considered a primary option for managing select patients with symptomatic stones 
in PKs before a percutaneous surgical approach.

Publication Types: 
    Review

PMID: 15708035 [PubMed - indexed for MEDLINE]

735: Int Braz J Urol. 2004 Jan-Feb;30(1):32-3; discussion 34.

Management of lithiasis in pelvic kidney through laparoscopy-guided percutaneous 
transperitoneal nephrolithotripsy.

Dos Santos AR, Rocha Filho DC, Tajra LC.

Center for Advanced Treatment of Urologic Diseases, Santa Maria Hospital
(Urocenter), Teresina, Piauí, Brazil.

We report the case of a patient with pain and an abdominal palpable mass whose
tests showed a left pelvic kidney with a 1.5-cm stone in the renal pelvis. We
describe the successful management through videolaparoscopy-guided percutaneous
transperitoneal nephrolithotripsy, stressing that this method is a therapeutic
option in such cases.

PMID: 15707512 [PubMed - indexed for MEDLINE]

736: BJU Int. 2005 Mar;95(4):631-4.

Percutaneous nephrolithotomy for treating renal calculi in children.

Boormans JL, Scheepe JR, Verkoelen CF, Verhagen PC.

Urology, Erasmus MC, Rotterdam, The Netherlands.

OBJECTIVE: To report our experience with the percutaneous management of renal
stone disease in children. PATIENTS AND METHODS: The medical and radiological
records of children up to 18 years old who were treated for renal calculi by
percutaneous nephrolithotomy (PCNL) at our institution between March 1995 and
April 2003 were reviewed. For stone removal a special paediatric 18 F access
sheath was used. RESULTS: In all, 26 PCNLs were used in 23 patients (10 boys and 
13 girls, aged 1.7-16.8 years). The presenting symptoms were urinary tract
infection, abdominal pain and/or haematuria. Of the 23 patients, 17 (75%) had
associated metabolic disease or underlying urological anatomical abnormalities.
Urinary tract infections were found in 15 patients (65%). The mean (range) stone 
burden was 6.0 (0.5-18.2) cm2, and the operative duration 127 (50-260) min. The
primary stone-free rate was 58%, which increased to 81% after treating residual
fragments. One blood transfusion was required and one patient developed urosepsis
after PCNL, which was treated with antibiotics. CONCLUSION: PCNL is an effective 
alternative for treating renal stones in children, and is the treatment of choice
for stones refractory to extracorporeal shock wave lithotripsy.

PMID: 15705093 [PubMed - indexed for MEDLINE]

737: Urol Res. 2005 Jun;33(3):213-9. Epub 2005 Feb 10.

A concerted protocol for the analysis of mineral deposits in biopsied tissue
using infrared microanalysis.

Anderson J, Dellomo J, Sommer A, Evan A, Bledsoe S.

Molecular Microspectroscopy Laboratory, Department of Chemistry and Biochemistry,
Miami University, Oxford, OH 45056, USA.

The mechanism(s) by which crystals are retained in the kidney resulting in stone 
disease remains unclear. Intratubular aggregation as well as crystal cell
binding, or internalization and translocation, or alternatively nucleation and
growth in the interstitial fluid are possible models. Our group is testing the
hypothesis that calcium phosphate deposits in kidneys of patients with calcium
renal stones arise in unique anatomical regions of the kidney. Furthermore, we
believe that their formation is conditioned by specific stone forming
pathophysiologies. To test this hypothesis, we performed intra-operative renal
papillary biopsies during percutaneous nephrolithotomy of kidneys from 15
idiopathic calcium stone formers as well as kidney tissue from a patient who
ingested ethylene glycol, and developed a new protocol to accurately identify the
composition of the calcium deposits located in the renal tissue. We developed a
new histological approach that incorporated a low-energy (low-E) reflective slide
substrate that has similar characteristics to a common microscope slide and
infrared absorption microspectroscopy. Infrared absorption microspectroscopy
revealed the crystal deposits in the idiopathic calcium oxalate stone formers to 
be hydroxyapatite in composition with an occasional region of calcium carbonate, 
while calcium oxalate was the predominant mineral in the kidney of the patient
who had ingested ethylene glycol. The results demonstrate that mixed sample types
containing tissue and mineralized deposits are easily analyzed while mounted on a
low-E slide using the attenuated total internal reflectance (ATR) method.
Reflection/absorption (R/A) analysis allows one to quickly survey a tissue
section and provides qualitative information about its components. Once
interesting sites have been identified by R/A analysis, ATR analysis can then be 
used to collect the best data possible. ATR analysis provides spectra free from
many of the artifacts associated with transmission and R/A analysis, and
completes the full picture of the components contained in the crystal deposits
and tissue. We present a method of analysis for mineralized materials embedded in
kidney tissue that uses readily or easily obtainable materials and
instrumentation. The sensitivity of this method allows tissue sections to remain 
unstained, alleviating the tedious and time-consuming constraints of earlier
methods of visual analysis. The present method will save time and training, while
simultaneously offering an unbiased analysis of mineralized components that is
more accurate and conducive to patient treatments than previous methods.

PMID: 15703966 [PubMed - indexed for MEDLINE]

738: Kidney Int. 2005 Mar;67(3):1053-61.

A twin study of genetic and dietary influences on nephrolithiasis: a report from 
the Vietnam Era Twin (VET) Registry.

Goldfarb DS, Fischer ME, Keich Y, Goldberg J.

Nephrology Section, New York Harbor VAMC, New York, NY, USA.
david.goldfarb@med.va.gov

BACKGROUND: Nephrolithiasis is a complex phenotype that is influenced by both
genetic and environmental factors. We conducted a large twin study to examine
genetic and nongenetic factors associated with stones. METHODS: The VET Registry 
includes approximately 7500 male-male twin pairs born between 1939 to 1955 with
both twins having served in the military from 1965 to 1975. In 1990, a mail and
telephone health survey was sent to 11,959 VET Registry members; 8870 (74.2%)
provided responses. The survey included a question asking if the individual had
ever been told of having a kidney stone by a physician. Detailed dietary habits
were elicited. In a classic twin study analysis, we compared concordance rates in
monozygotic (MZ) and dizygotic (DZ) twins. We also conducted a cotwin control
study of dietary risk factors in twins discordant for stones. RESULTS: Among
dizygotic twins, there were 17 concordant pairs and 162 discordant pairs for
kidney stones. Among monozygotic twins, there were 39 concordant pairs and 163
discordant pairs. The proband concordance rate in MZ twins (32.4%) was
significantly greater than the rate in DZ twins (17.3%) (chi(2)= 12.8; P <
0.001), consistent with a genetic influence. The heritability of the risk for
stones was 56%. In the multivariate analysis of twin pairs discordant for kidney 
stones, we found a protective dose-response pattern of coffee drinking (P= 0.03);
those who drank 5 or more cups of coffee were half as likely to develop kidney
stones as those who did not drink coffee (OR = 0.4, 95% CI 0.2, 0.9). Those who
drank at least 1 cup of milk per day were half as likely to report kidney stones 
(OR = 0.5, 95% CI 0.3, 0.8). There were also marginally significant protective
effects of increasing numbers of cups of tea per day and frequent consumption of 
fruits and vegetables. Other factors such as the use of calcium supplements,
alcohol drinking, consumption of solid dairy products, and the amount of animal
protein consumed were not significantly related to kidney stones in the
multivariate model. Conclusion: These results confirm that nephrolithiasis is at 
least in part a heritable disease. Coffee, and perhaps tea, fruits, and
vegetables were found to be protective for stone disease. This is the first twin 
study of kidney stones, and represents a new approach to elucidating the relative
roles of genetic and environmental factors associated with stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Twin Study

PMID: 15698445 [PubMed - indexed for MEDLINE]

739: Mymensingh Med J. 2005 Jan;14(1):58-60.

Necessity of antibiotics prophylaxis during extracorporeal shock wave
lithotripsy.

Islam MA, Shameem IA, Ahasan DN, Choudhury GM, Wahab MA.

Department of Urology, BSMMU, Dhaka, Bangladesh.

A total of 360 patients with renal and ureteral calculi who had sterile urine
before extracorporeal shock wave lithotripsy (ESWL) and did not have any
increased risk of infection received Tab.Ciprfloxacin (500 mg) 12 hourly for the 
next 5 days or no prophylaxis were included in this prospective study. Patients
were followed by urinalysis and culture together with clinical evaluations. In
antibiotic prophylactic group 10 (6.4%) had post ESWL urine culture positive
while in without prophylaxis 13 (8.8%) had positive urine culture. The incidence 
of urinary tract infection after ESWL is extremely low, provided that patients
have sterile urine before the procedure.

PMID: 15695957 [PubMed - indexed for MEDLINE]

740: An Acad Bras Cienc. 2005 Mar;77(1):95-101. Epub 2005 Feb 2.

Screening for CLCN5 mutation in renal calcium stone formers patients.

Rebelo MA, Tostes V, Araújo NC, Martini SV, Botelho BF, Guggino WB, Morales MM.

Faculdade de Ciências Médicas, Hospital Universitário Pedro Ernesto, Universidade
Estadual do Rio de Janeiro, Av. 28 de Setembro, 77, 20551-030 Rio de Janeiro, RJ,
Brazil.

Thirty-five patients (23 males and 12 females), age 35 +/- 13 years old,
presenting either idiopathic calcium nephrolithiasis, nephrocalcinosis or mild
renal failure with idiopathic calcium nephrolithiasis were selected for the
analysis of low molecular weight proteinuria and the possible mutations
occurrence in the chloride channel gene CLCN5. The urinary ratio of
beta2-microglobulin and creatinine (beta2M/Cr) was very high in a transplanted
woman with nephrocalcinosis (> 3.23 mg/mmol) and slightly high in five patients
(> 0.052 or < 1.0 mg/mmol) with multiple urological manipulations. Other studied 
patients showed beta2M/Cr ratio at normal range (0.003-0.052 mg/mmol) without
gender difference (p > 0.05). Mutation analysis of CLCN5 gene was performed in 26
patients of 35 selected (11 with idiopathic hypercalciuria; 6 men with normal
calciuria; 3 with mild renal insufficiency and 6 with nephrocalcinosis) and was
normal in all subjects even in those with abnormal molecular weight proteinuria. 
Conclusion: CLCN5 gene mutation is not a common cause of kidney stone disease or 
nephrocalcinosis in a group of Brazilian patients studied.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15692680 [PubMed - indexed for MEDLINE]

741: J Am Soc Nephrol. 2005 Mar;16(3):729-45. Epub 2005 Feb 2.

Genetic hypercalciuria.

Moe OW, Bonny O.

Charles and Jane Pak Center of Mineral Metabolism and Clinical Research,
University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard,
Dallas, TX 75390-8855, USA. orson.moe@utsouthwestern.edu

Hypercalciuria is an important, identifiable, and reversible risk factor in stone
formation. The foremost and most fundamental step in dissecting the genetics of
hypercalciuria is understanding its pathophysiology. Hypercalciuria is a complex 
trait. This article outlines the various factors that compromise the attempt to
dissect the genetics of hypercalciuria, summarizes the clinical and experimental 
monogenic causes of hypercalciuria, and outlines the initial results from
attempts in studying polygenic hypercalciuria. Finally, the problem is set in
perspective of the current database, technologic advances and limitations are
highlighted, and prospects of further advances in the field are speculated upon.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 15689405 [PubMed - indexed for MEDLINE]

742: Int Braz J Urol. 2004 Jul-Aug;30(4):316-8.

Spontaneous nephrocutaneous fistula.

Antunes AA, Calado AA, Falcão E.

Service of Urology, Getúlio Vargas Hospital, Recife, Pernambuco, Brazil.
betoazoubel@yahoo.com.br

Spontaneous renal fistula to the skin is rare. The majority of cases develop in
patients with antecedents of previous renal surgery, renal trauma, renal tumors, 
and chronic urinary tract infection with abscess formation. We report the case of
a 62-year old woman, who complained of urine leakage through the skin in the
lumbar region for 2 years. She underwent a fistulography that revealed drainage
of contrast agent to the collecting system and images suggesting renal lithiasis 
on this side. The patient underwent simple nephrectomy on this side and evolved
without intercurrences in the post-operative period. Currently, the occurrence of
spontaneous renal and perirenal abscesses is extremely rare, except in patients
with diabetes, neoplasias and immunodepression in general.

Publication Types: 
    Case Reports

PMID: 15679966 [PubMed - indexed for MEDLINE]

743: BJU Int. 2005 Feb;95(3):394-7.

Stone-bearing live-donor kidneys for transplantation.

Devasia A, Chacko N, Gnanaraj L, Cherian R, Gopalakrishnan G.

Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India.
antonydevasia@cmcvellore.ac.in

OBJECTIVE: To evaluate potential donor kidneys with asymptomatic calculi detected
during screening, and the management of the calculus before, during and after
transplantation, as with fewer live donors, marginal kidneys and donors are a
significant subgroup in renal transplantation. PATIENTS AND METHODS: Five
live-related donors, with one incidentally detected calculus during their routine
evaluation, were accepted for transplantation. Of these, three were detected only
on spiral computed angiography. There was no biochemical evidence of a metabolic 
abnormality or history of stone disease. One donor had elective lithotripsy and
another nephrolithotomy under ultrasonographic control immediately after
perfusion. The others were transplanted with the calculus in situ. Ureteric
reimplantation was by the Leadbetter-Politano technique over a JJ stent. RESULTS:
One recipient patient passed the calculus within 4 h of stent removal. The
follow-up ultrasonogram at 3 months showed a stone in only one recipient. In the 
others, the calculus could not be seen after stent removal. The maximum follow-up
was 2 years and graft function has remained normal in all. CONCLUSIONS: Voluntary
kidney donors with one calculus incidentally detected on routine evaluation form 
a unique group and can be accepted for transplantation in selected cases. Careful
follow-up of the donor and recipient is essential, with early intervention if
necessary.

Publication Types: 
    Evaluation Studies

PMID: 15679801 [PubMed - indexed for MEDLINE]

744: BJU Int. 2005 Feb;95(3):389-93.

Evaluation of a synchronous twin-pulse technique for shock wave lithotripsy: the 
first prospective clinical study.

Sheir KZ, El-Diasty TA, Ismail AM.

Department of Urology, Mansoura University, Elgomhoria St., 35516, Mansoura,
Egypt. kzsheir@hotmail.com

OBJECTIVE: To present the results of the first clinical study of a synchronous
twin-pulse technique for extracorporeal shock-wave lithotripsy (ESWL), which is
effective for in vitro stone fragmentation and safe when assessed in vivo on
animal tissue. PATIENTS AND METHODS: Fifty patients with urinary stones (35 men
and 15 women) were enrolled and treated with the TWINHEADS lithotripter. The
entry criteria were: age > or = 18 years, with a radio-opaque single stone in the
kidney or upper ureter, a normal laboratory profile (serum creatinine, liver
function, blood, bleeding and clotting times, and prothrombin concentration). The
exclusion criteria included lower ureteric stones, patients with urinary tract
infection, obstructed urinary tract distal to the stones, or congenital
abnormalities. All patients received one session and were evaluated by
ultrasonography (US), urinary tract plain X-ray, and complete laboratory
investigations before and immediately after treatment, and after 2, 14 and 30
days. Patients requiring re-treatment at the 14-day visit received a second
session and were re-evaluated after 7 and 14 days. RESULTS: The mean (sd, range) 
stone size (longest diameter) was 12.3 (2.6, 9-18) mm. Intravenous sedation was
used in 30 patients. There was mild haematuria in 25 patients on the day of
treatment. During the follow-up there was no evidence of haematoma, gross renal
injury, upper urinary tract obstruction or significant changes in the laboratory 
investigations. After 14 days, 17 patients (34%) were free of stones, with
residual stones of < or = 5 mm in 20 (40%); they were free of stones at the
1-month follow-up. Thirteen patients (26%) had residual stones of 6-9 mm, but the
stones were half or less of the original size. Patients with residual stones of >
5 mm had another ESWL session and were free of stones within 14 days. Thus all
patients were rendered stone-free within 1 month. CONCLUSIONS: Synchronous
twin-pulse ESWL is promising, seems safe and effective for treating patients with
renal and upper ureteric lithiasis.

Publication Types: 
    Clinical Trial

PMID: 15679800 [PubMed - indexed for MEDLINE]

745: J Clin Pathol. 2005 Feb;58(2):134-40.

ACP Best Practice No 181: Chemical pathology clinical investigation and
management of nephrolithiasis.

Reynolds TM.

Clinical Chemistry Department, Queen's Hospital, Burton on Trent, Staffordshire, 
UK. tim.reynolds@burtonh-tr.wmids.nhs.uk

Renal stones have afflicted humans for millennia but there is still no solution
to this problem. This review discusses the laboratory and metabolic aspects of
the clinical management of patients with renal stones, both primary and secondary
in origin. First, non-pharmacological interventions such as increased fluid
intake, decreased protein consumption, dietary changes in sodium, calcium,
oxalate, potassium, purine, vitamins, and essential fatty acids are considered.
Then specific pharmacological treatment to modify urine calcium, oxalate, urate, 
citrate, and acidity are considered. Finally, more unusual types of stone are
examined.

Publication Types: 
    Review

PMID: 15677531 [PubMed - indexed for MEDLINE]

746: J Altern Complement Med. 2004 Dec;10(6):967-9.

Ephedrine- and guaifenesin-induced nephrolithiasis.

Bennett S, Hoffman N, Monga M.

Department of Urologic Surgery, University of Minnesota, 420 Delaware Street SE, 
Minneapolis, MN 55455, USA.

OBJECTIVES: Ephedrine and guaifenesin are herbal supplements that have
experienced increased use over the past decade. Ephedrine has been used as a
stimulant and weight-loss product, guaifenesin as an expectorant and cough
suppressant; both are found in combination in many antitussives and expectorants.
This paper reviews the reported cases of ephedrine- and guaifenesin-induced
nephrolithiasis, as well as the diagnostic techniques and treatments that have
been successfully used for these stones. DESIGN: A systematic review of the
literature pertaining to nephrolithiasis and the compounds ephedrine and
guaifenesin was conducted. RESULTS: Ephedrine and guaifenesin use results in over
35% of urinary stones that are related to pharmaceutical metabolites, and
collectively are present in 0.1% of all urinary stones. These calculi are
radiolucent, requiring the use of computerized tomography (CT scan) for
diagnosis. Alkalinization therapy offers an alternative to surgical intervention 
and may have a role in prevention of recurrence. CONCLUSIONS: Ephedrine and
guaifenesin have been shown to cause nephrolithiasis in cases of abuse when taken
individually or in combination. It is important for the clinician to be aware of 
the potential for these compounds to cause nephrolithiasis.

Publication Types: 
    Review

PMID: 15673990 [PubMed - indexed for MEDLINE]

747: Kidney Int. 2005 Feb;67(2):685-90.

Comment in:
    J Urol. 2005 Aug;174(2):600-1.

Decreased renal function among adults with a history of nephrolithiasis: a study 
of NHANES III.

Gillen DL, Worcester EM, Coe FL.

Department of Health Studies, University of Chicago, Chicago, Illinois 60637,
USA. dgillen@health.bsd.uchicago.edu

BACKGROUND: Although intuitively appealing, the hypothesis that nephrolithiasis
is associated with decreased renal function has not thoroughly been investigated.
Because the prevalence of nephrolithiasis and chronic renal disease in
westernized societies has risen over the past three decades, we sought to
determine if persons with a history of kidney stones have lower renal function
relative to nonstone formers. METHODS: We used data from the Third National
Health and Nutrition Examination Survey (NHANES III) to compare estimated
glomerular filtration rate (GFR) between persons over age 30 with and without a
history of kidney stones. In total, 876 persons with a history of stones, and
14,129 persons without stones were available for analysis. RESULTS: We observed
that the association between history of stones and estimated GFR depends on body 
mass index (BMI) (P= 0.004). After adjustment for potential confounding factors, 
mean estimated GFR in stone formers with a BMI >/=27 kg/m(2) was 3.4 mL/min/1.73 
m(2) lower than that of similar nonstone formers (95% CI -5.8, -1.1) (P= 0.005). 
No difference was found among persons with a BMI <27 kg/m(2). The probability of 
an overweight stone former having an estimated GFR between 30 and 59 mL/min/1.73 
m(2) relative to a GFR above 90 mL/min/1.73 m(2) was nearly twice that of a
similar nonstone former [relative risk ratio (RRR) = 1.87, 95% CI 1.06, 3.30].
CONCLUSION: Among overweight persons, nephrolithiasis may not merely be a disease
of stones, but may also reduce kidney function. Further work in alternate study
samples is needed to validate this finding and determine the mechanisms
responsible.

PMID: 15673317 [PubMed - indexed for MEDLINE]

748: Kidney Int. 2005 Feb;67(2):576-91.

Crystal-associated nephropathy in patients with brushite nephrolithiasis.

Evan AP, Lingeman JE, Coe FL, Shao Y, Parks JH, Bledsoe SB, Phillips CL, Bonsib
S, Worcester EM, Sommer AJ, Kim SC, Tinmouth WW, Grynpas M.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46220, USA. evan@anatomy.iupui.edu

BACKGROUND: We have biopsied the renal cortex and papillae of patients who form
brushite renal stones asking if this unusual stone type is associated with
specific tissue changes. We contrasted these with biopsies of 15 calcium oxalate 
stone formers, three stone formers with intestinal bypass, and four normal
subjects. METHODS: We studied all ten brushite stone formers treated with
percutaneous nephrolithotomy (PNL) during the past 3 years using digital video
imaging of renal papillae, and obtained cortical and papillary biopsies. Biopsies
were analyzed by light and electron microscopy, microinfrared spectroscopy, and
electron diffraction. RESULTS: Apatite crystals plugged scattered terminal
collecting ducts whose cells were injured or dead, and surrounding interstitium
inflamed and fibrotic. White papillary deposits of interstitial apatite
particles, so called Randall's plaque, were also present. Glomerular changes and 
cortical tubular atrophy and interstitial fibrosis were moderate to severe.
CONCLUSION: Brushite stone formers combine the interstitial plaque of calcium
oxalate stone formers with the collecting duct apatite plugs found in stone
formers with intestinal bypass. Collecting duct injury and interstitial fibrosis 
are severe. Prominent cortical fibrosis, tubule atrophy, and glomerular pathology
seem secondary to the collecting duct plugging. We believe crystallization
obstructs and destroys terminal collecting duct segments thereby damaging
nephrons, perhaps via intranephronal obstruction, and producing a hitherto
unrecognized renal disease.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15673305 [PubMed - indexed for MEDLINE]

749: Kidney Int. 2005 Feb;67(2):483-91.

A potential cause for kidney stone formation during space flights: enhanced
growth of nanobacteria in microgravity.

Ciftçioglu N, Haddad RS, Golden DC, Morrison DR, McKay DS.

Universities Space Research Association, NASA, Houston, Texas 77058, USA.
nciftcio@ems.jsc.nasa.gov

BACKGROUND: Although some information is available regarding the
cellular/molecular changes in immune system exposed to microgravity, little is
known about the reasons of the increase in the kidney stone formation in
astronauts during and/or after long duration missions at zero gravity (0 g). In
our earlier studies, we have assessed a unique agent, nanobacteria (NB), in
kidney stones and hypothesized that NB have an active role in calcium
phosphate-carbonate deposition in kidney. In this research we studied effect of
microgravity on multiplication and calcification of NB in vitro. METHODS: We
examined NB cultures in High Aspect Rotating Vessels (HARVs) designed at the
NASA's Johnson Space Center, which are designed to stimulate some aspects of
microgravity. Multiplication rate and calcium phosphate composition of those NB
were compared with NB cultured on stationary and shaker flasks. Collected
aliquots of the cultures from different incubation periods were analyzed using
spectrophotometer, SEM, TEM, EDX, and x-ray diffraction techniques. RESULTS: The 
results showed that NB multiplied 4.6x faster in HARVs compared to stationary
cultures, and 3.2x faster than shaker flask conditions. X-ray diffraction and EDX
analysis showed that the degree of apatite crystal formation and the properties
of the apatite depend on the specific culture conditions used. CONCLUSION: We now
report an increased multiplication rate of NB in microgravity-simulated
conditions. Thus, NB infection may have a potential role in kidney stone
formation in crew members during space flights. For further proof to this
hypothesis, screening of the NB antigen and antibody level in flight crew before 
and after flight would be necessary.

PMID: 15673296 [PubMed - indexed for MEDLINE]

750: JAMA. 2005 Jan 26;293(4):455-62.

Obesity, weight gain, and the risk of kidney stones.

Taylor EN, Stampfer MJ, Curhan GC.

Channing Laboratory, Department of Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, Mass 02115, USA. entaylor@partners.org

CONTEXT: Larger body size may result in increased urinary excretion of calcium,
oxalate, and uric acid, thereby increasing the risk for calcium-containing kidney
stones. It is unclear if obesity increases the risk of stone formation, and it is
not known if weight gain influences risk. OBJECTIVE: To determine if weight,
weight gain, body mass index (BMI), and waist circumference are associated with
kidney stone formation. DESIGN, SETTING, AND PARTICIPANTS: A prospective study of
3 large cohorts: the Health Professionals Follow-up Study (N = 45,988 men; age
range at baseline, 40-75 years), the Nurses' Health Study I (N = 93,758 older
women; age range at baseline, 34-59 years), and the Nurses' Health Study II (N = 
101,877 younger women; age range at baseline, 27-44 years). MAIN OUTCOME
MEASURES: Incidence of symptomatic kidney stones. RESULTS: We documented 4827
incident kidney stones over a combined 46 years of follow-up. After adjusting for
age, dietary factors, fluid intake, and thiazide use, the relative risk (RR) for 
stone formation in men weighing more than 220 lb (100.0 kg) vs men less than 150 
lb (68.2 kg) was 1.44 (95% confidence interval [CI], 1.11-1.86; P = .002 for
trend). In older and younger women, RRs for these weight categories were 1.89
(95% CI, 1.52-2.36; P<.001 for trend) and 1.92 (95% CI, 1.59-2.31; P<.001 for
trend), respectively. The RR in men who gained more than 35 lb (15.9 kg) since
age 21 years vs men whose weight did not change was 1.39 (95% CI, 1.14-1.70; P = 
.001 for trend). Corresponding RRs for the same categories of weight gain since
age 18 years in older and younger women were 1.70 (95% CI, 1.40-2.05; P<.001 for 
trend) and 1.82 (95% CI, 1.50-2.21; P<.001 for trend). Body mass index was
associated with the risk of kidney stone formation: the RR for men with a BMI of 
30 or greater vs those with a BMI of 21 to 22.9 was 1.33 (95% CI, 1.08-1.63;
P<.001 for trend). Corresponding RRs for the same categories of BMI in older and 
younger women were 1.90 (95% CI, 1.61-2.25; P<.001 for trend) and 2.09 (95% CI,
1.77-2.48; P<.001 for trend). Waist circumference was also positively associated 
with risk in men (P = .002 for trend) and in older and younger women (P<.001 for 
trend for both). CONCLUSIONS: Obesity and weight gain increase the risk of kidney
stone formation. The magnitude of the increased risk may be greater in women than
in men.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15671430 [PubMed - indexed for MEDLINE]

751: J Endourol. 2004 Nov;18(9):858-61.

Laparoscopy-assisted transperitoneal percutaneous nephrolithotomy for recurrent
calculus in isthmic calix of horseshoe kidney.

Maheshwari PN, Bhandarkar DS, Shah RS, Andankar MG, Saple AL.

Department of Urology, R.G. Stone Urological Research Institute, Mumbai 400 036, 
India.

BACKGROUND AND PURPOSE: Management of urolithiasis in a horseshoe kidney (HSK)
poses a unique challenge. Although most patients can be managed by a combination 
of percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy
(SWL), calculi in the isthmic calix remain difficult to treat, as this area is
out of reach during rigid PCNL, and, owing to the poor evacuation of the
fragments, the results of SWL are suboptimal. CASE REPORT: A 59-year-old man
known to have an HSK presented with right-sided lower-abdominal pain and episodes
of urinary infection. In the past, he had undergone pyelolithotomy and
lithotripsy for lithiasis in the kidney. Imaging studies identified a large
recurrent calculus in the anteriorly directed isthmic calix. This was treated
successfully by a laparoscopy-assisted transperitoneal PCNL. The laparoscopic
view allowed the bowel to be retracted away from the site of the HSK, and PCNL
guided by fluoroscopy and laparoscopy was performed. Complete stone clearance was
achieved in a single stage. The patient remains free of symptoms and recurrence 3
months later. CONCLUSION: We believe this to be the first report describing this 
novel approach to lithiasis in an HSK.

Publication Types: 
    Case Reports

PMID: 15659919 [PubMed - indexed for MEDLINE]

752: J Endourol. 2004 Nov;18(9):853-7.

Stone disease in the Hmong of Minnesota: initial description of a high-risk
population.

Portis AJ, Hermans K, Culhane-Pera KA, Curhan GC.

Metro Urology, Fort Road Medical Building, 360 Sherman Street, Suite 400, St.
Paul, MN 55102, USA. aportis@metro-urology.com

BACKGROUND AND PURPOSE: The Hmong are an ethically distinct refugee population
from the highlands of Laos. Metropolitan Minneapolis-St. Paul, Minnesota is home 
to the largest population of Hmong ( 40,000) outside Asia. A clinical impression 
that the Hmong have a high rate of uric acid stone disease was evaluated.
PATIENTS AND METHODS: A retrospective chart review was performed. All adult Hmong
patients seen between January 1, 2000, and December 31, 2001, by a large urology 
group practice (N = 205) were compared with a similar number of non-Hmong
patients (N = 204). RESULTS: Of these patients, 94 Hmong (46%) and 23 non-Hmong
(11%) patients had stone disease (P < 0.001). After addition of 75 non-Hmong
stone patients to create a suitable comparison group, a total of 86 Hmong and 88 
non-Hmong stone patients had complete records. Sex (57% v 60% male) and mean age 
(47.9 v 47.3 years) were similar. Staghorn calculi were found in 21 Hmong (24%)
and 0 non-Hmong patients (P < 0.001). Surgical treatments differed between Hmong 
and non-Hmong (P = 0.004): SWL (16 v 35), ureteroscopy (24 v 29), percutaneous
nephrolithotomy (19 v 7), and nephrectomy (5 v 0). Treatment for staghorn calculi
was refused by 9 Hmong patients (43%). Stone composition was available in 40
Hmong and 39 non-Hmong. Uric acid (>10%) was found in 50% of Hmong and 10% of
non-Hmong stones (P < 0.001). CONCLUSIONS: Hmong patients who come to urologic
attention tend to do so for stone disease and tend to have uric acid calculi. The
frequent requirement for invasive therapy, including nephrectomy, in the Hmong is
of concern.

PMID: 15659918 [PubMed - indexed for MEDLINE]

753: J Endourol. 2004 Nov;18(9):844-7.

"Pass the ball!" Simultaneous flexible nephroscopy and retrograde intrarenal
surgery for large residual upper-pole staghorn stone.

Undre S, Olsen S, Mustafa N, Patel A.

Department of Urology, St. Mary's Hospital, Praed Street, Paddington, London W2
1NY, U.K. s.undre@imperial.ac.uk

Complex staghorn calculi have conventionally been treated with percutaneous
nephrolithotomy, extracorporeal lithotripsy, or, occasionally, open surgery.
Access to branched calculi is difficult through a single percutaneous track. We
tested and make a case for a synchronous bidirectional technique combining the
use of flexible instruments through percutaneous and retrograde approaches. We
present a case of "pass the ball," which may have a place in tackling large,
complex, or branched staghorn calculi without the need for multiple percutaneous 
punctures, removing larger fragments than is possible through the ureter and
avoiding multiple passes through the ureter, saving time and decreasing the
possibility of iatrogenic ureteral injury.

Publication Types: 
    Case Reports

PMID: 15659916 [PubMed - indexed for MEDLINE]

754: J Endourol. 2004 Oct;18(8):780-2.

Holmium laser percutaneous nephrolithotomy using a unique suction device.

Cuellar DC, Averch TD.

Department of Urology, The University of Pittsburgh Medical Center, Pittsburgh,
Pennsylvania 15213, USA.

BACKGROUND AND PURPOSE: Most percutaneous nephrolithotomies are performed with
electrohydraulic, ballistic, or ultrasonic lithotripsy, with holmium laser use
reserved for ureteroscopy or ureterorenoscopy. We evaluated the feasibility of
holmium laser use in percutaneous nephrolithotomy with the assistance of a unique
suction device. PATIENTS AND METHODS: The charts of 71 consecutive patients
undergoing 90 percutaneous procedures were reviewed. A unique suction device and 
the holmium laser were used in nearly half the patients. The average stone burden
was 3.25 cm. Use of holmium laser, energy settings, stone burden, operative time,
complications, and stone-free rate were evaluated. RESULTS: The average operative
time was 167 minutes with a complication rate of 14%. A stone-free rate of 83%
was achieved with the laser. CONCLUSIONS: With the assistance of a unique suction
device, the holmium laser can, in the appropriate situation, be an efficient and 
successful lithotrite with percutaneous nephrolithotomy.

PMID: 15659902 [PubMed - indexed for MEDLINE]

755: J Endourol. 2004 Oct;18(8):743-7.

No panacea for drainage after percutaneous nephrolithotomy.

Marcovich R, Jacobson AI, Singh J, Shah D, El-Hakim A, Lee BR, Smith AD.

Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York
11040-1496, USA.

BACKGROUND AND PURPOSE: The optimal postoperative drainage system for patients
undergoing percutaneous nephrolithotomy (PCNL) has not yet been determined. Each 
of the different tubes available has theoretical advantages and disadvantages.
The objective of this study was to determine if any one system of post-PCNL
drainage has any significant advantage over the others. PATIENTS AND METHODS:
Sixty patients were randomized to either a 24F Re-entry tube (Group 1), an 8F
pigtail catheter (Group 2), or a double-J stent (Group 3) (N = 20 for all
groups). The double-J stent patients also had an 18F Councill catheter as a
nephrostomy tube, which was removed on the morning of postoperative day 1. The
three groups were well-matched for age, stone size, operative time, and mean
number of percutaneous tracts (P > 0.05 for all). Data collected included
intraoperative findings, postoperative analog pain scores and narcotic usage,
presence of extravasation on postoperative nephrostogram, presence of perinephric
fluid on postoperative ultrasound scans, length of stay, and whether leakage from
the nephrostomy site persisted more than 48 hours after tube removal. RESULTS:
There were no statistically significant differences among the three groups in
terms of change in hematocrit or number of patients requiring blood transfusion; 
in the incidence of tube blockage, extravasation, or presence of perinephritic
fluid; or in complication rates, length of hospital stay, or persistent leakage
after tube removal. There was a strong trend to less postoperative leakage with
the 8F pigtail than the Reentry tube (P = 0.05). Postoperative analog pain scores
and narcotic usage were equivalent for all three groups. Patients Groups 1 and 2 
were free of all tubes sooner than patients in Group 3 (P < 0.001). CONCLUSIONS: 
This study did not demonstrate an overwhelming advantage of any one drainage
system over the others. All three systems were equally tolerated by patients.
There may be less chance of prolonged nephrostomy-site leakage with an 8F pigtail
catheter.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 15659895 [PubMed - indexed for MEDLINE]

756: J Endourol. 2004 Oct;18(8):715-22.

Factors affecting blood loss during percutaneous nephrolithotomy: prospective
study.

Kukreja R, Desai M, Patel S, Bapat S, Desai M.

Department of Urology, Muljibhai Patel Urological Hospital Nadiad, Gujarat,
India.

BACKGROUND AND PURPOSE: Bleeding is a major concern during percutaneous
nephrolithotomy (PCNL), especially with the use of multiple tracts. This
prospective study aimed to identify factors affecting blood loss during PCNL.
PATIENTS AND METHODS: Data were collected prospectively from 236 patients
undergoing 301 PCNL procedures at our institute since June 2002. Blood loss was
estimated by the postoperative drop in hemoglobin factored by the quantity of any
blood transfusion. Various patient-related and intraoperative factors were
assessed for association with total blood loss or blood transfusion requirement
using stepwise multivariate regression analysis. RESULTS: The average hemoglobin 
drop was 1.68 +/- 1.23 g/dL. Stepwise multivariate regression analysis showed
that the occurrence of operative complications (P < 0.0001), mature nephrostomy
tract (P < 0.0001), operative time (P < 0.0001), method of access guidance
(fluoroscopy v ultrasound) (P = 0.0001), method of tract dilatation (P = 0.0001),
multiple (> or =2) tracts (P = 0.003), size of the tract (P = 0.001), renal
parenchymal thickness (P = 0.05), and diabetes (P = 0.05) were significant
predictors of blood loss. The overall blood transfusion rate for all patients was
7.9%. Preoperative hemoglobin, multiple tracts, stone size, and total blood loss 
were significant in predicting perioperative blood transfusion requirement.
Factors such as age, hypertension, renal insufficiency, urinary infection, the
degree of hydronephrosis, stone bulk, and the function of the ipsilateral renal
unit did not have any effect on the blood loss. Technical factors such as the
operating surgeon and the calix of entry also did not affect the blood loss.
CONCLUSIONS: Diabetes, multiple-tract procedures, prolonged operative time, and
the occurrence of intraoperative complications are associated with significantly 
increased blood loss. Atrophic parenchyma and past ipsilateral intervention are
associated with reduced blood loss. On the basis of this evidence, maneuvers that
may reduce blood loss and transfusion rate include ultrasound-guided access, use 
of Amplatz or balloon dilatation systems, reducing the operative time, and
staging the procedure in cases of a large stone burden or intraoperative
complications. Reducing the tract size in pediatric cases, nonhydronephrotic
systems and those with a narrow infundibulum, and secondary tracts in a
multiple-tract procedure may also reduce blood loss during PCNL.

PMID: 15659890 [PubMed - indexed for MEDLINE]

757: J Altern Complement Med. 2004 Oct;10(5):785-9.

The unexpected outcomes of acupuncture: case reports in support of refocusing
research designs.

Schulman D.

schulman@isn.net

Two distinct positive outcomes are possible with Classical Acupuncture;
resolution of the "main complaint" for which the patient is seeking treatment and
unexpected resolution of health concerns for which the patient is not seeking
treatment. Two clinical cases are presented to illustrate this phenomenon
clearly. In both cases, the unexpected outcomes follow logically from the central
therapeutic imperative of Oriental medicine; treatment of both the patient's root
and branch. Research designs focused on single health conditions do little to
reflect this central clinical reality. To highlight this problem, the two cases
presented here are repositioned within the framework of research designs focused 
on single health conditions. It becomes clear that any eventual "gold standard"
of acupuncture-appropriate research designs would reflect the full health care
service provided by Classical Acupuncture. This, in turn, would ensure that
health care policies based on research results would be appropriate to the
realities of clinical acupuncture.

Publication Types: 
    Case Reports

PMID: 15650467 [PubMed - indexed for MEDLINE]

758: J Am Soc Nephrol. 2005 Feb;16(2):417-24. Epub 2005 Jan 12.

Thiazides reduce brushite, but not calcium oxalate, supersaturation, and stone
formation in genetic hypercalciuric stone-forming rats.

Bushinsky DA, Asplin JR.

Department of Medicine, University of Rochester School of Medicine and Dentistry,
Strong Memorial Hospital, 601 Elmwood Avenue, Box 675, Rochester, NY 14642, USA. 
david_bushinsky@urmc.rochester.edu

Over 59 generations, a strain of rats has been inbred to maximize urine calcium
excretion. The rats now excrete eight to 10 times as much calcium as controls.
These rats uniformly form calcium phosphate (apatite) kidney stones and have been
termed genetic hypercalciuric stone-forming (GHS) rats. The addition of a common 
amino acid and oxalate precursor, hydroxyproline, to the diet of the GHS rats
leads to formation of calcium oxalate (CaOx) kidney stones.
Hydroxyproline-supplemented GHS rats were used to test the hypothesis that the
thiazide diuretic chlorthalidone would decrease urine calcium excretion,
supersaturation, and perhaps stone formation. All GHS rats received a fixed
amount of a standard 1.2% calcium diet with 5% trans-4-hydroxy-l-proline
(hydroxyproline) so that the rats would exclusively form CaOx stones. Half of the
rats had chlorthalidone (Thz; 4 to 5 mg/kg per d) added to their diets. Urine was
collected weekly, and at the conclusion of the study, the kidneys, ureters, and
bladders were radiographed for the presence of stones. Compared with control, the
addition of Thz led to a significant reduction of urine calcium and phosphorus
excretion, whereas urine oxalate excretion increased. Supersaturation with
respect to the calcium hydrogen phosphate fell, whereas supersaturation with
respect to CaOx was unchanged. Rats that were fed Thz had fewer stones. As
calcium phosphate seems to be the preferred initial solid phase in patients with 
CaOx kidney stones, the reduction in supersaturation with respect to the calcium 
phosphate solid phase may be the mechanism by which thiazides reduce CaOx stone
formation.

Publication Types: 
    Comparative Study
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.

PMID: 15647340 [PubMed - indexed for MEDLINE]

759: J Urol. 2005 Feb;173(2):469-73.

Treatment of complete staghorn stones: a prospective randomized comparison of
open surgery versus percutaneous nephrolithotomy.

Al-Kohlany KM, Shokeir AA, Mosbah A, Mohsen T, Shoma AM, Eraky I, El-Kenawy M,
El-Kappany HA.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

PURPOSE: We studied the role of open surgery versus percutaneous nephrolithotomy 
(PCNL) in the treatment of complete staghorn stones in a prospective randomized
manner. MATERIALS AND METHODS: A total of 79 patients with 88 complete staghorn
stones, defined as filling the entire collecting system or at least 80% of it,
were prospectively randomized for PCNL (43) or open surgery (45). Intraoperative 
and postoperative morbidity, operative time, hospital stay, and stone clearance
at discharge home and followup were compared for both methods. Patients with
significant residuals in both groups were subjected to extracorporeal shock wave 
lithotripsy (Dornier Medical Systems, Inc., Marietta, Georgia) on an outpatient
basis. Followup was completed for all cases with a mean duration +/- SD of 4.9
+/- 2.5 months (range 3 to 14). Renal function was evaluated by
Tc-mercaptoacetyltriglycine renogram before and after treatment in both groups.
RESULTS: Intraoperative complications in terms of bleeding requiring blood
transfusion, and pleural, vascular or ureteral injuries were recorded in 7
patients (16.3%) in the PCNL and 17 (37.8%) in the open surgery groups, a
difference of significant value (p <0.05). Major postoperative complications
including massive hematuria requiring blood transfusion, septicemia, urinary
leakage and wound infection were observed in 8 patients (18.6%) in the PCNL group
and in 14 (31.1%) in the open surgery group, a difference of no significant
value. PCNL was associated with shorter operative time (127 +/- 30 vs 204 +/- 31 
minutes, p <0.001), shorter hospital stay (6.4 +/- 4.2 vs 10 +/- 4.2 days, p
<0.001) and earlier return to work (2.5 +/- 0.8 vs 4.1 +/- 1 weeks, p <0.001). On
the other hand both treatment groups were comparable in regard to stone-free
rates at discharge home (49% vs 66%) and at followup (74% vs 82%). At followup
renal function improved or remained stable in 91% and 86.7% in the PCNL and open 
surgery groups, respectively. CONCLUSIONS: PCNL is a valuable treatment option
for complete staghorn stones with a stone-free rate approaching that of open
surgery. Moreover, it has the advantages of lower morbidity, shorter operative
time, shorter hospital stay and earlier return to work.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 15643212 [PubMed - indexed for MEDLINE]

760: J Urol. 2005 Feb;173(2):458-62.

Emergency drainage for urosepsis associated with upper urinary tract calculi.

Yoshimura K, Utsunomiya N, Ichioka K, Ueda N, Matsui Y, Terai A.

Department of Urology, Kurashiki Central Hospital, Kuashiki, Japan.
ky7527@kchnet.or.jp

PURPOSE: We examined the characteristics of patients with urosepsis associated
with upper urinary tract calculi requiring emergency drainage. MATERIALS AND
METHODS: From January 1994 to December 2003, 424 patients were admitted to our
urological department a total of 473 times for treatment of upper urinary tract
calculi, of whom 53 required a total of 59 emergency drainage procedures for
urosepsis. We summarized the characteristics of these patients and events, and
determined risk factors for emergency drainage using logistic regression
analysis. RESULTS: In 14 events (24%) intensive management, such as the use of
vasopressors and anticoagulants, was performed. Transient thrombocytopenia less
than 100,000/mm occurred in 18 events (31%). Hyperbilirubinemia occurred in 8 of 
38 events (16%) without prior antibiotic therapy. One patient (2%) died of
urosepsis. Patients with calculi who underwent emergency drainage required a
longer hospital stay than those without emergency drainage (25.2 vs 14.8 days, p 
<0.001). Of the variables analyzed poor performance status (Karnofsky performance
status 70% or less, OR 2.9, p = 0.003), age 75 years or older (OR 2.1, p = 0.038)
and female sex (OR 1.8, p = 0.046) were risk factors on multivariate analysis.
CONCLUSIONS: Our findings suggest that the frequency of emergency drainage in
elderly patients with poor performance status has increased in recent years, at
least in our rural area of Japan. Preventing calculous formation and urinary
tract infection in individuals with poor performance status will be of
considerable importance in the future.

PMID: 15643207 [PubMed - indexed for MEDLINE]

761: BJU Int. 2005 Jan;95(1):137-9.

Simultaneous bilateral percutaneous nephrolithotomy in children.

Salah MA, Tállai B, Holman E, Khan MA, Tóth G, Tóth C.

Department of Urology, Medical and Health Science Center, University of Debrecen,
Nagyerdei krt. 98, 4032 Debrecen, Hungary. morshed@jaguar.unideb.hu

In the paediatric section, two papers relating to the upper urinary tract are
presented. The first, from Hungary, describes simultaneous bilateral percutaneous
nephrolithotomy in 13 patients, where it was deemed feasible; this is the first
such report. Authors from London report on unilateral nephrectomy in patients
with nephrogenic hypertension, and found that it was successful in normalising
blood pressure in patients with renal hypertension with a normal contralateral
kidney. OBJECTIVE: To evaluate the efficacy of removing bilateral kidney stones
simultaneously from children, in one session. PATIENTS AND METHODS: Thirteen
patients (three girls and 10 boys, 26 kidneys; mean age 8 years, range 3-14)
underwent simultaneous bilateral percutaneous nephrolithotomy (PCNL) in the same 
session, under general anaesthesia, starting with ureteric catheter insertion
into both kidneys and using a 26 F adult nephroscope. The mean (range) stone
diameter was 2 (1-3.5) cm. Three patients had staghorn stones in one of their
kidneys. Ultrasonic disintegration was used; two patients had bilateral and two
others unilateral endopylotomy, and one patient had percutaneous suprapubic
cystolithotomy in the same session. The mean (range) operative duration was 65
(55-90) min. RESULTS: All patients were rendered stone-free; there was no severe 
bleeding or any other complication. On one side in one of the patients, a second 
session was needed because of residual stone. The nephrostomy tubes were removed 
3 and 4 days after PCNL and the hospital stay was 6 (1-11) days. CONCLUSION: The 
advantages of simultaneous bilateral PCNL are reduced psychological stress, one
cystoscopy and anaesthesia, less medication and a shorter hospital stay and
convalescence, with considerable savings in cost. In experienced hands this
method can be used not only in adults but also in children. To our knowledge this
is the only report of this technique in children.

Publication Types: 
    Evaluation Studies

PMID: 15638911 [PubMed - indexed for MEDLINE]

762: Nephron Physiol. 2005;99(3):p69-73.

Chloride channels and endocytosis: new insights from Dent's disease and ClC-5
knockout mice.

Devuyst O, Jouret F, Auzanneau C, Courtoy PJ.

Division of Nephrology, CELL Unit, Christian de Duve Institute of Cellular
Pathology, Université catholique de Louvain Medical School, Brussels, Belgium.
devuyst@nefr.ucl.ac.be <devuyst@nefr.ucl.ac.be>

Dent's disease is a hereditary renal tubular disorder characterized by
low-molecular weight (LMW) proteinuria, hypercalciuria and nephrolithiasis. The
disease is due to mutations of ClC-5, a member of the family of voltage-gated CLC
chloride channels. ClC-5 is expressed in part in cells lining the proximal tubule
(PT) of the kidney, where it colocalizes with albumin-containing endocytic
vesicles belonging to the receptor-mediated endocytic pathway that ensures
efficient reabsorption of ultrafiltrated LMW proteins. Since progression along
the endocytic apparatus requires endosomal acidification, it has been suggested
that dysfunction of ClC-5 in endosomes may lead to inefficient reabsorption of
LMW proteins and dysfunction of PT cells. Analysis of a ClC-5 knockout (KO) mouse
model, displaying all the characteristic renal tubular defects of Dent's disease,
showed evidence of a severe LMW proteinuria. Cytochemical studies with the
endocytic tracer, peroxidase, showed poor transfer into early endocytic vesicles,
suggesting that impairment of receptor-mediated endocytosis in PT cells is the
basis for the defective uptake of LMW proteins in patients with Dent's disease.
Endocytosis and processing of LMW proteins involve the multiligand tandem
receptors, megalin and cubilin, that are abundantly expressed at the brush border
of PT cells. Characterization of the endocytic defect in ClC-5 KO mice revealed
that ligands of both megalin and cubilin were affected. The total kidney content 
of megalin and especially cubilin at the protein level was decreased but, more
importantly, using analytical subcellular fractionation and quantitative
immunogold labelling we demonstrated a selective disappearance of megalin and
cubilin at the brush border of PT cells. These observations allowed us to
conclude that defective protein endocytosis linked to ClC-5 inactivation is due
at least in part to a major and selective loss of megalin and cubilin at the
brush border, reflecting a trafficking defect in renal PT cells. These results
improve our understanding of Dent's disease, taken as a paradigm for renal
Fanconi syndrome and nephrolithiasis, and demonstrate multiple roles for ClC-5 in
the kidney. These studies also provided insights into important functions such as
apical endocytosis, handling of proteins by renal tubular cells, calcium
metabolism, and urinary acidification. Copyright (c) 2005 S. Karger AG, Basel.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15637424 [PubMed - indexed for MEDLINE]

763: Urol Res. 2005 Feb;33(1):51-6. Epub 2005 Jan 5.

An experimental study on residual lithiasis after shock wave lithotripsy.

Costa-Bauzá A, Perelló J, Isern B, Grases F.

Laboratory of Renal Lithiasis Research, Institute of Health Sciences Research
(IUNICS), University of Balearic Islands. 07122 Palma of Mallorca, Spain.

The main objective of this paper was to study residual lithiasis after
extracorporeal shock wave lithotripsy (post-ESWL), with the aim of contributing
to the development of effective prophylactic measures. In vivo regrown calcium
oxalate monohydrate (COM) post-ESWL residual fragments were studied by
stereoscopic microscopy, infrared spectroscopy and scanning electron microscopy
with an energy dispersive X-ray analyzer. An in vitro system was also used to
study the regrowth of post-ESWL fragments of COM calculi. The regrowth was
evaluated as the relative increase in the weight of the fragments. The effects of
a calcium oxalate crystallization inhibitor (phytate) were also evaluated. All of
the in vivo regrown COM real residual post-ESWL fragments exhibited practically
the same internal structural features. The in vitro studies demonstrated that the
regrowth of post-ESWL residual fragments, in the absence of crystallization
inhibitors, occurred even using normocalciuric/normooxaluric urine and could be
detected at 24 h. At 144-240 h, the formation of new COM columnar zones was
observed. The presence of 1.5 mg/l of phytate totally blocked the growth process.
When hypercalciuric/normooxaluric urine was used, significant amounts of
disorganized calcium oxalate dihydrate (COD) crystals were formed. The in vitro
regrowth of post-ESWL COM fragments was clearly influenced by the presence of
crystallization inhibitors. These data also demonstrate the importance that
effective prophylactic therapies could exert on preventing recurrence.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 15633055 [PubMed - indexed for MEDLINE]

764: J Ayub Med Coll Abbottabad. 2004 Jul-Sep;16(3):56-8.

Epidemiological risk factors and composition of urinary stones in Riyadh Saudi
Arabia.

Khan AS, Rai ME, Gandapur, Pervaiz A, Shah AH, Hussain AA, Siddiq M.

Women Medical College, Abbottabad.

BACKGROUND: The purpose of this study was to perform the chemical analysis of
stones to know the pattern of biochemical composition of stones and to determine 
epidemiological risk factors for stone formation in Riyadh Saudi Arabia. METHODS:
307 renal stones were analyzed during one year period from September 2000 to
August 2001. These stones were sent to central lab Riyadh for analysis from
different hospitals attached to this region. The stones were analyzed by
semiquantitative method. The kits supplied by Maascia Bruneli SPA. (Italy) was
used for chemical analysis of stones. The powered stones and standards both were 
analyzed for uric acid, cystine, oxalate, carbonate, phosphate, ammonia, calcium 
and magnesium contents. RESULTS: Male to female ratio was 5:1. The stone
frequency was 2.5 times more in Saudis as compared to non-Saudis. Maximum number 
of stones were analyzed in peak summer months. Calcium oxalate stones were the
commonest followed by uric acid and phosphate stones. No cystine stone was found 
in the series analyzed. CONCLUSION: From the study of epidemiological factors it 
seems that the Saudis are more prone to development of stones. A clear stone
season seems to exist in the area corresponding to the summer months. The
relative increased frequency of stones in the region indicates that nutritional, 
environmental and genetic factors play a role in the occurrence of stones.

PMID: 15631374 [PubMed - indexed for MEDLINE]

765: Urol Res. 2005 Feb;33(1):70-1. Epub 2004 Dec 30.

A knotted multi-length ureteral stent: a rare complication.

Sighinolfi MC, De Stefani S, Micali S, Mofferdin A, Baisi B, Celia A, Bianchi G.

Department of Urology, University of Modena and Reggio Emilia, Via Del Pozzo 71, 
41100 Modena, Italy. sighinolfic@yahoo.com

Ureteral catheters represent essential devices in the management of upper urinary
tract obstruction; complications are unusual. Knotting of the stent at its
proximal coiled end is a very rare but potentially dangerous event that should be
promptly recognized.

Publication Types: 
    Case Reports

PMID: 15625611 [PubMed - indexed for MEDLINE]

766: QJM. 2005 Jan;98(1):57-68.

Recurrent uric acid stones.

Kamel KS, Cheema-Dhadli S, Shafiee MA, Davids MR, Halperin ML.

St. Michael's Hospital, 38 Shuter Street, Toronto, Ontario M5B 1A6, Canada.

A 46-year-old female had a history of recurrent uric acid stone formation, but
the reason why uric acid precipitated in her urine was not obvious, because the
rate of urate excretion was not high, urine volume was not low, and the pH in her
24-h urine was not low enough. In his discussion of the case, Professor McCance
provided new insights into the pathophysiology of uric acid stone formation. He
illustrated that measuring the pH in a 24-h urine might obscure the fact that the
urine pH was low enough to cause uric acid to precipitate during most of the day.
Because he found a low rate of excretion of NH(4)(+) relative to that of sulphate
anions, as well as a high rate of citrate excretion, he speculated that the low
urine pH would be due to a more alkaline pH in proximal convoluted tubule cells. 
He went on to suspect that there was a problem in our understanding of the
function of renal medullary NH(3) shunt pathway, and he suggested that its major 
function might be to ensure a urine pH close to 6.0 throughout the day, to
minimize the likelihood of forming uric acid kidney stones.

Publication Types: 
    Review

PMID: 15625355 [PubMed - indexed for MEDLINE]

767: Proc Natl Acad Sci U S A. 2005 Jan 11;102(2):267-72. Epub 2004 Dec 29.

Adhesion at calcium oxalate crystal surfaces and the effect of urinary
constituents.

Sheng X, Jung T, Wesson JA, Ward MD.

Department of Chemical Engineering and Materials Science, University of
Minnesota, 421 Washington Avenue SE, Minneapolis, MN 55455, USA.

Kidney stones, aggregates of microcrystals, most commonly contain calcium oxalate
monohydrate (COM) as the primary constituent. The aggregation of COM
microcrystals and their attachment to epithelial cells are thought to involve
adhesion at COM crystal surfaces, mediated by anionic molecules or urinary
macromolecules. Identification of the most important functional group-crystal
face adhesive combinations is crucial to understanding the stability of COM
aggregates and the strength of their attachments to epithelial cell surfaces
under flow in the renal tubules of the kidney. Here, we describe direct
measurements of adhesion forces, by atomic force microscopy, between various
functional groups and select faces of COM crystals immersed in aqueous media.
Tip-immobilized carboxylate and amidinium groups displayed the largest adhesion
forces, and the adhesive strength of the COM crystal faces decreased in the order
(100) > (121) > (010), demonstrating that adhesion is sensitive to the structure 
and composition of crystal faces. The influence of citrate and certain urinary
proteins on adhesion was examined, and it was curious that osteopontin, a
suspected regulator of stone formation, increased the adhesion force between a
carboxylate tip and the (100) crystal face. This behavior was unique among the
various combinations of additives and COM crystal faces examined here.
Collectively, the force measurements demonstrate that adhesion of functional
groups and binding of soluble additives, including urinary macromolecules, to COM
crystal surfaces are highly specific in nature, suggesting a path toward a better
understanding of kidney stone disease and the eventual design of therapeutic
agents.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 15625112 [PubMed - indexed for MEDLINE]

768: Urol Res. 2005 May;33(2):93-8. Epub 2004 Dec 24.

A decrease in blood pressure following pyelolithotomy but not extracorporeal
lithotripsy.

Eterović D, Situm M, Juretić-Kuscić L, Dujić Z.

Department of Physiology and Biophysics, Medical School in Split, Soltanska 2,
21000 Split, Croatia. eterovic@bsb.mefst.hr

Our aim was to evaluate the hypothesis that relief of renal obstruction lowers
the arterial blood pressure if the procedure of stone removal does not injure the
kidney itself. Sixty patients with unilateral renal stone were evaluated at
baseline and 3 months after electrical shockwave lithotripsy (ESWL, n=30) or
Gil-Vernet intrasinus pyelolithotomy (n=30). Blood pressures were measured
noninvasively and renal vascular resistances were obtained from radionuclide
measurements of renal blood flow. At baseline, the renal vascular resistance of
the obstructed kidney was 2 and 2.5 times greater than of the unobstructed kidney
in the ESWL and pyelolithotomy groups, respectively. After 3 months in operated
patients, the blood pressure decreased (from 87 to 81 mm Hg, P=0.002, in case of 
diastolic, and from 140 to 132 mm Hg, P<0.0001, in case of systolic pressure),
while the vascular resistances of both kidneys were equal and normal. In
contrast, in the ESWL group the blood pressures and vascular resistances of the
treated kidney did not differ from the baseline values. Surgical relief of renal 
obstruction chronically lowers the arterial blood pressure, possibly by
normalizing the renal vascular resistance. ESWL does not change the blood
pressure or renal vascular resistance, which could reflect a balance between the 
relief of obstruction and kidney lesions induced by shock waves.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 15619123 [PubMed - indexed for MEDLINE]

769: Bull Mem Acad R Med Belg. 2004;159(Pt 2):212-7.

Chloride channels and endocytosis: new insights from Dent's disease and CLC-5
knockout mice.

Devuyst O.

Division of Nephrology, Université catholique de Louvain Medical School,
Brussels, Belgium.

Dent's disease is an hereditary renal tubular disorder characterized by
low-molecular-weight (LMW) proteinuria, hypercalciuria and nephrolithiasis. The
disease is due to mutations of CLC-5, a member of the family of voltage-gated CLC
chloride channels. CLC-5 is distributed in cells lining the proximal tubule (PT) 
of the kidney, where it co-localizes with albumin-containing endocytic vesicles
that form part of the receptor-mediated endocytic pathway that mediates the
reabsorption of low-molecular-weight (LMW) proteins filtered at the glomerular
level. Since progression along the endocytic apparatus requires endosomal
acidification, it has been suggested that dysfunction of CLC-5 in endosomes may
lead to inefficient reabsorption of LMW proteins and dysfunction of PT cells.
Investigations conducted in a CLC-5 knockout (KO) mouse model harbouring all the 
characteristic renal tubular defects of Dent's disease showed a severe impairment
of endocytosis by PT cells, such that the endocytic tracer peroxidase was poorly 
transferred into early endocytic vesicles. These data demonstrated that an
impairment of receptor-mediated endocytosis in PT cells is the basis for the
defective uptake of LMW proteins in patients with Dent's disease. The endocytosis
and processing of LMW proteins involves the multiligand tandem receptors, megalin
and cubilin, that are abundantly expressed at the brush border of PT cells. The
characterization of the endocytic defect in CLC-5 KO mice revealed that ligands
of both megalin and cubilin were affected, whereas a decrease in total kidney
content of megalin and cubilin at the protein level was detected. Using
analytical subcellular fractionation and quantitative immunogold labelling, we
demonstrated a selective disappearance of megalin and cubilin at the brush border
of PT cells. These observations allowed us to conclude that defective protein
endocytosis linked to CLC-5 inactivation is due to a major and selective loss of 
megalin and cubilin at the brush border, reflecting a trafficking defect in renal
PT cells. These results improve our understanding of Dent's disease, taken as a
paradigm for renal Fanconi syndrome and nephrolithiasis, and demonstrate multiple
roles for CLC-5 in the kidney. These studies also provided insights in important 
functions such as apical endocytosis, handling of proteins by renal tubular
cells, calcium metabolism, and urinary acidification.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15615095 [PubMed - indexed for MEDLINE]

770: Bull Mem Acad R Med Belg. 2004;159(Pt 2):199-211.

Dent's disease--a nephrolithiasis disorder associated with defective
receptor-mediated endocytosis.

Thakker R.

Nuffield Department of Clinical Medicine, University of Oxford, Oxford Centre for
Diabetes, Endocrinology and Metabolism, Churchill Hospital.

Dent's disease, a renal tubular disorder characterized by low-molecular-weight
proteinuria (LMWP), hypercalciuria, and nephrolithiasis, is due to inactivating
mutations in the x-linked renal specific chloride channel CLC-5. CLC-5 belongs to
the family of voltage-gated chloride channels, which function as homodimeric
proteins with each subunit consisting of 18 helices and a chloride selectivity
filter, i.e. pore. None of the 15 CLC-5 missense mutations reported in patients
with dent's disease involves the chloride selectivity filter, but 12 of these are
clustered around the interface of the two subunits, thereby emphasising the
important role for the interaction between the two subunits at the interface of
the homodimeric CLC-5. In the kidney, CLC-5 forms part of the receptor-mediated
endocytic pathway, and defects in this pathway due to a loss of CLC-5 function,
may help to account for the LMWP, hyperphosphaturia, hypercalciuria and
nephrolithiasis. The molecular studies and the generation of mouse models of the 
disease have increased our understanding of the renal tubular mechanisms that
regulate mineral homeostasis.

Publication Types: 
    Review

PMID: 15615094 [PubMed - indexed for MEDLINE]

771: J Gastroenterol Hepatol. 2004 Dec;19(12):1403-9.

Infrequency of colonization with Oxalobacter formigenes in inflammatory bowel
disease: possible role in renal stone formation.

Kumar R, Ghoshal UC, Singh G, Mittal RD.

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow, India.

BACKGROUND AND AIM: Calcium oxalate renal stones (RS) and hyperoxaluria are
common in patients with inflammatory bowel disease (IBD). The absence of
intestinal oxalate degrading bacteria, Oxalobacter formigenes, may cause
hyperoxaluria in IBD. The aim of the present study was to examine: (i) the
colonization of O. formigenes in patients with IBD and controls and to correlate 
its presence with urinary oxalate excretion; and (ii) urinary analytes
contributing to RS in IBD. METHODS: Stool samples were studied for O. formigenes 
using polymerase chain reaction and Southern blotting in patients with IBD (n =
48: ulcerative colitis, 37; Crohn's disease, 11), RS (n = 87) and healthy
subjects that were used as controls (n = 48). Levels of urinary oxalate, citrate,
calcium, magnesium, creatinine and uric acid were estimated
spectrophotometrically in each patient and in 13 controls for 24 h. RESULTS: Five
of the 48 (10.4%) patients with IBD had RS. Five of the 48 (10.4%) patients with 
IBD, 25 of the 87 (29%) with RS and 27 of the 48 (56%) controls were colonized
with O. formigenes (P < 0.001 for RS vs controls and P = 0.01 for RS vs IBD).
Patients without O. formigenes had higher urinary oxalate than those with it
(IBD, median 0.48 [range 0.11-2.09]vs 0.43 [range 0.16-1.10] mmol/24 h, P = NS;
RS, median 0.59 mmol/24 h, range 0.14-1.90 vs 0.44 mmol/24 h, range 0.23-0.97; P 
= 0.008, Mann-Whitney U-test). Median excretion of oxalate was higher in IBD and 
RS than in controls (0.47 [0.11-2.09], 0.56 [0.14-1.9] and 0.41 [0.21-0.62]
mmol/24 h; P < 0.01), respectively. Median calcium was also higher in IBD and RS 
than in controls (6.50 [1.38-21.00], 6.78 [1.55-20.30] and 4.99 [1.47-9.60]
mmol/24 h; P < 0.05, Kruskal-Wallis H-test), respectively. Median urinary
magnesium was higher in IBD than in RS and controls (4.57 [1.50-12.30], 3.60
[0.90-6.35] and 2.49 [0.74-4.80]; P < 0.001, Kruskal-Wallis H-test),
respectively. Urinary citrate excretion was comparable in IBD, RS and controls.
CONCLUSIONS: Patients with IBD and RS rarely have O. formigenes in their stools
as compared with controls; this may contribute to hyperoxaluria in IBD.
Hyperoxaluria and hypercalciuria may contribute to RS in patients with IBD.
Hypermagnesuria in patients with IBD may protect them from RS.

PMID: 15610315 [PubMed - indexed for MEDLINE]

772: BJU Int. 2004 Dec;94(9):1352-4.

Percutaneous nephrolithotomy in children before school age: experience of a
Pakistani centre.

Mahmud M, Zaidi Z.

Department of Paediatric Urology, The Kidney Centre Postgraduate Training
Institute, Karachi, Pakistan.

OBJECTIVE: To review our experience of percutaneous nephrolithotomy (PCNL) in
children before school age, and determine its efficacy and safety in this age
group. PATIENTS AND METHODS: The records of children aged < or = 5 years
undergoing PCNL were reviewed. Variables assessed included stone number, size,
location and type. The PCNL puncture site and number were also recorded. We
reviewed stone clearance with PCNL, ancillary procedures used, complication rates
and follow-up status of the children. RESULTS: There were 30 renal units in 29
children (median age 3.8 years, range 1.4-5). Because of poor growth the mean
(SD) body weight of the children was only 12.2 (2.8) kg, which is near the 50th
percentile for children of mean age 3.5 years. The median (range) stone burden
was 2.35 (1.3-6) cm; 60% of the patients had single stones while 28% had more
than five. There were five staghorn stones. All PCNL was primary and with one
puncture, using a 17 F angled nephroscope; stones were fragmented using a
pneumatic lithoclast. After PCNL stones were completely cleared in 60% of the
renal units, which increased to 100% after combining it with extracorporeal
shockwave lithotripsy. The median (range) follow-up was 24.9 (4-51) months; the
overall complication rate was 6%. In the long follow-up hypertension was not
detected in any child and isotopic renograms in 17 kidneys detected no new
scarring or loss of renal function. CONCLUSION: PCNL is a safe and effective for 
treating renal stones in very young children.

Publication Types: 
    Evaluation Studies

PMID: 15610120 [PubMed - indexed for MEDLINE]

773: J Endourol. 2004 Sep;18(7):672-4.

Retroperitoneoscopic treatment of caliceal diverticular calculi: report of two
cases and review of the literature.

Terai A, Habuchi T, Terachi T, Kamoto T, Ogawa O.

Department of Urology, Faculty of Medicine, Kyoto University, Kyoto, Japan.
at7899@kchnet.or.jp

Two women with symptomatic stone-filled caliceal diverticula were treated by a
retroperitoneoscopic approach. With a three-port technique, the diverticulum was 
marsupialized, the calculi removed, the cavity fulgurated, and perirenal fat
inserted. The patients had no morbidity and remain stone and symptom free. They
represent the 17th and 18th reported cases of this condition. We also review the 
clinical results in the literature.

Publication Types: 
    Case Reports
    Review

PMID: 15597660 [PubMed - indexed for MEDLINE]

774: J Endourol. 2004 Sep;18(7):629-33.

Effect of stone motion on in vitro comminution efficiency of Storz Modulith SLX.

Cleveland RO, Anglade R, Babayan RK.

Department of Aerospace and Mechanical Engineering, Boston University, Boston,
Massachusetts 02215, USA. robinc@bu.edu

BACKGROUND AND PURPOSE: During SWL, stone motion secondary to ventilatory motion 
can be as much as 50 mm. This is much larger than the 4- to 15-mm diameter of the
focal regions on most clinical machines. The goal of this study was to determine 
the effect of stone motion on the fragmentation efficiency of a clinical
lithotripter with a small (4-mm) focal spot. MATERIALS AND METHODS: A model stone
(6.5 x 7.5 mm) made of gypsum cement was used as an in vitro target for a Storz
Modulith SLX lithotripter with a custom-designed waterbath. A motorized
positioner was used to translate the stone in order to simulate ventilatory
motion. The excursion was variable up to 48 mm (+/- 24 mm about the focus). After
treatment by 400 shockwaves, the remnants (> 2 mm) were dried and weighed.
RESULTS: Fragmentation efficiency was reduced (P < 0.05) for motion of > or = 10 
mm. Similar results were found with different energy levels and firing rates. The
reduction in fragmentation efficiency was consistent with calculations of the
time the stone was outside the focal region. CONCLUSIONS: Clinically relevant
stone motion has a dramatic effect on in vitro comminution. Motion of 10 mm led
to a significant reduction in comminution, and for motion > 20 mm, it appeared
that three-quarters of the shockwaves missed the stone. These data imply that
ventilatory gating or stone tracking may result in fewer shockwaves being
required for successful treatment with this lithotripter.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15597649 [PubMed - indexed for MEDLINE]

775: J Nephrol. 2004 Nov-Dec;17(6):774-7.

Crystals, Randall's plaques and renal stones: do bone and atherosclerosis teach
us something?

Gambaro G, D'Angelo A, Fabris A, Tosetto E, Anglani F, Lupo A.

Division of Nephrology, Department of Biomedical and Surgical Sciences,
University Hospital of Verona, Italy. giovanni.gambaro@univr.it

The pathogenesis of calcium-oxalate (CaOx) renal stones is still debated and a
number of issues needs to be clarified. In particular, it is difficult to combine
the intraluminal physical-chemical imbalance and fixed particle theory with the
evidence that CaOx stones actually form and grow on Randall's plaque in the renal
pelvis. On the basis of recent findings in renal stone research, and data from
the biology of ectopic calcification, the hypothesis is advanced that abnormal
pre-urine CaOx supersaturation triggers inflammation in the long Henle's loop
cells at tip forceps level. This in turn induces differentiation of these cells
toward the osteogenic lineage, determining the synthesis of typical bone osteoid 
proteins (osteopontin, osteocalcin, BMP-2, etc) and hydroxyapatite mineralization
of the Henle's basement membrane (beneath the differentiating cells) which
precedes Randal's plaque formation. This may constitute a further, still
unexplored example of epithelial-mesenchymal-differentiation in the kidney.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15593050 [PubMed - indexed for MEDLINE]

776: J Urol. 2005 Jan;173(1):271-5.

Preventive effects of green tea on renal stone formation and the role of
oxidative stress in nephrolithiasis.

Itoh Y, Yasui T, Okada A, Tozawa K, Hayashi Y, Kohri K.

Department of Surgical Medicine, Nephro-urology, Nagoya City University Graduate 
School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya City, Aichi
467-8601, Japan. yasu-itoh@toyokawa-ch-aichi.jp

PURPOSE: Urinary stones are similar to arteriosclerosis in epidemiology,
mechanism, calcification composition and age at frequent occurrence. The
calcification that occurs in arteriosclerosis is inhibited by antioxidants. Green
tea leaves contain approximately 13% catechins, which have been shown to have
antioxidant effects. We investigated the inhibitory, antioxidative effects of
green tea on calcium urinary stone formation. MATERIALS AND METHODS: A total of
120 Wistar rats were divided into 4 groups, namely group 1-control rats receiving
saline, group 2-stone group rats administered ethylene glycol (EG) and vitamin
D3, group 3-drink group rats administered EG, vitamin D3 and green tea given as
drinking water, and group 4-powder group rats administered EG, vitamin D3 and
2.5% powdered green tea leaves mixed in a powder diet. Pooled 24-hour urine
samples and blood samples were collected and the 2 kidneys were excised 7, 14 and
21 days after administration, respectively. One kidney was used for
immunohistological examination of osteopontin, superoxide dismutase (SOD), p65,
p53 and bcl-2 expression, in situ hybridization of osteopontin and detection of
apoptosis, while the other was used for quantitative analysis of SOD activity.
RESULTS: Green tea treatment decreased urinary oxalate excretion and calcium
oxalate deposit formation. Green tea treatment increased SOD activity compared
with the stone group. The degree of apoptosis in the stone group was
significantly increased compared with the drink and powder groups. CONCLUSIONS:
The inhibitory effect of green tea on calcium oxalate urolithiasis is most likely
due to antioxidative effects.

PMID: 15592095 [PubMed - indexed for MEDLINE]

777: J Urol. 2005 Jan;173(1):124-6.

Percutaneous access to upper pole renal stones: role of prone 3-dimensional
computerized tomography in inspiratory and expiratory phases.

Ng CS, Herts BR, Streem SB.

Section of Endourology and Stone Disease, Glickman Urological Institute and
Department of Radiology, Cleveland Clinic Foundation, 9500 Euclid Avenue,
Cleveland, OH 44195, USA.

PURPOSE: We evaluated the role of noncontrast, prone position, inspiratory and
expiratory 3-dimensional spiral computerized tomography (PIE-CT) for preoperative
planning of percutaneous treatment in patients with complex upper pole renal
calculi. MATERIALS AND METHODS: In this pilot study a total of 6 renal units in 4
women and 1 man with complex upper pole calculi who were candidates for
percutaneous nephrolithotomy were evaluated with thin section PIE-CT. With the
patient imaged in the prone position percutaneous access was simulated under 4
potential access conditions, including subcostal and intercostal, in inspiration 
and expiration. Each potential access was then deemed transpleural or
extrapleural and minimally angulated or severely angulated cephalad. RESULTS:
PIE-CT was performed uneventfully in all patients. Ideal nonangulated
extrapleural percutaneous access was deemed possible in 5 of 6 renal units.
However, inspiratory plus expiratory phases were necessary to identify the most
suitable access site. In 2 renal units only 1 safe access site was identified. No
pulmonary complications were noted in any of these patients. In 1 renal unit no
suitable access could be identified and this patient was treated with
laparoscopic caliceal diverticulectomy. CONCLUSIONS: Thin section PIE-CT offers
3-dimensionally rendered images that clearly demonstrate anatomical relationships
among the kidney, calculi, pleura, diaphragm, ribs and surrounding organs. In
this pilot study PIE-CT provided useful data for planning urological intervention
for complex upper pole renal stones. This study also suggests that
generalizations regarding the safety of upper pole access in the inspiratory or
expiratory phase are not warranted.

PMID: 15592052 [PubMed - indexed for MEDLINE]

778: J Urol. 2005 Jan;173(1):120-3.

Urinary matrix calculi: our experience at a single institution.

Bani-Hani AH, Segura JW, Leroy AJ.

Department of Urology, 200 First Street SW, Mayo Clinic, Rochester, Minnesota
55905, USA.

PURPOSE: Matrix stones are an uncommon form of urinary calculi and may be
mistaken for tumors involving the renal collecting system, thereby presenting a
diagnostic and therapeutic dilemma to the practicing urologist. MATERIALS AND
METHODS: From 1980 to 2003 we identified 5 patients with urinary matrix stones
referred to our tertiary medical center for evaluation and treatment. RESULTS:
All 5 cases had complex clinical and radiographic features at presentation. We
outline the clinical presentations, imaging findings and management, and review
the literature of matrix stone disease. CONCLUSIONS: A high index of suspicion is
required in diagnosing matrix calculi in addition to carefully selected
radiographic imaging. Due to their variable appearance in standard radiological
studies, the evaluation of matrix stones may require invasive techniques such as 
ureteroscopy for accurate diagnosis. Percutaneous removal is the primary
treatment modality to render patients stone-free.

Publication Types: 
    Case Reports

PMID: 15592051 [PubMed - indexed for MEDLINE]

779: J Urol. 2005 Jan;173(1):117-9; discussion 119.

Stone formation is proportional to papillary surface coverage by Randall's
plaque.

Kim SC, Coe FL, Tinmouth WW, Kuo RL, Paterson RF, Parks JH, Munch LC, Evan AP,
Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School 
of Medicine, Indianapolis, Indiana 46202, USA.

PURPOSE: Randall's plaques are common in calcium oxalate (CaOx) stone formers
(SF). Plaque coverage correlates directly with urine calcium excretion and
inversely with urine volume. We hypothesize that plaque coverage should increase 
proportionally with increasing stone number. We measured plaque areas in
idiopathic CaOx stone formers and nonstone formers (NSF), and identified
significant relationships with quantified stone histories. MATERIALS AND METHODS:
A total of 13 SFs and 4 control NSFs underwent nephroscopic papillary mapping
with representative still images and MPEG (Moving Pictures Experts Group) movies 
used to identify plaque and papillary borders. Stone histories were obtained
through patient interviews, and from medical records and radiographs. The
relationship of plaque coverage to clinical stone events was assessed by general 
multivariate linear modeling. Log transformation normalized the distribution of
percent plaque coverage and stone number. RESULTS: Plaque surface area in SFs
differed significantly from that in NSFs (p <0.0001). The duration of stone
disease and the log transformed percent plaque coverage correlated significantly 
with the number of stones (0.677 and 0.620, p = 0.003 and 0.008, respectively).
On multivariate analysis and correcting for the duration of stone disease total
percent plaque coverage correlated significantly with the number of stones (R =
0.496, p = 0.05). Disease duration and plaque coverage did not correlate
significantly (p = 0.257). CONCLUSIONS: Percent plaque coverage directly
correlates with the number of stones formed even when corrected for the duration 
of stone disease. However, plaque coverage does not correlate with the duration
of stone disease. These results support the hypothesis that the pathogenesis of
CaOx stones begins with Randall's plaques.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15592050 [PubMed - indexed for MEDLINE]

780: J Am Soc Nephrol. 2004 Dec;15(12):3225-32.

Dietary factors and the risk of incident kidney stones in men: new insights after
14 years of follow-up.

Taylor EN, Stampfer MJ, Curhan GC.

Department of Medicine, Channing Laboratory, Third Floor, Brigham and Women's
Hospital, 181 Longwood Avenue, Boston, MA 02115, USA. entaylor@partners.org

Diet plays an important role in the pathogenesis of kidney stones. Because the
metabolism of many dietary factors, such as calcium, may change with age, the
relation between diet and kidney stones may be different in older adults.
Uncertainty also remains about the association between many dietary factors, such
as vitamin C, magnesium, and animal protein, and the risk of kidney stone
formation. To examine the association between dietary factors and the risk of
incident, symptomatic kidney stones in men and to determine whether these
associations vary with age, a prospective cohort study was conducted of 45,619
men without a history of nephrolithiasis. Self-administered food frequency
questionnaires were used to assess diet every 4 yr. A total of 1473 incident
symptomatic kidney stones were documented during 477,700 person-years of
follow-up. For men aged <60 yr, the multivariate relative risk (RR) for stone
formation in the highest quintile of dietary calcium as compared with the lowest 
quintile was 0.69 (95% confidence interval [CI], 0.56 to 0.87; P = 0.01 for
trend). By contrast, there was no association between dietary calcium and stone
formation in men aged 60 yr or older. The multivariate RR for men who consumed
1000 mg or greater of vitamin C per day compared with those who consumed less
than the recommended dietary allowance of 90 mg/d was 1.41 (95% CI, 1.11 to 1.80;
P = 0.01 for trend). Other dietary factors showed the following multivariate RR
among men in the highest quintile of intake compared with those in the lowest:
magnesium, 0.71 (95% CI, 0.56 to 0.89; P = 0.01 for trend); potassium, 0.54 (95% 
CI, 0.42 to 0.68; P < 0.001 for trend); and fluid, 0.71 (95% CI, 0.59 to 0.85; P 
< 0.001 for trend). Animal protein was associated with risk only in men with a
body mass index <25 kg/m(2) (RR, 1.38; 95% CI, 1.05 to 1.81; P = 0.03 for trend).
Sodium, phosphorus, sucrose, phytate, vitamin B(6), vitamin D, and supplemental
calcium were not independently associated with risk. In conclusion, the
association between calcium intake and kidney stone formation varies with age.
Magnesium intake decreases and total vitamin C intake seems to increase the risk 
of symptomatic nephrolithiasis. Because age and body size affect the relation
between diet and kidney stones, dietary recommendations for stone prevention
should be tailored to the individual patient.

PMID: 15579526 [PubMed - indexed for MEDLINE]

781: J Am Soc Nephrol. 2004 Dec;15(12):3052-62.

Modulation of proliferating renal epithelial cell affinity for calcium oxalate
monohydrate crystals.

Farell G, Huang E, Kim SY, Horstkorte R, Lieske JC.

Division of Nephrology, Mayo Clinic College of Medicine, 200 First Street SW,
Rochester, MN 55905, USA.

Adhesion of urinary crystals to distal tubular cells could be a critical event
that triggers a cascade of responses ending in kidney stone formation. Monolayer 
cultures of distal nephron-derived MDCKI cells were used as a model to study
crystal-cell interactions. COM crystal adhesion reached a peak 2 d after plating 
and progressively fell thereafter. The decline in crystal binding was accelerated
by prostaglandin E(2) (PGE(2)) supplementation and delayed by blockade of PG
production. Crystals avidly adhered to cells that migrated in to repair a scrape 
wound made in the monolayer and after a transient hypoglycemic insult. Exposure
of MDCKI cells to uric acid crystals and soluble uric acid was also associated
with increased crystal adhesion. Treatment of physically or hypoglycemically
injured cells with trypsin or neuraminidase reduced crystal binding to baseline
levels, suggesting that increased exposure of cell surface glycoproteins mediated
the effect, whereas PGE(2) treatment blunted crystal binding to regenerating
cells. Furthermore, when cells were grown in the presence of synthetic
d-mannosamine analogues that can modify the conformation of cell surface
sialoglycoconjugates, crystal binding to proliferating cells was decreased,
whereas blockade of N-glycosylation with tunicamycin increased crystal adhesion
to these cells. Therefore, COM crystal binding is enhanced to growing renal
cells, synthesis of N-glycosylated cell surface proteins is essential to
downregulate crystal binding to cells, and this response is modulated by
physiologic signals such as PGE(2). Sialic acid residues seem to mediate crystal 
adhesion to growing cells, either directly or via linkage to other
crystal-binding molecules. Subtle renal injury and subsequent nephron repair
could be a factor promoting crystal adhesion and favoring calculus formation.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15579508 [PubMed - indexed for MEDLINE]

782: Can J Urol. 2004 Oct;11(5):2383-9.

Percutaneous ultrasonic lithotripsy (PUL) after shock wave lithotripsy (SWL)
failure.

Krambeck AE, Krejci KC, Patterson DE, Leroy AJ, Segura JW.

Department of Urology, Mayo Clinic, Rochester, Minnesota 55901, USA.

OBJECTIVE: Shock wave lithotripsy (SWL) is an attractive initial treatment for
nephrolithiasis. Unfortunately, a significant number of stones are resistant to
SWL therapy and require subsequent percutaneous ultrasonic lithotripsy (PUL) for 
definitive treatment. Our objective was to determine if previous SWL had adverse 
effects on PUL success and if there were differences between the patients
undergoing primary PUL and those undergoing PUL after SWL failure. MATERIALS AND 
METHODS: In 2001, 108 PULs were performed at our institution, of which 40 (37%)
were performed after SWL failure. Stone location, anesthesia time, stone
composition and size, and complication rates were compared between patients who
had PUL alone and those who underwent PUL after SWL failure. Anesthesia time was 
considered a reflection of technical difficulty of the case. RESULTS: Stone
composition differed between the SWL failure and primary PUL groups. Cystine
stones were found to be more common in the ESWL failure group and calcium oxalate
monohydrate stones more common in the primary PUL group. There was not a
statistically significant difference in stone size, anesthesia time or
complication rates, between the PUL alone and PUL after SWL failure groups.
CONCLUSION: PUL remains a reliable and safe treatment of nephrolithiasis. Prior
SWL does not affect efficacy, technical difficulty, or postoperative
complications of subsequent PUL. Based on our data, prior SWL should not be
considered a negative factor in PUL outcomes. Stone composition should be
considered a prognostic indicator of SWL failure and alert the surgeon that
primary PUL may be indicated.

Publication Types: 
    Clinical Trial

PMID: 15576003 [PubMed - indexed for MEDLINE]

783: Nucleosides Nucleotides Nucleic Acids. 2004 Oct;23(8-9):1127-9.

Detection of prothrombin and osteopontin in a renal stone found in a
hyperuricemic patient using 2D-PAGE and LC-MS analysis.

Kaneko K, Yamanobe T, Nakagomi K, Mawatari K, Onoda M, Fujimori S.

Central Laboratory of Analytical Biochemistry, Faculty of Medicine, Teikyo
University, Tokyo, Japan.

The liquid chromatography-mass spectrometry (LC-MS) following on from the
two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) technique was
applied for the analysis of proteins in a renal stone found in a hyperuricemic
patient. This technique was sensitive enough to detect small quantities of
proteins even in a renal stone.

Publication Types: 
    Case Reports

PMID: 15571215 [PubMed - indexed for MEDLINE]

784: Arch Ital Urol Androl. 2004 Sep;76(3):129-34.

Cystinuria: definition, epidemiology and clinical aspects.

Trinchieri A, Dormia G, Montanari E, Zanetti G.

UO Urologia, Ospedale A.Manzoni, Lecco, Italy. a.trinchieri@ospedale.lecco.it

Cystinuria ia an inheritable autosomal recessive disorder of amino acids
transport affecting the epithelial cells of the renal tubules and
gastrointestinal tract. It is characterized by abnormal concentrations of cystine
and the other dibasic amino acids in the urine, resulting in a risk of renal
stone formation because of the low solubility of cystine in urine. According to
the recent advances in molecular genetics, two genes have been identified as
responsible for this disease (SLC3A1 and SLC7A9), but other unknown genes may be 
involved in cystinuria. We assessed the presence of cystinuria in 2086
consecutive patients with renal stones by using cyanide-nitroprusside test
(Brand's test). According to our experience, this screening test should be
performed in all patients at the onset of renal stone disease in order to avoid a
delay in the possible diagnosis of cystinuria. In fact cystinuric patients often 
have mixed calculi composed of substances other than cystine that can disguise
the presence of cystininuria that is so diagnosed many years after the onset of
the initial symptoms. Patients with positive cyanide-nitroprusside test were
further studied for identification of urine amino acids by quantitative
ion-exchange chromatography. Pathological cystinuria was confirmed in 39 (1.9%)
out of 41 patients with positive Brand test. The mean age of cystine stone
patients was 38.1 +/- 15.8 years, whereas the age at stone onset was 21.8 +/-
12.4. Renal stones were recurrent in 85% of cases, while other 6 patients were
observed at their first stone. The male to female ratio was 1:0.62. The mean
number of stone episodes for patient was 18.5 +/- 35.8 and the mean interval to
first recurrence was 4.1 +/- 4.3 years. The recurrence rate 5 years after the
first renal stone was 83%. Furthermore we studied 85 members from 24 families of 
patients with cystine stones. Twenty-four family members excreted excessive
amounts of cystine, but only 5 of them (21%) had cystine calculi. Twenty-two
patients were treated with 1-1.5 g alpha-mercaptopropionylglycine daily.
Treatment reduced stone formation from 0.93 to 0.46 stones/patient/year. Only six
patients had side effects of sufficient severity to require withdrawal.

Publication Types: 
    Review

PMID: 15568305 [PubMed - indexed for MEDLINE]

785: Urol Res. 2005 Feb;33(1):65-9. Epub 2004 Nov 25.

Renal tubular cell damage and oxidative stress in renal stone patients and the
effect of potassium citrate treatment.

Tungsanga K, Sriboonlue P, Futrakul P, Yachantha C, Tosukhowong P.

Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University,
Bangkok 10330, Thailand. fmedkts@md2.md.chula.ac.th

Our objective was to evaluate the oxidative stress and renal tubular cell damage 
in patients who have renal stones compared to normal subjects. The patients were 
re-evaluated after 1-months supplementation with potassium citrate. We recruited 
30 patients (11 males and 19 females) diagnosed with kidney stones and scheduled 
for surgical stone removal the following month, and 30 healthy non-stone formers 
(14 males and 16 females). Two 24-h urine samples and one heparinized blood
sample were collected from each subject. Plasma was separated from the
erythrocytes and assayed for creatinine, potassium, sodium, calcium, magnesium,
phosphate, malondialdehyde (MDA, a lipid peroxidation product) (P-MDA), protein
thiol as an indicator of protein oxidation, and vitamin E. Erythrocytes were
analysed for MDA (E-MDA), reduced glutathione (GSH) and cellular glutathione
peroxidase (cGPx) activity. The urine was analyzed for pH, creatinine, potassium,
sodium, calcium, magnesium, phosphate, oxalate, citrate, MDA (U-MDA), total
protein (U-protein) and N-acetyl-beta-glucosaminidase (NAG) activity. For the
stone patients, urine and blood samples were re-evaluated after supplementation
with potassium citrate (60 mEq/day) for 1 month. Renal stone patients had higher 
plasma creatinine and lower plasma potassium, urinary pH, potassium, magnesium,
phosphate and citrate than the controls. The patients had higher P-MDA, E-MDA,
U-MDA, U-protein and NAG activity, but lower GSH, cGPx activity, protein thiol
and vitamin E, when compared with controls. After potassium citrate
supplementation, P-MDA and E-MDA decreased while plasma vitamin E, urinary NAG
activity and citrate increased. Renal stone disease is associated with high
oxidative stress and damage to renal tubular cells. These abnormalities are
coincident with an increase in blood lipid peroxidation products and a decrease
in antioxidant status. Although supplementation with potassium citrate improved
urinary citrate levels and oxidative stress, it neither reduced urinary lipid
peroxidation products nor remedied the damage to renal tubular cells, probably
due to the existence of kidney stones.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial

PMID: 15565439 [PubMed - indexed for MEDLINE]

786: Urol Res. 2004 Dec;32(6):423-6. Epub 2004 Nov 25.

Uric acid stones following hepatic transplantation.

Hwang MT, Goldfarb DS.

Renal Section, Vanderbilt University School of Medicine, Nashville, TN, USA.

We report the case of a 52 year old man with a history of insulin-requiring
diabetes and hepatitis B with cirrhosis who received an orthotopic liver
transplant. One year later he developed renal colic and was found to have a 3 mm 
stone at the left ureterovesical junction. Numerous other stones formed and
infrared spectroscopy analysis demonstrated all to be composed of 100% uric acid.
Urine collections demonstrated a low urine pH of 5.1 without hyperuricosuria. His
stones were effectively prevented with potassium citrate therapy. Few incidence
data are available for uric acid stone occurrence in solid organ recipients.
Calcineurin inhibitors are thought to often cause hyperuricemia on the basis of
decreased urate excretion. However, this effect would not be expected to cause
hyperuricosuria nor uric acid stones. This class of drugs may also be associated 
with low urine pH, perhaps on the basis of hypoaldosteronism, but the
contribution of such a syndrome to uric acid stone formation is not established.

Publication Types: 
    Case Reports

PMID: 15565437 [PubMed - indexed for MEDLINE]

787: Neurology. 2004 Nov 23;63(10 Suppl 4):S24-9.

Metabolic concerns associated with antiepileptic medications.

Sheth RD.

Department of Neurology, University of Wisconsin, Madison, Wisconsin, USA.
Sheth@neurology.wisc.edu

Because treatment with antiepileptic drugs (AEDs) is often for years or lifelong,
physicians should be aware of the metabolic changes that can be associated with
AED use and the potential effects of these changes during long-term therapy.
Alterations of bone metabolism leading to decreased bone mineral density,
associated particularly but not exclusively with the hepatic enzyme-inducing
AEDs, can worsen the risk for fractures, which is already increased in patients
with epilepsy by factors such as seizure-related falls and trauma. Some AEDs are 
associated with weight gain, an effect that is not only distressing to many
patients but may be sufficient to increase the risk for cardiovascular disease
and other disorders associated with excessive body weight. The carbonic
anhydrase-inhibiting properties of some AEDs can lead to metabolic acidosis. The 
AEDs that inhibit carbonic anhydrase are also associated with an increase in risk
for renal stones, as is the ketogenic diet. Awareness of the potential metabolic 
disturbances associated with AED use is particularly important because many of
them are subtle and may take years to become clinically apparent.

Publication Types: 
    Review

PMID: 15557547 [PubMed - indexed for MEDLINE]

788: Clin Chim Acta. 2004 Dec;350(1-2):57-63.

Oxidative stress in urogenital tuberculosis patients: a predisposing factor for
renal stone formation--amelioration by vitamin E supplementation.

Srinivasan S, Pragasam V, Jenita X, Kalaiselvi P, Muthu V, Varalakshmi P.

Department of Medical Biochemistry, Dr. A.L. Mudaliar Post Graduate Institute of 
Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, India.

BACKGROUND: Previous studies have shown that urogenital tuberculosis (GuTb)
patients treated or untreated with regular anti-Tb regimen excrete comparatively 
high levels of urinary stone forming constituents than normal subjects. Enhanced 
oxidative stress is also considered as a prime factor that accelerates
urolithiasis. The present study was aimed to determine antioxidant status and
lipid peroxidation of these individuals in order to assess their risk for kidney 
stone formation. METHODS: GuTb patients and age-matched normal subjects were
divided into four groups: I: normal subjects (n=60), II: GuTb patients a day
before treatment (n=72), III: GuTb patients after treatment with isoniazid (300
mg), rifampicin (450 mg) and pyrazinamide (1.5 g) per day for 60 days (n=42), and
IV: GuTb patients supplemented with vitamin E (200 mg/day) along with regular
chemotherapy for 60 days (n=30). Blood was collected and tested for various
markers of oxidative stress. RESULTS: Increased levels of lipid peroxidation,
protein carbonyls (PCO), advanced oxidative protein products (AOPP) and reduced
antioxidant defenses by impairment in enzyme activities like superoxide
dismutase, catalase, glutathione peroxidase, reduced glutathione and decreased
plasma concentrations of non enzymatic antioxidants like vitamins C and E were
observed in the treated and untreated GuTb patients. CONCLUSIONS: These
biochemical disparities may lead to membrane disintegrity, which is favorable for
retention of mirolithis. Advocation of vitamin E enhanced the antioxidant status 
of the plasma, thereby preventing membrane injury, consequently reducing the risk
of stone formation in urogenital tuberculosis patients, who were treated with
their routine anti-tuberculosis drug regimen.

Publication Types: 
    Comparative Study

PMID: 15530460 [PubMed - indexed for MEDLINE]

789: Nephron Physiol. 2004;98(2):p55-63.

Role of nutrition in the formation of calcium-containing kidney stones.

Taylor EN, Curhan GC.

Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA.

Diet plays an important role in the pathogenesis of calcium-containing kidney
stones. Although much work has demonstrated that specific dietary components
alter urinary composition and supersaturation, relatively few studies link the
ingestion of these components with actual nephrolithiasis. This article reviews
the dietary factors thought to promote or inhibit the formation of calcium stones
and discusses the current controversies in the field of nutrition and
nephrolithiasis. Special attention is paid to the roles of dietary calcium,
supplemental calcium, oxalate, phytate, and n-3 fatty acids. We offer dietary
recommendations to individuals who have suffered from a calcium-containing kidney
stone, and emphasize that a patient's 24-hour urine chemistries should be used to
help guide dietary intervention. Copyright (c) 2004 S. Karger AG, Basel.

Publication Types: 
    Review

PMID: 15499216 [PubMed - indexed for MEDLINE]

790: Nephron Physiol. 2004;98(2):p43-7.

Osteopontin and calcium stone formation.

Kleinman JG, Wesson JA, Hughes J.

Nephrology Division, Veterans Affairs Medical Center, and Medical College of
Wisconsin, Milwaukee 53925, USA. kleinman@mcw.edu <kleinman@mcw.edu>

Osteopontin (OPN) is a phosphorylated protein of wide tissue distribution that is
found in association with dystrophic calcification including in the organic
matrix of kidney stones. It is a strong inhibitor of crystal formation and growth
in vitro, but there is still debate regarding its effects upon crystal adhesion
to tubular epithelial cells. In this brief review, we will outline the evidence
implicating OPN in stone disease with the primary emphasis being on the
interaction of OPN with calcium oxalate (CaOx), the major constituent of calcium 
containing stones. Finally, preliminary data is presented regarding the amounts
and features of OPN present in the urine of stone formers and normal individuals.
Copyright (c) 2004 S. Karger AG, Basel.

Publication Types: 
    Review

PMID: 15499214 [PubMed - indexed for MEDLINE]

791: Nephron Physiol. 2004;98(2):p21-30.

Kidney models of calcium oxalate stone formation.

Robertson WG.

University College London, Institute of Urology and Nephrology, London, UK.
w.robertson@ucl.ac.uk <w.robertson@ucl.ac.uk>

This review compares and contrasts three mathematical models used to describe the
flow of urine through the renal tubule and the composition of tubular fluid
throughout the length of the nephron. From these data the relative
supersaturation of tubular fluid with respect to calcium oxalate (CaOx) is
calculated at various points along the tubule. This shows that glomerular
filtrate is well undersaturated with respect to CaOx and is still undersaturated 
at the end of the proximal tubule. By the end of the descending limb of the loop 
of Henle, it is highly supersaturated as a result of water reabsorption and CaOx 
may nucleate in this region, particularly when the tubular concentration of
oxalate is increased. Supersaturation falls slightly by the end of the ascending 
limb and becomes briefly undersaturated again in the short distal tubule. The
final water adjustment in the collecting tubules causes the supersaturation to
rise to a very high value by the end of the collecting duct and spontaneous CaOx 
crystalluria is likely to occur. The review also examines the probability of
these crystals growing large enough to be trapped at some point in the nephron
within the transit time of tubular fluid from glomerular capsule to ducts of
Bellini. All three models agree that, under normal conditions, the likelihood of 
individual crystals growing large enough to be trapped within the measured urine 
transit time of 3-4 min is very small. It is concluded that either there has to
be aggregation of crystals or some other factor that delays the passage of
crystals for them to grow large enough to become lodged at some point in the
nephron. Three new hydrodynamic factors are introduced that may lead to delay of 
crystal passage: (a) fluid drag close to the tubule walls; (b) the drag effect of
tubular walls on particles travelling close to the tubule walls, and (c) the
effect of gravity on particles travelling in upward-draining sections of tubule. 
When these factors are introduced into the mathematical model of urine flow and
tubular concentration, it is shown that any crystals that form at the end of the 
descending limb of the loop of Henle and which travel close to the tubular walls 
may be delayed long enough to grow large enough to become trapped further down
the nephron, particularly in upward-draining sections of the nephron. This
possibility becomes increasingly significant as urinary oxalate concentration
increases. Crystals that nucleate in the late collecting duct, however, are
readily passed as small crystals and are at no risk of being trapped in the
tubular system. These predictions are used to explain data on the effects of
oxalate loading on CaOx crystalluria in stone formers and normal controls. The
data are interpreted as showing that if the additional hydrodynamic factors are
added to the mathematical model of nephron function, then the 'free-particle'
model of calcium stone formation is still possible. This possibility will be
further enhanced if crystal aggregation also takes place during the period when
crystal passage is delayed by these factors. Copyright (c) 2004 S. Karger AG,
Basel.

Publication Types: 
    Review

PMID: 15499211 [PubMed - indexed for MEDLINE]

792: Nephron Exp Nephrol. 2004;98(2):e61-4.

Intracellular events in the initiation of calcium oxalate stones.

Jonassen JA, Cao LC, Honeyman T, Scheid CR.

Department of Physiology, University of Massachusetts Medical School, Worcester
01655, USA. Julie.Jonassen@umassmed.edu <Julie.Jonassen@umassmed.edu>

This review summarizes our current understanding of intracellular events in the
initiation of kidney stone formation, focusing on results from studies using
renal epithelial cells in vitro. Such studies have shown that oxalate - either in
crystalline or in soluble form - triggers a spectrum of responses in renal cells 
that favor stone formation, including alterations in membrane surface properties 
that promote crystal attachment and alterations in cell viability that provide
debris for crystal nucleation. Activation of cytosolic PLA2 appears to play an
important role in oxalate actions, triggering a signaling cascade that generates 
several lipid mediators (arachidonic acid, AA; lysophosphatidylcholine, Lyso-PC; 
ceramide) that act on key intracellular targets (mitochondria, nucleus). The net 
effect is increased production of reactive oxygen molecules (that in turn affect 
other cellular processes), an increase in cell death and an induction of a number
of genes in surviving cells, some of which may promote proliferation for
replacement of damaged cells, or may promote secretion of urinary macromolecules 
that serve to modulate crystal formation. A scheme is provided that explains how 
such oxalate-induced alterations could initiate stone formation in vivo.
Copyright (c) 2004 S. Karger AG, Basel.

Publication Types: 
    Review

PMID: 15499209 [PubMed - indexed for MEDLINE]

793: Nephron Exp Nephrol. 2004;98(2):e55-60.

Role of renal epithelial cells in the initiation of calcium oxalate stones.

Khan SR.

Department of Pathology, College of Medicine, University of Florida, Gainesville 
32610-0275, USA. khan@pathology.ufl.edu <khan@pathology.ufl.edu>

Normal urinary environment is inhibitory to crystallization. Occasional crystals 
are internalized by the renal epithelial cells and sequestered to lysosomes or
externalized into the interstitium to be handled by the inflammatory cells.
Elevated levels of oxalate and calcium oxalate crystals, however, provoke renal
cells to increase the synthesis of osteopontin, bikunin, heparan sulfate
proteoglycan, monocyte chemoattractant protein-1, and prostaglandin E(2), which
are known mediators of the inflammatory processes and extracellular matrix
production. Osteopontin and bikunin are also modulators of crystallization.
Exposed renal epithelial cells are often injured and go through apoptosis and/or 
necrosis initiating a cascade of events leading to further crystallization,
crystal retention and development of stone nidi. Reactive oxygen species are
produced during the interactions between the oxalate/crystals and renal cells and
are responsible for the various cellular responses. Calcium oxalate crystal
deposition in the rat kidneys also activates the renin-angiotensin system. Both
oxalate and calcium oxalate crystals selectively activate p38 mitogen-activated
protein kinase in the exposed tubular cells. Extracellular environment changes
from one that inhibits crystal nucleation, growth, aggregation and retention to
that, which promotes these processes. Copyright (c) 2004 S. Karger AG, Basel.

Publication Types: 
    Review

PMID: 15499208 [PubMed - indexed for MEDLINE]

794: Nephron Exp Nephrol. 2004;98(2):e50-4.

Hypophosphatemia and calcium nephrolithiasis.

Prié D, Beck L, Silve C, Friedlander G.

Department of Physiology and Inserm U 426, Faculté de Médecine Xavier Bichat,
Université Denis Diderot, Paris, France.

Our knowledge of phosphate balance under physiological and pathological
situations has increased substantially during the last decade thanks to the
molecular identification of three dissimilar families of sodium-phosphate
cotransport systems, two of them almost exclusively expressed in epithelia
whereas the third one has a ubiquitous expression. Intracellular proteins such as
NHERF1 (sodium-proton exchanger regulatory factor 1) can interact with phosphate 
transporters through PDZ domains thus regulating the expression of the
transporters at the membrane. Moreover, newly acknowledged paracrine/endocrine
peptides, such as fibroblast growth factor 23 (FGF23), also affect the activity
of phosphate transporters. Renal phosphate leak, related to invalidation (in the 
mouse) or to mutations (in humans) of the renal phosphate transporter NPT2a,
leads to hypophosphatemia on the one hand, and to nephrolithiasis or bone
demineralization on the other hand. Similar features are observed during
invalidation of NHERF or in case of overproduction of FGF23. These observations
highlight the importance of phosphate homeostasis in common diseases such as
renal stones or bone loss. Copyright (c) 2004 S. Karger AG, Basel.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15499207 [PubMed - indexed for MEDLINE]

795: Nephron Clin Pract. 2004;98(2):c54-8.

Renal stone disease: the urological perspective.

Amiel J, Choong S.

Fédération d'Urologie-Nephrologie et Transplantation, Centre
Hospitalo-Universitaire Nice, Nice, France. urologie@chu-nice.fr

Percutaneous nephrolithotomy, extracorporeal lithotripsy and ureteroscopy have
changed the face of urolithiasis. Open surgery is becoming extremely rare today. 
Nevertheless, the cooperation between nephrologist and urologist remains
essential and is the only way to prevent recurrence. Copyright 2004 S. Karger AG,
Basel.

Publication Types: 
    Review

PMID: 15499204 [PubMed - indexed for MEDLINE]

796: Arch Dis Child. 2004 Nov;89(11):1069-72.

Nephrolithiasis associated with ceftriaxone therapy: a prospective study in 51
children.

Avci Z, Koktener A, Uras N, Catal F, Karadag A, Tekin O, Degirmencioglu H, Baskin
E.

Department of Pediatrics, Faculty of Medicine, Bakent University, Ankara, Turkey.

BACKGROUND: Ceftriaxone, a third generation cephalosporin, is widely used for
treating infection during childhood. The kidneys eliminate approximately 33-67%
of this agent, and the remainder is eliminated via the biliary system.
Ceftriaxone may bind with calcium ions and form insoluble precipitate leading to 
biliary pseudolithiasis. The aim of this study was to assess whether ceftriaxone 
associated nephrolithiasis develops by the same mechanism, and whether this
condition is dose related. METHODS: The study involved 51 children with various
infections. Of these, 24 were hospitalized with severe infection and received 100
mg/kg/day ceftriaxone divided into two equal intravenous doses. The other 27
patients received a single daily intramuscular injection of 50 mg/kg/day. Serum
and urine parameters were evaluated before and after treatment, and abdominal
ultrasonographic examinations were also carried out before and after treatment.
RESULTS: Serum urea, creatinine, and calcium levels were normal in all patients
before and after treatment. Post-treatment ultrasound identified nephrolithiasis 
in four (7.8%) of the 51 subjects. The stones were all of small size (2 mm).
Comparison of the groups with and without nephrolithiasis revealed no significant
differences with respect to age, sex distribution, duration of treatment, or
dose/route of administration of ceftriaxone. The renal stones disappeared
spontaneously in three of the four cases, but were still present in one patient 7
months after ceftriaxone treatment. CONCLUSIONS: Conclusions: The study showed
that children taking a 7 day course of normal or high dose ceftriaxone may
develop small sized asymptomatic renal stones. The overall incidence of
nephrolithiasis in this study was 7.8%.

PMID: 15499067 [PubMed - indexed for MEDLINE]

797: Kidney Int. 2004 Nov;66(5):2032-7.

Rapid Communication: relative effect of urinary calcium and oxalate on saturation
of calcium oxalate.

Pak CY, Adams-Huet B, Poindexter JR, Pearle MS, Peterson RD, Moe OW.

Center for Mineral Metabolism and Clinical Research, The University of Texas
Southwestern Medical Center, Dallas, Texas 75390-8571, USA.
charles.pak@usouthwestern.edu

BACKGROUND: The study compared the effect of urinary calcium with that of oxalate
on urinary saturation [relative saturation ratio (RSR)] of calcium oxalate.
METHODS: A retrospective data analysis was conducted on urinary stone risk
analysis from 667 patients with predominantly calcium oxalate stones. Urinary RSR
of calcium oxalate was individually calculated using Equil 2. A "theoretical"
curve of the relationship between urinary RSR of calcium oxalate and
concentration of calcium or oxalate was obtained at two stability constants for
calcium oxalate complex, while varying calcium or oxalate and using group mean
values for urinary constituents. RESULTS: At the stability constant of 7.07 x
10(3), the increase in RSR of calcium oxalate was less marked with calcium than
with oxalate. However, at the stability constant of 2.746 x 10(3) from the Equil 
2 that is considered the "gold standard," calcium and oxalate were equally
effective in increasing RSR of calcium oxalate. The above theoretical curves
(relating RSR with calcium or oxalate) were closely approximated by the actual
curves constructed with data from individual urine samples. Urinary saturation of
calcium oxalate was equally dependent on urinary concentrations of calcium and
oxalate (r= 0.75 unadjusted and 0.57 adjusted for variables, and P < 0.0001 for
calcium; r= 0.73 unadjusted and 0.60 adjusted, P <0.0001 for oxalate).
CONCLUSION: Among calcium oxalate stone-formers, urinary calcium is equally
effective as urinary oxalate in increasing RSR of calcium oxalate.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15496176 [PubMed - indexed for MEDLINE]

798: Am J Kidney Dis. 2004 Nov;44(5):799-805.

ESRD caused by nephrolithiasis: prevalence, mechanisms, and prevention.

Jungers P, Joly D, Barbey F, Choukroun G, Daudon M.

Department of Nephrology; Necker Hospital, Paris, France.

BACKGROUND: The contribution of nephrolithiasis-related end-stage renal disease
(ESRD) to patients requiring renal replacement therapy has never been
specifically evaluated. METHODS: Of the entire cohort of 1,391 consecutive
patients who started maintenance dialysis therapy at our nephrology department
between January 1989 and December 2000, a total of 45 patients (21 men) had renal
stone disease as the cause of ESRD and constitute the study material. Type and
cause of renal stone disease was determined in the 45 patients, as well as the
change in prevalence of nephrolithiasis-related ESRD with time during this
12-year period. RESULTS: The overall proportion of nephrolithiasis-related ESRD
was 3.2%. Infection (struvite) stones accounted for 42.2%; calcium stones, 26.7%;
uric acid nephrolithiasis, 17.8%; and hereditary diseases (including primary
hyperoxaluria type 1 and cystinuria), 13.3% of cases. Women were predominant
among patients with infection and calcium stones, whereas men were predominant
among patients with uric acid or hereditary stone disease. The proportion of
patients with nephrolithiasis-related ESRD decreased from 4.7% in the triennial
period 1989 to 1991 to 2.2% in the most recent period, 1998 to 2000 ( P = 0.07). 
This tendency to a decreasing prevalence mainly was caused by a rarefaction of
infection and calcium stones with time, whereas frequencies of uric acid and
hereditary stone disease remained essentially unchanged. CONCLUSION: Severe forms
of nephrolithiasis remain an underestimated cause of potentially avoidable ESRD
and need for renal replacement therapy. These findings highlight the crucial
importance of accurate stone analysis and metabolic evaluation to provide early
diagnosis and proper therapy for conditions that may lead to ESRD through
recurrent stone formation and/or parenchymal crystal infiltration.

PMID: 15492945 [PubMed - indexed for MEDLINE]

799: Urology. 2004 Oct;64(4):833-8.

Association between vitamin D receptor gene polymorphisms and fasting idiopathic 
hypercalciuria in recurrent stone-forming patients.

Rendina D, Mossetti G, Viceconti R, Sorrentino M, Castaldo R, Manno G, Guadagno
V, Strazzullo P, Nunziata V.

Department of Clinical and Experimental Medicine, Federico II University Medical 
School, Naples, Italy.

OBJECTIVES: To investigate the association between fasting idiopathic
hypercalciuria (IHc), defined as IHc in the fasting state associated with normal 
parathyroid function, and ApaI, BsmI, and FokI polymorphisms of the vitamin D
receptor (VDR) gene in 159 hypercalciuric recurrent stone formers. IHc
contributes to the formation of calcium kidney stones in more than one half of
reported cases. METHODS: We examined 62 patients with fasting IHc (24 women, mean
age 42.8 +/- 11.1 years, body mass index 25.7 +/- 4.8 kg/m2), 97 patients with
absorptive IHc (41 women, mean age 43.5 +/- 10.8 years, body mass index 26.1 +/- 
4.4 kg/m2), and 124 healthy control subjects (52 women, mean age 41.9 +/- 10.4
years, body mass index 25.4 +/- 5.1 kg/m2) without a history of nephrolithiasis
and without IHc. The bone mass density and VDR genotype and haplotype frequencies
were determined in the studied populations. RESULTS: A reduced bone mass density 
was observed in fasting IHc patients compared with absorptive IHc patients (P =
0.009) and control subjects (P = 0.006). The prevalence of ApaI and BsmI VDR
genotypes and alleles in patients with fasting IHc was significantly different
statistically (P <0.05) from that observed in patients with absorptive IHc and
control subjects, and the ba haplotype was overrepresented in these patients. No 
statistically significant difference in the distribution of FokI VDR genotypes
and alleles was found between the studied groups. CONCLUSIONS: Our results
suggest a genetic association between 3' VDR alleles, fasting IHc, and reduced
bone mass density in patients with recurrent stone formation.

Publication Types: 
    Comparative Study

PMID: 15491743 [PubMed - indexed for MEDLINE]

800: Urology. 2004 Oct;64(4):808-9.

Late recurrence of renal cholesteatoma after 15 years.

König J, Pannek J, Kickuth R, Noldus J.

Department of Urology, Ruhr Universität Bochum, Marienhospital Herne, Herne,
Germany.

We report a late recurrence of a cholesteatoma of the left kidney after 15 years.
Both the initial case and the recurrence were treated by endourologic and
percutaneous approaches.

Publication Types: 
    Case Reports
    Review

PMID: 15491737 [PubMed - indexed for MEDLINE]

801: Urology. 2004 Oct;64(4):664-8.

Recoverability of renal function after treatment of adult patients with
unilateral obstructive uropathy and normal contralateral kidney: a prospective
study.

Khalaf IM, Shokeir AA, El-Gyoushi FI, Amr HS, Amin MM.

Department of Urology, Al-Hussein University Hospital, Al-Azhar University,
Cairo, Egypt.

OBJECTIVES: To study the methods of prediction of recoverability of renal
function after the treatment of adult patients with unilateral obstructive
uropathy and a normal contralateral kidney. METHODS: This prospective study
included 91 consecutive adult patients with the diagnosis of unilateral
obstructive uropathy and a normal contralateral kidney. All patients had a
nonequivocal cause of obstruction that was successfully relieved after treatment.
All patients underwent plain abdominal x-ray, gray-scale ultrasonography, Doppler
ultrasonography, excretory urography, and technetium-99m-diethylenetriamine
pentaacetic acid radioisotope renography before and after treatment. Patients
were seen regularly at 3, 6, and 12 months for a mean duration of 13 +/- 6 months
(range 6 to 36). At each visit, ultrasonography and renography were performed,
and excretory urography was performed at least once during follow-up. Several
renographic and ultrasound parameters were studied before and after treatment to 
evaluate their value in predicting the recoverability of renal function. The
difference between the selective renographic glomerular filtration rate (GFR) of 
the ipsilateral kidney before treatment and its mean value after treatment was
considered as the reference variable to which all other variables were compared. 
All prognostic parameters were evaluated by both univariate and multivariate
analyses. RESULTS: On univariate analysis, the factors that significantly
affected the recoverability of renal function after the relief of obstruction
included preoperative renographic GFR, renal perfusion, parenchymal thickness,
parenchymal echogenicity, corticomedullary differentiation, reduction of the
renal resistive index of the corresponding kidney, and compensatory hypertrophy
of the contralateral normal kidney. However, using multivariate analysis, only
the preoperative selective renographic GFR and renal perfusion of the
corresponding kidney sustained their statistical significance as independent
factors affecting renal functional recovery. A preoperative GFR value of 10
mL/min/1.73 m2 was estimated as the cutoff point that can determine the best
prediction of stabilization or improvement of renal function after the relief of 
obstruction. CONCLUSIONS: Preoperative renographic clearance and perfusion of the
corresponding kidney were the only predictors of recoverability of unilateral
renal obstruction. Kidneys with a renographic GFR of less than 10 mL/min/1.73 m2 
were irreversibly damaged. Improvement or stabilization of function can be
expected after relief of obstruction of kidneys with a renographic GFR of 10
mL/min/1.73 m2 or greater.

Publication Types: 
    Comparative Study

PMID: 15491695 [PubMed - indexed for MEDLINE]

802: Curr Opin Nephrol Hypertens. 2004 Nov;13(6):675-81.

Sodium-phosphate cotransporters, nephrolithiasis and bone demineralization.

Prié D, Beck L, Friedlander G, Silve C.

Inserm U 426 et Institut Fédératif de Recherche 02, Faculté de Médecine Xavier
Bichat, 16 rue Henri Huchard, 75018 Paris, France. dprie@bichat.inserm.fr

PURPOSE OF REVIEW: We discuss how recent findings obtained in disorders of
phosphate metabolism in humans and in animal models have provided insights into
the pathogenesis of renal stone formation and bone demineralization. RECENT
FINDINGS: Mice that are null for the sodium-phosphate cotransporter (NPT)2a gene 
(NPT2a(-/-) mice) exhibit hypophosphataemia, increased urinary phosphate
excretion, hypercalciuria and nephrolithiasis, but no bone demineralization. Mice
null for the sodium-hydrogen exchanger regulatory factor (NHERF)1 (NHERF1(-/-)
mice) also exhibit hypophosphataemia and increased renal phosphate excretion with
decreased renal NPT2a expression, but they present with a severe sex-dependent
bone demineralization. Heterozygous loss-of-function mutations in the NPT2a gene 
in humans induce hypophosphataemia, increased urinary phosphate excretion,
hypercalciuria, nephrolithiasis in males (to date) and bone demineralization of
variable severity in both sexes. Patients and experimental animals with increased
circulating levels of fibroblast growth factor 23 present with hypophosphataemia,
increased urinary phosphate excretion, inappropriate calcitriol synthesis and
rickets/osteomalacia, but no nephrolithiasis except when treated. Low-phosphate
diet in spontaneously hypercalciuric rats and disruption of the
1-alpha-hydroxylase gene in NPT2a mice prevent renal stone formation. SUMMARY:
Increased urinary phosphate excretion is a risk factor for renal calcium stone
formation when it is associated with hypercalciuria. As yet undefined interplay
between NPT2a, NHERF1 and possibly other cotransporters or associated proteins in
bone cells may account for the diversity of bone phenotypes observed in disorders
of phosphate metabolism with impaired renal phosphate reabsorption. The
pathogenesis of both renal stone and bone demineralization appear to be affected 
by species, sex and mutation type, among other factors.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 15483460 [PubMed - indexed for MEDLINE]

803: Int J Urol. 2004 Oct;11(10):831-6.

Stones in anomalous kidneys: results of treatment by shock wave lithotripsy in
150 patients.

Tunc L, Tokgoz H, Tan MO, Kupeli B, Karaoglan U, Bozkirli I.

Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey.
luttunc@tnn.net

OBJECTIVE: To determine the efficacy of shock wave lithotripsy (SWL) in anomalous
kidneys. METHODS: From October 1990 to October 2002, 150 patients (93 men and 57 
women) with anomalous urinary tracts, including 45 horseshoe kidneys, 57 duplex
kidneys, 30 malrotated kidneys, 14 pelvic and four crossed ectopic kidneys were
treated with SWL for urolithiasis at the Gazi University Faculty of Medicine.
Shock wave lithotripsy was performed with Siemens Lithostar plus (Siemans,
Erlanger, Germany) device and all procedures were carried under fluoroscopic
control. Results: The mean shock wave number and intensity received by the
patients was 3770 (range, 1380-4100) shocks and 18.4 (range, 16.1-19) kV per
session, respectively. The minimum success rate was obtained in patients with
lower calyceal (50%) followed by middle calyceal (60%) calculi. The stone-free
rate decreased and the number of sessions per patient increased with increasing
stone diameter (dm). In patients with a stone dm > 30 mm, only 34% could be
stone-free, compared to a rate of 92% for calculi dm < 10 mm. The overall stone
free rate at the third month was 68%. The best stone-free rates were obtained in 
patients with ureteral duplication (80.7%). The stone-free rates in horseshoe,
malrotated, pelvic and crossed ectopic kidneys were found to be 66.7%, 56.7%,
57.2% and 25%, respectively. CONCLUSION: Shock wave lithotripsy might be an
effective and minimally invasive treatment alternative in stone-bearing anomalous
kidneys. The type of anomaly, stone burden and localization seem to be the main
parameters effecting the treatment success.

Publication Types: 
    Clinical Trial

PMID: 15479286 [PubMed - indexed for MEDLINE]

804: J Bone Miner Res. 2004 Nov;19(11):1771-8. Epub 2004 Aug 23.

Intravenous pamidronate prevents femoral bone loss and renal stone formation
during 90-day bed rest.

Watanabe Y, Ohshima H, Mizuno K, Sekiguchi C, Fukunaga M, Kohri K, Rittweger J,
Felsenberg D, Matsumoto T, Nakamura T.

Test Facilities Operation and Maintenance Section, Space Station Engineering
Department, Advanced Engineering Services, Co., Ltd., Ibaraki, Japan.

Long-term bed rest has potential risks of bone loss and renal stone formation. We
examined the effects of resistive exercise and intravenous pamidronate on BMD,
bone turnover, urinary calcium, and renal stone formation in 25 healthy males
during 90-day bed rest. Pamidronate prevented femoral bone loss and renal stone
formation, but resistive exercise showed little effects. INTRODUCTION: Long-term 
bed rest increases the risks of bone loss and urinary stone formation. Resistive 
exercise increases bone formation, and bisphosphonates reduce bone resorption.
However, the effects of muscle exercise and bisphosphonates have not been
examined side-by-side. The objectives of this study are to compare the effects of
pamidronate with resistive exercise on BMD and renal stone formation during
prolonged bed rest. MATERIALS AND METHODS: Twenty-five male white volunteers,
26-45 years of age, were randomly assigned to the control (n = 9), exercise (n = 
9), and pamidronate (n = 7) groups and underwent 90-day 6 degrees head-down tilt 
bed rest. Exercise group performed squats and heel raises on a flywheel device
for 30 minutes every 3 days. Pamidronate (60 mg) was administered intravenously
14 days before bed rest. BMD of the head, forearm, lumbar spine, and proximal
femur; biochemical bone markers; calcium (Ca) metabolism; and abdominal
radiographs were examined during 90 days of bed rest and 360 days of reloading.
RESULTS: In controls, proximal femoral BMD decreased, and bone resorption markers
and urinary Ca increased during bed rest, along with development of renal stones 
in two of nine subjects. Resistive exercise increased bone formation but was
unable to prevent femoral BMD decrease and increases in bone resorption and
urinary Ca during bed rest, with formation of renal stones in four of nine
subjects. Pamidronate maintained femoral BMD, reduced bone resorption and urinary
Ca, and completely prevented renal stone formation. CONCLUSIONS: Resistive
exercise increased bone formation but could not reduce bone resorption and the
risk of renal stones. In contrast, inhibition of bone resorption by pamidronate
could preserve bone mineral and reduce the risk of renal stone formation during
prolonged bed rest.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15476576 [PubMed - indexed for MEDLINE]

805: BJU Int. 2004 Oct;94(6):849-52; discussion 852.

Comment in:
    BJU Int. 2005 Mar;95(4):681.

Upper pole access for complex lower pole renal calculi.

Aron M, Goel R, Kesarwani PK, Seth A, Gupta NP.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
monisharon@hotmail.com

OBJECTIVES: To assess the efficacy of superior pole access for complex lower pole
calyceal calculi. PATIENTS AND METHODS: In all, 102 patients with complex
inferior calyceal calculi were included in a prospective unrandomized study.
Complex inferior calyceal calculi were defined as multiple calculi in two or more
inferior calyces of the lower polar group, with each calyx draining through a
separate infundibulum and at an acute angle to each other. In 33 patients (32%;
group 1) an inferior calyceal puncture was made and in 69 (68%; group 2) access
was obtained through a superior calyceal puncture. The stone-free rates, decrease
in haemoglobin, operative duration, requirement for additional tracts and second 
procedures in the two groups were compared. RESULTS: Stone clearance rates and
blood loss values were better in group 2, although they were not significantly
different. The mean operative duration, number of tracts required and the re-look
procedure rate was significantly less in group 2. Two patients (3%) in group 2
had hydrothorax related to supracostal puncture and required chest tube
insertion. CONCLUSIONS: Superior calyceal puncture (supracostal or infracostal)
affords optimum access to complex inferior calyceal stones, providing faster and 
better clearance with a single puncture, and less requirement for second-look
procedures.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 15476521 [PubMed - indexed for MEDLINE]

806: Surg Laparosc Endosc Percutan Tech. 2004 Jun;14(3):172-4.

Retroperitoneoscopic heminephrectomy of a horseshoe kidney for calculus disease.

Saggar VR, Singh K, Sarangi R.

Department of Surgery, Sir Ganga Ram Hospital, New Delhi, India.

Retroperitoneoscopic management of complications of a horseshoe kidney provides a
feasible and effective alternative to conventional management. We describe a
patient who had presented with multiple calculi and a poorly functioning left
moiety of a horseshoe kidney, in whom we performed a retroperitoneoscopic left
heminephrectomy. Most of the previous reports of laparoscopic nephrectomy have
been described via the transperitoneal route. Division of the isthmus was done
using ultrasonic shears. The patient had an uneventful recovery and was
discharged within 24 hours.

Publication Types: 
    Case Reports

PMID: 15471027 [PubMed - indexed for MEDLINE]

807: World J Urol. 2004 Oct;22(4):277-80. Epub 2004 Sep 22.

Percutaneous nephrolithotomy in children: experience with 138 cases in a
developing country.

Salah MA, Tóth C, Khan AM, Holman E.

Department of Urology, Medical and Health Science Center, University of Debrecen,
Nagyerdei krt. 98., 4032 Debrecen, Hungary. morshed@jaguar.dote.hu

Our aim was to evaluate our experience with percutaneous nephrolithotomy (PCNL)
in children in the Republic of Yemen. Between January 1993 and December 1998, 135
children underwent 138 percutaneous nephrolithotomies in Yemen. The patient's age
ranged between 8 months and 14 years (average 8.9 years). There were 117 boys and
18 girls (male:female ratio 6.5:1). The stone size ranged between 124 and 624 mm2
(average 507 mm2). A 26 F adult nephroscope was used. The stone free rate was
98.5% (136 out of the 138 cases). Two patients had clinically insignificant
fragments. A second session had to be performed because of residual stone in one 
patient. No severe intra- or postoperative complications were observed. We
conclude that percutaneous nephrolithotomy is a safe and effective method for the
treatment of kidney stones in children. It reduces morbidity and hospital stay
and thus the cost of treatment. To our knowledge, this is the largest reported
series.

PMID: 15448997 [PubMed - indexed for MEDLINE]

808: J Ultrasound Med. 2004 Oct;23(10):1361-7.

Sonographic mimics of renal calculi.

Durr-E-Sabih, Khan AN, Craig M, Worrall JA.

Multan Institute of Nuclear Medicine and Radiotherapy, Nishtar Hospital, Multan, 
Pakistan.

OBJECTIVES: To review sonographic findings that can mimic renal calculi. METHODS:
We comment on a number of echoes that can mimic renal calculi. RESULTS: There are
a number of sonographic renal artifacts, vascular and nonvascular, that may
confound a correct diagnosis. CONCLUSIONS: Awareness of these potential artifacts
will result in a more specific sonographic examination and will accurately guide 
the referring physician toward appropriate patient treatment. The importance of
other imaging modalities is also emphasized to ensure that a correct diagnosis is
obtained whenever the sonographic findings are inconclusive.

PMID: 15448326 [PubMed - indexed for MEDLINE]

809: J Emerg Med. 2004 Oct;27(3):225-31.

Impact of CT scan in patients with first episode of suspected nephrolithiasis.

Ha M, MacDonald RD.

Division of Emergency Medicine, Department of Family Medicine, University of
Manitoba, Winnipeg, Manitoba, Canada.

This prospective observational outcome study assessed the impact of helical
computed tomography (CT) scan in patients with a first episode of suspected
nephrolithiasis. Before CT scanning, Emergency Physicians completed a
questionnaire, including diagnostic certainty of nephrolithiasis and anticipated 
patient disposition. Primary outcome measure was the comparison of physician
diagnostic certainty and CT scan results. Secondary outcome measures included
alternate diagnoses and changes in patient disposition after CT scan. Four
categories grouped the pre-CT diagnostic certainty: 0-49%, 50-74%, 75-90%, and
90-100%. The CT scan found urinary calculi in 28.6%, 45.7%, 74.2%, and 80.5% of
patients in each category, respectively. CT scanning revealed alternate diagnoses
in 40 cases (33.1%). Of these, 19 (47.5%) included other significant pathology.
Before CT scanning, physicians planned to discharge 115 patients and admit six
patients. After CT scanning, six of the former group were admitted, and five of
the latter group were discharged. Patients presenting with a first episode of
clinically suspected nephrolithiasis should undergo CT scanning because it
enhances diagnostic certainty by identifying alternate diagnoses not suspected on
clinical grounds alone.

Publication Types: 
    Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 15388206 [PubMed - indexed for MEDLINE]

810: J Mater Sci Mater Med. 2004 May;15(5):613-7.

High strain rate testing of kidney stones.

Sylven ET, Agarwal S, Briant CL, Cleveland RO.

Division of Engineering, Brown University, Providence, RI 02912, USA.

Sections of struvite kidney stones were tested in compression at high strain
rates ( approximately 3000s(-1)) using a Kolsky bar and at low strain rates ( <
0.001 s(-1)) using an Instron testing machine. The peak stress in both cases
appeared to be similar. At high strain rates the values of flow stress measured
were between 40 and 65 MPa and at low strain rates they were between 37 and 58
MPa. However, the morphology of the damage was dramatically different. Stones
tested at low strain rates formed a small number of cracks but otherwise remained
intact at the end of the test. In comparison, stones tested at high strain rates 
were reduced to a powder. Kidney stones are a two-phase material consisting of a 
crystalline ceramic phase and an organic binder. We speculate that in the high
strain rate tests the large difference in the sound speed between the matrix and 
the crystalline grains leads to shear stresses that destroy the stone. These data
indicate that shear stress induced by the internal structure may be a mechanism
by which shock waves comminute kidney stones in lithotripsy.

Publication Types: 
    Comparative Study
    In Vitro
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15386970 [PubMed - indexed for MEDLINE]

811: Int J Urol. 2004 Sep;11(9):700-3.

Lower pole ratio: a new and accurate predictor of lower pole stone clearance
after shockwave lithotripsy?

Fong YK, Peh SO, Ho SH, Ng FC, Quek PL, Ng KK.

Department of Urology, Changi General Hospital, 2 Simei Street 3, Singapore
529889. excelsurg@hotmail.com

BACKGROUND: Lower pole spatial anatomy is an important determinant of success
after extracorporeal shockwave lithotripsy. In the present study, we determine
whether there is a significant relationship between lower pole ratio
(infundibular length : infundibular width) on preoperative intravenous urograms
and stone fragment clearances after shockwave lithotripsy. METHODS: A total of 42
patients with isolated lower pole stones were retrospectively reviewed.
Anatomical factors, such as infundibular length, width and infundibulopelvic
angle were measured and the lower pole ratio was calculated on pretreatment
intravenous urogram. Stone fragment clearance was assessed at three months with a
plain abdominal X-ray. RESULTS: The overall three-month stone-free rate was 62%. 
Mean stone size +/- SD was 10 +/- 4.8 mm, mean infundibular length was 21.7 +/-
6.9 mm, mean infundibular width was 6.1 +/- 2.3 mm, mean infundibulopelvic angle 
was 62.1 +/- 30.1 degrees and mean lower pole ratio was 4.3 +/- 2.8. Stone-free
status after shockwave lithotripsy was significantly related to infundibular
length and width as well as to lower pole ratio, but not to infundibulo-pelvic
angle. Infundibular length less than 30 mm, width greater than 5 mm and lower
pole ratio less than 3.5 were noted to have an improved three-month stone-free
rate (P = 0.049, 0.01 and <0.01, respectively). CONCLUSION: Caliceal anatomy is
an important consideration for lower pole stone clearance after shockwave
lithotripsy. The present study suggests that a lower pole ratio of less than 3.5,
which considers both infundibular length and width, is a promising predictor for 
stone-free status.

PMID: 15379931 [PubMed - indexed for MEDLINE]

812: J Ethnopharmacol. 2004 Nov;95(1):87-93.

Effect of aqueous extract from Herniaria hirsuta L. on experimentally
nephrolithiasic rats.

Atmani F, Slimani Y, Mimouni M, Aziz M, Hacht B, Ziyyat A.

Laboratory of Cellular Physiology and Pharmacology, Department of Biology,
Faculty of Sciences, University Mohammed 1, Oujda 60000, Morocco.
atmani@sciences.uni-oujda.ac.ma

Despite considerable progress in medical therapy, there is no satisfactory drug
to treat kidney stones. Therefore, this current study is aimed to look for an
alternative treatment by using Herniaria hirsuta on nephrolithiasic rats as a
preventive agent against the development of kidney stones. The experiment was
conducted in normal and calcium oxalate (CaOx) nephrolithiasic rats during 3
weeks. Several parameters were followed weekly including water intake, urinary
volume and pH, some urinary chemistries, and crystalluria. At the end, kidneys
were analyzed by light microscope. The results showed that water intake and
urinary volume increased in nephrolithiasic rats, but their urinary pH decreased 
especially in the third week of treatment. Urinary oxalate increased
significantly during the second week for untreated rats and remained constant in 
rats treated with Herniaria decoction. However, urinary calcium decreased
significantly in week 2 in untreated rats and remained constant in treated rats. 
Qualitative analysis of crystalluria showed that untreated rats excreted large
CaOx monohydrate and few dihydrate crystals while treated animals excreted mostly
small CaOx dihydrate crystals. The examination of kidney sections revealed that
CaOx deposition was limited in treated rats when compared to untreated ones.
These results obtained in vivo confirmed the beneficial effect of Herniaria
hirsuta and may justify its use as a preventive agent against the formation of
calcium oxalate kidney stones.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15374612 [PubMed - indexed for MEDLINE]

813: Int J Clin Pract. 2004 Aug;58(8):809-10.

Percutaneous nephrolithotomy in early pregnancy.

Shah A, Chandak P, Tiptaft R, Glass J, Dasgupta P.

Department of Urology, Guy's Hospital, London, UK.

Most cases of urolithiasis in pregnancy are managed conservatively either with
ureteric stents or percutaneous nephrostomy tubes, which need to be changed at
regular intervals. Definitive management of the stone is usually delayed till
after delivery. We describe a patient who presented with pyonephrosis in the
fifth week of gestation, due to a stone obstructing the right ureteropelvic
junction. This was managed by insertion of a nephrostomy tube. She declined
nephrostomy tube/stent changes during the rest of her pregnancy and requested
termination as an alternative. She successfully underwent percutaneous
nephrolithotomy in the 14th week of pregnancy, with radiation exposure strictly
localised to the kidney for 6 s. A healthy male baby was delivered at term.

Publication Types: 
    Case Reports

PMID: 15372856 [PubMed - indexed for MEDLINE]

814: J Urol. 2004 Oct;172(4 Pt 1):1510-4.

Extract from Herniaria hirsuta coats calcium oxalate monohydrate crystals and
blocks their adhesion to renal epithelial cells.

Atmani F, Farell G, Lieske JC.

Laboratory of Cellular Physiology and Pharmacology, Department of Biology,
Faculty of Sciences, University Mohammed 1, Oujda, Morocco.

PURPOSE: The interaction of calcium oxalate crystals with renal epithelial cells 
is a critical event in kidney stone formation. In this study we assessed the
effect of aqueous extract from Herniaria hirsuta on the adhesion of calcium
oxalate monohydrate (COM) crystals to cultured renal cells. MATERIALS AND
METHODS: Madin Darby canine kidney cells were used as a model for studying the
adhesion of radioactive COM crystals in the presence and absence of plant
extract. RESULTS: COM crystal binding to cells was inhibited by extract in a
concentration dependent manner. Prior exposure of crystals but not cells to
extract blocked crystal binding, suggesting that plant molecules can coat and
exert their effect at the crystal surface. Crystal attachment appeared related to
membrane fluidity since crystal adhesion increased at higher vs lower
temperatures (37C vs 0C) and Herniaria extract altered crystal adhesion only
under conditions of increased fluidity (increased temperature). Extract also
displaced a significant portion of prebound crystals without apparent effects on 
cell function or the morphology of preexisting calcium oxalate crystals.
Herniaria extract exerted no adverse or toxic effect on cells, which proliferated
normally in its presence even at relatively high concentrations. CONCLUSIONS: Our
current data suggest a mechanism whereby Herniaria hirsuta extract used in
traditional medicine might prevent and possibly eliminate preexisting kidney
stones. Further characterization of the active compound(s) could identify a new
candidate drug for patients with nephrolithiasis.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15371881 [PubMed - indexed for MEDLINE]

815: J Urol. 2004 Oct;172(4 Pt 1):1351-4.

Erratum in:
    J Urol. 2005 Mar;173(3):1051.

Percutaneous nephrostolithotomy: predictors of length of stay.

Matlaga BR, Hodges SJ, Shah OD, Passmore L, Hart LJ, Assimos DG.

Department of Urology, Wake Forest University School of Medicine, Winston-Salem, 
North Carolina 27157, USA.

PURPOSE: Percutaneous nephrostolithotomy (PNL) is commonly used to treat patients
with complex renal calculi. A goal at our medical center is to discharge patients
home less than 24 hours after PNL. We performed a study to determine factors that
caused patients to be hospitalized longer than this period. MATERIAL AND METHODS:
The available hospital records and office charts of 133 consecutive patients
undergoing initial PNL at our institution between January 1, 1999 and December
31, 2000 were reviewed. All PNL procedures were performed by one of us using a
(DGA) 1-stage technique. Mean patient age was 52 years (range 25 to 84). Of the
subjects 85 were male and 48 were female. RESULTS: A total of 91 patients (68%)
were discharged home less than 24 hours after surgery. The overall stone-free
rate was 91%. Mean length of stay in the entire group was 1.97 days. Mean length 
of stay in those hospitalized longer than 24 hours was 4.12 days. Mean operative 
time, including time to obtain access, was 188.6 minutes. Multivariate analysis
demonstrated that neurogenic bladder, endocrine comorbidity and perioperative
complications were factors associated with a length of stay of greater than 24
hours. Univariate analysis demonstrated that preoperative urinary tract infection
and infection related calculi were also associated with a length of stay of
greater than 24 hours. CONCLUSIONS: The majority of patients undergoing PNL can
be discharged home less than 24 hours after surgery. Patients with neurogenic
bladder, those with endocrine comorbidity, those who sustain significant
perioperative complications and those harboring stones associated with urinary
tract infection or preoperative urinary tract infection are more likely to
require longer hospitalization.

PMID: 15371840 [PubMed - indexed for MEDLINE]

816: J Urol. 2004 Oct;172(4 Pt 2):1600-3.

Outcome of small residual stone fragments following shock wave lithotripsy in
children.

Afshar K, McLorie G, Papanikolaou F, Malek R, Harvey E, Pippi-Salle JL, Bagli DJ,
Khoury AE, Farhat W.

Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.

PURPOSE: We evaluate the outcome of small residual stone fragments (RF) following
extra-corporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc.,
Marietta, Georgia) in children. MATERIALS AND METHODS: The medical records of 39 
boys and 44 girls (88 renal units) with urolithiasis who underwent ESWL were
reviewed. Median patient age was 7 years. Average stone burden was 14 mm. Mean
followup was 46 months. After the first ESWL 40 of the 88 (46%) renal units
became stone-free and 18 (20%) had RF 5 mm or less. The remaining 30 (34%) units 
required further treatment using ESWL or ancillary surgical procedures that
rendered 12 of them stone-free and 8 with RF. The 26 renal units with RF
constitute our study subjects. Adverse outcomes such as growth of RF, symptomatic
episodes or calculi recurrence in stone-free cases were recorded. RESULTS: Of the
26 renal units with RF 5 mm or less, 18 (69%) had an adverse clinical outcome
(symptoms or RF growth) and 8 (31%) patients were asymptomatic and had no stone
growth. Patients with RF had a significant increase in adverse clinical outcome
compared to stone-free subjects, with an odds ratio of 3.9 (95% CI 1.5-9.6). The 
presence of metabolic disorders was associated with RF growth (odds ratio 11.4,
95% CI 1.5-79). CONCLUSIONS: Small RF after ESWL is clinically significant in
children and increase the chance of adverse clinical outcome. These patients
require close followup, particularly those with identifiable predisposing
disorders.

PMID: 15371769 [PubMed - indexed for MEDLINE]

817: Int Urol Nephrol. 2004;36(2):289-91.

Rare presentation of Wilson's disease: a case report.

Kalra V, Mahajan S, Kesarwani PK.

Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar, 
New Delhi, India. docvikramkalra@rediffmail.com

A female presented with pain in left flank, detected to have bilateral renal
calculi with deranged liver functions. On investigation found her to have
Wilson's disease with hypercalciuria and incomplete distal renal tubular
acidosis. Patient was started on penicillamine following which her hepatitis
improved but hypercalciuria persisted after 10 weeks of follow up. The rarity of 
such presentation and literature review for the same is discussed.

Publication Types: 
    Case Reports
    Letter

PMID: 15368714 [PubMed - indexed for MEDLINE]

818: Int Urol Nephrol. 2004;36(2):235-7.

Renal stone masquerading as an occult renal cell cancer (incidental RCC).

Ansari MS, Singh I, Gupta NP.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
ansarimsa@hotmail.com

We report an unusual case of 40-year-old adult man who presented as a case of
urolithiasis but was found to be harboring an incidental renal cell
adenocarcinoma. He underwent an uneventful radical nephrectomy. The literature
regarding incidental renal cancer and it's association with urolithiasis has been
reviewed and discussed.

Publication Types: 
    Case Reports

PMID: 15368702 [PubMed - indexed for MEDLINE]

819: Int Urol Nephrol. 2004;36(2):149-51.

Squamous cell carcinoma of the renal pelvis manifesting after percutaneous
nephrolithotomy for long standing calculus.

Sivaramakrishna B, Aron M, Ansari MS, Seth A, Goel R, Mundada OP, Balchander.

Department of Urology, All India Institute of Medical Sciences, New Delhi 110
029, India.

Squamous cell carcinoma of the renal pelvis is a rare neoplasm and is usually
associated with long standing stone disease. The disease is aggressive in nature 
and usually has a poor prognosis. We report a case of renal lithiasis who
underwent successful percutaneous nephrolithotomy (PCNL) for renal pelvic
calculus, and eight months later presented with a large invasive squamous cell
carcinoma in the same location.

Publication Types: 
    Case Reports

PMID: 15368682 [PubMed - indexed for MEDLINE]

820: J Nephrol. 2004 May-Jun;17(3):436-40.

Novel mutations of the AGXT gene causing primary hyperoxaluria type 1.

Yuen YP, Lai CK, Tong GM, Wong PN, Wong FK, Mak SK, Lo KY, Wong AK, Tong SF, Chan
YW, Lam CW.

Department of Pathology, Princess Margaret Hospital, Hong Kong, China.

BACKGROUND: Primary hyperoxaluria type 1 (PH1), an inherited cause of
nephrolithiasis, is due to a functional defect of the liver-specific peroxisomal 
enzyme alanine:glyoxylate aminotransferase (AGT). A definitive PH1 diagnosis can 
be established by analyzing AGT activity in liver tissue or mutation analysis of 
the AGXT gene. METHODS: The molecular basis of PH1 in three Chinese patients, two
with adult-onset and one with childhood-onset recurrent nephrolithiasis, was
established by analyzing the entire AGXT gene. RESULTS: Three novel mutations
(c2T>C, c817insAG and c844C>T) and two previously reported mutations (c33insC and
679-IVS6+2delAAgt) were identified. c2T>C converts the initiation codon from ATG 
to ACG, which predicts significant reduction, if not complete abolition, of
protein translation. c817insAG leads to a frameshift and changes the amino acid
sequence after codon 274. c844C>T changes glutamine at codon 282 to a termination
codon, resulting in protein truncation. CONCLUSIONS: This is the first report
describing AGXT gene mutations in Chinese patients with PH1. AGXT genotypes
cannot fully explain the clinical heterogeneity of PH1, and other factors
involved in disease pathogenesis remain to be identified. Our experience
emphasizes the importance of excluding PH1 in patients with recurrent
nephrolithiasis to avoid delay or inappropriate management.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15365967 [PubMed - indexed for MEDLINE]

821: Urol Res. 2004 Oct;32(5):357-61. Epub 2004 Sep 7.

Calcium oxalate monohydrate binding protein: a diagnostic biomarker for calcium
oxalate kidney stone formers.

Asokan D, Kalaiselvi P, Muhammed Farooq S, Varalakshmi P.

Department of Medical Biochemistry, University of Madras, Taramani Campus,
Chennai 600 113, India.

Urinary oxalate is a biomarker for calcium oxalate kidney stone disease; however,
its assay is insensitive and nonspecific. Calcium oxalate monohydrate (COM)
binding protein (45 kDa) is a promoter of calcium oxalate kidney disease, which
is markedly upregulated by oxalate induced oxidative stress. The current study
was carried out to evaluate whether COM binding protein can serve as a diagnostic
marker for calcium oxalate kidney stone formers. COM binding protein was
isolated, purified and antibody was raised against it in rabbits. Urine samples
(24 h) were collected from patients suffering from various kidney diseases such
as acute nephritis, chronic nephritis, nephrotic syndrome, calcium oxalate (CaOx)
stone formers, uric acid stone formers, struvite stone formers and calcium
phosphate stone formers. This COM binding protein was quantified by an in house
ELISA method and the excretion was found to lie between 2 and 3 mg in control
samples, while in CaOx stone formers it was detected between 11 and 19 mg.
Urinary risk factors were assayed. We conclude that COM binding protein can serve
as a diagnostic marker for CaOx stone formers.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 15365653 [PubMed - indexed for MEDLINE]

822: Urology. 2004 Sep;64(3):589.

Furosemide nephrolithiasis causing ureteral obstruction and urinoma in a preterm 
neonate.

Alpert SA, Noe HN.

Department of Pediatric Urology, LeBonheur Children's Medical Center, University 
of Tennessee, Memphis, Tennessee, USA.

Nephrolithiasis and nephrocalcinosis in low-birth-weight, preterm neonates are
well-documented complications of furosemide administration. Perinephric urinomas 
and urinary ascites have been previously reported as complications of obstruction
due to posterior urethral valves or ureteropelvic junction obstruction. We
present an unusual case of furosemide-induced nephrolithiasis causing ureteral
obstruction, urinoma, and acute renal failure in a preterm neonate.

PMID: 15351602 [PubMed - indexed for MEDLINE]

823: Urology. 2004 Sep;64(3):430-4.

Clinical utility of dual active deflection flexible ureteroscope during upper
tract ureteropyeloscopy.

Ankem MK, Lowry PS, Slovick RW, Munoz del Rio A, Nakada SY.

Division of Urology, Department of Surgery, University of Wisconsin-Madison
Medical School, Madison, Wisconsin 53792, USA.

OBJECTIVES: To evaluate the clinical utility of a dual active deflection ACMI
DUR-8 Elite ureteroscope in a referral endourology practice. METHODS:
Retrospective chart review was performed on 54 consecutive patients who underwent
flexible ureteroscopy by a single surgeon (S.Y.N.) from February to July 2003.
Cases in which standard flexible ureteroscopes alone could complete the
procedure, cases in which standard flexible ureteroscopy could not complete the
procedure and the DUR-8 Elite ureteroscope did, and cases in which both
ureteroscopes failed to complete the procedure were analyzed. RESULTS: A total of
54 procedures were performed on 37 patients. Three cases were not analyzed
because they were distal ureter procedures. Of the remaining 51 procedures, 6
were removed from analysis because they were second-look procedures. When
classified by diagnosis, 27 patients had stones (79.4%), 5 had cancer (14.7%),
and 1 had hematuria (2.9%). The global success rate was 91.1%. The average use
rate of the DUR-8 was 28.9%, and the success rate using the DUR-8 Elite was 69.2%
in those cases in which it was necessary. Of the 13 cases in which the DUR-8 was 
used, 61.5% were for lower pole pathologic findings. The DUR Elite use and
success rate in the lower pole was 57.1% and 75%, respectively. A statistically
significant association was found between the diagnosis and procedure location (P
= 0.00128). CONCLUSIONS: Our preliminary data indicate that the dual deflecting
DUR-8 Elite ureteroscope may be helpful in cases in which the single deflection
flexible instruments fail to access and treat upper urinary tract pathologic
findings.

Publication Types: 
    Evaluation Studies

PMID: 15351558 [PubMed - indexed for MEDLINE]

824: Urology. 2004 Sep;64(3):426-9.

Percutaneous nephrolithotomy in treatment of large stones within horseshoe
kidneys.

Shokeir AA, El-Nahas AR, Shoma AM, Eraky I, El-Kenawy M, Mokhtar A, El-Kappany H.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

OBJECTIVES: To present our experience with percutaneous nephrolithotomy (PCNL) in
the treatment of large stones within horseshoe kidneys. METHODS: The study
included 34 patients with 45 stone-bearing horseshoe kidneys treated by PCNL in
one center. The indications for PCNL were large stone burden (greater than 2 cm) 
in 10 kidneys (22.2%), multiple complex stones in 22 (48.9%), staghorn stones in 
3 (6.7%), and failed extracorporeal shock wave lithotripsy (ESWL) in 10 kidneys
(22.2%). All PCNL procedures were performed in a standard one-session technique
with fluoroscopic guidance. Procedures were evaluated for intraoperative and
postoperative complications, use of auxiliary procedures (second-look PCNL,
ureteroscopy, and ESWL), and length of hospital stay. Moreover, the stone-free
rate was calculated at discharge from the hospital and 3 months later. In
addition, we assessed the need for secondary intervention during a mean follow-up
of 75 +/- 16 months (range 6 to 108). RESULTS: The stone burden ranged from 264
to 2408 mm(2) (mean 664 +/- 153). Access to the horseshoe kidneys was supracostal
in 10 (22.2%) and subcostal in 35 kidneys (77.8%). A single tract was used in 37 
(82%), and two tracts were created in the remaining 8 kidneys (18%). Major
complications were seen in six PCNL procedures (13.3%) and included significant
hematuria requiring blood transfusion in three, septicemia in one, ureteral
obstruction in one, and colonic injury in one. All complications were
successfully treated. Auxiliary procedures were required in 12 patients (35.3%)
and included ureteroscopy in 1, second-look PCNL in 3, and ESWL to fragment
residual caliceal stones in 8 patients. The mean hospital stay was 4 +/- 1.9 days
(range 3 to 12). The stone-free rate was 82% at discharge and 89% at 3 months.
During the course of follow-up, 19 patients (56%) developed stone recurrence and 
were successfully treated with ESWL in 8 and PCNL in 11. CONCLUSIONS: PCNL is a
safe and effective procedure in the treatment of large stones within horseshoe
kidneys.

PMID: 15351557 [PubMed - indexed for MEDLINE]

825: JSLS. 2004 Jul-Sep;8(3):223-8.

Laparoscopic pyeloplasty and flexible nephroscopy: simultaneous treatment of
ureteropelvic junction obstruction and nephrolithiasis.

Ball AJ, Leveillee RJ, Patel VR, Wong C.

Department of Urology, University of Miami School of Medicine, Miami, FL 33101,
USA.

BACKGROUND AND OBJECTIVE: Ureteropelvic junction obstruction and concomitant
calculus disease may coexist. Therapeutic controversy exists regarding their
ideal management. We report our use of flexible nephroscopy during laparoscopic
pyeloplasty for caliceal stone removal. METHODS: From August 1998 through May
2002, 50 laparoscopic pyeloplasties were performed. Seven patients had documented
ureteropelvic junction obstruction and ipsilateral nephrolithiasis. Preoperative 
stone burden and location were assessed. After pyelotomy, a 16 Fr flexible
endoscope was passed through the uppermost trocar under direct laparoscopic
guidance into the collecting system. Stone extraction was performed with a 2.4 Fr
Nitinol basket. Postoperative imaging was assessed. RESULTS: Complete stone-free 
status confirmed by postoperative imaging was achieved in 6 of 7 patients. The
longest individual stone diameter ranged from 4 mm to 13 mm (mean, 10.3 mm), and 
an average of 2.5 stones per patient was removed (range, 1 to 4 stones). Neither 
intraoperative fluoroscopy nor lithotripsy was required. No intraoperative or
delayed complications were noted during a mean follow-up of 8.5 months (range, 2 
to 17 months). CONCLUSIONS: Laparoscopic pyeloplasty and concomitant flexible
nephroscopy with basket extraction is a simple, attractive alternative for the
simultaneous treatment of ureteropelvic junction obstruction presenting with
coexisting nephrolithiasis. It appears more efficacious when the stone number is 
limited and diameters measure from 5 mm to 20 mm.

PMID: 15347108 [PubMed - indexed for MEDLINE]

826: Int Urol Nephrol. 2004;36(1):27-8.

The secret of the phantom stone: a case report.

Attar K, Lee G, Rowe E, Hudd C.

Department of Urology, Wexham Park Hospital, UK.

A 50-year old man, who has a history of allergies to i.v. contrast and NSAID, was
presented with right renal colic. He was treated with regular opiate injections. 
Plain abdominal X ray showed a 1 cm opacity at the level of L2 but spiral CT
failed to locate the urinary calculus. Abdominal examination revealed a small
piece of metal implanted in the subcutaneous anterior abdominal wall which was
also subsequently identified on CT scanning. When the opiate treatment was
withdrawn, the patient absconded.

Publication Types: 
    Case Reports

PMID: 15338668 [PubMed - indexed for MEDLINE]

827: Braz J Med Biol Res. 2004 Sep;37(9):1379-88. Epub 2004 Aug 24.

Response to an oral calcium load in nephrolithiasis patients with fluctuating
parathyroid hormone and ionized calcium levels.

Gomes SA, Lage A, Lazaretti-Castro M, Vieira JG, Heilberg IP.

Departamento de Endocrinologia, Universidade Federal de São Paulo, São Paulo, SP,
Brasil.

The response to an oral calcium load test was assessed in 17 hypercalciuric
nephrolithiasis patients who presented elevated parathyroid hormone (PTH)
irrespective of the ionized calcium (sCa2+) levels. Blood samples were collected 
at baseline (0 min) and at 60 and 180 min after 1 g calcium load for serum PTH,
total calcium, sCa2+, and 1.25(OH)2D3 determinations. According to the sCa2+
level at baseline, patients were classified as normocalcemic (N = 9) or
hypercalcemic (N = 8). Six healthy subjects were also evaluated as controls. Bone
mineral density was reduced in 14/17 patients. In the normocalcemic group, mean
PTH levels at 0, 60 and 180 min (95 +/- 76, 56 +/- 40, 57 +/- 45 pg/ml,
respectively) did not differ from the hypercalcemic group (130 +/- 75, 68 +/- 35,
80 +/- 33 pg/ml) but were significantly higher compared to healthy subjects
despite a similar elevation in sCa2+ after 60 and 180 min vs baseline in all 3
groups. Mean total calcium and 1.25(OH)2D3 were similar in the 3 groups.
Additionally, we observed that 5 of 9 normocalcemic patients presented a
significantly higher concentration-time curve for serum PTH (AUC0',60',180') than
the other 4 patients and the healthy subjects, suggesting a primary parathyroid
dysfunction. These data suggest that the individual response to an oral calcium
load test may be a valuable dynamic tool to disclose a subtle primary
hyperparathyroidism in patients with high PTH and fluctuating sCa2+ levels,
avoiding repeated measurements of both parameters.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15334204 [PubMed - indexed for MEDLINE]

828: J Endourol. 2004 Aug;18(6):534-9.

Progression of nephrolithiasis: long-term outcomes with observation of
asymptomatic calculi.

Burgher A, Beman M, Holtzman JL, Monga M.

Department of Urologic Surgery and Department of Medicine, University of
Minnesota, USA.

BACKGROUND AND PURPOSE: Observation is often recommended for patients presenting 
with asymptomatic renal calculi. This study evaluated the natural history of
asymptomatic calculi and the risk of progression of disease. PATIENTS AND
METHODS: We conducted a retrospective evaluation of 300 male patients average age
62.8 years who were followed for a mean of 3.26 years for asymptomatic renal
calculi in an outpatient urology clinic. At presentation, the mean cumulative
stone diameter was 10.8 mm; 56% were lower-pole stones, and 48% of the patients
had multiple calculi. Patients underwent annual radiographic imaging and clinic
visits with standardized questions regarding the development of symptoms or
complications from calculi. Progression of disease was defined as the need for
surgical intervention, the development of pain, or stone growth on serial
imaging. RESULTS: Overall, 77% of patients experienced disease progression, with 
26% requiring surgical intervention. Stone size was positively associated with
progression: those with an isolated stone >/=4 mm on presentation were 26% more
likely to fail observation than patients with smaller solitary calculi (P =
0.012). Stone growth was less common in those with upper-pole and middle-pole
stones (47% v 61%) for lower-pole stones; P = 0.002). Urine uric acid
concentration correlated positively with the rate of stone growth (P = 0.05).
Likewise, serum uric acid concentration predicted stone growth (odds ratio =
3.6). CONCLUSIONS: Stratification of risk of progression according to presenting 
stone size, location, and composition may facilitate discussions with the patient
regarding the alternatives of observation versus intervention. Specifically,
small non-uric acid calculi in the upper pole may be most amenable to
observation.

PMID: 15333216 [PubMed - indexed for MEDLINE]

829: J Endourol. 2004 Aug;18(6):527-30.

Results of shockwave lithotripsy for pediatric urolithiasis.

Tan AH, Al-Omar M, Watterson JD, Nott L, Denstedt JD, Razvi H.

Division of Urology, St. Joseph's Health Care, University of Western Ontario;
London, Ontario, Canada.

BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) is widely practiced in the
management of pediatric urolithiasis. However, the efficacy, need for ancillary
procedures, and treatment-related complications are not as clearly defined as in 
the adult population. We reviewed the outcomes of SWL in the pediatric population
at our lithotripsy unit. PATIENTS AND METHODS: A retrospective review of all
patients </=16 years of age treated with SWL between January 1991 and June 2002
was undertaken. One hundred patients with 115 stones underwent 131 SWL procedures
(115 first treatments, 16 retreatments). The mean age was 10.7 years (range 10
months-16 years). Stone locations were as follows: caliceal 42.6%, renal pelvic
27%, and ureteral (30.4%). The mean stone size was 7.8 mm (range 2-23 mm). Risk
factors for stone formation, the need for secondary therapies, and
treatment-related complications were noted. The stone-free rate for a
single-session SWL procedure, defined as complete absence of stone fragments on
plain film, intravenous urography, or renal ultrasonography, was calculated based
on 3-month follow-up. The efficiency quotient (EQ) was also calculated. RESULTS: 
Risk factors were identified in 31 children (27.0%), including metabolic and
anatomic abnormalities. Patients with a risk factor were less likely to be stone 
free after one SWL session than those without risk factors (31.7% v 64.7%; P <
0.001). General (74.8%), neurolept (24.4%), and epidural (0.8%) anesthesia were
utilized. Ureteral stents were placed in 25% of treatments. There were no
intraoperative complications. Minor complications were seen in 4.6% of patients. 
Ancillary procedures were required in 10 patients. Following initial SWL
treatment, 60.2% of patients were stone free. The retreatment rate was 13.9%.
Following a second treatment, the stone-free rate increased to 68%. The EQ was
54.3.CONCLUSION: Employing a strict definition of treatment success,
single-session SWL in our series offers moderate efficacy in the pediatric
population. Patients who have a large stone or risk factor such as an anatomic
abnormality are less likely to become stone free and might better undergo an
endourologic procedure.

PMID: 15333214 [PubMed - indexed for MEDLINE]

830: Ann R Coll Surg Engl. 2004 Sep;86(5):367-70.

Flexible ureterorenoscopy: prospective analysis of the Guy's experience.

Dasgupta P, Cynk MS, Bultitude MF, Tiptaft RC, Glass JM.

Endo-urology Unit, Guys and St Thomas' Hospital, London, UK. prokarurol@aol.com

OBJECTIVE: To report our outcomes with small diameter, actively deflectable
flexible ureterorenoscopy from a prospective database. PATIENTS and METHODS: 114 
flexible ureterorenoscopies were performed in 105 patients (mean age, 49.5 years;
range, 19-85 years; 71 males, 34 females) over a 9-month period. Of these, 101
were for refractory stones following failed ESWL and 13 for diagnostic reasons.
An Olympus URF P3 flexible ureteroscope with pressure irrigation was used.
Electrohydraulic lithotripsy was used to fragment stones and the fragments were
retrieved with Graspit, triradiate graspers or tipless baskets. RESULTS: Stents
had previously been placed in 53% and dilatation of the ureteric orifice was
necessary in 15%. In the stone group, the median operating time was 55 min
(range, 15-210 min) and the median screening time 2.2 min (range, 0.3-9.1 min).
Success was defined as complete stone clearance or good fragmentation to 2 mm or 
less. Overall success in this group was 72.3%. There was no statistically
significant difference between lower and other calyces (P=0.83 Chi-square test). 
Successful outcome was achieved in 72% for stone size 10 mm or less, 80% for
11-20 mm and 50% for greater than 20 mm. Two or more procedures were needed in 8 
patients. In the diagnostic group, the median operating time was 45 min (range,
20-60 min) and the median screening time 2 min (range, 0.3-8.3 min). The majority
were for upper tract filling defects. Access and successful diagnosis was
achieved in all cases. The major complication rate was 2.6%. The ureteroscope
needed repair once during this series. CONCLUSIONS: Flexible ureterorenoscopy is 
an effective diagnostic and therapeutic tool in a select group of patients. It
should be considered for ESWL-resistant upper tract stones but the results are
poor in stones larger than 20 mm and percutaneous nephrolithotomy may be a better
option in these patients.

PMID: 15333176 [PubMed - indexed for MEDLINE]

831: BJU Int. 2004 Sep;94(4):637-50.

Microarray analysis of changes in renal phenotype in the ethylene glycol rat
model of urolithiasis: potential and pitfalls.

Chen DH, Kaung HL, Miller CM, Resnick MI, Marengo SR.

The James and Eilleen Dicke Research Laboratory, Department of Urology, School of
Medicine, Case Western Reserve University/University Hospitals of Cleveland,
Cleveland, Ohio 44106-4931, USA.

OBJECTIVES: To investigate, in an initial study, the use of microarray analysis
(MA) to develop an information base for urolithiasis. MA enables the screening of
thousands of genes simultaneously making it the technique of choice for
situations where the results are known, but the underlying mechanisms are not.
Little is known about the pathological changes occurring in the kidney during
urolithiasis and this has severely hampered efforts to develop effective
therapeutics. MATERIALS AND METHODS: Male rats were treated with 0.75% ethylene
glycol for 2, 4 or 8 weeks; after death the kidneys were processed for RNA
isolation and MA, conducted using a rat-based chip (one kidney/chip) and the
results confirmed by reverse transcription-polymerase chain reaction (RT-PCR, 21 
probe sets; control, four rats; treated, five rats). Targets were defined as
different by the software if the fold change (FC) was >or= 2, and sorted into
functional categories using a data-mining tool. The repeatability of MA was
investigated by subjecting the 4-week samples to MA in two independent runs.
RESULTS: The results for targets with a FC of >or= 2 were plotted (y = 1.01x -
0.75; r(2) 0.84). Comparing the results obtained by RT-PCR and MA showed a good
qualitative correlation for those targets having a FC of >or= 5 as determined by 
MA. Changes in the expression of genes associated with tubule function and
regulation, oxidative damage, and inflammation were the most common in the
functional categories. Changes in the expression of tubule-specific markers
indicated that there was damage to the proximal (gamma-adducin, organic anion and
cation transporters, sodium-hydrogen exchange protein-isoform 3) and distal
tubules (gamma-adducin, kallikrein) at 2 and 4 weeks. Increased expression of
mitochondrial uncoupling protein indicated that there were changes to the
mitochondria and oxidative stress at 2 and 4 weeks. CONCLUSION: This study shows 
the power of MA as an exploratory technique, and changes in the expression of
several physiologically important genes whose expression has not previously been 
reported to be affected by hyperoxaluria or calcium oxalate crystalluria.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15329129 [PubMed - indexed for MEDLINE]

832: Kidney Int. 2004 Sep;66(3):1159-66.

Tamm-Horsfall protein is a critical renal defense factor protecting against
calcium oxalate crystal formation.

Mo L, Huang HY, Zhu XH, Shapiro E, Hasty DL, Wu XR.

Department of Urology, Kaplan Comprehensive Cancer Center, New York University
School of Medicine, New York, New York 10010, USA.

BACKGROUND: The tubular fluid of the mammalian kidney is often supersaturated
with mineral salts, but crystallization rarely occurs under normal conditions.
The unique ability of the kidney to avoid harmful crystal formation has long been
attributed to the inhibitory activity of the urinary macromolecules, although few
in vivo studies have been carried out to examine this hypothesis. Here we
examined the role of Tamm-Horsfall protein (THP), the principal urinary protein, 
in urinary defense against renal calcium crystal formation, using a THP knockout 
model that we recently developed. METHODS: Wild-type and THP knockout mice were
examined for the spontaneous formation of renal calcium crystals using von Kossa 
staining. The susceptibility of these mice to experimentally induced renal
crystal formation was evaluated by administering mice with ethylene glycol, a
precursor of oxalate, and vitamin D(3), which increases calcium absorption. Renal
calcium crystals were visualized by von Kossa stain, dark field microscopy with
polarized light and scanning electron microscopy. RESULTS: Inactivating the THP
gene in mouse embryonic stem cells results in spontaneous formation of calcium
crystals in adult kidneys. Excessive intake of calcium and oxalate, precursors of
the most common type of human renal stones, dramatically increases both the
frequency and the severity of renal calcium crystal formation in THP-deficient,
but not in wild-type mice. Under high calcium/oxalate conditions, the absence of 
THP triggers a marked, adaptive induction in renal epithelial cells of
osteopontin (OPN), a potent inhibitor of bone mineralization and vascular
calcification. Thus, OPN may serve as an inducible inhibitor of calcium
crystallization, whereas THP can serve as a constitutive and apparently more
effective inhibitor. CONCLUSION: These results provide the first in vivo evidence
that THP is a critical urinary defense factor and suggest that its deficiency
could be an important contributing factor in human nephrolithiasis, a condition
afflicting tens of millions of people in the world annually.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15327412 [PubMed - indexed for MEDLINE]

833: Int J Antimicrob Agents. 2004 Sep;24(3):284-5.

Nephrolithiasis and hydronephrosis in an HIV-infected man receiving tenofovir.

Cicconi P, Bongiovanni M, Melzi S, Tordato F, d'Arminio Monforte A, Bini T.

Institute of Infectious and Tropical Diseases, Luigi Sacco Hospital, via G.B.
Grassi 74, 20157 Milan, Italy.

The use of tenofovir as part of a HAART regimen has been widely used in
HIV-multi-experienced-patients because of its favourable resistance profile.
Tenofovir is mainly eliminated by the kidneys and renal toxicity should be
carefully monitored. We describe here the case of an HIV-infected patient,
without a prior history of renal failure who developed nephrolithiasis and
hydronephrosis after starting a tenofovir-containing HAART regimen.

Publication Types: 
    Case Reports

PMID: 15325433 [PubMed - indexed for MEDLINE]

834: J Urol. 2004 Sep;172(3):1082-6.

The impact of caliceal pelvic anatomy on stone clearance after shock wave
lithotripsy for pediatric lower pole stones.

Onal B, Demirkesen O, Tansu N, Kalkan M, Altintaş R, Yalçin V.

Department of Urology, University of Istanbul Cerrahpasa School of Medicine,
34730 Istanbul, Turkey. bulonal@yahoo.com

PURPOSE: The clearance rather than stone disintegration of lower pole stones
after shock wave lithotripsy (SWL) is significantly inferior according to the
other localizations of the kidney. We retrospectively evaluated the impact of
caliceal pelvic anatomy on stone clearance after SWL for pediatric lower pole
stones. MATERIALS AND METHODS: We treated 163 renal units (RUs) in children 16
years old or younger with SWL between March 1992 and February 2002. In 36 RUs
stones were localized in the lower calices. All patients were treated with
sedoanalgesia except 3 (8%) who were treated under general anesthesia. Patients
were evaluated by excretory urography and ultrasonography 12 weeks after the last
session, and were designated as stone-free or with residual stone. The lower
infundibular length, width, length-to-width ratio, pelvic caliceal height and
lower infundibulopelvic angle were determined on standard excretory urography
before SWL. All measurements were done by 1 urologist who was unaware of the
results. Statistical analysis was performed with chi-square, Fisher's exact and
Mann-Whitney U tests. ROC analysis was done to determine the cutoff points of
caliceal anatomy measurements for stone clearance. RESULTS: We treated 36 RUs in 
23 males and 10 females with isolated lower caliceal stones. Median patient age
was 10.5 years (range 2 to 16). Median stone burden was 0.7 cm (range 0.2 to 4), 
and median number of shock waves and energy used for the entire patient
population was 1,500 and 17.2 kV, respectively. Overall stone-free rates for the 
36 RUs were 61% after a median treatment session of 1 (range 1 to 7) and
retreatment rates were 39%. Of the patients rendered free of stones 13 (59%) were
treated in a single SWL session and 9 (41%) underwent 2 or more sessions. Median 
lower infundibular length, width, length-to-width ratio and pelvic caliceal
height in the stone-free and residual stone group were 25.5, 28.0 mm, 4.5, 5.0
mm, 6.4, 5.5 mm and 21.5, 21.5 mm, respectively (p = 0.810, 0.327, 0.511 and
0.511). Median lower infundibulopelvic angle in the stone-free and residual stone
groups was 92.50 and 92.50 degrees, and 60.0 and 54.50 degrees, respectively (p =
0.860 and 0.089). On ROC analysis no parameter predicting stone-free rate and
cutoff points of caliceal anatomy measurements for stone clearance was found.
CONCLUSIONS: Our results suggest that caliceal pelvic anatomy in pediatric lower 
pole stones has no significant impact on stone clearance after SWL. There was a
highly significant relation between retreatment rates and stone burden, which
should be considered for determining the treatment modality.

PMID: 15311043 [PubMed - indexed for MEDLINE]

835: J Urol. 2004 Sep;172(3):1078-81.

Percutaneous nephrolithotomy in children: early and late anatomical and
functional results.

Dawaba MS, Shokeir AA, Hafez AT, Shoma AM, El-Sherbiny MT, Mokhtar A, Eraky I,
El-Kenawy M, El-Kappany HA.

Urology & Nephrology Center, Mansoura University, Mansoura, Egypt.

PURPOSE: We report our experience with percutaneous nephrolithotomy (PCNL) in
children, and evaluate its early and late anatomical and functional results.
MATERIALS AND METHODS: A total of 65 children with renal calculi were treated
with PCNL. Patient age at operation ranged from 9 months to 16 years (mean +/- SD
of 5.9 +/- 0.9 years), and 27 (41.5%) were younger than 5 years. Seven patients
had bilateral renal stones and, therefore, the number of kidneys treated by PCNL 
was 72. The patients were followed regularly every 3 months during year 1 and
every 6 months thereafter. Renal scans using technetium dimercapto-succinic acid 
for detection of renal scarring and technetium diethylenetetramine-pentaacetic
acid for determination of selective glomerular filtration rate (GFR) were
performed in all patients at least once during followup, which ranged from 6 to
72 months (mean +/- SD 40 +/- 10). RESULTS: Early complications included
significant intraoperative bleeding in 1 case, renal pelvis perforation in 1 and 
transient fever in 2. Mean hospital stay +/- SD was 3 +/- 1.2 days (range 2 to
21). Of the renal units 62 (86%) were stone-free after a single PCNL, and the
remaining 10 with residual stones were treated with a second look PCNL (4) and
shock wave lithotripsy (6). Stone-free rates at hospital discharge and at 3
months were 93% and 100%, respectively. During followup 6 patients (9%) had
recurrence of small renal stones and were successfully treated with shock wave
lithotripsy. None of the kidneys had scarring on dimercapto-succinic acid renal
scan. All of the kidneys except 1 showed improvement or stabilization of the
corresponding GFR determined by diethylenetetraminepentaacetic acid renal scan.
Comparison of the mean preoperative GFR of the corresponding kidney (28.8 +/-
11.2 ml per minute) with mean value at followup (36.1 +/- 9.9) showed an increase
of statistical significance (p <0.01). CONCLUSIONS: PCNL is a safe and effective 
procedure for the treatment of children with renal calculi. At long-term followup
the procedure improves renal function without renal scarring.

PMID: 15311042 [PubMed - indexed for MEDLINE]

836: J Urol. 2004 Sep;172(3):965-6.

Spiral stent versus standard stent in patients with midsize renal stones treated 
with extracorporeal shock wave lithotripsy: which stent works better? A
prospective randomized trial.

Gerber R, Nitz C, Studer UE, Danuser H.

Department of Urology, University of Bern, CH-3010 Bern, Switzerland.
rolf.gerber@insel.ch

PURPOSE: It has been proposed that stone fragment clearance with a new spiral
Double-J stent (Medical Engineering Corp., New York, New York) is faster than
with a standard Double-J stent. Therefore, we evaluated stent insertion,
peri-interventional complications, as well as stone clearance in patients with
midsize kidney stones treated with extracorporeal shock wave lithotripsy (3,500
shock waves) in a prospective randomized trial. MATERIALS AND METHODS: A total of
32 patients were randomized for preoperative insertion of a spiral stent (16) or 
a standard stent (16). Stone volume was measured from an abdominal plain film.
Stent inserting time and stent handling problems, as well as perioperative and
postoperative complications were evaluated. Clearance of stone fragments was
analyzed by abdominal plain films and ultrasound on day 1, and at the end of
weeks 1, 2 and 6 after treatment or until stone fragments were completely
cleared. RESULTS: Median stone volume was 1.8 ccm (range 0.4 to 5.2) in the
spiral stent group and 1.3 ccm (range 0.4 to 2.6) in the standard stent group (p 
= 0.08). Median stent inserting time was 21 minutes (range 10 to 60) in the
spiral stent and 18 minutes (range 5 to 45) in the standard stent group (p =
0.94). Inserting difficulties occurred in 6 of 16 (38%) patients with spiral
stents and in none with standard stents (p = 0.005). Spontaneous stent
displacement occurred in 4 of 16 patients in the spiral stent group and did not
occur in the standard stent group (p = 0.03). The percentage of stone-free
patients 1 day, and 1, 2 and 6 weeks after treatment was 0%, 13%, 44% and 81% in 
the spiral stent group and 6%, 19%, 50% and 88% (p = 0.64) in the standard stent 
group, respectively. CONCLUSIONS: Spiral stents are more difficult to insert,
spontaneously dislocate more often and have no advantage in overall stone
clearance compared with standard stents.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 15311010 [PubMed - indexed for MEDLINE]

837: J Urol. 2004 Sep;172(3):962-4.

Coronal imaging to assess urinary tract stone size.

Nadler RB, Stern JA, Kimm S, Hoff F, Rademaker AW.

Department of Urology, Northwestern University Feinberg School of Medicine,
Chicago, IL, USA.

PURPOSE: Urinary tract stones are typically measured using axial images from
computerized tomography (CT). Such images provide a precise measurement of stone 
length and width. However, cephalocaudad dimensions can be difficult to determine
from axial images. Coronal reconstructions, which can more accurately measure
cephalocaudad dimensions, are seldom used to measure stones. We determined if
coronal reconstructions could aid in more precisely determining stone size.
MATERIALS AND METHODS: CT in patients who had undergone CT to evaluate
urolithiasis at our institution during the 9-month period of January 2001 to
September 2001 were reviewed. Length and width were measured using axial images, 
and cephalocaudad length and width were measured using coronal reconstructions.
Cephalocaudad length was also estimated from axial images. Total area was
calculated from axial and coronal reconstructions. The paired t test was used to 
assess statistical significance. RESULTS: The CT images of 102 patients with a
total of 151 stones had undergone coronal reconstructions and, thus, were
included in the study. Mean area in the axial and coronal reconstruction groups
was 22.23 and 31.29 mm, respectively. Mean greatest axial dimension (length or
width) was 4.87 mm and mean greatest coronal dimension (cephalocaudad length) was
6.51 mm. Cephalocaudad length estimated from axial images was 8.8 mm. Differences
for all 3 of these comparisons (axial vs coronal area, greatest axial vs coronal 
dimension and estimated vs actual cephalocaudad length) proved to be
statistically significant (p <0.0001). CONCLUSIONS: While urinary tract stones
have typically been measured using axial images, coronal images provide a
different impression of stone size. These data demonstrate that examining only
axial images provides an inaccurate measure of stone size. We suggest that
coronal images should also be used to measure more accurately stone size, which
is critical for clinical decision making.

PMID: 15311009 [PubMed - indexed for MEDLINE]

838: Urology. 2004 Aug;64(2):237-40.

Spiral computed tomography: role in determination of chemical compositions of
pure and mixed urinary stones--an in vitro study.

Deveci S, Coşkun M, Tekin MI, Peşkircioglu L, Tarhan NC, Ozkardeş H.

Department ofUrology, Başkent University School of Medicine, Ankara, Turkey.

OBJECTIVES: To determine the chemical composition of pure and mixed urinary
calculi by multislice helical computed tomography (CT) in an in vitro setting. CT
is becoming the preferred radiologic examination in diagnosis and management of
calculus disease. The management of calculus disease can be facilitated by
ascertaining the stone composition. Unnecessary shock wave treatment could be
avoided if the fragility of the stones could be predicted at diagnosis. METHODS: 
A total of 107 stones (86 pure and 21 mixed) were measured in a multislice
helical scanner within an air-filled environment. The scans were performed at two
energy levels, 80 kV and 120 kV, with a 1-mm slice thickness. The chemical
compositions of the urinary stones were assessed on the basis of the differences 
in the densities measured in Hounsfield units. The stones were assigned to six
different groups according to the density measured in Hounsfield units: uric
acid, struvite, cystine, calcium phosphate, calcium oxalate monohydrate, and
calcium oxalate dihydrate. RESULTS: The differences in the density measured by
multislice helical CT at 120 kV for the six groups of pure stones were
statistically significant. The densities of the different regions within the
mixed stones were also significantly different statistically from each other. The
densities of the different regions measured in the mixed stones were not
different from the densities of the corresponding pure stones. This finding
supports the idea that different chemical compositions within a stone can be
identified by their densities measured by multislice helical CT. CONCLUSIONS: The
chemical compositions of both pure and mixed stones can be determined by
multislice helical CT in an in vitro setting. The feasibility of in vivo
determinations remains to be clarified.

Publication Types: 
    Evaluation Studies
    In Vitro

PMID: 15302469 [PubMed - indexed for MEDLINE]

839: Chem Biol Interact. 2004 Aug 10;149(1):1-7.

Prophylactic role of phycocyanin: a study of oxalate mediated renal cell injury.

Farooq SM, Asokan D, Kalaiselvi P, Sakthivel R, Varalakshmi P.

Department of Medical Biochemistry, Dr. ALM Postgraduate Institute of Basic
Medical Sciences, University of Madras, Taramani, Chennai 600113, India.

Oxalate induced renal calculi formation and the associated renal injury is
thought to be caused by free radical mediated mechanisms. An in vivo model was
used to investigate the effect of phycocyanin (from Spirulina platensis), a known
antioxidant, against calcium oxalate urolithiasis. Male Wistar rats were divided 
into four groups. Hyperoxaluria was induced in two of these groups by
intraperitoneal infusion of sodium oxalate (70 mg/kg) and a pretreatment of
phycocyanin (100 mg/kg) as a single oral dosage was given, 1h prior to sodium
oxalate infusion. An untreated control and drug control (phycocyanin alone) were 
also included in the study. We observed that phycocyanin significantly controlled
the early biochemical changes in calcium oxalate stone formation. The
antiurolithic nature of the drug was evaluated by the assessment of urinary risk 
factors and light microscopic observation of urinary crystals. Renal tubular
damage as divulged by urinary marker enzymes (alkaline phosphatase, acid
phosphatase and gamma-glutamyl transferase) and histopathological observations
such as decreased tubulointerstitial, tubular dilatation and mononuclear
inflammatory cells, indicated that renal damage was minimised in drug-pretreated 
group. Oxalate levels (P < 0.001) and lipid peroxidation (P < 0.001) in kidney
tissue were significantly controlled by drug pretreatment, suggesting the ability
of phycocyanin to quench the free radicals, thereby preventing the lipid
peroxidation mediated tissue damage and oxalate entry. This accounts for the
prevention of CaOx stones. Thus, the present analysis revealed the antioxidant
and antiurolithic potential of phycocyanin thereby projecting it as a promising
therapeutic agent against renal cell injury associated kidney stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15294440 [PubMed - indexed for MEDLINE]

840: World J Urol. 2004 Nov;22(5):323-7. Epub 2004 Jul 29.

Imaging for kidney stones.

Rao PN.

South Manchester University Hospitals NHS Trust, Wythenshawe Hospital, Southmoor 
Road, Wythenshawe, Manchester M23 9LT, UK. Nagaraja.rao@ntlworld.com

Imaging investigations play a vital role in the management of patients with
kidney stones. The techniques available include plain x-ray of the abdomen,
ultrasound scan, intravenous urogram, computed tomography (CT) and magnetic
resonance imaging, amongst others. All of these techniques have their own
individual roles to play and also have limitations. CT has been establishing
itself as the imaging technique of choice and some exciting developments are on
the way. However, renal stone disease is a complex condition. Furthermore, there 
are a variety of surgical techniques used to treat stones. It is therefore
important that the strengths and weakness of each of the modalities are clearly
understood and the investigations are tailored to address the problem in hand.

Publication Types: 
    Review

PMID: 15290203 [PubMed - indexed for MEDLINE]

841: Ren Fail. 2004 Mar;26(2):135-40.

Salubrious effect of vitamin E supplementation on renal stone forming risk
factors in urogenital tuberculosis patients.

Srinivasan S, Jenita X, Kalaiselvi P, Muthu V, Chandrasekar D, Varalakshmi P.

Department of Medical Biochemistry, Dr. A.L. Mudaliar Post Graduate Institute of 
Basic Medical Sciences, University of Madras, Taramani, Chennai, India.

The incidence of renal calculi has been evaluated to be 25% in urogenital
tuberculosis patients. The stone could be caused due to the host, the pathogenic 
organism, or possibly by the treatment. Studies were carried out to find out the 
efficacy of vitamin E supplementation in reducing the risk of stone formation in 
renal tuberculosis patients. The study constituted four groups, Group I with 30
normal volunteers, the second group comprised of 36 renal tuberculosis patients
(GuTb) a day before treatment. Third group comprised of 24 patients with regular 
anti tuberculosis drug regimen for sixty days. In the fourth group, 12 patients
were treated with anti tuberculosis drug regimen along with supplementation of
antioxidant vitamin E (200 mg/day) for sixty days. Hyperuricosuria and
hypercalciuria were observed in group II and group III patients, along with
increased excretion of oxalate and creatinine, accompanied by decreased excretion
of inhibitors such as citrate and glycosaminoglycans (GAGs). Renal damage was
evident with increased leakage of Lactate dehydrogenase (LDH), Alkaline
phosphatase (ALP) and gamma-Glutamyl transferase (gamma-GT) in renal tuberculosis
patients. From the results of the above study, it is obvious that increased
urinary oxalate levels leads to cellular damage in GuTb patients, which is a
prerequisite for crystal retention as revealed by the elevated urinary marker
enzymes. Antioxidant therapy prevents membrane injury thereby reducing the risk
of stone formation. Hence vitamin E supplementation has a salubrious effect in
preventing stone forming tendency with routine anti tuberculosis drug regimen.

Publication Types: 
    Comparative Study

PMID: 15287196 [PubMed - indexed for MEDLINE]

842: J Clin Pathol. 2004 Aug;57(8):793-6.

A review of the heritability of idiopathic nephrolithiasis.

Griffin DG.

Department of Chemical Pathology, Morrison Hospital, Swansea, UK.
damian.griffin@swansea-tr.wales.nhs.uk

Familial aggregations of nephrolithiasis were already noted in the early 19th
century and over the intervening years there has been gradual progression in
classifying the familial forms of nephrolithiasis. To date, there are at least 10
different monogenic conditions where those affected have a predisposition to
nephrolithiasis. However, all of these rare conditions probably account for less 
than 2% of renal stone formers. This review, rather than considering these
clearly defined disorders, concentrates on research into the broad band of stone 
formers who have a propensity to nephrolithiasis without an obvious discrete
genetic basis.

Publication Types: 
    Review

PMID: 15280397 [PubMed - indexed for MEDLINE]

843: J Med Assoc Thai. 2004 Jun;87(6):704-8.

Comparative study of renal function between standard and modified anatrophic
nephrolithotomy by radionuclide renal scans.

Kijvikai K, Leenanupunth C, Sirisriro R, Lertsithichai P.

Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand. kittinutk@hotmail.com

OBJECTIVE: To compare the changes in renal function after surgery between
standard and modified anatrophic nephrolithotomy using the technetium 99m-DTPA
renal scan in patients with complex staghorn calculi. MATERIAL AND METHOD: From
July 2001 to March 2002, standard anatrophic nephrolithotomy (sANL) was performed
in 7 patients with complex staghorn calculi and modified anatrophic
nephrolithotomy (mANL) was performed in another group of 8 patients with the same
condition. Preoperative and postoperative renal function were assessed by
technetium 99m-DTPA renal scan. RESULTS: Mean patient age was 41 years in the
sANL group and 45 years in the mANL group. Male to female ratio was 4:3 in the
sANL group and 5:3 in the mANL group. Median operative time was 205 minutes in
the sANL group compare with 180 minutes in the mANL group (P = 0.03). Median
estimated blood loss was 300 ml. in the sANL group and 275 ml. in the mANL group 
(P = 0.17). Median percent reduction of GFR on the operated kidney was 9.13
(-30.03 to -3.15) in the sANL group and 27.25 (-41.81 to -1.55) in the mANL group
(P = 0.13). Residual small stone was seen in one patient of the sANL group and
ESWL was performed for stone fragmentation. There were no serious short-term
complications. CONCLUSION: The average operative time of sANL was longer than
mANL however, sANL preserved more renal function than mANL. This study suggested 
that sANL should be the procedure of choice in patients who have compromised
renal function.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 15279353 [PubMed - indexed for MEDLINE]

844: J Magn Reson Imaging. 2004 Aug;20(2):264-71.

Combined magnetic resonance urography and targeted helical CT in patients with
renal colic: a new approach to reduce delivered dose.

Blandino A, Minutoli F, Scribano E, Vinci S, Magno C, Pergolizzi S, Settineri N, 
Pandolfo I, Gaeta M.

Department of Radiologic Sciences, University of Messina, Policlinico G. Martino,
Contrada Gazzi, Messina 98125, Italy.

PURPOSE: To determine whether magnetic resonance urography (MRU), obtained before
helical computed tomography (CT) in patients with acute renal colic, can help
delimit the obstructed area to be subsequently examined by a targeted CT scan,
thus reducing the dose of radiation. MATERIALS AND METHODS: Patients (51) with
symptoms of acute renal colic underwent MRU and a total urinary tract helical CT.
CT images from the 5 cm below the level of ureteral obstruction as demonstrated
by MRU were selected out. Combined interpretation of MRU and selected CT images
constituted protocol A. Protocol B consisted of the entire unenhanced helical CT 
of the urinary tract. The two protocols were compared regarding the following
points: 1) sensitivity in diagnosing the presence of obstructing urinary stones, 
and 2) the delivered radiation dose. RESULTS: Protocol A and protocol B had,
respectively, 98% and 100% sensitivity in demonstrating ureteral stone as a cause
of renal colic. Estimated average dose calculated from phantom study was 0.52 mSv
for protocol A and 2.83 mSv for protocol B. Therefore, the effective radiation
dose was 5.4 times lower in protocol A compared to protocol B. CONCLUSION:
Combined MRU and short helical CT has a high sensitivity in detecting ureteral
calculi with a reduced radiation dose. Copyright 2004 Wiley-Liss, Inc.

PMID: 15269952 [PubMed - indexed for MEDLINE]

845: Clin Nephrol. 2004 Jul;62(1):58-61.

Always look beyond the stones: hyperoxaluria overlooked.

Chung TT, Summers S, Sheaff M, Cunningham J.

Department of Renal Medicine and Transplantation, The Royal London Hospital,
London, UK. Tengx2@hotmail.com

We report a case which demonstrates the disastrous consequences of late diagnosis
of hyperoxaluria in a 24-year-old woman with nephrocalcinosis, a staghorn
calculus and recurrent urinary tract infections. Her initial management at
another hospital included multiple percutaneous nephrostomies and lithropsies.
Metabolic screening was not undertaken. Hyperoxaluria was finally diagnosed by
elevated urine oxalate (1.235 mmol/24 h) and renal biopsy, by which time there
was already significant reduction of renal function. A diagnosis of hyperoxaluria
type I was confirmed by liver biopsy. Despite starting pyridoxine and
crystallization inhibitors, her renal function deteriorated, requiring
hemodialysis and she was referred for combined liver-renal transplantation.
Clinical clues of primary hyperoxaluria type I are a positive family history or
presentation with severe renal stones at an unusually early age. Irrespective of 
the above, all patients with first presentation of renal calculi should undergo
metabolic screening, including urine oxalate.

Publication Types: 
    Case Reports

PMID: 15267015 [PubMed - indexed for MEDLINE]

846: Acta Paediatr Taiwan. 2004 Jan-Feb;45(1):45-7.

Diffuse xanthogranulomatous pyelonephritis and staghorn calculus: report of one
case.

Chen TY, Yu TJ, Ko SF, Huang CC, Tain YL.

Department of Pediatrics, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.

Xanthogranulomatous pyelonephritis and staghorn calculus are rare in children. In
this report, we describe a Chinese boy without history of urinary tract infection
who developed insidious onset of left flank pain. Urine culture showed Proteus
mirabilis infection. Sonography and computed tomography of the abdomen showed
typical picture of xanthogranulomatous pyelonephritis and staghorn calculus.
Photomicrography showed characteristic lipid-laden macrophage aggregates. After
nephrectomy, he was symptom-free. In conclusion, xanthogranulomatous
pyelonephritis should be considered in afebrile children with flank pain and
staghorn calculus.

Publication Types: 
    Case Reports

PMID: 15264707 [PubMed - indexed for MEDLINE]

847: J Endourol. 2004 Jun;18(5):481-2.

Reflux of a staple after kock pouch urinary diversion: a nidus for renal stone
formation.

Gronau E, Pannek J.

Department of Urology and Neurourology, Ruhr-Universität Bochum, Marienhospital
Herne, Herne, Germany. Eckart.Gronau@dgn.de

A patient with cystectomy and urinary diversion after spinal cord injury had
multiple pouch concretements and a kidney stone formed around a staple that
apparently had refluxed from the nipple of the pouch. In such cases, the stone
and staple should be removed at the same time, either percutaneously or by
ureterorenoscopy.

Publication Types: 
    Case Reports

PMID: 15253826 [PubMed - indexed for MEDLINE]

848: Kidney Int. 2004 Aug;66(2):777-85.

Clinical implications of abundant calcium phosphate in routinely analyzed kidney 
stones.

Parks JH, Worcester EM, Coe FL, Evan AP, Lingeman JE.

Nephrology Section, Department of Medicine, University of Chicago, Chicago,
Illinois 60637, USA.

BACKGROUND: To better portray the clinical phenotype of kidney stone patients
with high calcium phosphate (CaP) stone abundance, we present here clinical and
laboratory findings of large numbers of stone formers (SF) with stone CaP ranging
from 0% to 100%. Our purpose was to inform clinicians and highlight areas that
seem to deserve further research. METHODS: We calculated average percent CaP
(CaP%) in all stones of 1201 patients, and classified them into CaOx (N= 1011) or
CaP (N= 190). Sex differences, stone formation rates, urine stone risk factors,
extracorporeal shock wave lithotripsy (ESWL) treatments, and relapse during
treatment were quantified in relation to stone CaP content. RESULTS: CaP% has
risen for three decades, especially among women. ESWL rates adjusted for numbers 
of stones and duration of stone disease were higher in CaP SF (0.6 vs. 1.86 and
0.73 vs. 1.82, CaOx vs. CaP, men and women, respectively, P < 0.001), and
especially when stones contained brushite (2.90 vs. 1.02 and 3.11 vs. 1.35,
brushite vs. not, males and females, respectively, P < 0.001). Urine pH and CaP
supersaturation rose in proportion to CaP% in a dose response manner. Relapse
rates of CaP and CaOx SF did not differ, and both did well with medical
prevention. CONCLUSION: Stone CaP% has risen for three decades. CaP SF,
particularly with brushite stones, receive more ESWL treatments than CaOx SF, not
explained by stone number or duration of stone disease. Urine supersaturations
explain the high CaP%. High CaP% does not hamper medical stone prevention.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15253733 [PubMed - indexed for MEDLINE]

849: Kidney Int. 2004 Aug;66(2):676-82.

Erratum in:
    Kidney Int. 2004 Sep;66(3):1304. Heiberg, Ita Pfeferman [corrected to Heilberg,
Ita Pfeferman].

Fat malabsorption induced by gastrointestinal lipase inhibitor leads to an
increase in urinary oxalate excretion.

Ferraz RR, Tiselius HG, Heilberg IP.

Nephrology Division, Universidade Federal de São Paulo, UNIFESP, São Paulo,
Brazil.

BACKGROUND: Unabsorbed fat and bile acids may react with calcium in the
intestinal lumen, limiting the amount of free calcium binding with oxalate and
thereby raising intestinal oxalate absorption leading to hyperoxaluria. The aim
of the present study was to determine whether orlistat (Xenical), a
gastrointestinal lipase inhibitor, might increase urinary oxalate in an
experimental rat model. METHODS: Thirty-nine male adult Wistar rats were fed a
standard diet alone (controls) or supplemented with either 2% sodium oxalate
(NaOx) or 3.2 mL of soy oil, or with both (NaOx + soy oil) for 4 weeks (diet
period). Orlistat (16 mg/day) was added to the diet from the 5th to the 8th week 
(diet + orlistat period). Urinary oxalate (uOx), calcium (uCa), magnesium (uMg), 
and citrate (uCit) were determined and the ion-activity product of calcium
oxalate [AP (CaOx) index(rat)] was estimated. RESULTS: Compared to baseline uOx
significantly increased after diet + orlistat in controls (0.64 +/- 0.1 mg/24
hours vs. 0.56 +/-0.1 mg/24 hours), soy oil (0.80 +/- 0.3 mg/24 hours vs. 0.49
+/-0.2 mg/24 hours), and NaOx (2.48 +/- 0.8 mg/24 hours vs. 0.57 +/- 0.2 mg/24
hours), but the most marked increase occurred in NaOx + soy oil (3.87 +/- 0.7
mg/24 hours vs. 0.47 +/- 0.1 mg/24 hours). All groups except controls presented a
significant reduction in uCa and uMg. Orlistat induced a significant increase in 
AP (CaOx) index(rat) compared, respectively, to baseline and to the diet period
in NaOx (4.52 +/- 2.34 mg/24 hours vs. 0.94 +/- 0.86 and 1.53 +/- 0.93 mg/24
hours) and NaOx + soy oil (6.49 +/- 4.03 mg/24 hours vs. 0.54 +/- 0.17 and 1.76
+/- 1.32 mg/24 hours). CONCLUSION: These data suggest that the use of lipase
inhibitors, especially under a diet rich in oxalate alone or associated with fat,
leads to a significant and marked increase in urinary oxalate and a slight
reduction in uCa and uMg that, taken together, resulted in an increase in AP
(CaOx) index(rat), elevating the risk of stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15253722 [PubMed - indexed for MEDLINE]

850: J Urol. 2004 Aug;172(2):680-3; discussion 683.

Transperitoneal laparoscopic pyelolithotomy after failed percutaneous access in
the pediatric patient.

Casale P, Grady RW, Joyner BD, Zeltser IS, Kuo RL, Mitchell ME.

Seattle Children's Hospital, University of Washington, 98105-0371, USA.
patcasale@seattlechildrens.org

PURPOSE: We present our experience with transperitoneal laparoscopic
pyelolithotomy in pediatric patients in whom percutaneous renal access failed and
the stone burden warranted open intervention. MATERIAL AND METHODS: A
transperitoneal laparoscopic approach was used for pyelolithotomy in 8 patients 3
months to 10 years old (mean age 4 years). Percutaneous access failed secondary
to a nondilated system and/or an occluding lower pole calculus. Inclusion
criteria were failed percutaneous access secondary to a nondilated system and/or 
stone occlusion of the lower pole system and failed shock wave lithotripsy or a
stone burden of greater than 2.5 cm2. A posterior pelviotomy was made. Stones in 
the renal pelvis were removed with rigid graspers under direct laparoscopic
vision. A flexible cystoscope was introduced through a port if caliceal stones
were present. The renal pelvis was reconstructed. A watertight anastomosis was
verified. RESULTS: Average operative time was 1.6 hours (range 0.8 to 2.3). Mean 
hospital stay was 2.15 days (range 2 to 3). A range of 1 to 3 stones (median of
1) were removed and the mean stone burden was 2.9 cm2. No intraoperative
complications were noted. Stone analysis revealed 3 patients with calcium oxalate
stones, 1 with a calcium phosphate stone and 4 with cysteine stones. There was 1 
patient with stone recurrence at a mean followup of 12 months (range 3 to 20).
Thus, the overall long-term stone-free rate was 87.5%. CONCLUSIONS:
Transperitoneal laparoscopic pyelolithotomy is feasible when percutaneous access 
fails and open pyelolithotomy is considered due to a large stone burden.

PMID: 15247760 [PubMed - indexed for MEDLINE]

851: J Urol. 2004 Aug;172(2):562-4.

Comparison of nitinol tipless stone baskets in an in vitro caliceal model.

Lukasewycz S, Skenazy J, Hoffman N, Kuskowski M, Hendlin K, Monga M.

Department of Urologic Surgery, University of Minnesota, Minneapolis, 55455, USA.

PURPOSE: Tipless stone baskets facilitate caliceal calculi extraction during
flexible ureteroscopy. We evaluated the stone capture rate of 9 commercially
available tipless stone baskets in an in vitro model using novice and expert
operators. MATERIALS AND METHODS: The Microvasive Zerotip (2.4Fr, 3.0Fr), Cook
N-Circle (2.2Fr, 3.0Fr, 3.2Fr), Bard Dimension (3.0Fr, Sacred Heart Medical Halo 
(1.9Fr), Vantage (1.9Fr) and Circon-ACMI Sur-Catch-NT (3.0Fr) were tested by 3
novice and 3 experienced basket operators. Each operator performed stone
extraction of 2, 5 and 8 mm calculi (size determined by digital caliper with 3
repetitions of each basket. The time to extraction of the calculus from a convex 
based test tube caliceal model was recorded. Statistical analysis was performed
using repeated measures ANOVA and Fisher's pairwise comparisons. RESULTS: After a
learning curve of 27 basket retrievals, there was no significant difference in
stone capture times between novice (38 +/- 54 seconds) and expert operators (32
+/- 49 seconds, p = 0.174). For total stone capture (all sizes) the Sacred Heart 
Halo resulted in the most rapid stone extraction (17 +/- 14 seconds) by novices
and experts, while the Sur-Catch NT resulted in the slowest stone extraction (78 
+/- 90, seconds, p = 0.001). The Halo (14 +/- 9 seconds) and Vantage (19 +/- 12
seconds) baskets were significantly faster for 2 mm calculi than the N-Circle (73
+/- 60 seconds, p = 0.006), Sur-Catch (169 +/- 85 seconds, p = 0.0005) and
Dimension (73 +/- 70 seconds, p = 0.017). The Zerotip functioned well for 2 mm
calculi in the hands of expert operators (15 +/- 9 seconds) but not novice
operators (94 +/- 95 seconds). The Sur-Catch NT was significantly slower for 2 mm
calculi than the N-Circle (p = 0.01), Dimension (p =.03), Halo (p =.0005),
Vantage (p =.001) and Zerotip (p =.002). For 5 mm calculi the Halo was superior
(12 +/- 8 seconds), while the Zerotip were superior for 8 mm calculi (8 +/- 3
seconds) compared to the N-Circle (23 +/- 28 seconds, p = 0.026), Halo (26 +/- 18
seconds, p = 0.021) and Vantage (23 +/- 15 seconds, p = 0.006). CONCLUSIONS: The 
Sacred Heart Halo and Vantage baskets resulted in the most expeditious stone
extraction, especially for 2 to 5 mm calculi while the Microvasive Zerotip was
optimal for 8 mm calculi. The Sur-Catch NT had the slowest stone capture rate for
all stone sizes. Caliceal models of stone basketing may be useful to train novice
urology residents and nursing assistants.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 15247730 [PubMed - indexed for MEDLINE]

852: J Urol. 2004 Aug;172(2):559-61.

Percutaneous renal stone extraction: in vitro study of retrieval devices.

Hoffman N, Lukasewycz SJ, Canales B, Botnaru A, Slaton JW, Monga M.

Department of Urologic Surgery, University of Minnesota, Minneapolis, 55455, USA.

PURPOSE: Traditionally, percutaneous stone extraction has relied on the use of
2-prong and 3-prong graspers, which are prone to causing trauma to the
urothelium. We evaluate the efficiency of stone removal with a novel tipless
stone basket designed specifically for percutaneous procedures. MATERIALS AND
METHODS: A 3, 5 and 8 mm human calculus were placed in the calix of a
percutaneous renal model. A 26Fr Storz nephroscope (27093B, Storz Medical AG,
Kreuzlingen, Switzerland) was inserted through a 30Fr Amplatz sheath into the
model with camera input from a Storz telecam SL-NTSC feeding to a 20-inch Sony
Triniton monitor (Sony Corp of America, New York, New York). Operators were
randomized to start stone extraction with a Storz 3-prong grasper (27090RB) or a 
Cook 12Fr Perc-NCircle (38 cm) (Cook Urological, Inc., Indianapolis, Indiana).
Subsequent testing alternated between the 2 devices until 10 extraction attempts 
were conducted with each device. Time to extraction of all 3 calculi and number
of inadvertent withdrawals of the sheath were recorded. Three experienced
operators tested each device. RESULTS: Stone extraction times were shorter with
the Cook Perc-NCircle than the 3-prong grasper for all operators. Mean time for
stone extraction was 25.3 +/- 11.2 seconds for the Perc-NCircle compared to 35.1 
+/- 18.5 seconds for the 3-prong grasper (p = 0.016). Loss of access by
inadvertent removal of the Amplatz sheath occurred in 53% of the attempts with
the 3-prong grasper compared to 7% of attempts with the Perc-NCircle.
CONCLUSIONS: The Cook Perc-NCircle facilitates a more expeditious approach to
percutaneous stone removal with less risk of sheath withdrawal.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 15247729 [PubMed - indexed for MEDLINE]

853: J Urol. 2004 Aug;172(2):555-8.

Comment in:
    J Urol. 2005 Mar;173(3):1048; author reply 1048-9.

Acute caffeine effects on urine composition and calcium kidney stone risk in
calcium stone formers.

Massey LK, Sutton RA.

Department of Food Science and Human Nutrition, Washington State University,
Spokane, 99120-1495, USA. massey@wsu.edu

PURPOSE: Caffeine increases urinary calcium (ca) excretion in nonstone formers.
We designed a study to determine the effect of caffeine consumption on urinary
composition in stone formers. MATERIALS AND METHODS: A total of 39 normocalcemic 
patients with calcium stones consumed caffeine (6 mg/kg lean body mass) after 14 
hours of fasting. Urinary composition was compared 2 hours before and 2 hours
after caffeine consumption. Control subjects included 9 nonstone formers studied 
contemporaneously with patients plus data from 39 nonstone formers from previous 
studies matched to each patient by level of fasting calcium/creatinine (Cr),
gender and age. RESULTS: Caffeine increased urinary Ca/Cr, magnesium/Cr,
citrate/Cr and sodium/Cr but not oxalate/Cr in stone formers and controls. The
Tiselius stone risk index for calcium oxalate precipitation increased from 2.4 to
3.1 in stone formers and from 1.7 to 2.5 in nonstone formers. Of the 39 stone
formers 32 had an increased Tiselius risk index after caffeine. Post-caffeine
increases in Ca/Cr and Na/Cr were highly correlated. CONCLUSIONS: Caffeine
consumption may modestly increase risk of calcium oxalate stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15247728 [PubMed - indexed for MEDLINE]

854: Int J Urol. 2004 Jul;11(7):581-4.

Laparoscopic pyelolithotomy--a technique for the management of stones in the
ectopic pelvic kidney.

Kamat N, Khandelwal P.

Department of Urology, Kamats Kidney Hospital, Kothi, Gujarat, India.
kamatnn@hotmail.com

We present our preliminary experience with the technique of laparoscopic
pyelolithotomy for ectopic pelvic kidney calculi. This surgery has low morbidity 
and is ideally suited for the ectopic pelvic kidney with a laterally or
anteriorly directed pelvis.

Publication Types: 
    Case Reports

PMID: 15242377 [PubMed - indexed for MEDLINE]

855: Acta Radiol. 2004 May;45(3):351-6.

Usefulness of reversed display of soft-copy abdominal radiographs for urinary
calculi detection.

Kang SS, Kim JK, Ryu JA, Choi N, Bae SJ, Kim B.

Department of Radiology, Sungkyunkwan University School of Medicine, Samsung
Medical Center, Kangnam-gu, Seoul, South Korea.

PURPOSE: To determine the usefulness of reversed display of soft-copy abdominal
radiographs for urinary calculi detection. MATERIAL AND METHODS: Sixty
radiographs with a single urinary calculus less than 5 mm in the long diameter
(15 in the kidney; 15 in the proximal ureter; 15 in the mid-ureter, 15 in the
distal ureter) and 15 radiographs without calculi were evaluated. Four readers
blinded to the presence or absence of urinary calculi on each radiograph reviewed
the radiographs in the conventional display, reversed display, and combination of
conventional and reversed displays at 1-week intervals. All images were evaluated
in random order and the presence or absence of urinary calculi was interpreted
using the confidence score from 1 to 5. RESULTS: Multireader analysis for calculi
in all locations showed a greater area under the receiver operating curve for
combination of the two displays (0.764) than for the conventional display alone
(0.655) (P=0.031). In the single-reader analysis for calculi in all locations,
the third reader showed a greater area under the receiver operating curve for the
reversed display (0.784) than for the conventional display (0.622) (P=0.027).
Multireader analysis of the calculi in the kidney showed a greater area under the
receiver operating curve for combination of the two displays (0.824) than for the
conventional display alone (0.703) (P=0.043). CONCLUSION: The reversed display of
soft-copy abdominal radiographs may be useful for urinary calculi detection.

PMID: 15239435 [PubMed - indexed for MEDLINE]

856: Urol Res. 2005 Feb;33(1):31-8. Epub 2004 Jul 3.

Apoptosis and its related genes in renal epithelial cells of the stone-forming
rat.

Miyazawa K, Suzuki K, Ikeda R, Moriyama MT, Ueda Y, Katsuda S.

Department of Urology, Kanazawa Medial University, Uchinada, Ishikawa, 920-0293, 
Japan. miyazawa@kanazawa-med.ac.jp

Experimental hyperoxaluria and calcium oxalate (CaOx) crystals are associated
with renal epithelial injury and cell death. A recent study has demonstrated an
oxalate-induced increase in cellular apoptosis in vitro, and speculates that this
phenomenon may contribute to stone formation. We investigated the incidence of
apoptotic cells and the expression of apoptosis related genes in the kidneys of
stone-forming rats. Male Wistar rats were administrated ethylene glycol in
drinking water and force fed with 1alpha-OH-D3. Apoptosis was detected as a
ladder of fragmented DNA in agarose gels of electrophoresed genomic DNA.
Apoptotic cells were localized by the terminal deoxynucleotidyl
transferase-mediated dUTP-biotin nick end labeling (TUNEL) method. The expression
of apoptosis-related genes was analyzed by both reverse transcription polymerase 
chain reaction (RT-PCR) and immunohistochemistry. While no labeling was detected 
in the controls or on the first day of administration by the TUNEL method,
labeling began to be detected in the renal tubular epithelium of the outer
medulla at day 3, and the number of labeled cells increased progressively during 
the observation period. A ladder of DNA fragments was demonstrated in the kidneys
of rats after 2 weeks. Immunohistochemical studies revealed the expression of Fas
ligand (Fas L), Bax and interleukin-1 beta converting enzyme (ICE) in the renal
tubular epithelium of the descending limb of loop of Henle and the distal
convoluted tubules. mRNA of the ICE, c-myc, p53 and Fas L genes was also
upregulated in the kidneys of the stone-forming rats.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15235756 [PubMed - indexed for MEDLINE]

857: Urol Res. 2004 Oct;32(5):311-6. Epub 2004 Jun 17.

The impact of dietary oxalate on kidney stone formation.

Holmes RP, Assimos DG.

Department of Urology, Wake Forest University Medical School, Medical Center
Blvd, Winston-Salem, NC 27157, USA.

The role of dietary oxalate in calcium oxalate kidney stone formation remains
unclear. However, due to the risk for stone disease that is associated with a low
calcium intake, dietary oxalate is believed to be an important contributing
factor. In this review, we have examined the available evidence related to the
ingestion of dietary oxalate, its intestinal absorption, and its handling by the 
kidney. The only difference identified to date between normal individuals and
those who form stones is in the intestinal absorption of oxalate. Differences in 
dietary oxalate intake and in renal oxalate excretion are two other parameters
that are likely to receive close scrutiny in the near future, because the
research tools required for these investigations are now available. Such
research, together with more extensive examinations of intestinal oxalate
absorption, should help clarify the role of dietary oxalate in stone formation.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 15221245 [PubMed - indexed for MEDLINE]

858: Am J Kidney Dis. 2004 Jul;44(1):e7-12.

Recurrent calcium nephrolithiasis associated with primary aldosteronism.

Shey J, Cameron MA, Sakhaee K, Moe OW.

Division of Nephrology, Department of Internal Medicine, University of Texas
Southwestern Medical Center, Dallas, TX 75390-8885, USA.

Typical manifestations of hyperaldosteronism include salt retention, hypokalemia,
and metabolic alkalosis. However, a consequence infrequently recognized and
described is hypocitraturia. In combination with hypercalciuria,
aldosterone-induced hypocitraturia can trigger calcium nephrolithiasis. The
authors report a case of an individual with primary hyperaldosteronism from an
adrenal adenoma that resulted in hypocitraturia. The patient had severe recurrent
renal calcium calculi that corrected with adrenalectomy. The clinical physiology 
of renal calcium and citrate handling in hyperaldosteronism is reviewed.

Publication Types: 
    Case Reports
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 15211456 [PubMed - indexed for MEDLINE]

859: Pediatr Nephrol. 2004 Aug;19(8):928-31. Epub 2004 Jun 17.

Sulfadiazine-induced nephrolithiasis in children.

Catalano-Pons C, Bargy S, Schlecht D, Tabone MD, Deschênes G, Bensman A, Ulinski 
T.

Department of Pediatric Nephrology, Hôpital Trousseau, 26 avenue du Dr.
Arnold-Netter, 75571, Paris Cedex 12, France.

Sulfadiazine-associated urinary calculi have been described in HIV-positive adult
patients but rarely in children. We report two pediatric cases of
sulfadiazine-induced nephrolithiasis and review 45 adult cases from the
literature. One had a hyper-IgM syndrome and was treated with sulfadiazine for
cerebral toxoplasmosis, the other had toxoplasmic retinitis. Both developed
multiple bilateral lithiasis with acute renal failure. Normalization of renal
function and reduction of calculi size was rapidly achieved after discontinuation
of sulfadiazine, hyperhydration, and alkalinization. Bilateral ureteral stents
were required in one patient because of anuria.

Publication Types: 
    Case Reports
    Review

PMID: 15206032 [PubMed - indexed for MEDLINE]

860: Scand J Urol Nephrol. 2004;38(2):161-7.

Comment in:
    Scand J Urol Nephrol. 2005;39(6):488.

Prediction of success rate after extracorporeal shock-wave lithotripsy of renal
stones--a multivariate analysis model.

Abdel-Khalek M, Sheir KZ, Mokhtar AA, Eraky I, Kenawy M, Bazeed M.

Urology and Nephrology Center, Mansoura University, Egypt. unc@mum.mans.edu.eg

OBJECTIVES: To define prognostic factors that affect the success rate after
extracorporeal shock-wave lithotripsy (ESWL) of renal calculi and to estimate the
probability of stone-free status using a regression analysis model. MATERIAL AND 
METHODS: Between February 1992 and February 2002, 2954 patients with single or
multiple radiopaque renal stones (<30 mm) underwent ESWL monotherapy. The results
of treatment were evaluated after 3 months of follow-up. Treatment success was
defined as complete clearance of the stones with no residual fragments. The
stone-free rate was correlated with stone features and patient characteristics
using the chi2 test. Factors found to be significant using the chi2 test were
further analyzed using multivariate regression analysis. RESULTS: At 3-month
follow-up, the overall stone-free rate using ESWL monotherapy was 86.7%. Failure 
to disintegrate the stones was observed in 7.3% of cases (n = 216) and failure to
clear the fragmented stones occurred in 6% (n = 177). Repeat ESWL was needed in
53% of cases. Static steinstrasse occurred in 4.9% of cases (n = 146) and
post-ESWL auxiliary procedures were required in 4% (n = 118). Using the chi2
test, patient age (p < 0.001), stone size (p < 0.001), location (p < 0.001),
number (p < 0.001) and nature (p = 0.003), radiological renal picture (p < 0.001)
and congenital renal anomalies (p < 0.001) had a significant impact on the
stone-free rate. Multivariate analysis excluded stone nature from the logistic
regression model while other factors maintained their statistically significant
effect on success rate, indicating that they were independent predictors. A
regression analysis model was designed to estimate the probability of stone-free 
status after ESWL. The sensitivity of the model was 83%, the specificity 91% and 
the overall accuracy 87%. CONCLUSION: Patient age, stone size, location and
number, radiological renal features and congenital renal anomalies are prognostic
factors determining stone clearance after ESWL of renal calculi. Our regression
model can predict the probability of the success of ESWL with an accuracy of 87%.

PMID: 15204407 [PubMed - indexed for MEDLINE]

861: Scand J Urol Nephrol. 2004;38(3):263-5.

Laparoscopic anatrophic nephrolithotomy.

Deger S, Tuellmann M, Schoenberger B, Winkelmann B, Peters R, Loening SA.

Department of Urology, Charité Campus Mitte, Humboldt University of Berlin,
Berlin, Germany. serdar.deger@charite.de

Management of staghorn calculi is still a challenge. To combine the surgical
principles of treatment with the minimal invasive access we performed a
laparoscopic anatrophic nephrolithotomy in a female patient successfully. Patient
was discharged free of stone on fifth postoperative day. No complications
occurred.

Publication Types: 
    Case Reports

PMID: 15204386 [PubMed - indexed for MEDLINE]

862: J Urol. 2004 Jul;172(1):349-54.

The effect of treatment strategy on stone comminution efficiency in shock wave
lithotripsy.

Zhou Y, Cocks FH, Preminger GM, Zhong P.

Department of Mechanical Engineering and Materials Science, Duke University,
Durham, North Carolina 27708-0300, USA.

PURPOSE: The comminution of kidney stones in shock wave lithotripsy (SWL) is a
dose dependent process caused primarily by the combination of 2 fundamental
mechanisms, namely stress waves and cavitation. The effect of treatment strategy 
with emphasis on enhancing the effect of stress waves or cavitation on stone
comminution in SWL was investigated. Because vascular injury in SWL is also dose 
dependent, optimization of the treatment strategy may produce improved stone
comminution with decreased tissue injury in SWL. MATERIALS AND METHODS: Using an 
in vitro experiment system that mimics stone fragmentation in the renal pelvis
spherical BegoStone (Bego USA, Smithfield, Rhode Island) phantoms (diameter 10
mm) were exposed to 1,500 shocks at a pulse repetition rate of 1 Hz in an
unmodified HM-3 lithotripter (Dornier Medical Systems, Kennesaw, Georgia). The 3 
treatment strategies used were increasing output voltage from 18 to 20 and then
to 22 kV every 500 shocks with emphasis on enhancing the effect of cavitation on 
medium fragments (2 to 4 mm) at the final treatment stage, decreasing output
voltage from 22 to 20 and then to 18 kV every 500 shocks with emphasis on
enhancing the effect of stress waves on large fragments (greater than 4 mm) at
the initial treatment stage and maintaining a constant output voltage at 20 kV,
as typically used in SWL procedures. Following shock wave exposure the size
distribution of fragments was determined by the sequential sieving method. In
addition, pressure waveforms at lithotripter focus (F2) produced at different
output settings were measured using a fiber optic probe hydrophone. RESULTS: The 
rate of stone comminution in SWL varied significantly in a dose dependent manner 
depending on the treatment strategies used. Specifically the comminution
efficiencies produced by the 3 strategies after the initial 500 shocks were
30.7%, 59% and 41.9%, respectively. After 1,000 shocks the corresponding
comminution efficiencies became similar (60.2%, 68.1% and 66.4%, respectively)
with no statistically significant differences (p = 0.08). After 1,500 shocks the 
final comminution efficiency produced by the first strategy was 88.7%, which was 
better than the corresponding values of 81.2% and 83.5%, respectively, for the
other 2 strategies. The difference between the final comminution efficiency of
the first and second strategies was statistically significant (p = 0.005).
CONCLUSIONS: Progressive increase in lithotripter output voltage can produce the 
best overall stone comminution in vitro.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15201809 [PubMed - indexed for MEDLINE]

863: J Urol. 2004 Jul;172(1):170-4.

Combined electrohydraulic and holmium:yag laser ureteroscopic nephrolithotripsy
for 20 to 40 mm renal calculi.

Mariani AJ.

Departmetn of Urology, University of Hawaii, John A. Burns School of Medicine,
Kaiser Medical Center, Honolulu 96819, USA. albert.mariani@kp.org

PURPOSE: Percutaneous nephrolithotripsy is standard treatment for renal calculi
greater than 2 cm. Modern flexible ureteroscopes using the complementary effects 
of electrohydraulic (EHL) and Ho:YAG laser lithotrites can treat 2 to 4 cm renal 
calculi in minimally invasive fashion with similar or superior results. We
evaluated the safety and efficacy of ureteroscopic nephrolithotripsy for the
management of 2 to 4 cm renal calculi in a community setting. MATERIALS AND
METHODS: Between January 2001 and November 2002 all 15 patients presenting with
renal calculi 22 to 42 mm long (mean 33) and 275 to 650 mm in area (mean 396), of
whom 40% had infection, underwent flexible ureteroscopic nephrolithotripsy. A
total of 13 patients had 3-month followup data. Hard stone components, namely
calcium oxalate monohydrate and/or apatite, were present in 13 cases (87%).
Treatment principles were the aggressive treatment of infection, EHL stone
debulking, Ho:YAG laser lithotripsy to weaken hard stones structurally, manual
piston irrigation to maintain visibility, bladder drainage to maintain low
intrarenal pressures, minimum 6-hour postoperative observation and physiological 
passage of stone fragments. RESULTS: In the 13 patients with 3-month followup
data the stone clearance rate was 92% for complete stone free status and 100% for
fragments less than 4 mm. This result was achieved at 1 stage in 10 cases 13
(77%) and at 2 to 4 stages in 1 each. Mean procedure time per stage was 47
minutes (range 25 to 90) and total procedure time per patient was 66 minutes
(range 25 to 240). There was no significant change in mean preoperative and
postoperative hemoglobin (p = 0.87) and creatinine (p = 0.85) in the 16 of 21
procedures for which data were available. Procedures were done on an outpatient
basis except in 1 patient, who was hospitalized overnight for the management of
preexisting pulmonary problems. One rehospitalization for colic management but no
other unplanned emergency department or clinic visits occurred. All patients were
rendered infection-free and symptom-free. CONCLUSIONS: Combined EHL and Ho:YAG
laser flexible ureteroscopic lithotripsy can be an effective treatment with low
morbidity. As such, it provides an attractive, minimally invasive alternative to 
percutaneous nephrolithotripsy or open surgery in patients with 2 to 4 cm renal
calculi.

PMID: 15201764 [PubMed - indexed for MEDLINE]

864: J Urol. 2004 Jul;172(1):166-9.

Fibrin sealant enables tubeless percutaneous stone surgery.

Noller MW, Baughman SM, Morey AF, Auge BK.

Urology Service, Brooke Army Medical Center, Fort Sam Houston, Houston, Texas,
USA.

PURPOSE: Fibrin sealant has been demonstrated to be safe and effective as a
hemostatic agent and urinary tract sealant. We assessed the ability of fibrin
sealant to facilitate tubeless management after uncomplicated percutaneous
nephrolithotomy (PCNL). MATERIALS AND METHODS: Eight consecutive patients
underwent single access tubeless PCNL for renal calculi in a total of 9 renal
units in a 2-month period. An additional patient with distal ureteral obstruction
underwent antegrade ureteroscopy for an 8 x 8 mm distal ureteral stone. Average
patient age was 47 years and mean stone size was 3.37 cm (range 0.64 to 9.90).
Following complete stone clearance a Double-J (Medical Engineering Corp., New
York, New York) ureteral stent was placed antegrade and 2 cc HEMASEEL APR
(Haemacure Corp., Sarasota, Florida) fibrin sealant was injected under
nephroscopic or fluoroscopic visualization into the parenchymal defect just
within the renal capsule. Preoperative and postoperative hematocrit (HCT) was
determined. Computerized tomography was performed on postoperative day 1 or 2 to 
evaluate retained stone fragments, perinephric fluid and urinary extravasation.
RESULTS: In the 10 renal units treated via this tubeless technique no
intraoperative or postoperative complications were noted. Average hospital stay
was 1.1 days. All patients were discharged home on postoperative day 1 except 1
undergoing asynchronous bilateral PCNL on consecutive days. The mean
intraoperative change in HCT was 2.8%. There was no significant change in HCT on 
postoperative day 1. No patient required transfusion. Seven renal units and 1
ureteral unit had no residual stone fragments for a complete stone-free rate of
80%. No gross leakage was observed on dressings and postoperative computerized
tomography failed to demonstrate urinary extravasation. CONCLUSIONS: Tubeless
PCNL using fibrin sealant at the renal parenchymal defect appears to be safe and 
feasible. Further experience is necessary to determine the role of fibrin sealant
in percutaneous renal surgery.

PMID: 15201763 [PubMed - indexed for MEDLINE]

865: J Urol. 2004 Jul;172(1):159-63.

Metabolic risk factors and the impact of medical therapy on the management of
nephrolithiasis in obese patients.

Ekeruo WO, Tan YH, Young MD, Dahm P, Maloney ME, Mathias BJ, Albala DM, Preminger
GM.

Comprehensive Kidney Stone Center, The Division of Urology, Department of
Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.

PURPOSE: Previous studies have demonstrated that obesity can increase the risk of
stone formation as well as recurrence rates of stone disease. Yet appropriate
medical management can significantly decrease the risk of recurrent stone
disease. Therefore, we analyzed our obese patient population, assessing the risk 
factors for stone formation and the impact of selective medical therapy on
recurrent stone formation. MATERIALS AND METHODS: A retrospective chart review
was performed to identify obese patients with stone disease from our Stone
Center. Metabolic risk factors for stones were identified as well as patient
response to medical therapy. A similar analysis was performed on a group of age
and sex matched nonobese stone formers. RESULTS: Of 1,021 patients 140 (14%) were
identified as obese (body mass index greater than 30). Of these patients complete
metabolic evaluations were available in 83 with an average followup of 2.3 years.
The most common presenting metabolic abnormalities among these obese patients
included gouty diathesis (54%), hypocitraturia (54%) and hyperuricosuria (43%),
which presented at levels that were significantly higher than those of the
nonobese stone formers (p <0.05). Stone analysis was available in 32 obese
patients with 63% having uric acid calculi. After initiating treatment with
selective medical therapy obese and nonobese patients demonstrated normalization 
of metabolic abnormalities, resulting in an average decrease in new stone
formation from 1.75 to 0.15 new stones formed per patient per year in both
groups. CONCLUSIONS: Obesity, as a result of dietary indiscretion, probable
purine gluttony and possible type II diabetes, appears to have a significant role
in recurrent stone formation. Appropriate metabolic evaluation, institution of
medical therapy and dietary recommendations to decrease animal protein intake can
significantly improve the risk of recurrent stone formation in these often
difficult to treat patients.

PMID: 15201761 [PubMed - indexed for MEDLINE]

866: Urol Res. 2004 Aug;32(4):304-9. Epub 2004 Jun 10.

The influence of oxalate on renal epithelial and interstitial cells.

Knoll T, Steidler A, Trojan L, Sagi S, Schaaf A, Yard B, Michel MS, Alken P.

Department of Urology, Endocrinology and Rheumatology, University Hospital
Mannheim, Th.-Kutzer-Ufer 1-3, 68135 Mannheim, Germany.
thomas.knoll@uro.ma.uni-heidelberg.de

Most renal stones in humans are composed of calcium oxalate. An increase in
urinary oxalate levels has been shown to result in renal epithelial cell injury
and crystal retention. However, the underlying mechanisms are unclear. Although
the localization of primary stone formation and the associated cells playing the 
pivotal role in stone formation are still unknown, renal epithelial cells and
interstitial cells seem to be involved in this process. The aim of this study was
to evaluate the effects of oxalate on distinct renal epithelial and endothelial
cells as well as fibroblasts. The first part focused on the toxicity of oxalate
on the cells and a potential time- and dose-dependency. In the second part, renal
epithelial cells were cultured in a two-compartment model to examine the
vulnerability of the tubular or basolateral side to oxalate. LLCPK1, MDCK, renal 
fibroblast and endothelial cell lines were cultured under standard conditions. In
part 1, cells were grown in standard culture flasks until confluent layers were
achieved. Sodium oxalate was delivered at final concentrations of 1, 2 and 4 mM
to either the apical or basolateral side (plain medium was delivered to the
contralateral side). Cell survival was assessed microscopically by trypan blue
staining after 1, 2 and 4 h. The influence of oxalate on proliferation and
apoptosis induction was also investigated. In the second part, MDCK and LLCPK1
cells were grown in 6-well plates until confluent layers were achieved. Sodium
oxalate at the above concentrations was applied, to either the apical or
basolateral side and plain medium was delivered to the opposite side. The same
protocol was then followed as in part 1. Part 1: sodium oxalate led to a time-
and concentration-dependent decline in cell survival that was comparable in
LLCPK1 and MDCK. Non-tubular cell lines like fibroblasts and endothelial cells
were significantly more vulnerable to oxalate. These observations were reflected 
by significant impairment to cell proliferation. We could not demonstrate an
induction of apoptosis in any cell line. Part 2: both cell lines were more
vulnerable to oxalate on the basolateral side. This effect was more pronounced in
MDCK cells at high oxalate concentrations (4 mM). Cells are apparently more
resistant on the apical (tubular) side. Our results show that sodium oxalate has 
a negative effect on the growth and survival of renal epithelial cells and, to a 
greater extent, also fibroblasts and endothelial cells. We could not demonstrate 
any induction of apoptotic processes which implies a direct induction of cell
necrosis. The finding of interstitial calcification and the proximity of tubules,
vessels and interstitial cells make involvement of non-tubular renal cells in
tissue calcification processes possible. Renal epithelial cells are apparently
more vulnerable to oxalate on their basolateral side. Therefore, calcification
processes within the interstitium may exert pronounced toxic effects to these
cells, leading to inflammation and necrosis. These observations further support
the idea of the interstitium as a site of primary stone formation. Copyright 2004
Springer-Verlag

Publication Types: 
    Comparative Study

PMID: 15197515 [PubMed - indexed for MEDLINE]

867: Minerva Urol Nefrol. 2004 Mar;56(1):33-48.

Advances in the surgical management of nephrolithiasis.

Marguet CG, Springhart WP, Auge BK, Preminger GM.

The Comprehensive Kidney Stone Center, The Division of Urology, Department of
Surgery, Duke University Medical Center, Durham, North Carolina, USA.

The surgical management of urinary calculus disease has undergone a dramatic
evolution over the past 2 decades. Twenty years ago, open surgical procedures for
urinary calculi were some of the most frequently performed urologic procedures.
Since then, however, stone management has been at the forefront of "minimally
invasive" intervention. Specifically, the initiation and refinement of
percutaneous and ureteroscopic access to the upper tracts, along with the rapid
and nearly simultaneous development of both extracorporeal and intracorporeal
lithotripsy techniques, has limited the role of open surgery to less than 1% of
patients undergoing intervention for their stone disease. This manuscript will
review the current indications for the surgical management of urinary calculi,
the basic physics of the most frequently utilized vehicles for both
extracorporeal and intracorporeal lithotripsy, and the respective roles of
extracorporeal and intracorporeal lithotripsy with percutaneous or ureteroscopic 
access and open surgery. In addition, the results and complications associated
with each of these forms of intervention will be reviewed. Finally, a discussion 
of specific clinical challenges to the urologist will be presented.

Publication Types: 
    Review

PMID: 15195029 [PubMed - indexed for MEDLINE]

868: Urology. 2004 Jun;63(6):1182-4.

Laparoscopic-assisted upper pole ureterocalicostomy using renal inversion and
autotransplantation.

Greene KL, Meng MV, Abrahams HM, Freise CE, Stoller ML.

Department of Urology, University of California, San Francisco, School of
Medicine, San Francisco, California 94143-0738, USA.

Despite various described methods of reconstruction after upper ureteral injury, 
many cases are complex and remain a surgical challenge. Careful preoperative
evaluation and planning are crucial in the selection of the appropriate
procedure, particularly in patients in whom preservation of the renal mass is
imperative. We report a case of severe upper ureteral injury and subsequent
fibrosis, with no usable renal pelvis and focal upper pole dilation, that was
managed with renal inversion and upper pole ureterocalicostomy. The option of
autotransplantation was provided by laparoscopic nephrectomy and ex vivo
reconstruction, minimizing patient morbidity and maximizing a successful outcome.
This case illustrates the expansion of laparoscopy from the mere extirpative to a
role in complex reconstruction. To our knowledge, this reconstructive strategy
has never been previously reported and may be applicable in a limited number of
situations.

Publication Types: 
    Case Reports

PMID: 15183982 [PubMed - indexed for MEDLINE]

869: Can J Urol. 2004 Apr;11(2):2207-9.

Laparoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible
ureteroscope.

Whelan JP, Wiesenthal JD.

Department of Surgery, McMaster University, St Joseph's Hospital, Hamilton,
Ontario, Canada.

Laparoscopic pyeloplasty is rapidly becoming the gold standard in the repair of
adults with uretero-pelvic junction obstruction. Renal calculi are a recognized
complication of uretero-pelvic junction obstruction and their presence has often 
been used to justify percutaneous nephrolithotomy and endopyelotomy as primary
treatment. Stones developing secondary to uretero-pelvic junction obstruction
have been removed through simultaneous laparoscopic pyeloplasty and
pyelolithotomy, but with rigid laparoscopic instruments access is limited to the 
renal pelvis. As exemplified within this report, endourologic techniques such as 
flexible ureteroscopy can be combined with laparoscopic pyeloplasty to deal with 
complex stone disease and to provide optimal treatment of the patient with a
uretero-pelvic junction obstruction.

Publication Types: 
    Case Reports

PMID: 15182411 [PubMed - indexed for MEDLINE]

870: BJU Int. 2004 Jun;93(9):1296-9.

Percutaneous stone surgery in the obese: outcome stratified according to body
mass index.

Koo BC, Burtt G, Burgess NA.

Department of Urology, Norfolk and Norwich University Hospital, Norwich, Norfolk,
UK. bkoo@doctors.org.uk

OBJECTIVE: To report our experience of percutaneous surgery for treating renal
pelvicalyceal stones over 6 years, to show that this approach is feasible and
safe in obese and morbidly obese patients, as the prevalence of obesity and stone
disease has risen in the last 20 years. PATIENTS AND METHODS: We retrospectively 
reviewed the results of 223 percutaneous nephrolithotomies (PCNLs) by one
urologist between 1995 and 2001. Patients were stratified into four groups
according to the World Health Organization classification of body mass index
(BMI), i.e. <25, 25-29.9 (overweight), 30-39.9 (obese) and > 40 kg/m(2) (morbidly
obese). The outcomes of surgery in these four groups were compared. RESULTS:
There were no statistically significant differences in operative duration,
decrease in haemoglobin concentration, postoperative analgesic use, hospital stay
and stone-free rates; nor was there a higher complication rate in patients who
were obese. CONCLUSION: The outcome of PCNL is independent of the patients' BMI
and results can be favourable in most patients. We therefore advocate treating
obese patients with symptomatic stone disease based on individual status, using
percutaneous surgery where appropriate.

PMID: 15180626 [PubMed - indexed for MEDLINE]

871: Magn Reson Imaging. 2004 Jun;22(5):715-9.

In vivo 31P-MRS assessment of muscle-pH, cytolsolic-[Mg2+] and phosphorylation
potential after supplementing hypokaliuric renal stone patients with potassium
and magnesium salts.

Mairiang E, Hanpanich P, Sriboonlue P.

Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen,
Thailand. eimmai@kku.ac.th

Renal stone patients in rural northeast Thailand have a low potassium and
magnesium status and low urinary excretion of citrate. We measured the changes of
urinary citrate excretion and assessed in vivo skeletal muscle metabolism for
intracellular-pH, cytosolic-[Mg(2+)] and phosphorylation potential (using the
phosphorus magnetic resonance spectroscopy (31)P-MRS) after oral supplementation 
to hypokaliuric renal stone patients with oral potassium and magnesium salts. The
patients comprised four groups: Group 1 (n = 10) control, Group 2 (n = 3), Group 
3 (n = 5) and Group 4 (n = 6) supplemented for a month with potassium citrate,
potassium citrate plus amino acid chelated magnesium, and potassium-magnesium
citrate, respectively. Though urinary citrate excretion was increased in all
three supplemented groups, the increases in intracellular-pH, cytosolic-[Mg(2+)] 
and phosphocreatine (PCr)/beta-ATP were prominent only in Group 3. The increase
in PCr/beta-ATP was also observed in Group 4.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15172066 [PubMed - indexed for MEDLINE]

872: Int Urol Nephrol. 2003;35(3):315-8.

Massive intraabdominal extravasation of fluid: a life threatening complication
following percutaneous nephrolithotomy.

Ghai B, Dureja GP, Arvind P.

Department of Anaesthesiology and Intensive Care, All India Institute of Medical 
Sciences, Ansari Nagar, New Delhi-110029, India.

Percutaneous nephrolithotomy provides an attractive alternative to the surgical
removal of renal stones as it is associated with reduced patient morbidity and
shortened hospital stay. The advantages of this procedure may, however, be
overshadowed by complications like bleeding, extravasation of irrigant fluid and 
infection, which can be life threatening. We report a case of massive
extravasation of irrigant fluid producing severe metabolic acidosis, persistent
peritonism and ileus leading to a prolonged hospital stay. The patient also
required a further surgery for the complete removal of the stones.

Publication Types: 
    Case Reports

PMID: 15160530 [PubMed - indexed for MEDLINE]

873: Int Urol Nephrol. 2003;35(3):313-4.

Bilateral simultaneous tubeless percutaneous nephrolithotomy.

Gupta NP, Kumar P, Aron M, Goel R.

Department of Urology, All India Institute of Medical Sciences, Ansari Ngar, New 
Delhi, India. narmadagupta@hotmail.com

A case of bilateral inferior calyceal calculi treated with simultaneous bilateral
tubeless percutaneous nephrolithotomy is presented. The patient had an uneventful
recovery and was discharged in twenty-three hours.

Publication Types: 
    Case Reports

PMID: 15160529 [PubMed - indexed for MEDLINE]

874: Nephron Physiol. 2004;97(1):p23-30.

Modulatory effect of the 23-kD calcium oxalate monohydrate binding protein on
calcium oxalate stone formation during oxalate stress.

Asokan D, Kalaiselvi P, Varalakshmi P.

Department of Medical Biochemistry, Dr. ALM PG Institute of Basic Medical
Sciences, University of Madras, Chennai, India.

AIMS: To isolate, characterize, and quantify the 23-kD calcium oxalate
monohydrate (COM) binding protein in the urine of controls and calcium oxalate
stone formers and to study its role in kidney stone formation. METHODS: Calcium
oxalate crystals were prepared and allowed to interact with human control kidney 
homogenate as well as urine of controls and calcium oxalate stone formers. EDTA
extract was used for the separation of the 23-kD COM-binding protein (partially
purified). This partially purified 23-kD COM-binding protein was further
separated by DEAE-cellulose column chromatography. SDS-PAGE confirmed the
molecular weight. An antibody was raised against the renal 23-kD COM-binding
protein in rabbits. The 23-kD COM-binding protein was quantified in the urine
from controls and stone formers by ELISA. Thiol group quantification,
oxalate-binding assay, and calcium oxalate crystal nucleation and aggregation
were performed. Morphological changes of the calcium oxalate crystals induced by 
the urinary 23-kDa protein were determined using scanning electron microscopy.
The expression of this protein using different concentrations of oxalate was also
determined in an in vitro model. RESULTS: The urinary excretion of the 23-kD
COM-binding protein varies between 0.5 and 1.5 mg/24 h in controls, while in
stone former its excretion was found to range from 5 to 7 mg/24 h. The protein
isolated from urine was found to inhibit crystal nucleation and aggregation in
controls, while the protein isolated from stone formers exhibited less inhibitory
activity with reduced thiol groups. The 23-kD COM-binding protein derived from
control urine formed COM crystals and intertwined calcium oxalate dihydrate
crystals in a crystal growth system, while protein isolated from stone formers'
urine induced aggregation of COM crystals. This protein expression was found to
be increased with increasing concentration of oxalate in renal epithelial cells
of the African green monkey kidney (VERO) cell line. CONCLUSIONS: Increased
expression and excretion of the 23-kD protein was observed in oxalate stress
conditions, and in stone formers this protein exhibited a promoting activity. The
increased excretion of this protein with promoting activity favors the lithogenic
process in stone formers. Copyright 2004 S. Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15153748 [PubMed - indexed for MEDLINE]

875: J Nephrol. 2004 Jan-Feb;17(1):34-42.

Sodium dicarboxylate cotransporter-1 expression in renal tissues and its role in 
rat experimental nephrolithiasis.

He Y, Chen X, Yu Z, Wu D, Lv Y, Shi S, Zhu H.

Department of Nephrology, Kidney Center and Key Lab of PLA, General Hospital of
PLA, Beijing, China.

BACKGROUND: Nephrolithiasis is a common disease with a high recurrence rate;
however, calcium stone pathogenesis remains unknown because of complex multiple
factors. Hypocitraturia induced by citrate transport disturbance is known to be
involved in nephrolithiasis development. Sodium dicarboxylate cotransporter
(NaDC) mediates citrate uptake from the renal proximal tubule. However, the role 
of NaDC in nephrolithiasis is unclear. This study aimed to investigate NaDC-1
expression in rat renal proximal tubule epithelial cells and its relationship
with experimental nephrolithiasis. METHODS: Male Wastar rats were divided into
control, ethylene glycol (EG)-treated and potassium citrate-treated groups.
Calcium oxalate (CaOx) crystal deposition and histological changes in the kidneys
were examined with anatomical and light microscopes. The plasma and urinary
biochemical parameters, such as citrate, oxalate etc, were analyzed by routine
biochemical methods. NaDC-1 mRNA expression in kidneys was determined by northern
blot analysis, the change in NaDC-1 protein abundance was detected by
immunohistochemistry. RESULTS: It was found that NaDC-1 expression and its mRNA
significantly increased in the EG group when compared with controls. Increased
NaDC-1 expression was associated with a decline in urinary citrate excretion.
Potassium citrate administration could significantly down-regulate NaDC-1
expression and its mRNA, and elevate urinary citrate content alleviate renal
pathological changes and reduce nephrolithiasis occurrence. CONCLUSION: Increased
NaDC-1 expression on the renal proximal tubule epithelial cells could play an
important role in nephrolithiasis development, suggesting it could be a
therapeutic target for the treatment of nephrolithiasis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15151257 [PubMed - indexed for MEDLINE]

876: Int J Urol. 2004 May;11(5):276-81.

Characteristics of patients with staghorn calculi in our experience.

Akagashi K, Tanda H, Kato S, Ohnishi S, Nakajima H, Nanbu A, Nitta T, Koroku M,
Sato Y, Hanzawa T.

Department of Urology, Sanjukai Hospital, Sapporo, Hokkaido, Japan.
akagashi@sanjukai.or.jp

PURPOSE: To elucidate the factors contributing to staghorn stone formation in
patients. MATERIALS AND METHODS: The records of 82 patients (44 men and 38 women)
with complete staghorn calculi were reviewed retrospectively for clinical
presentation, metabolic disturbances and anatomical abnormalities. RESULTS: There
were 79 unilateral and three bilateral cases. The patient performance of the
activities of daily life was assessed with the modified Rankin scale (MRS) and it
was found that 69 patients were functionally independent (84.1%, MRS 0-1) and 10 
patients had a severe disability (12.2%, MRS 4-5). Seven patients had chronic
indwelling catheters (8.5%). A positive urine culture was found in 24.4% of
patients. Analysis of stone composition revealed magnesium ammonium phosphate and
mixed calcium oxalate-phosphate were the most frequently identified types of
stone (32.1% and 22.2%, respectively). Urinary pH was low in patients with uric
acid stones (mean 5.4). Hyperuricemia, cystinuria and hypercalciuria were found
in 14.6%, 2.4% and 37.8%, respectively. Hypercalciuria was found more frequently 
in calcium-stone cases. Eleven patients (13.4%) showed structural abnormalities
of the kidney. CONCLUSIONS: Our data show that the patients with severe
disability, urinary tract infection and hypercalciuria could be recognized more
frequently in staghorn calculi compared with common urolithiasis. However, in
Western countries, the frequency of both urinary tract infection and struvite
stones is much higher than in our data. Other Japanese authors have also reported
the low frequency of struvite stones in staghorn calculi, suggesting that various
factors other than urinary tract infection possibly contribute to the formation
of staghorn calculi in Japan.

PMID: 15147542 [PubMed - indexed for MEDLINE]

877: Urol Int. 2004;72 Suppl 1:48-51.

Dornier Lithotripter S. The first 50 treatments in our department.

Di Pietro C, Micali S, De Stefani S, Celia A, De Carne C, Bianchi G.

Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
dpc.mont@tiscali.it

INTRODUCTION: We assessed the short-term efficacy of extracorporeal shockwave
lithotripsy with the Dornier Lithotripter S in the treatment of renal and
ureteral stones. MATERIALS AND METHODS: Between February and April 2003, 32 renal
and 19 ureteral stones were treated. Patients were evaluated 1 and 3 months
afterwards. Stone size and location, total number of shockwaves and the
stone-free rate were taken into consideration. RESULTS: The stone-free rate for
ureteral stones was 63% at 1 month and 84.2% at 3 months. The stone-free rate for
renal calculi was 75% at 1 month and 87.5% at 3 months. The overall stone-free
rate was 70.6% at 1 month and 86.3% at 3 months. Analgesia was necessary in 12
patients (23.5%). No serious complications were seen, except for one
steinstrasse. CONCLUSIONS: The Dornier Lithotripter S is very effective in the
treatment of renal and ureteral calculi. Copyright 2004 S. Karger AG, Basel

Publication Types: 
    Comparative Study

PMID: 15133335 [PubMed - indexed for MEDLINE]

878: Urol Int. 2004;72 Suppl 1:34-9.

Pain killers and antibacterial therapy for kidney colic and stones.

Porena M, Guiggi P, Balestra A, Micheli C.

Department of Urology and Andrology, University of Perugia, Perugia, Italy.

In 85% of patients, renal colic is caused by renal-ureteral stones with extrinsic
obstructions such as pelvic, retroperitoneal or intestinal abnormalities, and
intrinsic reno-ureteral obstructions, e.g. junction pathologies and malformation,
accounting for only 10 and 5%, respectively. The objectives of therapy for renal 
colic therapy are to eliminate pain, preserve renal function and eliminate the
obstruction by the excretory pathway. Many drugs can be used to relieve pain:
non-steroid anti-inflammatory agents (NSAIDs), opioid analgesics, antidiuretic
hormone (ADH), loco-regional anesthesia and acupuncture. Opiates are the
first-choice therapy during pregnancy as no other drug is indicated because of
tetragenic potential. Paracetamol (N-acetyl-p-aminophenol) is the only NSAID that
is registered for pediatric use because it has none of the adverse side effects
that are associated with NSAIDs. Tamsulosin, an alpha-lithic drug, has very
recently been included among the drugs that are used for stone expulsion. The
rationale underlying its use is that a high concentration of alpha-1D adrenergic 
receptors has been recently detected in the terminal ureter, especially in the
intramural tract. Inhibition of alpha-1D receptor stimulation should relax smooth
muscle in the intramural ureteral tract, making stone expulsion easier. Copyright
2004 S. Karger AG, Basel

Publication Types: 
    Comparative Study
    Review

PMID: 15133331 [PubMed - indexed for MEDLINE]

879: Urol Int. 2004;72 Suppl 1:29-33.

Body weight, diet and water intake in preventing stone disease.

Meschi T, Schianchi T, Ridolo E, Adorni G, Allegri F, Guerra A, Novarini A,
Borghi L.

Department of Clinical Sciences, University of Parma, Parma, Italy.

Nutrition plays a major role in the pathogenesis of the most widespread forms of 
nephrolithiasis, i.e. calcium (calcium oxalate and phosphate) and uric acid stone
disease. For this reason, dietary measures are the first level of intervention in
primary prevention, as well as in secondary prevention of recurrences. An
unbalanced diet or particular sensitivity to various foods in stone formers can
lead to urinary alterations such as hypercalciuria, hyperoxaluria,
hyperuricosuria, hypocitraturia and an excessively acid urinary pH. Over the
course of time, these conditions contribute to the formation or recurrence of
kidney stones, due to the effect they exert on the lithogenous salt profile. The 
fundamental aspects of the nutritional approach to the treatment of idiopathic
nephrolithiasis are body weight, diet and water intake. This paper will present
data resulting from our own investigations and the most significant evidence in
literature. Copyright 2004 S. Karger AG, Basel

Publication Types: 
    Comparative Study
    Review

PMID: 15133330 [PubMed - indexed for MEDLINE]

880: Urol Int. 2004;72 Suppl 1:24-8.

Uric acid, phosphate and oxalate stones: treatment and prophylaxis.

Caramia G, Di Gregorio L, Tarantino ML, Galuffo A, Iacolino R, Caramia M.

Extra-Corporeal Lithotripsy Service, Urology Section, Department of Internal
Medicine, Cardiovascular Diseases and Nephro-Urological Pathologies, University
of Palermo, Palermo, Italy. litotrissia.policlinicopa@neomedia.it

Medical treatment for the most commonly encountered types of renal stones is
described. Nowadays treatment for uric acid stones is well-defined: alkalinizing 
urine is easy with drugs that are sufficiently active and well enough managed.
Relapse is avoided in a high percentage of patients. Medical treatment of
phosphate or calcium stones is a more open question as results are far from
satisfactory compared with intra- and extra-corporeal approaches which are often 
minimally invasive and well accepted by both patient and urologist. Relapses are 
not easy to control because prophylactic measures such as changes in lifestyle
and diet are never activated or because they are adopted for a brief period of
time. Water therapy is examined, with the choice of water depending on the type
of stone, together with drug therapy. Drugs such as citrate, with or without
magnesium, and thiazides are considered excellent for curing renal stones and
relapses. Although medical therapy has a limited role in many types of stones,
its use is decisive in some others. Copyright 2004 S. Karger AG, Basel

Publication Types: 
    Comparative Study
    Review

PMID: 15133329 [PubMed - indexed for MEDLINE]

881: Urol Int. 2004;72 Suppl 1:20-3.

Pathophysiology of reno-ureteral colic.

Travaglini F, Bartoletti R, Gacci M, Rizzo M.

Department of Urology, University of Florence, Florence, Italy.
effectrava@hotmail.com

INTRODUCTION: Reno-ureteral colic presents with a complex of acute symptoms that 
usually indicate the presence of a stone in the collecting system, The aim of any
treatment is pain relief, stone removal and preservation of kidney function. We
focused our review on the pathophysiological aspects of reno-ureteral colic and, 
briefly, on its treatment. MATERIALS AND METHODS: A complete overview of
contemporary literature regarding reno-ureteral colic was performed by using
MEDLINE and website on-line publications like EAU Guidelines. RESULTS: Clinical
presentation of reno-ureteral colic, of mechanisms of ureteral peristalsis and
pathophysiology of renal colic is described. An overview of the available medical
treatments is presented. CONCLUSIONS: An accurate comprehension of the
pathophysiology of reno-ureteral colic allows the physician to tailor the best
treatment for each patient. Copyright 2004 S. Karger AG, Basel

Publication Types: 
    Comparative Study
    Review

PMID: 15133328 [PubMed - indexed for MEDLINE]

882: Urol Int. 2004;72 Suppl 1:17-9.

Osteoporosis and urolithiasis.

Caudarella R, Vescini F, Buffa A, La Manna G, Stefoni S.

Department of Clinical Medicine and Applied Biotechnology, Alma Mater Studiorum, 
University of Bologna, Bologna, Italy. renata.caudarella@unibo.it

Several studies have indicated that up to 60% of idiopathic calcium stone formers
present hypercalciuria. Many authors have described reduced bone mineral density 
(BMD) in stoneformers with hypercalciuria, but osteopenia has also been found in 
normocalciuric patients. Moreover, Jaeger's group found that bone mass was
reduced in all patients with calcium stone disease, independently of
hypercalciuria. Many factors may contribute to the pathogenesis of osteopenia in 
stone formers. A predominant role has been given to the low-calcium diet that is 
still prescribed in nephrolithiasis. Also slight metabolic acidosis, which is
frequently present in stone formers eating a diet rich in animal protein, can
contribute to bone loss. Finally, some authors described a pathogenetic role for 
cytokines, prostaglandins and vitamin D receptor gene polymorphisms. Copyright
2004 S. Karger AG, Basel

Publication Types: 
    Comparative Study
    Review

PMID: 15133327 [PubMed - indexed for MEDLINE]

883: Urol Int. 2004;72 Suppl 1:6-10.

Crystallization inhibitors in the pathophysiology and treatment of
nephrolithiasis.

Marangella M, Bagnis C, Bruno M, Vitale C, Petrarulo M, Ramello A.

Division of Nephrology, Dialysis and Renal Stone Centre, Mauriziano Hospital,
Torino, Italy. mmarangella@mauriziano.it

It is currently agreed that stone formation in the urinary tract requires
supersaturation with respect to a given solid phase. However, this principle
fully applies only to stones other than calcium-containing stones, in which case 
compounds acting as inhibitors are postulated to naturally occur in urine. Stone 
formation would therefore ensue from an imbalance between promoters and
inhibitors. The saturation state can be estimated by means of computer model
systems based on ab initio calculations, which account for the main soluble
complexes formed in urine between relevant cations and anions. This estimates the
overall promoting potential of urine. However, in the case of calcium
nephrolithiasis, supersaturation does not make a clear-cut separation between
normal subjects and patients. Several studies in the last two decades have
identified many inhibitors of calcium oxalate and calcium phosphate
crystallization, which are classified into the ionic and macromolecular. They
have been shown to act on kinetics by interfering with nucleation, growth and
aggregation of crystals. Unfortunately, except for citrate, none of the newly
discovered substances has been definitely characterized in its molecular
composition and structure, type and potency of inhibition, differences in
concentration and structure between stone-forming and non stone-forming subjects.
Citrate exhibits a dual action in urine, opposing crystal formation by both
thermodynamic and kinetic mechanisms. At present it is the only natural inhibitor
which can be measured in urine, quantitated as to inhibitory activity and used in
medical treatment. Copyright 2004 S. Karger AG, Basel

Publication Types: 
    Comparative Study
    Review

PMID: 15133325 [PubMed - indexed for MEDLINE]

884: Urol Int. 2004;72 Suppl 1:1-5.

Epidemiology of nephrolithiasis today.

Amato M, Lusini ML, Nelli F.

Nefro-Urology Department, Prato Hospital, Prato, Italy. mamato@usl4.toscana.it

The epidemiology of nephrolithiasis differs according to geographical area and
socio-economic conditions. In Italy the prevalence of the disease in 1993 was
17.2/1,000 inhabitants, most patients are men and elderly. The relative risk
increased in subjects with family history for calculosis, with the tendency to
eat protein-rich food and with overweight and body mass index (MBI) >32 kg/m2.
Calcium oxalate and/or phosphate stones account for almost 70% of all renal
stones observed in economically developed countries. Copyright 2004 S. Karger AG,
Basel

Publication Types: 
    Comparative Study
    Review

PMID: 15133324 [PubMed - indexed for MEDLINE]

885: Clin Nephrol. 2004 Apr;61(4):231-7.

Molecular and clinical studies of Dent's disease in Japan: biochemical
examination and renal ultrasonography do not predict carrier state.

Matsuyama T, Awazu M, Oikawa T, Inatomi J, Sekine T, Igarashi T.

Department of Pediatrics, Fussa Hospital, Fussa City, Tokyo, Japan.
mattsu@kf6.so-net.ne.jp

BACKGROUND: Dent's disease is an X-linked renal tubular disorder characterized by
low-molecular-weight-proteinuria, hypercalciuria, nephrolithiasis and renal
failure. The disease is due to inactivation of a renal chloride channel gene,
CLCN5. We have investigated 3 unrelated Japanese families for CLCN5 mutations and
assessed the carrier mothers biochemically and ultrasonogaraphically to ascertain
whether these clinical examinations can predict the carrier state of the disease.
MATERIAL AND METHODS: Twelve members from these families were studied
biochemically and ultrasonographically. Leukocyte DNA from probands was used with
CLCN5-specific primers for PCR amplification of the coding region and exon-intron
boundaries, and the DNA sequences of the products determined to identify
abnormalities in the gene. RESULTS: Three novel CLCN5 mutations consisting of a
single base "A" insertion between nucleotides 590 and 591, a nonsense mutation
(R28X) and a missense mutation (G506R) were exhibited. Hypophosphatemia was
detected in 2 patients, beta2-microglobulinuria, alpha1-microglobulinuria, and
hyperretinol binding proteinuria in 6 patients, hypercalciuria in 5 patients,
decreased urine osmolality in 3 patients, and nephrocalcinosis or nephrolithiasis
in 4 patients. Biochemical analysis of the urine and the renal ultrasonography in
each carrier mother were completely normal. CONCLUSIONS: Neither urinary
low-molecular-weight-proteins, urinary calcium to creatinine ratio, nor renal
ultrasonography was predictive of carrier state in the 3 families with this
disease, although each carrier mother had CLCN5 mutation. Hypophosphatemia and
decreased urine osmolality might be a hint to suspect the carrier state of Dent's
disease, although these findings are not found frequently.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 15125028 [PubMed - indexed for MEDLINE]

886: J Med Assoc Thai. 2004 Mar;87(3):255-63.

The effects of potassium and magnesium supplementations on urinary risk factors
of renal stone patients.

Jaipakdee S, Prasongwatana V, Premgamone A, Reungjui S, Tosukhowong P, Tungsanga 
K, Suwantrai S, Noppawinyoowong C, Maskasame S, Sriboonlue P.

Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen 
40002, Thailand.

The effects of potassium and magnesium supplementation on urinary risk factors
for renal stone disease were studied in 61 renal stone patients. The subjects
were divided into four groups and supplemented for a period of one month with
potassium chloride (KCl, Group 1), potassium sodium citrate (K Na citrate, Group 
2), magnesium glycine (Mg glycine, Group 3) and potassium magnesium citrate (K Mg
citrate, Group 4) with a daily dose of 42 mEq potassium, 21 mEq magnesium or
sodium and 63 mEq citrate, accordingly. The results showed that serum potassium
and magnesium of all four groups normalized after the supplementation. Though
urinary potassium significantly increased in all three groups supplemented with
elemental potassium containing solutions [i.e. KCl (p < 0.001), K Na citrate (p <
0.001) and K Mg citrate (p < 0.001)] only K Na citrate and K Mg citrate, caused a
significant increase in urinary pH and citrate but decrease in calcium.
Supplementation with Mg glycine in Group 3 although caused a significant increase
in urinary magnesium, its effects on urinary pH, citrate and calcium, however,
were similar to KCl, in that they caused a significant decrease in urinary pH
without any change in urinary citrate or calcium. Supplementation with K Mg
citrate in Group 4 seems to have given the best results, as far as lowering stone
risk factors in that it caused an increase in urinary pH, potassium and citrate
and decreased calcium excretions similar to K Na citrate in Group 2. In addition,
K Mg citrate also caused the enrichment of urine with magnesium, another
inhibitor of calcium-containing stones. Although the four supplements had no
effect on urinary saturation of calcium oxalate salt, their effects on the
saturations of brushite (CaHPO4 x 2H2O), octacalcium phosphate (Ca8H2 (PO4)6 x
5H2O) and uric acid were clearly associated with changes in urinary pH.
Therefore, in Group 1 and 3, subjects having a decrease in urinary pH, also
experienced a significant increase in uric acid saturation. Though the saturation
of brushite and octacalcium phosphate in Group 2 and 4 and the sodium acid urate 
in Group 2 were significantly increased, these urinary risk factors could be
overcome, however, by the concomitant increase in urinary citrate. The present
results demonstrate that for those stone vulnerable subjects having a high risk
of potassium and magnesium depletion, to obtain the best therapeutic results,
they should be provided supplementations of both potassium and magnesium together
and also in the forms that would result in the delivery of an alkali loading
effect.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15117041 [PubMed - indexed for MEDLINE]

887: BMC Med. 2004 Apr 28;2:15.

Is an excretory urogram mandatory in patients with small to medium-sized renal
and ureteric stones treated by extra corporeal shock wave lithotripsy?

Ather MH, Faruqui N, Akhtar S, Sulaiman MN.

Department of Surgery, Aga Khan University, Karachi, Pakistan.
hammad.ather@aku.edu

BACKGROUND: An intravenous urogram (IVU) has traditionally been considered
mandatory before treating renal and ureteric stones by extracorporeal shock wave 
lithotripsy (ESWL). This study was designed to see whether there is a difference 
in complications and the need for ancillary procedures in patients managed by
ESWL for renal and ureteric calculi, according to preoperative imaging technique.
METHODS: This retrospective study compared 133 patients undergoing ESWL from
January 2001 to July 2002. Patients were divided into three groups according to
the preoperative imaging technique used: i) IVU; ii) non-contrast enhanced
helical computed tomography (UHCT); and iii) ultrasound (US) + X-ray kidney,
ureter and bladder (KUB). The groups were matched in terms of age and gender, as 
well as location, side and size of stones. RESULTS: There was no statistically
significantly difference for number of ESWL sessions, number of shock waves and
use of ancillary procedures between the three groups. The stone-free rate was 98%
for the IVU and UHCT groups, and 97% for the US + X-ray KUB group. CONCLUSIONS:
The complication rate and need for ancillary procedures was comparable across the
three groups. Patients imaged by UHCT or US + X-ray KUB prior to ESWL for
uncomplicated renal and ureteric stones do not require IVU.

PMID: 15115545 [PubMed - indexed for MEDLINE]

888: Arch Intern Med. 2004 Apr 26;164(8):885-91.

Comment in:
    J Urol. 2005 Feb;173(2):479.

Dietary factors and the risk of incident kidney stones in younger women: Nurses' 
Health Study II.

Curhan GC, Willett WC, Knight EL, Stampfer MJ.

Channing Laboratory, Department of Medicine, Brigham and Womens' Hospital, 181
Longwood Avenue, Boston, MA 02115, USA. Gary.Curhan@channing.harvard.edu

BACKGROUND: In older women and men, greater intakes of dietary calcium,
potassium, and total fluid reduce the risk of kidney stone formation, while
supplemental calcium, sodium, animal protein, and sucrose may increase the risk. 
Recently, phytate has been suggested to play a role in stone formation. To our
knowledge, no prospective information on the role of dietary factors and risk of 
kidney stone formation is available in younger women. METHODS: We prospectively
examined, during an 8-year period, the association between dietary factors and
the risk of incident symptomatic kidney stones among 96 245 female participants
in the Nurses' Health Study II; the participants were aged 27 to 44 years and had
no history of kidney stones. Self-administered food frequency questionnaires were
used to assess diet in 1991 and 1995. The main outcome measure was an incident
symptomatic kidney stone. Cox proportional hazards regression models were used to
adjust simultaneously for various risk factors. RESULTS: We documented 1223
incident symptomatic kidney stones during 685 973 person-years of follow-up.
After adjusting for relevant risk factors, a higher dietary calcium intake was
associated with a reduced risk of kidney stones (P =.007 for trend). The
multivariate relative risk among women in the highest quintile of intake of
dietary calcium compared with women in the lowest quintile was 0.73 (95%
confidence interval, 0.59-0.90). Supplemental calcium intake was not associated
with risk of stone formation. Phytate intake was associated with a reduced risk
of stone formation. Compared with women in the lowest quintile of phytate intake,
the relative risk for those in the highest quintile was 0.63 (95% confidence
interval, 0.51-0.78). Other dietary factors showed the following relative risks
(95% confidence intervals) among women in the highest quintile of intake compared
with those in the lowest quintile: animal protein, 0.84 (0.68-1.04); fluid, 0.68 
(0.56-0.83); and sucrose, 1.31 (1.07-1.60). The intakes of sodium, potassium, and
magnesium were not independently associated with risk after adjusting for other
dietary factors. CONCLUSIONS: A higher intake of dietary calcium decreases the
risk of kidney stone formation in younger women, but supplemental calcium is not 
associated with risk. This study also suggests that some dietary risk factors may
differ by age and sex. Finally, dietary phytate may be a new, important, and safe
addition to our options for stone prevention.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15111375 [PubMed - indexed for MEDLINE]

889: Am J Physiol Renal Physiol. 2004 Sep;287(3):F373-83. Epub 2004 Apr 20.

Renal epithelial cells constitutively produce a protein that blocks adhesion of
crystals to their surface.

Kumar V, Yu S, Farell G, Toback FG, Lieske JC.

Division of Nephrology, Department of Internal Medicine, Mayo Clinic College of
Medicine, Rochester, Minnesota 55905, USA.

Attachment of newly formed crystals to renal tubular epithelial cells appears to 
be a critical step in the development of kidney stones. The present study was
undertaken to identify autocrine factors released from renal epithelial cells
into the culture medium that inhibit adhesion of calcium oxalate crystals to the 
cell surface. A 39-kDa glycoprotein that is constitutively secreted by renal
cells was purified by gel filtration chromatography. Amino acid microsequencing
revealed that it is novel and not structurally related to known inhibitors of
calcium oxalate crystallization. Hence, it was named crystal adhesion inhibitor, 
or CAI. Immunoreactive CAI was detected in diverse rat tissues, including kidney,
heart, pancreas, liver, and testis. Immunohistochemistry revealed that CAI is
present in the renal cell cytosol and is also on the plasma membrane.
Importantly, CAI is present in normal human urine, from which it can be purified 
using calcium oxalate monohydrate crystal affinity chromatography. CAI could be
an important defense against crystal attachment to tubular cells and the
subsequent development of renal stones in vivo.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15100100 [PubMed - indexed for MEDLINE]

890: Kidney Int. 2004 May;65(5):1835-41.

Schedule of taking calcium supplement and the risk of nephrolithiasis.

Domrongkitchaiporn S, Sopassathit W, Stitchantrakul W, Prapaipanich S, Ingsathit 
A, Rajatanavin R.

Department of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
rasdr@mahidol.ac.th

BACKGROUND: Variation in the timing of calcium supplement may affect
gastrointestinal absorption of both calcium and oxalate differently and may
associate with variable risk of calcium oxalate nephrolithiasis. There are few
human studies addressing specifically the appropriate time for taking calcium
supplement. Therefore, this study was performed to compare calcium
bioavailability and the risk of calcium oxalate stone formation for calcium
supplement taken with meal vs. taken at bedtime. METHODS: Thirty-two healthy male
navy privates, 22.7 +/- 1.9 years old (mean +/- SD), who had normal renal
function (serum creatinine less than 150 umol/L) and no history of renal stone,
participated in the study. The subjects were randomly allocated into two groups
of 16 each. Group A took 1 g of calcium carbonate with meal, 3 times/day; and
group B took 3 g/day of calcium carbonate at bedtime. After taking the regimens
for 1 week, followed by 1 month of washout period, crossover between both groups 
was done. The diet was controlled throughout the study. Twenty-four-hour urine
collections for the determination of urinary constituents were obtained at
baseline and after taking both regimens of calcium supplement. Activity product
for calcium oxalate was determined to assess the risk of calcium oxalate stone
formation. RESULTS: Urinary excretions of calcium were significantly elevated
above the baseline values when taking calcium supplement both with meal (3.48 +/-
2.13 mmol/day vs. 5.17 +/- 2.61 mmol/day, P < 0.05) and at bedtime (3.09 +/- 1.70
mmol/day vs. 5.08 +/- 2.34 mmol/day, P < 0.05). There was no difference between
the two regimens in the urinary calcium excretions. The urinary oxalate was
decreased significantly when the subjects took calcium supplement with meal
compared with the corresponding baseline value (0.13 +/- 0.05 vs. 0.17 +/- 0.07
mmol/d, P= 0.01). In contrast, there was no alteration in urinary oxalate when
calcium supplement was taken at bedtime compared to the baseline values (0.15 +/-
0.05 mmol/day vs. 0.15 +/- 0.06 mmol/day, P= 0.9). Compared with the
corresponding baseline values, there was no significant increase in the activity 
product for calcium oxalate when taking calcium with meal (0.54 +/- 0.25 vs. 0.57
+/- 0.22, P= 0.54), but it was increased significantly when calcium supplement
was taken at bedtime (0.47 +/- 0.21 vs. 0.72 +/- 0.27, P < 0.01). CONCLUSION:
Calcium supplement should be taken with meal in order to avoid increasing the
risk of calcium oxalate nephrolithiasis.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 15086924 [PubMed - indexed for MEDLINE]

891: Kidney Int. 2004 May;65(5):1724-30.

Citrate inhibits growth of residual fragments in an in vitro model of calcium
oxalate renal stones.

Chow K, Dixon J, Gilpin S, Kavanagh JP, Rao PN.

Department of Urology, South Manchester University Hospital, Manchester, United
Kingdom.

BACKGROUND: Alkaline citrate is thought to be helpful in reducing recurrences of 
calcium oxalate stones. The evidence for this is incomplete, there have been few 
good trials, all with their own limitations, and not all reported any significant
benefit. In vitro studies are usually cited to support the clinical studies but
these too have their drawbacks, in particular they relate to crystals and
microscopic aggregates and not to actual stone growth. Here we test citrate in
vitro using a model of macroscopic calcium oxalate stone enlargement. METHODS:
Twelve calcium oxalate stones were grown at a time in a stone farm. Six were
grown with 2 mmol/L citrate and six with 6 mmol/L citrate. Three protocols were
tested; artificial urine, artificial urine with urinary macromolecules (UMM) from
male controls and artificial urine with UMM from male stone formers. The stones
were grown continuously for at least 24 days. RESULTS: In all three experiments
the higher citrate concentration significantly reduced the growth rate of stones 
by more than 50% (P < 0.001). There was a small decrease in ionised calcium in
the stone growth media (P < 0.001) and significant (P < 0.001) but small increase
in pH (about 0.07 pH units). The inclusion of UMM also brought about a decrease
in stone growth, particularly at 2 mmol/L citrate. CONCLUSION: Citrate inhibited 
stone growth in this laboratory model. This was true both in defined media and
with addition of UMM. This adds to evidence justifying the use of alkaline
citrate in calcium oxalate nephrolithiasis.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 15086911 [PubMed - indexed for MEDLINE]

892: Kidney Int. 2004 May;65(5):1615-20.

Evidence for genetic heterogeneity in Dent's disease.

Hoopes RR Jr, Raja KM, Koich A, Hueber P, Reid R, Knohl SJ, Scheinman SJ.

Department of Medicine, State University of New York Upstate Medical University, 
Syracuse, New York 13210, USA.

BACKGROUND: Dent's disease (X-linked nephrolithiasis) is a proximal tubulopathy
that has been consistently associated with inactivating mutations in the CLCN5
gene encoding the ClC-5 chloride channel expressed in tubular epithelial cells.
METHODS: We performed mutation analysis of the coding region of CLCN5 by DNA
sequencing in 32 unrelated males, all of whom met the following three clinical
criteria for the diagnosis of Dent's disease: (1) low-molecular-weight (LMW)
proteinuria; (2) hypercalciuria; and (3) at least one of the following:
nephrocalcinosis, kidney stones, renal insufficiency, hypophosphatemia, or
hematuria. RESULTS: Sixteen mutations (ten missense, four nonsense, two
frameshift) were found in 19 patients. Mutations were confirmed by restriction
analysis or allele-specific polymerase chain reaction (PCR), segregated with
disease in the families, and were not polymorphisms. In the other 13 patients
with Dent's disease, the coding sequence of CLCN5 was normal. In these 13
patients, we also sequenced two regions of the CLCN5 promoter (626 and 586 bp,
respectively, 2.1 and 1 kb upstream of exon 2) containing regulatory sites
[activating protein-1 (AP-1)-like, AP-4, and cyclic adenosine monophosphate
(cAMP)-receptor element binding protein (CREB)] and primary and secondary
transcription start sites. We found no mutations in these promoter sequences in
any of the 13 patients. In one three-generation family, the absence of mutation
was confirmed by sequencing in two additional affected family members, and in
this family haplotype analysis excluded linkage to the region of the CLCN5 gene. 
There were no differences between the 19 patients with CLCN5 mutations and the 13
without mutations with regard to any clinical features of Dent's disease.
CONCLUSION: These findings suggest that mutation in other gene(s) may be
responsible for the phenotype of Dent's disease in some patients.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 15086899 [PubMed - indexed for MEDLINE]

893: Kidney Int. 2004 Apr;65(4):1422-5.

Association of urinary pH with body weight in nephrolithiasis.

Maalouf NM, Sakhaee K, Parks JH, Coe FL, Adams-Huet B, Pak CY.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, Dallas, Texas 75390, USA.

BACKGROUND: The prevalence of kidney stone disease in the United States is
progressively increasing, paralleling the growing rate of obesity. Uric acid
nephrolithiasis, a condition associated with a low urinary pH, has been linked to
obesity and insulin resistance. Based on these observations, we hypothesized that
urinary pH may be inversely associated to body weight in nephrolithiasis.
METHODS: Data were retrieved from 4883 patients with nephrolithiasis who
underwent ambulatory evaluation at two established stone clinics in Dallas and
Chicago. The patients collected 24-hour urine samples on an outpatient basis,
while avoiding any drug that could alter urinary pH. Patients were divided in
increasing sextiles of body weight, and urinary pH was adjusted for urinary
creatinine and for age. RESULTS: Urinary pH had a strong, graded inverse
association with body weight. Urinary creatinine and age were both found to be
significant covariates of urinary pH, while gender was not a significant
independent variable after adjustment for urinary creatinine. Mean 24-hour
urinary pH, adjusted for age and urinary creatinine, were 6.09, 6.04, 6.01, 5.99,
5.97, and 5.91 for sextiles of body weight in increasing order from Dallas (P for
linear trend <0.0001), and 6.18, 6.10, 6.04, 6.02, 5.97, and 5.88 for the
sextiles from Chicago (P for linear trend <0.0001). CONCLUSION: We conclude that 
urinary pH is inversely related to body weight among patients with stones. The
results confirm the previously proposed scheme that obesity may sometimes cause
uric acid nephrolithiasis by producing excessively acid urine due to insulin
resistance.

Publication Types: 
    Multicenter Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 15086484 [PubMed - indexed for MEDLINE]

894: Eur Urol. 2004 May;45(5):547-56; discussion 556.

Nephrolithiasis: why doesn't our "learning" progress?

Gambaro G, Reis-Santos JM, Rao N.

Department of Medical and Surgical Sciences, Division of Nephrology, University
of Padova, Padova, Italy. giga@unipd.it

OBJECTIVE: Stone research is stagnant with minor clinical fall-out. We wonder
whether this, in the ESWL era, depends only on ESWL and the consequent change in 
our clinical management habits, or is rather due to mistakes made by
investigators. We feel that indeed we did and do make some: (1) the patients we
are investigating may not be appropriate; and (2) we are missing to properly
recognise disease heterogeneity. CONCLUSIONS: From the public health side most
likely we are not investigating the right patients, and we probably need to
address the large part of the problem, i.e. the rarely relapsing stone formers
demanding 80% of all urological interventions. Although there is a consensus that
urolithiasis is very heterogeneous, this position is presently under
reconsideration. It is necessary to investigate the single or "occasional" stone 
former, and go back to the epidemiology and clinics with multicentre, prospective
studies. Being a multifactorial disease, we will need to evaluate as many aspects
as possible contemporaneously in the same patient. It is also necessary to
"revisit" the disease in an unbiased manner, because its relationship with
relevant aspects could be different than previously thought due to our incomplete
knowledge of its pathogenesis and pathophysiology.

Publication Types: 
    Review

PMID: 15082194 [PubMed - indexed for MEDLINE]

895: J Urol. 2004 May;171(5):1920-4.

The primary stone event: a new hypothesis involving a vascular etiology.

Stoller ML, Meng MV, Abrahams HM, Kane JP.

Department of Urology, University of California School of Medicine, San
Francisco, 94143-0738, USA.

PURPOSE: We detail a new hypothesis regarding a vascular phenomenon as the
primary event in the formation of urolithiasis. MATERIALS AND METHODS: A complete
MEDLINE search was performed to examine the existing literature regarding the
etiology of nephrolithiasis. In addition, urinary calculi were retrieved from 11 
patients undergoing percutaneous nephrolithotomy and analyzed for total and
esterified cholesterol content. RESULTS: A review of the literature on stone
disease revealed many factors inconsistent with the current paradigm of the
initiation of nephrolithiasis. These arguments can be based and classified on
epidemiological, clinical, physiological, anatomical, and molecular data. In our 
stone analysis free and esterified cholesterol were found in varying quantities
between 0.058 and 2.258 microg/mg stone and 0.012 and 0.777 microg/mg stone,
respectively. Esterified cholesterol was found to comprise 75% of total serum
cholesterol. In urinary stones esterified cholesterol accounted for 14% to 16% of
total cholesterol and the esterified-to-free cholesterol ratio appeared to be
related to stone composition. CONCLUSIONS: Numerous inconsistencies exist between
current theories of the initial event in nephrolithiasis formation and empirical 
observational data on stone disease. Our review of the literature and our study
of the cholesterol content of renal stones support a new theory regarding the
initial stone forming event. We base this novel hypothesis on multiple
epidemiological, physiological, anatomical and clinical observations. Further
studies are required to confirm this hypothesis and its clinical usefulness.

Publication Types: 
    Review

PMID: 15076312 [PubMed - indexed for MEDLINE]

896: J Urol. 2004 May;171(5):1797-801.

The use of chemical treatments for improved comminution of artificial stones.

Heimbach D, Kourambas J, Zhong P, Jacobs J, Hesse A, Mueller SC, Delvecchio FC,
Cocks FH, Preminger GM.

Department of Urology, Section of Experimental Urology, University of Bonn, Bonn,
Germany.

PURPOSE: The acoustic and mechanical properties of various stone compositions are
significantly different and thus result in varying degrees of fragility.
Consequently, results to shock wave lithotripsy (SWL) are influenced accordingly.
We report the results of a study of fragility of various stone compositions, and 
the influence on each stone's baseline physical properties and fragility when
exposed to various chemolytic solutions. MATERIALS AND METHODS: Before SWL
artificial stones of differing compositions were irrigated with various
chemolytic solutions. Calcium oxalate monohydrate (COM) stones were treated with 
ethylenediaminetetraacetic acid (EDTA), stones composed of magnesium ammonium
phosphate hydrogen were treated with hemiacidrin, and stones made of uric acid
(UA) were treated with tromethamine. Synthetic urine served as a control for all 
stone groups. Using an ultrasound transmission technique, longitudinal wave
propagation speed was measured in all groups of artificial stones. Stone density 
was also measured by using a pycnometer (based on Archimedes' principle). Based
on these measurements transverse (shear) wave speed (assuming a constant
Poisson's ratio), wave impedance and dynamic mechanical properties of the
artificial stones were calculated. Moreover, the microhardness of these
artificial stones was measured, and fragility testing using SWL with and without 
pretreatment with the previously mentioned chemolytic solutions, was performed.
RESULTS: Wave speed, wave impedance, dynamic mechanical properties and
microhardness of EDTA treated COM stones and tromethamine treated UA stones were 
found to decrease compared to untreated (synthetic urine) control groups. The
suggestion that chemolytic pretreatment increases stone fragility was verified by
the finding of increased stone comminution after SWL testing. Combining this
medical pretreatment and SWL, the findings demonstrate a significant impact of
various solvents on stone comminution, in particular EDTA treated COM stones,
tromethamine treated UA stones and hemiacidrin treated magnesium ammonium
phosphate hydrogen stones. These data suggest that by altering the chemical
environment of the fluid surrounding the stones it is possible to increase the
fragility of renal calculi in vitro. CONCLUSIONS: These results indicate that
appropriate chemical treatments may provide a useful adjunctive modality for
improving the efficacy of stone comminution during shock wave lithotripsy.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 15076279 [PubMed - indexed for MEDLINE]

897: Curr Opin Urol. 2004 Mar;14(2):123-7.

Nephrolithiasis and pregnancy.

McAleer SJ, Loughlin KR.

Division of Urology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 
02115, USA.

PURPOSE OF REVIEW: Urolithiasis during pregnancy is not common, however, it is a 
difficult condition to both diagnose and treat. There are many safety concerns
that must be considered for both the mother and fetus. In this review we detail
the different options available to the urologist and we highlight a treatment
algorithm that we use when faced with a pregnant patient suspect of having a
urinary calculus. RECENT FINDINGS: Changes in ultrasound, limited intravenous
urograms and magnetic resonance imaging have improved our ability to diagnose
urolithiasis in pregnancy. Additionally ureteroscopy has emerged not only as a
diagnostic tool but also as a modality for definitive treatment that can safely
be used during the intrapartum period. SUMMARY: When diagnosing urolithiasis in
the gravid patient, the first line study should be ultrasound, using change in
resistive index and transvaginal ultrasound. If these are not diagnostic, then a 
limited intravenous urograms should be performed. Once a diagnosis has been
established, initial treatment should be conservative since 70-80% of patients
will pass their stones. When intervention is necessary, the placements of an
internal stent or percutaneous nephrostomy tube or ureteroscopy with definitive
stone treatment are all reasonable options.

Publication Types: 
    Review

PMID: 15075842 [PubMed - indexed for MEDLINE]

898: Curr Opin Urol. 2004 Mar;14(2):117-21.

The use of shock wave lithotripsy for renal calculi.

Putman SS, Hamilton BD, Johnson DB.

Division of Urology, University of Utah Health Sciences Center, 50 North Medical 
Drive, Salt Lake City, UT 84132, USA.

PURPOSE OF REVIEW: Shock wave lithotripsy has been considered a mainstay of
therapy for renal calculi for the last 20 years. Shock wave lithotripsy is
noninvasive and requires the least anesthesia of the treatment modalities for
treatment of renal calculi and therein lies its popularity. In the last decade,
however, there have been changes in thinking regarding methods of patient
selection for shock wave lithotripsy, changes in the technique of the existing
shock wave lithotriptors and new technologies designed to increase the efficacy
of shock wave lithotriptors. RECENT FINDINGS: New studies have shown that shock
wave lithotripsy may be less effective than other modalities for treating lower
pole stones. Other existing technologies, such as computerized tomography, are
being used to more effectively select patients for shock wave lithotripsy.
Ongoing studies are evaluating changing the shock wave rate to increase stone
fragmentation. In addition, efforts are being made to improve lithotripsy by
designing more effective lithotriptors. SUMMARY: Shock wave lithotripsy has
become a widely used modality for treating renal calculi due to its noninvasive
nature and ease of application. Although success rates are reasonable, there is
room for improvement. With appropriate patient selection, significant
improvements in stone-free rates may be achieved. It is anticipated that, with
further research, improvements in lithotriptor design will result in higher
treatment success rates with reduced renal trauma and improved patient comfort.

Publication Types: 
    Review

PMID: 15075841 [PubMed - indexed for MEDLINE]

899: Urology. 2004 Apr;63(4):636-40.

Safety and efficacy of percutaneous nephrolithotomy in patients with neurogenic
bladder dysfunction.

Rubenstein JN, Gonzalez CM, Blunt LW, Clemens JQ, Nadler RB.

Department of Urology, Northwestern University Feinberg School of Medicine,
Chicago, Illinois 60611, USA.

OBJECTIVES: To review our experience performing percutaneous nephrolithotomy
(PNL) on patients with neurogenic bladder dysfunction with special attention paid
to the risks of surgical complications and stone recurrence. Patients with
neurogenic bladder dysfunction with or without urinary diversion are at increased
risk of urolithiasis, surgical complications, and recurrent stone disease.
METHODS: We retrospectively reviewed the 23 patients with neurogenic bladder
dysfunction who underwent PNL at our institution. Neurologic lesions included
spina bifida, traumatic spinal cord injury, exstrophy/epispadias, neonatal
meningitis, stroke, and spine chondrosarcoma. Bladder management included ileal
conduit (n = 8), intermittent catheterization (n = 7), indwelling catheter (n =
7), and ureterosigmoidostomy (n = 1). RESULTS: We performed 100 procedures on 47 
renal units (17 bilateral, 7 with recurrent stones). Urinary tract
infection/colonization was seen in 21 of 23 patients, most of whom had more than 
one organism. The stone-free rate was 96%. Six patients required three or more
procedures, each had a complete staghorn calculus. In an average of 36 months of 
follow-up, 10 patients (46%) had recurrent stone disease requiring intervention, 
and 5 patients (23%) underwent repeat PNL. The stone composition analysis
revealed mainly infection-related stones. CONCLUSIONS: PNL in patients with
neurogenic voiding dysfunction is safe and effective, with outcomes comparable to
that of patients without such lesions. The complication rate is small but
statistically significant. It is important to obtain adequate urine cultures,
because renal pelvis and bladder culture data may differ and affect the outcome. 
Risk factors for recurrent stone disease include a high spinal cord lesion,
indwelling urinary catheter, and ureterosigmoidostomy.

Publication Types: 
    Comparative Study

PMID: 15072868 [PubMed - indexed for MEDLINE]

900: Urology. 2004 Apr;63(4):630-4; discussion 634-5.

Stone clustering of patients with cystine urinary stone formation.

Purohit RS, Stoller ML.

Department of Urology, University of California, San Francisco, School of
Medicine, San Francisco, California 94143-0738, USA.

OBJECTIVES: To explore the history of symptomatic cystine stone formation.
Cystinuria is a genetic defect that may result in the formation of recurrent
cystine calculi. METHODS: Thirty-four patients with cystinuria were
retrospectively evaluated for treatment patterns, medical prophylaxis, and renal 
outcome. Patients were offered a conservative surgical regimen and routine
radiographic and laboratory follow-up and were encouraged to use medical
prophylaxis. A Poisson regression model was used to analyze the patterns of stone
formation. RESULTS: The mean age at presentation and at last follow-up was 18 and
38 years, respectively. Patients underwent a total of 249 procedures, with an
average of 7.3 procedures per patient, including 37% percutaneous
nephrolithotomies; 25.7% shock wave lithotripsy procedures; 22.1% ureteroscopies;
12.9% open lithotomies; and 1.6% nephrectomies. In 29% of patients, unilateral
surgery only was required. With a conservative treatment regimen, no patient
developed renal insufficiency or failure. The overdispersion estimated from the
Poisson model was 5.03 (P <0.001) if patients were evaluated from birth to last
follow-up and 2.06 (P <0.001) if followed from first presentation to
last-follow-up, suggesting a clustering of stone events. Overdispersion was
moderately related to increased age (older than 34 years). CONCLUSIONS: The
results of our study showed that patients with cystinuria develop symptomatic
calculi in clusters, with a slight predominance of stone formation after the age 
of 34. The cause of the stone clustering is unclear. Renal function can be
preserved with a conservative surgical treatment protocol. Contemporary medical
prophylaxis may be ineffective.

Publication Types: 
    Comparative Study

PMID: 15072865 [PubMed - indexed for MEDLINE]

901: J Endourol. 2004 Mar;18(2):157-61.

Comment in:
    J Urol. 2005 Aug;174(2):602-3.

Metabolic abnormalities associated with renal calculi in patients with horseshoe 
kidneys.

Raj GV, Auge BK, Assimos D, Preminger GM.

Division of Urology, Duke University Medical Center, Durham, North Carolina.

BACKGROUND AND PURPOSE: Horseshoe kidneys are a complex anatomic variant of fused
kidneys, with a 20% reported incidence of associated calculi. Anatomic causes
such as high insertion of the ureter on the renal pelvis and obstruction of the
ureteropelvic junction are thought to contribute to stone formation via impaired 
drainage, with urinary stasis, and an increased incidence of infection. In this
multi-institutional study, we evaluated whether metabolic factors contributed to 
stone development in patients with horseshoe kidneys. PATIENTS AND METHODS: A
retrospective review of 37 patients with horseshoe kidneys was performed to
determine if these patients had metabolic derangements that might have
contributed to calculus formation. Stone compositions as well as 24-hour urine
collections were examined. Specific data points of interest were total urine
volume; urine pH; urine concentrations of calcium, sodium, uric acid, oxalate,
and citrate; and number of abnormalities per patient per 24-hour urine
collection. These data were compared with those of a group of 13 patients with
stones in caliceal diverticula as well as 24 age-, race-, and sex-matched
controls with stones in anatomically normal kidneys. RESULTS: Eleven (9 men and 2
women) of the 37 patients (30%) with renal calculi in horseshoe kidneys had
complete metabolic evaluations available for review. All patients were noted to
have at least one abnormality, with an average of 2.68 abnormalities per 24-hour 
urine collection (range 1-4). One patient had primary hyperparathyroidism and
underwent a parathyroidectomy. Low urine volumes were noted in eight patients on 
at least one of the two specimens (range 350-1640 mL/day). Hypercalciuria,
hyperoxaluria, hyperuricosuria, and hypocitraturia were noted in seven, three,
six, and six patients, respectively. No patients were found to have gouty
diathesis or developed cystine stones. Comparative metabolic analyses of patients
with renal calculi in caliceal diverticula or normal kidneys revealed a distinct 
profile in patients with horseshoe kidneys, with a higher incidence of
hypocitraturia. CONCLUSIONS: All patients with renal calculi in horseshoe kidneys
were noted to have metabolic abnormalities predisposing to stone formation. In
this initial series of 11 patients, hypovolemia, hypercalcuria and hypocitraturia
were most common metabolic defects. These findings suggest that metabolic
derangements play a role in stone formation in patients with a horseshoe kidney. 
Patients with calculi in anatomically abnormal kidneys should be considered for a
metabolic evaluation to identify their stone-forming risk factors in order to
initiate preventative selective medical therapy and reduce the risk of recurrent 
calculus formation.

Publication Types: 
    Multicenter Study

PMID: 15072623 [PubMed - indexed for MEDLINE]

902: J Endourol. 2004 Mar;18(2):153-6.

In vitro assessment of lithoclast ultra intracorporeal lithotripter.

Kuo RL, Paterson RF, Siqueira TM Jr, Evan AP, McAteer JA, Williams JC Jr,
Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease.

PURPOSE: The Lithoclast Ultra (Boston Scientific Corporation, Natick, MA) enables
the simultaneous application of ultrasonic and pneumatic modalities for the
fragmentation and removal of stones during percutaneous nephrolithotomy (PCNL).
We evaluated the effectiveness of this unit using a hands-free in vitro testing
system. MATERIALS AND METHODS: An in vitro test system was used to assess the
efficiency of stone penetration when the Lithoclast Ultra was operated at
different settings of ultrasonic power and pneumatic frequency. The pneumatic and
ultrasonic handpieces were assembled, the probes were inserted into an irrigation
sheath (Cook Urological, Spencer, IN), and the complete unit was mounted upright 
(probe tip up). A gypsum artificial stone (mean length 12.8 +/- 0.6 mm; mean
diameter 7.6 +/- 0.1 mm) was centered on the probe tip. A weight (63.4 g) was
placed atop the stone to provide a constant force. Pneumatic frequency settings
of 12, 8, 4, and 1 Hz were tested in conjunction with ultrasonic power settings
of 100%, 70%, and 40%. The times required for complete stone penetration were
assessed for each combination of settings. Differences in mean stone penetration 
times were compared using ANOVA. RESULTS: The combination of 12 Hz and 100%
produced the fastest mean stone penetration time (8.9 +/- 1.1 seconds). Stone
penetration times decreased significantly with increases in pneumatic frequency
(P< 0.001) as well as with increases in ultrasonic power (P= 0.001). When
analyzing the effect of each modality on the total improvement in penetration
time, increasing the pneumatic frequency accounted for approximately 80% of the
performance improvement. The stone penetration times were better than those of
the most efficient ultrasonic device previously evaluated using this test system.
CONCLUSIONS: The Lithoclast Ultra exhibited excellent stone penetration
efficiency when evaluated with a hands-free in vitro test system. Increases in
either pneumatic frequency or ultrasonic power significantly improve penetration 
times, with the pneumatic modality contributing the majority of the effect.

PMID: 15072622 [PubMed - indexed for MEDLINE]

903: J Endourol. 2004 Mar;18(2):145-51.

Bilateral renal calculi: assessment of staged v synchronous percutaneous
nephrolithotomy.

Silverstein AD, Terranova SA, Auge BK, Weizer AZ, Delvecchio FC, Pietrow PK,
Munver R, Albala DM, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery,
Duke University Medical Center, Durham, North Carolina.

BACKGROUND AND PURPOSE: Percutaneous stone removal has replaced open renal
surgery and has become the treatment of choice for large or complex renal
calculi. However, patients with large bilateral stone burdens still present a
challenge. Simultaneous bilateral percutaneous nephrolithotomy (PCNL) has been
demonstrated to be a well-tolerated, safe, cost-effective, and expeditious
treatment. We present what is, to our knowledge, the first large retrospective
series comparing synchronous and asynchronous bilateral PCNL. PATIENTS AND
METHODS: A chart review was performed on 26 patients undergoing 57 PCNLs for
bilateral renal calculi over a 7-year period. Seven patients received synchronous
PCNL (same anesthesia; Group 1), and 19 patients underwent asynchronous PNL
(procedures separated by 1-3 months; Group 2). Complete surgical and hospital
records were available on all patients. The average stone burden for Group 1 was 
8.03 cm(2) on the left and 9.18 cm(2) on the right v 10.1 cm(2) on the left and
14.23 cm(2) on the right for Group 2 (P> 0.05). Variables of interest included
anesthesia time, operative time, blood loss, transfusion rates, length of
hospital stay, and complication rates. Each variable was evaluated per operation 
and per renal unit. Follow-up imaging with stone assessment was available on 20
patients. RESULTS: Group 1 required 1.14 access tracts per renal unit to attempt 
complete clearance of the targeted stones v 1.88 tracts per renal unit in Group 2
(P> 0.05). The average operative time per renal unit was significantly less in
Group 1 (83 minutes) than in Group 2 (168.5 minutes) (P< 0.0001), as was blood
loss (178.5 mL v 307.4 mL, respectively; P= 0.02). However, blood loss per
operation was similar at 357 mL in Group 1 and 282 mL in Group 2. Comparable
transfusion rates of 28.6% and 36.8%, respectively, were noted. Forty percent of 
the patients in Group 1 were completely stone free compared with 36% of the
patients in Group 2; however, an additional 50% and 57%, respectively, had
residual stone burden <4 mm (P> 0.05). Complications occurred in 2 of 7
operations (28%) in Group 1 and 8 of 42 operations (19%) in Group 2. The total
length of hospital stay was nearly doubled for patients undergoing staged PCNL
(P= 0.0005). CONCLUSIONS: These results demonstrate similar stone-free rates,
blood loss per operation, and transfusion rates for simultaneous and staged
bilateral PCNL. The reduced total operative time, hospital stay, and total blood 
loss, along with the requirement for only one anesthesia, makes synchronous
bilateral PCNL an attractive option for select individuals. However, in patients 
with larger, less easily accessible stones, excessive bleeding may be encountered
more frequently on the first side, thereby delaying management of the second side
to a later date. Synchronous bilateral PCNL should be considered in patients in
whom the first stage of stone removal is accomplished quickly and safely.

PMID: 15072621 [PubMed - indexed for MEDLINE]

904: Am J Med Genet A. 2004 Apr 15;126A(2):186-90.

Hypercalciuria and kidney calcifications in terminal 4q deletion syndrome:
further evidence for a putative gene on 4q.

Giuffrè M, La Placa S, Carta M, Cataliotti A, Marino M, Piccione M, Pusateri F,
Meli F, Corsello G.

Dipartimento Materno Infantile, University of Palermo, Via Cardinale Rampolla 1, 
90142 Palermo, Italy. giuffre@unipa.it

We report a newborn girl with a de novo terminal 4q deletion (q31.3 --> qter) and
a characteristic phenotype of minor facial anomalies, cleft palate, congenital
heart defect, abnormalities of hands and feet, and postnatal onset of growth
deficiency. Laboratory studies showed excessive urinary calcium excretion on
standard milk formula and on oral calcium load. Blood measurements of parathyroid
hormone, calcitonin, bicarbonate, calcium, phosphorus, magnesium, sodium,
chlorine, potassium, and urinary measurements of phosphorus, magnesium, sodium,
chlorine, potassium were normal for age. At 2 months of life, ultrasonography
showed kidney calcifications. Clinical and laboratory data support the diagnosis 
of absorptive hypercalciuria or abnormal regulation of calcium-sensing receptors 
in the renal tubules. The evidence of hypercalciuria and kidney calcifications
associated with 4q terminal deletion strengthens the hypothesis that a putative
gene for hypercalciuria is located on the terminal segment of chromosome 4q.
Copyright 2003 Wiley-Liss, Inc.

Publication Types: 
    Case Reports

PMID: 15057984 [PubMed - indexed for MEDLINE]

905: Surg Endosc. 2004 Jul;18(7):1151. Epub 2004 Apr 2.

Laparoscopically guided transperitoneal percutaneous nephrolithotomy for calculi 
in pelvic ectopic kidneys.

Maheshwari PN, Bhandarkar DS, Andankar MG, Shah RS.

Department of Urology, R. G. Stone Urological Research Institute, 14-A Road, Khar
(West), 400 052, Mumbai, India. reetapankaj@rediffmail.com

Although percutaneous nephrolithotomy is a well-established endourological
modality for the management of calculi in the normally placed kidney, it is not
easy to apply in the management of calculi in pelvic ectopic kidneys. We report
the cases of three patients who were found to have large calculi in pelvic
ectopic kidneys and subsequently underwent laparoscopically guided
transperitoneal percutaneous nephrolithotomy, all with successful outcome. In all
patients, complete stone clearance was achieved in a single operation with no
intraoperative or postoperative morbidity. They remain asymptomatic and
recurrence-free at a follow-up ranging from 2 to 38 months. Laparoscopic guidance
allows the transperitoneal route to be used safely for percutaneous
nephrolithotomy in patients with calculi in pelvic ectopic kidneys. We believe it
to be a feasible, safe, and valid minimally invasive management option for this
uncommon but challenging urological condition.

Publication Types: 
    Case Reports

PMID: 15054649 [PubMed - indexed for MEDLINE]

906: BJU Int. 2004 Apr;93(6):827-9.

The effect of intracalyceal distribution on the clearance of renal stones of > or
= 20 mm in children after extracorporeal lithotripsy.

Ather MH, Noor MA, Akhtar S.

Section of Urology, Department of Surgery, The Aga Khan University, PO Box 3500, 
Stadium Road, Karachi 74800, Pakistan. hammad.ather@aku.edu

OBJECTIVES: To determine the effect of the intracalyceal distribution of renal
stones on clearance rates after treating paediatric nephrolithiasis with
extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS: We assessed a
retrospective case series of children (aged < or = 14 years) undergoing
lithotripsy on an MPL 9000 (Dornier GmbH, Germany) echo-guided lithotripter.
Patients were identified using an international coding and indexing system and
ESWL registry. In all, 125 children were treated during 1990-2003, but 21 had
stones of > or = 20 mm. Stone clearance was assessed at 1 and 3 months, the
stone-free state being defined as no radiological evidence of stone or fragments 
of < or = 3 mm. Failed treatments were analysed to identify any correlation with 
stone site. RESULTS: The overall stone-free rate was 81%; in four children the
treatment failed (all girls) and subsequently they required ancillary procedures.
Nineteen patients (90%) received up to three sessions of ESWL; two required four 
or more sessions. Of the four children in whom treatment failed, two had JJ
stents; the stones were in the lower pole calyx in two, and the renal pelvis and 
lower pole calyx in two. The mean stone size in those where treatment failed was 
25 mm, vs 21 mm in the stone-free group. The complication rate was 19%, but only 
one child required admission to hospital. CONCLUSIONS: ESWL is very effective for
renal stones in children, with minimal morbidity. Lower pole and partial staghorn
stones with a major component in the lower pole calyx should preferably be
treated by a percutaneous approach.

PMID: 15049998 [PubMed - indexed for MEDLINE]

907: BJU Int. 2004 Apr;93(6):822-6.

Over-expression of anti-CD75 reactive proteins on distal and collecting renal
tubular epithelial cells in calcium-oxalate stone-forming kidneys in Egypt.

Kramer G, Steiner GE, Neumayer C, Prinz-Kashani M, Hohenfellner M, Gomha M,
Ghoneim M, Newman M, Marberger M.

Department of Urology, University of Vienna, Waehringer Guertel 18-20, A-1090
Vienna, Austria.

OBJECTIVE: To assess the nature, distribution and expression pattern of CD75, a
neuraminidase-sensitive lymphocyte cell surface differentiation antigen, in
calcium oxalate (CaOx) stone disease, as cell-surface sialic acid might be
involved CaOx crystal binding, and lectin-binding assays suggest that sialic acid
in the alpha2,6 position is upregulated in stone-forming kidneys. MATERIALS AND
METHODS: Human CaOx stone-forming and normal kidneys (13 each) and primary kidney
epithelial cells (CAKI-1, three samples) were analysed. The protein pattern,
distribution and expression of CD75 were analysed using Western blotting,
immunohistology and semi-quantitative confocal laser scanning microscopy (cLSM). 
Production was investigated by alpha2,6-sialyltransferase specific reverse
transcription-polymerase chain reaction. RESULTS: Western blotting showed one
strong band at approximately 43 kDa that reacted with anti-CD75 when renal
epithelial and CAKI-1 tumour cell extracts were analysed. However, in renal
tissue extracts of CaOx stone formers there were additional bands at 120 and 205 
kDa. Image processing after cLSM showed that anti-CD75 reactivity was
significantly greater on E-cadherin-positive distal and collecting tubular cells 
from CaOx stone-forming kidneys, at a mean (sd) intensity of 87 (7), than on
those from normal kidneys, at 41 (5) (P = 0.005). CONCLUSION: CD75 expression in 
human kidney was primarily on the luminal surface of distal tubules and
collecting ducts. Whether increased epithelial CD75 expression in CaOx stone
disease is a cause or result of the disease remains to be clarified.

PMID: 15049997 [PubMed - indexed for MEDLINE]

908: Urol Clin North Am. 2004 Feb;31(1):129-35, x.

Advanced intrarenal ureteroscopic procedures.

Monga M, Beeman WW.

Department of Urologic Surgery, MMC 394, University of Minnesota, 1420 Delaware
Street SE, Minneapolis, MN 55455, USA. endourol@yahoo.com

The role of flexible ureteroscopy in the management of intrarenal pathology has
undergone a dramatic evolution, powered by improvements in flexible ureteroscope 
design; deflection and image quality; diversification of small, disposable
instrumentation; and the use of holmium laser lithotripsy. This article reviews
the application of flexible ureteroscopy for advanced intrarenal procedures.

Publication Types: 
    Comparative Study
    Review

PMID: 15040409 [PubMed - indexed for MEDLINE]

909: Urol Clin North Am. 2004 Feb;31(1):89-98.

Ureteroscopic treatment of renal calculi.

Busby JE, Low RK.

Department of Urology, University of California, Davis, 4860 Y Street, Suite
3500, Sacramento, CA 95817, USA.

Although ureteroscopic treatment of renal calculi is safe and effective. it is
relatively inefficient compared with ESWL and PCNL. It should be considered
primary therapy for patients with lower pole stones who have adverse ESWL
characteristics and patients who are not suitable candidates for PCNL. There are 
also numerous clinical situations, as outlined previously, where the
ureteroscopic approach is favored over other treatment modalities.

Publication Types: 
    Comparative Study
    Review

PMID: 15040405 [PubMed - indexed for MEDLINE]

910: Ann Epidemiol. 2004 Mar;14(3):222-8.

History of kidney stones as a possible risk factor for chronic kidney disease.

Vupputuri S, Soucie JM, McClellan W, Sandler DP.

National Institute of Environmental Health Sciences, National Institutes of
Health, Department of Health and Human Services, Research Triangle Park, NC
27709, USA. vupputu1@niehs.nih.gov

PURPOSE: The incidence of treated end-stage renal disease has increased
progressively in the United States over the past several decades. It has been
suggested that kidney stones may be a contributing factor for a small percentage 
of these patients. METHODS: We conducted a case-control study utilizing 548
hospital cases and 514 age, race and gender-matched community controls. The main 
outcome measure was diagnosis of chronic kidney disease, assessed by
comprehensive chart review. History of kidney stones and other co-variables were 
obtained during telephone interviews. RESULTS: This study revealed 16.8% of cases
and 6.4% of controls with reported history of kidney stones. The odds ratios
(adjusted for confounding variables) for chronic kidney disease (overall),
diabetic nephropathy and interstitial nephritis for patients with kidney stones
were 1.9 (95% CI: 1.1, 3.3), 2.5 (95% CI: 0.87, 7.0) and 3.4 (95% CI: 1.5, 7.4), 
respectively. After stratifying by hypertensive status this increased risk
persisted only for study participants reporting no history of hypertension.
CONCLUSION: Kidney stones may play a role in the development of chronic kidney
disease. Our study suggests that the prevention of kidney stones may be a means
of delaying the onset of chronic kidney disease, however, further studies are
needed to make conclusive recommendations.

PMID: 15036227 [PubMed - indexed for MEDLINE]

911: Singapore Med J. 2004 Mar;45(3):125-6.

Mucinous adenocarcinoma of the renal pelvis associated with lithiasis and chronic
gout.

Kaur G, Naik VR, Rahman MN.

Department of Pathology, Universiti Sains Malaysia, Kota Bharu, 16150 Kelantan,
Malaysia. gurjeet@notes.usm.my

Diffusely-infiltrating mucinous adenocarcinoma of the renal pelvis associated
with lithiasis and chronic gout is reported in a 61-year-old Malay man. The
patient underwent left nephrectomy and vesiculo-lithotomy. This tumour is
postulated to arise in response to chronic irritation of the urothelium.

Publication Types: 
    Case Reports

PMID: 15029415 [PubMed - indexed for MEDLINE]

912: Urology. 2004 Mar;63(3):574-6.

Use of a ureteral access sheath to facilitate removal of large stone burden
during extracorporeal shock wave lithotripsy.

Okeke Z, Lam JS, Gupta M.

Department of Urology, New York-Presbyterian Hospital, Columbia University
College of Physicians and Surgeons, New York, New York 10032, USA.

Large renal stone burdens within a nondilated collecting system in patients with 
a relative contraindication to percutaneous nephrolithotomy can be a challenging 
problem. We describe a novel technique using a ureteral access sheath combined
with extracorporeal shock wave lithotripsy to facilitate passage of stone
fragments in such patients.

Publication Types: 
    Case Reports

PMID: 15028463 [PubMed - indexed for MEDLINE]

913: Ann Clin Biochem. 2004 Mar;41(Pt 2):166-9.

Topiramate increases biochemical risk of nephrolithiasis.

Lamb EJ, Stevens PE, Nashef L.

Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Kent and
Canterbury Hospital, Canterbury, CT1 3NG, UK. edmund.lamb@ekht.nhs.uk

The incidence of renal stone disease in patients receiving topiramate (Topamax)
is 2-4 times that expected in the background population. This has been attributed
to a weak carbonic anhydrase inhibitor effect, but published data are scant.
Following three cases of renal stones in patients receiving topiramate, we
evaluated biochemical risk for nephrolithiasis in eight further unselected
patients. Most patients demonstrated inadequate urinary acidification and
hypocitraturia; in some cases citrate was undetectable. Several patients also had
other risk factors for nephrolithiasis, including increased urinary sodium,
calcium and oxalate excretion. The biochemical changes induced by topiramate
appear highly penetrant. Experience with this drug is relatively short-lived and 
it is being prescribed for long-term use in (often) relatively young patients.
This report highlights the significantly increased metabolic risk of stone
formation in patients receiving topiramate.

Publication Types: 
    Case Reports

PMID: 15025812 [PubMed - indexed for MEDLINE]

914: Ann Clin Biochem. 2004 Mar;41(Pt 2):160-1.

2,8-Dihydroxyadenine renal stones in a 41-year-old man.

Wilkinson H, Samuell C, Stower M.

Department of Biochemistry, York Hospital, York, YO31 8HE, UK.
dandh3942@oldbaldpeg.org

A case is presented of a 41-year-old man with a history of recurrent renal stones
over 10 years. Analysis of the stone showed that, although it gave a positive
reaction with the non-specific phosphotungstic acid test, uricase failed to
identify any urate present. Analysis in a reference laboratory confirmed its
composition as dihydroxyadenine. Patients who are homozygous for the rare
autosomal-recessive adenine phosphoribosyltransferase deficiency, excrete large
amounts of 2,8-dihydroxyadenine, which has poor solubility at normal urinary pH. 
Treatment with the xanthine oxidase inhibitor allopurinol induces a total
cessation of stone formation. Increased awareness of the condition and knowledge 
of the limitations of some methods of laboratory analysis for renal stones should
help to identify this type of stone and prevent renal damage.

Publication Types: 
    Case Reports

PMID: 15025810 [PubMed - indexed for MEDLINE]

915: Nepal Med Coll J. 2003 Dec;5(2):102-4.

Is urinary tract infection a predisposing factor for renal stone formation?

Kumar A.

Department of Clinical Biochemistry, Nepal Medical College, Kathmandu, Nepal.
kumararun50@hotmail.com

The study was carried out to assess whether Urinary Tract Infection (UTI) is a
predisposing factor for Renal Stones (RS) formation. A total of 836 subjects
(males 300; females 536) attending Surgery Out Patient Department (OPD) of which 
were either diagnosed of UTI or had been detected of RS for a period of two years
from January 2001 to December 2002 were included. Of the 836, 240 had UTI and 596
were free from UTI. The prevalence of RS was higher without UTI (44.4%) than
those with UTI (27.8%) in males. In case of females the result showed (17.6%) and
(5.1%) in cases with and without UTI. Chi square test revealed statistically
significant difference in the proportion of prevalence between subjects with and 
without UTI with (p < 0.01) in males and (p < 0.001) in females. Males had higher
incidence of RS than females with a prevalence of (p < 0.0001). The higher
occurrence of RS was observed in age group between 21-40 years for both genders.

PMID: 15024779 [PubMed - indexed for MEDLINE]

916: Curr Opin Pediatr. 2004 Apr;16(2):188-93.

Comment in:
    J Urol. 2005 Aug;174(2):601.

The molecular basis of kidney stones.

Langman CB.

Feinberg School of Medicine, Northwestern University, Kidney Diseases, Children's
Memorial Hospital, Chicago, Illinois 60614, USA. c_langman@northwestern.edu

PURPOSE OF REVIEW: To emphasize an exploration of mechanisms of kidney stone
disease based on a molecular understanding of excess urinary excretions of
calcium, oxalate, cystine, and uric acid. RECENT FINDINGS: Hypercalciuria is
discussed relative to mutations in the renal chloride genes CLCN5 and CLCNKB, WNK
kinases, ATPB61, and NPT2. Hyperoxaluria is discussed relative to mutations in
AGXT and GRHPR. Cystinuria is discussed relative to mutations in SLC3A1 and
SLC7A9. Hyperuricosuria is discussed with novel gene findings, and
hyperxanthinuria with new findings in XDH. SUMMARY: An enhanced understanding of 
the diagnosis, course, and prognosis for genetic causes of kidney stone diseases 
has been made available to the clinician caring for patients with kidney stones
and to the scientist interested in their cause, as a result of molecular
breakthroughs in the kidney handling of normal urinary constituents. We look
forward to a new era of the therapeutics of kidney stones based on such advances.

Publication Types: 
    Review

PMID: 15021200 [PubMed - indexed for MEDLINE]

917: Eat Weight Disord. 2003 Dec;8(4):332-5.

Kidney stones in anorexia nervosa: a case report and review of the literature.

Jonat LM, Birmingham CL.

Eating Disorders Program, University of British Columbia, St. Paul's Hospital,
Vancouver, British Columbia, Canada.

Nephrolithiasis (kidney stones) is a recognized complication of anorexia nervosa 
(AN). We present the case of a 41-year-old woman with a 25-year history of AN.
Between 1978 and 1986, she had two episodes of calcium oxalate kidney stones.
Proper management of kidney stones in AN requires collection of the stone,
laboratory analysis of the stone to determine its composition, and laboratory
evaluation of the urine and blood to determine what treatment is necessary to
prevent recurrent kidney stone formation.

Publication Types: 
    Case Reports
    Review

PMID: 15018386 [PubMed - indexed for MEDLINE]

918: Climacteric. 2003 Oct;6 Suppl 3:36-48.

Potassium: more beneficial effects.

He FJ, MacGregor GA.

Blood Pressure Unit, St. George's Hospital Medical School, London, UK.

Over 70 years ago, potassium was found to have a natriuretic effect and was used 
in patients with heart failure. However, it took many years for its role in the
control of blood pressure to be recognized. Recently, epidemiological and
clinical studies in man and experimental studies in animals have shown that
increasing potassium intake towers blood pressure and that communities with a
high potassium intake tend to have lower population blood pressures. Several
studies have shown an interaction between salt intake and potassium intake.
However, the recent DASH-Sodium (Dietary Approaches to Stop Hypertension) study
demonstrates an additive effect of a low salt and high potassium diet on blood
pressure. Increasing potassium intake may have other beneficial effects, for
example, reducing the risk of stroke and preventing the development of renal
disease independent of its effect on blood pressure. A high potassium intake
reduces calcium excretion and could play an important role in the management of
hypercalciuria and kidney stone formation, as well as bone demineralization.
Potassium intake may also play an important role in carbohydrate intolerance. A
reduced serum potassium increases the risk of lethal ventricular arrhythmias in
those at risk, i.e. patients with ischemic heart disease, heart failure or left
ventricular hypertrophy, and increasing potassium intake may prevent this. In
this article, we address the evidence for the important role of potassium intake 
in regulating blood pressure and other beneficial effects of potassium which may 
be independent of and additional to its effect on blood pressure.

Publication Types: 
    Review

PMID: 15018247 [PubMed - indexed for MEDLINE]

919: J Urol. 2004 Apr;171(4):1436-9.

A computer model to predict the outcome and duration of ureteral or renal
calculous passage.

Parekattil SJ, White MD, Moran ME, Kogan BA.

Department of Urology, Albany Medical College, Albany, New York, USA.
sijo_p@hotmail.com

PURPOSE: We developed a computer model to predict the outcome and the duration
until passage of ureteral/renal calculi. MATERIALS AND METHODS: A retrospective, 
randomized study was performed of the outcome in 301 patients presenting to the
emergency room for renal colic. Presenting characteristics of those diagnosed
with a single calculus by computerized tomography were recorded for analysis.
Predictors of stone passage and passage duration were identified and then used to
create a logistic regression model. The algorithm was trained on 141 randomly
selected patients and then tested on a separate 160 patients. Model accuracy was 
compared to predictions from 10 experienced urologists and 9 urology residents in
77 randomly selected patients. The model was tested further in 30 randomly
selected patients at a private hospital to assess its general applicability.
RESULTS: The model prediction accuracy in 160 patients was 86.3% for passage and 
87.3% for duration (less or greater than 2 weeks). In the comparison group the
model, the 10 experienced urologists and the 9 urology residents had an overall
prediction accuracy of 88.3%, 70.5% (p = 0.006) and 72% (p = 0.007) for passage, 
and 87.1%, 71.6% (p = 0.007) and 81% (p = 0.075) for duration, respectively.
Prediction accuracy was 93.3% for passage and 90.3% for duration when tested at a
private hospital. CONCLUSIONS: Our model provides outcome and duration of passage
predictions for patients presenting acutely in the emergency room with a single
ureteral/renal calculus. It performs better than experienced urologists and
urology residents. It can be applied to a private practice setting with equal
accuracy.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 15017192 [PubMed - indexed for MEDLINE]

920: Transplant Proc. 2004 Jan-Feb;36(1):187-9.

Stone disease in kidney transplantation.

Yiğit B, Aydin C, Titiz I, Berber I, Sinanoğlu O, Altaca G.

Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
b.yigit@excite.com

The aim of this study was to evaluate etiologic, diagnostic, and management
aspects of stone disease in renal transplant recipients and donors. Calculi from 
five patients were analyzed. The immunosuppressive regimen included tacrolimus or
cyclosporine, mycophenolate mofetil, and corticosteroids in all cases. The
etiology of the stone disease was cadaveric donor-gifted in one patient and de
novo stone formation after transplantation in two patients. Additionally, stone
disease was found and treated in living related donors in two patients. The mean 
follow-up was 32.4 +/- 19.7 months. In the living related donors, stones were
initially treated by ESWL. Pyelotomy at the back table during the transplantation
was required in one of them. The patient with cadaver-gifted stone was also
treated by ESWL. In patients with de novo stone formation after transplantation, 
the stones were related to urinary infections and foreign body double-j (JJ)
stent. A small stone in one of these patients (de novo formation) passed
spontaneously after removal of the foreign body. Endoscopical lithotripsy was
performed in the other patient. Stones are more frequently transplanted with
allografts than expected; therefore, preoperative imaging of the donor is
important. ESWL is recommended for medium-sized calculi in transplant kidneys. JJ
stent insertion before ESWL might be needed in stones larger than 10 mm.

PMID: 15013342 [PubMed - indexed for MEDLINE]

921: J Endourol. 2004 Feb;18(1):33-6.

Ureteral access sheath provides protection against elevated renal pressures
during routine flexible ureteroscopic stone manipulation.

Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW, Preminger GM.

Department of Urology, Naval Medical Center, San Diego, California, USA.

BACKGROUND AND PURPOSE: New-generation flexible ureteroscopes allow the
management of proximal ureteral and intrarenal pathology with high success rates,
including complete removal of ureteral and renal calculi. One problem is that the
irrigation pressures generated within the collecting system can be significantly 
elevated, as evidenced by pyelovenous and pyelolymphatic backflow seen during
retrograde pyelography. We sought to determine if the ureteral access sheath
(UAS) can offer protection from high intrarenal pressures attained during routine
ureteroscopic stone surgery. PATIENTS AND METHODS: Five patients (average age
72.6 years) evaluated in the emergency department for obstructing calculi
underwent percutaneous nephrostomy (PCN) tube placement to decompress their
collecting systems. The indications for PCN tube placement were obstructive renal
failure (N=1), urosepsis (N=2), and obstruction with uncontrolled pain and
elevated white blood cell counts (N=2). Flexible ureteroscopy was subsequently
performed with and without the aid of the UAS while pressures were measured via
the nephrostomy tube connected to a pressure transducer. Pressures were recorded 
at baseline and in the distal, mid, and proximal ureter and renal pelvis, first
without the UAS, and then with the UAS in place. RESULTS: The average baseline
pressure within the collecting system was 13.6 mm Hg. The mean intrarenal
pressure with the ureteroscope in the distal ureter without the UAS was 60 mm Hg 
and with the UAS was 15 mm Hg. With the ureteroscope in the midureter, the
pressures were 65.6 and 17.5 mm Hg, respectively; with the ureteroscope in the
proximal ureter 79.2 and 24 mm Hg, and with the ureteroscope in the renal pelvis 
94.4 and 40.6 mm Hg, respectively. All differences at each location were
statistically significant (P<0.008). Compared with baseline, all pressures
measured without the UAS were significantly greater, but only pressures recorded 
in the proximal ureter and renal pelvis after UAS insertion were significantly
higher (P<0.03). CONCLUSIONS: The irrigation pressures transmitted to the renal
pelvis and subsequently to the parenchyma are significantly greater during
routine URS without the use of the UAS. The access sheath is potentially
protective against pyelovenous and pyelolymphatic backflow, with clinical
implications for the ureteroscopic management of upper-tract transitional cell
carcinoma, struvite stones, or calculi associated with urinary tract infection.

Publication Types: 
    Comparative Study

PMID: 15006050 [PubMed - indexed for MEDLINE]

922: J Endourol. 2004 Feb;18(1):29-32.

Nephroureterostomy-drained percutaneous nephrolithotomy: modification combining
safety with decreased morbidity.

Kader AK, Finelli A, Honey RJ.

St. Michael's Hospital, Division of Urology, Department of Surgery, University of
Toronto, Toronto, Ontario, Canada.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) has become well
established as the standard procedure for the management of certain renal
calculi. To minimize patient discomfort and reduce the hospital stay, a novel
modification of our previous technique was evaluated. A smaller internal/external
nephroureterostomy catheter (NUC) placed at the completion of the procedure was
compared with the larger Malecot nephrostomy tube. PATIENTS AND METHODS: We
conducted a 2:1 matched cohort study with historical controls. In 2002, a
consecutive series of 30 PCNL procedures at a single teaching hospital were
carried out in the conventional fashion. At the end of the procedure, an
8.5F/6.0F internal/external NUC was placed in the percutaneous tract instead of
the traditional 24F Malecot tube. These patients were compared with a cohort of
matched cases (60) performed between 1992 and 1997 on the basis of age, sex, and 
site of access (supracostal or infracostal). The endpoints were patient
discomfort (morphine equivalents used), safety (postoperative hemoglobin drop),
and length of hospital stay. RESULTS: The mean morphine equivalents used in the
first 24 postoperative hours were significantly different in the two groups
(study 16.5 mg and controls 47.8 mg; P<0.001). The percentage difference between 
the preoperative and postoperative hemoglobin values was comparable in the two
groups (mean study 12.8% and mean controls 13.4%; P=0.80). The median length of
hospital stay was significantly shorter in the study group than in the control
group, 1 v 4 days, respectively (P<0.001). CONCLUSION: Our data suggest that the 
NUC diminishes postoperative pain while maintaining ureteral patency and
nephrostomy access and decreases hospital stay.

Publication Types: 
    Comparative Study

PMID: 15006049 [PubMed - indexed for MEDLINE]

923: J Endourol. 2004 Feb;18(1):23-7.

Percutaneous nephrolithotomy for complex pediatric renal calculus disease.

Desai MR, Kukreja RA, Patel SH, Bapat SD.

Department of Urology, Muljibhai Patel Urological Hospital, Gujarat, India.
mrdesai@mpuh.org

BACKGROUND AND PURPOSE: Pediatric renal calculus disease has been a management
dilemma in view of the concern about the effects of the various treatment
modalities on the growing kidney, the significant recurrence rate, and the
long-term outcome. We report our experience with percutaneous nephrolithotomy
(PCNL) monotherapy in staghorn or complex pediatric renal calculi. PATIENTS AND
METHODS: We retrospectively analyzed the case records of 116 patients younger
than 15 years who underwent PCNL. The stones included 56 complex calculi. We
defined complex calculi as either staghorn (complete or partial) or those with a 
large bulk and involving more than one calix, the upper ureter, or both. RESULTS:
Complete clearance was achieved in 50 patients (89.8%). Of these, 22 (39%)
required a single tract, while 34 (61%) required multiple tracts. With subsequent
SWL, the clearance rate increased to 96%. The average hemoglobin drop was 1.9
g/dL. Assessing the factors affecting the hemoglobin drop, the number of tracts
and the size of tracts were found to be significant (P<0.01). The average change 
in the serum creatinine concentration between the preoperative and postoperative 
measurements was +0.03 mg/dL and was not different in patients with a single
tract and those with multiple tracts (+0.02 and +0.04 mg/dL, respectively; P=NS).
Intravenous urography done in 36 renal units postoperatively revealed good
function in all. A DMSA renal scan in six children showed no scar. CONCLUSIONS:
Monotherapy with PCNL is safe and effective in the management of staghorn and
complex renal calculi in single hospital stay. Ultrasound-guided peripheral
caliceal puncture and limiting the tract dilatation to 22F are important factors 
in reducing the blood loss. Multiple tracts increase the hemoglobin drop but are 
not associated with an increased risk of complications (bleeding, postoperative
infection, and prolonged urinary leak). Also, there is no deterioration in renal 
function after either single- or multiple-tract PCNL.

PMID: 15006048 [PubMed - indexed for MEDLINE]

924: J Endourol. 2004 Feb;18(1):17-22.

Extracorporeal shockwave lithotripsy for kidney stones reduces blood pressure:
use of 24-hour ambulatory monitoring for study of blood-pressure changes induced 
by SWL.

Protogerou V, Deliveliotis Ch, Protogerou A, Kotsis V, Karayiannis V, Zakopoulos 
N, Kostakopoulos A.

Urological Department, Athens Medical School, Sismanoglio Hospital, Athens,
Greece.

PURPOSE: To investigate the effects of shockwave lithotripsy (SWL) on blood
pressure with the use of 24-hour ambulatory blood-pressure monitoring (ABPM).
PATIENTS AND METHODS: We studied three groups of patients. Group I consisted of
60 patients with kidney stones treated with SWL. Group II was formed by 30
patients with stones in the lower third of the ureter treated in situ with SWL,
and group III consisted of 30 patients with ureteral stones treated with
ureteroscopy (URS). The ABPM measurements were performed before stone treatment, 
immediately after, and then every 3 months through 1 year. RESULTS: There was no 
new onset of hypertension in any group. The prevalences of hypertension before
stone treatment were 21 (35%), 12 (40%), and 9 (30%) for groups I, II, and III,
respectively. One-year post treatment, the numbers of hypertensive patients found
for groups I, II, and III were 15 (25%), 11 (33.3%), and 8 (22.2%), respectively.
In group I, a statistically significant decrease in blood pressure values was
noted 1 year post-treatment (p<0.05). This decrease was related (p<0.05) to the
power (r=0.35), as well as to the product of the number and the power (r=0.25),
of the shockwaves applied. CONCLUSION: Extracorporeal lithotripsy for kidney
stone may be responsible for a drop in blood pressure possibly caused by
alteration in intrarenal metabolism.

PMID: 15006047 [PubMed - indexed for MEDLINE]

925: J Endourol. 2004 Feb;18(1):7-15; discussion 15-6.

Evaluation of a bifocal reflector on a clinical lithotripter.

Loske AM, Prieto FE, Gutierrez J, Zendejas H, Saita A, Velez Gomez E.

Centro de Física Aplicada y Tecnología Avanzada, UNAM, Querétaro, Qro, México.
loske@fata.unam.mx

PURPOSE: To perform in vitro and in vivo tests using a clinical lithotripter in
order to determine whether a bifocal reflector is more efficient and produces the
same or less tissue damage than a conventional ellipsoidal reflector for
electrohydraulic lithotripters. MATERIALS AND METHODS: A standard ellipsoidal and
a novel bifocal reflector were tested on a Tripter Compact lithotripter (Direx
Medical Systems, Petach Tikva, Israel). The bifocal reflector was constructed by 
joining two sectors of two rotationally symmetrical ellipsoidal reflectors having
different distances between their foci. The F1 foci of the sectors coincided,
creating a separation between the F2 foci. The fragmentation efficiency of the
reflectors was compared using kidney-stone models. Shockwave-induced trauma was
evaluated in vivo by treating both kidneys of six healthy dogs. One kidney was
exposed to shockwaves generated with the conventional reflector, and the other
kidney was treated using the bifocal reflector. Pressure measurements were
obtained for both reflectors using needle hydrophones. RESULTS: The new design
appeared to be more efficient than the conventional reflector in breaking up
kidney-stone models. Tissue damage did not increase when using the bifocal
reflector. CONCLUSION: The use of bifocal, instead of standard ellipsoidal,
reflectors should be considered as an alternative to improve extracorporeal
shockwave lithotripsy.

PMID: 15006046 [PubMed - indexed for MEDLINE]

926: Urology. 2004 Feb;63(2):381-2.

Elevation of CA 19-9 in giant hydronephrosis induced by a renal calculus.

Meyer A, Kausch I, Krüger S, Fetscher S, Böhle A, Jocham D.

Department of Urology, Medical University of Schleswig-Holstein, Campus Lübeck,
Lübeck, Germany.

CA 19-9 is a tumor marker of pancreatic and gastrointestinal cancer. Elevation in
nonmalignant disease is rare. The case of a patient with a partial staghorn
calculus, giant hydronephrosis, and elevated CA 19-9 serum levels is presented.
Open transperitoneal right-sided nephrectomy was performed. In
immunohistochemical analysis, CA 19-9 was expressed in the renal tubular
epithelium and the renal pelvis. During postoperative follow-up, the CA 19-9
levels returned to normal. Hydronephrosis might cause false-positive results when
CA 19-9 measurement is used to screen for malignant disease. Posttreatment CA
19-9 levels of patients with hydronephrosis have to be monitored closely to
safely exclude malignant disease.

Publication Types: 
    Case Reports

PMID: 14972505 [PubMed - indexed for MEDLINE]

927: Urol Int. 2004;72(2):165-7.

Mini-invasive management of a rare complication of percutaneous stone treatment: 
entrapped nephrostomy tube.

Tasca A, Cacciola A.

Department of Urology, San Bortolo Hospital, Vicenza, Italy.

A case of entrapped nephrostomy tube in a 61-year-old woman who underwent
percutaneous nephrolithotomy and subsequent multiple ESWL for a left staghorn
stone is presented. A nephrostomy track was created alongside the Malecot
catheter and the overgrown tissue which was bridging the wings of the tube was
incised with a Sachse urethrotome. To prevent this complication the wings of the 
Malecot should freely expand in the renal collecting system and the catheter
should stay in situ for no more than 3 weeks. Copyright 2004 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 14963360 [PubMed - indexed for MEDLINE]

928: Urol Int. 2004;72(2):140-4.

Pneumatic lithotripsy through pyelotomy incision during open surgery for staghorn
calculi: an alternative method to anatrophic nephrolithotomy.

Unsal A, Cimentepe E, Saglam R, Balbay MD.

Department of Urology, Fatih University, School of Medicine, Ankara, Turkey.
anusal69@yahoo.com

INTRODUCTION: Our purpose was to remove large-volume staghorn calculi with less
morbidity and maximum ease without an anatrophic nephrolithotomy, with the use of
a pneumatic lithotriptor during pyelolithotomy to disintegrate the branches of
stones extending into the calyces and retained calyceal fragments. PATIENTS AND
METHODS: Sixteen patients (17 renal units) with large-volume staghorn stones were
evaluated with blood urea nitrogen (BUN), creatinine levels, urinalysis, and
culture, excretory urography (IVP), and 99mtechnetium dimercaptosuccinic acid
(DMSA) renal scintigraphy preoperatively. Patients were treated with a pneumatic 
lithotriptor at the time of open pyelolithotomy. Bilateral surgery was performed 
in 1 patient. The mean follow-up period was 12 (range 6-24) months. The patients 
were re-evaluated postoperatively at 6 months with BUN and serum creatinine
measurements, urinalysis and culture, IVP, and renal scintigraphy with DMSA. Data
were analyzed by one-way ANOVA test. p < 0.05 was considered statistically
significant. RESULTS: After treatment, 15 of 17 renal units (88%) were rendered
stone-free while residual fragments remained in two patients. Average operation
time was 190 min (range 135-285) with a mean blood loss of 226 ml (range
140-425). No patient required blood transfusion. Average length of hospital stay 
was 4.2 days (range 3-7). Six months after surgery, mean BUN and creatinine
levels were decreased from 31.2 to 28.2 mg/dl (p = 0.248) and from 1.3 to 1.1
mg/dl (p = 0.001), respectively. Renal scintigraphy with DMSA revealed an
increase in ipsilateral average renal function from 39 to 43% (p = 0.043). IVP
also revealed a decrease in pelvicalyceal dilatation in almost all patients with 
a well-functioning kidney and without any stone recurrence. No complications were
encountered postoperatively except for an episode of high fever in 1 patient.
CONCLUSION: Avoiding incision of the renal parenchyma and arterial clamping,
without significant bleeding and the nephron loss seem to be the advantages of
this technique. Kidney function can be preserved with this simple and easily
applicable method, which may be an alternative procedure to anatrophic
nephrolithotomy for the majority of patients with staghorn calculi requiring open
surgery. Copyright 2004 S. Karger AG, Basel

PMID: 14963355 [PubMed - indexed for MEDLINE]

929: Drugs. 2004;64(3):245-75.

Drug-induced renal calculi: epidemiology, prevention and management.

Daudon M, Jungers P.

CRISTAL Laboratory, Department of Biochemistry A, Necker Hospital, Paris, France.
m.daudon@infonie.fr

Drug-induced calculi represent 1-2% of all renal calculi. The drugs reported to
produce calculi formation may be divided into two groups. The first one includes 
poorly soluble drugs with high urine excretion that favours crystallisation in
the urine. Among poorly soluble molecules, triamterene was the leading cause of
drug-containing urinary calculi in the 1970s, and it is still currently
responsible for a significant number of calculi. In the last decade, drugs used
for the treatment of HIV-infected patients, namely indinavir and sulfadiazine,
have become the most frequent cause of drug-containing urinary calculi. Besides
these drugs, about twenty other molecules may induce nephrolithiasis in patients 
receiving long-term treatment or high doses. Calculi analysis by physical
methods, including infrared spectroscopy or x-ray diffraction, is needed to
demonstrate the presence of the drug or its metabolites within the calculi. The
second group includes drugs that provoke urinary calculi as a consequence of
their metabolic effects. Here, diagnosis relies on careful clinical inquiry
because physical methods are ineffective to differentiate between urinary calculi
induced by the metabolic effects of a drug and common metabolic calculi. The
incidence of such calculi, especially those resulting from calcium/vitamin D
supplementation, is probably underestimated. Although drug-induced urinary
calculi most often complicate high-dose, long-duration drug treatments, there
also exist specific patient risk factors in relation to urine pH, urine output
and other parameters, which provide a basis for preventive or curative treatment 
of calculi. Better awareness of the possible occurrence of lithogenic
complications, preventive measures based on drug solubility characteristics and
close surveillance of patients on long-term treatment with drugs with lithogenic 
potential, especially those with a history of urolithiasis, should reduce the
incidence of drug-induced nephrolithiasis.

Publication Types: 
    Review

PMID: 14871169 [PubMed - indexed for MEDLINE]

930: J Urol. 2004 Mar;171(3):1304-8.

Minipump induced hyperoxaluria and crystal deposition in rats: a model for
calcium oxalate urolithiasis.

Marengo SR, Chen DH, MacLennan GT, Resnick MI, Jacobs GH.

Department of Urology, School of Medicine, Case Western Reserve University,
Cleveland, Ohop 44106-4931, USA. susan.marengo@case.edu

PURPOSE: Unraveling the mechanisms leading to clinically active calcium oxalate
(CaOx) stone disease and the development of effective medical therapies to treat 
it have been hampered by the lack of appropriate animal models. To address this
problem we developed a model of hyperoxaluria and calcium oxalate crystal
deposition by implanting osmotic minipumps subcutaneously into male rats, that is
minipump induced hyperoxaluria and crystal deposition in rats. MATERIALS AND
METHODS: Male Harlan-Sprague Dawley rats (225 to 290 gm) were implanted
subcutaneously with 1-week 2 ml osmotic minipumps containing 1.5 M potassium
oxalate (360 microM KOx/24 hours, [KOx-trt], 11) or phosphate buffered saline
(PBS-trt, 9) on days 1 and 7. The 24-hour urine collections were performed on
days 0, 4, 7, 11 and 14. Data were analyzed by ANOVA and Tukey's HSD. Urinary
crystals were analyzed by light microscopy. Kidneys were harvested on day 14 and 
processed for light and polarizing microscopy, and RNA analysis.RESULTS Mean
overall creatinine excretion +/- SEM (PBS-trt 107 +/- 7 and KOx-trt 123 +/- 6
microM/24 hours, p >0.07) and day 14 serum creatinine (PBS-trt 83 +/- 4 and
KOx-trt 83 +/- 5 microM, p >or=0.9) were similar in the 2 treatment groups.
Overall urinary volume (PBS-trt 11.3 +/- 0.8 and KOx-trt 18.0 +/- 1.5 ml/24
hours, p <or=0.001) and oxalate (OX) excretion (PBS-trt 9.2 +/- 0.6 and KOx-trt
44 +/- 4.2 microM/24 hours, p <or=0.001) were higher in KOx-trt vs PBS-trt rats. 
In KOx-trt rats OX excretion on day 0 was significantly less than on any day
after implantation (p <or=0.01). All KOx-trt rats excreted calcium oxalate
dihydrate crystals by day 4 and had intrarenal deposits of birefringent crystals 
by day 14. Overall the morphology of kidneys of OX rats was normal, although
localized regions of inflammation and tubular debris were occasionally observed. 
Reverse transcriptase-polymerase chain reaction and Northern blot analysis
revealed that the expression of 3 distress molecules tumor necrosis factor
receptor, osteopontin and kidney injury molecule were up-regulated in KOx-trt
kidneys. CONCLUSIONS: The model of minipump induced hyperoxaluria and crystal
deposition in rats reliably induces hyperoxaluria, CaOx crystalluria and CaOx
crystal deposition. These characteristics make it an appropriate model for
investigations of the effects of OX on renal physiology as well as investigating 
the efficacy of new therapeutics.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14767338 [PubMed - indexed for MEDLINE]

931: J Urol. 2004 Mar;171(3):1301-3.

A porcine model of calcium oxalate kidney stone disease.

Mandel NS, Henderson JD Jr, Hung LY, Wille DF, Wiessner JH.

Departments of Medicine and Surgery, Medical College of Wisconsin,, Milwaukee,
Wisconsin, USA.

PURPOSE: The pig has been extensively used in biomedical research because of the 
similarities in organ structure and function to humans. It is desirable to have
an animal model of oxaluria and urolithiasis with physiological, anatomical and
nutritional characteristics that more closely resemble those of man. In this
study we determined if feeding pigs trans-4-hydroxy-l-proline (HP) increased
urine oxalate levels and if it would serve as a model for human hyperoxaluria and
stone disease. MATERIALS AND METHODS: Male Yorkshire-Durox cross-bred pigs were
fed HP for up to 20 days. Urine was periodically collected and analyzed for
oxalate levels and the presence of crystalluria. After 20 days of feeding the
kidneys were removed and examined grossly and microscopically for indications of 
injury, crystal deposition and stone formation. RESULTS: Feeding pigs 10% HP
(weight per weight HP/food) produced hyperoxaluria, which reached a maximum and
leveled off by day 6. Urine oxalate remained near this level until the study
ended at 20 days regardless of the further increase in HP to 20% of the weight of
the food. When the kidneys were removed and grossly examined, calcium oxalate
encrustations were observed on multiple papillary tips. Histopathological
observation of the papillary tissue showed tissue injury and crystal deposition. 
CONCLUSIONS: Pigs fed HP have hyperoxaluria and calcium oxalate crystalluria, and
calcium oxalate papillary deposits form that may be precursors of kidney stones. 
The use of the pig as a model of human hyperoxaluria and stone formation should
prove ideal for studies of these human diseases.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 14767337 [PubMed - indexed for MEDLINE]

932: J Urol. 2004 Mar;171(3):1046-9.

Biochemical and physicochemical presentations of patients with brushite stones.

Pak CY, Poindexter JR, Peterson RD, Heller HJ.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, Dallas, Texas 75390-8885, USA.

PURPOSE: We determined whether the biochemical and physicochemical backgrounds of
patients with brushite stones differ from those with hydroxyapatite and calcium
oxalate stones. MATERIALS AND METHODS: From a computer data base of patients
completing ambulatory evaluation 19 with brushite stones, 24 with hydroxyapatite 
stones and 762 with calcium oxalate stones were identified with the specified
composition in greater than 70% of stones. RESULTS: Absorptive hypercalciuria
type I was present in 63% of patients with brushite, 17% with hydroxyapatite and 
30% with calcium oxalate stones. Distal renal tubular acidosis was noted in 32%
of patients with brushite, 42% with hydroxyapatite and 3% with calcium oxalate
stones. Mean urinary calcium in the brushite group was significantly higher than 
in the hydroxyapatite and calcium oxalate groups (265 +/- 125 vs 186 +/- 103 and 
187 +/- 95 mg daily, respectively). Urinary pH in the brushite group was slightly
but significantly higher than in the calcium oxalate group (6.15 +/- 0.30 vs 5.91
+/- 0.42). The brushite relative saturation ratio in the brushite group was
marginally higher than in the hydroxyapatite group and significantly higher than 
in the calcium oxalate group (3.25 +/- 2.03 vs 2.34 +/- 1.51 and 1.83 +/- 1.66,
respectively). CONCLUSION: Patients with predominantly brushite stones could be
distinguished from those with predominantly hydroxyapatite and calcium oxalate
stones by higher urinary saturation with respect to brushite due mainly to
hypercalciuria from absorptive hypercalciuria.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 14767267 [PubMed - indexed for MEDLINE]

933: Front Biosci. 2004 Jan 1;9:797-808.

How elevated oxalate can promote kidney stone disease: changes at the surface and
in the cytosol of renal cells that promote crystal adherence and growth.

Scheid CR, Cao LC, Honeyman T, Jonassen JA.

University of Massachusetts Medical School, Department of Physiology, 55 Lake
Avenue North, Worcester, MA 01655, USA. Cheryl.Scheid@umassmed.edu

The present review assesses the mechanisms by which oxalate-induced alterations
in renal cell function may promote stone disease focusing on 1) changes in
membrane surface properties that promote the attachment of nascent crystals and
2) changes in the expression/secretion of urinary macromolecules that alter the
kinetics of crystal nucleation, agglomeration and growth. The general role of
renal cellular injury in promoting these responses and the specific role of
urinary oxalate in producing injury is emphasized, and the signaling pathways
that lead to the observed changes in cell surface properties and in the viability
and growth of renal cells are discussed. Particular attention is paid to evidence
linking oxalate-induced activation of cytosolic phospholipase A2 to changes in
gene expression and to the activation of a second signaling pathway involving
ceramide. The effects of the lipid signals, arachidonic acid,
lysophosphatidylcholine and ceramide, on mitochondrial function are considered in
some detail since many of the actions of oxalate appear to be secondary to
increased production of reactive oxygen molecules within these organelles. Data
from these studies and from a variety of other studies in vitro and in vivo were 
used to construct a model that illustrates possible mechanisms by which an
increase in urinary oxalate levels leads to an increase in kidney stone
formation. Further studies will be required to assess the validity of various
aspects of this proposed model and to determine effective strategies for
countering these responses in stone-forming individuals.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 14766409 [PubMed - indexed for MEDLINE]

934: BJU Int. 2004 Feb;93(3):364-8.

Efficacy of extracorporeal shock wave lithotripsy for solitary lower calyceal
stone: a statistical model.

Srivastava A, Zaman W, Singh V, Mandhani A, Kumar A, Singh U.

Department of Urology & Renal Transplantation, Sanjay Gandhi Post-Graduate
Institute of Medical Sciences, Lucknow, India. aneesh@sgpgi.ac.in

OBJECTIVE: To evaluate the effect of inferior calyceal radiographic anatomy,
number of extracorporeal shock wave lithotripsy (ESWL) sessions and stone size on
the successful clearance of solitary inferior calyceal calculi after ESWL.
PATIENTS AND METHODS: In a prospective study between January 2001 and November
2002, 66 renal units with a solitary inferior calyceal calculus of < or = 2 cm
were treated with electrohydraulic ESWL. The infundibulopelvic angle (two
definitions), infundibulovertebral angle, inferior calyceal infundibular
diameter, infundibular length, cortical thickness over the lower pole, number of 
minor calyces and stone size were determined from intravenous urography before
treatment. The number of ESWL sessions was also included in the analysis.
Treatments which produced residual fragments not clearing within 3 months of
satisfactory fragmentation were considered as failures. All patients in whom the 
treatment failed were treated successfully by percutaneous nephrolithotomy. The
data were then analysed using two different statistical methods; first by
intravariable differences using the test of proportion (Fisher's test) and then
all the variables together using logistic regression. RESULTS: At 3 months 78.8% 
of the renal units were clear of stone. All intravariable differences were
statistically significant except stone size (<1 cm, 1-2 cm). In a multivariate
analysis of all variables, only stone size was the most important predictor for
successful stone clearance (P = 0.03). CONCLUSIONS: ESWL is the initial treatment
of choice in selected patients with inferior calyceal stones. The stone size
appears to be the most important predictor for stone clearance.

Publication Types: 
    Evaluation Studies

PMID: 14764139 [PubMed - indexed for MEDLINE]

935: Urol Res. 2004 May;32(2):112-6. Epub 2004 Feb 3.

Kidney stone inhibitors in patients with renal stones and endemic renal tubular
acidosis in northeast Thailand.

Nakagawa Y, Carvalho M, Malasit P, Nimmannit S, Sritippaywan S, Vasuvattakul S,
Chutipongtanate S, Chaowagul V, Nilwarangkur S.

Kidney Stone Program, MC 5100, Division of Biological Sciences and the Pritzker
School of Medicine, University of Chicago, 5841 S. Maryland Ave., Chicago, IL
60637, USA. ynakagaw@medicine.bsd.uchicago.edu

Distal renal tubular acidosis (dRTA) is generally associated with hypercalciuria,
hypocitraturia, and nephrolithiasis. Our intention was to study
glycosaminoglycans (GAGS) and nephrocalcin (NC), two well-known crystal growth
inhibitors, in a population with endemic dRTA and nephrolithiasis in northeast
(NE) Thailand. We studied 13 patients, six with dRTA and seven with
nephrolithiasis with normal or undefined acidification function. Six healthy
adults living in the same area as the patients and another six from the Bangkok
(BKK) area were used as controls. We measured urinary pH, ammonia, calcium,
citrate, magnesium, oxalate, potassium, sodium and uric acid. GAGS were
determined by an Alcian blue precipitation method and were qualitated by agarose 
gel electrophoresis after being isolated using 5% cetyltrimethylammonium bromide 
at pH 6.0. NC isoforms were isolated as previously described by Nakagawa et al.
Citrate was higher in BKK controls ( p<0.04). There was a striking difference
among GAGS from BKK when compared with other groups (103.85+/-10.70 vs.
23.52+/-8.11 for dRTA, 22.36+/-14.98 for kidney stone patients and 14.73+/-2.87
mg/ml in controls from the NE region, ( p<0.0001). dRTA and stone-forming
patients excrete proportionally more (C+D) than (A+B) NC isoforms ( p<0.05).
Also, their NC showed a 100-fold weaker binding capacity of calcium oxalate
monohydrate crystals. The ratio of chondroitin sulfate/heparin sulfate in GAGS
was approximately 9/1. In addition to the traditional risk factors for
nephrolithiasis in dRTA, GAGS and NC might play an important role in the
pathogenesis of stone formation in this population.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 14758448 [PubMed - indexed for MEDLINE]

936: J Endourol. 2003 Dec;17(10):891-3.

Rapid communication: pure robot-assisted laparoscopic ureteral reimplantation for
ureteral stricture disease: case report.

Yohannes P, Chiou RK, Pelinkovic D.

Department of Surgery (Urology), Creighton University, 601 N. 30th Street, Suite 
3703, Omaha, NE 68131, USA. Pyohannes@hotmail.com

BACKGROUND AND PURPOSE: The role of the da Vinci robot is slowly being defined in
minimally invasive urologic surgery. We report its use in the management of
ureteral stricture disease. CASE REPORT: A 42-year-old man with recurrent kidney 
stone disease was found to have a left distal-ureteral stricture. After failure
of endoscopic treatment, a robot-assisted laparoscopic ureteral reimplantation
was performed. The total operative time was 210 minutes. The estimated blood loss
was <50 mL. There were no intraoperative or postoperative complications. Total
analgesic use was 30 mg of morphine. The hospital stay was 5 days. CONCLUSION:
Pure robot-assisted laparoscopic ureteral reimplantation is a safe and feasible
approach to the management of ureteral stricture disease.

Publication Types: 
    Case Reports

PMID: 14744356 [PubMed - indexed for MEDLINE]

937: J Endourol. 2003 Dec;17(10):875-9.

Nephrolithiasis associated with renal insufficiency: factors predicting outcome.

Kukreja R, Desai M, Patel SH, Desai MR.

Department of Urology, Muljibhai Patel Urological Hospital, Dr. V.V. Desai Road, 
Nadiad, Gujarat 387001, India.

BACKGROUND AND PURPOSE: Renal calculous disease may be associated with various
degrees of renal insufficiency secondary to a combination of obstruction, urinary
infection, frequent surgical intervention, and coexisting medical disease.
Herein, we present our data on the progression of renal function in patients with
stones associated with renal insufficiency and assess the significance of various
factors that could predict postoperative renal function deterioration. PATIENTS
AND METHODS: Data were obtained from 4400 patients undergoing treatment for
calculous disease at our institute since 1991. Renal insufficiency, defined as a 
baseline serum creatinine >1.5 mg/dL, was present in 84 (1.9%). Predictive
factors evaluated for renal function deterioration were preoperative (age,
duration of symptomatology and nephrolithiasis, urinary tract infection,
coexistent medical diseases, baseline serum creatinine, and stone burden),
intraoperative (number of percutaneous tracts), and postoperative (recurrent
infection, proteinuria, cortical atrophy, residual fragments, and stone
recurrence). RESULTS: Over a mean follow-up of 2.2 years (range 6 months-6
years), 33 patients (39.3%) showed improvement, 24 (28.6%) showed stabilization, 
and 27 (32.1%) showed deterioration in their renal function. Higher baseline
serum creatinine, proteinuria >300 mg/day, renal cortical atrophy, stone burden
>1500 mm(2), recurrent urinary infection, and age <15 years were significant
predictors of subsequent renal function deterioration. CONCLUSIONS: Patients with
nephrolithiasis and mild to moderate renal insufficiency warrant aggressive
treatment aimed at complete stone clearance and prevention of recurrence of
stones and urinary infection. A higher baseline preoperative serum creatinine,
proteinuria >300 mg/day on follow-up, renal cortical atrophy, stone burden >1500 
mm(2), recurrent urinary infection, and age <15 years are associated with a
significantly higher likelihood of renal function deterioration after treatment
of the calculous disease.

Publication Types: 
    Comparative Study

PMID: 14744353 [PubMed - indexed for MEDLINE]

938: J Endourol. 2003 Dec;17(10):835-9.

Is intravenous urography a prerequisite for renal shockwave lithotripsy?

Greenstein A, Beri A, Sofer M, Matzkin H.

Department of Urology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel
Aviv 64239, Israel. surge04@post.tau.ac.il

PURPOSE: To determine whether intravenous urography (IVU) is a prerequisite for
shockwave lithotripsy (SWL) of renal stones by addressing whether using
non-contrast-enhanced CT (NCCT) instead of IVU for delineating urinary tract
anatomy is associated with post-SWL complications. PATIENTS AND METHODS:
Thirty-eight patients treated by SWL (Econolith 2000) for radiopaque renal stones
underwent either IVU or NCCT. Twenty patients with normal urinary tracts or with 
mild hydronephrosis proximal to the stone on urography comprised the IVU group.
Eighteen patients who underwent NCCT and plain abdominal (KUB) films and had
urinary tract systems similar in appearance to the IVU group comprised the NCCT
group. The two groups were of similar mean age (45.75 years, range 24-73 years;
and 49.0 years, range 26-72 years, respectively) and had a similar mean stone
size (10.1-10.2 mm). Patients with internal ureteral or nephrostomy catheters
were excluded. Information on episodes of intractable renal colic, urinary tract 
infections, and hospitalization was recorded at follow-up 2 to 6 weeks post-SWL. 
RESULTS: The IVU and NCCT patients had similar mean stone fragmentation rates
(80% and 74%, respectively) at 2 to 6 weeks post-SWL. Four IVU patients (20%) had
intractable renal colic. One NCCT patient (5.5%) had a urinary infection.
Complication and hospitalization rates in the two groups were not significantly
different (P = 0.34; Fisher' exact test). CONCLUSIONS: Using only NCCT before SWL
was not associated with higher complication rates. Thus, IVU is not a
prerequisite for SWL of radiopaque renal stones in patients with a normal urinary
tract anatomy as seen on NCCT.

PMID: 14744344 [PubMed - indexed for MEDLINE]

939: J Wildl Dis. 2003 Oct;39(4):914-7.

Bilateral uric acid nephrolithiasis and ureteral hypertrophy in a free-ranging
river otter (Lontra canadensis).

Grove RA, Bildfell R, Henny CJ, Buhler DR.

USGS-Forest and Range Ecosystem Science Center, 3200 SW Jefferson Way, Corvallis,
Oregon 97331, USA. robert_grove@usgs.gov

We report the first case of uric acid nephrolithiasis in a free-ranging river
otter (Lontra canadensis). A 7 yr old male river otter collected from the Skagit 
River of western Washington (USA) had bilateral nephrolithiasis and severely
enlarged ureters (one of 305 examined [0.33%]). The uroliths were 97% uric acid
and 3% protein. Microscopic changes in the kidney were confined to expansion of
renal calyces, minor loss of medullary tissue, and multifocal atrophy of the
cortical tubules. No inflammation was observed in either kidney or the ureters.
The ureters were enlarged due to marked hypertrophy of smooth muscle plus
dilation of the lumen. Fusion of the major calyces into a single ureteral lumen
was several cm distal to that of two adult male otters used as histopathologic
control specimens. This case report is part of a large contaminant study of river
otters collected from Oregon and Washington. It is important to understand
diseases and lesions of the otter as part of our overall evaluation of this
population.

Publication Types: 
    Case Reports
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 14733290 [PubMed - indexed for MEDLINE]

940: Urol Int. 2004;72(1):76-8.

Percutaneous pneumatic and laser lithotripsy as a possible therapeutic strategy
for bilateral large calculi in a horseshoe kidney.

Seto C, Satoh K, Morishita H, Komatsu K, Namiki M.

Department of Urology, Kanazawa University School of Medicine, Kanazawa,
Ishikawa, Japan. chiseto@fd6.so-net.ne.jp

This report concerns a case of bilateral large calculi in a horseshoe kidney.
Three sessions of percutaneous nephrolithotripsy for the calculi successfully
disintegrated and removed the fragments without any complications. For complete
stone removal we used pneumatic and laser lithotriptors which were passed,
respectively, through a rigid nephroscope and a flexible pyeloscope. It is
emphasized that the selection of the most suitable lithotriptor by taking their
various features into account is important in endoscopic surgery for calculi
which are likely to recur such as stones accompanied by infection or for
anatomically anomalous kidneys such as horseshoe kidneys. Copyright 2004 S.
Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 14730171 [PubMed - indexed for MEDLINE]

941: AMIA Annu Symp Proc. 2003:850.

One size does not fit all: interpreting laboratory data in pediatric patients.

Gillespie RS, Johnson LC.

Department of Pediatrics, University of Washington, Seattle WA, USA.

Results of laboratory tests for kidney stone risk factors are reported based on
adult reference ranges and are not readily interpretable in children. We have
developed a solution which converts laboratory output to appropriate pediatric
patient-adjusted relative units, compares results using age-specific reference
ranges, and flags out-of-range values. The example presented demonstrates how
clinicians with technical skills can use existing computer resources to develop
effective solutions to problems they experience in clinical practice.

PMID: 14728355 [PubMed - indexed for MEDLINE]

942: Kidney Int. 2004 Feb;65(2):386-92.

The metabolic syndrome and uric acid nephrolithiasis: novel features of renal
manifestation of insulin resistance.

Abate N, Chandalia M, Cabo-Chan AV Jr, Moe OW, Sakhaee K.

Department of Internal Medicine, University of Texas Southwestern Medical Center,
Dallas, Texas 75390-9169, USA. Nicola.Abate@UTSouthwestern.edu

BACKGROUND: Uric acid nephrolithiasis primarily results from low urinary pH,
which increases the concentration of the insoluble undissociated uric acid,
causing formation of both uric acid and mixed uric acid/calcium oxalate stones.
These patients have recently been described as exhibiting features of insulin
resistance. This study was designed to evaluate if insulin resistance is
associated with excessively low urinary pH in overtly healthy volunteers
(non-stone formers) and if insulin resistance may explain the excessively low
urinary pH in patients with uric acid nephrolithiasis. METHODS: Fifty-five
healthy volunteers (non stone-formers) with a large range of body mass index and 
13 patients with recurrent uric acid nephrolithiasis underwent hyperinsulinemic
euglycemic clamp, 24-hour urinary studies, and anthropometric measurements of
adiposity. A subgroup of 35 non-stone formers had 2-hour timed urinary collection
before and during the hyperinsulinemic phase of the clamp studies. RESULTS: For
the non-stone former population, low insulin sensitivity measured as glucose
disposal rate significantly correlated with low 24-hour urinary pH (r= 0. 35; P= 
0.01). In addition to the previously described acidic urine pH and
hypouricosuria, patients with recurrent uric acid nephrolithiasis were found to
be severely insulin resistant (glucose disposal rate: uric acid stone-formers vs.
normals; 4.1 +/- 1.3 vs. 6.9 +/- 2.1 mg/min/kg of lean body mass, P= 0.008).
Acute hyperinsulinemia was associated with higher urinary pH (6.1 +/- 0.7 at
baseline to 6.8 +/- 0.7 during hyperinsulinemia; P < 0.0001), urinary ammonia
excretion (2.7 +/- 1.6 mEq/2 hr at baseline and 4.0 +/- 2.6 mEq/2 hr P= 0.002)
and urinary citrate excretion (48 +/- 33 mg/2 hr at baseline and 113 +/- 68 mg/2 
hr P < 0.0001). CONCLUSION: We conclude that one renal manifestation of insulin
resistance may be low urinary ammonium and pH. This defect can result in
increased risk of uric acid precipitation despite normouricosuria.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 14717908 [PubMed - indexed for MEDLINE]

943: Indian J Cancer. 2003 Jul-Sep;40(3):108-12.

Stones associated renal pelvic malignancies.

Raghavendran M, Rastogi A, Dubey D, Chaudhary H, Kumar A, Srivastava A, Mandhani 
A, Krishnani N, Kapoor R.

Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate
Institute of Medical Sciences, Rae Bareli Road, Lucknow - 226 014, India.

BACKGROUND: The clinico-pathological characteristics of renal pelvic malignancies
associated with stones were retrospectively analyzed. AIMS: The main objective
was to define the biological behavior and prognostic factors for these
malignancies. SETTINGS & DESIGN: The tumors were classified according to the
pathological types. The clinical data, imaging features and pathological features
were analyzed with relation to prognosis. MATERIAL AND METHODS: Eighteen cases of
malignancies associated with stone disease were retrospectively studied. The
institute review board permitted the study. RESULTS: High incidence (15/18) of
squamous cell carcinoma (SCC) was noted. The prognosis in this group of patients 
was uniformly poor. The median survival time was 3.6 months in the SCC group, 7.5
months in the Transitional Cell Carcinoma (TCC) group and 24 months in the
Adenocarcinoma (AC) group. Infectious and systemic symptoms were noted in the
majority of the patients. Preoperative Imaging techniques revealed tumor in only 
2 cases. Both underwent radical extirpation and the median survival is 18 months 
till date. In the other 16 patients, where the initial diagnosis was made only on
histological analysis of incomplete nephrectomy specimens, the survival was 3.56 
months. All patients had prolonged history of staghorn stone disease with
associated non-functioning kidney. We found that the main prognostic factor was
the stage of the disease. CONCLUSIONS: Malignancies associated with stone disease
have insidious onset of clinical symptoms and need a high degree of suspicion to 
identify them pre-operatively. The grave prognosis associated with incomplete
excision makes it imperative to diagnose them earlier.

Publication Types: 
    Clinical Trial

PMID: 14716114 [PubMed - indexed for MEDLINE]

944: Tokai J Exp Clin Med. 2003 Jul;28(2):65-70.

Urinary citrate in kidney stone disease.

Usui Y, Matsuzaki S, Matsushita K, Shima M.

Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa,
Japan.

BACKGROUNDS: Hypocitraturia, or low urinary citrate excretion is known as a risk 
for nephrolithiasis. Though urinary citrate excretion is basically determined by 
acid-base balance, metabolic acidosis is not always manifest in urinary stone
patients with hypocitraturia. From our stone clinic data, we estimated the
incidence of hypocitraturia and addressed its causes in the absence of obvious
acid-base imbalance. METHODS: We selected 310 stone patients in whom 24-hour
urine chemistry was examined on regular diets on 2 or more occasions during
follow-up. Totally, 1361 specimens were analyzed in them. RESULTS: In the male
subjects, the average urinary citrate excretion was 450.9 +/- 284.4 mg/ day,
whereas in the female, 536.5 +/- 305.9 mg/day (p < 0.0001). Eventually,
hypocitraturia was found in 119 of the 310 patients (38.4 %). Of 222 with calcium
stones, 70 (31.5 %) had hypocitraturia. In 32 of those, potential causes of
hypocitraturia were identified, but in the rest, no apparent cause was found. In 
the latter, the net gastrointestinal alkali absorption was calculated from the
24-hour urine chemical data, and it was lower in those with hypocitraturia than
in the normal control (9.2 vs. 34.4). CONCLUSION: It was suggested that defective
gastrointestinal alkali absorption may be involved in hypocitraturia of calcium
stone patients.

PMID: 14714831 [PubMed - indexed for MEDLINE]

945: Spinal Cord. 2004 Jan;42(1):7-13.

Calculus anuria in a spina bifida patient, who had solitary functioning kidney
and recurrent renal calculi.

Vaidyanathan S, Soni BM, Wyndaele JJ, Buczynski AZ, Iwatsubo E, Stoehrer M,
Madersbacher H, Peschel R, Singh G, Watt JW, Hughes PL, Sett P.

Regional Spinal Injuries Centre, District General Hospital, Southport, UK.

STUDY DESIGN: Clinical case report with comments by colleagues from Austria,
Belgium, Germany, Japan, and Poland. OBJECTIVES: To discuss challenges in the
management of spinal bifida patients, who have marked kyphoscoliosis and no
vascular access. SETTING: Regional Spinal Injuries Centre, Southport, UK.
METHODS: A female patient, who was born with spina bifida, paraplegia and
solitary right kidney, had undergone ileal loop urinary diversion. Renal calculi 
were noted in 1986. Percutaneous nephrostolithotomy was performed in 1989 and
there was no residual stone fragment. However, she developed recurrence of
calculi in the lower pole of the right kidney in 1991. Intravenous urography,
performed in 1995, revealed right staghorn calculus and hydronephrosis. Chest
X-ray showed markedly restricted lung volume due to severe kyphoscoliosis. In
2000, she was declared unsuitable for anaesthesia due to a lack of venous access 
and a high likelihood of difficulty in weaning off the ventilator in the
postoperative period. In June 2002, she developed anuria (urine output=18 ml/24
h) due to ball-valve-type obstruction by a renal stone at the ureteropelvic
junction. Urea: 14.4 mmol/l; creatinine: 236 microl/l. Ultrasound showed right
hydronephrosis. Percutaneous nephrostomy was performed. RESULTS: Following relief
of urinary tract obstruction, there was postobstructive diuresis (3765 ml/24 h). 
However, the patient expired 19 days later due to progressive respiratory
failure. CONCLUSION: In this spina bifida patient, who had reached the age of 35 
years, severe kyphoscoliosis and lack of vascular access presented insurmountable
challenges to implement the desired surgical procedure for removal of stones from
a solitary kidney.

Publication Types: 
    Case Reports
    Clinical Conference

PMID: 14713938 [PubMed - indexed for MEDLINE]

946: J Urol. 2004 Feb;171(2 Pt 1):575-8.

Sealing percutaneous nephrolithotomy tracts with gelatin matrix hemostatic
sealant: initial clinical use.

Lee DI, Uribe C, Eichel L, Khonsari S, Basillote J, Park HK, Li CC, McDougall EM,
Clayman RV.

Department of Urology, University of California, Irvine, USA.

PURPOSE: Tubeless percutaneous nephrolithotomy (PCNL) has been performed at
several centers with good success. However, these cases have been carefully
selected with regard to short duration and smaller stone burden to prevent
complications associated with the loss of access to the collecting system. We
describe the use of gelatin matrix hemostatic sealant (FloSeal Baxter Medical,
Fremont, California) as an adjunct to tubeless percutaneous nephrolithotomy to
help preclude bleeding complications. MATERIALS AND METHODS: Two patients were
treated with PCNL through a single nephrostomy tract. At the satisfactory
conclusion of the cases the tract was occluded retrograde with an occlusion
balloon catheter and gelatin matrix hemostatic sealant was injected down the
nephrostomy tract. An indwelling stent and bladder catheter were placed following
which all guidewires were removed and skin sutures were placed. RESULTS: The
operative times were 75 and 180 minutes, respectively. Both patients had stable
postoperative hemoglobin and no evidence of bleeding or obstruction on
postoperative computerized tomography. CONCLUSIONS: Injection of gelatin matrix
hemostatic sealant into the nephrostomy tract may be of value in preventing
bleeding after PCNL. In this pilot experience it provided immediate and effective
hemostasis.

Publication Types: 
    Case Reports

PMID: 14713762 [PubMed - indexed for MEDLINE]

947: Int J Urol. 2004 Feb;11(2):119-21.

Renal silica calculi in an infant.

Nishizono T, Eta S, Enokida H, Nishiyama K, Kawahara M, Nakagawa M.

Department of Urology, Kagoshima University Faculty of Medicine, Kagoshima,
Japan.

We report on a rare case of urinary silica calculi in a 10-month-old boy. The boy
showed acute pyelonephritis with left hydronephrosis. Ultrasonography and
computed tomography revealed a calculus at the left ureteropelvic junction and
three additional calculi in the left renal pelvis. Because his acute
pyelonephritis was refractory to conventional chemotherapy, the patient underwent
successful left percutaneous nephrostomy followed by percutaneous
nephrolithotripsy for the renal calculi. All stones disappeared and his
postoperative course was uneventful. On infrared spectrophotometry, the
wavelength pattern of the stones exhibited two peaks at 1100 and 1650 cm(-1),
consistent with the determination that the calculi consisted of a mixture of
silicate (78%) and calcium oxalate (22%). We consider that the etiology of the
calculi in this child can be ascribed to the silicate-rich water used to dilute
milk. In Japan, 46 adult patients with urinary silicate calculi have been
reported in the literature; however, there is no report of the disease in an
infant in Japan.

Publication Types: 
    Case Reports

PMID: 14706018 [PubMed - indexed for MEDLINE]

948: Can J Urol. 2003 Dec;10(6):2051-5.

Safety and efficacy of extracorporeal shock wave lithotripsy in infants.

McLorie GA, Pugach J, Pode D, Denstedt J, Bagli D, Meretyk S, D'A Honey RJ,
Merguerian PA, Shapiro A, Khoury AE, Landau EH.

Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) in older children appears
to have comparable results when compared to adults, no study has focused on its
use in younger children. We reviewed our ESWL experience in children under age
3.5 years to evaluate its safety, and define optimal treatment parameters.
METHODS: We retrospectively reviewed consecutive medical and diagnostic imaging
records from three ESWL centers, pertaining to 34 children under 3.5 years of age
(36 renal units-RU). The children were from two distinct populations served
exclusively by the three centers. We analyzed patient presentation, etiology,
age, weight, stone size, preoperative interventions, energy settings, number of
shock waves, number of treatments, success (stone fragments < 2 mm), and
complications. We performed all forty-nine procedures under general anesthesia
and modified the Dornier MFL 5000 table and the Dornier HM3 gantry to improve
coupling and localizing of the calculi. RESULTS: In each population, we noted
similar presentations, etiologies, and treatment parameters. Patient age ranged
from 6 to 40 months (mean 23.4 months). Stone size ranged from 4 mm to 22 mm
diameter (average 13 mm). ESWL parameters included an average of 2210 shocks
(range 900-3400) at average of 20.9 kV (range 19 kV-25 kV). Preoperative ureteral
stent placement was not shown to be beneficial. Our one and multiple treatment
ESWL success rates were 66% and 86%, respectively. No major acute or long-term
complications occurred. CONCLUSIONS: We successfully performed ESWL using
treatment parameters similar to adults in 86% of children under 3.5 years without
major complications. Modifications of the positioning device improved coupling
and localization in smaller patients. Routine preoperative ureteral stenting for 
large stones is not recommended.

Publication Types: 
    Multicenter Study

PMID: 14704109 [PubMed - indexed for MEDLINE]

949: Anal Biochem. 2004 Jan 15;324(2):191-6.

Detection of protein Z in a renal calculus composed of calcium oxalate
monohydrate with the use of liquid chromatography-mass spectrometry/mass
spectrometry following two-dimensional polyacrylamide gel electrophoresis
separation.

Kaneko K, Yamanobe T, Nakagomi K, Mawatari K, Onoda M, Fujimori S.

Central Laboratory of Analytical Biochemistry, Teikyo University, Tokyo 173-8605,
Japan. kikaneko@pharm.teikyo-u.ac.jp

Protein Z, a vitamin K-dependent plasma protein, has been detected for the first 
time in a renal calculus along with osteopontin and prothrombin. The renal
calculus was obtained from a hyperuricemic patient. Following two-dimensional
polyacrylamide gel electrophoresis, the calculus was analyzed with the use of
liquid chromatography mass spectrometry (LC-MS). The spectrometer was equipped
with a nanoelectrospray interface and an ion trap. Four peptides were determined 
from a protein in the calculus through LC-MS/MS analysis. Tandem mass spectrum
database matching tools were used to identify the protein as protein Z. Authentic
protein Z was also analyzed using the same method, and all four peptides
determined in the calculus were similarly identified. Whereas protein Z has been 
reported to be one of the vitamin K-dependent calcium-binding proteins, its role 
has not been well established. The fact that protein Z exists in a renal calculus
composed of calcium oxalate will be beneficial in any future investigations into 
its role in the body.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14690682 [PubMed - indexed for MEDLINE]

950: BJU Int. 2004 Jan;93(1):120-3.

Metabolic risk factors in patients with renal stones in KwaZulu Natal: an
inter-racial study (Asian and Whites).

Abdel Goad EH, Bereczky ZB.

Department of Urology, Nelson R. Mandela School of Medicine, Durban, South
Africa. abdelgoad@hotmail.com

OBJECTIVE: To identify any differences between Whites and Indians in KwaZulu
Natal province, South Africa, in the metabolic risk factors which predispose them
to urinary stone formation. PATIENTS AND METHODS: Urinary stone disease is often 
a manifestation of an underlying metabolic disorder in most patients. Intrinsic
and extrinsic factors affect the susceptibility of an individual to develop
urinary stones. Although South African-born Indians and Whites in KwaZulu Natal
share some of the same extrinsic factors, diet and genetic factors differ between
the groups. In a study from April 1999 until April 2001, 140 patients were
included who had a radiological diagnosis of renal calculi; they were evaluated
metabolically using previously recommended methods. RESULTS: All the patients had
at least one identifiable metabolic risk factor; the prevalence of the common
metabolic risk factors was similar in the two groups. The prevalence of complete 
renal tubular acidosis (type 1) was significantly higher in the Indian patients. 
The most common metabolic abnormalities were hypomagnesuria and hypocitraturia,
followed by low urinary volume. Hypercalciuria was not significant in this
population. While Indians had lower urine volumes than Whites, Whites had
significantly higher urinary calcium excretion than Indians. CONCLUSION: There
were a few variations in the metabolic risk factors between Indians and Whites,
and the differences could be attributed to genetic or dietary habits. The high
incidence of renal tubular acidosis in Indian patients could explain the higher
prevalence of urinary stone disease in this group than in other racial groups.

PMID: 14678382 [PubMed - indexed for MEDLINE]

951: Scand J Urol Nephrol. 2003;37(6):482-6.

Recurrence of renal lithiasis.

Grases F, Costa-Bauzá A, Ramis M, Montesinos V, Conte A.

Laboratory of Renal Lithiasis Research, Faculty of Sciences, University of
Balearic Islands, Palma de Mallorca, Spain. fgrases@uib.es

OBJECTIVE: It is well known that all renal stones are associated with a high
recurrence rate. The aim of this paper is to study the different types of renal
calculi recurrence. MATERIAL AND METHODS: The study included 220 patients who had
produced two or more renal calculi over a period of <5 years (total 634 calculi).
The procedure used to study renal calculi involved appropriate combinations of
stereoscopic microscopy with infrared spectrometry and scanning electron
microscopy coupled with X-ray microanalysis. RESULTS AND CONCLUSION: Recurrent
stone-formers can be classified into two large groups: those who always produce
the same type of calculus (the most common type of recurrence was calcium oxalate
dihydrate, followed by calcium oxalate monohydrate non-papillary and calcium
oxalate monohydrate papillary calculi); and those who produce different types of 
renal calculi (the most frequent recurrences in this group were the changes
calcium oxalate dihydrate-->calcium oxalate dihydrate/hydroxyapatite and calcium 
oxalate monohydrate-->calcium oxalate dihydrate).

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 14675921 [PubMed - indexed for MEDLINE]

952: Scand J Urol Nephrol. 2003;37(6):477-81.

Percutaneous nephrolithotomy for pediatric stone disease--our experience with
adult-sized equipment.

Gunes A, Yahya Ugras M, Yilmaz U, Baydinc C, Soylu A.

Department of Urology, Medical Faculty, Inönü University, Malatya, Turkey.
gunesali@yahoo.com

OBJECTIVE: We evaluated the outcomes and complications of percutaneous
nephrolithotomy (PNL) operations performed in pediatric patients using
adult-sized surgical equipment at our center. MATERIAL AND METHODS: The medical
and surgical records of 23 children who underwent a total of 25 PNL operations
using 24 or 26 F rigid nephroscopes were evaluated retrospectively. The following
aspects were considered: stone burden; duration of surgery and complications;
details concerning recovery, success, residual fragments and auxiliary
procedures; and follow-up details. RESULTS: The success rate of a single PNL
session was 70.8%; with the use of auxiliary procedures this was increased to
91.6%. Perioperative and early postoperative complications were excessive
bleeding and transfusion in two patients, hydro-pneumothorax in one, perforation 
of the collecting system in three and urinoma in one. Complications were more
common in children aged <7 years or with staghorn stones. The mean time to
catheter removal was 3.4 days and the mean hospitalization time was 4.8 days.
Idiopathic hypercalciuria, hypocitraturia, cystinuria and hyperoxaluria were
diagnosed in two, two, one and three patients, respectively. CONCLUSION:
Performing PNL with adult-sized equipment is associated with significant
complications in children aged <7 years or with staghorn stones. This treatment
should not be considered in routine clinical practice. As all stone-removal
methods are associated with complications, PNL should be used only if other
methods fail or are unavailable.

PMID: 14675920 [PubMed - indexed for MEDLINE]

953: Pediatr Nephrol. 2004 Feb;19(2):244-6. Epub 2003 Dec 11.

Nephrolithiasis in a child with glucose-galactose malabsorption.

Tasic V, Slaveska N, Blau N, Santer R.

Department of Pediatric Nephrology, University Children's Hospital, 17
Vodnjanska, 1000 Skopje, Macedonia. vtasic@freemail.com.mk

Glucose-galactose malabsorption (GGM) is a rare autosomal recessive disorder of
intestinal transport of glucose and galactose, leading to watery diarrhea,
dehydration, failure to thrive, or early death. We report a female newborn with
GGM, whose clinical diagnosis was confirmed by mutational analysis of the SGTL1
gene. Bilateral nephrolithiasis was discovered after an episode of hematuria.
Metabolic causes of nephrolithiasis were not found. The most likely explanation
for the development of nephrolithiasis is chronic diarrhea leading to dehydration
and highly concentrated urine. High fluid intake and rigorous prevention of
dehydration is therefore advised for these patients. Furthermore, life-long
monitoring of their renal status, including regular ultrasound examinations, is
warranted.

Publication Types: 
    Case Reports

PMID: 14673631 [PubMed - indexed for MEDLINE]

954: J Urol. 2004 Jan;171(1):85-8.

Outcome of metabolic evaluation and medical treatment for calcium nephrolithiasis
in a private urological practice.

Mardis HK, Parks JH, Muller G, Ganzel K, Coe FL.

Urology Center, PC, Omaha, Nebraska, USA.

PURPOSE: We determine if medications that have been proven effective for kidney
stone prevention in prospective controlled trials can reduce kidney stone
recurrence in a private practice of urology better than life-style advice,
including hydration. MATERIALS AND METHODS: Between July 1, 1995 and December 31,
1996, 203 patients with stones received care from 1 private practice. Physicians 
chose to evaluate these patients metabolically based on clinical judgement.
Thiazide, potassium citrate and allopurinol are recognized in this study as
active treatments, and drug treatment intervals were calculated. Relapse and
recurrent stones were counted as those stones manifesting after the initial index
event. A stone was called a relapse stone if its date was included in the active 
treatment interval. RESULTS: The association between use of active therapy and
ordering of metabolic evaluation was highly significant. Using survival tables,
we separately considered all patients and only those who had formed more than 1
stone. For both populations active treatment reduced stone recurrence
significantly more than diet advice and hydration. CONCLUSIONS: Medications
validated in trials and guided by metabolic evaluation lower stone recurrence
when used in a private practice setting as they do in trials.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 14665850 [PubMed - indexed for MEDLINE]

955: J Urol. 2004 Jan;171(1):58-60.

Comment in:
    J Urol. 2004 Jan;171(1):61-2.

Ex vivo ureteroscopic treatment of calculi in donor kidneys at renal
transplantation.

Rashid MG, Konnak JW, Wolf JS Jr, Punch JD, Magee JC, Arenas JD, Faerber GJ.

Department of Urology, University of Michigan Medical Center, Ann Arbor, 48109,
USA.

PURPOSE: We evaluated the safety and efficacy of ex vivo ureteroscopy (ExURS) as 
a means of rendering the donated kidney stone-free at live donor renal
transplantation. MATERIALS AND METHODS: A total of 10 suitable kidney donors with
small, unilateral nonobstructive calculi underwent live donor nephrectomy (8 open
flank, 2 hand assisted transperitoneal). Immediately after cold perfusion, ExURS 
was performed in an iced saline solution. Access to the collecting system was via
the ureteral stump. Calculi were either removed with endoscopic baskets and/or
completely fragmented with Holmium laser lithotripsy. RESULTS: Access to the
renal collecting system was technically successful in all cases. A total of 10
stones, ranging in largest diameter from 1 to 8 mm (average 5.2) were visualized.
Of the kidneys 6 had solitary stones, 2 had 2 stones and 1 had no stone. Of 10
stones 9 were successfully removed and/or fragmented with an average procedure
time of 6.5 minutes (range 3 to 28). Indwelling ureteral stents were placed at
transplantation in 5 of 10 kidneys. There were no intra-operative or
postoperative ureteral complications. At 1 month after transplant serum
creatinine ranged from 0.9 to 2.7 mg/dl (average 1.5). At a mean followup of 33.2
months new stones have not formed in any recipients and at mean 36.4-month
followup no new calculi have formed in the remaining kidney of any donors.
CONCLUSIONS: ExURS is a technically feasible means of rendering a stone bearing
kidney stone-free without compromising ureteral integrity or renal allograft
function.

PMID: 14665843 [PubMed - indexed for MEDLINE]

956: Urology. 2003 Dec;62(6):1123-8.

Lipid peroxidation and its correlations with urinary levels of oxalate, citric
acid, and osteopontin in patients with renal calcium oxalate stones.

Huang HS, Ma MC, Chen CF, Chen J.

Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.

OBJECTIVES: To determine whether lipid peroxidation plays a role in patients with
calcium oxalate kidney stones and to determine the correlation of lipid
peroxidation with tubular damage and the major urinary risk factors. We also used
the isoenzymes of glutathione S-transferase (GST) to examine which parts of the
renal tubules were injured in patients with renal stones. METHODS: This clinical 
study included two study groups. Group 1 included 32 normal volunteers, and group
2 included 32 patients with calcium oxalate kidney stones. A 24-hour urine sample
was collected from each subject, and the levels of Ca, P, Mg, oxalate, citrate,
N-acetyl-beta-glucosaminidase (NAG), beta-galactosidase (GAL), alphaGST, piGST,
osteopontin (OPN), thiobarbituric acid-reactive substances (TBARS), and
malondialdehyde (MDA) were examined. RESULTS: Hyperoxaluria, hypocitraturia, and 
low urinary OPN were the major abnormalities found in the patients with stones.
Elevated urinary alphaGST, NAG, and GAL were also noted in the patients with
stones; however, urinary piGST showed no statistically significant difference
compared with the controls. Urinary TBARS and MDA had statistically significant
correlations with alphaGST, GAL, NAG, Ca, and oxalate, but had no correlation
with piGST, citrate, OPN, Mg, and P. Urinary citrate had a negative, linear, and 
statistically significant correlation with alphaGST, GAL, and NAG. CONCLUSIONS:
Lipid peroxidation correlated with hyperoxaluria and renal tubular damage,
indicating that hyperoxaluria can induce tubular cell injury and that this injury
may be due to the production of free radicals in patients with calcium oxalate
stones. Renal tubular damage in patients with stones may be limited to the
proximal tubules.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 14665375 [PubMed - indexed for MEDLINE]

957: Best Pract Res Clin Gastroenterol. 2003 Dec;17(6):907-29.

Hepatobiliary, renal and bone complications of intestinal failure.

Nightingale JM.

Digestive Disease Centre, Leicester Royal Infirmary, Windsor Building, Leicester,
LE1 5WW, UK. jeremy.nightingale@uhl-tr.nhs.uk

Abnormal liver function tests in patients with intestinal failure (IF) may be due
to the underlying disease, IF or the treatments given (including parenteral
nutrition (PN)). PN-related liver disease in children usually relates to
intrahepatic cholestasis and in adults to steatosis. Steatosis may be consequent 
upon an excess of carbohydrate, lipid or protein, or upon a deficiency of a
specific molecule. Pigment-type gallstones are common in adults and children with
IF; these develop from biliary sludge that forms during periods of gallbladder
stasis. Ileal disease/resection, parenteral nutrition, surgery, rapid weight loss
and drugs all increase the risk of developing gallstones. Gallstone formation may
be prevented by reducing gallbladder stasis (oral/enteral feeding or prokinetic
agents), altering bile composition, or by means of a prophylactic
cholecystectomy. Calcium oxalate renal stones are common in patients with a short
bowel and retained functioning colon and are consequent upon increased absorption
of dietary oxalate; they are prevented by a low-oxalate diet. An osteopathy may
occur with long-term parenteral nutrition.

Publication Types: 
    Review

PMID: 14642857 [PubMed - indexed for MEDLINE]

958: Urol Int. 2003;71(4):350-4.

Outcome and safety of extracorporeal shock wave lithotripsy as first-line therapy
of lower pole nephrolithiasis.

Riedler I, Trummer H, Hebel P, Hubmer G.

Department of Urology, University of Graz Medical School, Graz, Austria.
ildiko.reider@kfunigraz.ac.at

INTRODUCTION: The aim of this study is to assess the efficiency of extracorporeal
shock wave lithotripsy (ESWL) as initial therapy for isolated lower pole kidney
stones smaller than 20 mm. PATIENTS AND METHODS: During a 24-month period 116
patients with previously untreated single stones under 20 mm in diameter were
treated with a Dornier lithotripter S. They were analyzed with regard to stone
site and size, number of ESWL sessions, auxiliary measures, retreatment rates,
complications and the time taken for stone clearance. RESULTS: 76 patients
(65.5%) became stone free, 50 of them (43.1%) within 3 months after ESWL.
Depending on stone size the stone-free rates were 67.1% for patients with a stone
diameter of <10 mm (59 of 88 patients), and 60.7% for stone diameters between 10 
and 20 mm (17 of 28 patients). Complications during and after treatment were
rare, i.e. the necessity of ureteral stent insertion due to colic (n = 10),
endoscopic stone removal (n = 2), acute pyelonephritis (n = 1), stonestreet (n = 
1) and 1 case of hematoma not requiring intervention. The recurrence rate during 
follow-up (13.2-36.9, mean 25.0 months) was low: 16 patients (13.8%) had
recurrent or persistent stones, and 74 patients (63.8%) had no evidence of
urolithiasis. CONCLUSIONS: ESWL is a safe and efficient first-line therapy for
treatment of isolated small lower pole kidney stones with acceptable stone-free
rates, low morbidity, few complications and a low stone recurrence rate.
Copyright 2003 S. Karger AG, Basel

Publication Types: 
    Clinical Trial

PMID: 14646431 [PubMed - indexed for MEDLINE]

959: J Cell Biochem. 2003 Dec 15;90(6):1261-75.

Concentration of a potent calcium oxalate monohydrate crystal growth inhibitor in
the urine of normal persons and kidney stone patients by ELISA-based assay system
employing monoclonal antibodies.

Moghadam MF, Tandon C, Aggarwal S, Singla SK, Singh SK, Sharma SK, Varshney GC,
Jethi RK.

Department of Biochemistry, Panjab University, Chandigarh-160014, India.

Standardized calcium oxalate monohydrate (COM) crystal growth assay system was
employed to study the ability of various test samples to influence growth rates
of COM crystals. The inhibitory activity (IA) of various samples was expressed in
terms of inhibitory units. Urine samples obtained from normal persons and kidney 
stone patients were found to have IA of 3.18 +/- 0.62 and 1.02 +/- 0.08,
respectively. A potent inhibitor having molecular weight between 14.2 and 16.2
kDa was found to be primarily responsible for the differences observed in the
urinary IAs between normal persons and kidney stone patients. The potent
inhibitor was found to be tightly associated with a chromophore resembling
Urobilirubin. An ELISA based assay system, using monoclonal antibodies against
the above most potent inhibitor confirmed the difference observed in the urinary 
IA between the normal persons and kidney stone patients. This assay system has
the potential to be routinely used to screen human beings for potential stone
formers. Copyright 2003 Wiley-Liss, Inc.

PMID: 14635198 [PubMed - indexed for MEDLINE]

960: J Urol. 2003 Dec;170(6 Pt 1):2198-201.

Retrograde intrarenal lithotripsy outcome after failure of shock wave
lithotripsy.

Stav K, Cooper A, Zisman A, Leibovici D, Lindner A, Siegel YI.

Department of Urology, Assaf Harofeh Medical Center affiliated with Sackler
Faculty of Medicine, Tel Aviv University, Zerifin, Israel.

PURPOSE: We report our experience with retrograde intrarenal lithotripsy (RIRL)
for renal stones not alleviated by shock wave lithotripsy (SWL). MATERIALS AND
METHODS: A total of 28 females and 53 males with a mean age of 53 years (range 18
to 86) were studied. They had been treated with a mean of 3.2 previous SWLs. Mean
stone size was 9.2 mm (range 4 to 22) and the mean number of stones per patient
was 1.27 (range 1 to 5) for a total of 103 stones overall. In 70 patients there
was 1 stone. Rigid and flexible ureteroscopes were used in 8 and 67 cases,
respectively, while a combined approach was used in 6. A holmium:YAG laser was
used for fragmentation in 52 patients. Success was defined as stone-free status
or residual fragments less than 3 mm. RESULTS: The overall success rate was 67%. 
RIRL yielded a 46% stone-free rate. Of the 44 patients 17 (39%) had residual
stones less than 3 mm, while 13 required ancillary procedures. There were no
residual ureteral stones. Original stone size correlated inversely with the
success rate. Most failures involved lower pole stones, in that laser fiber
deflection prevented reaching them in 9 cases. The procedure was interrupted due 
to extravasation or bleeding in 5 patients and 6 had postoperative urinary tract 
infections (16% overall complication rate). CONCLUSIONS: RIRL effectively and
safely alleviated upper tract stones unresponsive to earlier SWL. It can be
considered salvage therapy in such cases. RIRL is well suited for treating stones
less than 2 cm with better stone-free rates than SWL in the same circumstances.
Residual stones were more likely in lower pole cases.

PMID: 14634378 [PubMed - indexed for MEDLINE]

961: J Urol. 2003 Dec;170(6 Pt 1):2186-9.

Endoscopic renal papillary biopsies: a tissue retrieval technique for
histological studies in patients with nephrolithiasis.

Kuo RL, Lingeman JE, Evan AP, Paterson RF, Bledsoe SB, Kim SC, Munch LC, Coe FL.

Methodist Hospital Institute for Kidney Stone Disease and Indiana University
School of Medicine, Indianapolis, USA.

PURPOSE: The mechanisms behind calcium nephrolithiasis remain unclear. Previous
research has relied on animal models or cell lines, yielding limited insight into
the pathophysiology of human calcium stone disease. To determine changes
occurring in the human kidney during active stone disease we used an endoscopic
renal papillary biopsy protocol in calcium stone formers undergoing percutaneous 
nephrolithotomy. MATERIALS AND METHODS: Following stone burden clearance via
percutaneous nephrolithotomy 15 idiopathic calcium oxalate and 4 ileal bypass
stone formers underwent flexible and rigid nephroscopy. Biopsies from select
papillae in the peripheral and interpolar regions were obtained with 5Fr flexible
cup biopsy forceps. A papilla adjacent to the accessed calix was biopsied with
10Fr cup biopsy forceps. Cortical biopsies along the access tract were also
obtained with the 10Fr forceps. RESULTS: All patients had successful biopsy
completion. No complications were attributable to the biopsy process and no blood
transfusions were required. Of the 19 patients 12 were contacted for followup at 
a mean of 21.7 +/- 9.0 months with none experiencing adverse sequelae such as
bleeding or significant pain. A total of 14 patients had followup serum
creatinine available showing that the difference in mean preoperative and
postoperative values was not clinically significant (1.00 +/- 0.27 and 1.11 +/-
0.27 mg/dl, respectively). The quality of biopsied tissue permitted accurate
immunohistochemical staining of crystal deposits and mineral analysis.
CONCLUSIONS: Endoscopic papillary biopsies were performed safely in a small
patient population. Tissue obtained using this protocol can be used for detailed 
histological and analytical studies, which may lead to significant advances in
our understanding of stone formation mechanisms.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14634375 [PubMed - indexed for MEDLINE]

962: Kidney Int. 2003 Dec;64(6):2204-13.

Causes and consequences of kidney loss in patients with nephrolithiasis.

Worcester E, Parks JH, Josephson MA, Thisted RA, Coe FL.

Departments of Medicine and Health Studies, University of Chicago, Chicago,
Illinois, USA.

BACKGROUND: It is unknown whether stone formers may safely donate a kidney.
Nephrectomy could accelerate stone formation, or loss of filtration with age. We 
contrast, here, the course of stone patients with two versus one kidney. METHODS:
One hundred fifteen patients with a single functioning kidney were compared with 
3151 patients with two kidneys. Cause of kidney loss was determined, along with
stone types, rates of stone formation, urine stone risk factors, and creatinine
clearance. RESULTS: Women were 49.6% of the patients with kidney loss, compared
to 33.6% of ordinary stone formers. Obstruction, stone burden, and infection were
the most common reasons for kidney loss. We found an increased number of struvite
and calcium phosphate stones among single kidney patients. Before and during
treatment, single kidney patients had fewer stones than ordinary stone formers.
Creatinine clearance was lower in the single kidney patients; rate of loss of
kidney function with age was higher among single kidney males versus two kidney
males if all patients are considered. Among males >age 45 years, the difference
disappears. Females with one and two kidneys lost function with age at equivalent
rates. Compared with nonstone formers, male stone formers lose kidney function
with age at an accelerated rate. CONCLUSION: Nephrectomy does not worsen stone
disease. It may increase loss of renal function among younger males. The pattern 
of renal function loss with age differs between stone formers and nonstone
formers.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 14633144 [PubMed - indexed for MEDLINE]

963: Kidney Int. 2003 Dec;64(6):2150-4.

Urine calcium and volume predict coverage of renal papilla by Randall's plaque.

Kuo RL, Lingeman JE, Evan AP, Paterson RF, Parks JH, Bledsoe SB, Munch LC, Coe
FL.

The Methodist Hospital Institute for Kidney Stone Disease and Indiana University 
School of Medicine, Indianapolis, Indiana, USA.

BACKGROUND: Renal papillary plaques are common in calcium stone formers. We
hypothesized that plaque should increase directly with urine calcium excretion,
and inversely with urine volume. To test this, we measured papillary plaque areas
in both idiopathic calcium oxalate stone formers and nonstone formers and
examined 24-hour urine data to identify significant correlations. METHODS:
Fourteen stone formers and four nonstone forming controls underwent papillary
mapping with flexible nephroscopy. For each papillum, representative still images
and moving pictures expert group (MPEG) movies were used to identify plaque
extent and papillary borders. The mean fractional plaque coverage for each polar 
region (upper, inter, lower) and per papillum was calculated. The relationship of
the plaque coverage data to urine measurements was assessed with general
multivariate linear modeling. RESULTS: Mean polar fractional plaque coverage was 
higher in the calcium oxalate stone formers (7.4% vs. 0.5%, P= 0.012) as was mean
fractional plaque per papillum (7.6% vs. 0.6%, P= 0.011). When correlating mean
polar plaque coverage to urine data, urine volume and calcium excretion were the 
only measurements with independent relationships to plaque (P= 0.002, adjusted
multiple R2= 0.521), with higher calcium and lower volume increasing coverage.
The same relationships hold for mean plaque per papillum, except that urine pH
also becomes an independent factor (P= 0.001, adjusted multiple R2= 0.606).
CONCLUSION: Utilizing advanced digital video and endoscopic equipment, we have
achieved the most accurate estimation of papillary plaque coverage to date. Our
findings support the idea that urine volume and calcium are the main correlates
of plaque coverage.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14633137 [PubMed - indexed for MEDLINE]

964: Kidney Int. 2003 Dec;64(6):2142-9.

Comment in:
    Kidney Int. 2004 May;65(5):1970; author reply 1970.

Effect of high protein diet on stone-forming propensity and bone loss in rats.

Amanzadeh J, Gitomer WL, Zerwekh JE, Preisig PA, Moe OW, Pak CY, Levi M.

Center for Mineral Metabolism and Clinical Research and Department of Internal
Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
75390-8885, USA.

BACKGROUND: High protein diets are believed to cause kidney stone formation and
bone loss, but the mechanisms mediating these changes are unknown. The purpose of
this study was to create an animal model of animal protein excess and to evaluate
the response of kidney and bone to the dietary protein load. METHODS: Rats (12
per group) were pair-fed with a high (48%) and low (12%) casein diets that were
otherwise identical in their content of sodium, potassium, calcium, phosphorus,
and magnesium. RESULTS: Compared with the low casein group, the high casein group
delivered a substantial acid load during 59 days of study, since it significantly
decreased urinary pH, and increased urinary ammonium, titratable acidity, and net
acid excretion. Animals on high casein diet also had higher urinary volumes. On
the high casein diet, urinary calcium excretion was significantly higher and
urinary citrate excretion and concentration was significantly lower. On the high 
casein diet, urinary saturation of calcium phosphate was higher. Serum calcitriol
concentration did not significantly differ between the two groups.
Histomorphometric analysis of femur procured after 59 days on the diet showed
marked increase in bone resorption in the high casein group. Hypocitraturia was
associated with increased activity of sodium-citrate cotransporter in renal
cortical brush-border membranes (BBM) in the high casein group. CONCLUSION: Both 
the kidney and bone contribute to the pathogenesis of hypercalciuria during high 
casein diet in rats. Hypocitraturia is probably renal in origin. This rat model
will be useful in elucidating the mechanisms by which high protein intake
increases the risk of nephrolithiasis and bone loss in human beings.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 14633136 [PubMed - indexed for MEDLINE]

965: Urol Res. 2004 Feb;32(1):61-8. Epub 2003 Nov 20.

Vitamin B6 metabolites in idiopathic calcium stone formers: no evidence for a
link to hyperoxaluria.

Kaelin A, Casez JP, Jaeger P.

Department of Nephrology, University Hospital, P.O. Box 69, 06002, Nice cedex 1, 
France.

Vitamin B6 metabolites and their potential correlates to urinary oxalate
excretion in idiopathic calcium stone formers (ICSF) compared with healthy
subjects were investigated. This clinical study was performed in a population of 
male ICSF with (Hyperoxalurics, n=55) or without hyperoxaluria (Normooxalurics,
n=57) as well as in 100 healthy male control subjects. Pyridoxal 5'-phosphate
serum concentration (S-pyridoxal 5'P) and 24-h urinary excretion of 4-pyridoxic
acid (U-4pyridoxic acid) were measured using HPLC; 24-h urinary excretion of
oxalate (U-oxalate) was measured concurrently. A subgroup of subjects (40
Hyperoxalurics, 15 Normooxalurics and 50 controls) underwent the same
measurements before and after 7-day pyridoxine loading per os (pyridoxine
hydrochloride, 300 mg/d). Under usual conditions, U-4pyridoxic acid was similar
in the three groups, whereas mean S-pyridoxal 5'P was significantly lower (
p<0.0001) in the Hyperoxalurics (59.6+/-21.2 nmol/L) and in the Normooxalurics
(64.9+/-19.7 nmol/L) than in the controls (86.0+/-31.0 nmol/L). No correlation
could be found between U-oxalate and U-4pyridoxic acid or S-pyridoxal 5'P. After 
B6 loading, S-pyridoxal 5'P was still significantly lower in the Hyperoxalurics
(415+/-180 nmol/L, p<0.001) and in the Normooxalurics (429+/-115 nmol/L, p=0.036)
than in the controls (546+/-180 nmol/L), although there was no difference between
groups for U-4pyridoxic acid. No correlation in any group could be found between 
changes in U-oxalate and changes in U-4pyridoxic acid or S-pyridoxal 5'P.
Although there is no vitamin B6 deficiency in ICSF with or without hyperoxaluria,
these patients, on average, have lower levels of S-pyridoxal 5'P than healthy
subjects. However, this slight decrease does not seem to account for idiopathic
hyperoxaluria.

PMID: 14628106 [PubMed - indexed for MEDLINE]

966: Int Urol Nephrol. 2003;35(1):73-6.

Evaluation of role of retroperitoneoscopic pyelolithotomy and its comparison with
percutaneous nephrolithotripsy.

Goel A, Hemal AK.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

OBJECTIVES: To evaluate the role of retroperitoneoscopic pyelolithotomy (RPPL)
for the management of renal pelvic calculus and its comparison with percutaneous 
nephrolithotripsy (PCNL). PATIENTS AND METHODS: Eighteen RPPLs were performed
between March 1995 and March 2002, and 16 out of these were compared
retrospectively with 12 cases of PCNL performed in the year 2000 for solitary
renal pelvic stone more than 3-cm in size. Laparoscopic pyelolithotomy was
carried out with retroperitoneal approach and subsequent to stone removal
pyelotomy was sutured with intracorporeal interrupted sutures. RESULTS: The two
groups were similar as regards the patient age and sex. The mean stone sizes in
RPPL and PCNL groups were 3.6 and 4.2 cm respectively (p < 0.006). There were 2
conversions in the RPPL group due to stone migration into calyx and dense
perirenal adhesions making dissection difficult. The mean operating time was
142.18 min for RPPL as compared to 71.6 min for PCNL (p < 0.000). The blood loss 
was 173.1 ml in RPPL as compared to 147.9 ml for PCNL (p NS). The mean hospital
stay was 3.8 and 3-days in RPPL and PCNL groups respectively. CONCLUSIONS:
Laparoscopic pyelolithotomy takes longer to perform, more invasive, less cosmetic
and requires more skills at present as compared to PCNL. In this limited study it
is clearly demonstrated that PCNL is the better treatment modality for renal
stones and laparoscopy should be offered to those who needs adjunctive procedure 
such as pyeloplasty or puncture during PCNL under vision.

Publication Types: 
    Comparative Study

PMID: 14620289 [PubMed - indexed for MEDLINE]

967: J Laparoendosc Adv Surg Tech A. 2003 Oct;13(5):317-9.

Residual air persists in the renal collecting system following percutaneous
nephrolithotomy.

Aldana JP, Lee BR, Lee WJ, El-Hakim A, Marcovich R, Smith AD.

Department of Urology, Albert Einstein College of Medicine, Long Island Jewish
Medical Center Campus, New Hyde Park, New York 11040, USA.

OBJECTIVES: To determine the presence or absence of air in the renal collecting
system 48 hours following percutaneous nephrolithotomy (PCNL). METHODS: The study
was based on a review of the records of the last 100 consecutive patients
undergoing PCNL for stone extraction. Two urologists and a uroradiologist
reviewed post-PCNL nephrostogram films and determined the presence or absence of 
air in the urinary tract. RESULTS: Nephrostography was routinely performed 48
hours after PCNL, and all films of the 100 patients were reviewed. Gas was
detected in 98 (98%) of the 100 cases that appeared as gas pyelograms outlining
the renal calyces. Of the 98 cases, 33 (34%) demonstrated gas in the upper calyx,
10 (10%) in the middle calyx, 12 (13%) in the lower calyx, and 43 (44%) in more
than one calyx. Gas was not detected in the renal parenchyma or perirenal areas. 
CONCLUSIONS: Gas is present within the renal collecting system 48 hours after a
percutaneous procedure. Prospective studies should be performed to document the
amount of time needed for complete resolution of gas from the collecting system.

PMID: 14617390 [PubMed - indexed for MEDLINE]

968: BJU Int. 2003 Nov;92(7):765-8.

Influence of cranberry juice on the urinary risk factors for calcium oxalate
kidney stone formation.

McHarg T, Rodgers A, Charlton K.

Department of Medicine, University of Cape Town, Cape Town, South Africa.

OBJECTIVE: To investigate the potential influence of cranberry juice on urinary
biochemical and physicochemical risk factors associated with the formation of
calcium oxalate kidney stones, as this product might affect the chemical
composition of urine. SUBJECTS AND METHODS: Urinary variables were assessed in a 
randomized cross-over trial in 20 South African men (students) with no previous
history of kidney stones. The first group of 10 subjects drank 500 mL of
cranberry juice diluted with 1500 mL tap water for 2 weeks, while the second
group drank 2000 mL of tap water for the same period. This was followed by a
2-week 'washout' period before the two groups crossed over. During the
experimental phase subjects kept a 3-day food diary to assess their dietary and
fluid intakes; 24-h urine samples were collected at baseline and on day 14 of the
trial periods, and analysed using modern laboratory techniques. Urine analysis
data were used to calculate the relative urinary supersaturations of calcium
oxalate, uric acid and calcium phosphate. Data were assessed statistically by
analysis of variance. RESULTS: The ingestion of cranberry juice significantly and
uniquely altered three key urinary risk factors. Oxalate and phosphate excretion 
decreased while citrate excretion increased. In addition, there was a decrease in
the relative supersaturation of calcium oxalate, which tended to be significantly
lower than that induced by water alone. CONCLUSION: Cranberry juice has
antilithogenic properties and, as such, deserves consideration as a conservative 
therapeutic protocol in managing calcium oxalate urolithiasis.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 14616463 [PubMed - indexed for MEDLINE]

969: Arch Dis Child. 2003 Nov;88(11):962-5.

Erratum in:
    Arch Dis Child. 2004 Aug;89(8):797.

Epidemiology of paediatric renal stone disease in the UK.

Coward RJ, Peters CJ, Duffy PG, Corry D, Kellett MJ, Choong S, van't Hoff WG.

Nephro-Urology Unit, Institute of Child Health, London, UK.
Richard.Coward@bristol.ac.uk

BACKGROUND: The previous epidemiological study of paediatric nephrolithiasis in
Britain was conducted more than 30 years ago. AIMS: To examine the presenting
features, predisposing factors, and treatment strategies used in paediatric
stones presenting to a British centre over the past five years. METHODS: A total 
of 121 children presented with a urinary tract renal stone, to one adult and one 
paediatric centre, over a five year period (1997-2001). All children were
reviewed in a dedicated stone clinic and had a full infective and metabolic stone
investigative work up. Treatment was assessed by retrospective hospital note
review. RESULTS: A metabolic abnormality was found in 44% of children, 30% were
classified as infective, and 26% idiopathic. Bilateral stones on presentation
occurred in 26% of the metabolic group compared to 12% in the
infective/idiopathic group (odds ratio 2.7, 95% CI 1.03 to 7.02). Coexisting
urinary tract infection was common (49%) in the metabolic group. Surgically,
minimally invasive techniques (lithotripsy, percutaneous nephrolithotomy, and
endoscopy) were used in 68% of patients. CONCLUSIONS: There has been a shift in
the epidemiology of paediatric renal stone disease in the UK over the past 30
years. Underlying metabolic causes are now the most common but can be masked by
coexisting urinary tract infection. Treatment has progressed, especially
surgically, with sophisticated minimally invasive techniques now employed. All
children with renal stones should have a metabolic screen.

Publication Types: 
    Multicenter Study

PMID: 14612355 [PubMed - indexed for MEDLINE]

970: J Postgrad Med. 2003 Jul-Sep;49(3):246-8.

Primary giant cell malignant fibrous histiocytoma of the kidney with staghorn
calculi.

Chen CH, Lee PS, Han WJ, Shen KH.

Division of Urology, Department of Surgery, Department of Pathology, Chi Mei
Medical Center, Tainan, Taiwan.

Malignant fibrous histiocytomas (MFH) as primary renal tumours are rare, with
less than 50 cases described in the literature. We report a case of primary renal
MFH of giant cell type in a 56-year-old man, who presented with bilateral dull
flank pain, intermittent gross haematuria and body weight loss (6 kg in 3
months). Intravenous urography, computerized tomography (CT) and magnetic
resonance image (MRI) showed right ureteral stones with mild hydronephrosis, and 
a solid mass at the lower pole of the left kidney associated with staghorn
calculi, as well as tumour thrombi in the left renal vein and inferior vena cava.
Left radical nephrectomy and evacuation of tumour thrombi from the left renal
vein and inferior vena cava were performed. Histopathologic examination revealed 
malignant fibrous histiocytoma (MFH) of giant cell type. To the best of our
knowledge, this is the first report of primary renal MFH associated with staghorn
calculi.

Publication Types: 
    Case Reports

PMID: 14597788 [PubMed - indexed for MEDLINE]

971: Scand J Urol Nephrol. 2003;37(5):408-12.

Effects of extracorporeal shock-wave lithotripsy on intrarenal resistive index.

Nazaroglu H, Akay AF, Bükte Y, Sahin H, Akkus Z, Bilici A.

Department of Radiology, Faculty of Medicine, Dicle University, TR-21280
Diyarbakir, Turkey. hnazarog@dicle.edu.tr

OBJECTIVE: This prospective study was performed to determine whether
extracorporeal shock-wave lithotripsy (ESWL), widely used for treating renal and 
ureteral stones, affects the kidney interlobar artery resistive index (RI).
MATERIAL AND METHODS: A total of 43 patients (30 with renal and 13 with ureteral 
stones) underwent color Doppler examination before and 30 min and 3 h after ESWL.
Seventeen patients with renal and nine with ureteral stones underwent Doppler
examination 2 weeks later. Measurements were made near the stones (nearby
region), at least 2 cm from the stones (remote region) and in the contralateral
kidney for renal stones, and in the ipsilateral and contralateral kidneys for
ureteral stones. RESULTS: In patients with renal stones, the RI was increased 30 
min and 3 h after ESWL in the nearby and remote regions, and more markedly in the
former. In the contralateral kidney, there was an increase in RI only at 3 h,
which was less than that in the ipsilateral kidney. The RI at 2 weeks post-ESWL
in the nearby region and contralateral kidney did not differ from the pre-ESWL
values. ESWL performed for ureteral stones caused no increase in RI in the
ipsilateral kidney. CONCLUSION: Patients with renal stones had a temporary
increase in RI in the hours following ESWL in both the ipsilateral and
contralateral kidneys, which was highest in the region near the stones and lowest
in the contralateral kidney. Two weeks later, the RI in both areas had returned
to pre-ESWL levels.

Publication Types: 
    Comparative Study

PMID: 14594690 [PubMed - indexed for MEDLINE]

972: Int Urol Nephrol. 2002-2003;34(4):457-61.

Extracorporeal shock wave lithotripsy for cystine urolithiasis in children:
outcome and complications.

Slavković A, Radovanović M, Sirić Z, Vlajković M, Stefanović V.

Clinic for Pediatric Surgery, Clinical Center, Nis, Yugoslavia.

The Siemens Lithostar Litotriptor was used to treat 6 children with cystine
nephrolithiasis, previously treated by open surgery. Five children had renal
calculi (3 multiple caliceal, 2 pelvis) and one had ureteral calculus. Stone size
ranged from 0.2-2.5 cm in diameter, and stone burden was from 0.24 to 10.81 cm3
per kidney. From one to 4 ESWL sessions per unit were applied, with a total of
1,800 to 12,000 shock waves. The stone free rate at 3 months was 50%. A complete 
elimination was obtained with cystine stones in renal pelvis and ureter, however,
up to 4 ESWL treatments failed in caliceal stones. Rather location of cystine
calculi than previous surgery was associated with ESWL success rate. Two patients
with positive urine cultures were successfully treated with appropriate
antibiotics before ESWL was attempted. Perirenal hematoma was major complication 
demonstrated by radionuclide scintigraphy in one patient, and resolved
spontaneously by 3 months. In the combined treatment of cystine urolithiasis in
children ESWL, as auxillary procedure, was safe and effective in pelvis stone but
failed in caliceal stones. Medical dissolution for retained fragments was found
effective.

PMID: 14577484 [PubMed - indexed for MEDLINE]

973: Urol Res. 2004 Feb;32(1):41-3. Epub 2003 Oct 24.

Occupational risk for nephrolithiasis and bladder dysfunction in a chauffeur.

Chang MA, Goldfarb DS.

North Medical Clinic, Module E, Bellevue Hospital, 462 First Ave., New York, NY
10016, USA.

The occupational risks for nephrolithiasis have not been widely studied. The
published literature focuses on exposure to heat stress and toxic substances, not
on the equally important behavioral risk factor of limited water consumption over
many years. Urologic morbidity has been associated with suppressing the need to
drink or void under restrictive work environments; however, no such studies link 
work related behavioral change with the development of kidney stones. This case
report is the first to associate a restrictive work environment with limited
fluid consumption, resulting in the development of nephrolithiasis.

Publication Types: 
    Case Reports

PMID: 14576963 [PubMed - indexed for MEDLINE]

974: Urol Res. 2003 Oct;31(5):347-51. Epub 2003 Sep 13.

Effects of shock wave lithotripsy on plasma and urinary levels of nitrite and
adrenomedullin.

Sarica K, Balat A, Erbagci A, Cekmen M, Yurekli M, Yagci F.

Departments of Urology and Pediatrics, Medical School, Sahinbey Medical Center,
University of Gaziantep, Gaziantep, Turkey. kemalsarica@superonline.com

PURPOSE: In this prospective clinical study, we aimed to determine whether
shockwave lithotripsy (SWL) has any specific effect on plasma as well as urinary 
nitrite, a stabile metabolite of nitric oxide (NO) and adrenomedullin (AM)
concentrations, and to investigate whether these variables can be used as a
marker for detecting shockwave-induced impairment of renal tubular and glomerular
cells. MATERIAL AND METHODS: A total of 20 patients with renal pelvic or caliceal
stones < or =2 cm undergoing anesthesia-free SWL without auxiliary measures and a
control group of ten patients without any urological symptoms were included in
this study. The plasma and urinary concentrations of nitrite and AM were measured
before, 24 h, and 7 days after SWL. Nitrite levels were measured by Griess
reaction. Reverse-phase high-performance liquid chromatography (HPLC) was used to
determine AM levels. RESULTS: Application of high-energy shock waves (HESW) in
our study caused a statistically significant increase in plasma levels of both NO
and AM, which reflected an organized response of the kidney to this type of
trauma in an attempt to maintain normal renal hemodynamics. Mean plasma nitrite
concentration before SWL application was 29.9+/-7.6 micromol/l and this value was
found to be 39.02+/-8.45 micromol/l at 24-h follow-up. Comparative evaluation of 
the plasma concentrations of AM revealed a significant increase at the 24-h
examination: 20.51+/-3.0 pmol/ml and 32.54+/-4.3 pmol/l, respectively. On the
other hand, comparative evaluation of urinary levels of both nitrite and AM
levels before as well as 24 h after SWL application revealed a statistically
significant increase related to markers. CONCLUSION: This first clinical study on
plasma-urinary nitrite and AM levels in patients undergoing the SWL procedure
indicated that plasma and urine levels of both peptides were increased. Our
findings in turn suggested that SWL application to kidney can stimulate the
NO-cGMP signalling pathway to increase NO production in the kidney. Our findings 
also indicated that the increased levels of NO and AM secretion during renal
parenchymal ischemia may be protective enough for renal pathological alterations 
resulting from SWL-induced renal trauma. We suggest that this increase may be a
compensatory response to SWL induced injury.

Publication Types: 
    Comparative Study

PMID: 14574541 [PubMed - indexed for MEDLINE]

975: Urol Res. 2004 Feb;32(1):55-60. Epub 2003 Oct 22.

A stone farm: development of a method for simultaneous production of multiple
calcium oxalate stones in vitro.

Chow K, Dixon J, Gilpin S, Kavanagh JP, Rao PN.

Department of Urology, Education and Research Centre, South Manchester University
Hospital, Wythenshawe, Southmoor Road, M23 9LT, Manchester, UK.

We have previously shown how individual calcium oxalate stones of about 1 cm can 
be grown in vitro. While this proved a design concept, it was severely limited as
an experimental tool because of the time required to undertake comparative
studies. Here we describe a development of this system in which six parallel
pairs of stone generators are supplied with feed solutions generating a medium
that is supersaturated with calcium oxalate. Twelve stones were grown
simultaneously in aseptically prepared artificial urine over a period of 32 days 
from 100 mg to about 250 mg. Flow rates, pH and [Ca(2+)] were stable and
reproducible over the course of the experiment. Sodium azide (0.02%) was included
in the growth medium of six stones and caused a modest decrease in growth rate
from 5.5 to 3.4 mg/day. The experimental design is such that this was readily
detectable both visually and statistically ( p<0.001). This multiple stone
growing system ("a stone farm") shows improved consistency and illustrates the
statistical power of the technique. Azide has only a minor effect on the growth
kinetics and can be used as an antibacterial agent in studies involving urinary
macromolecules. The technique is suitable for practical and meaningful
investigation of calcium oxalate stone formation in vitro.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 14574529 [PubMed - indexed for MEDLINE]

976: Med J Malaysia. 2002 Mar;57(1):108-10.

Day care percutaneous renal surgery--is this viable?

Chong WL, Murali S, Sahabudin RM, Khairullah A.

Institute of Urology, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur.

Pros and cons of Percutaneous Nephrolithotripsy (PCNL) versus Extracorporeal
Shockwave Lithotripsy (ESWL) have often been highlighted when one discusses on
the management of renal stones. An oft quoted point is that PCNL entails a
prolonged hospital stay whereas ESWL sessions are day surgical in nature.
However, PCNL has superior stone clearance rate as compared to ESWL especially
for lower pole stones. In addition, PCNL is more suitable for large bulk stones
and when ancillary procedures are required e.g. endopyelotomy. The first 50 cases
of successful tubeless PCNL were reported by Bellman et al in 1997. The
remarkable recovery of patients in their series encouraged them to employ this
technique as their technique of choice for the majority of their cases. A similar
technique was employed on endopyelotomy by Liang et al and they concluded that
this was a safe, less morbid and effective technique. We report our first case of
tubeless PCNL.

Publication Types: 
    Case Reports

PMID: 14569727 [PubMed - indexed for MEDLINE]

977: J Endourol. 2003 Sep;17(7):501-3.

Management of lower-pole caliceal stones.

Gerber GS.

Division of Urology, University of Chicago Medical School, Chicago, Illinois
60637, USA. ggerber@bsd.uchicago.edu

A series of 205 urologists answered questions about their choice of treatment for
lower-caliceal stones. The preferred approaches were extracorporeal shockwave
lithotripsy (SWL) for stones <1 cm and percutaneous nephrolithotomy (PCNL) for
those >2 cm. For stones of 1 to 2 cm, 65% preferred SWL and 30% would advise
PCNL. Thus, SWL is recommended for lower-caliceal stones more frequently than is 
justified by published success rates. Continued efforts need to be made to inform
practicing urologists regarding the most appropriate therapy for patients with
lower-pole stones >1 cm.

PMID: 14565883 [PubMed - indexed for MEDLINE]

978: J Endourol. 2003 Sep;17(7):495-6.

Baskets in the kidney: an old problem in a new situation.

Allen D, Hindley RG, Glass JM.

Department of Urology, Guy's Hospital, London, England.
richard.hindley@virgin.net

A potential complication of using a zero-tip basket to remove stones from a
lower-lower pole calix of the kidney is impaction in this position. We report an 
endourologic technique involving a hydrogel-coated ureteral dilator to facilitate
closure of the wires and removal of the basket following lithotripsy to fragment 
the stone.

Publication Types: 
    Case Reports

PMID: 14565881 [PubMed - indexed for MEDLINE]

979: J Endourol. 2003 Sep;17(7):435-46.

Cavitation bubble cluster activity in the breakage of kidney stones by
lithotripter shockwaves.

Pishchalnikov YA, Sapozhnikov OA, Bailey MR, Williams JC Jr, Cleveland RO,
Colonius T, Crum LA, Evan AP, McAteer JA.

Department of Acoustics, Physics Faculty, M.V. Lomonosov Moscow State University,
Moscow, Russia.

BACKGROUND AND PURPOSE: There is strong evidence that cavitation bubble activity 
contributes to stone breakage and that shockwave-bubble interactions are involved
in the tissue trauma associated with shockwave lithotripsy. Cavitation control
may thus be a way to improve lithotripsy. MATERIALS AND METHODS: High-speed
photography was used to analyze cavitation bubble activity at the surface of
artificial and natural kidney stones during exposure to lithotripter shockwaves
in vitro. RESULTS: Numerous individual bubbles formed on the surfaces of stones, 
but these bubbles did not remain independent but rather combined to form
clusters. Bubble clusters formed at the proximal and distal ends and at the sides
of stones. Each cluster collapsed to a narrow point of impact. Collapse of the
proximal cluster eroded the leading face of the stone, and the collapse of
clusters at the sides of stones appeared to contribute to the growth of cracks.
Collapse of the distal cluster caused minimal damage. CONCLUSION:
Cavitation-mediated damage to stones is attributable, not to the action of
solitary bubbles, but to the growth and collapse of bubble clusters.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 14565872 [PubMed - indexed for MEDLINE]

980: Urol Nurs. 2003 Aug;23(4):310-3.

Calcium oxalate kidney stones: another reason to encourage moderate calcium
intakes and other dietary changes.

Moyad MA.

University of Michigan Medical Center, Department of Urology, Ann Arbor, MI, USA.

Conventional medical thought several decades ago was to restrict the amount of
calcium intake in individuals with a history of calcium oxalate stones. In the
past decade, several studies have suggested that increasing the intake of calcium
may actually reduce the risk of calcium oxalate stone formation. The largest
randomized trial of diet and stone recurrence was recently completed.
Interestingly, individuals that had normal calcium intakes and lower intakes of
protein and salt had a significantly reduced rate of calcium oxalate stone
recurrence. This recent trial along with several past epidemiologic studies
should be discussed with patients at high risk of stone recurrence. Currently,
health professionals have a wealth of information that can be distributed to
individuals at high risk of nephrolithiasis, and simple dietary recommendations
may be one of the best ways to reduce the risk of calcium oxalate stones.

Publication Types: 
    Review

PMID: 14552081 [PubMed - indexed for MEDLINE]

981: Nephrol Dial Transplant. 2003 Nov;18(11):2278-83.

Mutational analysis of the xanthine dehydrogenase gene in a Turkish family with
autosomal recessive classical xanthinuria.

Gok F, Ichida K, Topaloglu R.

Department of Pediatric Nephrology, Gulhane Military Medical School, Ankara,
Turkey.

BACKGROUND: Classical xanthinuria is classified into two categories: type I,
deficient only in xanthine dehydrogenase (XDH) activity; and type II, deficient
in both XDH and aldehyde oxidase. Both types present mainly with renal stones and
lead to renal failure in some cases. We studied the molecular basis of
xanthinuria in a Turkish family with two affected siblings. METHODS: We examined 
two brothers aged 1 and 14 years who presented with histories of passing several 
urinary stones. We measured their serum and urine levels of uric acid and
oxypurine, chemically analysed their stones and performed allopurinol loading
tests to diagnose the type of xanthinuria. In addition, we studied the coding
regions of the XDH gene in family members. RESULTS: In the siblings, serum uric
acid was undetectable and serum oxypurine was elevated. Laboratory studies showed
that the stones that they passed were composed of xanthine, and both were
diagnosed as having classical xanthinuria. The allopurinol loading tests
indicated their xanthinuria to be type I. Within the entire coding region of the 
XDH gene, an A to T base change at nucleotide position 2164 was identified in the
siblings, indicating a nonsense substitution from AAG (Lys) to TAG (Tyr) at codon
722. Concerning this novel nonsense mutation, restriction fragment length
polymorphism (RFLP) analysis showed that the brothers were both homozygous, while
the parents were heterozygous, and this confirmed the autosomal recessive
inheritance of the XDH gene mutation. CONCLUSIONS: In a Turkish family, we
identified a novel point mutation in the XDH gene responsible for classical type 
I xanthinuria. That both parents had a history of passing renal stones in spite
of being heterozygous for that mutation may indicate that individuals with a
heterozygous nonsense XDH mutation are more susceptible to nephrolithiasis than
healthy individuals. This raises the point that individuals with a heterozygous
XDH mutation may also present with renal stones.

Publication Types: 
    Case Reports
    Research Support, Non-U.S. Gov't

PMID: 14551354 [PubMed - indexed for MEDLINE]

982: J Urol. 2003 Nov;170(5):1731-3.

In vitro comparison of 4 ultrasound lithotripsy devices.

Haupt G, Haupt A.

Department of Urology, University of Cologne, Germany.

PURPOSE: Endoscopic lithotripsy is still the method of choice for a number of
stones, especially large renal stones. Various disintegration techniques exist.
Ultrasound is widely used because it is the only method that allows
disintegration and active suction of stone debris at the same time. We evaluated 
4 ultrasound lithotriptors in vitro. MATERIALS AND METHODS: We used a newly
developed experimental setup and compared 4 ultrasound devices, namely the 27085 
K (Karl Storz Endoscopy, Tuttlingen, Germany), 2167.01 (Wolf, Knittlingen,
Germany), USL 2000 (Circon Corp., Santa Barbara, California) and an ultrasound
prototype lithotriptor (EMS, Nyon, Switzerland).RESULTS All ultrasound
lithotriptors achieved stone disintegration, which depended on the pressure used 
to apply ultrasound. Newer devices with modified technology provided better
disintegration. CONCLUSIONS: All ultrasound devices are effective for
lithotripsy. Changes in the ultrasound setup and integration of modern technical 
knowledge into ultrasound devices increase efficacy.

Publication Types: 
    Comparative Study
    Evaluation Studies
    In Vitro

PMID: 14532764 [PubMed - indexed for MEDLINE]

983: Radiology. 2003 Nov;229(2):575-80. Epub 2003 Oct 2.

Helical CT for nephrolithiasis and ureterolithiasis: comparison of conventional
and reduced radiation-dose techniques.

Heneghan JP, McGuire KA, Leder RA, DeLong DM, Yoshizumi T, Nelson RC.

Department of Radiology, Duke University Medical Center, Durham, NC, USA.
heneghanj@sehb.ie

PURPOSE: To determine the accuracy of unenhanced helical computed tomography (CT)
performed at reduced milliampere-second, and therefore at a reduced patient
radiation dose, by using conventional unenhanced helical CT as the standard.
MATERIALS AND METHODS: Fifty patients with acute flank pain who weighed less than
200 lb (90 kg) were prospectively recruited for this study. Conventional helical 
CT scans were obtained with patients in the prone position by using 5-mm-thick
sections, 140 kVp, 135-208 mAs (mean, 160 mAs), and a pitch of 1.5
(single-detector row CT) or 0.75 (multi-detector row CT, 4 x 5-mm detector
configuration). Conventional CT was immediately followed by low-dose scanning,
whereby the tube current was reduced to 100 mA (mean, 76 mAs). All other
technical parameters and anatomic coverage remained constant. Three independent
readers who were blinded to patient identity interpreted the scans in random
order. The observers noted the location, size, and number of calculi; secondary
signs of obstruction; and other clinically relevant findings. High- and low-dose 
scans were compared by using paired t tests and the signed rank test. RESULTS:
Calculi were found in 33 (66%) patients; 25 (50%) had renal calculi and 19 (38%) 
had an obstructing ureteral calculus. The accuracy rates (averaged over the three
readers) for determining the various findings on the low-dose scan compared with 
the high-dose scan were as follows: nephrolithiasis, 91%; ureterolithiasis, 94%; 
obstruction, 91%; and normal findings, 92%. When interpretations between readers 
were compared, agreement rates were 90%-95% for standard-dose scans and 90%-92%
for reduced-dose scans (P >.5). Uncomplicated mild diverticulitis was found in
three patients. No other clinically important abnormality was identified. A
reduction in the tube current to 100 mA resulted in a dose reduction of 25% for
multi-detector row CT and 42% for single-detector row CT. CONCLUSION: In patients
who weighed less than 200 lb, unenhanced helical CT performed at a reduced tube
current of 100 mA, and therefore at a reduced patient dose, resulted in scans of 
high accuracy. Copyright RSNA, 2003

Publication Types: 
    Comparative Study

PMID: 14526095 [PubMed - indexed for MEDLINE]

984: Pathol Res Pract. 2003;199(7):489-92.

Carcinosarcoma and squamous cell carcinoma of the renal pelvis associated with
nephrolithiasis: a case report of each tumor type.

Kayaselçuk F, Bal N, Guvel S, Egilmez T, Kilinc F, Tuncer I.

Department of Pathology, Başkent University Faculty of Medicine, Adana Teaching
and Medical Research Center, Yüreğir, Turkey. faziletks@baskent-adn.edu.tr

Both squamous cell carcinoma and carcinosarcoma of the renal pelvis are uncommon.
We report on two cases, one carcinosarcoma and one squamous cell carcinoma of the
renal pelvis. In the patient with squamous cell carcinoma of the left kidney, the
tumor was neither detectable on preoperative radiological evaluation nor grossly 
visible in the surgical specimen. This patient, a 56-year-old man, presented with
left lumbar pain, hematuria, fever, 4-5 kg weight loss, and untreated
nephrolithiasis of the left kidney that had been diagnosed 20 years earlier. The 
second patient, an 87-year-old woman, also had a long history of left kidney
nephrolithiasis and presented with left lumbar pain and hematuria. Both patients 
underwent nephrectomy for removal of the non-functioning hydronephrotic left
kidney. In both cases, microscopic examination of the surgical specimen revealed 
squamous metaplasia and dysplasia in the pelvicalyceal mucosa, and islands of
atypical squamous cells in the renal parenchyma. In the second case, the kidney
also showed sarcomatous changes in the pelvis.

Publication Types: 
    Case Reports

PMID: 14521266 [PubMed - indexed for MEDLINE]

985: Urol Res. 2004 Feb;32(1):25-7. Epub 2003 Oct 1.

Reversible acute renal failure after unilateral extracorporeal shock-wave
lithotripsy.

Liguori G, Trombetta C, Bucci S, Salamè L, Savoldi S, Belgrano E.

Dept. of Urology and Nephrology, University of Trieste, Trieste, Italy.
Gioliguori@libero.it

Extracorporeal shock-wave lithotripsy (ESWL) is the treatment of choice for the
majority of patients with renal or proximal ureteral stones. We describe an
unusual case of anuric renal failure following ESWL, in absence of obstruction or
myoglobinuria, in the presence of unilateral nephrolithiasis and two normally
functioning kidneys. A mechanism for this patient's acute renal failure (ARF) is 
postulated. Although the frequency of ARF after ESWL is extremely rare and the
mechanism responsible for ARF is not understood, the appearance of ARF, when
ureteral obstruction or hematoma are absent, should be included among
complications following EWSL. Attention should be paid to older patients.

Publication Types: 
    Case Reports

PMID: 14520505 [PubMed - indexed for MEDLINE]

986: Int J Urol. 2003 Oct;10(10):530-5.

Identification of bikunin isolated from human urine inhibits calcium oxalate
crystal growth and its localization in the kidneys.

Okuyama M, Yamaguchi S, Yachiku S.

Department of Urology, Asahikawa Medical College, Asahikawa, Japan.
ZVM11657@nifty.ne.jp

BACKGROUND: We previously reported a high molecular weight substance purified
from human urine that strongly inhibited calcium oxalate (CaOx) crystal growth in
vitro. In the study present herein, we identified and investigated a protein
purified from human urine that strongly inhibits CaOx crystal growth using a
column chromatography series. METHODS: The protein was identified by amino acid
sequencing and was investigated by sodium dodecyl sulfate polyacrylamide gel
electrophoresis (SDS-PAGE), western blotting and immunohistochemical staining.
RESULTS: The molecular weight of this protein was approximately 35 KDa, and it
also had another band around 20 KDa. We determined that the amino acid sequence
of the protein was homologous with that of bikunin, the light chain of the
inter-alpha-trypsin inhibitor, which is known as a strong CaOx crystallization
inhibitor in vitro. On western blotting analysis, the molecular weight was also
found to be around 35K Da, the same as that of bikunin. Immunohistochemical
staining revealed that it was mainly located in the epithelial cells of the
proximal tubules and the thin descending segment near the loop of Henle, but not 
in the glomeruli, distal tubules or the collecting ducts. CONCLUSION: In the
present study, the protein extracted from human urine was identical to bikunin,
which may be expressed mainly in the proximal tubules and the thin descending
segment near the loop of Henle, and which prevents CaOx crystallization in vitro.

PMID: 14516400 [PubMed - indexed for MEDLINE]

987: Urol Int. 2003;71(3):325-8.

Cavernous hemangioma of the renal hilum presenting as an avascularized solid
mass.

Virgili G, Di Stasi SM, Bove P, Orlandi A, Preziosi P, Vespasiani G.

Department of Urology, University of Rome Tor Vergata, Casilino Hospital, Rome,
Italy. guidovirgili@tiscalinet.it

Hemangiomas are slowly growing benign vascular tumours which rarely involve the
kidney. They usually occur in the mucosa or subepithelial tissue of the pelvis,
in the pyramid of the kidney and in the cortex. We report a case of cavernous
hemangioma presenting as a solid, paradoxically avascular mass of the right renal
hilum. Copyright 2003 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 14512658 [PubMed - indexed for MEDLINE]

988: Urol Res. 2003 Dec;31(6):414-6. Epub 2003 Sep 24.

Staghorn calculus in renal allograft presenting as acute renal failure.

Thakar CV, Lara A, Goel M, Nally JV Jr.

Department of Nephrology and Hypertension, The Cleveland Clinic Foundation, Desk 
A-51, 9500 Euclid Avenue, Cleveland OH 44195, USA. drcharu@hotmail.com

BACKGROUND: Urolithiasis is a rare complication in renal transplant recipients.
We report a case of a staghorn calculus occurring in renal allograft, presenting 
as anuric renal failure with Gram-negative sepsis. METHODS AND RESULTS: A
48-year-old Caucasian female, with end-stage renal disease due to autosomal
dominant polycystic kidney disease, underwent cadaveric renal transplantation in 
1986. Sixteen years after transplant, she presented with Gram-negative sepsis
with Proteus mirabilis and acute anuric renal failure in the allograft. After
undergoing an emergency nephrostomy and treatment of sepsis, a staghorn calculus 
was subsequently removed by percutaneous nephrolithotomy. Based on the stone
analysis and history of urinary tract infections with urease splitting bacteria, 
the calculus was thought to be infection-induced. CONCLUSION: Although a rare
complication, urolithiasis in an allograft can be associated with significant
morbidity. Immediate recognition is critical to restore renal allograft function 
and to treat associated serious infection in an immunocompromised patient.

Publication Types: 
    Case Reports

PMID: 14508619 [PubMed - indexed for MEDLINE]

989: J Urol. 2003 Oct;170(4 Pt 1):1151-4.

Microsatellite instability in urothelial carcinoma of the upper urinary tract.

Amira N, Rivet J, Soliman H, Cancel-Tassin G, Le Duc A, Janin A, Cussenot O.

Centre de Recherche sur les Pathologies Prostatiques, Equipe d'Accuil 3104,
Départments d'Urologie, C.H.U. Saint-Louis, Evry, France.

PURPOSE: Transitional cell carcinoma (TCC) of the upper urinary tract (TCC-UUT)
may develop with high frequency in patients with hereditary nonpolyposis
colorectal cancer syndrome. Tumors in patients with this syndrome show genomic
lesions in DNA mismatch repair genes that are detectable as microsatellite
instability (MSI). Because little is known about genetic lesions in TCC-UUT
compared with bladder TCC, we determined the genetic profiles (MSI and allelic
loss) in a series of 26 upper urinary tract tumors using 5 informative
microsatellite markers. MATERIALS AND METHODS: A total of 26 paraffin embedded
samples from 24 patients with clinically diagnosed TCC-UUT (renal pelvis and/or
ureter) were tested for loss of heterozygosity (LOH) and MSI with the
dinucleotide markers D9S171 (9p21) and D5S346 (5q22), and the mononucleotide
repeats BAT25 (4q12), BAT26 (2p16) and BAT40 (1p13.1). RESULTS: MSI was detected 
at 1 or more microsatellite loci in 12 of the 26 tumors (46%). The markers BAT40,
BAT25, BAT26, D9S171 and D5S346 showed instability in 7, 4, 4, 2 and 3 tumor
samples, respectively. LOH at D9S171 was detected in 58% of the cases and 10 of
the 14 tumors showing LOH were superficial. LOH at D5S346 occurred in 27% of the 
cases and it was a feature of invasive high grade TCC-UUT. CONCLUSIONS: Frequent 
LOH at D9S171 in TCC-UUT confirms that LOH at 9p21 is not only observed in
bladder TCC, but rather in whole urinary tract TCC. Furthermore, our study
indicates a high level of MSI in TCC-UUT, although it is a rare event in bladder 
cancer. The establishment of distinct genetic profiles between upper and lower
urinary tract tumors could provide an additional tool to improve diagnosis,
disease monitoring and prediction of prognosis.

PMID: 14501713 [PubMed - indexed for MEDLINE]

990: J Urol. 2003 Oct;170(4 Pt 1):1105-10.

Experience with instrumental chemolysis for urolithiasis.

Dormia E, Dormia G, Malagola G, Minervini S.

Department of Urology, San Carlo Borromeo Hospital, Milano, Italy.

PURPOSE: We describe a more efficient solution for calcium magnesium stones, an
irrigation technique devised by us, and the indications for and results of our
20-year experience with direct renal or ureteral chemolysis. MATERIALS AND
METHODS: Renal and ureteral perfusion is performed with 2 coaxial catheters
(where the interspace is 1-way circulation), a normal ureteral catheter to a
nephrostomy tube or, if the ureter is impractical, a nephrostomy tube after
inserting it in a thin catheter achieving coaxial circulation. The perfusion
operates by gravity with continuous flow maintaining a negative pressure in the
cavities and keeping the circuits sealed during treatment. All equipment is
mounted on a mobile support which the patient can take anywhere in the hospital. 
RESULTS: During the last 20 years 8 cystine stones and 20 "difficult" stones have
been completely dissolved and the volume of 39 staghorn struvite stones has been 
reduced an average of up to 80% before 1 or 2 final lithotripsy sessions without 
significant side effects. Small fragments remained in the inferior calices in
only 2 cases. CONCLUSIONS: Chemolysis is useful for eliminating cystine stones as
well as for cases in which lithotripsy or endourology is considered difficult or 
risky. Furthermore, chemolysis proved to be a useful method for reducing staghorn
stones before performing lithotripsy.

PMID: 14501702 [PubMed - indexed for MEDLINE]

991: J Urol. 2003 Oct;170(4 Pt 1):1101-4.

In vitro assessment of ultrasonic lithotriptors.

Kuo RL, Paterson RF, Siqueira TM Jr, Evan AP, McAteer JA, Williams JC Jr,
Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana,
USA.

PURPOSE: Ultrasonic lithotriptors are commonly used to fragment and remove stones
during percutaneous nephrolithotomy. To date a comparative assessment of current 
units has not been accomplished without potential operator bias. An objective
testing environment is required for optimal appraisal of the efficiency of
ultrasonic lithotriptors. MATERIALS AND METHODS: An in vitro test system was
devised to evaluate the ability of ultrasonic lithotriptors to core through
artificial stones. The system consisted of an irrigation sheath (Cook Urological,
Spencer, Indiana) through which ultrasonic probes were placed. Ultrasonic hand
pieces and probes were secured in an upright position. An Ultracal-30 (U.S.
Gypsum, Chicago, Illinois) stone cylinder (mean length 12.8 +/- 0.6 mm, mean
diameter 7.6 +/- 0.07 mm) was centered on the probe tip. A weight (62.7 gm) was
placed atop the stone to provide a constant force. We evaluated the Olympus LUS-1
and LUS-2 (Olympus, Melville, New York), Circon-ACMI USL-2000 (Circon-ACMI,
Southborough, Massachusetts), Karl Storz Calcuson (Karl Storz, Culver City,
California) and Richard Wolf model 2271.004 (Richard Wolf, Vernon Hills,
Illinois). All probes had outer diameters of 3.4 mm except for the Circon-ACMI
unit (3.8 mm). Using 100% power settings times for complete stone penetration
were assessed for all units. Differences in mean stone penetration times were
compared using ANOVA. RESULTS: The Olympus LUS-2 had the fastest mean stone
penetration time (28.8 +/- 2.7 seconds). This value was used to normalize the
data into efficiency ratios, where other unit times were expressed as multiples
of the LUS-2 time: Olympus LUS-2 (1.0 +/- 0.1) equals Circon-ACMI USL-2000 (1.1
+/- 0.3) greater than Karl Storz Calcuson (1.4 +/- 0.3) greater than Olympus
LUS-1 (2.1 +/- 0.5) greater than Richard Wolf (3.6 +/- 0.8). Efficiencies of the 
LUS-2 and USL-2000 units were essentially equivalent, with all others
significantly less efficient (p <0.05). CONCLUSIONS: This new in vitro testing
model provides an objective, reproducible method for evaluating the efficiency of
intracorporeal lithotriptors. Of the units tested the Olympus LUS-2 and
Circon-ACMI USL-2000 were the most efficient.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 14501701 [PubMed - indexed for MEDLINE]

992: J Urol. 2003 Oct;170(4 Pt 1):1097-100.

Prediction of fragility of urinary calculi by dual X-ray absorptiometry.

Mandhani A, Raghavendran M, Srivastava A, Kapoor R, Singh U, Kumar A, Bhandari M.

Department of Urology, Sanjay Ghandhi Post Graduate Institute of Medical
Sciences, Lucknow, India. mandhani@sgpgi.ac.in

PURPOSE: Stone fragility is a key factor for the success of shock wave
lithotripsy (SWL). Dual x-ray absorptiometry is the gold standard for measuring
bone mineral content and density, which helps in determining bone mass and the
fracture risk. The same principle was applied to determine the relationship of
stone mineral content (SMC) and density (SMD) to predict the fragility of stone
before SWL. MATERIALS AND METHODS: A total of 102 patients with a solitary renal 
and upper ureteral stone of less than 3 cm treated at a single center with a
lithotriptor were included. Prior to SWL all patients underwent dual x-ray
absorptiometry evaluation for SMC and SMD. Plain x-ray documented disintegration 
after SWL. Stone size and site, the number of shock waves and energy levels were 
recorded. Failure was defined as no fragmentation to a size of less than 4 mm,
which would pass unaided, up to a maximum of 3,000 shock waves. RESULTS: Overall 
94 patients with renal stones were included. Mean stone size was 16.68 +/- 7 mm
(range 5 to 30). Mean and median SMC was 0.63 +/- 0.83 and 0.34 gm (range 0.01 to
5.54), and mean and median SMD was 0.48 +/- 0.19 and 0.46 gm/cm2 (range 0.05 to
1.12), respectively. Overall 67 patients (71%) had successful fragmentation and
clearance at a mean of 1,623.58 +/- 658.77 shock waves (range 355 to 3,000). On
logistic regression analysis only SMC was the significant factor affecting the
outcome in terms of fragmentation. At a SMC of more than 1.27 gm 95% of the
stones would not fragment or needed more than 3,000 shock waves. CONCLUSIONS:
Patients with high stone mineral content (SMC greater than 1.27 gm) could be
directly offered percutaneous nephrolithotomy, thus, avoiding the unnecessary
cost of prior SWL.

PMID: 14501700 [PubMed - indexed for MEDLINE]

993: J Comput Assist Tomogr. 2003 Sep-Oct;27(5):810-3.

Matrix stone.

Liu CC, Li CC, Shih MC, Chou YH, Huang CH.

Department of Urology, Kaohsiung Medical University, Taiwan.

Matrix stone is a rare form of renal calculi, and it is often difficult to make
an exact preoperative diagnosis. To our knowledge, we reported the first case of 
matrix stones which received magnetic resonance imaging (MRI) for image study.
They showed hypointense signal in T1-weighted images and slight hyperintense
signal in T2-weighted images. No obvious contrast enhancement was found after
gadolinium administration in T1-weighted images. Besides, postoperative study of 
computerized tomography (CT) for matrix stones also showed the characteristic of 
soft tissue densities by measuring the Hounsfield units. We think our experiences
may provide some help for the diagnosis of matrix stones when someone encounters 
the same situation and may prevent overtreatment due to misdiagnosis as
malignancy.

Publication Types: 
    Case Reports
    Review

PMID: 14501375 [PubMed - indexed for MEDLINE]

994: Urol Res. 2003 Dec;31(6):378-81. Epub 2003 Sep 13.

Renal phosphate leak in patients with idiopathic hypercalciuria and calcium
nephrolithiasis.

Negri AL, Spivacow R, Del Valle E, Fradinger E, Marino A, Zanchetta JR.

Instituto de Investigaciones Metabólicas, Universidad del Salvador, Libertad 836 
1 piso, Buenos Aires 10 12, Argentina. negri@casasco.com.ar

Although urine phosphate loss has been associated with hypercalciuria, it is
debated how frequently renal phosphate leak is present in hypercalciuric
patients. We reviewed the records of 100 consecutive adult patients who were
diagnosed with idiopathic hypercalciuria and calcium urolithiasis, searching for 
the presence of renal phosphate leak. The renal phosphate threshold, normalized
for the glomerular filtration rate (TmPO4/GFR), of the hypercalciuric patients
followed a normal distribution and had a good correlation with serum phosphate ( 
r=0.77; p<0.0001). There were no correlations between TmPO4/GFR and urinary
calcium or between serum phosphorus and urinary calcium. We found only nine
patients (9%) with renal phosphate leak. These patients had a mean TmPO4/GFR of
2.19 mg% (0.70 mmol/l) and serum phosphorus of 2.65 mg% (0.85 mmol/l).
Nevertheless, urinary calcium was not significantly different between patients
with or without low TmPO4/GFR. We conclude that renal phosphate leak is an
infrequent finding in patients with idiopathic hypercalciuria and is not
associated with a higher urinary calcium loss.

PMID: 13680023 [PubMed - indexed for MEDLINE]

995: Am J Physiol Cell Physiol. 2004 Jan;286(1):C79-89. Epub 2003 Sep 17.

Coexpression of complementary fragments of ClC-5 and restoration of chloride
channel function in a Dent's disease mutation.

Mo L, Xiong W, Qian T, Sun H, Wills NK.

Departments of Physiology & Biophysics, University of Texas Medical Branch,
Galveston, TX 77555-0641, USA.

The human hereditary disorder Dent's disease is linked to loss-of-function
mutations of the chloride channel ClC-5. Many of these mutations involve
insertion of premature stop codons, resulting in truncation of the protein. We
determined whether the functional activity of ClC-5 could be restored by
coexpression of the truncated protein (containing the NH2-terminal region) with
its complementary "missing" COOH-terminal region. Split channel constructs for
ClC-5, consisting of complementary N and C protein regions, were created at an
arbitrary site in the COOH-terminal region (V655) and at four Dent's disease
mutation sites (R347, Y617, R648, and R704). Coexpression of complementary
fragments for the split channel at V655 produced currents with anion and pH
sensitivity similar to those of wild-type ClC-5. Channel activity was similarly
restored when complementary split channel constructs made for Dent's mutation
R648 were coexpressed, but no ClC-5 currents were found when split channels for
mutations R347, Y617, or R704 were coexpressed. Immunoblot and immunofluorescence
studies of COS-7 cells revealed that N or C protein fragments could be
transiently expressed and detected in the plasma membrane, even in split channels
that failed to show functional activity. The results suggest that ClC-5 channel
activity can be restored for specific Dent's mutations by expression of the
missing portion of the ClC-5 molecule.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 13679301 [PubMed - indexed for MEDLINE]

996: Kidney Int. 2003 Oct;64(4):1283-91.

Calcium phosphate-induced renal epithelial injury and stone formation:
involvement of reactive oxygen species.

Aihara K, Byer KJ, Khan SR.

Department of Pathology, College of Medicine, University of Florida, Gainesville,
Florida 32610, USA.

BACKGROUND: Crystal formation and retention are critical events for the formation
of kidney stones. Oxalate and calcium oxalate (CaOx) crystals are injurious to
renal epithelium, and membranes of injured cells promote crystal adherence and
retention. Calcium phosphate (CaP) is the most common crystal in both urine and
stones, most likely to form in the early segments of the nephron and can nucleate
CaOx in a metastable solution. We hypothesized that CaP can also injure the renal
epithelial cells. METHODS: We exposed proximal tubular origin line derived from
pig proximal tubules (LLC-PK1), and collecting duct origin Madin-Darby canine
kidney (MDCK) cell lines to various concentrations of Brushite (Br) crystals and 
investigated staining with Trypan Blue and the release of lactate dehydrogenase
(LDH) into the medium as an indicator of injury. In order to determine the
involvement of reactive oxygen species, we also measured LDH release in the
presence of superoxide dismutase (SOD) and production of hydrogen peroxide (H2O2)
and 8-isoprostane (8-IP) in the presence of the catalase. RESULTS: Exposure to Br
crystals was associated with LDH release by both cell types, induced the
production of H2O2 and 8-IP. Presence of SOD and catalase reduced LDH release as 
well as staining with trypan blue. Catalase was also associated with reduced
production of H2O2 and 8-IP. CONCLUSION: Brushite crystals are injurious to cells
of both the proximal tubules as well as collecting ducts. Injury is mediated by
reactive oxygen species. We propose that CaP crystals can independently interact 
with renal epithelium, promote sites for crystal attachment, and then either grow
into mature CaP stones or create sites for CaOx crystal nucleation, retention,
and stone development.

PMID: 12969146 [PubMed - indexed for MEDLINE]

997: Med Princ Pract. 2003 Oct-Dec;12(4):208-13.

Stone composition, metabolic profile and the presence of the gut-inhabiting
bacterium Oxalobacter formigenes as risk factors for renal stone formation.

Mittal RD, Kumar R, Mittal B, Prasad R, Bhandari M.

Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow, India. rmittal@sgpgi.ac.in

OBJECTIVE: To examine stone composition, metabolic evaluation and colonization of
Oxalobacter formigenes as risk factors for renal stone formation. SUBJECTS AND
METHODS: Eighty patients with renal stones and 70 healthy controls were enrolled 
in the study. Of the 80 patients, 48 were first-time stone formers (FSF) and 32
were 'recurrent' stone formers (RSF), recurrent indicating 2 or more episodes of 
stone formation. Stone analysis by X-ray crystallography, 24-hour urine metabolic
profile and detection of O. formigenes-specific DNA by PCR were performed for
each patient. Detection of O. formigenes was also performed on 45 and urinary
metabolic profile on an additional 25 controls. RESULTS: Calcium oxalate
monohydrate was the major component of stones, hyperoxaluria and hypocitraturia
were the most common urinary abnormalities in the 80 patients, 46% of RSF
patients had hypercalciuria. Urinary abnormalities were far less frequent in the 
controls, with the exception of hypocitraturia (40%). Of the urinary metabolites,
only calcium levels were significantly different (p < 0.05) between FSF (6.50 +/-
4.08 mmol/24 h) and RSF (8.21 +/- 5.26 mmol/24 h) patients. Colonization of O.
formigenes was higher in controls (62.2%) than in FSF (33.3%) or RSF (28%)
patients, it was least in patients with more than 4 episodes (7%) of stone
formation. CONCLUSION: The findings indicate that lack of colonization of O.
formigenes may be an important risk factor for recurrence of stone formation
(calcium oxalate monohydrate). Copyright 2003 S. Karger AG, Basel

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12966191 [PubMed - indexed for MEDLINE]

998: J Endourol. 2003 Aug;17(6):397-400.

Removal of asymptomatic ipsilateral renal stones following rigid ureteroscopy for
ureteral stones.

Bilgasem S, Pace KT, Dyer S, Honey RJ.

Division of Urology, St. Michael's Hospital, University of Toronto, Toronto,
Ontario, Canada.

PURPOSE: To evaluate the feasibility and outcome of flexible ureteroscopic
removal of small (<1-cm) asymptomatic renal stone(s) following rigid ureteroscopy
for ureteral stones. PATIENTS AND METHODS: Ten female and nineteen male patients 
underwent rigid ureteroscopy and holmium lasertripsy for removal of ureteral
stone(s). All had asymptomatic renal stone(s) on the same side, which were then
removed using flexible ureteroscopy. The renal stones were either removed intact 
with a tipless Nitinol basket or fragmented with the laser to small pieces (<2
mm), with basket removal of larger fragments. The number and size of stones,
total operative time, added time needed for flexible ureteroscopy, and
intraoperative and postoperative complications were recorded. Follow-up at 1
month included a plain abdominal film and renal ultrasonography or noncontrast CT
scan. RESULTS: Fifty-six renal stones with a mean size of 5.7 mm were treated.
Fourteen patients had stones on the right side, and 15 had stones on the left.
The mean total operative time was 56.5 minutes, with a mean added time of 16.7
minutes for flexible ureteroscopy. Stones were removed intact in 18 patients and 
fragmented in 8 patients, resulting in an immediate success rate of 90%. There
were three failures. One-month follow-up confirmed all patients were either
stone-free or had residual fragments <2 mm in diameter, with no new-onset
hydronephrosis. CONCLUSIONS: Removal of small asymptomatic renal stones at the
time of ureteroscopy for ureteral stones appears safe and effective and requires 
little additional operative time.

Publication Types: 
    Clinical Trial

PMID: 12965066 [PubMed - indexed for MEDLINE]

999: J Endourol. 2003 Aug;17(6):355-63.

Practice patterns in the treatment of large renal stones.

Bird VG, Fallon B, Winfield HN.

Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa,
USA. vbird@med.miami.edu

PURPOSE: To determine the current practice patterns of a large group of
urologists in the treatment of large renal stones. MATERIALS AND METHODS: A
survey was sent to all actively practicing members of the North Central Section
of the American Urological Association. The questions pertained to age, time in
practice, type of practice, time devoted to treating stones, residency training, 
case scenarios with treatment options, and whether they or a radiologist
performed percutaneous access. The data were statistically analyzed. RESULTS: The
response rate was 51% (564/1102 surveys returned). Three quarters (73%) of the
urologists were comfortable performing percutaneous nephrolithotomy (PCNL), and
35% gave reasons they do not perform PCNL. Only 11% of those performing PCNL
routinely obtained the percutaneous access themselves. Trends in the analysis
included: (1) those trained to perform PCNL during residency were more often
comfortable with this procedure; (2) younger urologists were more comfortable
performing PCNL, even if they had been in practice for only a short time; (3)
urologists in private practice were nearly as comfortable performing PCNL as were
academic urologists; (4) urologists not comfortable with PCNL more often
recommended SWL over PCNL as a primary treatment for moderate/large renal stones;
and (5) few urologists routinely obtained percutaneous access themselves.
CONCLUSIONS: Many urologists trained in recent years are comfortable performing
PCNL. The type of training received influences treatment recommendations, and
percutaneous access is most often obtained by/in conjunction with radiologists.
This information may be useful in guiding residency training programs in the
preparation of residents for the treatment of large renal stones.

PMID: 12965059 [PubMed - indexed for MEDLINE]

1000: Front Biosci. 2003 Sep 1;8:s1339-55.

Uric acid stone disease.

Moran ME.

Peter's Kidney Stone Center, Albany, NY, USA. memoran2@juno.com

The trend in uric acid stone formation appears to be on the rise again throughout
much of the world. This is thought secondary to diet, body habitus, and social
reasons. Uric acid stone disease has a rich and fascinating medical history and
probably is the oldest known stone disease. Uric acid stone disease is strongly
linked to the purine metabolic pathway, and its treatment is primarily medical.
Uric acid stone disease can be prevented and these are one of the few urinary
tract stones that can be dissolved successfully. Surgical intervention with uric 
acid stone disease represents a failure of medical therapy and a whole host of
modern, minimally invasive methods are available for treating patients with this 
disease. Finally, uric acid nephrolithiasis is associated with a variety of
inborn errors of metabolism based on mutations of key enzymes in the purine
metabolic pathways. This review of uric acid stone formation will start with
historical consideration, review basic biochemistry, and physiology and then
focus upon specific clinical scenarios. The discussions will be heavily
referenced for those interested in greater details.

Publication Types: 
    Review

PMID: 12957851 [PubMed - indexed for MEDLINE]

1001: Front Biosci. 2003 Sep 1;8:s1084-106.

Citrate and mineral metabolism: kidney stones and bone disease.

Caudarella R, Vescini F, Buffa A, Stefoni S.

Department of Internal Medicine and Applied Biotechnology, D. Campanacci
University of Bologna. Italy. renata.caudarella@med.unibo.it

Citrate is a weak acid that is formed in the tricarboxylic acid cycle or that may
be introduced with diet. In the present paper all the mechanisms involved in
intestinal absorption, renal handling and modulation of citrate will be reviewed.
The evaluation of plasma citric acid is scarcely used in the diagnosis of human
diseases. On the contrary urinary citrate excretion is a common tool in the
differential diagnosis of kidney stones, renal tubular acidosis and it plays also
a role in bone diseases. Therefore the importance of hypocitraturia will be
reviewed with regard to bone mass, urine crystallization and urolithiasis.
Finally particular attention will be paid to the incidence of hypocitraturia and 
to the therapy with citrate salts, both in kidney stone disease and in
osteopenia.

Publication Types: 
    Review

PMID: 12957820 [PubMed - indexed for MEDLINE]

1002: Urology. 2003 Sep;62(3):566-70.

Role of urinary inhibitors of crystallization in uric acid nephrolithiasis:
Dalmatian dog model.

Carvalho M, Lulich JP, Osborne CA, Nakagawa Y.

Kidney Stone Program, Division of Biological Sciences, University of Chicago
Pritzker School of Medicine, Chicago, Illinois, USA.

OBJECTIVES: To study the role of urinary inhibitors on
crystallization-nephrocalcin, Tamm-Horsfall protein (THP), and glycosaminoglycans
(GAGs)-in hyperuricosuric nephrolithiasis using Dalmatian dogs, a breed
well-known for high levels of uric acid excretion, in an in vivo model. METHODS: 
Urine samples were collected from 10 stone-forming Dalmatian dogs and from 5
age-matched Dalmatians without kidney stones. Purine derivatives present in urine
were studied by high-performance liquid chromatography. THP, GAGs, and
nephrocalcin were isolated and measured. RESULTS: As expected, the Dalmatians
excreted a large amount of uric acid in urine, but without differences between
the two groups (0.42 +/- 0.08 mg/mg creatinine versus 0.48 +/- 0.11 mg/mg
creatinine for stone-forming and healthy Dalmatians, respectively, P = 0.64). No 
other metabolites were derived from purine in their urine. Stone-forming
Dalmatians showed significantly lower urinary excretion of THP than did normal
Dalmatians (0.09 +/- 0.03 mg/mg creatinine versus 0.21 +/- 0.03 mg/mg creatinine,
P <0.03). The urinary excretion of GAGs was lower in the stone-forming
Dalmatians, although the difference was not statistically significant. Inhibition
of calcium oxalate monohydrate crystal growth caused by nephrocalcin isoforms
from healthy and stone-forming dogs were in the same order of approximately
10(-7) M, as calculated from a Langmuir isotherm type plot. CONCLUSIONS: The
urinary excretion of THP and GAGs was decreased in stone-forming Dalmatians
compared with healthy ones. Our results support the suitability of Dalmatian dogs
as an in vivo model to investigate the interrelationship of urine inhibitors of
crystallization and hyperuricosuria.

PMID: 12946778 [PubMed - indexed for MEDLINE]

1003: Urology. 2003 Sep;62(3):416-20.

Urinary glycosaminoglycans as risk factors for uric acid nephrolithiasis: case
control study in a Sardinian genetic isolate.

Ombra MN, Casula S, Biino G, Maestrale G, Cardia F, Melis P, Pirastu M.

Istituto di Genetica delle Popolazioni, CNR Alghero, Italy.

OBJECTIVES: To assess the clinical association between glycosaminoglycan (GAG)
excretion and uric acid (UA) nephrolithiasis by measuring urinary GAG levels in a
case-control study conducted in a Sardinian genetic isolate. Inhibitors of
crystallization such as GAGs seem to be involved in kidney stone formation.
METHODS: Overnight (12-hour) urinary excretion of GAGs, calcium, oxalate, and UA 
were measured in urine samples from 60 patients who had formed at least one
urinary stone (UA or mixed) and 52 healthy controls. The total GAG concentration 
was measured by a dye-binding assay, and the values were normalized against
creatinine to obtain values in micrograms of GAG per milligram creatinine.
Statistical analysis was performed using t tests and logistic regression
analysis. RESULTS: No significant difference was found between the two groups
with respect to calcium and oxalate concentrations. Nonetheless, stone formers
had significantly lower levels of GAGs (29.5 +/- 2.2 versus 36.4 +/- 3.9
microg/mg creatinine, P = 0.003) and greater levels of UA (385.11 +/- 38.2 versus
298.43 +/- 31.4 mg/12 hr, P = 0.0010) than did the normal controls. CONCLUSIONS: 
We report that the lower excretion of GAGs in stone formers could impair their
inhibitory activity on UA stone formation, and, as a consequence, it may
represent a risk factor for this form of urolithiasis.

PMID: 12946738 [PubMed - indexed for MEDLINE]

1004: Urology. 2003 Sep;62(3):410-4; discussion 414-5.

University of Wisconsin experience using the Doli S lithotriptor.

Johnson DB, Lowry PS, Schluckebier JA, Kryger JV, Nakada SY.

Department of Surgery, Division of Urology, University of Wisconsin Medical
School, Madison 53792-3236, USA.

OBJECTIVES: To present our initial results using the Dornier Doli S lithotriptor 
with the 220 electromagnetic shock wave emitter to treat urinary calculi. At
present, there is no published report of the efficacy of this instrument in
service in the United States. METHODS: We retrospectively reviewed the outcome of
shock wave lithotripsy in 270 consecutive patients with solitary renal and/or
ureteral stones treated from September 1998 to October 2001 with the Dornier Doli
S lithotriptor. Data were collected with respect to stone size, location, and
fragmentation. RESULTS: Of the 270 patients treated, 204 had renal stones and 66 
had ureteral stones. All patients had solitary stones. The renal stones averaged 
9.7 mm in size (range 4 to 26). The ureteral stones averaged 7.8 mm (range 4 to
17). Of the renal stones, 51% were located in the renal pelvis, with 18%, 5%, and
25% located in the upper, middle, and lower poles, respectively. Of the ureteral 
stones, 68% were located in the proximal ureter, with 14% and 18% in the mid and 
distal ureter, respectively. In the renal group, 176 (86%) of 204 patients
achieved clinical success. Of these patients, 148 were stone free (73%) and 28
had residual fragments less than 4 mm in size (14%). In the ureteral group, 52
(79%) of 66 patients achieved clinical success. Of these patients, 50 were stone 
free (76%) and 2 (3%) patients had fragments less than 4 mm in size. Thirteen
(6%) of 204 patients in the renal group required retreatment. Four (6%) of 62
patients in the ureteral group required retreatment. Of the patients in whom
treatment failed and who had stone analysis, 16 (76%) of 21 had stones composed
of predominantly calcium oxalate monohydrate. Four patients developed
steinstrasse. Two were treated with retrograde stent placement, and the other two
with placement of percutaneous nephrostomy. One patient developed a known
perinephric hematoma but did not require a blood transfusion. CONCLUSIONS: Shock 
wave lithotripsy using the Doli S in appropriately selected patients is an
effective instrument for treating urinary calculi throughout the urinary tract.

Publication Types: 
    Comparative Study

PMID: 12946735 [PubMed - indexed for MEDLINE]

1005: AJR Am J Roentgenol. 2003 Sep;181(3):781-4.

Bowel wall fat halo sign in patients without intestinal disease.

Harisinghani MG, Wittenberg J, Lee W, Chen S, Gutierrez AL, Mueller PR.

Division of Abdominal Imaging and Intervention, Massachusetts General Hospital,
White 270, 55 Fruit St., Boston MA 02114, USA. mharisinghani@partners.org

OBJECTIVE: Stratification with a fat layer in the intestinal wall is thought to
be a reliable marker for inflammatory bowel disease. We evaluated the presence
and frequency of the bowel wall fat halo sign in patients undergoing abdominal CT
for clinical indications unrelated to the gastrointestinal tract. MATERIALS AND
METHODS: We performed a retrospective review of 100 consecutive abdominal and
pelvic CT examinations in 61 men and 39 women (mean age, 56 years) with clinical 
suspicion of renal stone disease. Two radiologists experienced in abdominal
imaging performed qualitative and quantifiable assessment of the images. Five
segments of the colon (ascending colon, transverse colon, descending colon,
sigmoid colon, and rectum) and the terminal ileum (for approximately 1 ft [30
cm]) were evaluated for the presence of the fat halo sign. If the fat halo sign
was present, fat density and total wall-thickness assessments were made. Presence
or absence of clinical and radiologic signs of inflammatory bowel disease was
determined. The Student's t test was used to evaluate the statistical
significance, correlating body weight and presence of the halo sign. RESULTS: The
fat halo sign was seen in 21 (21%) of 100 patients. Of the 21 patients with the
fat halo sign, six (29%) had renal stone disease and 15 (71%) had no stone
disease. The density value of the halo sign ranged from -18 to -64 H (mean, -41
H). The distribution of the fat halo sign was as follows: the terminal ileum, 4%;
the ascending colon, 28%; the transverse colon, 34%; the descending colon, 36%;
the sigmoid colon, 14%; and rectum, 10%. No patient with this sign had any
remote, recent, or subsequently recorded history of inflammatory bowel disease. A
statistically significant relationship (p < 0.001) was seen between the presence 
of the fat halo sign and body weight distribution, with 16 of 21 patients
weighing over 200 lb (90 kg). CONCLUSION: In the absence of clinical or
radiologic evidence of inflammatory bowel disease, the presence of the fat halo
sign may represent a normal finding that is possibly related to obesity.

Publication Types: 
    Evaluation Studies

PMID: 12933481 [PubMed - indexed for MEDLINE]

1006: Asian J Surg. 2003 Jul;26(3):186-8.

Pyeloduodenocolic fistula.

Poon JT, Tam PC, Chu KM.

Department of Surgery, University of Hong Kong Medical Centre, Queen Mary
Hospital, Hong Kong.

A 75-year-old man presented with epigastric pain and melaena. Multiple right
renal stones were seen on abdominal X-ray. Computed tomography of the abdomen and
oesophagogastroduodenoscopy revealed features of a pyeloduodenal fistula.
Elective surgery was planned but the patient developed torrential bleeding with
shock. Emergency laparotomy revealed a necrotic right kidney with a
pyeloduodenocolic fistula. This report is the first of a pyeloduodenocolic
fistula caused by squamous cell carcinoma of the renal pelvis. We review the
literature and discuss the aetiologies, clinical presentations, diagnosis, and
treatment of pyeloduodenal fistula.

Publication Types: 
    Case Reports

PMID: 12925297 [PubMed - indexed for MEDLINE]

1007: Hum Mol Genet. 2003 Sep 1;12(17):2097-108. Epub 2003 Jul 15.

Slc7a9-deficient mice develop cystinuria non-I and cystine urolithiasis.

Feliubadaló L, Arbonés ML, Mañas S, Chillarón J, Visa J, Rodés M, Rousaud F,
Zorzano A, Palacín M, Nunes V.

Centre de Genètica Mèdica i Molecular, Institut de Recerca Oncològica, Gran Via
de Les Corts Catalanes s/n km 2,7, L'Hospitalet de Llobregat, Barcelona 08907,
Spain.

Cystinuria is a common recessive disorder of renal reabsorption of cystine and
dibasic amino acids that results in urolithiasis of cystine. Cystinuria is caused
by defects in the amino acid transport system b0,+ (i.e. the rBAT/b0,+AT
heteromeric complex). Mutations in SLC3A1, encoding rBAT, cause cystinuria type
A, characterized by a silent phenotype in heterozygotes (phenotype I). Mutations 
in SLC7A9, encoding b0,+AT, cause cystinuria type B, in which heterozygotes in
most cases hyperexcrete cystine and dibasic amino acids (phenotype non-I). To
facilitate in vivo investigation of b0,+AT in cystinuria, Slc7a9 knockout mice
have been generated. Expression of b0,+AT protein is completely abolished in the 
kidney of Slc7a9-/- mice ('Stones'). In contrast, Stones expressed significant
amounts of rBAT protein, which is covalently linked to unidentified light
subunit(s). Stones mice present a dramatic hyperexcretion of cystine and dibasic 
amino acids, while Slc7a9+/- mice show moderate but significant hyperexcretion of
these amino acids (phenotype non-I). Forty-two per cent of Stones mice develop
cystine calculi in the urinary system. Calculi develop during the first month of 
life and grow throughout the life span of the animals. Histopathology in kidney
reveals typical changes for urolithiasis (tubular and pelvic dilatation, tubular 
necrosis, tubular hyaline droplets and chronic interstitial nephritis). The fact 
that some Stones mice, generated in a mixed genetic background, develop cystine
calculi from an early age, while others do not develop them in their first year
of life, suggests the involvement of modifier genes in the lithiasis phenotype.
Thus, Stones provide a valid model of cystinuria which can be used in the study
of genetic, pharmacological and environmental factors involved in cystine
urolithiasis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12915471 [PubMed - indexed for MEDLINE]

1008: Kidney Int. 2003 Sep;64(3):1022-6.

The association between gout and nephrolithiasis in men: The Health
Professionals' Follow-Up Study.

Kramer HJ, Choi HK, Atkinson K, Stampfer M, Curhan GC.

Department of Preventive Medicine and Epidemiology, Division of Nephrology,
Loyola University Medical Center, Maywood, Illinois, USA.

Approximately 10 million adults in the United States have experienced the passage
of a kidney stone, and up to 5 million have been diagnosed with gout by a
physician. Previous reports have suggested that gout increases the risk for the
development of kidney stones, but there are no prospective data. We used data
from a cohort of 51,529 male health care professionals to examine the independent
association between gout and kidney stone disease. In a cross-sectional analysis 
of gout and kidney stone disease reported on the 1986 baseline questionnaire, the
prevalence of kidney stone disease was almost twofold higher in men with history 
of gout compared to those without (15% vs. 8%). After adjusting for age and body 
mass index (BMI), a history of gout remained significantly associated with kidney
stone disease (OR 1.88; 95% CI 1.68 to 2.11). We then prospectively examined the 
risk of incident kidney stones in men with and without a confirmed diagnosis of
gout after excluding men who reported a history of kidney stone disease or gout
on the baseline questionnaire. A confirmed diagnosis of gout increased the
multivariate relative risk of incident kidney stones (RR 2.12; 95% CI 1.22 to
3.68). In contrast, a history of kidney stone disease was not associated with
increased risk of gout (RR 1.05; 95% CI 0.54 to 2.07). In conclusion, a history
of gout independently increases the risk for incident kidney stones in men.
Physicians should provide dietary counseling, such as increasing fluid intake and
decreasing salt consumption, to subjects with gout in addition to other risk
factors, such as family history of kidney stones, in order to decrease the
likelihood of stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12911552 [PubMed - indexed for MEDLINE]

1009: Eur Radiol. 2003 Nov;13(11):2513-20. Epub 2003 Jul 24.

Erratum in:
    Eur Radiol. 2007 Sep;17(9):2440.

Unenhanced helical computed tomography vs intravenous urography in patients with 
acute flank pain: accuracy and economic impact in a randomized prospective trial.

Pfister SA, Deckart A, Laschke S, Dellas S, Otto U, Buitrago C, Roth J, Wiesner
W, Bongartz G, Gasser TC.

Department of Radiology, University Hospital, Petersgraben 4, 4031, Basel,
Switzerland. pfister@centralnet.ch

Unenhanced helical computed tomography (UHCT) has evolved into a well-accepted
alternative to intravenous urography (IVU) in patients with acute flank pain and 
suspected ureterolithiasis. The purpose of our randomized prospective study was
to analyse the diagnostic accuracy of UHCT vs IVU in the normal clinical setting 
with special interest on economic impact, applied radiation dose and time savings
in patient management. A total of 122 consecutive patients with acute flank pain 
suggestive of urolithiasis were randomized for UHCT ( n=59) or IVU ( n=63).
Patient management (time, contrast media), costs and radiation dose were
analysed. The films were independently interpreted by four radiologists, unaware 
of previous findings, clinical history and clinical outcome. Alternative
diagnoses if present were assessed. Direct costs of UHCT and IVU are nearly
identical (310/309 Euro). Indirect costs are much lower for UHCT because it saves
examination time and when performed immediately initial abdominal plain film
(KUB) and sonography are not necessary. Time delay between access to the
emergency room and start of the imaging procedure was 32 h 7 min for UHCT and 36 
h 55 min for IVU. The UHCT took an average in-room time of 23 min vs 1 h 21 min
for IVU. Mild to moderate adverse reactions for contrast material were seen in 3 
(5%) patients. The UHCT was safe, as no contrast material was needed. The mean
applied radiation dose was 3.3 mSv for IVU and 6.5 mSv for UHCT. Alternative
diagnoses were identified in 4 (7%) UHCT patients and 3 (5%) IVU patients.
Sensitivity and specificity of UHCT and IVU was 94.1 and 94.2%, and 85.2 and
90.4%, respectively. In patients with suspected renal colic KUB and US may be the
least expensive and most easily accessable modalities; however, if needed and
available, UHCT can be considered a better alternative than IVU because it has a 
higher diagnostic accuracy and a better economic impact since it is more
effective, faster, less expensive and less risky than IVU. In addition, it also
has the capability of detecting various additional renal and extrarenal
pathologies.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Review

PMID: 12898174 [PubMed - indexed for MEDLINE]

1010: Urol Int. 2003;71(2):143-5.

Relook percutaneous nephrolithotomy: a simple technique to re-enter the
pelvicalyceal system.

Goel A, Aron M, Gupta NP, Hemal AK.

Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New
Delhi, India.

We describe a simple technique of reentry into the pelvicalyceal system for
removal of residual fragments that is simple, rapid and cheap. Copyright 2003 S. 
Karger AG, Basel

PMID: 12890949 [PubMed - indexed for MEDLINE]

1011: J Paediatr Child Health. 2003 Jul;39(5):381-5.

Carbohydrate intolerance and kidney stones in children in the Goldfields.

Baldwin DN, Spencer JL, Jeffries-Stokes CA.

University of Western Australia, Department of Paediatrics, Rural Paediatric
Unit, Kalgoorlie, Western Australia, Australia.

Renal stones have been reported as a common finding in Australian Aboriginal
children. The stones are predominantly urate in composition. We report on five
children with nephrolithiasis from the Goldfields region of Western Australia.
All were diagnosed when under 5 years of age, the majority being under 3 years.
All five children also had lactose intolerance, and we postulate that
carbohydrate malabsorption, together with the ensuing chronic diarrhoea and
intraluminal breakdown of sugars by enteric bacteria may result in a situation of
chronic metabolic acidosis. Chronic metabolic acidosis can lead to protein
catabolism, increased urate excretion and the formation of renal stones.
Carbohydrate intolerance may be an aetiological factor in the development of
renal stones and possibly chronic renal disease, particularly in Aboriginal
Australians. Renal disease represents one of the most significant factors
affecting the health of Australian Aboriginal people. The incidence of end stage 
renal failure in this population exceeds that of non-Aboriginals by a factor of
13:1, and this disproportionate figure is increasing. It is likely that chronic
renal damage is multifactorial; however, it is probable that at least some
aetiological factors have their onset during childhood.

Publication Types: 
    Case Reports

PMID: 12887672 [PubMed - indexed for MEDLINE]

1012: Ultrasound Med Biol. 2003 Jul;29(7):1045-52.

Dual-pulse lithotripter accelerates stone fragmentation and reduces cell lysis in
vitro.

Sokolov DL, Bailey MR, Crum LA.

Center for Industrial and Medical Ultrasound, Applied Physics Laboratory,
University of Washington, Seattle, WA 98105, USA.

Lithotripsy is a common effective treatment for kidney stones. However, focal
volumes are often larger than stones, and surrounding tissue is often injured.
Our goal was to test in vitro a new lithotripter consisting of two opposing,
confocal and simultaneously triggered electrohydraulic sources. The pulses
superimpose at the common focus, resulting in pressure doubling and enhanced
cavitation growth in a localized, approximately 1-cm wide volume. Model gypsum
stones and human erythrocytes were exposed to dual pulses or single pulses. At
the focus, model stones treated with 100 dual pulses at a charging voltage of 15 
kV broke into 8 times the number of fragments as stones treated with 200 single
pulses at 18 kV. At axial positions 2 and 4 cm away from the focus, lysis of
erythrocytes was reduced or equivalent for dual pulses vs. single pulses. Hence, 
in half the time, dual pulses increased comminution at the focus without
increasing injury in surrounding regions.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12878251 [PubMed - indexed for MEDLINE]

1013: Chin Med J (Engl). 2003 Apr;116(4):569-72.

Decreased renal vitamin K-dependent gamma-glutamyl carboxylase activity in
calcium oxalate calculi patients.

Chen J, Liu J, Zhang Y, Ye Z, Wang S.

Department of Urology, Wuhan First Hospital, Wuhan 430022, China.
jhch800@hotmail.com

OBJECTIVE: To study the activity of vitamin K-dependent gamma-glutamyl
carboxylase in patients with calcium oxalate (CaOx) urolithiasis compared with
healthy individuals and to assess its relationship to the renal calcium oxalate
urolithiasis. METHODS: Renal parenchymas were harvested from urolithic patients
and renal tumor patients undergoing nephrectomy. The renal carboxylase activity
was evaluated as the radioactivity of [(14)C] labeled sodium bicarbonate in
carboxylic reactions in vitro using beta-liquid scintillation counting. RESULTS: 
Significantly reduced activity of renal vitamin K-dependent gamma-glutamyl
carboxylase was observed in the urolithic group as compared with normal controls 
(P < 0.01). CONCLUSION: It suggests that the reduced carboxylase activity
observed in the urolithic patients may play an important role in the course of
renal calcium oxalate urolithiasis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12875724 [PubMed - indexed for MEDLINE]

1014: Am J Med. 2003 Jul;115(1):26-32.

Predictive value of kidney stone composition in the detection of metabolic
abnormalities.

Pak CY, Poindexter JR, Adams-Huet B, Pearle MS.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, Dallas, Texas 75390-8885, USA.
charles.pak@utsouthwestern.edu

PURPOSE: To determine if kidney stone composition can predict the underlying
medical diagnosis, and vice versa. METHODS: We studied 1392 patients with kidney 
stones who underwent a complete ambulatory evaluation and who submitted one or
more stones for analysis. We ascertained the associations between medical
diagnosis and stone composition. RESULTS: The most common kidney stones were
composed of calcium oxalate (n = 1041 patients [74.8%]), mixed calcium
oxalate-calcium apatite (n = 485 [34.8%]), and calcium apatite alone (n = 146
[10.5%]). The most common medical diagnoses were hypocitraturia (n = 616 patients
[44.3%]), absorptive hypercalciuria (n = 511 [36.7%]), and hyperuricosuria (n =
395 [28.4%]). Calcium apatite and mixed calcium oxalate-calcium apatite stones
were associated with the diagnoses of renal tubular acidosis and primary
hyperparathyroidism (odds ratios >/=2), but not with chronic diarrheal syndromes.
As the phosphate content of the stone increased from calcium oxalate to mixed
calcium oxalate-calcium apatite, and finally to calcium apatite, the percentage
of patients with renal tubular acidosis increased from 5% (57/1041) to 39%
(57/146), and those with primary hyperparathyroidism increased from 2% (26/1041) 
to 10% (14/146). Calcium oxalate stones were associated with chronic diarrheal
syndromes, but not with renal tubular acidosis. Pure and mixed uric acid stones
were strongly associated with a gouty diathesis, and vice versa. Chronic
diarrheal syndromes and uric acid stones were associated with one another, and
brushite stones were associated with renal tubular acidosis. As expected, there
was a very strong association between infection stones and infection, and between
cystine stones and cystinuria. CONCLUSION: Stone composition has some predictive 
value in diagnosing medical conditions, and vice versa, especially for
noncalcareous stones.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12867231 [PubMed - indexed for MEDLINE]

1015: Urol Res. 2003 Aug;31(4):257-61. Epub 2003 Jul 11.

Impaired expression of an organic cation transporter, IMPT1, in a knockout mouse 
model for kidney stone disease.

Tzortzaki EG, Yang M, Glass D, Deng L, Evan AP, Bledsoe SB, Stambrook PJ, Sahota 
A, Tischfield JA.

Department of Genetics, Rutgers University, 604 Allison Road, NJ 08854-8082,
Piscataway, USA.

The imprinted multimembrane-spanning polyspecific transporter-like gene 1 (
IMPT1) encodes a predicted protein with organic cation transport capabilities. As
a first step in understanding the function of IMPT1, we identified the renal
structures expressing this gene in knockout mice with adenine
phosphoribosyltransferase (APRT) deficiency and 2,8-dihydroxyadenine (DHA)
nephrolithiasis. IMPT1 mRNA was not detected using a standard in situ
hybridization (ISH) protocol, but we observed intense staining in
cortico-medullary tubules and glomeruli in wild-type mice using an improved
reverse transcription-polymerase chain reaction (RT-PCR) ISH procedure. IMPT1
mRNA expression was significantly decreased in the cortical region in kidney
sections from APRT-deficient male mice. APRT-deficient female mice are less
severely affected by DHA-induced kidney stone disease, and we observed only a
modest reduction in IMPT1 expression in kidneys from these mice. IMPT1 expression
in APRT heterozygous mice was comparable to that in wild-type mice, suggesting
imprinting of one of the parental alleles. These findings suggest that decreased 
IMPT1 mRNA expression may contribute to the impaired renal function in
APRT-deficient male mice, and that RT-PCR ISH is a valuable tool for localizing
the site of expression of transcripts that are not detectable using standard ISH 
procedures.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12856169 [PubMed - indexed for MEDLINE]

1016: Urol Res. 2003 Aug;31(4):242-56. Epub 2003 Jul 11.

Oxalate binding proteins in calcium oxalate nephrolithiasis.

Selvam R, Kalaiselvi P.

Department of Medical Biochemistry, Dr ALM Post-Graduate Institute of Basic
Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India.

The existence of several oxalate specific binding proteins have been demonstrated
in human and rat kidney. These occur in both cortical and medullary cells and are
distributed mostly in the subcellular organelles. About 1/3 of the total cellular
oxalate binding was localised in the inner mitochondrial membrane while the rest 
was in the nucleus. The purified mitochondrial oxalate binding protein (62 kDa)
was composed, with a higher molar proportion, of basic amino acids, and could
accumulate oxalate on incorporation into liposomes. In the nucleus, histone H(1B)
(27.5 kDa), nuclear membrane protein (68 kDa) and nuclear pore complex protein
(205 kDa) were present with oxalate binding activities. In addition, a 45 kDa
calcium oxalate binding protein was identified in most of the subcellular
organelles. Both mitochondrial and nuclear oxalate binding proteins and calcium
oxalate binding protein have shown the kinetic properties of specificity,
saturability, pH and temperature dependency, energy of activation and inhibition 
by substrate analogues. All oxalate binding proteins were sensitive to the
transport inhibitor 4'-4' diisothiocyano stilbene-2-2 disulphonic acid (DIDS),
which is known to interact with the lysine moiety of the proteins. Calcium
oxalate monohydrate (COM) crystals adsorbed oxalate binding proteins from human
and rat kidney, and oxalate binding proteins isolated from human kidney stone
matrix also exhibited the above kinetic properties. In experimental
hyperoxaluria, all of the renal oxalate binding proteins showed enhanced oxalate 
binding activity with increased protein concentration. This enhanced oxalate
binding activity was also attributed to increased lipid peroxidation, which
correlated positively, and to decreased thiol status, which correlated
negatively. A positive correlation was observed between the lipid peroxidation
and both the oxalate binding activity of the in vitro peroxidised subcellular
organelles and the purified protein. Similarly, in an in vivo hyperoxaluric
condition, a negative correlation was observed between thiol content and both the
oxalate binding activity of the peroxidised subcellular organelles and the
purified protein. In the calcium oxalate crystal growth system, the oxalate
binding proteins behaved either as promoters or inhibitors of the nucleation and 
aggregation of crystals. Following the peroxidation of the proteins, the degree
of effect of the promoter protein was further stimulated while the degree of
inhibition caused by the inhibitor protein further declined. Similar observations
were duplicated with the proteins derived from hyperoxaluric rat kidney or kidney
homogenate subjected to in vitro lipid peroxidation. The oxalate binding proteins
were thought to modulate the crystallisation process in an hyperoxaluric
condition similar to calcium specific binding protein modulators.

Publication Types: 
    Review

PMID: 12856168 [PubMed - indexed for MEDLINE]

1017: J Urol. 2003 Aug;170(2 Pt 1):393-6.

Thiazide does not affect urine oxalate excretion.

Parks JH, Coe FL.

Nephrology Section, University of Chicago, Illinois 60637, USA.

PURPOSE: We assessed the effects of thiazide treatment on urine oxalate excretion
in patients with kidney stones. MATERIALS AND METHODS: Of 537 patients (231
women), 209 (81 women) received thiazide for stone prevention. Urine oxalate was 
measured in 3, 24-hour urines before treatment, and in 1, 24-hour urine after 6
to 12 weeks of treatment. This was an observational cohort and treatment was not 
randomized. RESULTS: Urine oxalate increased in general. There was no difference 
in increase with or without thiazide, whether one considered simple t test
comparisons or used ANOVA with pretreatment oxalate excretion as a covariate.
CONCLUSIONS: Thiazide administration exerts no measurable effect on urine oxalate
excretion that can be detected in clinical practice.

Publication Types: 
    Clinical Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 12853783 [PubMed - indexed for MEDLINE]

1018: Crit Rev Eukaryot Gene Expr. 2003;13(1):55-72.

Mechanisms mediating oxalate-induced alterations in renal cell functions.

Jonassen JA, Cao LC, Honeyman T, Scheid CR.

Department of Physiology, University of Massachusetts Medical School, Worcester, 
MA 01655, USA. Julie.Jonassen@umassmed.edu

Oxalate is a major component of the most common form of kidney stones--calcium
oxalate stones. High concentrations of oxalate promote stone formation in two
ways: (1) by providing urinary conditions favorable to the formation of calcium
oxalate crystals, and (2) by inducing renal injury that generates cellular debris
and promotes crystal nucleation and attachment. Oxalate toxicity is mediated in
part by activation of lipid signaling pathways that produce arachidonic acid,
lysophospholipids, and ceramide. These lipids disrupt mitochondrial function by
increasing reactive oxygen species (ROS), decreasing mitochondrial membrane
potential, and increasing mitochondrial permeability. The net response is
cytochrome C release, activation of caspases, and apoptosis or necrosis. Not all 
cells succumb to oxalate toxicity, however, in those cells that don't, ROS and
lipid-signaling molecules induce changes in gene expression that allow them to
survive and adapt to the toxic insult. The increased expression of immediate
early genes (IEGs), osteopontin, extracellular matrix (ECM) proteins,
crystallization inhibitors, and chemokines orchestrates a group of cellular
responses--including cell proliferation, secretion of kidney stone inhibitory
proteins, recruitment of immune cells, and tissue remodeling--that limit
accumulation of cell debris or increase the production of inhibitors of calcium
oxalate crystallization, thereby limiting stone formation.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12839097 [PubMed - indexed for MEDLINE]

1019: Urology. 2003 Jul;62(1):17-21.

Early changes of oxalate and calcium urine excretion in those with calcium
oxalate stone formation after extracorporeal shock wave lithotripsy.

Oehlschläger S, Albrecht S, Hakenberg OW, Schrödter S, Froehner M, Manseck A,
Wirth MP.

Department of Urology, Technical University Dresden, Dresden, Germany.

OBJECTIVES: To determine the extent of transient changes of tubular function in
idiopathic calcium-oxalate (CaOx) stone-bearing patients after extracorporeal
shock wave lithotripsy (ESWL), calcium and oxalate excretion were measured before
and after ESWL.METHODS: In 22 patients with renal CaOx stones, the plasma values 
and urine excretion of creatinine, calcium, oxalate, magnesium, and citrate were 
measured before and on days 1 and 2 after ESWL under conditions of a standardized
diet. Overnight urine collection for an 8-hour period was used to measure the
urine excretion, and the values were extrapolated to a 24-hour period. For
calculation of the urine ion activity, the AP(CaOx) index EQ(s) and the CaOx risk
index were used. RESULTS: After ESWL, hyperoxaluria was noted in 10 patients
compared with 2 before ESWL. Hypercalciuria was seen in 11 patients after ESWL
compared with 3 before. Combined hyperoxaluria and hypercalciuria was found in 7 
patients after ESWL compared with 1 before. Both the oxalate/creatinine and
calcium/creatinine ratios were significantly increased after ESWL. The AP(CaOx)
index EQ(s) and the CaOx risk index were significantly increased after ESWL in
patients with increased post-ESWL calcium and/or oxalate excretion. CONCLUSIONS: 
Increased calcium and/or oxalate excretion can be seen in patients with CaOx
stones early after ESWL. This increased excretion of lithogenic substances
represents an increased risk of fragment apposition after ESWL for the group with
a significantly increased AP(CaOx) index EQ(s) and CaOx risk index. Therefore,
prophylactic measures in patients at risk early after ESWL might be warranted to 
prevent possible recurrent stone formation.

Publication Types: 
    Comparative Study

PMID: 12837412 [PubMed - indexed for MEDLINE]

1020: Urology. 2003 Jul;62(1):10-5; discussion 15-6.

Extracorporeal shock wave lithotripsy in anomalous kidneys: 11-year experience
with two second-generation lithotripters.

Sheir KZ, Madbouly K, Elsobky E, Abdelkhalek M.

Department of Urology, Mansoura Urology and Nephrology Center, Mansoura
University, Mansoura, Egypt.

OBJECTIVES:To present our experience with extracorporeal shock wave lithotripsy
(ESWL) in patients with anomalous kidneys and to determine the factors that may
influence the stone-free rate in such patients. METHODS: From February 1989 to
February 2000, 198 patients were treated for urolithiasis in anomalous kidneys
using ESWL. The mean patient age (SD) was 40.48 (11.53) years. The kidneys were
horseshoe in 49 (24.7%), malrotated in 120 (60.6%), and duplex in 29 (14.7%). All
patients were treated on an outpatient basis using two second-generation
lithotripters (Dornier MFL 5000 and Toshiba Echolith). Pretreatment auxiliary
measures were required in 6 patients (3%). Follow-up data were recorded at 3
months. The statistical analysis was performed using the chi-square and
Mann-Whitney U tests, with differences considered statistically significant if P 
<0.05. RESULTS: The mean stone length (SD) was 13.54 (5.49) mm. The stones were
single in 148 (74.7%), of new onset in 155 (78.3%), and on the right side in 82
(41.4%). All stones, but 5 (2.5%), were radiopaque. The overall stone-free rate
was 72.2%. Neither the type of renal anomaly nor the type of lithotripter had any
impact on the stone-free rate (P >0.05). Stone burden (length and number) had a
significant influence on the stone-free rate (P <0.05). No extraordinary
complications were recorded. Steinstrasse developed in 7 patients (3.5%). No
deterioration of renal function or configuration was detected. CONCLUSIONS: ESWL 
is safe and reliable for treatment of urolithiasis in anomalous kidneys. It
should be the primary therapy when the stones are less than 20 mm. The ESWL
outcome is comparable for normal and anomalous kidneys when the calculus size is 
considered.

Publication Types: 
    Comparative Study
    Review

PMID: 12837409 [PubMed - indexed for MEDLINE]

1021: Am J Kidney Dis. 2003 Jul;42(1):1-11.

The association of nephrolithiasis with cystic fibrosis.

Gibney EM, Goldfarb DS.

University of Colorado Health Sciences Center, Denver, CO, USA.

BACKGROUND: There is a growing body of evidence regarding the association between
cystic fibrosis (CF) and nephrolithiasis and the role that Oxalobacter formigenes
may have in that association. METHODS: We performed a MEDLINE search of "cystic
fibrosis and nephrolithiasis" and "Oxalobacter formigenes." Epidemiological and
experimental evidence and possible mechanisms explaining the association were
critically reviewed. RESULTS: Of patients with CF, 3.0% to 6.3% are affected with
nephrolithiasis, a percentage greater than that of age-matched controls without
CF, in whom the rate is 1% to 2%. Studies have suggested possible mechanisms for 
the association, including hyperuricosuria, hyperoxaluria, primary defects in
calcium handling caused by mutation of the CF transmembrane regulator (CFTR),
hypocitraturia, and lack of colonization with O formigenes, an enteric
oxalate-degrading bacterium. The absence of colonization could be related to
frequent courses of antibiotics. CONCLUSION: Although the incidence of stones in 
patients with CF may be increased compared with controls without CF, many
possible mechanisms are implicated. The relative contributions of these
mechanisms remain uncertain. Future directions may include specific
identification of lithogenic risks and therapy aimed at stone prevention in this 
population.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12830451 [PubMed - indexed for MEDLINE]

1022: Pediatr Radiol. 2003 Sep;33(9):648-51. Epub 2003 Jun 26.

Ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis in a child.

Prince JS, Senac MO Jr.

Department of Radiology, UCSD Medical Center, 200 West Arbor Dr., Mail Code 8756,
San Diego, CA 92103-8756, USA. jeffreysprince@earthlink.net

Ceftriaxone is a widely used third-generation cephalosporin. It is generally very
safe, but complications of biliary pseudolithiasis and, rarely, nephrolithiasis
have been reported in children. These complications generally resolve
spontaneously with cessation of the ceftriaxone therapy; however, they may
symptomatically mimic more serious clinical problems, such as cholecystitis. We
report a case of both ceftriaxone-induced biliary pseudolithiasis and
nephrolithiasis.

Publication Types: 
    Case Reports

PMID: 12830336 [PubMed - indexed for MEDLINE]

1023: BJU Int. 2003 Jul;92(1):137-40.

Prophylaxis of calcium oxalate stones by Herniaria hirsuta on experimentally
induced nephrolithiasis in rats.

Atmani F, Slimani Y, Mimouni M, Hacht B.

Laboratory of Cellular Physiology and Pharmacology, Department of Biology,
University Mohammed 1, Oujda, Morocco. atmani@sciences.univ-oujda.ac.ma

OBJECTIVE: To evaluate the prophylactic potential of a herbal decoction from
Herniaria hirsuta, a medicinal plant widely used in Morocco to treat kidney
stones, by assessing the effect of oral administration in experimentally induced 
calcium oxalate (CaOx) nephrolithiasis in rats. MATERIAL AND METHODS: Two groups 
of six rats each were rendered nephrolithic by treating with ethylene glycol
0.75% and ammonium chloride 1% for 3 days, and then ethylene glycol only for 3
weeks. Maintained on ethylene glycol, one group of rats was also given 1 mL/day
of the plant decoction, while the others received 1 mL of water instead for 2
weeks. Urine samples (24 h) were collected individually at 1, 3, 7, and 14 days
for physicochemical analysis. On completing the treatment the kidneys were
collected and analysed by light microscopy. RESULTS: The water intake and
diuresis decreased in the treated rats; there was no significant difference in
urinary pH between the groups. Urinary chemistry was apparently unaffected by the
plant extract, except for the magnesium content, which was higher in treated
rats. Crystalluria was characterized by the excretion of large CaOx monohydrate
and dihydrate crystals in untreated, but smaller crystals in treated rats. The
histology showed large deposits of CaOx crystals in all parts of the kidney in
untreated rats but with almost no deposits in those of treated rats. CONCLUSION: 
H. hirsuta has an impressive prophylactic effect on CaOx stones in nephrolithic
rats; the effect did not seem to be mediated by biochemical or diuretic changes.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12823398 [PubMed - indexed for MEDLINE]

1024: BJU Int. 2003 Jul;92(1):92-6.

The effect of drotaverine hydrochloride in acute colicky pain caused by renal and
ureteric stones.

Romics I, Molnár DL, Timberg G, Mrklic B, Jelakovic B, Köszegi G, Blaskó G.

Urology Clinic, Semmelweis University, SocioMed Ltd, Budapest, Hungary.
romimre@urol.sote.hu

OBJECTIVE: To assess the spasmolytic effect of drotaverine hydrochloride in
colicky pain caused by renal and ureteric stones. PATIENTS AND METHODS: In a
placebo-controlled, multicentre, multinational, randomized, double-blind study
changes in the intensity of pain were recorded using a visual analogue scale
(VAS), a four-grade (five points) pain intensity (PI) scale and a pain-relief
scale. The primary endpoint was the evaluation of the antispasmodic effect of
drotaverine during a 3-h study period, to confirm that drotaverine abolished or
significantly decreased the intensity of pain in renal colic. The painkilling
effect was defined as a decrease by at least half in the PI scale, and/or a >or= 
40% decrease in the VAS 40 min after either the first or the second injection of 
80 mg drotaverine or placebo (if necessary the dose could be repeated once). In
all, 140 patients were enrolled but 38 withdrew, leaving 102 patients for
analysis (48 drotaverine, 54 placebo; mean age 42.5 years, sd 11.25, and 41.7, sd
10.79). RESULTS: Drotaverine was effective in 79% of patients and placebo in only
46% (P < 0.001). There were no serious adverse effects. There were 20 minor
side-effects in the drotaverine and four in the placebo group; none of the
patients required treatment. The most frequent side-effects were a transitory
decrease in blood pressure, vertigo, nausea or vomiting. CONCLUSION: Intravenous 
drotaverine provides effective pain relief in more than two-thirds of patients
with renal colic, with no serious side-effects.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial

PMID: 12823389 [PubMed - indexed for MEDLINE]

1025: J Am Soc Nephrol. 2003 Jul;14(7):1844-50.

Quantitative trait loci for hypercalciuria in a rat model of kidney stone
disease.

Hoopes RR Jr, Reid R, Sen S, Szpirer C, Dixon P, Pannett AA, Thakker RV,
Bushinsky DA, Scheinman SJ.

Department of Medicine, State University of New York Upstate Medical University, 
750 East Adams Street, Syracuse, NY 13210, USA.

Hypercalciuria is the most common risk factor for kidney stones and has a
recognized familial component. The genetic hypercalciuric stone-forming (GHS) rat
is an animal model that closely resembles human idiopathic hypercalciuria, with
excessive intestinal calcium absorption, increased bone resorption, and impaired 
renal calcium reabsorption; overexpression of the vitamin D receptor (VDR) in
target tissues; and calcium nephrolithiasis. For identifying genetic loci that
contribute to hypercalciuria in the GHS rat, an F2 generation of 156 rats bred
from GHS female rats and normocalciuric WKY male rats was studied. The calcium
excretion was six- to eightfold higher in the GHS female than in the WKY male
progenitors. Selective genotyping of those F2 rats with the highest 30% and
lowest 30% rates of calcium excretion was performed, scoring 98 markers with a
mean interval of 23 cM across all 20 autosomes and the X chromosome. With the use
of strict criteria for significance, significant linkage was found between
hypercalciuria and a region of chromosome 1 at D1Rat169 (LOD, 2.91). Suggestive
linkage to regions of chromosomes 4, 7, 10, and 14 was found. The proportion of
phenotypic variance contributed by the region on chromosome 1, with appropriate
adjustments, was estimated to be 7%. Candidate genes encoding the VDR and the
calcium-sensing receptor were localized to regions on rat chromosomes 7 and 11,
respectively, but the suggestive quantitative trait locus on chromosome 7 was not
in the region of the VDR gene locus. Identification of genes that contribute to
hypercalciuria in this animal model should prove valuable in understanding
idiopathic hypercalciuria and kidney stone disease in humans.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12819244 [PubMed - indexed for MEDLINE]

1026: Eur Urol. 2003 Jul;44(1):150-4.

Polymorphisms in the vitamin D receptor gene and the risk of calcium
nephrolithiasis in children.

Ozkaya O, Söylemezoğlu O, Misirlioğlu M, Gönen S, Buyan N, Hasanoğlu E.

Department of Pediatric Nephrology, Gazi University School of Medicine, Ankara,
Turkey. ozanozkaya@yahoo.com

OBJECTIVE: Polymorphism in the Vitamin D Receptor (VDR) gene has recently been
reported to be associated with calcium metabolism disorders. This study was
conducted to investigate the association of VDR gene polymorphism with the risk
of calcium nephrolithiasis. METHODS: We investigated the VDR ApaI, BsmI and TaqI 
polymorphisms, in relation to serum calcium, phosphate, intact parathyroid
hormone and 1.25(OH)(2)D(3) in 64 hypercalciuric stone-forming children and 90
healthy children. DNA was isolated from peripheral blood, and genotyping was
performed with PCR-based methods. RESULTS: The frequency of ApaI AA genotype was 
significantly higher in the children with calcium nephrolithiasis than the
controls (chi(2)=9.5; p=0.008). The distribution of BsmI and TaqI genotypes in
stone-forming patients was similar to those in the control group. There was a
significant association between TaqI TT genotype and the strength of the family
history. The patients with TT genotype were observed to have a 8 times more risk 
than patients with Tt/tt genotype for recurrent stone episodes (OR 8, 95%CI
1.61-39.6). CONCLUSION: VDR genotype determination may provide a tool to identify
individuals who are at a risk for calcium nephrolithiasis.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12814692 [PubMed - indexed for MEDLINE]

1027: Urology. 2003 Jun;61(6):1244-5.

Ureteroscopically assisted percutaneous renal access.

Kidd CF, Conlin MJ.

Oregon Health and Science University, Portland 97201-3098, USA.

Percutaneous nephrostolithotomy is a common procedure for removing kidney stones.
Obtaining percutaneous access can be difficult in some patients. We describe our 
technique of ureteroscopically assisted percutaneous renal access for patients in
whom standard percutaneous access may be challenging.

Publication Types: 
    Case Reports

PMID: 12809911 [PubMed - indexed for MEDLINE]

1028: Urology. 2003 Jun;61(6):1092-6; discussion 1097.

Variability of renal stone fragility in shock wave lithotripsy.

Williams JC Jr, Saw KC, Paterson RF, Hatt EK, McAteer JA, Lingeman JE.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis 46202, USA.

OBJECTIVES: To measure, in an in vitro study, the number of shock waves to
complete comminution for 195 human stones, representing six major stone types.
Not all renal calculi are easily broken with shock wave lithotripsy. Different
types of stones are thought to have characteristic fragilities, and suggestions
have been made in published reports of variation in the fragility within some
types of stones, but few quantitative data are available. METHODS: Kidney stones 
classified by their dominant mineral content were broken in an unmodified Dornier
HM3 lithotripter or in a research lithotripter modeled after the HM3, and the
number of shock waves was counted for each stone until all fragments passed
through a sieve (3-mm-round or 2-mm-square holes). RESULTS: The mean +/- SD
number of shock waves to complete comminution was 400 +/- 333 per gram (n = 39)
for uric acid; 965 +/- 900 per gram (n = 75) for calcium oxalate monohydrate;
1134 +/- 770 per gram (n = 21) for hydroxyapatite; 1138 +/- 746 per gram (n = 13)
for struvite; 1681 +/- 1363 per gram (n = 23) for brushite; and 5937 +/- 6190 per
gram (n = 24) for cystine. The variation for these natural stones (83% +/- 15%
coefficient of variation) was greater than that for artificial (eg, gypsum-based)
stones (17% +/- 8%). CONCLUSIONS: The variability in stone fragility to shock
waves is large, even within groups defined by mineral composition. Thus, knowing 
the major composition of a stone may not allow adequate prediction of its
fragility in lithotripsy treatment. The variation in stone structure could
underlie the variation in stone fragility within type, but testing of this
hypothesis remains to be done.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12809867 [PubMed - indexed for MEDLINE]

1029: J Endourol. 2003 Apr;17(3):169-71.

Phase I trial of a temporary ureteral drainage stent.

Lingeman JE, Schulsinger DA, Kuo RL.

Clarian Health Partners, Methodist Hospital Institute for Kidney Stone Disease
and Indiana University School of Medicine, Indianapolis, Indiana, USA.

BACKGROUND AND PURPOSE: The temporary ureteral drainage stent (TUDS; Boston
Scientific/Microvasive, Natick, MA) is a biodegradable device that is designed to
maintain patency for 48 hours with gradual softening and spontaneous expulsion
thereafter. We evaluated the durability, patency, and safety of TUDS in a Phase I
clinical trial. PATIENTS AND METHODS: Eighteen stone patients requiring
sequential percutaneous nephrolithotomies (PNL) for complex stone disease
underwent antegrade TUDS placement following initial percutaneous treatment.
Nineteen devices were placed in 21 attempts, with one patient undergoing
bilateral TUDS placement. Day 2 nephrostograms were performed to allow assessment
of stent status and to demonstrate antegrade flow. Stents were removed at the
time of the secondary PNL (day 2 or 3). RESULTS: No complications occurred during
TUDS placement. On day 2, 1 stent had passed into the bladder. Eleven stents were
completely intact, with seven others partially intact. Day 2 ureteral patency was
demonstrated in all 19 stented ureters. Eighteen TUDS were removed completely
during the secondary PNL with one incident of partial retention. All stent
material had passed out of the body in all patients by 1 month. No adverse events
were attributable to the TUDS. CONCLUSIONS: The TUDS appears to facilitate
ureteral drainage for at least 48 hours after placement. Although occasional
stent tail detachments were noted, these did not interfere with device function. 
The safety profile of TUDS was favorable, with no complications attributable to
the device itself. A larger prospective clinical study in patients receiving TUDS
placed retrograde after uncomplicated ureteroscopic manipulation appears
appropriate on the basis of these initial findings.

Publication Types: 
    Clinical Trial
    Clinical Trial, Phase I
    Research Support, Non-U.S. Gov't

PMID: 12803989 [PubMed - indexed for MEDLINE]

1030: J Urol. 2003 Jul;170(1):48-51.

Comment in:
    J Urol. 2005 Dec;174(6):2424.

Percutaneous management of calculi within horseshoe kidneys.

Raj GV, Auge BK, Weizer AZ, Denstedt JD, Watterson JD, Beiko DT, Assimos DG,
Preminger GM.

Department of Urology, Duke University Medical Center, Durham, NC 27710, USA.

PURPOSE: Percutaneous treatment of patients with calculi in a horseshoe kidney
can be challenging due to the altered anatomical relationship in the
retroperitoneum. Therefore, we performed a multi-institutional review to assess
the safety and efficacy of this minimally invasive technique. MATERIALS AND
METHODS: Of 37 patients identified with calculi in a horseshoe kidney at 3
institutions 24 (65%) underwent percutaneous nephrolithotripsy as primary
treatment. Average patient age was 48.4 years and 75% of the patients were male. 
In 3 patients with staghorn calculi mean stone size as measured by computed
digitized stone surface area was 448 mm2. Mean followup was 5.8 months. The
stone-free rate, complication rate, need for secondary intervention and stone
composition were evaluated. RESULTS: Renal access was obtained through an upper
pole calix in 63% of the cases, a lower calix in 25% and a middle calix in 4%.
Access location was not documented in 1 patient (4%). Of the 24 patients 21
(87.5%) were rendered stone-free after primary or second look procedures.
Flexible nephroscopy was used in 84% of cases. Minor complications occurred in 4 
patients (16.7%), whereas 3 (12.5%) experienced major complications, including
significant bleeding necessitating early cessation, nephropleural fistula and
pneumothorax. No deaths occurred as a result of this treatment choice. Stone
analysis was available for 21 cases (87.5%). Calcium stones predominated (87.5%),
followed by uric acid (9.5%) and struvite (4.8%). CONCLUSIONS: Percutaneous
treatment of patients with renal calculi in a horseshoe kidney is technically
challenging, usually requiring upper pole access and flexible nephroscopy due to 
the altered anatomical relationships of the fused renal units. The success rate
based on stone-free results and a relatively low incidence of major complications
suggest that this minimally invasive management option is an effective means of
stone management in this complex patient population.

Publication Types: 
    Multicenter Study

PMID: 12796642 [PubMed - indexed for MEDLINE]

1031: J Urol. 2003 Jul;170(1):45-7.

Computerized tomography guided access for percutaneous nephrostolithotomy.

Matlaga BR, Shah OD, Zagoria RJ, Dyer RB, Streem SB, Assimos DG.

Department of Urology, Wake Forest University School of Medicine, Medical Center 
Boulevard, Winston-Salem, NC 27157, USA.

PURPOSE: Access for percutaneous nephrostolithotomy (PNL) using conventional
fluoroscopic guidance may carry an increased risk of damage to surrounding organs
in patients with renal calculi and aberrant anatomy. In these situations
cross-sectional anatomical imaging may facilitate safe percutaneous access. We
describe our experience with computerized tomography (CT) guided percutaneous
access for such patients undergoing PNL. MATERIALS AND METHODS: Between June 2000
and December 2001, 154 patients underwent PNL at our institution. Five of these
patients (3%) required a total of 6 percutaneous access tracks under CT guidance.
All patients in this group had anatomical abnormalities precluding standard
access to the collecting system without risk to adjacent organs. These
abnormalities included a retrorenal colon in 2 and a severely distorted body
habitus due to spinal dysraphism in 3. RESULTS: Percutaneous access was achieved 
without complication in all cases. At subsequent PNL 5 of the 6 renal units (83%)
were rendered completely stone-free. CONCLUSION: CT guided percutaneous access is
infrequently required for PNL. However, there is a select group of patients with 
anatomical anomalies that may predictably require this procedure to facilitate
safe and efficacious PNL.

PMID: 12796641 [PubMed - indexed for MEDLINE]

1032: Clin Radiol. 2003 Jun;58(6):422-33.

Urinary tract stones--Part II: current status of treatment.

Sandhu C, Anson KM, Patel U.

Department of Radiology, St Georges' Hospital, London, UK.
uday.patel@stgeorges.nhs.uk

The majority of renal and ureteric stones are now managed by minimally invasive
techniques, for example nephrostomy, ureteral stents, extracorporeal shockwave
lithotripsy or percutaneous nephrolithotomy. A multi-disciplinary approach is
necessary, and this review examines the status of modern stone therapy and the
contribution of the radiology department.

Publication Types: 
    Review

PMID: 12788311 [PubMed - indexed for MEDLINE]

1033: Clin Radiol. 2003 Jun;58(6):415-21.

Urinary tract stones--Part I: role of radiological imaging in diagnosis and
treatment planning.

Sandhu C, Anson KM, Patel U.

Department of Radiology, St Georges' Hospital, London, UK.
uday.patel@stgeorges.nhs.uk

The modern management of urolithiasis requires a multi-disciplinary approach.
Imaging plays a central role in both diagnosis and planning therapy of renal and 
ureteric calculi. This article reviews the current status of diagnosis and
management of stone disease, and the contribution of radiological imaging in
accurately triaging a given case to the most appropriate therapy.

Publication Types: 
    Review

PMID: 12788310 [PubMed - indexed for MEDLINE]

1034: BJU Int. 2003 Jun;91(9):821-4.

Artificial neural networks in predicting optimum renal stone fragmentation by
extracorporeal shock wave lithotripsy: a preliminary study.

Hamid A, Dwivedi US, Singh TN, Gopi Kishore M, Mahmood M, Singh H, Tandon V,
Singh PB.

Department of Urology, Institute of Medical Sciences, Banaras Hindu University,
Varanasi, Uttar Pradesh, India.

OBJECTIVE: To assess the ability of artificial neural networks (ANNs) to predict 
optimum renal stone fragmentation in patients being managed by extracorporeal
shock wave lithotripsy (ESWL). PATIENTS AND METHODS: The study included 82
patients with renal stones who were being treated by ESWL. Data (input and output
values) from 60 patients in whom there was optimum fragmentation of stones by
ESWL were used for training the ANN. These data mainly included the 24-h urinary 
variables, the radiological features of the stone disease and the ESWL settings
used. The predictability of the trained ANN was tested on 22 subsequent patients,
by supplying the input variables of the 22 patients into the trained ANN and
recording the output values (predicted values). After subjecting these patients
to ESWL, the actual results (observed values) were recorded. The predicted and
the observed values were then compared. RESULTS: In the 22 patients in whom
predictability was tested, the trained ANN predicted optimum fragmentation at <
or = 13 000 shocks/stone (as per study protocol) in 17 and optimum fragmentation 
at> 13 000 shocks/stone in the other five. In the 17 patients (test set) where
the trained ANN had predicted optimum fragmentation at < or = 13 000
shocks/stone, the optimum fragmentation was at that value, although the predicted
and observed values were not identical. The overall correlation between the
predicted and the observed values was 75.5% (correlation coefficient 0.7547) in
these 17 patients. Of the other five patients, none had optimum fragmentation at 
< 13 000 shocks/stone, as predicted by the trained ANN, giving complete accuracy 
for this factor. CONCLUSION: This was a pilot study, i.e. an initial attempt to
use an ANN in this regard, and although there were few patients, such that it is 
not possible to make final recommendations, the overall predictability was
approximately 75%. An encouraging outcome of the study was that the trained ANN
identified patients unlikely to benefit from ESWL. Using a larger dataset and
identifying more significant variables, while eliminating inputs with a negative 
effect, the efficiency and utility of this ANN can probably be enhanced and in
future it might be possible to predict stone fragmentation with reasonable
accuracy.

PMID: 12780841 [PubMed - indexed for MEDLINE]

1035: Int Urol Nephrol. 2002;34(2):183-4.

Simple method of residual stone retrieval through the nephrostomy catheter after 
PCNL: point of technique.

Goel A, Aron M, Hemal AK, Gupta NP.

Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New
Delhi, India.

A simple technique of removal of residual stone fragments in patients who have
undergone percutaneous nephrolithotripsy (PCNL) and have a nephrostomy tube in
situ is described. Under local anesthesia and sedation a rigid 8.5 F ureteroscope
is passed through the nephrostomy tube and the stones retrieved. This technique
is indicated in patients who have 1-3 residual fragments, none larger than 5 mm, 
and located in the same calyx or pelvis as the tip of the nephrostomy tube.

PMID: 12775089 [PubMed - indexed for MEDLINE]

1036: J Nephrol. 2003 Mar-Apr;16(2):260-6.

Bone mass loss in calcium stone disease: focus on hypercalciuria and metabolic
factors.

Caudarella R, Vescini F, Buffa A, Sinicropi G, Rizzoli E, La Manna G, Stefoni S.

Department of Nephrology, Dialysis and Kidney Transplant, Unit of Mineral
Metabolism, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
renataca@med.unibo.it

BACKGROUND: Several authors have observed that idiopathic calcium stone formers
show a bone mass reduction, which is more evident in those with idiopathic
hypercalciuria. The aim of this work was the evaluation of osteopenia and
osteoporosis rate in a group of idiopathic calcium stone formers. The influence
of hypercalciuria, nutritional factors and anthropometric parameters on bone mass
was evaluated in these patients as well. METHODS: We enrolled 196 idiopathic
calcium stone formers; 102 males, and 94 females. All subjects underwent a
metabolic study. BMC and BMD were evaluated as well as QUS. RESULTS: Males showed
greater weight, height, BMI, densitometric values and plasma creatinine, uric
acid, urea, sodium, magnesium, GFR and urinary osmolarity than females. Moreover 
males excreted more uric acid, urea, creatinine, sulphate, phosphate, oxalate and
citrate than females. The prevalence of osteopenia and osteoporosis, according to
T-score, was 54% and 14% respectively. Hypercalciuria was demonstrated in 21.7%
of the patients. Hypercalciuric men showed a higher excretion of urea, phosphate,
sulphate and magnesium. CONCLUSIONS: Our results confirm the importance of QUS in
the evaluation of stone formers' bone mass. Anthropometric characteristics and
dietary habits seem to play a role in bone loss. We did not demonstrate any
influence of hypercalciuria on bone mass. Although the pathogenesis of bone loss 
in stone formers still remains unclear, it can be hypothesized that a slight
degree of metabolic acidosis, probably of alimentary origin, may be involved in
the reduction of bone mass.

Publication Types: 
    Comparative Study

PMID: 12768074 [PubMed - indexed for MEDLINE]

1037: Med Princ Pract. 2003 Jul-Sep;12(3):145-50.

Sectorial technetium-99m-dimercaptosuccinic acid scintigraphy for monitoring the 
effect of extracorporeal piezoelectric lithotripsy for calyceal calculi on
regional renal function.

Al-Tawheed A, Al-Awadi KA, Kehinde EO, Loutfi I, Abdul-Haleem H, Al-Mohannadi S.

Department of Surgery, Division of Urology, Faculty of Medicine, Kuwait
University, Safat, Kuwait.

OBJECTIVE: To apply a semiquantitative method for analysis of
technetium-99m-dimercaptosuccinic acid ((99m)Tc-DMSA) renal scintigraphy for
monitoring the effect of extracorporeal piezoelectric lithotripsy (EPL) in
patients with calyceal stones on regional kidney function and to check whether
EPL had caused any deleterious effect on the target calyceal renal parenchymal
function. PATIENTS AND METHODS: Forty patients (mean age 35 years) suffering from
calyceal stones documented by abdominal plain radiography, intravenous urogram or
abdominal ultrasound were studied. All patients were treated by EPL. (99m)Tc-DMSA
scan was performed before and 4 weeks after EPL. Sector analysis involved
calculation of the relative function of the target calyx to the function of the
ipsilateral kidney and the relative function of the treated kidney to global
renal function. RESULTS: The stone sizes were 6-11 mm in diameter and 11 were
located in the upper, 13 in the middle and 16 in the lower calyx. After EPL, the 
overall stone clearance rate was 85% (100% for calculi in the upper and middle
calyces, 62% for lower calyces). The sector analysis did not show statistically
significant change of the relative regional (calyceal) or whole kidney function
between the pre- and post-EPL (99m)Tc-DMSA scans. Using sector analysis, EPL
appeared to be a safe modality and its usage was not associated with any untoward
effect on calyceal or whole kidney function. CONCLUSION: Sector analysis of
(99m)Tc-DMSA renal scan is a simple semiquantitative method for monitoring
regional changes of kidney function after EPL for treatment of calyceal stone.
Copyright 2003 S. Karger AG, Basel

PMID: 12766330 [PubMed - indexed for MEDLINE]

1038: Med Sci Monit. 2003 May;9(5):CS25-8.

Use of drotrecorgin alfa--recombinant activated human protein C in treatment of
septic shock in the course of therapy for nephrolithiasis.

Biernacka J, Wośko J, Dabrowski W, Nestorowicz A.

Chair and 1st Department of Anesthesiology and Intensive Care, Medical University
of Lublin, Poland. jbiernac2@wp.pl

BACKGROUND: Septic shock is the most dangerous complication of nephrolithiasis
management utilizing percutaneous methods. CASE REPORT: The patient, D.M., aged
60 was subjected to scheduled percutaneous nephrolithotomy due to coral
calculosis of the pyelocalyceal system. As pyuria was noted intraoperatively,
nephrostomy was left after the procedure. Over ten hours after the surgery the
patient developed the symptoms of severe septic shock with progressive
respiratory distress, renal failure, intravascular coagulation syndrome and
impaired consciousness. Nephrectomy was performed, antibiotic treatment and high 
doses of norepinephrine instituted. Hemodynamic stabilization was obtained,
without, however, marked improvement of the patient's condition. Because of
persistent coagulation disorders and multiorgan dysfunction, recombinant
activated protein C preparation--drotrecorgin alfa (Xigris Eli Lilly) was added
to the therapeutic regimen. From the second day of infusion, systematic
improvement of the coagulation system parameters was observed, making it possible
to reduce the doses of catecholamines, oxygen concentration in the gas mixture
used for ventilation, as well as stabilization of the function of the preserved
kidney. The patient was weaned off the respirator on the 8th day of treatment and
on the 13th day referred to the Urology Department, from which she was soon
discharged home. CONCLUSIONS: 1. Surgical resection of the infection source and
cause of the septic shock is the prerequisite for successful pharmacological
treatment. 2. Administration of rh-APC to a patient meeting the PROWESS criteria 
may be an effective and safe method of treatment in the complex management of
septic shock.

Publication Types: 
    Case Reports

PMID: 12761458 [PubMed - indexed for MEDLINE]

1039: Saudi Med J. 2003 Apr;24(4):406-8.

Erratum in:
    Saudi Med J. 2003 Jun 6;24(6):693.

Isolation of Salmonella paratyphi A from a patient with nephrolithiases.

Al-Otaibi FE.

Department of Pathology/Microbiology, College of Medicine, King Khalid University
Hospital, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia.

We describe a case of Salmonella paratyphi A isolated from urine of a 37-year-old
Saudi patient who is a known case of nephrolithiasis and hydronephrosis with
frequent admission for management of renal stones. History of enteric fever was
not documented and urinary schistosomiasis in such a patient from endemic area is
a strong possibility. Relevant literature was discussed.

Publication Types: 
    Case Reports

PMID: 12754545 [PubMed - indexed for MEDLINE]

1040: Ultrasound Med Biol. 2003 May;29(5):705-12.

Hit/Miss monitoring of ESWL by spectral Doppler ultrasound.

Bohris C, Bayer T, Lechner C.

Dornier MedTech, Wessling, Germany. cbohris@dornier.com

The objective of this study was to investigate spectral Doppler ultrasound (US)
for monitoring extracorporeal shock-wave lithotripsy (ESWL). In vitro experiments
with model stones showed that Doppler spectra acquired after a shock wave hit
result in a high peak followed by a decaying signal. The duration of decay was
dependent on shock-wave energy, stone size, gas content of the water and the
level of disintegration. It typically ranged from 30 ms to 150 ms. It was found, 
by comparison with optical high-speed imaging and US B-scan imaging, that the
signal originated from fragments released by the stone and cavitation. If the
monitored volume contained no target, the signal duration was significantly
shorter. By this means, hits were reliably distinguished from misses. The results
of clinical treatments were highly consistent with those of in vitro experiments.
Therefore, spectral Doppler US is an excellent tool for hit/miss monitoring in
ESWL.

PMID: 12754070 [PubMed - indexed for MEDLINE]

1041: Eur J Pediatr. 2003 Jul;162(7-8):481-7. Epub 2003 May 16.

Urinary lithogenic and inhibitory factors in preterm neonates receiving either
total parenteral nutrition or milk formula.

Giapros VI, Papaloukas AL, Challa AS, Nikolopoulos PD, Tsampoulas CG, Andronikou 
SK.

Neonatology and Research Laboratory of Child Health, Child Health Department,
University of Ioannina Medical School, PO Box 1186, Ioannina 451 10, Greece.
sandroni@cc.uoi.gr

The aim of this study was to evaluate prospectively the influence of nutrition on
certain factors which may inhibit or promote nephrocalcinosis in two groups of
preterm infants, receiving total parenteral nutrition (TPN) and special preterm
milk formula respectively, but not furosemide. A total of 37 preterm infants, 15 
on TPN and 22 fed a special preterm formula were studied at the end of the 1st,
2nd and 3rd weeks of life, at which time serum and 8 h urine specimens were
collected. High ratios of urinary calcium to urinary creatinine (UCa/cr), urinary
oxalate to urinary creatinine (Uox/cr) and urinary calcium to urinary citrate
(UCa/cit) indicates an increased risk for nephrocalcinosis while high urinary
citrate to urinary creatinine (Ucit/cr) ratio indicates protection. Uox/cr
increased significantly (P<0.05) in those infants fed preterm formula, from the
end of 2nd week of life and was two-fold higher than in the TPN group of preterm 
infants (P<0.01). Ucit/cr was higher throughout the study period in the formula
fed than in the TPN preterm infants. UCa/cit was five-fold higher (P<0.01) in the
TPN group, by the end of the 3rd week. Urinary calcium and magnesium was similar 
in both groups during the study period. Two of the infants studied (5.4%), one
from each group, developed nephrocalcinosis.CONCLUSION: In preterm neonates on
total parenteral nutrition, urinary oxalate -to-creatinine ratio (a potent
lithogenic factor) was lower and urinary citrate -to-creatinine ratio (a
lithoprotective factor) also lower than in formula fed neonates. The type of
feeding (total parenteral nutrition or special preterm milk formula) seems to
affect urinary oxalate and citrate but not calcium and magnesium in
non-furosemide treated preterm infants during the first 3 weeks of life.

PMID: 12750999 [PubMed - indexed for MEDLINE]

1042: Med Inform Internet Med. 2002 Dec;27(4):229-36.

Segmentation of renal calculi in ultrasound images.

Sridhar S, Kumaravel N, Easwarakumar KS.

School of Computer Science and Engineering, Anna University, Chennai-600025,
India. ssridhar@annauniv.edu

An algorithm proposed by Sridhar and Kumaravel is extended to include a framework
for the detection of renal calculi. Calculi occur due to abnormal collection of
certain chemicals like oxalate, phosphate and uric acid. These calculi can be
present in the kidney, ureter or urinary bladder. Performance analysis is done to
a set of five known algorithms using parameters such as success rate in calculi
detection, border error metric and time. The framework is constructed by
combining the best algorithm based on the performance analysis and a procedure to
validate the detected calculi using the shadow it casts in ultrasound images.
Ultrasound images of 37 patients are used for testing the algorithm. The detected
calculi based on the framework match those determined by expert clinicians in
more than 95% of the cases.

Publication Types: 
    Validation Studies

PMID: 12745904 [PubMed - indexed for MEDLINE]

1043: Scand J Urol Nephrol. 2003;37(2):189-90.

Multiple myeloma presenting as bilateral renal complex stones.

Janane A, Ghadouane M, Alami M, Abbar M.

Department of Urology, Military Hospital Mohamed V, Rabat, Morocco.
a.janane@caramail.com

Hypercalcaemia is a frequent complication of multiple myeloma. A mild degree of
nephrocalcinosis has been noted in occasional patients and renal calculi are also
sometimes present. We report herein a case of multiple myeloma that was revealed 
by the presence of bilateral calcium renal staghorn calculi. Medical treatment of
myeloma, surgical management of this complex lithiasis and the course of multiple
myeloma are discussed.

Publication Types: 
    Case Reports

PMID: 12745734 [PubMed - indexed for MEDLINE]

1044: Chir Ital. 2003 Mar-Apr;55(2):279-82.

Pancreatic pseudocyst caused by extracorporeal shock wave lithotripsy for right
renal pelvic calculi.

Florio G, Cicia S, Del Papa M, Carnì D.

Department of General Surgery, San Giovanni Evangelista Hospital, Tivoli, Roma.

A 39-year-old white man with a history of right renal pelvic stones treated 1
year before by extracorporeal shock wave lithotripsy, but with no history of
major surgery, alcoholism, pancreatitis, hyperparathyroidism or trauma, was
admitted, suffering from an abdominal mass. Abdominal and pelvic computed
tomography revealed an enlarged pancreatic head (9 cm in transverse diameter)
with, inside it, a heterogeneous, cyst-like structure, measuring 7 cm in
diameter. It was suspected that this lesion was a cystic neoplasm and the patient
underwent a proximal pancreaticoduodenectomy and a cholecystectomy. After the
operation, the microscopic findings ruled out the presence of a neoplasm and we
were obliged to reconsider the case. Speculating as to the possible role of past 
extracorporeal shock wave lithotripsy in determining the pancreatic pseudocyst,
it was found that damage to the intra-abdominal organs during extracorporeal
shock wave lithotripsy has been mentioned in published series, but it was also
noted that this case seemed to differ from the other published cases, where
cirrhosis and thrombocytopenia, gallbladder stones, or adhesions between the
pancreas and surrounding tissue caused by laparotomy were considered the causes
of the lithotripsy complications. We suggest a direct traumatic disruption of the
pancreas as a result of the extracorporeal shock wave lithotripsy and conclude
that the post-lithotripsy follow-up should include periodic ultrasonographic
investigation of the pancreas and serum amylase level determinations in order to 
diagnose pancreatic complications, if any, and plan the correct treatment.

Publication Types: 
    Case Reports

PMID: 12744107 [PubMed - indexed for MEDLINE]

1045: Ann Urol (Paris). 2003 Apr;37(2):47-50.

Effects of intraperitoneally administered vitamin E and selenium on calcium
oxalate renal stone formation: experimental study in rat.

Sakly R, Chaouch A, el Hani A, Najjar MF.

Ecole supérieure des sciences et techniques de la santé, avenue Avicenne, 5019
Monastir, Tunisia. sakly-esm@voila.fr

Forty-eight Wistar rats were treated for 3 weeks with water containing 0.7%
ethylene-glycol and divided into four groups. The first group, used as control,
has received sodium chloride at 1 ml/100 g BW daily. The second group was
intraperitoneally injected with selenium at 10 micrograms/d per 100 g BW as
NaSeO3 for 3 weeks. The third group was intraperitoneally administered with 15 mg
Vit E/d per 100 g BW as alpha-tocopherol acetate for 3 weeks. The last group was 
simultaneously administered vitamin E and Se at the same doses and periods as the
precedent groups. One day before the end of the treatment, each animal was placed
in a metabolic cage for collection of 24 h urine samples and determination of
urinary creatinin, urea, calcium, magnesium, phosphate and oxalate levels.
Immediately thereafter, all the rats were anesthetized and aortic blood was
collected to determine the same parameters as in urine. The kidneys were also
removed to determine calcium oxalate deposits, dry weight and to conduct a
histological examination. Our results showed decreased ionic product and
increased magnesium fractional reabsorption in the group receiving only selenium 
and in the group receiving selenium in combination with vitamin E, in comparison 
with the control animals. In view of the knowledge concerning the same protective
action of Vit E and selenium, regardless of tubular membrane alteration, the
absence of any inhibitory effect of Vit E on calcium oxalate formation suggests
that selenium, like other minerals, could be stuck onto the crystal surface and
would inhibit induction of new crystals, growth and aggregation.

PMID: 12741189 [PubMed - indexed for MEDLINE]

1046: Am J Hum Genet. 2003 Jun;72(6):1479-91. Epub 2003 May 9.

Identification of a novel gene and a common variant associated with uric acid
nephrolithiasis in a Sardinian genetic isolate.

Gianfrancesco F, Esposito T, Ombra MN, Forabosco P, Maninchedda G, Fattorini M,
Casula S, Vaccargiu S, Casu G, Cardia F, Deiana I, Melis P, Falchi M, Pirastu M.

Istituto di Genetica delle Popolazioni, Consiglio Nazionale delle Ricerche,
Alghero, Italy. F.Gianfrancesco@igm.ss.cnr.it

Uric acid nephrolithiasis (UAN) is a common disease with an established genetic
component that presents a complex mode of inheritance. While studying an ancient 
founder population in Talana, a village in Sardinia, we recently identified a
susceptibility locus of approximately 2.5 cM for UAN on 10q21-q22 in a relatively
small sample that was carefully selected through genealogical information. To
refine the critical region and to identify the susceptibility gene, we extended
our analysis to severely affected subjects from the same village. We confirm the 
involvement of this region in UAN through identical-by-descent sharing and
autozygosity mapping, and we refine the critical region to an interval of
approximately 67 kb associated with UAN by linkage-disequilibrium mapping. After 
inspecting the genomic sequences available in public databases, we determined
that a novel gene overlaps this interval. This gene is divided into 15 exons,
spanning a region of approximately 300 kb and generating at least four different 
proteins (407, 333, 462, and 216 amino acids). Interestingly, the last isoform
was completely included in the 67-kb associated interval. Computer-assisted
analysis of this isoform revealed at least one membrane-spanning domain and
several N- and O-glycosylation consensus sites at N-termini, suggesting that it
could be an integral membrane protein. Mutational analysis shows that a coding
nucleotide variant (Ala62Thr), causing a missense in exon 12, is in strong
association with UAN (P=.0051). Moreover, Ala62Thr modifies predicted protein
secondary structure, suggesting that it may have a role in UAN etiology. The
present study underscores the value of our small, genealogically
well-characterized, isolated population as a model for the identification of
susceptibility genes underlying complex diseases. Indeed, using a relatively
small sample of affected and unaffected subjects, we identified a candidate gene 
for multifactorial UAN.

PMID: 12740763 [PubMed - indexed for MEDLINE]

1047: Urol Int. 2003;70(4):265-8.

Evaluation of fragmentation with single or multiple pulse setting of Lithoclast
for renal calculi during percutaneous nephrolithotripsy and its impact on
clearance.

Hemal AK, Goel A, Aron M, Seth A, Dogra PN, Gupta NP.

Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New
Delhi, India. ahemal1@hfhs.org

OBJECTIVES: To evaluate the impact of single or multiple pulse settings of
Lithoclast to fragment renal calculi, and its effect on fragment size and
clearance. MATERIAL AND METHODS: In a prospective study 153 patients, who had
been treated over a period of 35 months for renal stone disease by percutaneous
nephrolithotomy, were evaluated. In 69 cases the single and in 84 cases the
multiple pulse modes were used to fragment the stone intracorporeally using the
pneumatic lithoclast. The 2 groups were similar with regard to patient
characteristics, stone location and size. RESULTS: Most stones were staghorn. The
lithoclast was effective with good fragmentation in all cases. The mean operating
and fluoroscopy times in the single and multiple pulse mode were 124.1 and 5.8,
and 141.2 and 7.4 min, respectively (both differences statistically significant, 
p < 0.001). Immediate postoperatively residual stone fragments were seen in 16
cases with the single and 35 cases with the multiple pulse mode setting
(difference statistically significant, p < 0.05). Relook procedures were required
in 14 cases with the single and 22 cases with the multiple pulse setting
(difference not statistically significant). No specific complication was seen
related to the use of either of the two modes. On follow-up 1 patient in the
multiple pulse setting developed stone recurrence after 19 months. CONCLUSIONS:
The single pulse mode was associated with controlled fragmentation of the stone, 
formation of larger fragments which were easier to pick up, less stone scatter,
shorter operating time and less exposure to fluoroscopy. The single pulse mode
was also associated with statistically less chances of postoperative residual
fragments. Copyright 2003 S. Karger AG, Basel

Publication Types: 
    Comparative Study

PMID: 12740488 [PubMed - indexed for MEDLINE]

1048: Ren Fail. 2003 Mar;25(2):315-22.

Donor calculi induced acute renal failure.

Qazi YA, Ali Y, Venuto RC.

Department of Medicine, State University of New York at Buffalo School of
Medicine and Biomedical Science, Erie County Medical Center, Buffalo, New York
14215, USA.

Nephrolithiasis is an infrequent complication following renal transplantation and
acquisition of a stone with the donor kidney is rare. Indeed only a few cases of 
donor stones causing renal failure have been reported. Since the grafted kidney
is denervated, stone disease may not present with the classic renal colic but
rather with acute renal failure secondary to the obstruction. Identification of
the precise cause is critical in order to avoid inappropriate therapy. We present
our experience of two renal transplant patients who developed obstructive
uropathy by stones originating from the donor kidneys.

Publication Types: 
    Case Reports

PMID: 12739839 [PubMed - indexed for MEDLINE]

1049: Biochem J. 2003 Aug 15;374(Pt 1):79-87.

Correction of an enzyme trafficking defect in hereditary kidney stone disease in 
vitro.

Lumb MJ, Birdsey GM, Danpure CJ.

Department of Biology, University College London, Gower Street, London WC1E 6BT, 
UK.

In normal human hepatocytes, the intermediary-metabolic enzyme alanine:glyoxylate
aminotransferase (AGT) is located within the peroxisomes. However, in approx.
one-third of patients suffering from the hereditary kidney stone disease primary 
hyperoxaluria type 1, AGT is mistargeted to the mitochondria. AGT mistargeting
results from the synergistic interaction between a common P11L (Pro11-->Leu)
polymorphism and a disease-specific G170R mutation. The polymorphism generates a 
functionally weak mitochondrial targeting sequence, the efficiency of which is
increased by the mutation. The two substitutions together, but not in isolation, 
inhibit AGT dimerization, highlighting the different structural requirements of
the peroxisomal and mitochondrial protein-import machineries. In the present
study, we show that treatments known to increase the stability of proteins
non-specifically (i.e. lowering the temperature from 37 to 30 degrees C or by the
addition of glycerol) completely normalize the intracellular targeting of mutant 
AGT expressed in transfected COS cells. On the other hand, treatments known to
decrease protein stability (e.g. increasing the temperature from 37 to 42 degrees
C) exacerbate the targeting defect. Neither of the treatments affects the
relative efficiencies of the peroxisomal and mitochondrial protein-import
pathways intrinsically. Results are discussed in the light of the known
structural requirements of the two protein trafficking pathways and the
formulation of possible treatment strategies for primary hyperoxaluria type 1.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12737622 [PubMed - indexed for MEDLINE]

1050: Urology. 2003 May;61(5):1035.

Resolution of ephedrine stones with dissolution therapy.

Hoffman N, McGee SM, Hulbert JC.

Department of Urologic Surgery, University of Minnesota Medical School,
Minneapolis, Minnesota 55455, USA.

A patient with a history of ingesting large quantities of an over-the-counter
stimulant developed renal calculi that on further analysis, after stone passage, 
revealed increased amounts of ephedrine. Over the course of 7 months, all of the 
patient's ephedrine stones were managed successfully by alkalinization. Similar
to previously reported ephedrine calculi, these stones were radiolucent on x-ray 
imaging, but their course was monitored on serial nonenhanced computed tomography
scans. We believe this to be the first reported use of alkaline therapy for the
dissolution of renal stones containing ephedrine.

Publication Types: 
    Case Reports

PMID: 12736038 [PubMed - indexed for MEDLINE]

1051: Urology. 2003 May;61(5):902-5.

Does shock wave lithotripsy of renal stones cause cardiac muscle injury? A
troponin I-based study.

Greenstein A, Sofer M, Lidawi G, Matzkin H.

Department of Urology, Tel Aviv Sourasky Medical Center, Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel.

OBJECTIVES: To investigate whether shock wave lithotripsy (SWL) causes cardiac
muscle injury that alters the levels of troponin I plasma, a cardio-specific
enzyme shown to be useful in diagnosing cardiac muscle injury because of its high
specificity. METHODS: Patients treated by SWL for renal stones participated in
the study. They had undergone a baseline 12-lead electrocardiogram (ECG) a few
days earlier. One day after SWL, they were queried about any chest discomfort,
blood was drawn for evaluation of troponin I and creatine kinase with isoenzymes 
(CK-MB), and an ECG was carried out. RESULTS: Thirty-two patients (21 men and 11 
women, mean age +/- SD 51.0 +/- 10.6 years) comprised the study group. Fourteen
SWL treatments were on the right side and 18 on the left. The mean number of
shock waves was 2859 +/- 202. The mean time to evaluation after SWL was 22.3 +/- 
1.3 hours. None of the patients reported chest discomfort. The mean value was 6.6
+/- 9.2 mU/mL for CK-MB and 0.02 l +/- 0.04 ng/mL for troponin I. No ECG changes 
suggestive of myocardial injury were evident. None of the 5 patients who
experienced ventricular extrasystoles during SWL had any evidence of cardiac
muscle injury. CONCLUSIONS: We evaluated the symptoms, perioperative ECG changes,
and cardiac troponin I and CK-MB plasma levels in patients who underwent SWL for 
renal stones and did not identify any myocardial damage. Troponin I plasma levels
were not elevated after this procedure and, therefore, remain suitable for
evaluation of patients complaining of chest pain after SWL.

PMID: 12736000 [PubMed - indexed for MEDLINE]

1052: J Clin Endocrinol Metab. 2003 May;88(5):2076-80.

Nephrolithiasis in Cushing's disease: prevalence, etiopathogenesis, and
modification after disease cure.

Faggiano A, Pivonello R, Melis D, Filippella M, Di Somma C, Petretta M, Lombardi 
G, Colao A.

Department of Molecular and Clinical Endocrinology and Oncology, Federico II
University, Naples, Italy.

The pathogenesis of nephrolithiasis in Cushing's syndrome is still not completely
clarified. The current study aimed at investigating prevalence of nephrolithiasis
and role of different lithogenic factors in Cushing's disease (CD). Forty-six CD 
patients (24 with active and 22 with cured disease) and 46 sex- and age-matched
controls entered the study. Body mass index, blood pressure, fasting glucose and 
insulin, serum and urinary creatinine, urea, uric acid, electrolytes, and
cystine, urinary volume, pH, oxalate, and citrate levels, and renal
ultrasonography (US) were performed in all patients and controls. Nephrolithiasis
was found in 50% of active patients, 27.3% of cured patients, and 6.5% of
controls (P < 0.001). Compared with controls, patients with active disease had a 
significantly increased prevalence of obesity, arterial hypertension, diabetes
mellitus, hypercalciuria, hypocitraturia, and hyperuricosuria, significantly
higher levels of serum and urinary cystine, urinary creatinine, urea, uric acid, 
potassium, calcium, phosphorus, and oxalate, significantly lower levels of
urinary citrate levels. Compared with controls, patients cured from CD had a
significantly increased prevalence of obesity, systemic arterial hypertension,
and diabetes mellitus, whereas urinary citrate was significantly decreased. At
multivariate analysis, a significantly increased risk to develop kidney stones
was independently associated with urinary excretion of uric acid (odds ratio =
1.6, confidence interval = 1.0-2.5) and systemic arterial blood pressure (odds
ratio = 2.6, confidence interval = 1.1-6.6). In conclusion, patients with active 
CD have an increased prevalence of nephrolithiasis compared with general
population, which decreases but not disappears in patients successfully cured
from the disease. This complication is likely caused by the synergic effect of
different hypercortisolism-dependent metabolic and hemodynamic abnormalities,
among which systemic arterial hypertension and excessive urinary uric acid
excretion seem to play a pivotal role.

PMID: 12727957 [PubMed - indexed for MEDLINE]

1053: Pediatr Radiol. 2003 Apr;33(4):250-2. Epub 2003 Feb 15.

Renal calculus at presentation in a child with Crohn's disease.

Joy HM, Fairhurst JJ, Beattie RM.

Department of Paediatric Radiology, Southampton General Hospital, Tremona Road,
Southampton, SO16 6YD, UK.

Genitourinary complications are relatively common in inflammatory bowel disease, 
with a reported incidence of 4-23%, although they more frequently occur in
established disease. We present the case of a 12-year-old boy, already under
investigation for short stature, who only developed florid symptoms of colitis
after removal of a large staghorn calculus. In all cases of childhood
nephrolithiasis, the possibility of underlying inflammatory bowel disease needs
to be considered.

Publication Types: 
    Case Reports

PMID: 12709754 [PubMed - indexed for MEDLINE]

1054: J Am Soc Nephrol. 2003 May;14(5):1272-7.

Menopause and postmenopausal hormone use and risk of incident kidney stones.

Mattix Kramer HJ, Grodstein F, Stampfer MJ, Curhan GC.

Department of Preventive Medicine and Epidemiology, Loyola University Medical
Center, Chicago, Illinois, USA.

Menopause is associated with increased urinary calcium excretion, which could
increase the risk for the development of calcium-containing kidney stones.
However, it is unknown whether menopause and postmenopausal hormone (PMH) use are
independent risk factors for incident kidney stone disease in women. Data from
91,731 female Nurses' Health Study participants who provided information on diet,
menopause status, and kidney stone disease were used to examine the independent
association between menopause and PMH use and risk of incident kidney stones. No 
association was found between menopause and incident kidney stones in
age-adjusted (relative risk [RR], 1.07; 95% CI, 0.85 to 1.34) or multivariate
models (RR, 1.12; 95% CI, 0.89 to 1.41). However, when the association between
the type of menopause and risk of incident kidney stones was examined, surgical
menopause was associated with an increased risk in both the age-adjusted (RR,
1.37; 95% CI, 1.05 to 1.77) and multivariate models (RR, 1.39; 95% CI, 1.07 to
1.81), whereas natural menopause was not. Compared with never-use, past or
current PMH use (including duration of PMH use) was not associated with incident 
kidney stones among postmenopausal women. In conclusion, no association was found
between menopause and PMH use and incident kidney stones. Surgical menopause,
however, may be associated with an increased risk.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12707395 [PubMed - indexed for MEDLINE]

1055: Front Biosci. 2003 May 1;8:s584-94.

Dietary influences on urinary oxalate and risk of kidney stones.

Massey LK.

Food Science and Human Nutrition, Washington State University, Spokane WA 99210, 
USA. massey@wsu.edu

Calcium oxalate is the most common constituent of kidney stones. Increases in
urinary oxalate increase risk of calcium oxalate supersaturation more than
increases in urinary calcium, as the physiological level of oxalate is about
one-fifth to one-tenth that of urinary calcium. Urinary oxalate derives from two 
sources: endogenous synthesis and diet. Endogenous synthesis is proportional to
lean body mass, and cannot be altered by any current treatment. Dietary oxalate
is found in all plant foods. A single food may vary 2-15 fold in oxalate content,
depending on variety and growth conditions. The salt form of oxalate, whether
sodium, potassium, calcium or magnesium is likely to affect absorption, but has
been little studied. Absorption of oxalate from food sources typically is 3-8% of
its total oxalate in non-stone-forming individuals. Recent research shows that
40-50% of urinary oxalate comes from the diet of healthy individuals consuming
typical diets with 150-250 mg/d dietary oxalate. However, a subpopulation of
oxalate "hyperabsorbers" is found in most studies of stoneforming patients. It is
likely that all stone formers will benefit from reduction of dietary oxalate, but
especially hyperoxaluric stone formers.

Publication Types: 
    Review

PMID: 12700096 [PubMed - indexed for MEDLINE]

1056: Am J Transplant. 2003 Apr;3(4):465-70.

Hospitalized nephrolithiasis after renal transplantation in the United States.

Abbott KC, Schenkman N, Swanson SJ, Agodoa LY.

Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001,
USA. kevin.abbott@na.amedd.army.mil

The national incidence of and risk factors for hospitalized nephrolithiasis (NEP)
in renal transplant (RT) recipients has not been reported. We conducted a
historical cohort study of 42 096 RT recipients in the United States Renal Data
System between 1 July 1994 and 30 June 1998. The 1-year incidence of NEP (ICD-9
codes 592.x) after RT in 1997 was compared to the rate of NEP in the general
population using the National Hospital Discharge Survey. Associations with time
to hospitalizations for a primary diagnosis of nephrolithiasis were assessed by
Cox Regression. NEP was uncommon after RT (104 cases per 100 000 person years in 
1997). However, females, but not males, had a statistically significant increased
risk of NEP compared to the general population (rate ratio for females, 2.84, 95%
confidence interval, 2.35-3.58). Kidney stones were more common than ureteral
stones, and percutaneous procedures were more common than ureteroscopy or
extracorporeal shock wave lithotripsy (ESWL). The only risk factor identified for
NEP was renal failure due to stone disease (only one case). NEP was uncommon
after RT, but was still more common than in the general population. We identified
differences in the presentation and management of NEP after RT in comparison to
the general population.

PMID: 12694070 [PubMed - indexed for MEDLINE]

1057: Curr Opin Urol. 2003 May;13(3):249-53.

Intracorporeal lithotripsy: which modality is best?

Leveillee RJ, Lobik L.

Department of Urology, University of Miami School of Medicine, Florida 33101,
USA. rleveill@med.miami.edu

PURPOSE OF REVIEW: A large number of related articles published within the last
year were reviewed. Different types of intracorporeal lithotripter devices were
compared according to their advantages, disadvantages, efficacy, safety and
clinical applications. General directions of future developments are discussed.
RECENT FINDINGS: Ultrasound lithotripters employed through rigid endoscopes
provide high fragmentation rates (97-100%) and stone free rate (94%). Clinical
evaluation of a new combination ultrasound and pneumatic lithotripter reported an
overall stone free rate of 80-89.7%. No major complications were observed. The
holmium:YAG (Yttrium-Aluminum-Garnet) laser lithotripter is able to destroy all
compositions of stone. The stone free rate for ureteral stones is close to 100%. 
Complications are rare and minimal. Newer wavelengths such as erbium:YAG are
currently impractical. There are limited clinical data regarding
frequency-doubled double-pulse neodymium:YAG laser lithotripsy. SUMMARY:
Ultrasound lithotripsy is still the preferable modality applied through rigid
endoscopes. A new combination of ultrasound and pneumatic impactor includes the
advantages of each mode. The holmium:YAG laser lithotripter is the method of
choice for flexible endoscopic procedures. Further development of new
lithotripters with different energy sources and their combination is necessary.

Publication Types: 
    Review

PMID: 12692450 [PubMed - indexed for MEDLINE]

1058: Curr Opin Urol. 2003 May;13(3):243-7.

Endoscopic surgery for renal calculi.

Fuchs GJ, Yurkanin JP.

Endourology Institute, Cedars Sinai Medical Center, Los Angeles, California
90048, USA. gerhard.fuchs@cshs.org

PURPOSE OF REVIEW: Endoscopic surgery plays an important role in the treatment of
renal calculi, especially for the more complex cases. Recent advancements have
improved the efficacy of procedures, and increasing surgeon experience is
associated with low complication rates. This article will review recent
literature pertinent to endoscopic surgery for renal calculi. RECENT FINDINGS:
Endoscopic renal calculus removal is associated with up to >90% calculus
clearance rates. This is true for both retrograde and percutaneous approaches.
The added utility of flexible instrumentation and holmium laser therapy have
contributed greatly to improving surgical success. With increased experience in
endoscopic techniques, major complications occur in approximately 1% of patients.
Most procedures are performed on an outpatient (retrograde) basis or a <23 h
inpatient (percutaneous) basis. SUMMARY: Endoscopic surgery is safe, and the most
efficacious therapy with low morbidity for renal calculi.

Publication Types: 
    Review

PMID: 12692449 [PubMed - indexed for MEDLINE]

1059: Curr Opin Urol. 2003 May;13(3):235-41.

Comment in:
    J Urol. 2005 Apr;173(4):1199.

Percutaneous nephrolithotomy: an update.

Kim SC, Kuo RL, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease and Indiana University
School of Medicine, Indianapolis, Indiana, USA.

PURPOSE OF REVIEW: Percutaneous nephrolithotomy has undergone an evolution in
technique and in equipment since its introduction in the late 1970s. This
evolution continues today and is evidenced by the numerous publications about the
technique. This review summarizes some of the important articles over the past
year. RECENT FINDINGS: Although ureteroscopy and shock wave lithotripsy
predominate in the treatment of urolithiasis, percutaneous nephrolithotomy
continues to play an important role. Percutaneous nephrolithotomy is advantageous
as it causes minimal renal injury and maximizes stone clearance, especially in
patients with complex stone disease. Although nephrostomy drainage tubes have
always been placed after percutaneous nephrolithotomy, there may be specific
indications for tubeless percutaneous nephrolithotomy. SUMMARY: Percutaneous
nephrolithotomy continues to be an important part of the urologist's
armamentarium. Recent studies have redefined the role of percutaneous
nephrolithotomy and future studies will further delineate the importance of this 
procedure in the treatment of urolithiasis.

Publication Types: 
    Review

PMID: 12692448 [PubMed - indexed for MEDLINE]

1060: Curr Opin Urol. 2003 May;13(3):229-33.

Medical management of stone disease.

Delvecchio FC, Preminger GM.

Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical
Center, Durham, North Carolina, USA.

PURPOSE OF REVIEW: Dietary manipulation still remains one of the most important
strategies for therapy. A growing body of evidence, however, suggests that severe
calcium restriction is inappropriate in patients with recurrent nephrolithiasis. 
Dietary recommendations based on recent evidence and the role of bacteria in the 
pathogenesis of calcium nephrolithiasis are discussed. RECENT FINDINGS: New
evidence strongly supports the role of oxalate, salt and animal protein dietary
restrictions in the prevention of calcium stone recurrence. Moderate calcium
restriction is only effective in absorptive hypercalciuria. Calcium restriction
is not effective in other etiologies of calcium stones and its implementation can
lead to bone demineralization. New evidence has implicated the lack of intestinal
bacteria to be responsible for the degradation of dietary oxalate, with its
higher absorption resulting in an increased risk of calcium oxalate stone
formation. The role of Oxalobacter formigenes is herein discussed. SUMMARY:
Metabolic abnormalities responsible for stone recurrence are currently identified
in 97% of evaluated patients and remission rates of medical prophylaxis in
calcium stone formers are approaching 80%. Urinary calcium excretion in most
renal stone formers is more dependent on the dietary acid load than on the
dietary calcium intake itself. Reducing the acid-ash content of the diet has an
impact on decreasing stone recurrence, while preventing bone loss. New evidence
associates the decolonization of oxalate degrading intestinal flora with a higher
risk of calcium oxalate stone formation, possibly opening the door for biological
manipulation as a novel approach for the prevention of urinary stone formation.

Publication Types: 
    Review

PMID: 12692447 [PubMed - indexed for MEDLINE]

1061: J Coll Physicians Surg Pak. 2003 Mar;13(3):180-2.

Unenhanced helical CT scan for the investigation of acute ureteral colic.

Bari V, Usman MU, Murad M, Yaqoob J.

Department of Radiology, Aga Khan University Hospital, Stadium Road, Karachi.
vaqarb@yahoo.com

Unenhanced helical CT is presently considered a superior imaging technique for
investigating acute urinary colic compared to intravenous urography and
ultrasound. It was introduced in Pakistan around the year 2000 and is in the
process of being acknowledged as the first line investigation in emergency
departments. We have discussed the advantages and the disadvantages of the
technique, and have compared it with other imaging modalities.

Publication Types: 
    Comparative Study
    Review

PMID: 12689546 [PubMed - indexed for MEDLINE]

1062: J Endourol. 2003 Mar;17(2):97-101.

Transurethral ureterorenolithotripsy using new automated irrigation/suction
system controlling pressure and flow compared with standard irrigation: a
randomized pilot study.

Lechevallier E, Luciani M, Nahon O, Lay F, Coulange C.

Department of Urology, Hôpital Salvator, Marseille, France.
ELECHEVALLIER@mail.ap-hm.fr

PURPOSE: To compare in a random fashion an automated irrigation/suction pump
system with the standard pressurized technique during transurethral
ureterorenolithotripsy. PATIENTS AND METHODS: Between July 2001 and December
2001, 47 patients were prospectively included. Prior to randomization, rigid
instruments were allocated to 25 patients (group R) and flexible instruments to
22 patients (group F) according to stone location. The groups R and F were then
randomized separately, and the pressurized technique was employed in groups R1
and F1, while the automated system was employed in groups R2 and F2. Operative
time, amount of liquid consumed, and stone-free rate at the end of the procedure 
were analyzed. RESULTS: For the entire series, ureteroscopy time using the
automated system (mean 42 +/- 17[SD] minutes; range 15-90 minutes) was 35% less
than with the pressurized technique (mean 65 +/- 25 minutes; range 20-135
minutes) (P = 0.04 Wilcoxon score). The stone-free rate was significantly higher 
in groups R2 + F2 (92%) than in groups R1 + F1 (69%) (P = 0.048). CONCLUSION:
With the ENDO FMS UROLOGY system, there was a significant reduction in the mean
ureteroscopy time: 32% less with the rigid instrument and 53% less with the
flexible instrument. This seems to be attributable to a wider working space and
highly improved visibility. The integrated suction at constant flow allows
efficient evacuation of stone fragments while limiting cavity pressure. These
results, obtained on 47 patients, should be confirmed by larger randomized
studies.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 12689403 [PubMed - indexed for MEDLINE]

1063: J Urol. 2003 May;169(5):1813-4.

Endotoxin content in renal calculi.

McAleer IM, Kaplan GW, Bradley JS, Carroll SF, Griffith DP.

Department of Urology, Children's Hospital, San Diego, CA, USA.

PURPOSE: Manipulation of infection calculi (struvite and calcium apatite) can
cause the sepsis syndrome due to endotoxemia or bacteremia. We sought to
determine whether concentrations of endotoxin sufficient to produce the sepsis
syndrome could be embedded in renal infection stones. MATERIALS AND METHODS:
Fragments of infection and noninfection renal calculi were processed and assayed 
for endotoxin concentration. Endotoxin concentrations, recorded as endotoxin
units per gm. calculus, were converted to ng. (10 endotoxin units = 1 ng.). Urine
culture results were available for some patients with infection stones. RESULTS: 
A total of 34 renal calculi (16 infection and 18 noninfection) were evaluated.
The composition of 62.5% of the infection stones was struvite, whereas 50% of the
noninfection stones were calcium oxalate monohydrate. Mean endotoxin
concentration in infection calculi was 12,223 ng./gm. stone (range 0.6 to
50,000), compared to 340.3 ng./gm. stone (range 0 to 3,490) in noninfection
calculi. The endotoxin content difference was significant (p = 0.001). Urine
culture results available from 9 patients with infection stones did not correlate
with endotoxin concentrations. CONCLUSIONS: Large endotoxin concentrations can be
found in renal infection calculi. Noninfection stones can contain endotoxin but
in much lower amounts. Massive endotoxin release could occur with infection stone
manipulation, possibly producing increased serum endotoxin concentrations similar
to those seen in gram-negative sepsis. Anti-endotoxin strategies may be
beneficial in preventing and treating stone induced endotoxemia and the sepsis
syndrome.

Publication Types: 
    Comparative Study

PMID: 12686850 [PubMed - indexed for MEDLINE]

1064: Biochim Biophys Acta. 2003 Apr 11;1647(1-2):70-5.

Alanine:glyoxylate aminotransferase peroxisome-to-mitochondrion mistargeting in
human hereditary kidney stone disease.

Danpure CJ, Lumb MJ, Birdsey GM, Zhang X.

Department of Biology, University College London, Gower Street, London WC1E 6BT, 
UK. c.danpure@ucl.ac.uk

The pyridoxal-phosphate (PLP)-dependent enzyme alanine:glyoxylate
aminotransferase (AGT) is mistargeted from peroxisomes to mitochondria in
patients with the hereditary kidney stone disease primary hyperoxaluria type 1
(PH1) due to the synergistic interaction between a common Pro(11)Leu polymorphism
and a PH1-specific Gly(170)Arg mutation. The kinetic partitioning of newly
synthesised AGT between peroxisomes and mitochondria is determined by the
combined effects of (1) the generation of cryptic mitochondrial targeting
information, and (2) the inhibition of AGT dimerization. The crystal structure of
AGT has recently been solved, allowing the effects of the various polymorphisms
and mutations to be rationalised in terms of AGT's three-dimensional
conformation. Procedures that increase dimer stability and/or increase the rate
of dimer formation have potential in the formulation of novel strategies to treat
this otherwise intractable life-threatening disease.

Publication Types: 
    Review

PMID: 12686111 [PubMed - indexed for MEDLINE]

1065: Kidney Int. 2003 May;63(5):1817-23.

Comment in:
    Kidney Int. 2003 May;63(5):1951-2.

Time trends in reported prevalence of kidney stones in the United States:
1976-1994.

Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC.

Renal Unit, Blue Cross Hospital, Athens, Greece. stamatelos@tee.gr

BACKGROUND: A body of evidence establishes that the occurrence of kidney stone
disease has increased in some communities of industrialized countries.
Information on recent temporal trends in the United States is lacking and
population-based data on epidemiologic patterns are limited. Study objective was 
to determine whether kidney stone disease prevalence increased in the United
States over a 20-year period and the influence of region, race/ethnicity, and
gender on stone disease risk. METHODS: We measured the prevalence of kidney stone
disease history from the United States National Health and Nutrition Examination 
Survey (II and III), population-based, cross-sectional studies, involving 15,364 
adult United States residents in 1976 to 1980 and 16,115 adult United States
residents in 1988 to 1994. RESULTS: Disease prevalence among 20- to 74-year-old
United States residents was greater in 1988 to 1994 than in 1976 to 1980 (5.2%
vs. 3.8%, P < 0.05), greater in males than females, and increased with age in
each time period. Among 1988 to 1994 adults, non-Hispanic African Americans had
reduced risk of disease compared to non-Hispanic Caucasians (1.7% vs. 5.9%, P <
0.05), and Mexican Americans (1.7% vs. 2.6%, P < 0.05). Also, age-adjusted
prevalence was highest in the South (6.6%) and lowest in the West (3.3%).
Findings were consistent across gender and multivariate adjusted odds ratios for 
stone disease history, including all demographic variables, as well as diuretic
use, tea or coffee consumption, and dietary intake of calcium, protein, and fat
did not materially change the results. CONCLUSION: Prevalence of kidney stone
disease history in the United States population increased between 1980 and 1994. 
A history of stone disease was strongly associated with race/ethnicity and region
of residence.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12675858 [PubMed - indexed for MEDLINE]

1066: J Bone Miner Res. 2003 Apr;18(4):644-57.

Renal calcification in mice homozygous for the disrupted type IIa Na/Pi
cotransporter gene Npt2.

Chau H, El-Maadawy S, McKee MD, Tenenhouse HS.

Department of Biology, McGill University, Montreal, Quebec, Canada.

Mice homozygous for the disrupted renal type IIa sodium/phosphate (Na/Pi)
cotransporter gene (Npt2-/-) exhibit renal Pi wasting, hypophosphatemia, and an
adaptive increase in the serum concentration of 1,25-dihydroxyvitamin D with
associated hypercalcemia and hypercalciuria. Because hypercalciuria is a risk
factor for nephrocalcinosis, we determined whether Npt2-/- mice form renal
stones. Analysis of renal sections by von Kossa staining and intact kidneys by
microcomputed tomography revealed renal calcification in adult Npt2-/- mice but
not in Npt2+/+ littermates. Energy-dispersive spectroscopy and selected-area
electron diffraction indicated that the calcifications are comprised of calcium
and Pi with an apatitic mineral phase. To determine the age of onset of
nephrocalcinosis, we examined renal sections of newborn and weanling mice. At
both ages, mutant but not wild-type mice display renal calcification, which is
associated with renal Pi wasting and hypercalciuria. Immunohistochemistry
revealed that osteopontin co-localizes with the calcifications. Furthermore,
renal osteopontin messenger RNA abundance is significantly elevated in Npt2-/-
mice compared with Npt2+/+ mice. The onset of renal stones correlated
developmentally with the absence of Npt2 expression and the expression of the
genes responsible for the renal production (1alpha-hydroxylase) and catabolism
(24-hydroxylase) of 1,25-dihydroxyvitamin D. In summary, we show that Npt2 gene
ablation is associated with renal calcification and suggest that mutations in the
NPT2 gene may contribute to nephrocalcinosis in a subset of patients with
familial hypercalciuria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12674325 [PubMed - indexed for MEDLINE]

1067: J Bone Miner Res. 2003 Apr;18(4):615-23.

The ClC-5 knockout mouse model of Dent's disease has renal hypercalciuria and
increased bone turnover.

Silva IV, Cebotaru V, Wang H, Wang XT, Wang SS, Guo G, Devuyst O, Thakker RV,
Guggino WB, Guggino SE.

Department of Physiology, The Johns Hopkins School of Medicine, Johns Hopkins
University, Baltimore, Maryland 21205, USA.

Dent's disease is a nephrolithiasis disorder associated with hypercalciuria and
low molecular weight proteinuria that is caused by mutations in the voltage-gated
chloride channel ClC-5. Because the exact cause of hypercalciuria in this disease
is unknown and could come from a renal, intestinal, or bone origin, we have
investigated overall calcium handling in the ClC-5 knockout mouse (ClC-5 KO). On 
a high calcium diet, ClC-5 KO mice had elevated serum 1alpha,25-dihydroxyvitamin 
D3 (1alpha,25D3), alkaline phosphatase (AP), osteocalcin (OC), and urinary
deoxypyridinoline (DPD), but serum parathyroid hormone (PTH), calcium, and
intestinal calcium uptake was similar to that of wild-type (WT) mice. A 30-fold
decrease in dietary calcium intake caused elevation of serum PTH and urinary
cyclic adenosine monophosphate in ClC-5 KO mice and decreased the renal calcium
excretion, which still remained 2-fold above that of WT mice. On this low calcium
diet, both groups of mice had the same serum 1alpha,25D3, with similar increments
in intestinal calcium absorption, serum AP, OC, and urinary DPD. These data
indicate that the hypercalciuria in the ClC-5 KO mice on low and high calcium
diets is of bone and renal origin and is not caused by increased intestinal
calcium absorption, despite an elevated serum 1alpha,25D3. These mice data
suggest that young patients with this disease may have a propensity for altered
bone homeostasis that should be monitored clinically.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12674322 [PubMed - indexed for MEDLINE]

1068: Urol Res. 2003 Jun;31(2):47-54. Epub 2003 Mar 27.

Characteristics of nanobacteria and their possible role in stone formation.

Kajander EO, Ciftcioglu N, Aho K, Garcia-Cuerpo E.

Department of Biochemistry, University of Kuopio, PO Box 1627, 70211 Kuopio,
Finland. olavi.kajander@uku.fi

Kidney stone formation is a multifactorial disease in which the defence
mechanisms and risk factors are imbalanced in favour of stone formation. We have 
proposed a novel infectious agent, mineral forming nanobacteria (NB), to be
active nidi that attach to, invade and damage the urinary epithelium of
collecting ducts and papilla forming the calcium phosphate center(s) found in
most kidney stones. Stone formation may proceed in urine supersaturated with
calcium phosphate, calcium oxalate and uric acid/urate under the influence of
crystallization promoters and inhibitors. Our hypothesis underlines the role of
active nidi: even supersaturated urine requires nidi for crystallization to
appear.

Publication Types: 
    Editorial
    Research Support, Non-U.S. Gov't
    Review

PMID: 12669155 [PubMed - indexed for MEDLINE]

1069: J Pak Med Assoc. 2003 Jan;53(1):24-5.

The prevalence of silent kidney stones--an ultrasonographic screening study.

Buchholz NP, Abbas F, Afzal M, Khan R, Rizvi I, Talati J.

Department of Urology, The Aga Khan University, Karachi.

OBJECTIVE: Silent and not yet discovered stones of the upper urinary tract are
potentially dangerous, since in due course they may cause infection, obstruction 
and renal damage. The aim of this study was to determine the prevalence of such
silent kidney stones in a representative Pakistani population of Karachi.
SUBJECTS AND METHODS: We studied 201 consecutive subjects at our hospital who
underwent additional kidney screening whilst undergoing abdominal ultrasound. All
these subjects did not have a history or symptoms of urolithiasis. RESULT: We
found silent kidney stones in 3% of subjects. All stone bearers were males. Most 
stones were in the left kidney. Notably, multiple stones and stones of a
considerable size went unnoticed. CONCLUSION: In addition to the usual figures of
incidence and prevalence of stone disease drawn from patient data, there is a
prevalence of 3% silent stones that may only be discovered incidentally or by
screening. This is true for a "'stone country" like Pakistan. Figures for other
regions have yet to be determined. Due to socioeconomic reasons, we believe that 
a general kidney screening for urolithiasis is, however, not indicated, at least 
in our country.

PMID: 12666848 [PubMed - indexed for MEDLINE]

1070: Ceylon Med J. 2002 Dec;47(4):115-6.

An observational study of staghorn calculi in south Sri Lanka.

Abeygunasekera A, Nirupika H, Bulegoda H.

Teaching Hospital, Karapitiya, Galle. amabey@sltnet.lk

OBJECTIVES: To ascertain patient characteristics, management strategies and
outcome of patients with staghorn calculi in southern Sri Lanka. METHODS: All
patients with staghorn calculi seen at the urology unit in a teaching hospital
during a period of eighteen months were included in this prospective study. Data 
in relation to patient demography, investigations, treatment and postoperative
complications were collected. RESULTS: There were 60 patients with a mean age of 
54 years. Eight (13%) of them were female. Urine pH was less than 7.0 in 52 (87%)
patients. Urine culture was positive for bacteria in four (7%) patients. 58
patients underwent open surgery, and two patients were managed non-operatively.
Seven (12%) patients developed postoperative complications. CONCLUSIONS: Staghorn
calculi elsewhere are usually commoner in females and associated with alkaline
urine. But in our study there was a clear male preponderance (M:F = 6.5:1), and
urine pH was alkaline in 8 (13%) patients only. Hence the aetiological factors
for staghorn calculi in Sri Lanka appear to be different. Although open surgical 
procedures which form the mainstay of treatment of staghom calculi in Sri Lanka
can be performed safely and effectively, there is a necessity to provide minimal 
access surgical facilities.

PMID: 12661339 [PubMed - indexed for MEDLINE]

1071: BJU Int. 2003 Apr;91(6):554-9.

Cell-surface matrix proteins and sialic acids in cell-crystal adhesion; the
effect of crystal binding on the viability of human CAKI-1 renal epithelial
cells.

Kramer G, Steiner GE, Prinz-Kashani M, Bursa B, Marberger M.

Department of Urology, University of Vienna, Austria.

OBJECTIVE: To investigate the role of sialic acids and cellular matrix proteins
as crystal-binding molecules in human calcium-oxalate nephrolithiasis. MATERIALS 
AND METHODS: The well-defined human renal cancer cell line CAKI-1 was used a
standard cell culture system. After enzymatic digestion of various cell surface
molecules, the binding of alpha2,6 (Sambucus nigra, SN-) and alpha2,3 (Maackia
amurensis, MA)-specific lectins to CAKI-1 cells was analysed. Simultaneously, the
effect on adhesion and release of calcium oxalate monohydrate crystals was
investigated (eight replicates). The effect of crystal adhesion on cell viability
was assessed using Trypan blue exclusion (five replicates). RESULTS:
Neuraminidase decreased MA-lectin binding of CAKI-1 cells by 39% (P < 0.05) but
elevated SN-lectin binding by 812% (P < 0.05). Simultaneously, crystal binding to
CAKI-1 cells was increased by 28% (P > 0.05). Pretreatment with collagenase type 
I, trypsin and dispase II reduced crystal-binding by 61-74% (P < 0.05) with no
effect on sialic acid-specific lectin-binding. However, only collagenase type I
and dispase (ratio 4 : 1) were also able to release crystals from their
receptor-binding sites (P < 0.05). An increase in the number of cell
surface-bound crystals correlated significantly with a decrease in cell viability
(P < 0.05). CONCLUSIONS: alpha2,3-linked sialic acids protect cells from
crystal-binding. Much greater SN-lectin binding associated with only moderately
increased crystal binding argues against alpha2,6-linked sialic acids as a main
target structure of crystals. In contrast, collagen type I, type IV and/or
fibronectin seem to be potent crystal-binding molecules on human renal epithelial
cells, with collagen type I involved in a potential second step of crystal-cell
interaction.

PMID: 12656914 [PubMed - indexed for MEDLINE]

1072: Clin Nephrol. 2003 Mar;59(3):222-4.

Staghorn calculi complicating renal transplantation in patients with persistent
post-transplantation hyperparathyroidism.

Jayawardene SA, Goldsmith DJ.

Department of Nephrology, Guy's and St. Thomas' Hospitals, London, UK.

Renal stones rarely complicate renal transplants. Their causation is diverse. We 
describe 2 patients with significant staghorn calculi caused by metabolic
factors.

Publication Types: 
    Case Reports

PMID: 12653268 [PubMed - indexed for MEDLINE]

1073: Clin Nephrol. 2003 Mar;59(3):160-3.

Which factors account for renal stone formation in cystic fibrosis?

von der Heiden R, Balestra AP, Bianchetti MG, Casaulta Aebischer C, Mullis PE,
Lippuner K, Jaeger P.

Department of Pediatrics, University Hospital, Berne, Switzerland.

AIMS: Studies dealing with the increased tendency to stone formation noted in
cystic fibrosis, focus on enteric hyperoxaluria. It is well recognized, however, 
that low urine volume, hypocitraturia and perhaps even hypercalciuria are further
risk factors for stone formation. METHODS: Nineteen patients with cystic fibrosis
(14 boys and 5 girls, aged 10-23, median 15 years) underwent a standard protocol 
for metabolic evaluation of the lithogenic tendency. In 10 patients, the study
was repeated after treatment with recombinant human growth hormone 43
microgram/kg body weight daily for 12 months. RESULTS: The metabolic evaluation
disclosed low urine output in 12, hyperoxaluria in 8 and hypocitraturia in 9 of
the 19 cystic fibrosis patients. The mentioned parameters were not influenced by 
treatment with recombinant human growth hormone. CONCLUSION: The report indicates
that in cystic fibrosis low urine volume, hypocitraturia and hyperoxaluria act in
concert and contribute to the likelihood of stone formation. This tendency is not
modified by treatment with recombinant human growth hormone.

PMID: 12653257 [PubMed - indexed for MEDLINE]

1074: Urology. 2003 Mar;61(3):644-5.

Pinball calculus in a ureterosigmoidostomy.

Mondet F, Pasqui F, Lucas JJ, Conort P, Chartier-Kastler EJ, Richard F.

Department of Urology, Pitie-Salpetriere Hospital, Paris, France

We report a complication during the treatment of lithiasis with extracorporeal
shock wave lithotripsy in a patient with a ureterosigmoidostomy. This woman
presented with renal colic bilaterally and renal insufficiency and was found to
have an extremely mobile calculus. A significant gaseous reflux from the sigmoid 
colon was found to propel the solitary calculus in a retrograde fashion across
the ureteroileal anastomosis up the ureter into one kidney, and then later, after
re-descent to the level of the anastomosis, up into the opposite kidney. After
several days of playing hide and seek with this migrating calculus, using
extracorporeal shock wave lithotripsy, the patient became stone free.

Publication Types: 
    Case Reports

PMID: 12639667 [PubMed - indexed for MEDLINE]

1075: J Endourol. 2003 Feb;17(1):7-9.

Erect and supine radiographs to assess effectiveness of SWL for stones in a
caliceal diverticulum or dilated calix.

Bilgasem S, Pace KT, Dyer S, Honey RJ.

Division of Urology, St. Michael's Hospital, University of Toronto, Toronto,
Ontario, Canada.

BACKGROUND AND PURPOSE: There are patients who have been treated with shockwave
lithotripsy (SWL) for stones in a caliceal diverticulum (CD) or a dilated calix
in whom the degree of fragmentation is difficult to assess. The aim of this study
was to see if adequate fragmentation could be confirmed by the demonstration of
layering of fine fragments on an erect radiograph. PATIENTS AND METHODS: Over a
period of 9 months, 13 patients with stones in a CD or a dilated calix with a
stenosed infundibulum were studied 2 weeks after SWL with erect and supine
radiographs. RESULTS: One of eight patients with a CD cleared all fragments. Two 
patients showed no change in the appearance of the stone on either the supine or 
the erect film, and of the remaining five patients, three demonstrated layering
of sand at the base of the CD. Five patients with a dilated calix and a narrow
infundibulum were also studied: two of these patients became stone free, two
demonstrated complete fragmentation with layering of the sand, and in one
patient, a 4-mm fragment, hidden within the sand, was revealed only on the erect 
film. CONCLUSION: There are patients who have been treated with SWL for stones in
a CD or a dilated calix in whom adequate fragmentation is difficult to
demonstrate. An erect radiograph in these patients may demonstrate layering of
the fragments to confirm fragmentation and obviate repeat SWL.

PMID: 12639354 [PubMed - indexed for MEDLINE]

1076: Nephrol Dial Transplant. 2003 Apr;18(4):664-9.

Increased expression of monocyte chemoattractant protein-1 (MCP-1) by renal
epithelial cells in culture on exposure to calcium oxalate, phosphate and uric
acid crystals.

Umekawa T, Chegini N, Khan SR.

Department of Pathology and Laboratory Medicine, University of Florida College of
Medicine, Gainesville, FL 32610-0275, USA.

BACKGROUND: During the development of non-infectious kidney stones, crystals form
and deposit in the kidneys and become surrounded by monocytes/macrophages (M/M). 
We have proposed that in response to crystal exposure renal epithelial cells
produce chemokines, which attract the M/M to the sites of crystal deposition. We 
investigated the expression of monocyte chemoattractant protein-1 (MCP-1) mRNA
and protein by NRK52E rat renal tubular epithelial cells exposed to calcium
oxalate (CaOx), brushite (Br, a calcium phosphate) and uric acid (UA) crystals.
METHODS: Confluent cultures of NRK52E cells were exposed to CaOx, Br or UA at a
concentration of 250 micro g/ml (66.7 micro g/cm(2)). They were exposed for 1, 3,
6, 12, 24 and 48 h for isolation of mRNA and 24 h for ELISA to determine the
secretion of protein into the culture medium. Since cells are known to produce
free radicals on exposure to CaOx crystals we also investigated the effect of
free radical scavenger catalase on the crystal induced expression of MCP-1 mRNA
and protein. RESULTS: Exposure of NRK52E cells to the crystals resulted in
increased expression of MCP-1 mRNA and production of the chemoattractant. CaOx
crystals were most provocative while UA the least. Treatment with catalase had a 
negative effect on the increased expression of both MCP-1 mRNA and protein, which
indicates the involvement of free radicals in up-regulation of MCP-1 production. 
CONCLUSION: Exposure to both CaOx and calcium phosphate crystals stimulates
increased production of MCP-1. Free radicals appear to be involved in this
up-regulation. Results indicate that MCP-1, which is often associated with
localized inflammation, may be one of the chemokine mediators associated with the
deposition of various urinary crystals in the kidneys during kidney stone
formation. Because of the small number of experiments performed here, results
must be confirmed by more extensive studies with larger sample size.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 12637633 [PubMed - indexed for MEDLINE]

1077: Clin Chem Lab Med. 2003 Jan;41(1):39-45.

Effects of calcium carbonate, magnesium oxide and sodium citrate bicarbonate
health supplements on the urinary risk factors for kidney stone formation.

Allie S, Rodgers A.

Department of Chemistry, University of Cape Town, Cape Town, South Africa.

We describe a model to illustrate different chemical interactions that can occur 
in urine following ingestion of individual and combined health supplements. Two
types of interactions are defined: synergism and addition. The model was applied 
to eight healthy males who participated in a study to investigate the chemical
interactions between calcium carbonate, magnesium oxide and sodium
citrate-bicarbonate health supplements on calcium oxalate urinary stone risk
factors. Subjects ingested these components individually and in combination for 7
days. Twenty-four-hour urines were collected at baseline and during the final day
of supplementation. These were analysed using standard laboratory techniques.
Three different chemical interactions, all involving citrate, were identified:
magnesium and citrate exerted a synergistic effect on lowering the relative
superaturation (RS) of brushite; the same two components produced a synergistic
effect on raising pH; finally, calcium and citrate exerted an additive effect on 
lowering the RS of uric acid. We propose that the novel approach described in
this paper allows for the evaluation of individual, additive and synergistic
interactions in the assessment of the efficacy of stone-risk reducing
preparations.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12636048 [PubMed - indexed for MEDLINE]

1078: Kidney Int. 2003 Feb;63(2):662-9.

Bone mineral density and urine calcium excretion among subjects with and without 
nephrolithiasis.

Asplin JR, Bauer KA, Kinder J, Müller G, Coe BJ, Parks JH, Coe FL.

Litholink Corporation, and Renal Section, University of Chicago, Chicago,
Illinois 60612, USA.

BACKGROUND: Bone mineral density (BMD) is reduced among patients with idiopathic 
hypercalciuria (IH) and nephrolithiasis. To disentangle effects of diet, stone
formation, and physiology upon BMD, we studied vertebral and femoral neck BMD
among relatives of hypercalciuric stone formers, and contrasted those with to
those without stones. METHODS: Among 59 subjects from 11 families, vertebral and 
femoral neck BMD, diet calcium intake, urine excretions of calcium, sodium,
ammonium, titratable acid, sulfate, urea nitrogen, and serum levels of calcitriol
and markers of bone turnover were studied. RESULTS: Stone formers (SF) consumed
less calcium than non-stone formers (NSF). Spine and femoral neck BMD z-scores
varied inversely with urine calcium loss and urine ammonium excretion among SF
but not NSF. No correlations of BMD z-score were found for bone markers,
calcitriol, or any of the other measurements. CONCLUSION: SF consumed less
calcium, presumably to prevent more stones, and displayed a bone mineral
responsiveness to calcium loss and ammonium excretion not present among NSF, who 
ate more calcium. Lowered calcium consumption in IH, perhaps in response to stone
formation, alters bone responses in a direction that can predispose to mineral
loss and eventual fracture.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12631132 [PubMed - indexed for MEDLINE]

1079: Kidney Int. 2003 Mar;63(3):1066-71.

Comment in:
    J Urol. 2005 Feb;173(2):478-9.

Effect of vitamin C supplements on urinary oxalate and pH in calcium
stone-forming patients.

Baxmann AC, De O G Mendonça C, Heilberg IP.

Nephrology Division, Universidade Federal de São Paulo, UNIFESP, Brazil.

BACKGROUND: The contribution of ascorbate to urinary oxalate is controversial.
The present study aimed to determine whether urinary oxalate and pH may be
affected by vitamin C supplementation in calcium stone-forming patients. METHODS:
Forty-seven adult calcium stone-forming patients received either 1 g (N=23) or 2 
g (N=24) of vitamin C supplement for 3 days and 20 healthy subjects received 1 g.
A 24-hour urine sample was obtained both before and after vitamin C for calcium, 
oxalate, magnesium, citrate, sodium, potassium, and creatinine determination. The
Tiselius index was used as a calcium oxalate crystallization index. A spot
fasting morning urine sample was also obtained to determine the urinary pH before
and after vitamin C. RESULTS: Fasting urinary pH did not change after 1 g (5.8
+/- 0.6 vs. 5.8 +/- 0.7) or 2 g vitamin C (5.8 +/- 0.8 vs. 5.8 +/- 0.7). A
significant increase in mean urinary oxalate was observed in calcium
stone-forming patients receiving either 1 g (50 +/- 16 vs. 31 +/- 12 mg/24 hours)
or 2 g (48 +/- 21 vs. 34 +/- 12 mg/24 hours) of vitamin C and in healthy subjects
(25 +/- 12 vs. 39 +/- 13 mg/24 hours). A significant increase in mean Tiselius
index was observed in calcium stone-forming patients after 1 g (1.43 +/- 0.70 vs.
0.92 +/- 0.65) or 2 g vitamin C (1.61 +/- 1.05 vs. 0.99 +/- 0.55) and in healthy 
subjects (1.50 +/- 0.69 vs. 0.91 +/- 0.46). Ancillary analyses of spot urine
obtained after vitamin C were performed in 15 control subjects in vessels with or
without ethylenediaminetetraacetic acid (EDTA) with no difference in urinary
oxalate between them (28 +/- 23 vs. 26 +/- 21 mg/L), suggesting that the in vitro
conversion of ascorbate to oxalate did not occur. CONCLUSION: These data suggest 
that vitamin C supplementation may increase urinary oxalate excretion and the
risk of calcium oxalate crystallization in calcium stone-forming patients.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 12631089 [PubMed - indexed for MEDLINE]

1080: J Urol. 2003 Apr;169(4):1250-6.

Prediction of lower pole stone clearance after shock wave lithotripsy using an
artificial neural network.

Poulakis V, Dahm P, Witzsch U, de Vries R, Remplik J, Becht E.

Department of Urology and Pediatric Urology, Krankenhaus Nordwest, Teaching
Hospital of Johann-Wolfgang-Goethe-University, Frankfurt, Frankfurt/Main,
Germany.

PURPOSE: We performed this study as a comprehensive evaluation of variables
reported to affect lower pole stone clearance after shock wave lithotripsy using 
artificial neural network analysis. MATERIALS AND METHODS: The radiographic
images and treatment records of 680 patients with lower pole renal calculi
treated with primary shock wave lithotripsy using the Wolf Piezolith 2500 (Wolf, 
Knittlingen, Germany) lithotriptor were retrospectively evaluated by applying
artificial neural network analysis. Successful stone clearance was defined as
absent fragments of any size detected on plain x-ray with tomography and/or
excretory pyelography performed 6 months after treatment. Prognostic variables
included patient characteristics, laboratory values, stone characteristics and
the spatial anatomy of the lower pole, as defined by infundibular length,
diameter, caliceal pelvic height, 2 measurements of the lower infundibulopelvic
and infundibuloureteropelvic angles as well as the pattern of dynamic urinary
transport. RESULTS: Artificial neural network analysis had 92% accuracy for
correctly predicting lower pole stone clearance. The pattern of dynamic urinary
transport represented the most influential predictor of stone clearance, followed
by a measure of the infundibuloureteropelvic angle, body mass index, caliceal
pelvic height and stone size. Anatomical measurements of lower pole anatomy and
classification of the type of urinary transport were well reproducible with low
intra-observer and interobserver variability (correlation coefficient alpha
>0.8). CONCLUSIONS: In a comprehensive analysis of variables reported to
influence lower pole stone clearance artificial neural network analysis predicted
stone clearance with a high degree of accuracy. The relative importance of
dynamic urinary transport in lower pole stones and the usefulness of artificial
neural network analysis to predict shock wave lithotripsy outcomes in individuals
must be confirmed in a prospective trial.

PMID: 12629337 [PubMed - indexed for MEDLINE]

1081: J Urol. 2003 Apr;169(4):1247-9.

Clinical efficacy of a combination pneumatic and ultrasonic lithotrite.

Pietrow PK, Auge BK, Zhong P, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery,
Duke University Medical Center, Durham, North Carolina, USA.

PURPOSE: A new combination pneumatic/ultrasonic intracorporeal lithotriptor has
been developed for percutaneous applications. It combines the stone clearing
efficiency of an ultrasonic device with the fragmentation strength of a pneumatic
probe into a single handpiece. We present our early clinical experience with this
device in a prospective, randomized comparison a combination pneumatic/ultrasound
lithotrite and standard ultrasonic lithotripsy. MATERIALS AND METHODS: A total of
20 consecutive patients undergoing percutaneous nephrolithotomy for symptomatic
calculi were randomized to receive stone fragmentation and removal using a
standard ultrasonic device or a new combination pneumatic/ultrasonic unit. Stone 
location and burden were assessed before the operative procedure. The stone
clearance rate in mm.2 per minute was calculated for the 2 devices. Complications
and stone-free rates were compared in the 2 groups. RESULTS: There were no
significant differences in stone location and composition in the 2 groups of
patients. Average time required for complete stone clearance was considerably
less for the combination device (21.1 versus 43.7 minutes, p = 0.036). The
opposite was true for the average rate of stone clearance in mm.2 per minute, in 
that the standard ultrasonic device could clear 16.8 versus 39.5 mm.2 per minute 
for the combination unit (p = 0.028). Stone-free and complications rates were
slightly superior for the combination device but it was likely attributable to
patient factors. CONCLUSIONS: The combination pneumatic/ultrasonic lithotrite is 
capable of disintegrating and extracting stone material at a more rapid rate than
standard ultrasonic devices. Moreover, stone-free and complication rates appear
to be slightly superior with the combination unit. This new combination
pneumatic/ultrasonic device appears to be efficacious and safe for removing large
renal calculi.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 12629336 [PubMed - indexed for MEDLINE]

1082: Scand J Urol Nephrol. 2002;36(6):426-30.

Modified anatrophic nephrolithotomy for complete staghorn calculus disease --
does it still have a place?

Melissourgos ND, Davilas EN, Fragoulis A, Kiminas E, Farmakis A.

Department of Urology, General Hospital of Athens G. Gennimatas, Athens, Greece. 
psari@otenet.gr

OBJECTIVE: To report our experience with open surgery for the management of
complete staghorn calculi using a modified anatrophic nephrolithotomy technique. 
MATERIAL AND METHODS: Between 1990 and 2001, 24 patients underwent anatrophic
nephrolithotomy in our department. Bilateral complex stone disease was present in
9 patients, so that a total of 33 procedures were carried out. Preoperative
evaluation included excretory urography (intravenous pyelography) and routine
laboratory study in all patients and in 9 patients renal function was assessed
using (99m)Tc dimercaptosuccinic acid renal scans before and 6 months after
surgery. Postoperative follow-up consisted of kidney-ureter-bladder (KUB),
ultrasound (U/S), urinalysis and urine culture. RESULTS: The mean operative time 
was 180 min, mean blood loss was 500 ml and renal ischemia time ranged between 10
and 35 min. Deep vein thrombosis occurred on the 5th postoperative day in an
obese female patient. No other operative or postoperative complications were
observed. Mean hospital stay was 8.2 days (range 7-12 days). The stone-free rate 
was 83.3%. Long-term follow up demonstrated stone fragments <4 mm in diameter in 
4 patients (16.6%). Renal function remained unchanged or slightly improved in 15 
patients; a slight worsening of renal function was noted in 9 patients (from an
average of 39% before to 35% after the procedure). CONCLUSIONS: Anatrophic
nephrolithotomy, although a major operative procedure, remains the most
appropriate method for the one-stage management of a selected group of patients
harboring large staghorn calculi with infundibular stenosis, and is associated
with the highest stone-free rates.

PMID: 12623506 [PubMed - indexed for MEDLINE]

1083: J Clin Invest. 2003 Mar;111(5):607-16.

Comment in:
    J Clin Invest. 2003 Mar;111(5):602-5.

Randall's plaque of patients with nephrolithiasis begins in basement membranes of
thin loops of Henle.

Evan AP, Lingeman JE, Coe FL, Parks JH, Bledsoe SB, Shao Y, Sommer AJ, Paterson
RF, Kuo RL, Grynpas M.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46220, USA. evan@anatomy.iupui.edu

Our purpose here is to test the hypothesis that Randall's plaques, calcium
phosphate deposits in kidneys of patients with calcium renal stones, arise in
unique anatomical regions of the kidney, their formation conditioned by specific 
stone-forming pathophysiologies. To test this hypothesis, we performed
intraoperative biopsies of plaques in kidneys of idiopathic-calcium-stone formers
and patients with stones due to obesity-related bypass procedures and obtained
papillary specimens from non-stone formers after nephrectomy. Plaque originates
in the basement membranes of the thin loops of Henle and spreads from there
through the interstitium to beneath the urothelium. Patients who have undergone
bypass surgery do not produce such plaque but instead form intratubular
hydroxyapatite crystals in collecting ducts. Non-stone formers also do not form
plaque. Plaque is specific to certain kinds of stone-forming patients and is
initiated specifically in thin-limb basement membranes by mechanisms that remain 
to be elucidated.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12618515 [PubMed - indexed for MEDLINE]

1084: J Am Chem Soc. 2003 Mar 12;125(10):2854-5.

Adhesion between molecules and calcium oxalate crystals: critical interactions in
kidney stone formation.

Sheng X, Ward MD, Wesson JA.

Department of Chemical Engineering and Materials Science, University of
Minnesota, 421 Washington Avenue SE, Minneapolis, Minnesota 55455, USA.

Kidney stones are crystal aggregates, most commonly containing calcium oxalate
monohydrate (COM) crystals as the primary constituent. Notably, in vitro studies 
have suggested that anionic molecules or macromolecules with substantial anionic 
functionality (e.g., carboxylate) play an important role in crystal aggregation
and crystal attachment to renal epithelial cells. Furthermore, kidney stones
contain measurable amounts of carboxylate-rich proteins that may serve as
adhesives and promote aggregation of COM crystals. Atomic force microscopy (AFM) 
measurements of adhesion forces between tip-immobilized molecules and the COM
(100) surface in aqueous media, described herein, reveal the effect of functional
groups on adhesion and support an important role for the carboxylate group in
processes responsible for kidney stone formation, specifically
macromolecule-mediated adhesion of COM crystals to cells and crystal aggregation.
The presence of poly(aspartic acid) during force measurements results in a
reduction in the adhesion force measured for carboxylate-modified tips,
consistent with the blocking of binding sites on the COM (100) surface by the
carboxylate-rich polymer. This competitive binding behavior mimics the known
reduction in attachment of COM crystals to renal epithelial cells in the presence
of carboxylate-rich urinary macromolecules. These results suggest a feasible
methodology for identifying the most important crystal surface-macromolecule
combinations related to stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12617634 [PubMed - indexed for MEDLINE]

1085: Urol Res. 2003 Feb;30(6):374-9. Epub 2003 Jan 21.

Effects of an aqueous extract from Phyllantus niruri on calcium oxalate
crystallization in vitro.

Barros ME, Schor N, Boim MA.

Nephrology Division, Escola Paulista de Medicina, Universidade Federal de São
Paulo, São Paulo, Brazil.

Phyllanthus niruri is a plant used in Brazilian folk medicine for the treatment
of urolithiasis. It was previously observed that P. niruri shows no toxicity,
potentially increases calculus voiding by stone forming patients and inhibits the
endocytosis of calcium oxalate (CaOx) crystals by MDCK cells. In addition, in a
rat model of urolithiasis it reduced calculus growth. In the present study, we
evaluated the effect of an aqueous extract of P. niruri on CaOx crystallization
in vitro. CaOx precipitation was induced by the addition of 0.1 M sodium oxalate 
to unfiltered urine samples from Wistar rats (n=14) and normal humans (n=18) in
the presence or absence of P. niruri extract (0.25 mg/ml of urine). The presence 
of CaOx crystals was evaluated immediately and 24 h later. In vitro
crystallization of human urine produced typical mono- and dihydrated CaOx
crystals, but only a few typical CaOx crystals were found in rat urine. The
presence of P. niruri extract did not inhibit CaOx precipitation and even more
crystals were obtained, although they were significantly smaller than those in
the control urine. Crystal aggregation observed 24 h after crystallization was
also inhibited by P. niruri extract. The results showed an inhibitory effect of
P. niruri extract on CaOx crystal growth and aggregation in human urine,
suggesting that it may interfere with the early stages of stone formation and may
represent an alternative form of treatment and/or prevention of urolithiasis

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 12599017 [PubMed - indexed for MEDLINE]

1086: Urology. 2003 Feb;61(2):462.

Percutaneous nephrolithotomy of an intrathoracic kidney.

Lenz DL, Clair DL, Fetzer AE, Wong C.

Division of Urology, Pennsylvania State University, Milton S. Hershey Medical
Center, Hershey, Pennsylvania, USA.

We present a 35-year-old woman with symptomatic urolithiasis in an intrathoracic 
kidney. Percutaneous nephrolithotomy was successfully performed after
ureteroscopy failed because of the unusual length of the ureter associated with
the kidney position. We report the first case of percutaneous nephrolithotomy of 
an intrathoracic kidney.

Publication Types: 
    Case Reports

PMID: 12597975 [PubMed - indexed for MEDLINE]

1087: Magn Reson Imaging. 2002 Dec;20(10):777-9.

Proton magnetic resonance spectroscopy of the kidney in renal stone disease.

Mairiang E, Hanpanich P, Sriboonlue P.

Department of Radiology, Faculty of Medicine, Khon Kaen University.
eimmai@kku.ac.th

Previous studies of renal stone disease (RSD) in Thailand indicated abnormal
urinary aggregator and inhibitor composition among farmers with excessive sweat
loss. Our aim was to compare the proton MR spectra obtained from the kidneys of
32 proven cases of RSD (aged 38 to 65 yrs) with nine age-matched normal control
subjects. We used the STEAM sequence with TE = 15 ms and TR = 2,000 ms. The
spectra at 3.25, 3.6 and 3.9 ppm were analyzed. The results showed a correlation 
between the three peaks (p < 0.001), however, there was no significant difference
between the RSD group and the normal control subjects. We therefore concluded
that there was no overloading of these osmolytes among the renal stone patients.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12591573 [PubMed - indexed for MEDLINE]

1088: J Pediatr. 2003 Feb;142(2):206-8.

Hypercalciuria in Beckwith-Wiedemann syndrome.

Goldman M, Shuman C, Weksberg R, Rosenblum ND.

Division of Nephrology and the Program in Developmental Biology, The Hospital for
Sick Children, University of Toronto, Ontario, Canada.

We determined the incidence of hypercalciuria (HC) and its association with
nephrocalcinosis and nephrolithiasis in 18 consecutive patients with
Beckwith-Weidemann syndrome (BWS). Random, nonfasting urine samples were obtained
from each patient. All patients had abdominal ultrasonography, most on several
occasions. Four patients (22%) had HC. Of these, 2 had nephrocalcinosis, one had 
hyperechoic kidneys, and one had normal renal imaging. Serum calcium was normal
in all patients with HC. Because we found that an increased prevalence in the
occurrence of HC and its complications in a group of children with BWS, any child
with BWS should be evaluated for HC.

PMID: 12584548 [PubMed - indexed for MEDLINE]

1089: J Urol. 2003 Mar;169(3):875-7.

The role of mannitol in alleviating renal injury during extracorporeal shock wave
lithotripsy.

Ogiste JS, Nejat RJ, Rashid HH, Greene T, Gupta M.

Squier Urological Clinic, New York-Presbyterain Hospital, Columbia College of
Physicians and Surgeons, New York, New York, USA.

PURPOSE: We determined the role of mannitol in preventing or alleviating renal
injury during extracorporeal shock wave lithotripsy (ESWL, Dornier Medical
Systems, Inc., Marietta, Georgia). MATERIALS AND METHODS: Patients undergoing
ESWL were randomized to receive mannitol or control. Change in the levels of
urinary enzymes, beta 2-microglobulin and microalbumin were compared in the
groups before and after the procedure. RESULTS: Mannitol treated patients had a
statistically significant decrease in beta 2-microglobulin excretion after ESWL
compared with the control group. CONCLUSIONS: Mannitol may serve a protective
function by decreasing the amount of renal injury caused by ESWL for renal
calculous disease.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 12576803 [PubMed - indexed for MEDLINE]

1090: J Urol. 2003 Mar;169(3):863-6.

Changes in urine volume accomplished by physicians treating nephrolithiasis.

Parks JH, Goldfischer ER, Coe FL.

Nephrology Section, University of Chicago, Illinois, USA.

PURPOSE: We quantified the changes in urine volume and sodium accomplished in
various practice settings and the consequent effects on calcium oxalate
supersaturation. MATERIALS AND METHODS: We determined comprehensive urine stone
risk factors in 2,877 patients treated in 14 practices, including a university
referral center and private sector practices. Changes in urine volume and stone
risk factors were measured. RESULTS: In a wide range of practice settings the
volume increase was about 0.3 l. daily. Urine sodium excretion increased with
volume for unexplained reasons, as did urine calcium excretion. As expected,
thiazide lowered calcium excretion but the effect progressively decreased as
urine volume increased. Therefore, urine calcium and calcium oxalate
supersaturation changes were the result of opposing forces. The net effect was a 
decrease partly offset by sodium and calcium excretion increases. CONCLUSIONS:
Urine volume increments are modest in practice and they are modestly offset by
increases in urine sodium due to increased sodium intake. Clinicians should
strive for higher volume increases than are currently achieved and be vigilant
concerning what seems to be a strong tendency toward a higher sodium intake with 
more fluids.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12576800 [PubMed - indexed for MEDLINE]

1091: Eur Urol. 2003 Feb;43(2):188-93.

The impact of radiological anatomy in clearance of lower calyceal stones after
shock wave lithotripsy in paediatric patients.

Ozgür Tan M, Karaoğlan U, Sen I, Deniz N, Bozkirli I.

Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey.
muzgurtan@yahoo.com

OBJECTIVE: To determine the factors affecting stone clearance after
extracorporeal shock wave lithotripsy (ESWL) in children with lower calyceal
stones. MATERIALS AND METHODS: Lower pole stone clearance was reviewed in 34
patients aged between 2 and 16 years (23 boys and 11 girls) treated with ESWL
between 1989 and 2001 in our clinic. Renal anatomy was determined on standard
intravenous urograms. The lower infundibulopelvic angle (IPA) was measured by two
different methods based either on measuring the angle between vertical pelvis
axis and vertical axis of lower infundibulum or finding the angle between the
ureteropelvic axis and vertical axis of lower infundibulum. RESULTS: The mean age
of the patients was 12.1+/-4.16 (2-16) years. The mean stone burden was found as 
96.93+/-87.13 mm(2) and the mean shock wave number per session and power as
2631.4+/-593.1 and 17.57+/-1.1 kV, respectively. The stone-free rate was 55.9%.
Fifteen (44.1%) cases had residual fragments retained in lower calices after
lithotripsy and are still followed. The stone clearance was found to be unrelated
to stone burden and infundibulum width (p=0.44 and p=0.34, respectively).
However, a significant difference was present between mean lower pole
infundibular length (p=0.0032) and lower IPA measurements according to both
methods between stone-free cases and others. The most remarkable factor that had 
a significant influence on stone clearance was an acutely oriented infundibulum
defined according to IPA-ureteropelvic axis angle determination method
(p=0.00001) followed by Sampaio's pelvic axis method (p=0.0001). Only 1 (5%)
patient was stone-free under 40 degrees and 1 (6%) case with an angle of 45
degrees had residual fragments in the former method. Similarly none of the cases 
had residual fragments over 90 degrees for Sampaio's method and 90% of the
stone-free cases had a more obtuse angle. Thus, we determined that a cut-off
point of 40 degrees for the IPA-ureteropelvic axis method and 90 degrees for
Sampaio's method was most useful to determine the clearance of lower pole
fragments. CONCLUSION: The factors affecting stone clearance in paediatric
patients are similar to adults.

PMID: 12565778 [PubMed - indexed for MEDLINE]

1092: J Ren Nutr. 2003 Jan;13(1):39-46.

Effects of an oxalate load on urinary oxalate excretion in calcium stone formers.

de O G Mendonça C, Martini LA, Baxmann AC, Nishiura JL, Cuppari L, Sigulem DM,
Heilberg IP.

Nephrology Division, Universidade Federal de São Paulo, Brazil.

OBJECTIVE: To investigate the oxalate intake and the effect of an oxalate load on
urinary oxalate excretion in calcium stone-forming (CSF) patients. DESIGN:
Prospective study. SETTING: University-affiliated outpatient Renal Lithiasis
Unit. Patients and controls: Seventy (70) CSF and 41 healthy subjects (HS)
collected a 24-hour urine sample and were submitted to a 3-day dietary record to 
determine mean oxalate (Ox), calcium (Ca) and vitamin C intake. Fifty-eight (58) 
CSF patients were randomly selected to receive milk (N = 28) or dark (N = 30)
chocolate as an oxalate load. INTERVENTION: Administration of either milk (94 mg 
Ox + 430 mg Ca) or dark chocolate (94 mg Ox + 26 mg Ca) for 3 days. A 24-hour
urine sample was obtained before and after the load to determine calcium,
oxalate, sodium, potassium, urea, and creatinine. MAIN OUTCOME MEASURE: Oxalate
intake and excretion. RESULTS: CSF patients presented mean Ox intake of 98 +/-
137 mg/d, similar to that of HS (108 +/- 139 mg/d). Mean Ox and vitamin C intake 
was directly correlated with Ox excretion only in CSF. The consumption of dark
chocolate induced a significant increase in mean urinary Ox (36 +/- 14 versus 30 
+/- 10 mg/24 hr) not observed in the milk chocolate group. Thus, a 2-fold
increase in Ox intake in this population of CSF patients produced a significant
20% increase in oxaluria, not observed when Ca was consumed simultaneously.
CONCLUSION: The present study suggests that even small increases in Ox intake
affect oxalate excretion and the mitigation of urinary oxalate increase by Ca
consumption reinforces that Ca and Ox intakes for CSF patients should be in
balance. Further studies are necessary to assess whether or not a 20% increase in
oxaluria will lead to a higher risk of stone formation. Copyright 2003 by the
National Kidney Foundation, Inc.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 12563622 [PubMed - indexed for MEDLINE]

1093: Semin Nephrol. 2003 Jan;23(1):77-87.

Renal stones in the tropics.

Robertson WG.

Institute of Urology and Nephrology, University College London, London, UK.

Urolithiasis is a problem that is generally increasing in the tropics as it is in
most Western countries. There are 2 main types of the disorder-bladder stones in 
children, a form of the disorder that disappeared from Europe in the late 19th
and early 20th centuries, and upper urinary tract stones in adults. The former
has been decreasing in most countries in the so-called endemic bladder stone belt
with gradual improvements in levels of nutrition. However, as living standards
increase, particularly in the urban areas of the more affluent developing
countries, so the incidence of upper urinary tract stones in adults is
increasing. The types of stones formed depend mainly on the composition of urine,
which, in turn, reflects the type of diet consumed in the countries concerned.
The main factor that leads to the formation of bladder stones in children is a
nutritionally poor diet that is low in animal protein, calcium, and phosphate,
but high in cereal and is acidogenic. This leads to the formation of urine with a
relatively high content of ammonium and urate ions and consequently to the
formation of ammonium acid urate crystals and stones. In countries where there is
also a high intake of oxalate from local leaves and vegetables, urinary oxalate
is increased and, as a result, the ammonium acid urate stones often contain
calcium oxalate as well. The stone problem in the tropics is compounded by low
urine volumes resulting in some areas from poor drinking water, which causes
chronic diarrhea, and in others from the hot climate and fluid losses through the
skin. As nutrition improves in these countries, the formation of bladder stones
gives way to upper urinary tract stones consisting of calcium oxalate, often
mixed with calcium phosphate or uric acid, such as are formed in most Western
countries. Copyright 2003, Elsevier Science (USA). All rights reserved.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12563603 [PubMed - indexed for MEDLINE]

1094: Urology. 2003 Jan;61(1):212-5; discussion 215.

Does size and site matter for renal stones up to 30-mm in size in children
treated by extracorporeal lithotripsy?

Ather MH, Noor MA.

Section of Urology, Department of Surgery, Aga Khan University, Karachi,
Pakistan.

OBJECTIVES: To determine the safety and efficacy of extracorporeal shock wave
lithotripsy (ESWL) in the treatment of pediatric nephrolithiasis and to analyze
the impact of renal stone size and location on stone clearance. METHODS: This was
a retrospective case series of pediatric patients (14 years or younger)
undergoing lithotripsy using a Dornier MPL 9000 echo-guided lithotriptor.
Patients were identified using an international coding and indexing system (9th
edition) and ESWL registry. One hundred five patients were treated from January
1990 to December 2001. Stone clearance was assessed at 1 and 3 months. A
stone-free state was defined as no radiologic evidence of stone or fragments 3 mm
or less. Treatment failure was analyzed to find any correlation with stone size
and site. RESULTS: The overall stone-free rate was 95%. The treatment failed in 5
patients, who subsequently required ancillary procedures. Three patients received
one session of ESWL, after which they were lost to treatment and were not
analyzed further. Four of the five patients with treatment failure had a double-J
stent; the stones were located in the lower pole calix in 2, renal pelvis and
lower pole calix in 1, and at the ureteropelvic junction in 2 patients. The mean 
stone size in the treatment failure group was 15.88 mm compared with 14 mm in the
stone-free group. The complication rate was 8%, but only 3 patients required
admission. CONCLUSIONS: ESWL is highly effective for pediatric renal stones, with
minimal morbidity. Stone clearance is not adversely affected by a stone size up
to 30 mm; however, lower pole caliceal stones and stones impacted at the
ureteropelvic junction have relatively poorer clearance. Eighty percent of
patients who failed to clear their stones had a double-J stent.

Publication Types: 
    Comparative Study

PMID: 12559298 [PubMed - indexed for MEDLINE]

1095: J Acoust Soc Am. 2003 Jan;113(1):586-97.

Suppression of large intraluminal bubble expansion in shock wave lithotripsy
without compromising stone comminution: refinement of reflector geometry.

Zhou Y, Zhong P.

Department of Mechanical Engineering and Materials Science, Duke University,
Durham, North Carolina 27708, USA.

Using the Hamilton model [Hamilton, J. Acoust. Soc. Am. 93, 1256-1266 (1993)],
the effects of reflector geometry on the pulse profile and sequence of the shock 
waves produced by the original and upgraded reflector of an HM-3 lithotripter
were evaluated qualitatively. Guided by this analysis, we have refined the
geometry of the upgraded reflector to enhance its suppressive effect on
intraluminal bubble expansion without compromising stone comminution in shock
wave lithotripsy. Using the original HM-3 reflector at 20 kV, rupture of a
standard vessel phantom made of cellulose hollow fiber (i.d. = 0.2 mm), in which 
degassed water seeded with ultrasound contrast agents was circulated, was
produced at the lithotripter focus after about 30 shocks. In contrast, using the 
upgraded reflector at 24 kV no rupture of the vessel phantom could be produced
within a 20-mm diameter around the lithotripter focus even after 200 shocks. On
the other hand, stone comminution was comparable between the two reflector
configurations, although slightly larger fragments were produced by the upgraded 
reflector. After 2000 shocks, stone comminution efficiency produced by the
original HM-3 reflector at 20 kV is 97.15 +/- 1.92% (mean +/- SD), compared to
90.35 +/- 1.96% produced by the upgraded reflector at 24 kV (p<0.02). All
together, it was found that the upgraded reflector could significantly reduce the
propensity for vessel rupture in shock wave lithotripsy while maintaining
satisfactory stone comminution.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12558294 [PubMed - indexed for MEDLINE]

1096: J Med Assoc Thai. 2002 Nov;85 Suppl 4:S1281-6.

Cystinuria: cause of recurrent renal stones in a 4-year-old girl.

Tangnararatchakit K, Ariyaprakai W, Tapaneya-Olarn W, Shotelersuk V, Petchthong
T.

Nephrology Unit, Department of Pediatrics, Ramathibodi Hospital, Mahidol
University, Bangkok 10400, Thailand.

This paper presents the case report of a 4-year and 6-month old girl with
cystinuria. She clinically presented with recurrent radiopaque renal stones since
the age of 3 years. She received 2 subsequent operations of pyelolithotomy
combined with ureterolithotomy at the age of 3 years 6 months, and pyelolithotomy
alone at the age of 5 years. She was initially diagnosed as having cystinuria by 
the presence of hexagonal plate crystals in her acidified urine and positive for 
the urinary cyanide-nitroprusside test. The diagnosis was confirmed by urinary
amino acid analysis using quantitative ion-exchange chromatography which revealed
increased amounts of cystine and dibasic amino acids of lysine and ornithine. In 
spite of maintaining a high fluid intake and alkalinizing urine by giving
potassium citrate after the first operation, recurrent renal stones were found.
Therefore, after the second operation, D-penicillamine was additionally
introduced. During the 18-month follow-up, although there were recurrent renal
stones, the rate of stone formation was slower. To the authors' knowledge, this
is the first case report in Thailand.

Publication Types: 
    Case Reports

PMID: 12549807 [PubMed - indexed for MEDLINE]

1097: Int Urol Nephrol. 2002;34(1):135-41.

Renal stone disease, elevated iPTH level and normocalcemia.

Dimkovic NB, Wallele AA, Oreopoulos DG.

Division of Nephrology, University Health Network and University of Toronto,
Ontario, Canada.

BACKGROUND: There is a well established relationship between primary
hyperparathyroidism and recurrent calcium-containing calculi. Traditionally, the 
diagnosis is confirmed by the presence of elevated intact parathyroid hormone
(iPTH) and serum ionised calcium levels. The prevalence and role of elevated iPTH
in the presence of normocalcemia in patients with renal stone disease is poorly
understood. The aim of the present study was to describe the findings in patients
who had renal stone disease, an elevated iPTH level and normocalcemia. METHODS:
During the last decade, 414 patients, who had normal renal function, were
investigated and treated for renal calculi in the Renal Stone Clinic of the
Toronto Western Hospital. Of these 414 patients, 40 (9.6%) had an elevated intact
iPTH level and normal serum calcium (total and ionised) on repeated measurements.
In all these patients we performed detailed clinical and laboratory
investigations to determine risk factors for stone formation. Correlation
analysis was done using Pearson test and the weights of factors influencing iPTH 
level were compared using multiple regression analysis. RESULTS: The average
duration of a history of stone disease was 12.0 +/- 10.5 years. Most of these
patients had passed their stones spontaneously, 15 underwent lithotripsy, in six 
the stones were removed by basket catheters and one patient each had partial
nephrectomy, nepholithotomy or uretero-lithotomy. Twelve had a positive family
history, two had history of intestinal malabsorption and one patients had a
history of immobilisation. All of these patients had elevated serum parathyroid
hormone in the range of 3% to 134% (median 20.5%) above upper limit of normal (F 
= M); all had normal serum total and ionised calcium and normal urine excretion
of calcium (except in one). Additional risk factor for stone formation included: 
low level of 25-hydroxyvitamin D in four patients, low output and high urine
osmolality in four patients, high urine sodium in nine and high oxalate excretion
in eight patients. Citrate excretion was low in seven, magnesium excretion in six
patients and tubular reabsorption of phosphate in 22 patients. Urine
hydroxyprolin was increased in two and decreased in four patients. Combined
abnormalities were found in 14 while 17 patients did not have any abnormality
apart from elevated iPTH level. Multiple regression analysis did not suggest that
any of the selected predictors had a significant influence on PTH release.
CONCLUSIONS: 9.6% of patients with recurrent kidney stones had normocalcemia and 
elevated iPTH level in the presence of normal renal function. The study did not
show any distinct pattern of abnormalities that would suggest a mechanism of
stone disease in these patients. Further investigations are necessary to
determine the significance of elevated iPTH in normocalcemic patients with renal 
stone disease and establish whether we should consider neck exploration for
parathyroidectomy in these patients.

PMID: 12549656 [PubMed - indexed for MEDLINE]

1098: BMC Urol. 2003 Jan 21;3:1. Epub 2003 Jan 21.

Stone clearance in lower pole nephrolithiasis after extra corporeal shock wave
lithotripsy - the controversy continues.

Ather MH, Abid F, Akhtar S, Khawaja K.

Dept of Surgery, The Aga Khan University, Karachi, Pakistan. hammad.ather@aku.edu

BACKGROUND: To determine factors influencing the clearance of fragments after
extra-corporeal shock wave lithotripsy (ESWL) for lower pole calyceal (LPC)
stones. METHODS: In the period between July 1998 and Oct 2001, 100 patients with 
isolated lower polar calyceal calculi <or= 20 mm, in patients aged >or= 14 years,
were included in the study. Intravenous urograms (IVU) were reviewed to define
the LPC anatomy (width of the infundibulum and pelvicalyceal angle). Study end
points i.e. stone free status; number of shock waves used and number of sessions 
were correlated with variables like LPC anatomy, body mass index and stone size. 
RESULTS: At three months follow up the clearance for stone size <or= 10 mm, 11-15
mm and 16-20 mm were 95, 96 and 90% respectively. Patients with acute LPC (<90
degrees ) and obtuse angle (>90 degrees ) had stone clearance of 94 and 100%
respectively. For the infundibular width of < 4 mm, the stone clearance was 93%
were as for > 4 mm, it was 100%. For body mass index (BMI) less than and > 30
kg/m2, the stone clearance was 92 and 95% respectively. CONCLUSIONS: There is a
trend towards more ESWL sessions and shock wave requirement in patients with
acute pelvi-calyceal angle and narrow infundibulum but it is not statistically
significant. Size (<or= 20 mm) and BMI has no relation with stone clearance. With
modern lithotripter, stones up to 20 mm could primarily be treated by ESWL,
irrespective of an un-favorable lower polar calyceal anatomy and body habitus.

PMID: 12546707 [PubMed - indexed for MEDLINE]

1099: J Urol. 2003 Feb;169(2):691-6.

Comment in:
    J Urol. 2003 Dec;170(6 Pt 1):2390.

Laparoscopic anatrophic nephrolithotomy: feasibility study in a chronic porcine
model.

Kaouk JH, Gill IS, Desai MM, Banks KL, Raja SS, Skacel M, Sung GT.

Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute,
Departments of Nuclear Medicine and Pathology and Minimally Invasive Surgery
Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

PURPOSE Anatrophic nephrolithotomy performed via open surgery involves incising
the renal parenchyma along an avascular plane to remove a large, complex renal
stone. We determined the feasibility of performing laparoscopic anatrophic
nephrolithotomy in a survival porcine model. Furthermore, we present a novel
technique of creating a staghorn calculus in the porcine model.MATERIALS AND
METHODS After developing the technique in 3 pigs the survival study was performed
in 10 consecutive animals. The procedure comprised 2 aspects. 1) We developed an 
animal model for staghorn calculi by retrograde injection of polyurethane (Fomo
Products, Inc., Norton, Ohio) into the renal pelvis through a ureteral catheter. 
For a 2-week period the staghorn calculus was allowed to create hydronephrosis.
2) Laparoscopic anatrophic nephrolithotomy was done, involving control of the
renal artery and vein, in situ renal hypothermia with ice slush in 1 animal,
lateral renal parenchymal incision, stone extraction and suture repair of the
incised collecting system and renal parenchyma.RESULTS Synthetic stone formation 
and laparoscopic anatrophic nephrolithotomy were successful in all 10 animals,
including 1 that underwent staged bilateral anatrophic nephrolithotomy. Mean
operative time for anatrophic nephrolithotomy was 125 minutes. Mean blood loss
was 68 cc and mean warm ischemia time was 30 minutes (range 23 to 39). A residual
small pelvicaliceal calculus was noted postoperatively in the initial 3 cases
only. Thereafter, routine intraoperative ultrasonography and flexible endoscopy
were done for stone localization, resulting in a stone-free rate of 100% in all 7
remaining animals. Diethylenetriamine pentaacetic acid renal scans documented
improvement in the glomerular filtration rate from a mean of 26.4 ml. per minute 
after stone creation and hydronephrosis to 54.8 ml. per minute 4 to 5 weeks after
laparoscopic anatrophic nephrolithotomy.CONCLUSIONS Laparoscopic techniques can
be applied to complex stone surgery such as anatrophic nephrolithotomy with
encouraging surgical and functional outcomes. To our knowledge this report
represents the initial study of in situ creation of experimental staghorn calculi
and laparoscopic anatrophic nephrolithotomy performed completely intracorporeally
in a chronic porcine model.

PMID: 12544344 [PubMed - indexed for MEDLINE]

1100: J Urol. 2003 Feb;169(2):629-33.

Pediatric staghorn calculi: the role of extracorporeal shock wave lithotripsy
monotherapy with special reference to ureteral stenting.

Al-Busaidy SS, Prem AR, Medhat M.

Department of Urology, Armed Forces Hospital, Muscat, Sultanate of Oman.

PURPOSE: Treatment for staghorn calculi in children represents a unique
challenge. We assessed the efficacy of extracorporeal shock wave lithotripsy
(ESWL) (Dornier Medical Systems, Inc., Marietta, Georgia) monotherapy for the
management of staghorn calculi in children with special reference to ureteral
stenting. MATERIALS AND METHODS: From June 1992 to January 2001 we treated 42
children 9 months to 12 years old with staghorn stones using the Piezolith 2501
(Richard Wolf GmBH, Knittlingen, Germany) lithotriptor. The initial group of 19
patients underwent ESWL without prophylactic ureteral stenting, while in the
latter group of 23 a Double-J (Medical Engineering Corp., New York, New York)
ureteral stent was inserted immediately before the first ESWL session. Mean
patient age, stone size, number of shock waves and ESWL sessions, hospital stay, 
stone-free rate and major complications were compared in the 2 groups. RESULTS:
Overall 33 children (79%) were stone-free after 3 months. The 2 groups were
comparable in regard to patient age, stone size, number of shock waves and ESWL
sessions, and stone-free rates. Major complications developed in 21% of the
unstented group, whereas none were observed in stented cases. This difference was
statistically significant (p = 0.035). Seven post-ESWL auxiliary procedures were 
required in the unstented group to manage complications. Hospital stay was
significantly longer in the unstented compared with the stented group (p =
0.022). At a followup of 9 to 102 months (mean 47) stones recurred in 2 children,
who were treated with further ESWL. CONCLUSIONS: ESWL monotherapy was an
efficient and safe modality for the treatment of staghorn calculi in children.
Stented patients had fewer major complications and a shorter hospital stay.
Prophylactic ureteral stenting is advisable before ESWL for staghorn calculi in
children.

PMID: 12544330 [PubMed - indexed for MEDLINE]

1101: J Urol. 2003 Feb;169(2):475-7.

The etiology of urolithiasis in HIV infected patients.

Nadler RB, Rubenstein JN, Eggener SE, Loor MM, Smith ND.

Department of Urology, Tarry 11-715, Northwestern University Medical School, 303 
E. Chicago Ave., T-229, Chicago, Illinois 60611-3008, USA.

PURPOSE: It is commonly thought that urinary lithiasis in HIV infected patients
on protease inhibitor therapy is composed primarily of the protease inhibitor
itself. Since many HIV infected patients on protease inhibitors presenting to our
institution had nonprotease inhibitor stones, we investigated potential
underlying metabolic abnormalities that may account for the lithogenesis.
MATERIALS AND METHODS: We retrospectively reviewed all HIV infected patients on
protease inhibitors with renal colic and evidence of nephrolithiasis who
presented to our institution between June 1996 and January 2001. Patients were
evaluated for stone composition and metabolic abnormalities of blood and urine
when possible. RESULTS: A total of 24 patients were identified, and all were or
had been on protease inhibitors (indinavir 14, ritonavir 3, nelfnavir 2,
unspecified 5). Of the 14 patients on indinavir only 4 (28.6%) had indinavir
containing stones. The remaining stones in this group and in those not on
indinavir contained various amounts of calcium oxalate monohydrate and dihydrate,
ammonium acid urate and uric acid. Of 10 patients who underwent 24-hour urine
collection for metabolic evaluation 8 (80%) had abnormalities, including
hypocitraturia in 5, hyperoxaluria in 4, hypomagnesuria in 4, hypercalciuria in
3, increased supersaturation of calcium oxalate in 3 and hyperuricosuria in 2.
Abnormalities in the levels of urinary phosphate and sodium were also observed.
CONCLUSIONS: HIV infected patients form many types of stones, which probably are 
attributable to underlying metabolic abnormalities rather than the use of
protease inhibitors. A complete metabolic evaluation is warranted in these
patients, as a means of guiding treatment to prevent future stone episodes, while
avoiding the need to alter antiretroviral regimens.

PMID: 12544290 [PubMed - indexed for MEDLINE]

1102: J Urol. 2003 Feb;169(2):470-4.

Comment in:
    J Urol. 2003 Feb;169(2):478-9.

Effect of dietary calcium on stone forming propensity.

Heller HJ, Doerner MF, Brinkley LJ, Adams-Huet B, Pak CY.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas
75390-8885, USA.

PURPOSE: Epidemiological studies have reported that high calcium diet protects
against kidney stone formation in normal subjects. This metabolic study was
designed to elucidate the physiological and physicochemical effects conferring
this apparent protection. MATERIALS AND METHODS: A total of 21 normal volunteers 
underwent 2 phases of study in a crossover, randomized design, wherein they
consumed constant metabolic diets that matched the estimated highest and lowest
quintiles of calcium intake from published epidemiological studies. RESULTS:
Urinary calcium was significantly greater on the high calcium diet (148 +/- 55
versus 118 +/- 43 mg. daily, p <0.01, p <0.01) but urinary oxalate did not differ
between diets. There was no difference in relative saturation ratio of calcium
oxalate between the 2 diets. The high calcium diet significantly increased
saturation of brushite and decreased that of uric acid. Due to the other
differences between the diets (more fluid, potassium, magnesium and phosphate in 
the high calcium diet), the high calcium diet also increased 24-hour urinary
volume, potassium, phosphorus, pH and citrate. After adjustment of these
confounding variables, the high calcium diet significantly increased relative
saturation ratio of calcium oxalate by 24%. CONCLUSIONS: High calcium diet from
published epidemiological studies does not alter the propensity for calcium
oxalate crystallization in normal subjects despite increased urinary calcium and 
unaltered urinary oxalate because of the greater amounts of ingested fluid,
potassium and phosphate. However, high calcium intake alone, without concomitant 
changes in the diet, poses a modest risk for calcium stone formation.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 12544289 [PubMed - indexed for MEDLINE]

1103: J Urol. 2003 Feb;169(2):465-9.

Comment in:
    J Urol. 2003 Feb;169(2):478-9.

Prevention of stone formation and bone loss in absorptive hypercalciuria by
combined dietary and pharmacological interventions.

Pak CY, Heller HJ, Pearle MS, Odvina CV, Poindexter JR, Peterson RD.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390-8885,
USA.

PURPOSE: We determined whether dietary restriction of calcium and oxalate,
combined with thiazide and potassium citrate treatment, would prevent stone
formation and avert bone loss in 18 men and 10 women with type I absorptive
hypercalciuria. MATERIALS AND METHODS: Patients were treated with thiazide (20)
or indapamide (8) and potassium citrate (average dose 35 mEq. daily) for 1 to 11 
years (mean 3.7) while maintained on low calcium oxalate diet. Serum and urinary 
chemistry studies and bone mineral density were measured at baseline and at the
end of treatment. New stones formed were quantitated during 3 years before and
during treatment. RESULTS: During treatment urinary calcium significantly
decreased (346 +/- 85 to 248 +/- 79 mg. daily, p <0.001) but urinary oxalate did 
not change. Urinary pH and citrate significantly increased, and urinary
saturation of calcium oxalate significantly decreased by 46%. Stone formation
rate decreased significantly from 2.94 to 0.05 per year (p <0.001). L2-L4 bone
mineral density increased significantly by 5.7% compared to normal peak value,
and by 7.1% compared with normal age and gender matched value. Femoral neck bone 
mineral density also increased significantly. CONCLUSIONS: Dietary restriction of
calcium and oxalate, combined with thiazide and potassium citrate, satisfactorily
controlled hypercalciuria, prevented the secondary increase in urinary oxalate,
reduced urinary saturation of calcium oxalate, virtually eliminated recurrent
stone formation, and increased bone density of the spine and femoral neck. Thus, 
this dietary pharmacological program controlled stone formation as well as bone
loss that often accompany type 1 absorptive hypercalciuria.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12544288 [PubMed - indexed for MEDLINE]

1104: J Endourol. 2002 Dec;16(10):717-20.

Shockwave lithotripsy for urinary stones in patients with urinary diversion after
radical cystectomy.

Deliveliotis C, Varkarakis J, Argiropoulos V, Protogerou V, Skolarikos A, Albanis
S, Constantine D.

Second Department of Urology, Sismanoglion Hospital, University of Athens,
Greece. nikistra@hol.gr

BACKGROUND AND PURPOSE: During recent years, survival of patients with invasive
bladder cancer has been improved by early diagnosis and radical treatment.
Urinary lithiasis is not rare in patients who have been submitted to radical
cystectomy and urinary diversion. We have demonstrated the effectiveness and
safety of SWL for these patients. PATIENTS AND METHODS: We studied 11 patients
who presented to our lithotripsy department suffering from urinary lithiasis
after radical cystectomy. They were all cancer free at the time of treatment, and
all underwent SWL on the Dornier HM-3 lithotripter as a first-line treatment. The
mean stone burden was 1.85 cm(2), and the stone-to-patient ratio was 1:1.
RESULTS: The stone-free rate 1 month after SWL was 63.7%. Patients who were not
stone free underwent a second SWL, and the stone-free rate after the second SWL
session was 81.8%. We performed percutaneous nephrolithotripsy in one patient
after the second SWL session because of the large stone burden remaining (3.2
cm(2)). The remaining patient was submitted to ureterolithotomy. CONCLUSION:
Application of SWL gives very good results in the treatment of urinary lithiasis 
in patients with a urinary diversion. Indeed, the results are equivalent to those
achieved in patients without urinary diversion.

PMID: 12542873 [PubMed - indexed for MEDLINE]

1105: J Endourol. 2002 Dec;16(10):709-15.

Prefocal alignment improves stone comminution in shockwave lithotripsy.

Sokolov DL, Bailey MR, Crum LA, Blomgren PM, Connors BA, Evan AP.

Center for Industrial and Medical Ultrasound, Applied Physics Laboratory,
University of Washington, Seattle 98105, USA.

BACKGROUND: The Dornier HM-3 machine continues to be one of the most effective
lithotripters in use. However, tissue damage occurs in most, if not all,
shockwave lithotripsy (SWL) treatments. Cavitation appears to contribute to
desired stone comminution as well as to undesired tissue damage. Studies of
cavitation in electrohydraulic shockwave lithotripters indicate that the greatest
cavitation activity occurs, not at the geometric focus, F2, but at a site
proximal to F2 by 1 to 3 cm. In clinical practice, however, stones are aligned
with F2. MATERIALS AND METHODS: In vitro stone comminution, hemolysis, and
free-radical production were assessed along the focal axis, and pig kidneys
treated with SWL in vivo were sectioned to determine the extent of hemorrhagic
injury along the focal axis. Model gypsum stones received 200 shockwaves in vitro
at 18 kV. RESULTS: At F2, the average number of fragments >1.5 mm was 1.3 +/-
0.5, and the weight loss was 11.3 +/- 1.1%. At 2 cm from F2 (F2-2 cm), these
values increased to 4 +/- 2.8 and 16.1 +/- 4.2%, respectively. Samples of 10%
hematocrit blood were similarly exposed. Hemolysis was equivalent at F2-2 cm
(14.7 +/- 2.3%) and F2 (15.2 +/- 3%) but decreased significantly at all other
positions. Samples of iodine solution received 1500 shockwaves at 20 kV. Hydroxyl
radical production was greatest at F2-2 cm (0.384 +/- 0.035 microM) and decreased
significantly distal to this position. The volume of tissue injury in pig kidneys
was greatest with prefocal shockwave exposure. CONCLUSION: Stone comminution may 
be achieved more rapidly without greater tissue damage by a simple shift in stone
alignment to F2-2 cm.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12542872 [PubMed - indexed for MEDLINE]

1106: J Intern Med. 2003 Feb;253(2):194-200.

Association between vitamin D receptor gene polymorphisms and tubular citrate
handling in calcium nephrolithiasis.

Mossetti G, Vuotto P, Rendina D, Numis FG, Viceconti R, Giordano F, Cioffi M,
Scopacasa F, Nunziata V.

Department of Clinical and Experimental Medicine, Federico II University Medical 
School, via S. Pansini 5, 80131 Naples, Italy.

OBJECTIVES: Hypocitraturia is a risk factor for calcium nephrolithiasis.
1,25(OH)2D3 influences renal citrate handling and enhances citraturia. The aim of
this study was to evaluate the relationship between vitamin D receptor (VDR)
allelic variant and urinary citrate excretion in recurrent stone formers (SF)
patients. DESIGN: Case-control study. SUBJECTS: A total of 220 recurrent calcium 
oxalate SF patients and 114 healthy control (C) subjects were enrolled for this
study. Subjects with urinary tract infections, hyperparathyroidism, cystinuria
>70 micromol/24 h, gouty diathesis, renal tubular acidosis, renal failure,
chronic diarrhoeal states, intake of thiazide diuretics, angiotensin-converting
enzyme (ACE)-inhibitors, glucocorticoids or oestrogens were excluded. A standard 
constant diet was given for 7 days. The 24-h urinary citrate excretion and the
active tubular reabsorption of filtered citrate (Rcit) were evaluated.
Hypocitraturia was defined as a urinary citrate excretion lower than 1.7 mmol
day-1. Stone formers patients and C were genotyped for BsmI and TaqI VDR alleles.
Contingency table chi-square tests were used to compare genotype frequencies in
hypocitraturic SF patients, normocitraturic SF and C. RESULTS: The prevalence of 
hypocitraturia in SF patients was 32.7% (72 of 200). Hypocitraturia in these
patients resulted from excessive Rcit of a normal load of citrate. We found a
different distribution (P < 0.05) of BsmI and TaqI VDR genotypes in
hypocitraturic SF patients compared with normocitraturic SF and C. In particular,
the prevalence of bb and TT VDR genotypes in hypocitraturic SF was significantly 
higher than in normocitraturic SF and C. CONCLUSIONS: These results point to a
genetic association between BsmI and TaqI VDR polymorphisms and idiopathic
hypocitraturia in calcium-oxalate recurrent SF patients.

PMID: 12542560 [PubMed - indexed for MEDLINE]

1107: Int J Urol. 2003 Jan;10(1):56-8.

Calcium nephrolithiasis and distal tubular acidosis in type 1 glycogen storage
disease.

Iida S, Matsuoka K, Inoue M, Tomiyasu K, Noda S.

Department of Urology, Kurume University School of Medicine, Kurume, Japan.
iidas@med.kurume-u.ac.jp

A 36-year-old man was admitted to hospital due to right flank pain as a result of
ureteral stones. He had been followed up for type 1 glycogen storage disease
since the age of 11 years. He had four episodes of spontaneous stone birth during
the previous 2 years, and each stone was composed mainly of calcium oxalate.
Intravenous pyelography showed right hydronephrosis due to ureteral stones and
bilateral multiple renal stones. We carried out transurethral ureterolithotripsy 
(TUL) on the right ureteral stones. The composition was a mixture of calcium
oxalate and calcium phosphate. Laboratory evaluation demonstrated the association
of distal renal tubular acidosis (RTA). These observations suggest that
hypocitraturia and distal RTA are strongly correlated to recurrence of calcium
nephrolithiasis. The patient's serum uric acid and urinary citrate excretion
levels normalized after allopurinol and potassium citrate administration.

Publication Types: 
    Case Reports

PMID: 12534929 [PubMed - indexed for MEDLINE]

1108: Arch Ital Urol Androl. 2002 Dec;74(4):197-9.

Intraoperative localisation and management of renal calculi during
nephrolithotomy by real-time ultrasonography.

Marino G, Gamba P, Del Noce G, Pugno E, Bradac R, Garberoglio R, Laudi M.

Service of Sonography, Mauriziano Hospital, Turin, Italy.

OBJECTIVE: To evaluate the role of ultrasound as a sole procedure for
intraoperative localisation and management of complex renal calculi. MATERIAL AND
METHODS: Between September 1997 and November 2001, 16 patients underwent complex 
surgery for multiple, large or recurrent renal stones using the ultrasound image 
as a the sole intraoperative diagnostic procedure. A 8.5 MHz sector transducer
with a pulse Doppler signal was used to identify the avascular area, the shortest
distance between the renal surface and the stone. RESULTS: Complete stone removal
was achieved in all patients without complications. CONCLUSION: Intraoperative
sonography for localisation of the intrarenal arteries combined with B scan
sonography for intraoperative localisation of stones allows complete removal via 
radial nephrotomies without peduncle clamping and cooling procedure. The
advantage is the exact and quick localisation of stones avoiding X-ray.

PMID: 12508730 [PubMed - indexed for MEDLINE]

1109: J Am Soc Nephrol. 2003 Jan;14(1):107-15.

Crystal retention capacity of cells in the human nephron: involvement of CD44 and
its ligands hyaluronic acid and osteopontin in the transition of a crystal
binding- into a nonadherent epithelium.

Verhulst A, Asselman M, Persy VP, Schepers MS, Helbert MF, Verkoelen CF, De Broe 
ME.

Department of Nephrology-Hypertension, University of Antwerp, Antwerp, Belgium.

Nephrolithiasis requires formation of crystals followed by their retention and
accumulation in the kidney. Crystal retention can be caused by the association of
crystals with the epithelial cells lining the renal tubules. The present study
investigated the interaction between calcium oxalate monohydrate (COM) crystals
and primary cultures of human proximal (PTC) and distal tubular/collecting duct
cells (DTC). Both PTC and DTC were susceptible to crystal binding during the
first days post-seeding (4.9 +/- 0.8 micro g COM/cm2), but DTC lost this affinity
when the cultures developed into confluent monolayers with functional tight
junctions (0.05 +/- 0.02 micro g COM/cm2). Confocal microscopy demonstrated the
expression of the transmembrane receptor protein CD44 and its ligands osteopontin
(OPN) and hyaluronic acid (HA) at the apical membrane of proliferating tubular
cells; at confluence, CD44 was expressed at the basolateral membrane and OPN and 
HA were no longer detectable. In addition, a particle exclusion technique
revealed that proliferating cells were surrounded by HA-rich pericellular
matrices or "cell coats" extending several microns from the cell surface.
Disintegration of these coats with hyaluronidase significantly decreased the cell
surface affinity for crystals. Furthermore, CD44, OPN, and HA were also expressed
in vivo at the luminal side of tubular cells in damaged kidneys. These results
suggest (1) that the intact distal tubular epithelium of the human kidney does
not bind crystals, and (2) that crystal retention in the human kidney may depend 
on the expression of CD44-, OPN-, and-HA rich cell coats by damaged distal
tubular epithelium.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12506143 [PubMed - indexed for MEDLINE]

1110: Curr Opin Urol. 2003 Jan;13(1):63-7.

Infection and urinary stones.

Abrahams HM, Stoller ML.

Department of Urology, University of California San Francisco, 400 Parnassus
Avenue, San Francisco, CA 94143, USA.

PURPOSE OF REVIEW: Despite modern antibiotic therapy and technological advances
in lithotripsy, the presence of infection in urinary stone patients as well as
infectious stones are still a significant cause of morbidity and mortality. Many 
new investigations are focusing on the pathogenesis and treatment of these
difficult cases. RECENT FINDINGS: Most of the current literature on the subject
focuses on pathogenesis of infectious urinary stones. The remaining literature
highlights difficult cases, outcomes of treatments, and overall reviews of the
subject. SUMMARY: Recent findings lend more theories as to how infection leads to
stone formation. Further investigation is critically needed to improve the
outcomes of patients suffering from infections with urinary stones and infectious
stones.

Publication Types: 
    Review

PMID: 12490818 [PubMed - indexed for MEDLINE]

1111: J Endourol. 2002 Nov;16(9):655-7.

Extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy in a left
pelvic kidney.

Troxel SA, Low RK, Das S.

Department of Urology, University of California-Davis Medical Center, 4860 Y
Street, Suite 3500, Sacramento, CA 95817, USA.

Treatment of urolithiasis within a pelvic kidney presents a technical challenge. 
We report an extraperitoneal laparoscopy-assisted percutaneous approach to access
the lower-pole calix of a pelvic kidney for percutaneous nephrolithotomy.

Publication Types: 
    Case Reports

PMID: 12490018 [PubMed - indexed for MEDLINE]

1112: J Endourol. 2002 Nov;16(9):649-53.

Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81
patients.

Doğan HS, Sahin A, Cetinkaya Y, Akdoğan B, Ozden E, Kendi S.

Department of Urology, Section of Infectious Diseases, Hacettepe University
Faculty of Medicine, Ankara, Turkey.

PURPOSE: To compare single-dose and short-course antibiotic prophylaxis protocols
in percutaneous nephrolithotomy. PATIENTS AND METHODS: Eighty-one patients with
sterile urine preoperatively who underwent percutaneous nephrolithotomy were
divided into two groups. The first group (N = 43) received a single intravenous
dose of antibiotic (200 mg of ofloxacin) during anesthetic induction, and the
second group (N = 38) received treatment doses of antibiotic (400 mg of ofloxacin
per day) until the nephrostomy catheter was removed. The two groups were
identical according to demographic and treatment characteristics. For each
patient, microbiologic evaluation of extracted stones and urine samples was done.
If patients developed fever in the postoperative period, blood and urine cultures
were taken. Factors that might have affected the development of postoperative
fever and infection were analyzed. RESULTS: Nine patients in the first group had 
postoperative fever. Three had bacteriuria, and one had bacteremia. In the second
group, eight patients had fever. One had bacteriuria and bacteremia. Nineteen
patients (eleven in the first group, eight in the second) had positive stone
cultures. No statistical difference was observed between the two groups in terms 
of bacteriuria, bacteremia, positive stone cultures, or postoperative fever. The 
febrile patients had longer operations with the use of more irrigation fluid and 
longer postoperative hospital stays. CONCLUSIONS: In patients whose preoperative 
urine cultures are sterile, short-term prophylaxis has no advantage over
single-dose prophylaxis as a means of preventing infection. The duration of
surgery and the amount of irrigation fluid are significant risk factors for
postoperative fever.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial

PMID: 12490017 [PubMed - indexed for MEDLINE]

1113: Scand J Urol Nephrol. 2002;36(5):368-72.

The diagnostic value of the phosphate levels in serum and 24-hour urine samples
in patients with recurrent renal stone disease.

Müezzinoğlu T, Gümüş B, Sener E, Ari Z, Büyüksu C.

Department of Urology, Medical Faculty, Celal Bayar University, Manisa, Turkey.
talhadr@hotmail.com

OBJECTIVE: The aim of this study is to investigate the value of phosphate levels 
in serum and urine in patients with recurrent renal stone disease. MATERIALS AND 
METHODS: The patients (n:60) were divided into two groups as first-time stone
disease (group 1) and recurrent renal stone disease (group 2). The demographical 
datas and their historical information were recorded and physical examination was
done. The sera and urine for 24 hr were obtained from patients to measure
electrolyte levels especially phosphorus. In addition, based on presenting serum 
phosphate levels, patients were divided into the hypophosphatemia group, less
than 2.5 mg/dl; normophosphatemia group, between 2.5-5.2 mg/dl; and
hyperphosphatemia group greater than 5.2 mg/dl. RESULTS: The mean age of study
group was 45 (21-70) years. Thirty-six patients (60%) were in group 1 and 24
patients (40%) were in group 2. No statistically correlation was found between
stone recurrence and phosphate levels both in serum and urine. There was only a
statistical association of K levels in 24-hour urine samples between group 1 and 
2. CONCLUSION: There was no significant association between stone recurrence and 
initial phosphate levels in the serum or in urine. We do not propose to determine
phosphate levels routinely in management of patients with stone disease.

Publication Types: 
    Comparative Study

PMID: 12487742 [PubMed - indexed for MEDLINE]

1114: J Histochem Cytochem. 2002 Dec;50(12):1663-9.

Gender- and age-dependent changes in kidney androgen protein mRNA expression in a
knockout mouse model for nephrolithiasis.

Tzortzaki EG, Glass D, Yang M, Evan AP, Bledsoe SB, Stambrook PJ, Sahota A,
Tischfield JA.

Department of Genetics, Rutgers University, Piscataway, New Jersey 08854, USA.

Kidney androgen-regulated protein (Kap) is the most abundant protein in the mouse
kidney, but its function is unknown. We previously observed a significant
decrease in Kap mRNA expression in whole kidney tissue from male mice with
adenine phosphoribosyltransferase (APRT) deficiency and 2,8-dihydroxyadenine
(DHA) nephrolithiasis. The disease phenotype is more severe in male mice and is
age-dependent. To identify the cellular basis for differential Kap expression, we
used in situ hybridization (ISH) and reverse transcription-polymerase chain
reaction ISH (RT-PCR ISH) to identify the cell types expressing this mRNA in
paraffin-embedded kidney sections. In 1-month-old wild-type male mice, Kap was
detected primarily in S3 proximal tubule segments, but expression was very low in
female mice. In 1-month-old APRT-deficient male mice, Kap expression was
decreased significantly and was undetectable in female mice. Kap mRNA was not
detected in 3- or 6-month-old mice using our standard ISH protocol, but we
observed intense cytoplasmic staining in S3 proximal tubules in wild-type male
mice of these age groups using an improved RT-PCR ISH procedure. Our studies
demonstrate age-, gender-, and APRT genotype-dependent changes in Kap mRNA
expression in mouse kidney. Kap expression is under multihormonal control, and
hormonal changes in DHA-induced nephrolithiasis may account for the decreased Kap
expression in APRT-deficient mice.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12486089 [PubMed - indexed for MEDLINE]

1115: J Urol. 2003 Jan;169(1):64-7.

Combined percutaneous and retrograde approach to staghorn calculi with
application of the ureteral access sheath to facilitate percutaneous
nephrolithotomy.

Landman J, Venkatesh R, Lee DI, Rehman J, Ragab M, Darcy M, Sundaram CP.

Division of Urology, Department of Radiology, Mallinkrodt Institute of Radiology,
Washington University School of Medicine, St. Louis, MO, USA.

PURPOSE: We describe our technique and clinical experience with application of
the ureteral access sheath for single access ablation of staghorn and partial
staghorn calculi. MATERIALS AND METHODS: We retrospectively reviewed our
experience with 9 patients who underwent percutaneous nephrolithotomy for
staghorn (6) or partial staghorn (3) renal calculi using a combined antegrade and
retrograde approach. Patient data, operative parameters, efficacy of stone
ablation and convalescence parameters were reviewed. RESULTS: Mean operative time
for the primary procedure was 3.1 hours with a mean estimated blood loss of 290
ml. Postoperatively, the mean analgesic requirement was 33.2 mg. MSO(4)
equivalents. Hospital stay was 3.2 days. There were no major and 4 minor (44%)
complications. No patient required transfusion. Complete stone clearance was
achieved in 7 of the 9 cases (78%) using a single percutaneous nephrostomy tract.
CONCLUSIONS: Our preliminary clinical experience using the ureteral access sheath
during percutaneous nephrolithotomy for simultaneous antegrade and retrograde
stone treatment has been favorable. A large renal stone burden can be
successfully managed with a single percutaneous access and limited blood loss.

PMID: 12478104 [PubMed - indexed for MEDLINE]

1116: J Urol. 2003 Jan;169(1):58-62.

Comment in:
    J Urol. 2003 Jan;169(1):63.

Matched pair analysis of shock wave lithotripsy effectiveness for comparison of
lithotriptors.

Portis AJ, Yan Y, Pattaras JG, Andreoni C, Moore R, Clayman RV.

Department of Surgery, Division of Urologic Surgery, Washington University School
of Medicine, St. Louis, Missouri, USA.

PURPOSE: In an effort to streamline a comparison of the effectiveness of a new
lithotriptor with the standard HM3 lithotriptor (Dornier Medical Systems, Inc.,
Marietta, Georgia) we used a matched pair analysis design. A matched design often
provides more efficient estimates (smaller variances) than an unmatched design
given the same sample size. MATERIALS AND METHODS: Patients with solitary renal
or ureteral calculi treated on a LithoTron shock wave lithotriptor
(HealthTronics, Marietta, Georgia) between October 1999 and February 2000 with a 
minimum followup of 3 months were identified. Evaluable patients treated with the
LithoTron were matched using 5 parameters to a data base of patients treated with
an unmodified HM3 shock wave lithotriptor between October 1997 and February 2000.
Matching criteria consisted of calculus side, calculus location (1 of 7
categories), maximum stone diameter (+/-2 mm.), minimum stone diameter (+/-2 mm.)
and patient body mass index (BMI +/-6). When more than 1 match was suitable,
matching was directed by random numbers. Following matching, clinical charts and 
radiographic reports were evaluated for stone clearance and post-shock wave
lithotripsy interventions. Stone treatment success was defined as residual
fragments less than 2 mm. without need for further intervention. RESULTS: A total
of 94 potentially evaluable patients treated with the LithoTron were identified
and 38 matched pairs were created. Average maximum stone diameter, minimum stone 
diameter, and BMI were 9.6 and 9.9 mm., 6.7 and 6.8 mm. and 29.3 and 28.9 kg./m. 
for HM3 and LithoTron cases, respectively. All calculi were radiopaque and
consisted of mixed calcium oxalate monohydrate (19 and 13), calcium oxalate
dihydrate (1 and 1) or calcium phosphate (2 and 2) in the HM3 and LithoTron
groups, respectively. Patients were not specifically matched on stone composition
because of incomplete availability. Overall intervention-free, stone treatment
success rate was 79% for the HM3 and 58% for the LithoTron. OR for failure of
LithoTron versus HM3 treatment was 3.004 (McNemar test p = 0.08). There were 16
discordant pairs. In 4 cases LithoTron was successful and HM3 failed, and in 12
cases LithoTron failed and HM3 was successful. Subgroup analysis revealed a trend
for LithoTron treatment failure for lower pole calculi, calculi 10 mm. or greater
and BMI of 30 kg./m. or greater. CONCLUSIONS: In this initial evaluation the HM3,
despite a relatively small study sample size, appeared to provide superior
clinical results to the LithoTron (p = 0.08). The use of matched pair analysis
using a large cohort of patients treated with the HM3 for retrospective matching 
may allow for accurate determination of the effectiveness of new lithotripsy
technology with a relatively small clinical study group.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12478102 [PubMed - indexed for MEDLINE]

1117: J Urol. 2003 Jan;169(1):54-7.

Comment in:
    J Urol. 2003 Jan;169(1):63.

A prospective randomized trial comparing 2 lithotriptors for stone disintegration
and induced renal trauma.

Graber SF, Danuser H, Hochreiter WW, Studer UE.

Department of Urology, University of Bern, Bern, Switzerland.

PURPOSE: We compare the efficacy and resulting kidney trauma of the HM3 (Dornier 
Medical Systems, Inc., Marietta, Georgia) and Lithostar Plus (Siemens, Issaquah, 
Washington) lithotriptors in a prospective randomized trial treating calix and
renal pelvis stones. MATERIALS AND METHODS: Patients with a solitary renal pelvic
stone 2 cm. or less in diameter or a solitary calix stone 1 cm. or less in
diameter were randomized for treatment with the HM3 or Lithostar Plus. Stone
disintegration and dilatation of the pyelocaliceal system were evaluated by
abdominal plain x-ray and renal ultrasound 1 day and 3 months after treatment.
Kidney trauma was determined by measurement of N-acetyl-beta-glucosaminidase and 
beta-galactosidase (NAG) in pretreatment urine and 4, 12-hour urine samples
collected within the first 2 days after extracorporeal shock wave lithotripsy
(ESWL, Dornier Medical Systems, Inc.). RESULTS: Of 167 patients with 176 stones
91 were randomized to the HM3 and 85 to the Lithostar Plus lithotriptor group.
The preoperative stone burden was comparable in both groups. On postoperative day
1 patients treated with the HM3 or Lithostar Plus were stone-free or had
fragments 2 mm. or less (91% and 65%, p <0.001), 3 to 5 mm. (8% and 25%, p =
0.003) and 6 mm. or greater (1% and 10%, p = 0.008), respectively. Patients
treated with the HM3 had less posttreatment dilatation of the collecting system
(p = 0.01). Obstructive pyelonephritis occurred in 1% of the HM3 and 8% of the
Lithostar Plus group (p = 0.02). Re-treatment rate was 4% in the HM3 and 13% in
the Lithostar Plus group (p = 0.05). Mean excretion of urinary NAG per treatment 
(including re-treatments) was comparable in both groups but NAG excretion in
relation to stone volume and shock wave number 12 to 24 hours after ESWL was
significantly higher in the HM3 group (p <0.05). At 3-months postoperatively 89% 
of the patients treated with the HM3 and 87% treated with the Lithostar plus were
stone-free with no dilatation of the collecting system. CONCLUSIONS: This
prospectively randomized study indicated that the HM3 is still the gold standard 
in regard to disintegration of pelvicaliceal stones. Stone disintegration with
the HM3 is better with fewer shock waves, re-treatment rate is lower, and
posttreatment dilatation of the collecting system and complications such as
obstructive pyelonephritis are less than those with the Lithostar Plus. ESWL
induced kidney trauma is minor and resolves within 2 days. The HM3 delivers more 
energy per shock wave into the kidney as assessed by urinary NAG.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 12478101 [PubMed - indexed for MEDLINE]

1118: Eur Urol. 2002 Dec;42(6):590-3.

Is infundibuloureteropelvic angle (IUPA) a significant risk factor in formation
of inferior calyceal calculi?

Nabi G, Gupta NP, Mandal S, Hemal AK, Dogra PN, Ansari MS.

Department of Urology, All India Institute of Medical Sciences, New Delhi 29,
India. nabeegholam@hotmail.com

INTRODUCTION: Many studies confirm the fact that radiographic anatomy of inferior
calyx has a significant role in the clearance of a stone lodged in it [Br. J.
Urol. 50 (1978) 449; Invest. Urol. 18 (2) (1980) 167; BJU Int. 83 (Suppl) (1999) 
24; J. Urol. 132 (1984) 1085]. Acutely angled and narrow infundibular neck of a
inferior calyx has a poorer stone clearance in comparison to that with a less
acute angled and wider infundibular neck [Br. J. Urol. 50 (1978) 449; Invest.
Urol. 18 (2) (1980) 167; Br. J. Urol. 82 (1998) 12; BJU Int. 83 (Suppl) (1999)
24]. Incidence of bilateral stones in clinical practice is significantly less
than unilateral stones. This study was taken up to define the significance of
radiographic anatomy of the inferior calyx as a risk factor predisposing to stone
formation in a patient and compared the anatomy of inferior calyx of the stone
forming and contralateral kidney. The fact that inspite of the similar known
etiological factors (intrinsic and extrinsic) of stone formation, why stone forms
unilaterally? MATERIAL AND METHODS: 100 consecutive cases of non-obstructed
unilateral inferior calyceal calculus with non-metabolically active stones were
studied. The infundibuloureteropelvic angle (IUPA) and infundibular width of the 
stone forming and non-stone forming contralateral side were compared. RESULTS:
IUPA of stone forming side was more acute than the non-stone forming side, in 74%
of the cases, more obtuse in 18% of the cases, and same in 8% of the cases. The
difference in the IUPA of the stone forming and that of non-stone forming
contralateral side was statistically significant (p<0.0002). The infundibular
width of the stone forming side ranged from 1 to 16 mm and that of non-stone
forming side from 2 to 11 mm. There was no statistically significant difference
between the infundibular width of both the sides. Exactly, how and more
importantly under what influences the macromolecules in the urine transforms into
a calculus in the pelvicalyceal system is still not known till date but from our 
observations we conclude that IUPA is a significant risk factor which predisposes
to calculus formation in inferior calyx. CONCLUSION: IUPA is a significant risk
factor, which predisposes to urolithiasis in inferior calyx.

PMID: 12477655 [PubMed - indexed for MEDLINE]

1119: Phys Med Biol. 2002 Nov 21;47(22):3945-57.

Tandem shock wave cavitation enhancement for extracorporeal lithotripsy.

Loske AM, Prieto FE, Fernandez F, van Cauwelaert J.

Centro de Física Aplicada y Tecnología Avanzada, UNAM, Campus Juriquilla,
Querétaro, Mexico. loske@fisica.unam.mx

Extracorporeal shock wave lithotripsy (ESWL) has been successful for more than
twenty years in treating patients with kidney stones. Hundreds of underwater
shock waves are generated outside the patient's body and focused on the kidney
stone. Stones fracture mainly due to spalling, cavitation and layer separation.
Cavitation bubbles are produced in the vicinity of the stone by the tensile phase
of each shock wave. Bubbles expand, stabilize and finally collapse violently,
creating stone-damaging secondary shock waves and microjets. Bubble collapse can 
be intensified by sending a second shock wave a few hundred microseconds after
the first. A novel method of generating two piezoelectrically generated shock
waves with an adjustable time delay between 50 and 950 micros is described and
tested. The objective is to enhance cavitation-induced damage to kidney stones
during ESWL in order to reduce treatment time. In vitro kidney stone model
fragmentation efficiency and pressure measurements were compared with those for a
standard ESWL system. Results indicate that fragmentation efficiency was
significantly enhanced at a shock wave delay of about 400 and 250 micros using
rectangular and spherical stone phantoms, respectively. The system presented here
could be installed in clinical devices at relatively low cost, without the need
for a second shock wave generator.

Publication Types: 
    Evaluation Studies
    Validation Studies

PMID: 12476975 [PubMed - indexed for MEDLINE]

1120: Urology. 2002 Dec;60(6):1111.

Acute pancreatitis after extracorporeal shock wave lithotripsy for a renal
calculus.

Hassan I, Zietlow SP.

Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester,
Minnesota, USA.

Extracorporeal shock wave lithotripsy (ESWL) is currently considered the standard
treatment for most renal and upper ureteral calculi. The complication rates with 
ESWL have been reported to be low, resulting in its widespread acceptance and
use. However, as the technique has become more widely available, serious
complications as a result of injury to the kidney and the surrounding organs have
been recognized. We report on the development of severe acute pancreatitis in a
patient after ESWL for a right-sided renal calculus. The patient history and
chronologic clinical course strongly suggest a causal association between the
ESWL and the development of pancreatitis.

Publication Types: 
    Case Reports

PMID: 12475688 [PubMed - indexed for MEDLINE]

1121: Endocrinol Metab Clin North Am. 2002 Dec;31(4):1065-82.

Surgical management of urolithiasis.

Auge BK, Preminger GM.

Division of Urology, Department of Surgery, Comprehensive Kidney Stone Center,
Box 3167, Room 1572D, White Zone, Duke University Medical Center, Durham, NC
27710, USA.

The surgical management of urinary calculus disease has changed dramatically in
the past two decades. Minimally invasive options have made open stone surgery
nearly obsolete. The development of shock wave lithotripsy, percutaneous
nephrostolithotomy techniques and intracorporeal lithotripsy devices has
conferred unprecedented management tools for upper tract stones. Moreover,
transfusion rates, hospital costs, and convalescence periods have been markedly
reduced when compared to open surgery. Likewise, the advent of fiberoptic
technology has resulted in miniaturization of ureteroscopes making access to the 
entire collecting system possible from either a retrograde or antegrade approach.
With experience, successful stone retrieval has occurred in upwards of 90% of
cases, again with minimal complications. The subspecialty of Endourology has
emerged over the past 20 years and significantly changed the management of
urinary tract calculi within this short period of time. Further advancements in
shock wave and laser technology, training modules and the development of more
durable endoscopes may prove beneficial in providing even better stone treatments
with a reduction in morbidity.

Publication Types: 
    Review

PMID: 12474646 [PubMed - indexed for MEDLINE]

1122: Endocrinol Metab Clin North Am. 2002 Dec;31(4):1051-64, x.

Medical treatment of nephrolithiasis.

Borghi L, Meschi T, Schianchi T, Allegri F, Guerra A, Maggiore U, Novarini A.

Department of Clinical Sciences, University of Parma, Via Gramsci 14, 43100
Parma, Italy. loris.borghi@unipr.it

The medical treatment of nephrolithiasis is aimed in particular at the prevention
of relapses, even though in some cases, such as cystine or uric acid lithiasis,
the calculi also can be dissolved on site. When the diagnosis and metabolic
profile have been performed correctly, medical treatment is effective in a large 
number of patients. The greatest difficulty is the patient's compliance with the 
most suitable prevention measures and the frequency of follow-up controls. This
compliance can be influenced significantly by the amount of time that the doctor 
spends to explain the origin of the disease. This article reviews the main
methods available for the medical treatment of various nephrolithiasis types,
namely water intake, diet, and drugs, supplying the relevant information about
the mechanism of action, metabolic consequences, indications, evidence provided
from studies, dosage, efficacy, and side-effects. Finally, brief simplified
guidelines are given for the medical treatment of stone disease caused by calcium
oxalate or calcium phosphate, uric acid, cystine, and struvite.

Publication Types: 
    Review

PMID: 12474645 [PubMed - indexed for MEDLINE]

1123: Endocrinol Metab Clin North Am. 2002 Dec;31(4):1031-50.

Medical evaluation of nephrolithiasis.

Tiselius HG.

Department of Urology, Huddinge University Hospital, Division of Urology, Center 
for Surgical Sciences, Karolinska Institutet, Stockholm, Sweden.
hans-goran.tiselius@urol.hs.sll.se

A careful and individualized evaluation of risk factors is a fundamental part of 
the management of patients with urinary tract stone disease. Identification and
correction of important abnormalities provide the basis for designing an
efficient and rational treatment program, aiming at an arrest or at least
reduction of recurrent stone formation. It is beyond doubt that appropriate
therapeutic steps in this regard are of great benefit for the patient. It needs
to be emphasized, however, that no success will be obtained unless the patient is
willing and able to follow the ensuing dietary recommendations and medical
advice.

Publication Types: 
    Review

PMID: 12474644 [PubMed - indexed for MEDLINE]

1124: Endocrinol Metab Clin North Am. 2002 Dec;31(4):1017-30, ix-x.

Nutritional aspects of stone disease.

Hess B.

Departments of Internal Medicine and Nephrology, Hospital Zimmerberg, CH-8820
Waedenswil, Switzerland. b.hess@spital-zimmerberg.ch

Kidney stones can form during a state of urinary supersaturation. Because urine
often is supersaturated with respect to various salts, crystal formation is very 
common in nonstone formers and stone formers alike, and it may even be absent in 
kidney stone formers. Thus, uncomplicated crystalluria does not distinguish
between stone formers and healthy people. Landmark clinical studies, however,
have shown that under identical conditions of dietary and fluid intake, healthy
controls almost exclusively excrete single calcium oxalate crystals 3 to 4
microns in diameter, whereas recurrent calcium stone formers pass larger
crystals, 10 to 12 microns in diameter, often fused into polycrystalline
aggregates 20 to 300 microns in diameter. Thus, those who form stones appear to
be more "sensitive" to a given diet than nonstone formers. It is in these
subjects that "bad dietary habits" induce nephrolithiasis, making nutritional
aspects important. This article reviews the current evidence-based knowledge of
the impact of nutrition on the recurrence of a kidney stone.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12474643 [PubMed - indexed for MEDLINE]

1125: Endocrinol Metab Clin North Am. 2002 Dec;31(4):1001-15, ix.

Childhood stones.

Stapleton FB.

Children's Hospital and Regional Medical Center, University of Washington
Seattle, 4800 Sand Point Way North East, CH-65, Seattle, WA 98105, USA.
bstaplet@u.washington.edu

Urinary stones in children are usually genetic and most commonly due to
hypercalciuria. Symptoms of urolithiasis in children differ among age groups.
Isolated hematuria in children may be caused by hypercalciuria and precede
calculus formation. Careful evaluation successfully identifies the cause of
urinary stones in most children, although diagnostic criteria may vary in
different age groups. Therapies should be targeted to the underlying diagnosis.

Publication Types: 
    Review

PMID: 12474642 [PubMed - indexed for MEDLINE]

1126: Endocrinol Metab Clin North Am. 2002 Dec;31(4):979-99.

Stones from bowel disease.

Worcester EM.

Lake Park Dialysis Unit, Division of Nephrology, Department of Clinical Medicine,
University of Chicago, 1531 East Hyde Park Boulevard, Chicago, IL 60615, USA.
eworcest@medicine.bsd.uchicago.edu

Kidney stones are increased in patients with bowel disease, particularly those
who have had resection of part of their gastrointestinal tract. These stones are 
usually CaOx, but there is a marked increase in the tendency to form uric acid
stones, as well, particularly in patients with colon resection. These patients
all share a tendency to chronic volume contraction due to loss of water and salt 
in diarrheal stool, which leads to decreased urine volumes. They also have
decreased absorption, and therefore diminished urinary excretion, of citrate and 
magnesium, which normally act as inhibitors of CaOx crystallization. Patients
with colon resection and ileostomy form uric acid stones, as loss of bicarbonate 
in the ileostomy effluent leads to formation of an acid urine. This, coupled with
low urine volume, decreases the solubility of uric acid, causing crystallization 
and stone formation. Prevention of stones requires treatment with alkalinizing
agents to raise urine pH to about 6.5, and attempts to increase urine volume,
which increases the solubility of uric acid and prevents crystallization.
Patients with small bowel resection may develop steatorrhea; if the colon is
present, they are at risk of hyperoxaluria due to increased permeability of the
colon to oxalate in the presence of fatty acids, and increased concentrations of 
free oxalate in the bowel lumen due to fatty acid binding of luminal calcium. EH 
leads to supersaturation of urine with respect to CaOx, in conjunction with low
volume, hypocitraturia and hypomagnesuria. Therapy involves a low-fat,
low-oxalate diet, attempts to increase urine volume, and agents such as calcium
given to bind oxalate in the gut lumen. Correction of hypocitraturia and
hypomagnesuria are also helpful.

Publication Types: 
    Review

PMID: 12474641 [PubMed - indexed for MEDLINE]

1127: Endocrinol Metab Clin North Am. 2002 Dec;31(4):951-77.

Cystinuria and other noncalcareous calculi.

Shekarriz B, Stoller ML.

Department of Urology, SUNY, Upstate Medical University, Syracuse, NY 13210, USA.

Urinary stone disease is the only clinical presentation in patients with
cystinuria. Two genes have been associated with type I (SLC3A1) and non-type I
(SLC7A9) cystinuria and multiple mutations of these genes have been identified.
The type I form is completely recessive while the non-type I form is incompletely
recessive. Clinically, heterozygotes with type I mutations are silent while
heterozygotes with non-type I (types II and III) present with a wide range of
urinary cystine levels and some even have symptomatic urolithiasis. Although the 
exact molecular basis for these differences needs additional investigations, the 
future of medical management of cystinuria is based on molecular and gene
therapy. Minimally invasive surgery using percutaneous and ureteroscopic
techniques is the cornerstone of surgical management. Both cystine and struvite
calculi can form staghorn configuration with propensity for rapid growth and
frequent recurrences after surgical treatment. While urinary alkalinization for
cystine calculi is an integral part of medical management, the effect of oral
alkalinizing agents is limited because of the high pKa (8.3) of cystine.
Chelating agents, therefore, are frequently used to decrease cystine solubility
and stone recurrences. Similarly, urinary acidification for struvite calculi may 
dissolve existing stones and prevent recurrences. However, no effective oral
agent is available today. A future challenge will be to introduce reliable oral
agents for urinary acidification.

Publication Types: 
    Review

PMID: 12474640 [PubMed - indexed for MEDLINE]

1128: Endocrinol Metab Clin North Am. 2002 Dec;31(4):927-49.

Hyperoxaluric calcium nephrolithiasis.

Asplin JR.

University of Chicago and Litholink Corporation, 2250 W. Campbell Park Drive,
Chicago, IL 60612, USA. jasplin@litholink.com

Hyperoxaluria leads to increased calcium oxalate supersaturation and calcium
oxalate stone formation. Excess oxalate can arise from endogenous overproduction 
as in primary hyperoxaluria or from dietary sources. In the last 15 years great
strides have been made in the diagnosis and treatment of primary hyperoxaluria.
However options still seem limited in treating the mild hyperoxaluria found in
many stone formers. Inadequate knowledge of food oxalate content, the effect of
dietary oxalate precursors on oxalate excretion, and the factors affecting
handling of oxalate by the intestine prevent development of rational therapies
for treatment of hyperoxaluria. Recent studies of oxalate degrading bacteria and 
renewed interest in the role of diet calcium in oxalate absorption may lead to
better therapeutic strategies for hyperoxaluric calcium nephrolithiasis.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12474639 [PubMed - indexed for MEDLINE]

1129: Endocrinol Metab Clin North Am. 2002 Dec;31(4):915-25.

Hyperuricosuric calcium nephrolithiasis.

Sorensen CM, Chandhoke PS.

Division of Urology, University of Colorado Health Sciences Center, 4200 East 9th
Avenue, Box C-319, Denver, CO 80262, USA.

Since the findings of Yü and Gutman [1], the hyperuricosuric calcium stone former
is a unique clinical entity. While an impressive number of clinical and
epidemiologic studies implicate hyperuricosuria in calcium stone formation, the
exact physicochemical mechanism by which uric acid affects calcium oxalate
crystallization has not been proven. Allopurinol decreases stone recurrences and 
is the drug of choice for patients with isolated HCN.

Publication Types: 
    Review

PMID: 12474638 [PubMed - indexed for MEDLINE]

1130: Endocrinol Metab Clin North Am. 2002 Dec;31(4):895-914.

Pathophysiology of uric acid nephrolithiasis.

Moe OW, Abate N, Sakhaee K.

Department of Internal Medicine, Center for Mineral Metabolism and Clinical
Research, Center of Human Nutrition, University of Texas Southwestern Medical
Center, Department of Veteran Affairs Medical Center, Dallas, TX, USA.
orson.moe@utsouthwestern.edu

Humans although a predominantly ureotylic organism, has preserved the ability to 
excrete nitrogen as uric acid and ammonia. An imbalance between these two
secondary modes of nitrogen excretion has resulted in uric acid precipitation in 
human urine. Uric acid nephrolithiasis can arise from diverse etiologies all with
distinct underlying defects converging to one or more of three defects of
hyperuricosuria, acidic urine pH, and low urinary volume, originating from
secondary, genetic or heretofore undefined (idiopathic) causes. A subset of
idiopathic uric acid nephrolithiasis (gouty diathesis) may be the "tip of the
icebergp" of a broader systemic illness characterized by insulin resistance. A
novel renal manifestation of insulin resistance is a mild defect in ammonium
excretion, which is not severe enough to disturb acid-base homeostasis, but is
sufficient to set up the chemical milieu for uric acid nephrolithiasis.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12474637 [PubMed - indexed for MEDLINE]

1131: Endocrinol Metab Clin North Am. 2002 Dec;31(4):885-93, viii.

Pathophysiology of hypocitraturic nephrolithiasis.

Hamm LL, Hering-Smith KS.

Section of Nephrology and Hypertension, Department of Medicine, Tulane University
Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
Lhamm@tulane.edu

Urinary citrate inhibits calcium stone formation by complexing calcium in a
soluble form and by effects on urinary crystals to prevent growth to stones. Low 
urinary citrate has been recognized for several decades as a contributing factor 
in some stone forming patients, but recent studies have elucidated the mechanisms
and derangements of the renal handling of citrate in various conditions. In
addition, oral citrate as an alkalinizing agent can not only increase urinary
citrate, but also favorably impact other stone-promoting conditions. This review 
will focus on the understanding of these concepts.

Publication Types: 
    Review

PMID: 12474636 [PubMed - indexed for MEDLINE]

1132: Endocrinol Metab Clin North Am. 2002 Dec;31(4):869-84.

Pathogenesis of hypercalciuric nephrolithiasis.

Zerwekh JE, Reed-Gitomer BY, Pak CY.

Department of Internal Medicine, Center for Mineral Metabolism and Clinical
Research, University of Texas Southwestern Medical Center at Dallas, 5323 Harry
Hines Boulevard, Dallas, TX 75390-8885, USA. joseph.zerwekh@utsouthwestern.edu

The major contribution of hypercalciuria in raising urinary state of saturation
with respect to calcium salts and subsequent risk of nephrolithiasis is
appreciated. Derangements in the physiological mechanisms that regulate calcium
homeostasis and contribute to hypercalciuria have also been identified. New
avenues of research are beginning to explore the specific defects that may
contribute to hypercalciuria. From such studies, an understanding of the role of 
certain dietary excesses as contributors to the development of hypercalciuria
and, in some cases, attendant bone loss, is beginning. The contribution of
genetics to hypercalciuria has provided a powerful means of identifying genes
that contribute to the hypercalciuric phenotype in a number of hypercalciuric
conditions. Such studies have disclosed that hypercalciuria is probably polygenic
in nature and will require a concerted effort to better understand the defects
while attempting to develop gene-specific countermeasures.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12474635 [PubMed - indexed for MEDLINE]

1133: Endocrinol Metab Clin North Am. 2002 Dec;31(4):855-67.

Clinical implications of physicochemistry of stone formation.

Kok DJ.

Department of Pediatric Urology, Josephine Nefkens Institute, Erasmus University 
Rotterdam, FGG-EUR, Be362B, 3000 DR Rotterdam, The Netherlands.
kok@udn.fgg.eur.nl

Measuring crystallization processes for assessing the risk of stone formation or 
the effect of treatment on that risk. In summary, crystallization processes are
involved in the risk for stone formation at several levels. Several tests are
available for assessing if crystalization is disturbed. It is important to first 
establish for which part of the urinary tract the information is sought and then 
adapt the experimental conditions to that site [53]. This information helps in
visualizing what is happening inside the urinary tract of a SF and what the
treatment measures prescribed may do to change that situation.

Publication Types: 
    Review

PMID: 12474634 [PubMed - indexed for MEDLINE]

1134: Kidney Int. 2003 Jan;63(1):240-7.

Comment in:
    J Urol. 2005 Apr;173(4):1200.

Long-term combined treatment with thiazide and potassium citrate in
nephrolithiasis does not lead to hypokalemia or hypochloremic metabolic
alkalosis.

Odvina CV, Preminger GM, Lindberg JS, Moe OW, Pak CY.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, and Department of Veterans Affairs Medical Center,
Dallas, Texas 75390-8885, USA. clarita.odvina@utsouthwestern.edu

BACKGROUND: Potassium citrate is commonly used in combination with a thiazide
diuretic in the medical management of recurrent hypercalciuric nephrolithiasis.
However, concerns have been raised that administration of this nonchloride
potassium alkali with a kaliuretic and natriuretic agent such as thiazide may not
be efficacious in correcting or preventing hypokalemia, and may produce
hypochloremic metabolic alkalosis. This retrospective analysis was conducted to
determine if these two potential complications are encountered in patients on
long-term potassium citrate and thiazide therapy. METHODS: Data were collected on
95 patients who had been on combination therapy for at least 4 months from the
stone clinics of the University of Texas Southwestern Medical Center, Duke
University Medical Center, and Ochsner Clinic. RESULTS: Mean serum potassium
concentration remained within normal limits without a significant decrease during
combined therapy. Serum chloride was significantly lower from pretreatment but by
only 1 mEq/L and remained within normal limits throughout treatment. There was a 
small increase in serum bicarbonate concentration compared to the baseline level 
of less than 1 mEq/L at 8 to 12 and 18 to 24 months, but not at other treatment
periods. CONCLUSION: Co-administration of potassium citrate did not induce
hypokalemia or hypochloremic metabolic alkalosis in our thiazide-treated patient 
population.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12472789 [PubMed - indexed for MEDLINE]

1135: Kurume Med J. 2002;49(3):99-107.

Heparan sulfate (HS)/heparan sulfate proteoglycan (HSPG) and bikunin are
up-regulated during calcium oxalate nephrolithiasis in rat kidney.

Eguchi Y, Inoue M, Iida S, Matsuoka K, Noda S.

Department of Urology, Kurume University School of Medicine, 67 Asahi-machi,
Kurume 830-0011, Japan.

We reported that expression of both HSPG and of bikunin are increased in calcium 
oxalate (CaOx) nephrolithic rat kidneys (lida et al., J. Am. Soc. Nephrol. 1999, 
Urol. Res. 1997). However, these findings were obtained from separate
experiments. The present study evaluates whether levels of HSPG and bikunin
expression differ in the rat kidney during calcium oxalate nephrolithiasis.
Twenty-four male Wistar rats weighing 200-250 g were assigned to one of four
groups (n = 6 each group) and administered with 0.5% ethylene glycol daily and
0.5 microgram of 1 alpha-OH-D3 every other day to induce CaOx nephrolithiasis.
Animals were sacrificed 1 or 2 weeks later and both kidneys were excised. The
cortex was separated from the medulla and papillary tips in the right kidney,
then stored in liquid nitrogen for quantitative competitive-reverse
transcription-polymerase chain reaction (QC-RT-PCR). The left kidney was fixed in
10% buffered formalin for histochemical studies. We assessed the variable gene
expression of both HSPG and bikunin by QC-RT-PCR. Immunohistochemical analyses of
left kidney tissue samples determined the localization of HSPG and bikunin.
Normal rats serving as controls (n = 6 each) were also sacrificed and processed
in the same manner as the experimental groups. QC-RT-PCR confirmed that HSPG and 
bikunin mRNA expression is significantly increased in nephrolithic kidneys (p <
0.05; Mann-Whitney test), and that medulla and papillary tips tended to express
more mRNA of both. Immunohistochemical studies revealed that the production of HS
and bikunin was increased in both the distal and proximal tubules of nephrolithic
kidneys. These findings suggest that the increased expression of both HSPG and
bikunin play an important role during calcium oxalate stone formation. In
addition, this phenomenon might be associated with the progression of urothelial 
damage.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12471724 [PubMed - indexed for MEDLINE]

1136: J Endourol. 2002 Oct;16(8):543-7.

Percutaneous stone implantation in the pig kidney: a new animal model for
lithotripsy research.

Paterson RF, Lingeman JE, Evan AP, Connors BA, Williams JC Jr, McAteer JA.

Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana
46202, USA. rpaterson@clarion.org

PURPOSE: This report describes a new animal model for research on the parameters 
of shockwave delivery and the mechanisms of shockwave action in SWL. MATERIALS
AND METHODS: Female pigs (approximately 45 kg) were anesthetized for creation of 
an upper pole peripheral caliceal access. The tract was dilated with a 30F
Nephromax balloon and Amplatz sheath, and a 24F rigid nephroscope was used to
guide a gypsum artificial stone into a lower pole calix. An internal ureteral
stent was then placed. After a 2-hour recovery period, lithotripsy was performed 
using an unmodified Dornier HM3 lithotripter. Following SWL, en bloc excision of 
the urinary tract was performed, and the stone fragments were collected. RESULTS:
As observed by nephroscopy, most stones were surrounded by urine that was free of
clot or debris. Urine output was >1 mL/kg per minute by the time the animal was
positioned for SWL after a 2-hour observation period. When the conditions of
shockwave (SW) exposure were 400 SWs, 20 kV, and 120 SW/min, the efficiency of
stone fragment recovery was 85% +/- 2% (N = 6 stones). CONCLUSIONS: This
procedure provides a minimally invasive method for placement of model stones of
clinically relevant size within the pig kidney. Stone implantation is efficient
and permits experiments to be conducted in 1 day. Stone fragmentation can be
quantitated, and the animal can serve as its own control. Long-term experiments
are also feasible. Overall, this new animal model is appropriate for
experimentation on the parameters of SW delivery in SWL.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12470460 [PubMed - indexed for MEDLINE]

1137: J R Coll Surg Edinb. 2002 Oct;47(5):668-75.

Contemporary management of renal calculus disease.

Downey P, Tolley D.

Department of Urology, Wythenshawe Hospital, Manchester, UK. pauldowneymd@aol.com

The management of renal calculus disease has changed. Non-invasive and minimally 
invasive techniques of stone disintegration and removal have replaced open stone 
surgery in managing this condition. In this article we discuss the investigation 
and management of patients with renal stone disease as currently performed in
specialist stone centres.

PMID: 12463705 [PubMed - indexed for MEDLINE]

1138: BJU Int. 2002 Dec;90(9):939-44.

Enlargement of calcium oxalate stones to clinically significant size in an
in-vitro stone generator.

Ananth K, Kavanagh JP, Walton RC, Rao PN.

Lithotriptor Unit, South Manchester University Hospital Trust, Wythenshawe
Hospital, Manchester, UK.

OBJECTIVE: To develop and validate an in vitro method suitable for the
quantitative investigation of the growth of calcium oxalate stones through to a
clinically significant size. MATERIALS AND METHODS: Small fragments of calcium
oxalate calculi were suspended in a mixed suspension/mixed product removal
crystalliser supplied with artificial urine supersaturated with calcium oxalate. 
The fragments were weighed at regular intervals until they reached approximately 
equal 500 mg. The results were plotted as weight against time and fitted to
equations corresponding to constant increase in diameter, surface area-controlled
and constant-deposition growth patterns. The choice of the most appropriate model
was based on the squared regression coefficient (r2). RESULTS: Eight fragments
(2-6 mm in diameter) were grown to approximately 10 mm in diameter over periods
from 137 to 369 h. Seven of the growth curves were best-fitted (r2 > or = 0.988) 
by the equation w = kt(3/2) + c, where w is the weight, k is a growth constant, t
is the time and c is a constant approximating to the initial weight. This
corresponds to a surface area-dependent mechanism. CONCLUSIONS: The growth of
these small fragments to a clinically significant size accelerated throughout the
experimental period in a way which was consistent with a surface area-dependent
mechanism. We have developed a resilient model suitable for studying the kinetics
of calcium oxalate stone growth in vitro.

PMID: 12460360 [PubMed - indexed for MEDLINE]

1139: BJU Int. 2002 Dec;90(9):809-13.

Prospective evaluation of safety and efficacy of the supracostal approach for
percutaneous nephrolithotomy.

Gupta R, Kumar A, Kapoor R, Srivastava A, Mandhani A.

Department of Urology and Renal Transplantation, Sajay Gandhi Post Graduate
Institute of Medical Science, Lucknow, India.

OBJECTIVE: To prospectively evaluate the safety and efficacy of the supracostal
approach for percu-taneous nephrolithotomy (PCNL), as it is usually avoided
because of concerns about potential chest complications. PATIENTS AND METHODS:
Between August 1998 and August 2001, 465 patients underwent PCNL. Supracostal
access was obtained in 62 patients (63 renal units), comprising 13% of the
procedures. The indications for a supracostal approach were staghorn, upper
ureteric, superior calyceal stones and high-lying kidneys. The data were analysed
for stone clearance, need for additional punctures and the complications
associated with supracostal puncture. RESULTS: The supracostal was the only
access in 63% of the PCNL procedures. Additional punctures were required mainly
for staghorn stones (15 of 23). Overall, 90% of the patients were rendered
stone-free or had clinically insignificant residuals with PCNL alone. In patients
with staghorn stones, they were completely cleared in 84% of renal units.
Significant chest complications developed in three (5%) patients, which required 
insertion of a chest tube. One (2%) patient developed haemothorax secondary to
injury of the intercostal artery. All the patients recovered uneventfully.
CONCLUSIONS: These results indicate that supracostal access provides high
clearance rates with acceptable complications; it should not be avoided for fear 
of chest complications. A chest X-ray after surgery should be routine, to detect 
any complication.

Publication Types: 
    Evaluation Studies

PMID: 12460337 [PubMed - indexed for MEDLINE]

1140: Int Urol Nephrol. 2001;33(4):605-8.

Inhibition of oxalate nephrolithiasis with Ammi visnaga (AI-Khillah).

Khan ZA, Assiri AM, Al-Afghani HM, Maghrabi TM.

Department of Biochemistry, Faculty of Medicine and Medical Sciences, Umm Al-Qura
University, Makkah, Saudi Arabia.

We investigated the effect of Ammi visnaga seeds on experimentally - induced
kidney stones - in male Wistar albino rats. Oxalate nephrolithiasis was
experimentally induced by 3% glycolic acid (added in their diet) given for the
period of four weeks. A highly significant amount of deposits were found in the
kidneys, which were analyzed quantitatively. These deposits were mainly of
calcium oxalate in composition. Daily oral (gavage) treatment with Ammi visnaga
(500 mg/kg) highly reduced the incidence of nephrolithiasis (calcium oxalate
deposition in the kidneys). Ammi visnaga seeds extract showed highly potent
diuretic activity. The reduction in body weight, increase in kidneys weight,
increase in water intake, decrease in urine output found in glycolic acid control
group were prevented to various extent on Ammi visnaga treatment; and the values 
became to insignificant difference with control group. The changes in weights of 
liver, heart and lungs of the three groups were insignificant. Uraemia and
hyperbilirubinaemia observed in glycolic acid control group were found to be
ameliorated by Ammi visnaga seed extract treatment.

Publication Types: 
    Evaluation Studies

PMID: 12452606 [PubMed - indexed for MEDLINE]

1141: J Chromatogr B Analyt Technol Biomed Life Sci. 2002 Dec 5;781(1-2):433-55.

Urinary analysis of nephrolithiasis markers.

Barbas C, García A, Saavedra L, Muros M.

Facultad de CC Experimentales y de la Salud, Universidad San Pablo-CEU,
Urbanización Montepríncipe, Ctra. Boadilla del Monte, km 5,3, 28668 Madrid,
Spain. cbarbas@ceu.es

Renal stone disease is an ancient and common affliction, common in industrialised
nations. The causes and incidence of nephrolithiasis are presented. Afterwards,
the promoters and inhibitors of renal stone formation analysis in urine are
described including enzymatic methods, chromatography, capillary electrophoresis 
and other techniques. Aspects such as sample collection and storage are also
included. The review article includes referenced tables that provide summaries of
methodology for the analysis of nephrolithiasis related compounds.

Publication Types: 
    Review

PMID: 12450673 [PubMed - indexed for MEDLINE]

1142: Urol Int. 2002;69(4):306-8.

Incidence and management of dialysis patients with renal calculi.

Viterbo R, Mydlo JH.

Department of Urology, Temple University School of Medicine, Philadelphia, PA
19140, USA.

OBJECTIVE: The incidence of renal stones in patients on dialysis, while lower in 
number compared to the general population because of decreased renal function, is
nonetheless a clinical dilemma. We wanted to evaluate the incidence and
management of stone disease in patients on hemodialysis. METHODS: We reviewed the
literature from 1966 to the present using Medline. Study inclusion criteria were 
detection and treatment of stone disease in both hemodialysis and peritoneal
dialysis patients. RESULTS: It is estimated that between 5 and 13% of all
dialysis patients will develop symptomatic renal calculi and many more
asymptomatic calculi. Many of the stone-forming dialysis patients will have
recurring stone disease with one study finding an 83.3% recurrence rate.
CONCLUSION: Since dialysis patients have a wide range of urine output, the
clinician should be alert to the possibility of stone formation. We recommend
yearly ultrasound examinations on all dialysis patients as well as citrate and
magnesium supplements with careful follow-up of laboratory results and urine
electrolytes. We also recommend careful follow-up of all patients on
aluminum-hydroxide phosphate binders as they are predisposed to form Al-Mg-urate 
stones. For those dialysis patients that form renal calculi, watchful waiting and
symptomatic treatment is recommended since almost all patients will spontaneously
pass their stones. However, ESWL and other current modalities may be used with no
greater morbidity compared to nondialysis cohorts. We also suggest that patients 
with severe recurring intractable stone disease who are candidates for renal
transplantation should be offered bilateral nephrectomies. Copyright 2002 S.
Karger AG, Basel

Publication Types: 
    Review

PMID: 12444289 [PubMed - indexed for MEDLINE]

1143: J Am Soc Nephrol. 2002 Dec;13(12):2938-44.

Responsiveness of hypercalciuria to thiazide in Dent's disease.

Raja KA, Schurman S, D'mello RG, Blowey D, Goodyer P, Van Why S, Ploutz-Snyder
RJ, Asplin J, Scheinman SJ.

Departments of Medicine and Pediatrics, SUNY Upstate Medical University, 750 E.
Adams Street, Syracuse, NY 13210, USA.

Hypercalciuria is the major risk factor promoting stone formation in Dent's
disease, also known as X-linked recessive nephrolithiasis, but the effects of
diuretics on calcium excretion and other stone risk factors in this disease are
unknown. This study examined urine composition in eight male patients with Dent's
disease, ages 6 to 49 yr, all of whom were hypercalciuric and had inactivating
mutations of CLCN5. Eight males, ages 7 to 34 yr, with idiopathic hypercalciuria 
(IH) served as controls. Patients were instructed to maintain a consistent intake
of sodium, potassium, calcium, and protein. Two consecutive 24-h urine
collections were obtained after a baseline period and after 2 wk of
chlorthalidone (25 mg), amiloride (5 mg), and the two diuretics in combination,
with a week off drug separating the treatment periods in a randomized crossover
design. Doses were reduced by half in boys under age 12 yr. Chlorthalidone alone 
(P < 0.002) and the combination of chlorthalidone and amiloride (P < 0.003)
reduced calcium excretion significantly in either patient group. With
chlorthalidone, calcium excretion fell to normal (<4.0 mg/kg per d) in all but
one patient in each group. Amiloride alone had no significant effect on urinary
calcium excretion, in either patient group. In patients with Dent's disease
during chlorthalidone therapy, the supersaturation ratios for calcium oxalate and
calcium phosphate fell by 25% and 35%, respectively. Mean citrate excretion was
reduced by chlorthalidone (P <.04) and by chlorthalidone in combination with
amiloride (P <.02). There were no significant differences in the responses to
these diuretics between the patient groups in any of the urinary parameters. The 
intact hypocalciuric response to a thiazide diuretic indicates that inactivation 
of the ClC-5 chloride channel does not impair calcium transport in the distal
convoluted tubule and indicates that thiazides should be useful in reducing the
risk of kidney stone recurrence in patients with Dent's disease.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

PMID: 12444212 [PubMed - indexed for MEDLINE]

1144: J Urol. 2002 Dec;168(6):2572-4.

Oral potassium citrate treatment for idiopathic hypocitruria in children with
calcium urolithiasis.

Tekin A, Tekgul S, Atsu N, Bakkaloglu M, Kendi S.

Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

PURPOSE :We evaluated the clinical and laboratory outcome of oral potassium
citrate treatment in children with idiopathic hypocitruria and calcium stones.
MATERIALS AND METHODS: The charts of 64 children 1 to 15 years old with
hypocitruria and calcium stones (median age 7.2) treated with oral potassium
citrate were reviewed. Evaluation parameters were tolerability, adverse
reactions, metabolic profile and stone recurrence. RESULTS: No serious adverse
reaction due to potassium citrate administration was recorded. Normal citrate
excretion was restored in all patients. After treatment median urinary citrate
daily plus or minus SD increased from 197 +/- 72 to 632 +/- 218 mg./1.73 m.2 (p
<0.001) and mean urinary pH increased from 5.3 +/- 0.3 to 6.2 +/- 0.7 (p <0.01). 
Mean calcium excretion decreased from 3.5 +/- 2.7 to 2.5 +/- 2.7 mg./kg. (p
<0.05). At an average followup of 22 months (range 3 to 67) the recurrence rate
in the group overall was 0.07 per patient-year. The previous recurrence rate of
0.32 per patient-year in the 20 children with a history of recurrent stone
disease decreased to 0.17 per patient-year after treatment. None of the 44
initial stone formers had recurrent stones. CONCLUSIONS: Our results show the
safety and efficacy of oral potassium citrate treatment for restoring normal
urinary citrate and suggest a preventive effect for recurrent calcium stone
disease in children with hypocitruria and calcium stones.

PMID: 12441986 [PubMed - indexed for MEDLINE]

1145: J Urol. 2002 Dec;168(6):2377-82; discussion 2382.

Is lower pole caliceal anatomy predictive of extracorporeal shock wave
lithotripsy success for primary lower pole kidney stones?

Sorensen CM, Chandhoke PS.

Department of Surgery, University of Colorado Health Science Center, Denver, USA.

PURPOSE: The management of lower pole kidney stones is controversial. We examined
whether lower pole caliceal anatomy could predict the success of extracorporeal
shock wave lithotripsy of primary lower pole kidney stones 20 mm. or less.
MATERIALS AND METHODS: From December 1997 to June 2001, 246 adults with a single,
20 mm. or less radiopaque lower pole renal stone were treated with the Doli 50
lithotriptor (Dornier Medical Systems, Marietta, Georgia) while under general
anesthesia. Of the 246 patients 190 (77%) had excretory urography available for
review. Lower pole infundibular length and width, lower pole infundibulopelvic
angle and caliceal-pelvic height were measurable on 161 (85%), 129 (68%), 128
(67%) and 163 (86%) excretory urograms, respectively. Extracorporeal shock wave
lithotripsy was considered a failure if residual stone fragments remained after 1
month, or an auxiliary procedure or re-treatment was required.RESULTS The overall
stone-free rate was 78% (32 of 41) for stones 5 mm. or less, 73% (98 of 135) for 
stones 6 to 10 mm., 43% (22 of 51) for stones 11 to 15 mm. and 30% (7 of 19) for 
stones 16 to 20 mm. in maximum linear dimension. The stone-free rates grouped
according to stone surface area were 76% (48 of 63 stones) for stone surface area
25 mm.2 or less, 69% (97 of 141) for 26 to 100 mm.2 and 33% (14 of 42) for 101 to
400 mm.2. Caliceal anatomy was not predictive of success even with stones grouped
as 10 or less or 11 to 20 mm. Grouping patients with favorable (lower pole
infundibulopelvic angle 70 degrees or greater, lower pole infundibular length 30 
mm. or less and lower pole infundibular width greater than 5 mm.) versus
unfavorable (70 degrees or less, greater than 30 mm. and 5 mm. or less,
respectively) anatomy was also not predictive of success. CONCLUSIONS: On the
Doli 50 machine stone size rather than caliceal anatomy is predictive of
treatment outcome. Initial treatment failures with this machine should be managed
by alternative endoscopic procedures if necessary rather than by repeat shock
wave lithotripsy.

PMID: 12441921 [PubMed - indexed for MEDLINE]

1146: Clin Chem Lab Med. 2002 Sep;40(9):930-6.

Synergism between urinary prothrombin fragment 1 and urine: a comparison of
inhibitory activities in stone-prone and stone-free population groups.

Webber D, Rodgers AL, Sturrock ED.

Chemistry Department, University of Cape Town, Rondebosch, South Africa.

South African blacks rarely form kidney stones compared with whites. This study
investigated whether purified urinary prothrombin fragment 1 (UPTF1) derived from
blacks is a more potent inhibitor of calcium oxalate crystallisation than that
from whites. UPTF1 was purified from the urine of both population groups and
their inhibitory activities were compared in a cross-over design in which each
protein was tested in ultrafiltered urine from both population groups. Coulter
Multisizer, [14C]-oxalate deposition and scanning electron microscopy experiments
were used to monitor crystallisation. The study has demonstrated for the first
time that UPTF1 promotes nucleation and that inhibitory activity is
synergistically dependent upon urine composition. The activity of the whites'
UPTF1 was greater than that of the blacks in the whites' urine (e.g. particle
size decrease: 31.7% vs. 25.2%), while the blacks' UPTF1 was superior to that of 
the whites in the blacks' urine (e.g. particle size decrease: 46.5% vs. 32.4%).
In addition, when tested in their respective endogenous urines, the blacks' UPTF1
demonstrated superior inhibitory activity on an absolute scale (e.g. particle
size decrease: 46.5% vs. 31.7%). Thus, the urine composition of black South
Africans may influence their UPTF1 conformation, conferring greater efficacy for 
inhibition of calcium oxalate crystallisation.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12435111 [PubMed - indexed for MEDLINE]

1147: Cleve Clin J Med. 2002 Nov;69(11):885-8.

Preventing kidney stones: calcium restriction not warranted.

Hall PM.

Department of Nephrology and Hypertension, Renal Stone Clinic, The Cleveland
Clinic Foundation, Ohio 44195, USA.

The traditional wisdom on preventing calcium stones, the most common form of
kidney stone, has been to advise patients to limit dietary calcium. Research has 
proved this wrong, however. Normal dietary calcium intake, along with reduced
salt and protein, is now advised. This paper also summarizes the diagnosis and
treatment of the less-common forms of kidney stones-struvite, uric acid, and
cystine.

PMID: 12430973 [PubMed - indexed for MEDLINE]

1148: Kidney Int. 2002 Dec;62(6):2062-72.

Presence of lipids in urine, crystals and stones: implications for the formation 
of kidney stones.

Khan SR, Glenton PA, Backov R, Talham DR.

Department of Pathology, University of Florida, Gainesville, Florida 32610, USA. 
khan@pathology.ufl.edu

BACKGROUND: Cell membranes and their lipids play critical roles in calcification.
Specific membrane phospholipids promote the formation of calcium phosphate and
become a part of the organic matrix of growing calcification. We propose that
membrane lipids also promote the formation of calcium oxalate (CaOx) and calcium 
phosphate (CaP) containing kidney stones, and become a part of their stone
matrix. METHODS: Human urine, crystals of CaOx and CaP produced in the urine of
healthy individuals, and urinary stones containing struvite, uric acid, CaOx and 
CaP crystals for the presence of membrane lipids were analyzed. Crystallization
of CaOx monohydrate at Langmuir monolayers of dipalmitoylphosphatidylglycerol
(DPPG), dipalmitoylphosphatidylcholine (DPPC), dipalmitoylphosphatidylserine
(DPPS), dioleoylphosphatidylglycerol (DOPG), palmitoyloleoylphosphatidylglycerol 
(POPG) and dimyristoylphosphatidylglycerol (DMPG) was investigated to directly
demonstrate that phospholipid assemblies can catalyze CaOx nucleation. RESULTS:
Urine as well as CaOx and CaP crystals made in the urine and various types of
urinary stones investigated contained some lipids. Urine of both CaOx and uric
acid stone formers contained significantly more cholesterol, cholesterol ester
and triglycerides than urine of healthy subjects. However, urine of CaOx stone
formers contained more acidic phospholipids. The organic matrix of calcific
stones contained significantly more acidic and complexed phospholipids than uric 
acid and struvite stones. For each Langmuir monolayer precipitation was
heterogeneous and selective with respect to the orientation and morphology of the
CaOx crystals. Crystals were predominantly monohydrate, and most often grew
singly with the calcium rich (10-1) face toward the monolayer. The number of
crystals/mm2 decreased in the order DPPG> DPPC and was inversely proportional to 
surface pressure and mean molecular area/molecule. CONCLUSIONS: Stone forming
conditions in the kidneys greatly impact their epithelial cells producing
significant differences in the urinary lipids between healthy and stone forming
individuals. Altered membrane lipids promote face selective nucleation and
retention of calcium oxalate crystals, and in the process become a part of the
growing crystals and stones.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12427130 [PubMed - indexed for MEDLINE]

1149: Braz J Med Biol Res. 2002 Oct;35(10):1165-72. Epub 2002 Oct 13.

Role of Tamm-Horsfall protein and uromodulin in calcium oxalate crystallization.

Carvalho M, Mulinari RA, Nakagawa Y.

Kidney Stone Program, Division of Biological Sciences and the Pritzker School of 
Medicine, University of Chicago, Chicago, IL, USA. carvalho@mais.sul.com.br

One of the defenses against nephrolithiasis is provided by macromolecules that
modulate the nucleation, growth, aggregation and retention of crystals in the
kidneys. The aim of the present study was to determine the behavior of two of
these proteins, Tamm-Horsfall and uromodulin, in calcium oxalate crystallization 
in vitro. We studied a group of 10 male stone formers who had formed at least one
kidney stone composed of calcium oxalate. They were classified as having
idiopathic nephrolithiasis and had no well-known metabolic risk factors involved 
in kidney stone pathogenesis. Ten normal men were used as controls, as was a
group consisting of five normal women and another consisting of five pregnant
women. Crystallization was induced by a fixed supersaturation of calcium oxalate 
and measured with a Coulter Counter. All findings were confirmed by light and
scanning electron microscopy. The number of particulate material deposited from
patients with Tamm-Horsfall protein was higher than that of the controls
(P<0.001). However, Tamm-Horsfall protein decreased the particle diameter of the 
stone formers when analyzed by the mode of the volume distribution curve
(P<0.002) (5.64 +/- 0.55 microm compared to 11.41 +/- 0.48 microm of uromodulin; 
15.94 +/- 3.93 microm and 12.45 +/- 0.97 microm of normal men Tamm-Horsfall
protein and uromodulin, respectively; 8.17 +/- 1.57 microm and 9.82 +/- 0.95
microm of normal women Tamm-Horsfall protein and uromodulin, respectively; 12.17 
+/- 1.41 m and 12.99 +/- 0.51 microm of pregnant Tamm-Horsfall protein and
uromodulin, respectively). Uromodulin produced fewer particles than Tamm-Horsfall
protein in all groups. Nonetheless, the total volume of the crystals produced by 
uromodulin was higher than that produced by Tamm-Horsfall protein. Our results
indicate a different effect of Tamm-Horsfall protein and uromodulin. This dual
behavior suggests different functions. Tamm-Horsfall protein may act on
nucleation and inhibit crystal aggregation, while uromodulin may promote
aggregation of calcium oxalate crystals.

PMID: 12424489 [PubMed - indexed for MEDLINE]

1150: Jpn J Clin Oncol. 2002 Sep;32(9):365-7.

Acute myeloid leukemia complicated with staghorn calculus.

Jaing TH, Hung IJ, Lin CJ, Chiu CH, Luo CC, Wang CJ.

Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's 
Hospital, Taoyuan, Taiwan.

An 11-year-old girl who presented with hyperleukocytosis accompanied by
significant increases in serum uric acid and lactate dehydrogenase levels was
discovered to be suffering from acute myeloid leukemia (AML). Subsequently a
staghorn calculus was identified 22 months after the start of chemotherapy. The
diagnosis of staghorn calculi was suggested by plain abdominal X-ray and
ultrasonography. This paper describes the course of an adolescent patient with
AML and focuses specifically upon her urological complications. To the best of
our knowledge, this is the first reported pediatric case of AML complicated with 
staghorn calculi, which developed following repeated episodes of septicemia.

Publication Types: 
    Case Reports

PMID: 12417604 [PubMed - indexed for MEDLINE]

1151: Spinal Cord. 2002 Nov;40(11):609-14.

Atrophy of kidney following extra corporeal shock wave lithotripsy of renal
calculus in a paraplegic patient with marked spinal curvature.

Vaidyanathan S, Johnson H, Singh G, Hughes P, Soni BM, Parsons KF, Sett P.

Regional Spinal Injuries Centre, District General Hospital, Southport, UK.

OBJECTIVES: To discuss a rare complication of extra corporeal shock wave
lithotripsy (ESWL) of renal calculus in a paraplegic patient, who had marked
curvature of thoracic and lumbar spine. DESIGN: A case report of a paraplegic
patient, who developed renal atrophy and hypertension after undergoing ESWL of
staghorn calculus. SETTING: Regional Spinal Injuries Centre, Southport and Mersey
Regional Lithotripsy Unit, Royal Liverpool University Hospital, Liverpool, UK.
PARTICIPANT: A 28-year-old male with spina bifida, paraplegia at L-1 level and
considerable curvature of spine and tilting of pelvis. METHOD: ESWL was carried
out in three sessions by delivering 1934, 1876, and 2025 shock waves
respectively. Localisation of the staghorn calculus was difficult because of
spinal curvature and pelvic tilt. RESULTS: A follow-up IVU, performed 3 months
after last ESWL treatment, revealed no residual stone in the left kidney, apart
from a little low-density calcification in the renal parenchyma adjacent to the
lower pole calyx. There were no calculi in the left ureter. The left kidney had
become small, though still functioning. MAG-3 isotope renogram showed the left
kidney to be markedly atrophic. Relative renal function: right kidney, 94%; and
left kidney, 6%. He developed hypertension and a laparoscopic left nephrectomy
was performed at another hospital. CONCLUSION: Difficulty in localisation of
renal calculi for ESWL must be anticipated in spinal bifida and spinal cord
injury patients, who have significant spinal curvature. Because of problems in
the positioning of a patient with marked curvature of spine and pelvic tilt, and 
consequent difficulties in accurate localisation of renal calculi for
lithotripsy, these patients may be at increased risk of developing renal
parenchymal and vascular damage following ESWL.

Publication Types: 
    Case Reports

PMID: 12411971 [PubMed - indexed for MEDLINE]

1152: Int J Urol. 2002 Sep;9(9):515-6.

Transitional cell carcinoma of the ureteral stump eight years after nephrectomy
for benign disease.

Inui M, Yamashita M, Taketa S, Takenaka I, Kakehi Y.

Department of Urology, Kagawa Medical University, Kagawa, Japan. minui@kms.ac.jp

A case of primary carcinoma of the ureteral stump is reported. A 68-year-old man 
presented with asymptomatic gross hematuria. He had undergone a right nephrectomy
for a benign disease previously. Cystoscopy and left ureteroscopy showed no
abnormalities. A computed tomography showed a solid mass on the region of the
right ureteral stump. He underwent a right ureterectomy and bladder cuff
resection. A pathological examination showed transitional cell carcinoma.

Publication Types: 
    Case Reports

PMID: 12410932 [PubMed - indexed for MEDLINE]

1153: BJU Int. 2002 Nov;90(7):635-9.

Magnesium status of patients with renal stones and its effect on urinary citrate 
excretion.

Reungjui S, Prasongwatana V, Premgamone A, Tosukhowong P, Jirakulsomchok S,
Sriboonlue P.

Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon 
Kaen, Thailand.

OBJECTIVES: To assess the magnesium status and its effect on urinary citrate
excretion in patients with renal stones, as they have a low muscular magnesium
content. PATIENTS, SUBJECTS AND METHODS: Using a magnesium-tolerance test (0.1
mmol/L MgSO4/kg body weight, delivered intravenously), the magnesium status was
assessed in 17 patients with renal stones from rural North-east Thailand, and in 
three groups of normal subjects from different environments (i.e. 17 from rural
Central Thailand, 16 from urban and 14 from rural North-east Thailand).
Participants with magnesium deficiency (magnesium retention > 50%) were
supplemented with 300 mg chelated magnesium daily for 1 month and reassessed.
Their urinary citrate excretion was also measured before and after
supplementation. RESULTS: Nine of the patients with renal stones were magnesium
deficient, as were six normal subjects from the same area, whereas only one and
two of the rural Central and urban North-east Thais had magnesium deficiency. The
magnesium status of the 13 deficient subjects significantly improved (P = 0.003) 
after supplementation with chelated magnesium. The supplement also caused a
significant increase in mean (sd) urinary citrate excretion, from 237.7 (173.1)
to 361.3 (284.1) mg/day (P= 0.012). CONCLUSIONS: These results indicate that
magnesium deficiency is common among patients with renal stones in rural
North-east Thailand, and that the probable cause is environmental. The increase
in urinary citrate excretion after magnesium supplementation suggests that
magnesium is important in renal stone formation, through its effect on citrate
metabolism.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12410738 [PubMed - indexed for MEDLINE]

1154: Dig Liver Dis. 2002 Sep;34 Suppl 2:S160-3.

Effect of acute load of grapefruit juice on urinary excretion of citrate and
urinary risk factors for renal stone formation.

Trinchieri A, Lizzano R, Bernardini P, Nicola M, Pozzoni F, Romano AL, Serrago
MP, Confalanieri S.

Department of Urology, IRCCS Ospedale Maggiore, Milan, Italy.
uropoli@mailserver.unimi.it

The effect of citrus fruit juice ingestion on the risk of calcium oxalate stone
formation is still debated. The present study was undertaken to investigate
changes in urinary stone risk factors after administration of a soft drink
containing grapefruit juice. Seven healthy subjects, with no history of kidney
stones, were submitted to an acute oral load (20 ml/kg body weight over 60 min)
of a soft drink containing grapefruit juice diluted (10%) in mineral water. After
a 7-day wash-out period, each subject underwent an oral load with mineral water
alone under the same conditions. Urine specimens were collected before (for 120
min) and after each oral fluid load (for 180 min). Urinary flow was significantly
increased after both grapefruit juice (46+/-26 vs 186+/-109 ml/h, p = 0.01) and
mineral water (42+/-16 vs 230+/-72 ml/h, p=0.001) compared to baseline. Compared 
to mineral water, grapefruit juice significantly (p=0.021) increased urinary
excretion of citrate (25.8+/-9.3 vs 18.7+/-6.2 mg/h), calcium (6.7+/-4.3 vs
3.3+/-2.3 mg/h, p=0.015) and magnesium (2.9+/-1.5 vs 1.0+/-0.7 mg/h, p=0.003).
Citrus fruit juices could represent a natural alternative to potassium citrate in
the management of nephrolithiasis, because they could be better tolerated and
cost-effective than pharmacological calcium treatment. However, in order to
obtain a beneficial effect in the prevention of calcium renal stones a reduced
sugar content is desirable to avoid the increase of urinary calcium due to the
effect of sugar supplementation.

PMID: 12408462 [PubMed - indexed for MEDLINE]

1155: J Endourol. 2002 Sep;16(7):477-81.

Single upper-pole percutaneous access for treatment of > or = 5-cm complex
branched staghorn calculi: is shockwave lithotripsy necessary?

Wong C, Leveillee RJ.

Department of Urology, University of Miami, 1400 NW 10th Avenue, Suite No. 507,
Miami, FL 33126, USA.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy for staghorn calculi is
reported to have a residual stone rate of 28%, while shockwave lithotripsy alone 
results in residual stones in approximately 50% of cases. Combination therapy,
sandwich therapy, and multiple percutaneous accesses have also been advocated for
staghorn stones. We believe these stones can often be removed with a staged
procedure via a single upper-pole percutaneous access using flexible nephroscopy 
and the holmium:YAG laser. Our experience is reviewed. PATIENTS AND METHODS: The 
hospital records of patients having a cumulative stone burden > or =5 cm who
underwent percutaneous nephrolithotripsy (PCNL) for a single complex staghorn
calculus were reviewed. There were 15 male and 34 female patients having 45
complete and 7 partial staghorn calculi constituting a mean stone burden of 6.7
cm (range 5.0-10.0 cm). A calix was punctured that would provide access to the
majority of the involved calices. Thirty-five renal units were approached through
a single upper-pole percutaneous access, and four and six renal units were
accessed through single middle or lower-pole calices, respectively. The remaining
seven renal units were treated with multiple percutaneous accesses. RESULTS: In
the renal units having only a single access, a mean of 1.6 (range 1-3) procedures
were required to achieve stone-free status. The mean operating room time was 2.9 
hours (range 2.0-3.5 hours). For the second PCNL, the mean operating room time
was 63 minutes (range 30-90 minutes). Two patients (two renal units) had residual
stones <1 cm in diameter. One refused additional surgery, and the other is
awaiting further treatment. The mean estimated blood loss was 238 mL (range
50-800 mL), with only one procedure (2.2%) necessitating a blood transfusion. One
(2.8%) hydrothorax developed among the 35 upper-pole puncture cases. Six patients
had transient oral temperature readings >101 degrees F with negative blood
cultures. Other early complications included single cases of leg cellulitis,
atrial fibrillation, and noncardiac chest pain. There were no delayed surgical
complications. Patients were discharged from the hospital a mean 2 days (range
1-10 days) after the first PCNL. CONCLUSION: Use of flexible nephroscopy with
holmium:YAG laser lithotripsy and Nitinol basket stone extraction has allowed us 
to render staghorn-containing renal units stone free in a mean of 1.6 procedures.
Of the 45 renal units treated through a single percutaneous access, 43 (95%) were
rendered stone free. The holmium:YAG laser appears to be a safe lithotrite for
the kidney, as no complications occurred from its use.

PMID: 12396440 [PubMed - indexed for MEDLINE]

1156: J Endourol. 2002 Sep;16(7):471-5.

Robotic percutaneous access to the kidney: comparison with standard manual
access.

Su LM, Stoianovici D, Jarrett TW, Patriciu A, Roberts WW, Cadeddu JA, Ramakumar
S, Solomon SB, Kavoussi LR.

James Buchanan Brady Urological Institute, The Johns Hopkins Medical
Institutions, 4940 Eastern Avenue, A3 East, Baltimore, MD 21224, USA.
LSU11@jhmi.edu

PURPOSE: To evaluate the efficiency, accuracy, and safety of robotic percutaneous
access to the kidney (PAKY) for percutaneous nephrolithotomy in comparison with
conventional manual techniques. MATERIALS AND METHODS: We compared the
intraoperative access variables (number of access attempts, time to successful
access, estimated blood loss, complications) of 23 patients who underwent robotic
PAKY with the remote center of motion device (PAKY-RCM) with the same data from a
contemporaneous series of 23 patients who underwent conventional manual
percutaneous access to the kidney. The PAKY-RCM incorporates a robotic arm and a 
friction transmission with axial loading system to accurately position and insert
a standard 18-gauge needle percutaneously into the kidney. The blood loss during 
percutaneous access was estimated on a four-point scale (1 = minimal to 4 =
large). The color of effluent urine was graded on a four-point scale (1 = clear
to 4 = red). RESULTS: The mean target calix width was 13.5 +/- 9.2 mm in the
robotic group and 12.2 +/- 4.5 mm in the manual group (P = 0.57). When comparing 
PAKY-RCM with standard manual techniques, the mean number of attempts was 2.2 +/-
1.6 v 3.2 +/- 2.5 (P = 0.14), time to access was 10.4 +/- 6.5 minutes v 15.1 +/- 
8.8 minutes (P = 0.06), estimated blood loss score was 1.3 +/- 0.49 v 1.7 +/-
0.66 (P = 0.14), and color of effluent urine following access was 2.0 +/- 0.90 v 
2.1 +/- 0.7 (P = 0.82). The PAKY-RCM was successful in obtaining access in 87%
(20 of 23) of cases. The other three patients (13%) required conversion to manual
techniques. There were no major intraoperative complications in either group.
CONCLUSIONS: Robotic PAKY is a feasible, safe, and efficacious method of
obtaining renal access for nephrolithotomy. The number of attempts and time to
access were comparable to those of standard manual percutaneous access
techniques. These findings provide the groundwork for the development of a
completely automated robot-assisted percutaneous renal access device.

Publication Types: 
    Comparative Study

PMID: 12396439 [PubMed - indexed for MEDLINE]

1157: J Urol. 2002 Nov;168(5):2211-5.

Stone fragmentation during shock wave lithotripsy is improved by slowing the
shock wave rate: studies with a new animal model.

Paterson RF, Lifshitz DA, Lingeman JE, Evan AP, Connors BA, Fineberg NS, Williams
JC Jr, McAteer JA.

Department of Anatomy and Cell Biology , Indiana University School of Medicine
and Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana,
USA.

PURPOSE: The current trend toward ungated shock wave lithotripsy means that more 
patients are being treated with shock waves delivered at a rapid rate (120 shock 
waves per minute or greater). However, no benefit of an increased shock wave rate
has been shown and in vitro studies indicate that slowing the shock wave rate
actually improves stone fragmentation. We tested the effect of the shock wave
rate on stone comminution in a new animal model. MATERIALS AND METHODS: Gypsum
model stones were inserted via upper pole percutaneous access into the lower pole
calix of the kidneys of female pigs weighing approximately 100 pounds. Shock wave
lithotripsy was performed (400 shock waves uninterrupted at 20 kV. and 30 or 120 
shock waves per minute) 2 hours later using an unmodified HM3 lithotriptor
(Dornier Medical Systems, Marietta, Georgia). After en bloc excision of the
urinary tract stone fragments were collected and sieved through 2 mm. mesh. The
particles were weighed and surface area was determined. RESULTS: Stones treated
at 30 shock waves per minute broke more completely than stones treated at 120
shock waves per minute. The percent of fragments greater than 2 mm. was
significantly higher for stones treated at the fast rate of 120 versus the slow
rate of 30 shock waves per minute (mean +/- SEM 81% +/- 14% versus 45% +/- 12%, p
<0.005). When stone fragmentation was expressed as the percent increase in
fragment surface area, significantly greater fragmentation occurred at the slower
than at the more rapid rate (327% +/- 63% versus 135% +/- 136%, p <0.02).
CONCLUSIONS: Slowing the rate of shock wave administration during shock wave
lithotripsy significantly improves the efficiency of stone fragmentation in vivo.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12394761 [PubMed - indexed for MEDLINE]

1158: J Urol. 2002 Nov;168(5):1923-7.

Etiological role of estrogen status in renal stone formation.

Heller HJ, Sakhaee K, Moe OW, Pak CY.

Department of Internal Medicine, University of Texas Southwestern Medical Center 
at Dallas, Center for Mineral Metabolism and Clinical Research, USA.

PURPOSE: Estrogen may protect against kidney stone formation since
nephrolithiasis is more common in men than in women. Moreover, the incidence of
stones rises after menopause in women. We examined the contribution of estrogen
to kidney stone risk by comparing outpatient evaluations in the 2 genders, and in
estrogen treated and untreated postmenopausal women. MATERIALS AND METHODS: We
reviewed the results of the initial evaluation of 1,454 adult calcium oxalate
stone formers, including 1,050 men and 404 women. Of the postmenopausal women 39 
and 50 were estrogen treated and untreated, respectively. Samples of urine and
blood were collected 1 week after the imposition of a diet restricted moderately 
in sodium and calcium, and modestly in oxalate and animal protein. RESULTS:
Compared with men the daily excretion of urinary calcium, oxalate and uric acid
was lower in women. Women had lower saturations of calcium oxalate and brushite
as well as lower excretion of undissociated uric acid. Compared with men urinary 
calcium was lower in women until age 50 years, when it equaled that of men.
Citrate was equal in the genders until the age 60 years, when it tended to
decrease in women. Compared with nontreated postmenopausal women those treated
with estrogen had lower mean 24-hour calcium plus or minus SD (155 +/- 62 versus 
193 +/- 90 mg. per day, p <0.02), mean 2-hour fasting urine calcium (0.08 +/-
0.05 versus 0.12 +/- 0.09 mg./mg. creatinine, p <0.01) and mean calcium oxalate
saturation (5.07 +/- 2.27 versus 6.48 +/- 3.44, p <0.05). CONCLUSIONS: The lower 
risk of stone formation in women may be due to the lower urinary saturation of
stone forming salts. Estrogen treatment may decrease the risk of stone recurrence
in postmenopausal women by lowering urinary calcium and calcium oxalate
saturation.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12394677 [PubMed - indexed for MEDLINE]

1159: Urol Res. 2002 Oct;30(5):329-35. Epub 2002 Aug 15.

The preventive effect of sodium pentosan polysulfate against renal stone
formation in hyperoxaluric rats.

Nakatani T, Ishii K, Yoneda Y, Kamikawa S, Kanazawa T, Sugimoto T, Osswald H.

Department of Urology, Osaka City University Medical School, 1-4-3 Asahi-machi,
Abeno-ku, Osaka 545-8585, Japan. nakatani@msic.med.osaka-cu.ac.jp

Sodium pentosan polysulfate (SPP), a semi-synthetic glycosaminoglycan, was
administered to rats with hyperoxaluria, induced by a vitamin B6 deficient diet, 
as a model of calcium oxalate stone formation. We studied the preventive effects 
of SPP on stone formation as well as its inhibitory effects on stone growth by
autoradiography and radioluminography after intravenous injection of
(14)C-oxalate. The rats were divided into non-treated and SPP-treated groups. The
non-treated rats were divided into three groups: one group was fed a regular
diet, while the other two groups were fed a vitamin B6 deficient diet for 2 and 4
weeks, respectively. The SPP-treated rats were divided into two groups: one group
was intravenously injected with SPP from the start of the vitamin B6 deficient
diet for a total of 4 weeks and the other group was injected with the same amount
of SPP after 2 weeks of the diet for 2 weeks. (14)C-oxalate renal
macroautoradiograms were prepared, and calcium oxalate deposits in the renal
tissues were compared between the non-treated and SPP-treated groups. The
preventive effects on calcium oxalate stone formation were clearly observed in
the group injected with SPP for 4 weeks. Even in the other SPP-treated group, in 
which the administration of SPP was started at 2 weeks after the start of the
diet when calcium oxalate stone formation was already observed, the size of the
calcium oxalate deposits observed after 4 weeks was smaller than that in the
non-treated group fed a vitamin B6 deficient diet for 4 weeks. In conclusion, our
results show that SPP has not only preventive effects on calcium oxalate stone
formation but also growth inhibitory effects on stones in hyperoxaluric rats.

PMID: 12389123 [PubMed - indexed for MEDLINE]

1160: Ren Fail. 2002 Sep;24(5):659-65.

Unusual clinical presentation of Klebsiella pneumoniae induced endogenous
endophthalmitis and xanthogranulomatous pyelonephritis in a non-nephrolithiasis
and non-obstructive urinary tract.

Lin HH, Chien CC, Fang JT, Lai RH, Huang CC.

Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.

The genitourinary tract is well recognized as a route through which bacteria
could gain access to the blood circulation. Under some circumstances, metastatic 
infections may occur in distant organs, including endogenous endophthalmitis.
Xanthogranulomatous pyelonephritis (XGP) is an unusual variant of chronic
pyelonephritis. It most often occurs in middle-aged women who frequently have a
history of recurrent urinary tract infections combined with obstruction and a
kidney of poor function. We reported an unusual case of urinary tract infection
in a non-nephrolithiasis and non-obstructive urinary tract complicated by
Klebsiella pneumoniae endogenous endophthalmitis and developed XGP in two months.

Publication Types: 
    Case Reports

PMID: 12380913 [PubMed - indexed for MEDLINE]

1161: BMJ. 2002 Oct 12;325(7368):807.

Comment in:
    BMJ. 2002 Oct 12;325(7368):785-6.

Risk of renal stone events in primary hyperparathyroidism before and after
parathyroid surgery: controlled retrospective follow up study.

Mollerup CL, Vestergaard P, Frøkjaer VG, Mosekilde L, Christiansen P,
Blichert-Toft M.

Department of Endocrine and Breast Surgery, Copenhagen University Hospital,
Rigshospitalet, DK 2100 Copenhagen, Denmark. molle@rh.dk

AIM: To study the risk of renal stone episodes and risk factors for renal stones 
in primary hyperparathyroidism before and after surgery. DESIGN: Register based, 
controlled retrospective follow up study. SETTING: Tertiary hospitals in Denmark.
PARTICIPANTS: 674 consecutive patients with surgically verified primary
hyperparathyroidism. Each patient was compared with three age- and sex-matched
controls randomly drawn from the background population. Hospital admissions for
renal stone disease were compared between patients and controls. Risk factors for
renal stones among patients were assessed. MAIN OUTCOME MEASURES: Number of renal
stone episodes; comparison of hospital admissions for renal stones in patients
and controls; assessment of risk factors for renal stones. RESULTS: Relative risk
of a stone episode was 40 (95% confidence interval 31 to 53) before surgery and
16 (12 to 23) after surgery. Risk was increased 10 years before surgery, and
became normal more than 10 years after surgery. Stone-free survival 20 years
after surgery was 90.4% in patients and 98.7% in controls (risk difference 8.3%, 
4.8% to 11.7%). Patients with preoperative stones had 27 times the risk of
postoperative stone incidents than controls. Before surgery, males had more stone
episodes than females and younger patients had more stone episodes than older
patients. Neither parathyroid pathology, weight of removed tissue, plasma calcium
levels, nor skeletal pathology (fractures) influenced the risk of renal stones.
After surgery, younger age, preoperative stones and ureteral strictures were
significant risk factors for stones. CONCLUSIONS: The risk of renal stones is
increased in primary hyperparathyroidism and decreases after surgery. The risk
profile is normal 10 years after surgery. Preoperative stone events increase the 
risk of postoperative stones. Stone formers and non-stone formers had the same
risk of skeletal complications.

Publication Types: 
    Multicenter Study

PMID: 12376441 [PubMed - indexed for MEDLINE]

1162: Eur J Clin Nutr. 2002 Oct;56(10):1020-3.

Effect of blackcurrant-, cranberry- and plum juice consumption on risk factors
associated with kidney stone formation.

Kessler T, Jansen B, Hesse A.

Division of Experimental Urology, Department of Urology, University of Bonn,
Bonn, Germany. Kessler@Uni-Bonn.de

OBJECTIVE: To evaluate the influence of plum-, cranberry- and blackcurrant juice 
on urinary stone risk factors. DESIGN: Investigations were carried out in 12
healthy male subjects aged 18-38 y. All subjects received a standardized diet
formulated according to the dietary recommendations of the German Society of
Nutrition. The subjects provided 24 h urine collections in a control, three
loading phases. In each loading phase a neutral mineral water was substituted for
330 ml of the particular juice. RESULTS: Cranberry juice decreased the urinary
pH, whereas the excretion of oxalic acid and the relative supersaturation for
uric acid were increased. Blackcurrant juice increased the urinary pH and the
excretion of citric acid. The excretion of oxalic acid was increased too. All
changes were statistically significant. The plum juice had no significant effect 
on the urinary composition. CONCLUSION: It is concluded that blackcurrant juice
could support the treatment and metaphylaxis of uric acid stone disease because
of its alkalizing effect. Since cranberry juice acidifies urine it could be
useful in the treatment of brushite and struvite stones as well as urinary tract 
infection. SPONSORSHIP: Funded by our own Division respectively the University.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12373623 [PubMed - indexed for MEDLINE]

1163: Indian Pediatr. 2002 Sep;39(9):819-25.

Urinary citrate excretion in idiopathic nephrolithiasis.

Ratan SK, Bhatnagar V, Mitra DK, Basu N, Malhotra LK.

Department of Pediatric Surgery, All India Institute of Medical Sciences, New
Delhi, India.

OBJECTIVE: To determine urinary citrate excretion in children with
nephrolithiasis and normal controls. DESIGN: Prospective. SETTING: Tertiary care 
center in New Delhi. METHODS: This study was done on 50 children, below the age
of 12 years, with idiopathic urinary calculi and 150 age and weight matched
controls. The children were divided into 3 groups: Group 1 (1-4 years), Group 2
(5-8 years) and Group 3 (9-12 years). Urinary citrate was estimated in a 24-hour 
urine sample using colorimetric method. The stones removed from these children
were also analysed. RESULTS: There was a preponderance of urinary stones in
males; the highest incidence being in Group 1. Excretion of citrate in 24-hour
urine sample was significantly lower in patients compared to controls, for males 
in all age groups and for females in Group 3. However, there was no statistically
significant difference in the urinary citrate value between males and females in 
a given age group for either controls or patients. The urinary citrate excretion 
increased with age in patients and controls, but the levels in patients were
lower. Depending upon the constituents, four types of stones were identified,
calcium phosphate, calcium oxalate, uric acid and magnesium ammonium phosphate.
Nine stones had at least more than one major constituent. Hypocitraturia was
detected in 43 percent cases. The incidence was 76 percent for calcium phosphate,
87 percent for calcium oxalate, 40 percent for uric acid stones and 50 percent
for magnesium ammonium phosphate. CONCLUSION: This study shows that low urinary
citrate is associated with urinary stones in children, especially in endemic
areas, in the absence of obvious etiological factors. Urinary citrate excretion
should be determined in all children with nephrolithiasis.

PMID: 12368525 [PubMed - indexed for MEDLINE]

1164: Clin Chim Acta. 2002 Nov;325(1-2):71-8.

Urinary citrate excretion in patients with renal stone: roles of leucocyte ATP
citrate lyase activity and potassium salts therapy.

Tosukhowong P, Borvonpadungkitti S, Prasongwatana V, Tungsanga K, Jutuporn S,
Dissayabutr T, Reungjui S, Sriboonlue P.

Department of Biochemistry, Faculty of Medicine, Chulalongkorn University,
Bangkok 10330, Thailand. piyaratana_t@hotmail.com

BACKGROUND: Hypocitraturia is a major metabolic abnormality in rural Northeast
Thais with renal stones. These people also have low serum and urinary potassium
and consume a high carbohydrate and low fat diet, which together might influence 
the intracellular metabolism and urinary excretion of citrate. METHODS: In Study 
A, we measured plasma and urinary chemistries and assayed leucocyte ATP citrate
lyase (ACL) activity in 30 normal urban control subjects (Group A1) and 30 rural 
renal stone patients (Group A2) in Northeast Thailand. Some of the subjects from 
both groups were also used to evaluate the intake of carbohydrate, protein and
fat. In Study B, we examined the effects of potassium salts therapy with another 
group of 30 rural renal stone patients: Group B1 (n = 15) treated with potassium 
chloride and Group B2 (n = 15) with potassium-sodium citrate (with an aim to
achieve 42 mEq potassium, 21 mEq sodium and 62 mEq citrate per day for 1 month). 
RESULTS: In Study A, the leucocyte ACL activity of Group A1 was much lower than
that of Group A2 (3.2 +/- 0.7 vs. 9.3 +/- 3.8 micromol acetylhydroxamate/mg
protein/30 min, p < 0.0001). The plasma potassium, urinary excretions of
potassium and citrate in Group A1 were higher than in Group A2. When data of the 
two groups were combined, urinary citrate excretion was inversely correlated with
leucocyte ACL activity (r = 0.6783, p < 0.001). While the dietary protein intake 
did not differ between Groups A1 and A2, the carbohydrate intake by Group A1 was 
significantly lower (65.2 +/- 7.9% vs. 83.1 +/- 2.9%, p < 0.01) and fat higher
(21.0 +/- 6.4% vs. 6.2 +/- 4.1%, p < 0.002) than Group A2. After treatment with
potassium chloride (Group B1), only the potassium was increased (p < 0.001),
while those treated with potassium-sodium citrate (Group B2) experienced a
significant increase in urinary pH (p < 0.002), potassium (p < 0.001) and citrate
(p < 0.001), and a decrease in leucocyte ACL activity (p < 0.001). CONCLUSIONS:
Compared to normal subjects, renal stone patients have low urinary citrate
excretion with high leucocyte ACL activity. In Northeast Thailand, low potassium 
status and a high carbohydrate and low fat diet may cause the increased ACL
activity. However, hypokaliuria, hypocitraturia and high leucocyte ACL activity
can be corrected by potassium-sodium citrate salt therapy. Copyright 2002
Elsevier Science B.V.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12367768 [PubMed - indexed for MEDLINE]

1165: Epilepsia. 2002 Oct;43(10):1168-71.

Comment in:
    Epilepsia. 2003 May;44(5):735; author reply 736.

Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet.

Kossoff EH, Pyzik PL, Furth SL, Hladky HD, Freeman JM, Vining EP.

The Pediatric Epilepsy Center, Departments of Neurology and Pediatrics, and
Division of Pediatric Nephrology, Department of Pediatrics, The Johns Hopkins
Medical Institutions, Baltimore, Maryland 21287-1000, USA. ekossoff@jhmi.edu

PURPOSE: Because carbonic anhydrase inhibitors and the ketogenic diet are each
known risk factors for kidney stones, simultaneous use of these therapies has
been discouraged. The objective of this study was to establish the prevalence of 
nephrolithiasis in children in this combination-therapy population. METHODS:
Since 1996, 301 children have been started on the ketogenic diet at our
institution. A retrospective cohort study of renal calculi in ketogenic diet
patients was performed to evaluate the increased risk with combined use of a
carbonic anhydrase inhibitor. RESULTS: In 15 (6.7%) of 221 children on the
ketogenic diet without the use of carbonic anhydrase inhibitors, stones
developed. In five (6.3%) of the 80 children on the diet in combination with
topiramate or zonisamide, stones developed. There was no difference between these
two groups (p = 0.82). No child was treated with either acetazolamide or more
than one carbonic anhydrase inhibitor simultaneously. Prior ketogenic diet
duration was shorter (10.4 vs. 22.4 months; p = 0.03), and more children had
either a family history of renal stones or significant urologic abnormalities (80
vs. 27%; p = 0.04) in the combination-therapy group. CONCLUSIONS: The combined
use of carbonic anhydrase inhibitors and the ketogenic diet does not increase the
risk of kidney stones. We recommend that all patients treated with combination
therapy should be treated with increased hydration. Urine alkalinization should
be considered for children with previous renal abnormalities, family histories of
kidney stones, hematuria, or elevated urine calcium-to-creatinine ratios. If
renal stones are found, we advocate discontinuation of the carbonic anhydrase
inhibitor.

Publication Types: 
    Comparative Study

PMID: 12366731 [PubMed - indexed for MEDLINE]

1166: Eur Urol. 2002 Oct;42(4):376-81.

Experimental studies and first clinical experience with a new Lithoclast and
ultrasound combination for lithotripsy.

Hofmann R, Weber J, Heidenreich A, Varga Z, Olbert P.

Department of Urology and Pediatric Urology, Medical School, Philipps Universität
Marburg, Baldingerstreet, 35033 Marburg, Germany. r.hofmann@mailer.uni-marburg.de

OBJECTIVES: A new lithotriptor for intracorporeal lithotripsy was developed
combining the two most effective lithotriptors. A combination of the mechanically
driven Lithoclast Master and a new ultrasonic device was constructed. Efficacy
was tested in standardized model stones and in patient treatment. MATERIAL: The
new lithotriptor is composed of a Lithoclast Master and an ultrasonic device
(EMS, Nyon, Switzerland). The 1.0 mm Lithoclast probe is advanced off-center
through the hollow 3.3 mm ultrasonic probe and protrudes about 1 mm. Five
different artificial stones of defined hardness and density were used as model
stones for disintegration. Time until first fragmentation and complete
fragmentation (particles smaller than 2.2 mm to fit through the ultrasonic
probe), percent disintegration after 1 min and time until 50% disintegration were
determined for the new device as well as lithoclast and ultrasound alone. A total
of 68 patients were treated by percutaneous nephrolitholapaxy (PNL) with the new 
device from February 1999 to August 2001. Lithotripsy was performed after
fluoroscopically guided puncture of the lower calix and dilatation of the
nephrostomy tract with coaxial bougies. Thirty-five patients had complete and 33 
patients partial staghorn calculi. RESULTS: First fragmentation was reached
25-200 times faster with the combination as with either mode alone. Disintegrated
stone mass after 1 min was 1.5-4 times larger in combined lithotripsy and 50%
disintegration time 30-50% shorter. Clinically, complete stone free rate (KUB and
ultrasound) was 66% after the first PNL. Sixteen out of 68 patients had a second 
look PNL with an overall stone free rate of 89.7% by dismission. Stone
composition was calcium-oxalate-monohydrate in 13%, Ca-ox-monohydrate/uric acid
in 35%, apatite in 20% and cystine in 11%. CONCLUSION: In in vitro experiments
and clinically the new lithotriptor provides easy handling and high effectivity
in fragmentation of all stones regardless of their composition. Copyright 2002
Elsevier Science B.V.

Publication Types: 
    Clinical Trial

PMID: 12361904 [PubMed - indexed for MEDLINE]

1167: Nutrition. 2002 Oct;18(10):857-63.

Nutrition and renal stone disease in space.

Zerwekh JE.

Collaborators: Zerwekh JE.

Department of Internal Medicine, University of Texas Southwestern Medical Center,
Dallas, Texas 75390, USA. Joseph.zerwekh@utsouthwestern.edu

There is a growing body of evidence from the National Aeronautics and Space
Administration and the Russian space program showing that humans exposed to the
microgravity environment of space have a greater risk for developing renal
stones. Increased bone resorption and the attendant hypercalciuria and
hyperphosphaturia contribute significantly to raising the urinary state of
saturation with respect to the calcium salts, namely calcium oxalate and calcium 
phosphate. In addition, other environmental and dietary factors may adversely
affect urine composition and increase stone formation risk during space flight.
For example, reductions in urinary volume, pH, and citrate contribute to raising 
stone formation risk. In addition to raising the risk for calcium stone
formation, this metabolic profile is conducive to the formation of uric acid
stones. Although observations to date have suggested that there may actually be a
reduced food intake during the early phase of flight, crew members on
longer-duration flights may increase food intake and be at increased risk for
stone formation. Taken together, these findings support the use of nutritional
recommendations for crew members that would serve to reduce the stone-forming
propensity of the urinary environment. Pharmacologic intervention should be
directed at raising urinary volumes, diminishing bone losses, and preventing
reductions in urinary pH and citrate. Success in reducing the risk for stone
formation in astronauts would also be of potential major benefit to the estimated
20 million Americans with nephrolithiasis.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12361779 [PubMed - indexed for MEDLINE]

1168: Radiology. 2002 Oct;225(1):91-6.

Conspicuity of renal calculi at unenhanced CT: effects of calculus composition
and size and CT technique.

Tublin ME, Murphy ME, Delong DM, Tessler FN, Kliewer MA.

Department of Radiology, Albany Medical College, NY, USA. tublinme@msx.upmc.edu

PURPOSE: To determine the effects of calculus size, composition, and technique
(kilovolt and milliampere settings) on the conspicuity of renal calculi at
unenhanced helical computed tomography (CT). MATERIALS AND METHODS: The authors
performed unenhanced CT of a phantom containing 188 renal calculi of varying size
and chemical composition (brushite, cystine, struvite, weddellite, whewellite,
and uric acid) at 24 combinations of four kilovolt (80-140 kV) and six
milliampere (200-300 mA) levels. Two radiologists, who were unaware of the
location and number of calculi, reviewed the CT images and recorded where stones 
were detected. These observations were compared with the known positions of
calculi to generate true-positive and false-positive rates. Logistic regression
analysis was performed to investigate the effects of stone size, composition, and
technique and to generate probability estimates of detection. Interobserver
agreement was estimated with kappa statistics. RESULTS: Interobserver agreement
was high: the mean kappa value for the two observers was 0.86. The conspicuity of
stone fragments increased with increasing kilovolt and milliampere levels for all
stone types. At the highest settings (140 kV and 300 mA), the detection threshold
size (ie, the size of calculus that had a 50% probability of being detected)
ranged from 0.81 mm + 0.03 (weddellite) to 1.3 mm + 0.1 (uric acid). Detection
threshold size for each type of calculus increased up to 1.17-fold at lower
kilovolt settings and up to 1.08-fold at lower milliampere settings. CONCLUSION: 
The conspicuity of small renal calculi at CT increases with higher kilovolt and
milliampere settings, with higher kilovolts being particularly important. Small
uric acid calculi may be imperceptible, even with maximal CT technique.

PMID: 12354990 [PubMed - indexed for MEDLINE]

1169: J Urol. 2002 Oct;168(4 Pt 1):1344-7.

Comment in:
    J Urol. 2003 Dec;170(6 Pt 1):2390.

Predictors of lower pole renal stone clearance after extracorporeal shock wave
lithotripsy.

Sumino Y, Mimata H, Tasaki Y, Ohno H, Hoshino T, Nomura T, Nomura Y.

Department of Urology, Oita Medical University, Japan.

PURPOSE: Lower pole renal stones are well known to show a poor stone clearance
rate after extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems,
Marietta, Georgia). In the current study we analyzed several anatomical factors
as predictors of lower pole stone clearance that may be used to indicate the
usefulness of ESWL in such patients. MATERIALS AND METHODS: Between January 1993 
and October 2000, 63 patients with a unilateral single lower pole stone of 2 cm. 
or less were included in the study. Excretory urography was done to determine the
lower infundibulopelvic angle, caliceal pelvic height, lower infundibular length 
and diameter, lower infundibular length-to-diameter ratio and number of lower
pole minor calices. Stone-free status was assessed by x-ray. RESULTS: The overall
stone clearance rate was 54% (34 of 63 patients). While caliceal pelvic height,
lower infundibular diameter, length, length-to-diameter ratio and number of minor
calices were different in the stone-free and residual stone groups on univariate 
analysis, multivariate logistic analysis revealed that the lower infundibular
length-to-diameter ratio, diameter and number of minor calices were independent
predictors of successful stone clearance. The 13 patients (20.6%) who showed all 
3 favorable anatomical factors (lower infundibular length-to-diameter ratio less 
than 7, diameter greater than 4 mm. and a single minor calix) achieved an
impressive 84.6% stone clearance rate. In patients with only 1 or 2 favorable
factors the stone clearance rate was still greater than 60%. In contrast, the
stone clearance rate was only 6.7% in the 15 patients who showed none of these
factors. CONCLUSIONS: From this study it is apparent that successful ESWL is
highly sensitive to the anatomy of the lower pole of the kidney. If a patient
with a lower pole stone has at least 1 of the favorable factors identified in
this study, ESWL may be advocated as first line therapy with a greater than 60%
prospect of a successful outcome. Other treatment options should be considered in
those without any of these predictive factors.

PMID: 12352389 [PubMed - indexed for MEDLINE]

1170: J Urol. 2002 Oct;168(4 Pt 1):1341-3.

Urinary calculi in aviation pilots: what is the best therapeutic approach?

Zheng W, Beiko DT, Segura JW, Preminger GM, Albala DM, Denstedt JD.

Division of urology, University of Western Ontario, London, Canada.

PURPOSE: We reviewed treatment outcomes in a series of aviation pilots treated in
the era of modern surgical techniques and provide recommendations regarding
treatment in this unique group. MATERIALS AND METHODS: We retrospectively
analyzed the records of all aviation pilots surgically treated for urinary
calculi at our 4 tertiary stone centers from January 1988 to June 2000.
Preoperative data and postoperative results were evaluated. Primary outcome
measures included stone-free status after initial therapy, time lost from work
and overall stone-free rates. Secondary outcome measures included the need for
secondary procedures and complications. RESULTS: Of the 36 patients 17 had renal 
and 19 had ureteral stones. In 4 patients the stones passed spontaneously, while 
17 were initially treated with extracorporeal shock wave lithotripsy (ESWL)
(Dornier Medical Systems, Marietta, Georgia), 9 were initially treated with
ureteroscopy and 6 were treated with percutaneous nephrolithotripsy. There was 1 
complication. The stone-free rate for ESWL, percutaneous nephrolithotripsy and
ureteroscopy after initial therapy was 35%, 100% and 100%, respectively. All
patients were rendered stone-free after secondary therapy. Mean time lost from
work for ESWL, percutaneous nephrolithotripsy and ureteroscopy was 4.7, 2.6 and
1.6 weeks, respectively. CONCLUSIONS: Aviation pilots with surgical urolithiasis 
are best treated with an initial endoscopic procedure. Stone-free rates can be
maximized, while time lost from work can be minimized when an endoscopic approach
is used initially. All pilots with urolithiasis should undergo mandatory
metabolic evaluations to institute medical therapy when indicated.

Publication Types: 
    Comparative Study

PMID: 12352388 [PubMed - indexed for MEDLINE]

1171: J Urol. 2002 Oct;168(4 Pt 1):1307-14.

Uric acid nephrolithiasis: current concepts and controversies.

Shekarriz B, Stoller ML.

Department of Urology, SUNY Upstate Medical University, Syracuse, NY 13210, USA.

PURPOSE: Uric acid calculi with or without a calcium component comprise a
significant proportion of urinary stones. Knowledge of the pathophysiology of
stone formation is important to direct medical treatment. The aim of this review 
is to provide an update on the epidemiology, pathophysiology and management of
uric acid renal stones. MATERIALS AND METHODS: A MEDLINE search was performed on 
the topic of uric acid stones. Current literature was reviewed with regard to the
epidemiology, pathophysiology, associated medical conditions and management of
uric acid stones. RESULTS: The incidence of uric acid stones varies between
countries and accounts for 5% to 40% of all urinary calculi. Hyperuricuria, low
urinary output and acidic urine are well known contributing factors. However, the
most important factor for uric acid stone formation is persistently acidic urine.
Gout and myeloproliferative disorders are associated with uric acid stones. Why
most patients with gout present with acidic urine yet only 20% have uric acid
stone formation remains unclear. The pathophysiological basis for persistent
urine acidity also remains unclear although various mechanisms have been
proposed. Urinary alkalization with potassium citrate or sodium bicarbonate is a 
highly effective treatment, resulting in dissolution of existing stones and
prevention of recurrence. CONCLUSIONS: Acidic urine is a prerequisite for uric
acid stone formation and growth. Medical management with urinary alkalization for
stone dissolution and prevention of recurrence is effective and should be the
cornerstone of treatment.

Publication Types: 
    Review

PMID: 12352383 [PubMed - indexed for MEDLINE]

1172: Urology. 2002 Sep;60(3):393-7; discussion 397.

Comment in:
    J Urol. 2003 Aug;170(2 Pt 1):687.

Ureteroscopic treatment of renal calculi in morbidly obese patients: a
stone-matched comparison.

Dash A, Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS Jr.

Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan
48109, USA,

OBJECTIVES: To report a matched comparison of morbidly obese (MO) patients and
normal weight (NW) patients who underwent ureteroscopic (URS) treatment of renal 
calculi. Shock wave lithotripsy and percutaneous nephrostolithotomy may be
precluded in MO patients, and URS treatment offers a minimally invasive
alternative. METHODS: We retrospectively reviewed the charts of patients who
underwent URS at our institution between 1997 and 2000. Fifty-four patients
underwent URS treatment solely for renal calculi. Sixteen MO patients underwent
18 procedures. Thirty-eight NW patients, who underwent 39 procedures, were
matched to the MO patients by stone location and size. Stones were categorized by
location and size, less than 10 mm or 10 mm or greater. The factors and outcomes 
assessed were stone length, operative time, presence of a ureteral stent,
success, and complications. RESULTS: The overall success rate was 83% (15 of 18
procedures) for MO patients and 67% (26 of 39 procedures) for NW patients, but
this difference was not significant (P = 0.23). The difference in the success
rate for renal calculi 10 mm or greater (100% versus 38%) approached significance
(P = 0.09). This may be related to other distinctions between the groups. URS
treatment was often a salvage therapy in the NW group after other modalities
failed. No significant differences were found between the other outcomes.
CONCLUSIONS: URS treatment of renal calculi when matched for location and size is
as successful and no more morbid in MO than in NW patients. URS treatment of
renal calculi is a safe and effective first-line treatment for renal calculi in
MO patients.

Publication Types: 
    Comparative Study

PMID: 12350468 [PubMed - indexed for MEDLINE]

1173: Urology. 2002 Sep;60(3):388-92.

Percutaneous nephrolithotomy in the supine position: technical aspects and
functional outcome compared with the prone technique.

Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

OBJECTIVES: To compare the results of percutaneous nephrolithotomy in the supine 
and prone positions. METHODS: A total of 130 patients who underwent percutaneous 
nephrolithotomy for renal or upper ureteral stones were evaluated in a
prospective and nonrandomized manner. The procedure was carried out in the supine
or prone position in 53 and 77 patients, respectively. The results in both
positions were compared regarding the technical aspects, success rate, and
morbidity. RESULTS: Regardless of the position, the pelvicaliceal system could be
successfully approached in all patients, and the posterior calices were the most 
common site of entry. Punctures through the anterior calices were more frequently
reported with the supine position. A higher incidence of anteromedial
displacement of the kidney during tract dilation was reported with the supine
approach. The overall success rate was 89% and 84% in the supine and prone
positions, respectively. The complication rates were similar in both groups, and 
none of the patients experienced injury of adjacent organs. CONCLUSIONS: The
approach to the pelvicaliceal system is feasible in the supine position. The
success and complication rates are comparable to the prone approach.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 12350467 [PubMed - indexed for MEDLINE]

1174: N Engl J Med. 2002 Sep 26;347(13):983-91.

Comment in:
    N Engl J Med. 2002 Sep 26;347(13):1022-4.    N Engl J Med. 2003 Jan 16;348(3):264-5; author reply 264-5.

Nephrolithiasis and osteoporosis associated with hypophosphatemia caused by
mutations in the type 2a sodium-phosphate cotransporter.

Prié D, Huart V, Bakouh N, Planelles G, Dellis O, Gérard B, Hulin P,
Benqué-Blanchet F, Silve C, Grandchamp B, Friedlander G.

Service de Physiologie-Explorations Fonctionnelles, Hôpital Bichat, Assistance
Publique-Hôpitaux de Paris, Paris, France. dprie@bichat.inserm.fr

BACKGROUND: Epidemiologic studies suggest that genetic factors confer a
predisposition to the formation of renal calcium stones or bone demineralization.
Low serum phosphate concentrations due to a decrease in renal phosphate
reabsorption have been reported in some patients with these conditions,
suggesting that genetic factors leading to a decrease in renal phosphate
reabsorption may contribute to them. We hypothesized that mutations in the gene
coding for the main renal sodium-phosphate cotransporter (NPT2a) may be present
in patients with these disorders. METHODS: We studied 20 patients with
urolithiasis or bone demineralization and persistent idiopathic hypophosphatemia 
associated with a decrease in maximal renal phosphate reabsorption. The coding
region of the gene for NPT2a was sequenced in all patients. The functional
consequences of the mutations identified were analyzed by expressing the mutated 
RNA in Xenopus laevis oocytes. RESULTS: Two patients, one with recurrent
urolithiasis and one with bone demineralization, were heterozygous for two
distinct mutations. One mutation resulted in the substitution of phenylalanine
for alanine at position 48, and the other in a substitution of methionine for
valine at position 147. Phosphate-induced current and sodium-dependent phosphate 
uptake were impaired in oocytes expressing the mutant NPT2a. Coinjection of
oocytes with wild-type and mutant RNA indicated that the mutant protein had
altered function. CONCLUSIONS: Heterozygous mutations in the NPT2a gene may be
responsible for hypophosphatemia and urinary phosphate loss in persons with
urolithiasis or bone demineralization. Copyright 2002 Massachusetts Medical
Society

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12324554 [PubMed - indexed for MEDLINE]

1175: BMC Urol. 2002 Sep 24;2:11.

Single session endoscopic management of intrinsic ureteropelvic junction
obstruction and concomitant renal stone disease in a child: a case report.

Ugras M, Gunes A, Yilmaz U, Baydinc C.

Department of Urology, Inönü University, Faculty of Medicine, 44069 - Malatya,
Turkey. mugras35@yahoo.com

BACKGROUND: Percutaneous nephrolithotomy is a well known therapeutic modality for
stone diseases of childhood. Antegrade and retrograde endopyelotomies are also
well defined options of treatment for secondary ureteropelvic junction
obstruction. Yet there are few reports regarding endoscopic therapy of intrinsic 
ureteropelvic junction obstruction. To our knowledge, there exist only a few
reports of endosurgical treatment of children with stone disease and with
concomitant intrinsic ureteropelvic junction obstruction, in the literature. CASE
PRESENTATION: We present the endoscopic management of stone disease and
concomitant intrinsic ureteropelvic junction obstruction of a child in one
session. CONCLUSION: Percutaneous nephrolithotomy and antegrade endopyelotomy is 
combined safely with successful outcome in a child.

Publication Types: 
    Case Reports

PMID: 12296974 [PubMed - indexed for MEDLINE]

1176: J Laparoendosc Adv Surg Tech A. 2002 Aug;12(4):299-303.

Retroperitoneal laparoscopic pyelolithotomy for staghorn stones.

Gaur DD, Trivedi S, Prabhudesai MR, Gopichand M.

Bombay Hospital Institute of Medical Sciences, India. ddgaur@vsnl.com

PURPOSE: To establish the feasibility of the retroperitoneal laparoscopic
approach for treatment of patients with staghorn renal calculi who are under
consideration for an open pyelolithotomy. PATIENTS AND METHODS: Retroperitoneal
laparoscopic pyelolithotomy was performed in three patients with impacted
staghorn renal calculi between 22 and 45 mm in largest diameter. One of the
patients also had multiple caliceal stones. These patients wanted an open
procedure but had agreed to have their stone removal done laparoscopically in
view of our experience. The previously described retroperitoneal laparoscopic
approach was used, and the handling of some of the specific problems in such
patients is described in the text. RESULTS AND CONCLUSION: The stones were
removed successfully in all the three patients, and there were no complications. 
Although no definitive conclusion can be drawn from this small series, the paper 
shows the feasibility of the retroperitoneal laparoscopic approach in a select
group of patients with staghorn renal calculi.

Publication Types: 
    Case Reports

PMID: 12269502 [PubMed - indexed for MEDLINE]

1177: J Acoust Soc Am. 2002 Sep;112(3 Pt 1):1183-95.

Comment in:
    J Urol. 2003 Aug;170(2 Pt 1):689.

Effect of overpressure and pulse repetition frequency on cavitation in shock wave
lithotripsy.

Sapozhnikov OA, Khokhlova VA, Bailey MR, Williams JC Jr, McAteer JA, Cleveland
RO, Crum LA.

Department of Acoustics, Physics Faculty, M. V Lomonosov Moscow State University,
Russia.

Cavitation appears to contribute to tissue injury in lithotripsy. Reports have
shown that increasing pulse repetition frequency [(PRF) 0.5-100 Hz] increases
tissue damage and increasing static pressure (1-3 bar) reduces cell damage
without decreasing stone comminution. Our hypothesis is that overpressure or slow
PRF causes unstabilized bubbles produced by one shock pulse to dissolve before
they nucleate cavitation by subsequent shock pulses. The effects of PRF and
overpressure on bubble dynamics and lifetimes were studied experimentally with
passive cavitation detection, high-speed photography, and B-mode ultrasound and
theoretically. Overpressure significantly reduced calculated (100-2 s) and
measured (55-0.5 s) bubble lifetimes. At 1.5 bar static pressure, a dense bubble 
cluster was measured with clinically high PRF (2-3 Hz) and a sparse cluster with 
clinically low PRF (0.5-1 Hz), indicating bubble lifetimes of 0.5-1 s, consistent
with calculations. In contrast to cavitation in water, high-speed photography
showed that overpressure did not suppress cavitation of bubbles stabilized on a
cracked surface. These results suggest that a judicious use of overpressure and
PRF in lithotripsy could reduce cavitation damage of tissue while maintaining
cavitation comminution of stones.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12243163 [PubMed - indexed for MEDLINE]

1178: Hinyokika Kiyo. 2002 Aug;48(8):483-6.

Ammonium acid urate urinary stone caused by a low-caloric diet: a case report.

Nakamura K, Kokubo H, Kato K, Aoki S, Taki T, Mitsui K, Yamada Y, Honda N,
Fukatsu H, Kamijo A.

Department of Urology, Aichi Medical University Graduate School of Medicine.

A 32-year-old woman complained of right back pain and pyuria. The plain
radiograph (KUB) and drip infusion pyelography (DIP) demonstrated a right renal
stone and hydronephrosis. The stone was successfully treated using extracorporeal
shock wave lithotripsy. Infrared spectrophotometry revealed that the stone was
composed of pure ammonium acid urate. The patient had a 3-year history of
excessive anorexia. The low-caloric diet was considered to have caused the
disease.

Publication Types: 
    Case Reports

PMID: 12243074 [PubMed - indexed for MEDLINE]

1179: J Am Soc Nephrol. 2002 Oct;13(10):2517-23.

Influence of calcium-sensing receptor gene on urinary calcium excretion in
stone-forming patients.

Vezzoli G, Tanini A, Ferrucci L, Soldati L, Bianchin C, Franceschelli F,
Malentacchi C, Porfirio B, Adamo D, Terranegra A, Falchetti A, Cusi D, Bianchi G,
Brandi ML.

Division of Nephrology Dialysis and Hypertension, Postgraduate School of
Nephrology, Ateneo Vita e Salute, IRCCS San Raffaele Hospital, Milan, Italy.

Calcium-sensing receptor (CaSR) is a plasma membrane protein that regulates
tubular reabsorption of Ca. To establish its role in idiopathic hypercalciuria,
the association of urinary Ca excretion with the polymorphisms of CASR gene has
been studied in healthy subjects and in hypercalciuric and normocalciuric Ca
stone formers. CASR exon 7 single nucleotide polymorphisms (SNP), G/T at codon
986, G/A at codon 990, and C/G at codon 1011, were evaluated by PCR amplification
and direct sequencing in 97 normocalciuric stone formers, 134 hypercalciuric
stone formers, and 101 normocalciuric healthy controls. Four haplotypes were
defined on the basis of CASR gene SNP: haplotype 1 was characterized by the most 
frequent sequence; haplotypes 2, 3, or 4 by the presence of a single polymorphic 
variant at codon 986, 990, or 1011, respectively. The relative risk of
hypercalciuria was calculated with multinomial logistic regression and was
significantly increased only in individuals carrying haplotype 3 (Odds ratio,
13.0 [95% confidence interval, 1.7 to 99.4]). Accordingly, Ca excretion was
higher in subjects bearing haplotype 3, whereas those bearing haplotype 2 showed 
a slight increase of plasma Ca concentration. Multiple regression analysis showed
that haplotype 3 explained 4.1% of the total variance of Ca excretion and 12.6%
of the variance explained by the variables considered in the study. In
conclusion, CASR gene could be a component of the complex genetic background
regulating Ca excretion. Arg990Gly polymorphism could facilitate activation of
CaSR and increase Ca excretion and susceptibility to idiopathic hypercalciuria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12239240 [PubMed - indexed for MEDLINE]

1180: BMC Urol. 2002 Sep 18;2:10.

Severe renal bleeding caused by a ruptured renal sheath: case report of a rare
complication of percutaneous nephrolithotomy.

Ugras M, Gunes A, Baydinc C.

Department of Urology, Inönü University, Faculty of Medicine, Malatya, Turkey.
mugras35@yahoo.com

BACKGROUND: Percutaneous nephrolithotomy is a minimally invasive intervention for
renal stone disease. Complications, which are rare and usually presented as case 
reports, are diversified as the utilization of the procedure is expanded. The
procedure causes less blood loss and less morbidity when compared to open
surgical procedures. Yet, there are some reports involving severe bleeding and
relevant morbidity during surgery. These are usually related with the surgical
technique or experience of the surgeon.Renal sheaths are designed to cause
minimal trauma inside the kidney and, to our knowledge, there are no reports
presenting the rupture of a sheath causing severe bleeding during the procedure. 
CASE REPORT: We present an adult patient who had severe bleeding during
percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal
sheath. During retrieval, due probably to rough handling of the equipment, a
piece of stone with serrated edges ruptured the tip of the sheath, and this tip
caused damage inside the kidney. The operation was terminated and measures were
taken to control bleeding. The patient was transfused with a total of 1600 ml of 
blood, and the stones were cleared in a second look operation. CONCLUSION:
Although considered to be a minimally invasive procedure, some unexpected
complications may arise during percutaneous nephrolithotomy. After being
fragmanted, stone pieces may damage surgical equipment, causing acute and severe 
harm to the kidney. Surgeons must manipulate the equipment with fine and careful 
movements in order to prevent this situation.

Publication Types: 
    Case Reports

PMID: 12236904 [PubMed - indexed for MEDLINE]

1181: BJU Int. 2002 Oct;90(6):513-7.

Levels of urinary inter-alpha-trypsin inhibitor trimer as a function of age and
sex-hormone status in males and females not forming stones.

Ricchiuti V, Hartke DM, Yang LZ, Goldman HB, Elder JS, Resnick MI, Marengo SR.

James and Eilleen Dicke Research Laboratory, Department of Urology, Care Western 
Reserve University, School of Medicine and the University Hospitals of Cleveland,
Cleveland, OH 44106-4931, USA.

OBJECTIVES: To determine if levels of inter-alpha-trypsin inhibitor (I alpha
TI)-trimer differ in normal individuals based on age, gender or hormonal status, 
as the regulation of calcium oxalate (CaOx) crystallization inhibitors, e.g. by
sex steroids, could be a mechanism contributing to the differences in CaOx
urolithiasis between the sexes. SUBJECTS AND METHODS: Voided urine samples were
collected from normal males and females. In Experiment 1 samples were grouped by 
gender and age, i.e. paediatric (PED) < or = 10 years, male (M) 21, female (F)
14; young adult (YGAD) 20-30 years, M 23, F 18; adults (AD), 35-50 year, M 25, F 
13; adults aged > or = 60 years (> 60), M 24, F 16 (totals, M 93, F 61). In
Experiment 2 samples were grouped by gender, age and hormonal status, i.e. PED, M
24, F 17; AD, M 24, F 22; > 60 and not on hormonal therapy, M 23, F 30; M > 60
and on androgen deprivation therapy (ANDEP) 18; and F > 60 on oestrogen
supplementation, F+EST, 18 (total M 89, F 85). Levels of urinary I alpha
TI-trimer were determined by immunoblotting and enhanced chemiluminescence, and
relative densities of the bands determined. RESULTS: In both experiments the
relative levels of I alpha TI-trimer were 2-7 times higher in M-PED than in all
other groups of males (P < or = 0.007). Among adult males, I alpha TI-trimer
levels were similar in all groups, including ANDEP (P > or = 0.9). There were no 
differences in the relative levels of I alpha TI-trimer among any of the groups
of females, regardless of age or hormonal status (P > or = 0.7). CONCLUSIONS: In 
males a decrease in I alpha TI-trimer was associated with the onset of adulthood 
and entry into the 'stone-forming years'. Females did not show this decrease, and
neither sex showed an increase in I alpha TI-trimer in the > 60 group, when the
incidence of CaOx urolithiasis is supposedly declining. While changes in urinary 
I alpha TI-trimer levels in males may reflect maturational changes in the kidney,
overall these data do not support the hypothesis that the age-related changes in 
the incidence of urolithiasis are paralleled by changes in the expression I alpha
TI-trimer. Additionally, the sex steroids do not appear to acutely regulate the
expression of I alpha TI-trimer in adults, making differences in I alpha
TI-trimer levels unlikely to be the reason for the disparity in the incidence of 
CaOx urolithiasis between the sexes.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12230607 [PubMed - indexed for MEDLINE]

1182: J Endourol. 2002 Aug;16(6):383-6.

Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly
obese or kyphotic patient.

Gofrit ON, Shapiro A, Donchin Y, Bloom AI, Shenfeld OZ, Landau EH, Pode D.

Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem,
Israel. ong1000@netvision.net.il

BACKGROUND AND PURPOSE: Morbidly obese or debilitated patients do not tolerate
the prone position used for percutaneous nephrolithotripsy (PCNL) well and may
suffer from severe cardiorespiratory compromise in this position. The purpose of 
this study is to demonstrate a simple way to overcome this difficulty. PATIENTS
AND METHODS: Two morbidly obese patients, ages 48 and 32 years, with Body Mass
Indices of 47.5 and 43.2 and a 68-year old patient severely debilitated by
multiple cerebral infarctions, ischemic heart disease, and kyphosis suffered from
relatively high renal stone burdens. For PCNL, the patients were placed in the
lateral decubitus position. To obtain an anteroposterior projection in this
position, the C-arm fluoroscopy unit was tilted to one side and the operating
table to the other. Tract dilation, stone fragmentation, and fragment extraction 
were performed with the patient in this position. RESULTS: An attempt to perform 
PCNL in the prone position in the first patient was aborted because of severe
hypoxemia and hypercarbia. In the lateral decubitus position, the procedures were
easily performed in all patients without any complications. It was noted that by 
rotating the C-arm to a perpendicular position, it was possible to perform
nephroscopy and use fluoroscopy simultaneously. CONCLUSION: We highly recommend
using the lateral position for PCNL in morbidly obese patients and in patients
suffering from kyphosis. This position is safe and convenient.

Publication Types: 
    Case Reports

PMID: 12227914 [PubMed - indexed for MEDLINE]

1183: Methods Find Exp Clin Pharmacol. 2002 Jul-Aug;24(6):357-9.

Studies on the antilithic effect of Rotula aquatica lour in male Wistar rats.

Christina AJ, Priya Mole M, Moorthy P.

Department of Pharmacology, K.M. College of Pharmacology, Tamil Nadu, India.
tinatina38@rediffmail.com

The decoction of Rotula aquatica lour was screened for antilithic activity in
male Wistar rats and the results were summarized based on the ionic changes in
both urine and serum. Nephrolithiasis was induced in rats by feeding them 3%
glycolic acid mixed feed for 45 days, which resulted in high urinary calcium,
oxalate and high serum potassium. Simultaneous treatment with the decoction
reduced calcium and oxalate ion concentration in urine, confirming the stone
inhibitory effect. Histopathological studies of kidney tissue samples further
substantiated the findings. The decoction was found to be nontoxic over the
45-day treatment period.

Publication Types: 
    Comparative Study

PMID: 12224442 [PubMed - indexed for MEDLINE]

1184: J Emerg Med. 2002 Jul;23(1):19-21.

Pyelocalyceal diverticulum: an unusual cause of acute renal colic.

Wogan JM.

Emergency Department, Greater Baltimore Medical Center, Towson, Maryland 21204,
USA.

The differential diagnosis of acute flank pain includes kidney stones, urinary
tract infection, dissecting abdominal aortic aneurysm (AAA), arterial or venous
compromise of the kidney, renal abscess, renal carcinoma, and papillary necrosis.
This is a report of an unusual cause of renal colic: pyelocalyceal diverticulum. 
Stasis of urine within a diverticulum promotes both calculus formation and
urinary tract infection, either of which can lead to colic. Several radiographic 
findings may suggest a calyceal diverticulum, including, on plain X-ray, a very
peripheral or mobile renal calculus, or on intravenous pyelogram, an early
filling-defect and delayed or retained filing of a circular or ovoid mass.

Publication Types: 
    Case Reports

PMID: 12217467 [PubMed - indexed for MEDLINE]

1185: J Urol. 2002 Sep;168(3):1173-81.

Expression of osteopontin in rat kidneys: induction during ethylene glycol
induced calcium oxalate nephrolithiasis.

Khan SR, Johnson JM, Peck AB, Cornelius JG, Glenton PA.

Department of Pathology, College of Medicine, University of Florida, Gainesville,
Florida, USA.

PURPOSE: Osteopontin is a well-known component of stone matrix and a strong
inhibitor of the nucleation, growth and aggregation of calcium oxalate crystals
in vitro. To understand its involvement in vivo in calcium oxalate
nephrolithiasis we investigated the renal expression and urinary excretion of
osteopontin in normal rats, and rats with hyperoxaluria and calcium oxalate
crystal deposits in the kidneys. MATERIALS AND METHODS: Calcium oxalate
nephrolithiasis was induced by administering ethylene glycol.
Immunohistochemistry and in situ hybridization were done to localize osteopontin 
and osteopontin messenger RNA in the kidneys, while sensitive reverse
transcriptase quantitative competitive template polymerase chain reaction was
performed to detect and quantify osteopontin messenger RNA expression. Urinary
excretion was determined by sodium dodecyl sulfate-polyacrylamide gel
electrophoresis and Western blot analysis, and then quantified by densitometry of
the Western blots. RESULTS: Osteopontin expression in the kidneys was
significantly increased after hyperoxaluria and it increased further after the
deposition of calcium oxalate crystals in the kidneys. Urinary excretion of
osteopontin increased concomitantly. The results reveal differences in renal
responses after exposure to oxalate and calcium oxalate crystals. In normal
kidneys osteopontin expression was limited to a small number of cells of the thin
limbs of the loop of Henle and papillary surface epithelium. During hyperoxaluria
osteopontin expression in the kidneys was increased but still mostly limited to
cells of the thin limb and papillary surface epithelium. However, after calcium
oxalate crystal deposition osteopontin expression was observed throughout the
kidneys, including segments of the proximal tubules. CONCLUSIONS: In response to 
exposure to oxalate and calcium oxalate crystals renal epithelial cells increase 
the production of osteopontin, which may have a significant role in calcium
oxalate nephrolithiasis.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12187263 [PubMed - indexed for MEDLINE]

1186: J Urol. 2002 Sep;168(3):931-6.

Comment in:
    J Urol. 2003 May;169(5):1798.

Effects of 5 different diets on urinary risk factors for calcium oxalate kidney
stone formation: evidence of different renal handling mechanisms in different
race groups.

Rodgers AL, Lewandowski S.

Department of Chemistry, University of Cape Town, South Africa.

PURPOSE: Since the incidence of renal calculi in the South African black
population is extremely rare while in white subjects it occurs at the same rate
as elsewhere in the western world, we investigated the possibility that different
renal handling mechanisms in response to different dietary challenges might occur
in the 2 race groups. MATERIALS AND METHODS: We administered 5 different dietary 
protocols, including low calcium, high oxalate, vitamin C, high salt and
lacto-vegetarian, to 10 healthy male subjects from each race group. We collected 
24-hour urine at baseline and after 4 days on the prescribed diet which were
analyzed for biochemical and physicochemical risk factors. Dietary intake was
controlled throughout the experimental period. A 24-hour dietary recall
questionnaire was recorded at baseline and analyzed using food composition
tables. Statistical analysis of variance was performed on all the data. RESULTS: 
The low calcium diet caused statistically significant changes only in black
subjects, which consisted of urinary oxalate increase (0.17 to 0.23 mmol./24
hours, p = 0.01), relative supersaturation of calcium oxalate decrease (1.88 to
0.97, p = 0.03) and relative supersaturation of brushite increase (0.85 to 1.69, 
p = 0.03). The high oxalate diet caused statistically significant changes in both
race groups but these changes were different in the 2 groups. In white subjects
urinary pH increased (6.24 to 6.62, p = 0.01), potassium excretion increased
(40.01 to 73.49, p = 0.01) and relative supersaturation of brushite increased
(1.34 to 2.12, p = 0.05). In black subjects urinary citrate increased (1.94 to
2.99 mmol./24 hours, p = 0.01). Clinically unimportant changes occurred in both
race groups after the other 3 diets. CONCLUSIONS: Renal handling of dietary
calcium and oxalate in South African black and white subjects is different and
may explain the different stone incidence in the 2 race groups.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12187193 [PubMed - indexed for MEDLINE]

1187: J Endourol. 2002 Jun;16(5):273-80.

Pressure-release versus rigid reflector for extracorporeal shockwave lithotripsy.

Loske AM, Prieto FE.

Centro de Física Applicada y Technología Avanzada, UNAM, Querétaro, Mexico.
loske@fisica.unam.mx

PURPOSE: To evaluate the advantages and disadvantages of using a pressure-release
reflector instead of a rigid reflector to concentrate shockwaves for
extracorporeal shockwave lithotripsy (SWL). MATERIALS AND METHODS: As in all
electrohydraulic lithotripters, shockwaves were generated by electrical breakdown
of water between two electrodes, located at the focus (F1) closest to a
paraellipsoidal reflector. A pressure-release reflector, made out of polyurethane
foam, was constructed and tested on a research lithotripter using kidney stone
models. Fragmentation data and pressure measurements were compared with those of 
a conventional rigid reflector tested on the same device. RESULTS: The weight of 
stone model fragments remaining after shockwave exposure was less with the
pressure-release reflector after screening through a 3.0 x 3.0-mm mesh. The
residual fragment weight was less with the rigid reflector using 1.0 x 1.0- and
0.6 x 0.6-mm meshes. CONCLUSION: Pressure-release reflectors may maintain
acceptable stone fragmentation while offering improved patient safety and should 
be considered for SWL.

Publication Types: 
    Evaluation Studies
    Research Support, Non-U.S. Gov't

PMID: 12184076 [PubMed - indexed for MEDLINE]

1188: Eur Urol. 2002 Mar;41(3):312-6; discussion 316-7.

Comment in:
    J Urol. 2003 Aug;170(2 Pt 1):686-7.

Flexible ureterorenoscopy for the treatment of lower pole calyx stones: influence
of different lithotripsy probes and stone extraction tools on scope deflection
and irrigation flow.

Michel MS, Knoll T, Ptaschnyk T, Köhrmann KU, Alken P.

Department of Urology, University Hospital Mannheim, 68135 Mannheim, Germany.
maurice-stephan.michel@uro.ma.uni-heidelberg.de

The 7.5 and 9.0 F flexible ureterorenoscopes are used widely in endourology.
These scopes, along with new available tools and probes, enable intrarenal
ureteroscopic access to renal stones in the lower pole. Following individual
clinical experiences the infundibulopelvic angle has to be respected for the
selection of different scopes, tools and probes. The aim of this study was to
determine the influence of different scopes, tools and probes on the angle of the
active and passive flexion of the flexible ureterorenoscope. The angles of the
active and passive flexion and maximum irrigation flow of different flexible
ureterorenoscope (9.0 F Wolf, 7.5 F Olympus, 7.5 F Storz) were measured
repeatedly in vitro using nine different inserted tools and/or probes. In
addition, the maximum allowing for easy passage of the nine different
tools/probes through the channel of the scope were measured. The Olympus scope
without working instrument present, allows for the greatest deflection. The
flexible Lithoclast, the non-nitinol baskets, and the 365 microns laser probes
significantly inhibit the deflection of all scopes. The greatest deflection with 
inserted working tool was possible using the Wolf and Storz scopes. Both nitinol 
tools as well as the 200 microns laser probe had only minimal influence on the
deflection. The 200 microns laser probe reduces the irrigation flow from 50 to 28
ml/min. In contrast, the baskets reduce the irrigation flow from 50 to 2 ml/min. 
There are significant differences of the active and passive flexion depending on 
the ureterorenoscopes itself and the different tools. In order to perform a
successful flexible ureterorenoscopic stone treatment in the lower pole, the
inhibition of the flexion of the different scopes together with the individual
infundibulopelvic angle must be respected when selecting different tools and
probes.

Publication Types: 
    Comparative Study

PMID: 12180234 [PubMed - indexed for MEDLINE]

1189: Biochem Biophys Res Commun. 2002 Aug 23;296(3):544-52.

Global analysis of differentially expressed genes during progression of calcium
oxalate nephrolithiasis.

Katsuma S, Shiojima S, Hirasawa A, Takagaki K, Kaminishi Y, Koba M, Hagidai Y,
Murai M, Ohgi T, Yano J, Tsujimoto G.

Department of Molecular, Cell Pharmacology, National Center for Child Health and 
Development Research Institute, 3-35-31 Taishido, Setagaya-Ku, Tokyo 154-8567,
Japan.

The process of nephrolithiasis development is poorly understood at the molecular 
level. Here, we constructed a cDNA microarray from a rat kidney normalized cDNA
library, and investigated the pattern of gene expression in rat kidneys from a
calcium oxalate (CaOx) nephrolithiasis model. One hundred and seventy-three genes
were found to be at least 2-fold regulated at one or more time points during
progression of nephrolithiasis. RT-PCR and immunohistochemical analyses confirmed
differential expression at both transcriptional and translational levels of genes
identified by cDNA microarray screening. The differentially regulated genes were 
grouped into six clusters based on their expression profiles; the magnitude and
the temporal patterns of gene expression identified known and novel molecular
components involved in inflammation and matrix expansion in the CaOx
nephrolithiasis kidney. This microarray study is the first report on gene
expression programs underlying the process of nephrolithiasis.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12176015 [PubMed - indexed for MEDLINE]

1190: Int J Urol. 2002 Jul;9(7):363-7; discussion 367.

Significance and diagnostic accuracy of renal calculi found by ultrasonography in
patients with asymptomatic microscopic hematuria.

Marumo K, Horiguchi Y, Nakagawa K, Oya M, Ohigashi T, Asakura H, Nakashima J,
Murai M.

Department of Urology, School of Medicine, Keio University, Tokyo, Japan.
kmarumo@sc.itc.keio.ac.jp

BACKGROUND: The purpose of the present study was to evaluate the clinical
significance and the accuracy of the diagnosis of renal calculi incidentally
found by ultrasonography (US). METHODS: A total of 906 subjects (639 men and 267 
women) aged 18-78 years were referred for asymptomatic microscopic hematuria. Of 
these, 743 patients who underwent US were studied. RESULTS: Hyperechogenic spots 
in the central echo complex suggesting renal calculi were noted in 195 patients
(21.5%). The occurrence of hyperechogenic spots was higher in patients with 20 or
more urinary red blood cells per high-power field (chi(2) = 4.896, P = 0.0269)
and in men than in women (chi(2) = 7.101, P = 0.0077), but it was lowest in
patients who were 29 years old or younger. Of these 195 patients, who were
followed up for 1-161 months (average: 33.5 months), 24 patients (12.3%) needed
urological management. Extracorporeal shockwave lithotripsy was carried out in
eight patients, transureteral lithotripsy was carried out in three patients,
spontaneous passage occurred in 11 patients and medication for hyperuricemia was 
initiated in two patients (1%). Among the patients in whom hyperechogenic spots
were found on the kidney by US but calculi were not visible on abdominal plain
radiographs, 39 patients underwent computed tomography. Of them, 31 patients were
confirmed to have renal calculi. CONCLUSION: The obtained results suggest that US
is an effective and reliable means of detecting renal calculi in patients with
asymptomatic microscopic hematuria, and in facilitating prompt urological
intervention or predicting the natural course of renal calculi.

PMID: 12165017 [PubMed - indexed for MEDLINE]

1191: Kidney Int. 2002 Sep;62(3):971-9.

Pathophysiologic basis for normouricosuric uric acid nephrolithiasis.

Sakhaee K, Adams-Huet B, Moe OW, Pak CY.

Center of Mineral Metabolism and Clinical Research, Department of Internal
Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines
Boulevard, Dallas, TX 75390-8891, USA.

BACKGROUND: Low urinary pH is the commonest and by far the most important factor 
in uric acid nephrolithiasis but the reason(s) for this defect is (are) unknown. 
Patients with uric acid nephrolithaisis have normal acid-base parameters
according conventional clinical tests. METHODS: We studied steady-state plasma
and urinary parameters of acid-base balance in subjects with normouricosuric pure
uric acid stones. We also tested the ability of these subjects to excrete
ammonium in response to an acute acid load. We compared these parameters in
patients with pure uric acid stones to patients with mixed uric acid/calcium
oxalate stones, pure calcium stones, and normal volunteers. RESULTS: Pure uric
acid stone formers have a much higher incidence of either diabetes or glucose
intolerance. After equilibration to a control diet, patients with uric acid
stones have lower urinary pH and they excrete less of their acid as ammonium.
This is compensated by higher titratable acidity and hypocitraturia. Despite
their low baseline urinary pH, uric acid stone formers further acidify their
urine after an acid load because of a severely impaired ammonia excretory
response. Their characteristics are significantly different from normal
volunteers and pure calcium stone formers. Patients with mixed uric acid/calcium 
stones exhibit intermediate characteristics. CONCLUSION: We propose that certain 
patients with normouricosuric uric acid nephrolithiasis have a renal
acidification disease. The primary defect lies in renal ammonium excretion, which
may be linked to the insulin-resistant state. Although net acid excretion is
maintained at the expense of increased titratable acidity and to some degree
hypocitraturia, the compromise is acid urine pH and may result in uric acid
nephrolithiasis.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

PMID: 12164880 [PubMed - indexed for MEDLINE]

1192: Am J Clin Pathol. 2002 Aug;118(2):179-83.

Integration of text, image, and graphic data from different sources in laboratory
reports: example of kidney stone reporting system.

Lin SC, Van Lente F, Fadlalla A, Henricks WH.

Division of Pathology and Laboratory Medicine, Cleveland Clinic Foundation, OH
44195, USA.

Laboratory analyses may generate multiple data types that may reside in disparate
systems, and combining data into a report often requires laborious, error-prone
methods. Kidney stone analysis, which includes biochemical composition analysis
and gross feature documentation, is an example of such a situation. We developed 
the kidney stone reporting system (KISS) that integrates patient and specimen
information from the laboratory information system, digital images of stones, and
analytic instrument data into a concise report for the ordering clinicians. The
database management environment facilitates archival and retrieval capabilities. 
Implementation of the system has reduced the number of manual steps necessary to 
produce a report and has saved approximately 30 technologist hours per week.
Transcription errors have been virtually eliminated. The KISS represents an
innovative use of standard tools to integrate text, image, and graphic data from 
disparate systems into an integrated laboratory report, without the need for
expensive interfaces.

PMID: 12162675 [PubMed - indexed for MEDLINE]

1193: Arch Ital Urol Androl. 2002 Jun;74(2):61-4.

Urinary patterns of patients with renal stones associated with chronic
inflammatory bowel disease.

Trinchieri A, Lizzano R, Castelnuovo C, Zanetti G, Pisani E.

Institute of Urology, IRCCS Ospedale Maggiore, Milano, Italy.
uropoli@mailserver.unimit.it

OBJECTIVE: The aim of this study was to analyze the frequency of renal stone
patients with chronic inflammatory bowel disease and their urinary patterns.
METHODS: During a 20-year period, 1941 consecutive patients with renal stone
disease underwent routine laboratory procedures including a fasting blood sample 
for chemistry profile and a 24-hour urine collection for analyses of
electrolytes. Thorough histories including chronic inflammatory disease or ileal 
resection were obtained. Patients with inflammatory bowel disease together with a
control group comprising 47 idiopathic renal calcium stone formers were submitted
to a xylose absorption test for evaluation of intestinal absorption. RESULTS: We 
observed 10 patients with Crohn's disease, 12 with ulcerative colitis and one
patient with ileal bypass for obesity. Six patients underwent ileal resection and
10 patients total colectomy. Urinary oxalate excretion was significantly higher
and urinary citrate lower in stone patients with ileal disease (Ox 60 +/- 23, Cit
113 + 7-118 mg/day) than in idiopathic stone formers (Ox 28.2 +/- 11.5, Cit 381
+/- 205) and stone patients with ulcerative colitis (Ox 20.3 +/- 14.8, Cit 369
+/- 247). Urinary volume was significantly lower in patients with ulcerative
colitis. A significant inverse correlation (-0.38, p < 0.01) between oxalate
urinary excretion and blood xylose level was found 2 hours after ingestion of
xylose. No significant reduction of xylose absorption was demonstrated in both
normoxaluric and hyperoxaluric idiopathic stone patients. CONCLUSIONS: Crohn's
disease and ulcerative colitis are characterized by recurrent inflammatory
involvement of different intestinal segments involving distinctive urinary
patterns. Malabosorption associated with ileal disease causes increased oxalate
absorption by increasing oxalate solubility in the intestinal lumen and
permeability of the colonic mucosa; a reduced citrate excretion is associated in 
relation to mild acidosis due to the loss of bicarbonate in the liquid stool. In 
ulcerative colitis, especially if an ileostomy is present, urine are scanty and
concentrated, and urine pH falls, leading to uric acid or mixed stones. Mild
hyperoxaluria of idiopathic renal stone formers is not related to subtle
intestinal malabsorption.

Publication Types: 
    Comparative Study

PMID: 12161938 [PubMed - indexed for MEDLINE]

1194: Am J Kidney Dis. 2002 Aug;40(2):265-74.

Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming
propensity, and calcium metabolism.

Reddy ST, Wang CY, Sakhaee K, Brinkley L, Pak CY.

Department of Internal Medicine, Section of General Internal Medicine, The
University of Chicago, IL 60637, USA. sreddy@medicine.bsd.uchicago.edu

BACKGROUND: Low-carbohydrate high-protein (LCHP) diets are used commonly for
weight reduction. This study explores the relationship between such diets and
acid-base balance, kidney-stone risk, and calcium and bone metabolism. METHODS:
Ten healthy subjects participated in a metabolic study. Subjects initially
consumed their usual non-weight-reducing diet, then a severely
carbohydrate-restricted induction diet for 2 weeks, followed by a moderately
carbohydrate-restricted maintenance diet for 4 weeks. Results: Urine pH decreased
from 6.09 (Usual) to 5.56 (Induction; P < 0.01) to 5.67 (Maintenance;P < 0.05).
Net acid excretion increased by 56 mEq/d (Induction; P < 0.001) and 51 mEq/d
(Maintenance; P < 0.001) from a baseline of 61 mEq/d. Urinary citrate levels
decreased from 763 mg/d (3.98 mmol/d) to 449 mg/d (2.34 mmol/d; P < 0.01) to 581 
mg/d (3.03 mmol/d; P < 0.05). Urinary saturation of undissociated uric acid
increased more than twofold. Urinary calcium levels increased from 160 mg/d (3.99
mmol/d) to 258 mg/d (6.44 mmol/d; P < 0.001) to 248 mg/d (6.19 mmol/d; P < 0.01).
This increase in urinary calcium levels was not compensated by a commensurate
increase in fractional intestinal calcium absorption. Therefore, estimated
calcium balance decreased by 130 mg/d (3.24 mmol/d; P < 0.001) and 90 mg/d (2.25 
mmol/d; P < 0.05). Urinary deoxypyridinoline and N-telopeptide levels trended
upward, whereas serum osteocalcin concentrations decreased significantly (P <
0.01). CONCLUSION: Consumption of an LCHP diet for 6 weeks delivers a marked acid
load to the kidney, increases the risk for stone formation, decreases estimated
calcium balance, and may increase the risk for bone loss. Copyright 2002 by the
National Kidney Foundation, Inc.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 12148098 [PubMed - indexed for MEDLINE]

1195: Nutr Rev. 2002 Jul;60(7 Pt 1):212-4.

Stop dietary calcium restriction in kidney stone-forming patients.

Martini LA, Heilberg IP.

Nutrition Department, Faculdade de Saúde Pública, Universidade de Săo Paulo,
Brazil.

Epidemiologic studies have demonstrated an increased incidence of kidney stones
in individuals with low calcium intake. More recently, a 5-year clinical study
found the recurrence of kidney stones was higher in stone-formers on a low
dietary calcium treatment. Considering these important new findings, and the
known adverse effect on bone mass, dietary calcium restriction should be avoided 
in kidney stone-forming individuals.

Publication Types: 
    Review

PMID: 12144200 [PubMed - indexed for MEDLINE]

1196: J Pediatr Hematol Oncol. 2002 Jun-Jul;24(5):389-93.

Severe intrarenal fibrosis, infundibular stenosis, renal cysts, and persistent
perilobar nephrogenic rests in a patient with Beckwith-Wiedemann syndrome 27
years after diffuse nephroblastomatosis and Wilms tumor: natural progression or a
consequence of treatment?

Kulkarni R, Wolf JS Jr, Padiyar N, Zuckerman L, Gera R, Scott-Emuakpor AB.

Michigan State University, East Lansing, Michigan, USA. Kulkarni@ht.msu.edu

A27-year-old woman presented with back and abdominal pain. She was diagnosed in
infancy with Beckwith-Wiedemann syndrome and bilateral multifocal perilobar
nephrogenic rests that progressed to diffuse nephroblastomatosis with neoplastic 
nephroblastomatous rests at 14 months of age and subsequently to a right Wilms
tumor at 5 years of age. Computed tomography of the abdomen during the current
admission showed multiple obstructed calices. Ureteroscopic inspection of the
left kidney revealed severe intrarenal scarring with multiple infundibular
stenosis, hydrocalices, and nephrocalcinosis. Renal biopsy showed sclerotic
glomeruli with calcification and scarring and persistent subcapsular nodular
renal blastema. Electrocautery incision and balloon dilatation provided temporary
pain relief. After discharge, the patient has had two or three episodes of
recurrent pain associated with new areas of infundibular stenoses and renal
cysts. Bilateral nephrectomy and renal transplantation is being considered for
management of progressive disease and relief of intractable pain. The potential
causes of progressive and severe intrarenal fibrosis, infundibular stenosis and
nephrocalcinosis, and renal cysts in this patient may include abnormal renal
development secondary to Beckwith-Wiedemann syndrome itself, radiation or
chemotherapy damage, or a combination.

Publication Types: 
    Case Reports

PMID: 12142789 [PubMed - indexed for MEDLINE]

1197: Nephron. 2002 Aug;91(4):742-3.

Acute renal failure due to a calculus obstructing a transplanted kidney.

Fabbian F, Catalano C, Rizzioli E, Normanno M, Conz PA.

Renal Unit, Monselice Hospital, Monselice, Padua, Italy. hrfabbia@tin.it

Nephrolithiasis is a rare finding in kidney transplantation and anuria could be
the only clinical sign. We report the case of a 52-year-old Caucasian male renal 
transplant recipient admitted due to acute renal failure (ARF) and anuria. He
reported no symptoms and a palpable bulge in the right iliac fossa corresponding 
to the graft was present. Ultrasonography showed hydronephrosis of the graft. A
double-J ureteral stent was inserted with resolution of ARF. ARF with anuria and 
the presence of a palpable non-tender, elastic mass over the graft could be the
clinical picture of obstructive ARF in a transplanted kidney. Copyright 2002 S.
Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 12138281 [PubMed - indexed for MEDLINE]

1198: Urology. 2002 Aug;60(2):228-32.

Recurrent kidney stone: a 25-year follow-up study in persons with spinal cord
injury.

Chen Y, DeVivo MJ, Stover SL, Lloyd LK.

Department of Physical Medicine and Rehabilitation, University of Alabama at
Birmingham, Birmingham, Alabama 35249-7330, USA.

OBJECTIVES: To document the recurrence rate of kidney stones in patients with
spinal cord injury and to assess the potential contributing factors and long-term
renal function outcome. METHODS: A consecutive sample of 77 patients with initial
kidney stones followed up on a yearly basis between 1973 and 1999 was used to
estimate stone recurrence, stratified by demographic and clinical
characteristics. Longitudinal data analyses were performed to assess the change
in renal function over time among various post-treatment outcomes. RESULTS:
During an average of 7 years (range 1 to 21) of follow-up after the initial stone
episode, 19 patients with recurrence, 15 with residual stones, and 43 who were
stone free were documented. It was estimated that approximately 34% of the
patients with an initial stone would develop a second stone episode within 5
years. This figure did not significantly change during the past 25 years (P =
0.18). Stone recurrence was two or more times greater for men than for women, for
whites than for blacks, and for tetraplegics than for paraplegics, but the
differences were not statistically significant (P >0.05). Renal function did not 
significantly decline over time for any of the post-treatment outcomes of the
initial stones. CONCLUSIONS: Despite marked improvement in urologic
rehabilitation, little progress has been made during the past 25 years in
reducing stone recurrence in persons with spinal cord injury. Future studies are 
required to determine the critical components of the causal pathway to stone
formation, which may lead to the establishment of effective prophylactic
interventions.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 12137815 [PubMed - indexed for MEDLINE]

1199: Coll Antropol. 2002 Jun;26(1):11-21.

Inbreeding and nephrolithiasis in Croatian island isolates.

Rudan I, Padovan M, Rudan D, Campbell H, Biloglav Z, Janićjević B,
Smolej-Narancić N, Rudan P.

School of Public Health A. Stampar, University Medical School, Zagreb, Croatia.
irudan@hotmail.com

The aim of this study was to investigate a recessive genetic component in
susceptibility to nephrolithiasis (NL) by comparing its prevalence in highly
inbred, moderately inbred and non-inbred villages of three Croatian islands:
Brac, Hvar and Korcula. The average inbreeding coefficient of each village
population (F) was estimated in a random sample of 20-30% adults from 14 villages
using Wright's path method (based on genealogical information), isonymy data and 
average deviation from Hardy-Weinberg expectations for MN, Ss and Kk serogenetic 
polymorphisms. The six villages with the greatest genealogical F value
(0.025-0.049; current total population N=1,401), the four with intermediate value
(0.012-0.015; N=998) and the four with the smallest value (0.002-0.008; N=1,500) 
were chosen for this study. Medical records of entire populations were reviewed
and the diagnosis of NL was established according to unified criteria, based on
the information from the specialists in general hospitals and on the agreement in
diagnosis between the investigators and local general practitioners. The variance
in environmental and socio-cultural factors between villages was shown to be
minimal. Prevalence of NL in each village was standardised by sex and age to the 
total population of all 14 villages. The standardized prevalence of NL was 1.5%
in the group of villages with low F, 2.3% in the group with moderate F (p<0.10), 
and 5.4% in the group with high F (p<0.001). The correlation factor between F
values by villages and the standardized prevalence of NL was 0.45 (p<0.05). The
study showed that a large number of predominantly recessive genetic factors might
mediate the susceptibility to formation of renal stones in humans.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12137291 [PubMed - indexed for MEDLINE]

1200: Am J Med. 2002 Aug 1;113(2):99-103.

Risk factors for nephrolithiasis in patients with familial idiopathic
hypercalciuria.

Lerolle N, Lantz B, Paillard F, Gattegno B, Flahault A, Ronco P, Houillier P,
Rondeau E.

Service de Néphrologie A, Hôpital Tenon, Paris, France.

PURPOSE: About 40% of patients with nephrolithiasis have idiopathic
hypercalciuria, sometimes associated with a family history of kidney stones. In
these families, little is known about the frequency of, and risk factors for,
stone formation among hypercalciuric patients. We therefore conducted a
prospective study of 216 subjects from 33 families with idiopathic
hypercalciuria. MATERIALS AND METHODS: We recorded the age, weight, and history
of calcium stones in all subjects, and measured 24-hour urine volume and
excretion of calcium, uric acid, sodium, magnesium, urea, citrate, phosphate, and
sulfate on a nonrestricted diet. We performed a more complete metabolic
evaluation in many of the hypercalciuric subjects (calciuria/weight >0.1
mmol/kg/d). Multivariate logistic regression analysis was performed to identify
independent risk factors for stone formation. RESULTS: The prevalence of
self-reported nephrolithiasis was 46% (61/132) in hypercalciuric subjects and 11%
(7/63) in normocalciuric subjects (P <0.0001). In multivariate analysis, age
(odds ratio [OR] per 10 years of age = 1.3; 95% confidence interval [CI]: 1.1 to 
1.6), urine calcium excretion (OR = 1.3 per mmol/d increase; 95% CI: 1.2 to 1.5),
and uric acid excretion (OR = 3.3 per mmol/d increase; 95% CI: 1.4 to 7.5) were
independent risk factors for nephrolithiasis. The risk of nephrolithiasis
increased progressively with greater levels of hypercalciuria. CONCLUSION: We
found a significant dose-effect association between calciuria and stone disease
in patients with familial hypercalciuria. Other factors associated with stone
formation included higher uric acid excretion, probably reflecting higher food
intake, and age, probably reflecting the length of exposure to hypercalciuria and
hyperuricosuria.

Publication Types: 
    Comparative Study

PMID: 12133747 [PubMed - indexed for MEDLINE]

1201: BJU Int. 2002 Aug;90(3):336-44.

An oxalate-binding protein with crystal growth promoter activity from human
kidney stone matrix.

Govindaraj A, Selvam R.

Department of Medical Biochemistry, Dr A.L.M. PG Institute of Basic Medical
Sciences, University of Madras, Taramani, Chennai, India.

OBJECTIVE: To fractionate renal-stone matrix proteins, identify the presence of
oxalate-binding protein and assess its effect in a calcium oxalate (CaOx) crystal
growth system. MATERIALS AND METHODS: Proteins were isolated from the matrix of
kidney stones containing CaOx as the major constituent, using EDTA as a
demineralizing agent. The solubilized proteins were subjected to cellulose-column
chromatography by eluting with increasing sodium chloride concentrations in
Tris-HCl buffer. Three protein fraction peaks were eluted, i.e. fraction I in
buffer, fraction II in 0.05 mol/L NaCl in buffer and fraction III in 0.3 mol/L
NaCl in buffer. The protein fractions were tested for their effects on CaOx
crystal growth. RESULTS: All three fractions had maximum CaOx binding activity at
pH 7.4 but fraction II also had activity at pH 4.5. Fraction I promoted in vitro 
CaOx crystal growth, while fractions II and III were inhibitory. When fraction I 
was further separated on a Sephadex G-200 column, two protein fractions (Ia and
Ib) were obtained. Fraction Ia protein had high and fraction Ib low CaOx-binding 
activity. Fraction Ia had a molecular weight of 48 kDa on gel electrophoresis and
Western blotting. The 48 kDa protein did not cross-react with crystal matrix
protein antibody, band-3 protein antibody, or albumin. The protein promoted CaOx 
crystal growth, with an optimum temperature of 37 degrees C and pH 6.5. The
inhibitory effect of citrate on crystal growth was significantly lower in the
presence of the 48 kDa protein. The protein promoted nucleation and aggregation
of CaOx crystals in the in vitro crystallization system at pH 6.5, whereas
fraction Ib (29 kDa) inhibited both nucleation and aggregation. Using the 48 kDa 
antibody, the yield of the protein from the stone matrix was 32% by EDTA
extraction and only 3% with other methods. The protein was also detected in the
nucleus and mitochondria, and in other matrix fractions of calcium phosphate and 
uric acid stones. CONCLUSION: The 48 kDa protein isolated from stone matrix is a 
potent promoter of CaOx crystal growth with high oxalate-binding activity; it is 
enriched in the nucleus and mitochondria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12133075 [PubMed - indexed for MEDLINE]

1202: Eur J Emerg Med. 2002 Jun;9(2):135-9.

Comparison of stone size and response to analgesic treatment in predicting
outcome of patients with renal colic.

Prina LD, Rancatore E, Secic M, Weber RE.

Department of Emergency Medicine, Cleveland Clinic Florida, Fort Lauderdale, USA.

The aim of this study was to compare the prognostic value of stone size and
response to analgesic treatment in patients with renal colic. We reviewed the
charts of patients treated for renal colic in our Emergency Department. The
eligibility criteria were a radiological examination demonstrating direct or
indirect signs of ureteral obstruction and/or a stone. The primary endpoint was
the requirement for surgical treatment. The parameters considered as prognostic
factors were pain relief with ketorolac (K) or ketorolac plus opiate treatment
(KO), and stone size (>or= or <6 mm). Ninety-five patients were considered for
analysis. Of these, 49 (52%) had a stone demonstrated radiologically. Four out of
27 patients (15%) in the KO group and six out of 68 patients (8.8%) in the K
group required a surgical procedure to relieve the obstruction (NS). Four out of 
five patients (80%) with a stone >or=6 mm required a surgical procedure, compared
with one out of 44 (2.2%) who had a stone smaller than 6 mm (P<0.001). In
conclusion, stone size is a better prognostic factor than the response to
analgesic treatment in predicting the clinical outcome of patients with renal
colic. A stone >or=6 mm in patients with renal colic should alert the emergency
physician that urological complications requiring surgical intervention may occur
and that urological management may be warranted.

Publication Types: 
    Comparative Study

PMID: 12131636 [PubMed - indexed for MEDLINE]

1203: J Urol. 2002 Aug;168(2):442-5.

Safety and efficacy of holmium: YAG laser lithotripsy in patients with bleeding
diatheses.

Watterson JD, Girvan AR, Cook AJ, Beiko DT, Nott L, Auge BK, Preminger GM,
Denstedt JD.

Division of Urology, University of Western Ontario, London, Ontario, Canada.

PURPOSE: We assessed the safety and efficacy of ureteroscopy and holmium:YAG
laser lithotripsy for treating upper urinary tract calculi in patients with known
and uncorrected bleeding diathesis. MATERIALS AND METHODS: We retrospectively
reviewed the charts at 2 tertiary stone centers to identify patients with known
bleeding diathesis who were treated with holmium:YAG laser lithotripsy for upper 
urinary tract calculi. A total of 25 patients (29 upper urinary tract calculi)
underwent ureteroscopic holmium laser lithotripsy. Bleeding diathesis involved
warfarin administration for various conditions in 17 patients, liver dysfunction 
in 3, thrombocytopenia in 4 and von Willebrand's disease in 1. The mean
international normalized ratio, platelet count and bleeding time were 2.3, 50 x
109/l. and greater than 16 minutes in patients on warfarin and in those with
liver dysfunction, thrombocytopenia and von Willebrand's disease, respectively.
RESULTS: Overall the stone-free rate was 96% (27 of 28 cases) and 29 of 30
procedures were completed successfully without significant complication. In a
patient treated concomitantly with electrohydraulic lithotripsy significant
retroperitoneal hemorrhage required blood transfusion. CONCLUSIONS: Upper tract
urinary calculi in patients with uncorrected bleeding diathesis can be safely
managed by contemporary small caliber ureteroscopes and the holmium laser as the 
only modality of lithotripsy. Ureteroscopic holmium laser lithotripsy without
preoperatively correcting hemostatic parameters limits the risk of thromboembolic
complications and costs associated with an extended hospital stay. Avoiding
electrohydraulic lithotripsy is crucial for decreasing bleeding complications in 
this cohort of patients.

PMID: 12131284 [PubMed - indexed for MEDLINE]

1204: J Urol. 2002 Aug;168(2):436-41.

Erbium: YAG laser lithotripsy mechanism.

Chan KF, Lee H, Teichman JM, Kamerer A, McGuff HS, Vargas G, Welch AJ.

Department of Electrical and Computer Engineering, Biomedical Engineering
Program, University of Texas at Austin, Austin, Texas, USA.

PURPOSE: We tested the hypothesis that the mechanism of long pulse erbium:YAG
laser lithotripsy is photothermal. MATERIALS AND METHODS: Human urinary calculi
were placed in deionized water and irradiated with erbium:YAG laser energy
delivered through a sapphire optical fiber. Erbium:YAG bubble dynamics were
visualized with Schlieren flash photography and correlated to acoustic emissions 
measured by a polyvinylidene fluoride needle hydrophone. The sapphire fiber was
placed either parallel or perpendicular to the calculus surface to assess the
contribution of acoustic transients to fragmentation. Stones were irradiated
using desiccated stone irradiated in air, hydrated stone irradiated in air and
hydrated stone irradiated in water. Ablation crater sizes were compared. Uric
acid stones were irradiated in water and the water was assayed for cyanide.
RESULTS: During the early phase of vapor bubble expansion, acoustic transients
had minimal effects on calculus fragmentation. Fragmentation occurred due to
direct absorption of laser energy transmitted to the calculus through the vapor
channel between the sapphire fiber tip and calculus. The forward axial expansion 
of the bubble occurred more rapidly than the radial expansion. A parallel
oriented fiber on the calculus surface produced no fragmentation but generated
larger amplitude acoustic transients compared to perpendicular orientation. In
perpendicular orientation the erbium:YAG laser did not generate any collapse
acoustic waves but fragmentation occurred. Crater width was greatest for
desiccated stones irradiated in air (p <0.03). Cyanide production increased as
erbium:YAG irradiation of uric acid calculi increased, (r2 = 0.98). CONCLUSIONS: 
The erbium:YAG laser fragments stones through a photothermal mechanism.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 12131283 [PubMed - indexed for MEDLINE]

1205: Ultrasound Med Biol. 2002 Jun;28(6):769-74.

Comment in:
    J Urol. 2003 Aug;170(2 Pt 1):688-9.

The first clinical results of "wide-focus and low-pressure" ESWL.

Eisenmenger W, Du XX, Tang C, Zhao S, Wang Y, Rong F, Dai D, Guan M, Qi A.

Physical Institute, University of Stuttgart, Stuttgart, Germany.
w.eisenmenger@physik.uni-stuttgart.

A clinical study of the concept "wide-focus and low-pressure" extracorporal
shock-wave lithotripsy (ESWL) was performed in a scientific cooperation between
the Physical Institute of the University of Stuttgart and the Xixin Medical
Instruments Co. Ltd. in Wuxian-Suzhou, China. In this cooperation, self-focusing 
electromagnetic shock-wave generator systems from the University of Stuttgart
were integrated into Xixin lithotripters and installed in seven hospitals in
China. A total of 297 detailed patient protocols revealed an average of 1532
shock pulses for successful treatment with no necessity for pain medication and
auxiliary measures, and a stone-free rate of 86% after a follow-up of 3 months.
These results are discussed in terms of the wide-focus low-pressure conditions
and the mechanism of binary fragmentation by squeezing.

PMID: 12113789 [PubMed - indexed for MEDLINE]

1206: Clin Chim Acta. 2002 Aug;322(1-2):29-36.

Simple classification of renal calculi closely related to their micromorphology
and etiology.

Grases F, Costa-Bauzá A, Ramis M, Montesinos V, Conte A.

Laboratory of Renal Lithiasis Research, Faculty of Sciences, University of
Balearic Islands, Ctra. Valldemossa Km. 7.5, 07071-Palma de Mallorca, Spain.
dqufgf0@ps.ubi.es

BACKGROUND: Classification of renal calculi with clear correlation with the main 
urinary etiological conditions has been previously established. However, such
information is complex and difficult to adapt to clinical routine practice.
METHODS: A simple classification of renal calculi based on their structure and
composition is proposed and applied to 2500 renal calculi to achieve the
percentage of each category. The urines of 700 individuals chosen randomly have
been analyzed and the results compared with those obtained with 51 healthy
subjects. RESULTS: 12.9% calculi corresponded to calcium oxalate monohydrate
papillary calculi, 16.4% to calcium oxalate monohydrate unattached calculi, 33.8%
to calcium oxalate dihydrate calculi, 11.2% calcium oxalate
dihydrate/hydroxyapatite mixed calculi, 7.1% hydroxyapatite calculi, 4.1%
struvite calculi, 0.6% brushite calculi, 8.2% uric acid calculi, 2.6% calcium
oxalate/uric acid mixed calculi, 1.1% cystine calculi and 1.9% various infrequent
calculi. Based on the corresponding urinary analytical studies, each kind of
calculus is related with the more frequently associated urinary alterations.
CONCLUSIONS: An important aspect of this classification is the possibility to
establish, by means of the correct study of the calculus, some of the main
possible etiologic factors closely related to its formation. Copyright 2002
Elsevier Science B.V.

PMID: 12104078 [PubMed - indexed for MEDLINE]

1207: Urology. 2002 Jul;60(1):164.

Urinary calculus containing gas.

Paterson RF, Welsch JM, Koerner T, Lingeman JE.

Department of Urology, Indiana University School of Medicine, Indianapolis,
Indiana 46202, USA.

The combination of gas in the upper urinary tract along with renal calculi has
been reported in the setting of emphysematous renal infections, urinary tract
instrumentation, and urinary-gastrointestinal fistulas. We present a case of a
46-year-old nondiabetic man with the isolated finding of a gas-containing renal
calculus. The significant history in this case included recurrent urinary tract
infections and primary hyperparathyroidism with persistent hypercalcemia despite 
previous parathyroid explorations. The patient was treated with oral antibiotics 
and rendered stone and infection free by percutaneous nephrolithotomy. The stone 
culture was negative, and the stone analysis revealed 100% hydroxyapatite.

Publication Types: 
    Case Reports

PMID: 12100949 [PubMed - indexed for MEDLINE]

1208: World J Surg. 2002 May;26(5):532-5. Epub 2002 Feb 19.

Primary hyperparathyroidism: renal calcium excretion in patients with and without
renal stone sisease before and after parathyroidectomy.

Frøkjaer VG, Mollerup CL.

Department of Endocrine and Breast Surgery, Copenhagen University Hospital,
Rigshospitalet 3104, Blegdamsvej 9, DK 2100 Copenhagen, Denmark. vibe@mac.com

The effect of parathyroidectomy on renal calcium excretion per 24 hours in
patients with primary hyperparathyroidism with and without a history of renal
stone disease was evaluated. Altogether, 91 patients operated on for primary
hyperparathyroidism formed the study group for preoperative analysis. Of these
patients, 42 were evaluated 1 to 3 years postoperatively. The median preoperative
serum calcium level was 2.92 mmol/L, and it was the same for patients with or
without renal stones. Preoperatively we found no differences in renal calcium
excretion between patients with and without renal stone disease. The median renal
calcium excretion was 6.80 mmol/24 hr. At 1 to 3 years after successful
parathyroidectomy the group with renal stone disease had higher renal calcium
excretion than the group without renal stones (p = 0.03). The reduced effect of
parathyroidectomy on renal calcium excretion in the patients with renal stone
disease indicates that factors not related to the hyperparathyroid state could
contribute to disturbances in renal calcium excretion and hence stone formation. 
In conclusion, the pathologic basis for renal stone formation in patients with
primary hyperparathyroidism might not be the hyperparathyroid state alone; stone 
formation could be related to other predisposing factors as well. Therefore,
although parathyroidectomy can cure hyperparathyroidism, the curative effect on
renal stone disease should be reconsidered.

PMID: 12098039 [PubMed - indexed for MEDLINE]

1209: Am J Nephrol. 2002 Jul;22(2-3):254-9.

Nephrolithiasis at the turn of the 18th to 19th centuries: biochemical
disturbances. A genuine cascade giving rise to clinical chemistry.

Richet G.

Académie Nationale de Médecine, 76 rue d'Assas, F-75006 Paris, France.

This report will discuss the relationship between urinary calculi, urine
composition and urinary sediment and the link to chemistry unveiled during the
years 1775-1840. It was by this interconnection that physicians, who were also
chemists, introduced some basic sciences into medicine particularly in studying
normal and diseased metabolism. The chemistry of urinary stones definitely
influenced the progress of medicine in the post-Enlightment period. "We would
probably still not have chemistry, botany, or anatomy had not physicians studied 
and taught them." G. Cuvier Report on Natural Sciences, Paris 1980. Copyright
2002 S. Karger AG, Basel

Publication Types: 
    Historical Article

PMID: 12097749 [PubMed - indexed for MEDLINE]

1210: Am J Nephrol. 2002 Jul;22(2-3):172-9.

Use of natural substances in the treatment of renal stones and other urinary
disorders in the medieval Levant.

Lev E, Dolev E.

Department of Eretz Israel Studies, University of Haifa, Haifa, Israel.
levefr@zahar.ret.il

Urinary disorders were common in the ancient world, especially in the
Mediterranean region. In semi-arid zones and countries with unreliable water
sources, renal stones and other urinary problems occur with greater frequency. A 
lack of water and correspondingly high levels of calcium saturation are among the
main reasons for the formation of calcium sediments in the urinary tract, and it 
is hardly surprising, therefore, that many generations of physicians and healers 
have been called upon to treat these disorders, or at least alleviate the pain
associated with them. Down the ages, many natural substances have been used for
this purpose. This article focuses on 62 plants, 9 animal-based remedies, 1
mineral preparation and 4 medicinal substances of different or uncertain origin, 
traced in a recent survey of relevant historical literature (both medical and
non-medical). Many of these materials, used to treat urinary disorders in the
Levant between the 8th and the 18th centuries, had already been in use since the 
classical period, and several are still used today in traditional medicine.
Copyright 2002 S. Karger AG, Basel

Publication Types: 
    Historical Article
    Research Support, Non-U.S. Gov't

PMID: 12097736 [PubMed - indexed for MEDLINE]

1211: Int Urol Nephrol. 2001;33(2):335-40.

Estimating the effectiveness of various methods of evacuation of kidney stones,
on the basis of data obtained on percentage of "stone free" and recurrent stone
formation.

Bilobrov VM, Roy A, Bilobrov SV.

Institute of Physical Organic and Coal Chemistry, National Academy of Sciences of
the Ukraine, Donetsk.

Using the materials of more than 200 scientific papers of recent years in this
review it has been carried out analysis of the effectiveness and also discussed
the merits and demerits of various methods of treatment of urinary stone diseases
(USD). With this purpose, for the first time it has been carried out analysis of 
treatment quality of USD using more important quantitative parameters of
treatment efficacy: 1--percentage of "stone free"; 2--percentage of recurrent
stone formation. It has been emphasized on the higher effectiveness of treatment 
in combination of the method of ESWL with the methods of ascending litholysis. It
was shown that in order to solve problems such as etiology and pathogenesis of
the disease, elaboration of quantitative risk factors of the disease, and search 
for effective measures on pro- and metaphylaxis of USD, and also elaboration of
various (including therapeutics) medium and methods for complete and rapid
evacuation of stones, it is needed to carry out intensively fundamental and
applied researches in the field of urinary stone diseases.

Publication Types: 
    Review

PMID: 12092650 [PubMed - indexed for MEDLINE]

1212: Int Urol Nephrol. 2001;33(2):311-3.

Acute renal failure due to bilateral matrix renal calculi--a diagnostic dilemma.

Singh H, Pandey S, Dorairajan LN, Kumar S.

Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and
Research, Pondicherry, India.

We report an unusual case of acute renal failure caused by bilateral matrix
calculi. The difficulties in diagnosing the cause of renal failure and the
management of the case are discussed. Matrix calculi are rare causes of acute
renal failure. Being radiolucent they can be elusive and systematic investigation
and a diligent search are required for correct diagnosis and appropriate
treatment.

Publication Types: 
    Case Reports
    Review

PMID: 12092645 [PubMed - indexed for MEDLINE]

1213: Int Urol Nephrol. 2001;33(2):293-8.

Comment in:
    J Urol. 2003 Aug;170(2 Pt 1):685-6.

Efficacy and outcome of surgical intervention in patients with nephrolithiasis
and chronic renal failure.

Singh I, Gupta NP, Hemal AK, Aron M, Dogra PN, Seth A.

Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New
Delhi.

AIM: To prospectively evaluate the efficacy and outcome of surgical intervention 
in patients with renal stones and chronic renal insufficiency. METHODS: The study
was carried out from January 1999 till January 2001. Only patients with chronic
renal failure without medical renal disease were taken up for study. All patients
were subjected to an ultrasound assessment of the kidney, ureter and bladder. In 
case of obstructed and infected systems a preliminary percutaneous nephrostomy
was carried out. After correction of dyselectrolytemia, acid base imbalance and
dialysis (if indicated) patients were subjected to surgical intervention (open
surgery or percutaneous nephrolithotomy). ESWL was offered for stones persisting 
after surgery. The stone burden, composition, therapeutic procedures required to 
render patients stone free were assessed. The outcome of stone removal on renal
function was also evaluated by serial renal dynamic scans and creatinine
clearance estimations. RESULTS: Out of 90 patients operated for staghorn or
calyceal calculi, complete follow up data was available in 70.
Pyelo-nephrolithotomy and percutaneous nephrolithotomy was carried out in 63 and 
7 patients respectively. Out of 15 patients with residual stones ESWL was
successfully performed in 9 cases. Mixed, calcium oxalate monohydrate, calcium
oxalate dihydrate, and struvite stones were encountered in 48%, 14%, 17% and 21% 
respectively. The average pre operative serum creatinine was 4.76 (1.9-16) mg%.
The maximum duration of follow up was 9 months. By the 9th post operative month
the average fall in serum creatinine values was 1.53 mg/dl (32%) and the average 
functional improvement by renal dynamic scans stood at 20.665%. 41 patients were 
saved from further dialysis. CONCLUSION: Patients with mild to moderate renal
failure showed maximal improvement in renal function forestalling or reducing the
need for dialysis/renal replacement therapy.

PMID: 12092642 [PubMed - indexed for MEDLINE]

1214: Am J Kidney Dis. 2002 Jul;40(1):37-42.

The association between gout and nephrolithiasis: the National Health and
Nutrition Examination Survey III, 1988-1994.

Kramer HM, Curhan G.

Renal Unit, Department of Medicine, Massachusetts General Hospital, USA.

BACKGROUND: Gout, an inflammatory arthritis, reportedly afflicts more than 2
million men and women in the United States. Previous reports have suggested an
association between gout and kidney stone disease; however, these studies did not
adjust for such important potential confounders as obesity and the presence of
hypertension. To our knowledge, no published study has examined the independent
association between gout and kidney stone disease. METHODS: We used a national
probability sample of the US population to determine the independent association 
between reported gout and history of kidney stone disease. RESULTS: Among men and
women 20 years and older, 5.6% (10 million) reported the previous passage of a
kidney stone and 2.7% (5.1 million) reported a diagnosis of gout by a physician. 
Moreover, 8.6% of individuals who reported the passage of a kidney stone on two
or more occasions had a history of gout. Conversely, the prevalence of previous
kidney stones in subjects with reported gout was 13.9%. In the age-adjusted
model, gout was associated with an increased odds ratio (OR) for previous kidney 
stones (OR, 1.97; 95% confidence interval [CI], 1.37 to 2.83). After further
adjustment for sex, race, body mass index, and presence of hypertension, the OR
for previous kidney stones in individuals with gout decreased to 1.49 (95% CI,
1.04 to 2.14). CONCLUSION: Showing an independent association between kidney
stone disease and gout strongly suggests that they share common underlying
pathophysiological mechanisms. Identification of these mechanisms may lead to
improved preventive strategies for both conditions. Copyright 2002 by the
National Kidney Foundation, Inc.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12087559 [PubMed - indexed for MEDLINE]

1215: BJU Int. 2002 Jul;90(1):16-9.

Clinical experience with a new ultrasonic and LithoClast combination for
percutaneous litholapaxy.

Hofmann R, Olbert P, Weber J, Wille S, Varga Z.

Department of Urology and Paediatric Urology, Medicl School, Phillipps
Universität Marburg, Germany. R.Hofmann@mailer.uni-marburg.de

OBJECTIVE: To assess a new lithotripter for intracorporal lithotripsy, which
combines the mechanically driven pneumatic LithoClast (Electro-Medical Systems,
Nyon, Switzerland) and a new ultrasonic device (Electro-Medical Systems), for use
in percutaneous nephrolitholapaxy (PNL). PATIENTS AND METHODS: The new
lithotripter consists of a LithoClast Master with 12 Hz repetition rate and a new
ultrasonic device. The 1.0 mm LithoClast probe is advanced off-centre through the
hollow 3.3 mm ultrasonic probe and protrudes about 1 mm. A new irrigation system 
with a pinch valve compressing the irrigation tube, a foot-switch for activating 
the ultrasound, the LithoClast and both together, and a stone bucket at the
outlet tube are new features. Between February 1999 and August 2001, 68 patients 
were treated by PNL with the new device; 35 had complete and 33 had partial
staghorn calculi. PNL was administered under fluoroscopic control and with the
patient prone. RESULTS: The mean (range) duration of surgery was 61 (42-119) min.
The complete stone-free rate was 66% after the first PNL; of the 68 patients, 16 
received a second PNL, giving a final stone-free rate of 76% and 80%. The stone
was composed of calcium oxalate monohydrate (COM) in 13%, COM with uric acid in
35%, apatite in 20% and cystine in 11%. Clinically the new lithotripter was very 
effective, producing smaller stone particles and thus fewer residual stone
fragments after PNL than with the LithoClast or ultrasonic fragmentation alone.
CONCLUSION: The new lithotripter provides easily managed and highly effective
stone fragmentation of all stones, regardless of their composition.

PMID: 12081762 [PubMed - indexed for MEDLINE]

1216: Ultrasound Med Biol. 2002 May;28(5):661-71.

The role of stress waves and cavitation in stone comminution in shock wave
lithotripsy.

Zhu S, Cocks FH, Preminger GM, Zhong P.

Department of Mechanical Engineering and Materials Science, Duke University,
Durham, NC 27708-0300, USA.

Using an experimental system that mimics stone fragmentation in the renal pelvis,
we have investigated the role of stress waves and cavitation in stone comminution
in shock-wave lithotripsy (SWL). Spherical plaster-of-Paris stone phantoms (D =
10 mm) were exposed to 25, 50, 100, 200, 300 and 500 shocks at the beam focus of 
a Dornier HM-3 lithotripter operated at 20 kV and a pulse repetition rate of 1
Hz. The stone phantoms were immersed either in degassed water or in castor oil to
delineate the contribution of stress waves and cavitation to stone comminution.
It was found that, while in degassed water there is a progressive disintegration 
of the stone phantoms into small pieces, the fragments produced in castor oil are
fairly sizable. From 25 to 500 shocks, clinically passable fragments (< 2 mm)
produced in degassed water increases from 3% to 66%, whereas, in castor oil, the 
corresponding values are from 2% to 11%. Similar observations were confirmed
using kidney stones with a primary composition of calcium oxalate monohydrate.
After 200 shocks, 89% of the fragments of the kidney stones treated in degassed
water became passable, but only 22% of the fragments of the kidney stones treated
in castor oil were less than 2 mm in size. This apparent size limitation of the
stone fragments produced primarily by stress waves (in castor oil) is likely
caused by the destructive superposition of the stress waves reverberating inside 
the fragments, when their sizes are less than half of the compressive wavelength 
in the stone material. On the other hand, if a stone is only exposed to
cavitation bubbles induced in SWL, the resultant fragmentation is much less
effective than that produced by the combination of stress waves and cavitation.
It is concluded that, although stress wave-induced fracture is important for the 
initial disintegration of kidney stones, cavitation is necessary to produce fine 
passable fragments, which are most critical for the success of clinical SWL.
Stress waves and cavitation work synergistically, rather than independently, to
produce effective and successful disintegration of renal calculi in SWL

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 12079703 [PubMed - indexed for MEDLINE]

1217: Eur Urol. 2002 Apr;41(4):474-7.

Long term results of percutaneous treatment of caliceal diverticular calculi.

Landry JL, Colombel M, Rouviere O, Lezrek M, Gelet A, Dubernard JM, Martin X.

Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard HERRIOT,
Lyon, France.

PURPOSE: We reviewed the long term outcome of percutaneous caliceal diverticular 
stone extraction. The objective was to define factors of treatment failure and
recurrence. MATERIAL AND METHODS: Percutaneous caliceal diverticular stone
extraction was performed in 24 women and 7 men (age range 21-69 years old).
Diverticula were located throughout the kidney including the upper, middle and
lower calices. In all cases stones were removed using a direct approach and
diverticular neck was incised or dilated. Fulguration of the diverticular walls
was performed in 6 cases. Trans-diverticular drainage was maintained from 3 to 5 
days (mean 3.4 days) until a nephrostomogram demonstrated no extravasation.
Patients were evaluated at 3 months and yearly thereafter. Success criteria were:
no symptoms, no stone recurrence, no diverticulum left as assessed by IVP.
Evaluation at 1 year minimum is presented. RESULTS: The average operative time
and hospital stay were 103 min (range 90-130) and 3 days (range 4-9 days),
respectively. No major complications and no mortality were observed. At 1 year
stone free rate was 84% and diverticulum obliteration was obtained in 68% of
patients. Overall 88% of patients were asymptomatic at average followup 24.6
months (range from 18 to 96 months). In all cases morphological or symptomatic
failures were related to the quality of immediate result at surgery which relates
to the location of the diverticulum. CONCLUSION: The percutaneous management of
diverticular caliceal stones is a well standardized technique, however, surgical 
alternatives must be discussed any time the percutaneous approach seems difficult
because high failure rates are expected in these cases.

PMID: 12074821 [PubMed - indexed for MEDLINE]

1218: Eur Urol. 2002 Apr;41(4):406-10.

Comparative investigations on the retrieval capabilities of various baskets and
graspers in four ex vivo models.

Ptashnyk T, Cueva-Martinez A, Michel MS, Alken P, Köhrmann KU.

Department of Urology, Klinikum Mannheim gGmbH, D-68135 Mannheim, Germany.
ptashnykt@hotmail.com

OBJECTIVES: The increasing application of ureterorenoscopy for the treatment of
urolithiasis has produced a myriad of different help-tools for stone retrieval.
In this study, we compared the retrieval capabilities of different baskets and
graspers in ex vivo models and attempted to find the most appropriate tool for
stone extraction considering the location and size of stone, number of stones and
potential harm to urinary tract tissue. METHODS: We created four different ex
vivo models with porcine kidneys and ureters and natural human stones: (1) single
ureteral stone (4mm); (2) single impacted ureteral stone (6mm); (3) Steinstrasse;
(4) single lower-pole stone (5mm). With the aid of four baskets of different
design (flat-wire basket Segura and Nitinol basket Zerotip, helical Gemini, and
Parachute) and three graspers (two-prong, three-prong Tricep, and Nitinol grasper
Graspit) we performed repeated stone extraction 10 times in each model. The time 
for complete stone removal was calculated. Macroscopical evaluation of tissue
damage was performed after each series. In the Steinstrasse model the frequency
of instrument reinsertion into the ureter was also calculated. RESULTS: In the
single ureteral stone model, the fastest stone removal was achieved with the
two-prong graspers, three-prong graspers and helical basket (20, 26 and 31s,
respectively). Segura and Parachute needed more time (55 and 86s, respectively). 
Impacted stones were removed fastest with the two- and three-prong graspers (38
and 52s, respectively), Segura and Gemini were slower (89 and 114s,
respectively). The Steinstrasse was cleared fastest by the helical basket with
the lowest frequency of endoscope reinsertion (66s, 1.4 reinsertion). The Segura,
149s with 3.2 reinsertion was needed for the same procedure. With the Parachute
and two-prong graspers 163s, 1.8 reinsertion and 261s, 4.6 reinsertion were
needed, respectively. During postprocedural macroscopical evaluation of uretral
tissue, the Parachute basket and three-prong graspers demonstrated the highest
risk of mucosal and muscle damage. In the lower-pole kidney model, the poor
deflectability of the ureterorenoscope prevented access to the lower-pole with
the two- and three-prong graspers. There was no significant difference in stone
retrieval time between the remaining Nitinol basket Zerotip and Nitinol grasper
Graspit (87 and 61s, respectively ). The number of failures was 4/10 for Zerotip 
and 5/10 for Graspit. No significant mucosal damage was noted with these tools.
CONCLUSIONS: Our ex vivo models demonstrated that the design of graspers and
baskets affects the time of stone retrieval in different situations and causes
the various grades of tissue damage.

Publication Types: 
    Comparative Study

PMID: 12074812 [PubMed - indexed for MEDLINE]

1219: Curr Opin Urol. 2002 Jul;12(4):291-5.

The effect of rate of shock wave delivery on the efficiency of lithotripsy.

Paterson RF, Kuo RL, Lingeman JE.

Methodist Hospital Institute for Kidney Stone Disease, Department of Urology,
Indiana University School of Medicine, Indianapolis, Indiana, USA.

PURPOSE OF REVIEW: The potential mechanisms of a shock wave rate effect are
reviewed here, together with a report on the results of in-vitro, in-vivo and
clinical studies that have assessed the effect of altering the shock wave rate on
stone breakage and tissue injury by shock wave lithotripsy. RECENT FINDINGS: The 
vast majority of studies assessing shock wave rate have reported improved stone
fragmentation and a reduction in shock wave lithotripsy-induced tissue damage
with slower rates of shock wave delivery. However, the optimal shock wave rate
has not been determined. SUMMARY: Slower rates of shock wave lithotripsy appear
to improve the efficiency of this approach and therefore this suggests the need
for a randomized clinical trial to assess shock wave rate.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 12072649 [PubMed - indexed for MEDLINE]

1220: Curr Opin Urol. 2002 Jul;12(4):281-6.

Is there a role for prophylactic shock wave lithotripsy for asymptomatic calyceal
stones?

Collins JW, Keeley FX Jr.

Lithotripsy Unit, Southmead Hospital, Westbury-on-Trym, UK. jwcol@yahoo.co.uk

PURPOSE OF REVIEW: The tolerability of extracorporeal shock wave lithotripsy has 
led to an increase in the treatment of small, asymptomatic renal calculi, yet we 
know very little about the natural history of such stones or about the long-term 
effects of this treatment. The efficacy of extracorporeal shock wave lithotripsy 
has been called into question, especially for lower pole stones. Several recent
clinical studies have addressed these issues as well as the natural history of
residual stone fragments following extracorporeal shock wave lithotripsy. RECENT 
FINDINGS: Preliminary results of a randomized controlled trial show that
prophylactic extracorporeal shock wave lithotripsy for small, asymptomatic renal 
calyceal stones does not appear to offer any advantage to patients in terms of
stone-free rates, quality of life, renal function, symptoms, or hospital
admissions, nor does it appear to affect blood pressure. However, a policy of
observation is associated with a greater risk of requiring more invasive
procedures. Reports regarding the incidence of hypertension following
extracorporeal shock wave lithotripsy are conflicting, as are reports regarding
anatomical factors affecting the clearance of lower pole stones. Percutaneous
removal appears to be superior to extracorporeal shock wave lithotripsy for the
treatment of lower pole stones. SUMMARY: Extracorporeal shock wave lithotripsy
does not appear to improve the clinical outcome of patients with small,
asymptomatic calyceal calculi. Longer follow-up is required to assess the
validity of the preliminary findings and may shed light on the long-term effects 
of this technique on blood pressure and stone growth/recurrence. Anatomical
factors affecting the clearance of lower pole stones require standardization and 
further study. Further in-vitro studies are required to study the kinetics of
stone growth and the effects of urine composition, flow rate, and macromolecular 
components.

Publication Types: 
    Review

PMID: 12072647 [PubMed - indexed for MEDLINE]

1221: Curr Opin Urol. 2002 Jul;12(4):277-80.

Expanding role of ureteroscopy and laser lithotripsy for treatment of proximal
ureteral and intrarenal calculi.

Bagley DH.

Department of Urology, Jefferson Medical College, Thomas Jefferson University,
Philadelphia, Pennsylvania 19107, USA. demetrius.bagley@mail.tju.edu

PURPOSE OF REVIEW: Ureteroscopy has assumed an expanded and important role in the
treatment of proximal ureteral and intrarenal calculi with the development of new
endoscopes, more effective grasping devices, and the holmium laser lithotriptor. 
RECENT FINDINGS: The success rate for treating proximal ureteral stones with
small rigid and flexible ureteroscopes and the holmium laser is well over 90%.
Lower pole renal calculi can also be treated with a success rate of approximately
80%, which surpasses that of shock wave lithotripsy. Selected stones that are
over 2 cm in diameter, along with branched stones, can also be treated
successfully with ureteroscopy. SUMMARY: Ureteroscopy is the most successful
technique for the treatment of ureteral calculi (success rates >90%) and is an
optional treatment for many renal calculi.

Publication Types: 
    Review

PMID: 12072646 [PubMed - indexed for MEDLINE]

1222: Curr Opin Urol. 2002 Jul;12(4):271-6.

Crystal-cell interaction in the pathogenesis of kidney stone disease.

Asselman M, Verkoelen CF.

Department of Urology, Erasmus Medical Center Rotterdam, Rotterdam, The
Netherlands.

PURPOSE OF REVIEW: Renal stone formation depends not so much on the formation of 
crystals, but on their retention in the kidney. Evidence has emerged that crystal
retention is caused predominantly by the adherence of crystals to the epithelial 
cells lining the renal tubules. Understanding the mechanisms involved in crystal 
retention could lead to new therapeutic approaches for interfering with the renal
stone-forming process in patients. Cell-culture studies have been performed to
obtain insights into the susceptibility of the cell surface to crystal
attachment, and to uncover cell-surface crystal-binding molecules. This review
aims to put the relevant publications of the last decade in perspective. RECENT
FINDINGS: Crystal-cell interaction has been investigated by using various renal
tubular cell types in culture. Such studies have yielded several candidate
crystal-binding molecules, including phosphatidylserine, sialic acid, collagen
IV, osteopontin and, recently, hyaluronan. SUMMARY: Here, the results obtained in
crystal-binding studies are recapitulated, compared and evaluated. Arguments are 
provided in support of the view that many of the proposed crystal-binding
molecules could be linked in the series of events resulting in crystal retention.
Under pathological conditions, pericellular matrices rich in the polysaccharide
hyaluronan are proposed as the key binding substance for crystals at the surface 
of renal tubular cells.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12072645 [PubMed - indexed for MEDLINE]

1223: Antimicrob Agents Chemother. 2002 Jul;46(7):2077-86.

Inhibition of nanobacteria by antimicrobial drugs as measured by a modified
microdilution method.

Cíftçíoglu N, Miller-Hjelle MA, Hjelle JT, Kajander EO.

Department of Biochemistry, University of Kuopio, FIN-70211, Kuopio, Finland.

Compounds from 16 classes of antimicrobial drugs were tested for their abilities 
to inhibit the in vitro multiplication of nanobacteria (NB), a newly discovered
infectious agent found in human kidney stones and kidney cyst fluids from
patients with polycystic kidney disease (PKD). Because NB form surface
calcifications at physiologic levels of calcium and phosphate, they have been
hypothesized to mediate the formation of tissue calcifications. We describe a
modified microdilution inhibitory test that accommodates the unique growth
conditions and long multiplication times of NB. This modified microdilution
method included inoculation of 96-well plates and determination of inhibition by 
periodic measurement of the absorbance for 14 days in cell culture medium under
cell culture conditions. Bactericidal or bacteriostatic drug effects were
distinguished by subsequent subculture in drug-free media and monitoring for
increasing absorbance. NB isolated from fetal bovine serum (FBS) were inhibited
by tetracycline HCl, nitrofurantoin, trimethoprim, trimethoprim-sulfamethoxazole,
and ampicillin at levels achievable in serum and urine; all drugs except
ampicillin were cidal. Tetracycline also inhibited multiplication of isolates of 
NB from human kidney stones and kidney cyst fluids from patients with PKD. The
other antibiotics tested against FBS-derived NB either had no effect or exhibited
an inhibitory concentration above clinically achievable levels; the
aminoglycosides and vancomycin were bacteriostatic. Antibiotic-induced
morphological changes to NB were observed by electron microscopy.
Bisphosphonates, aminocaproic acid, potassium citrate-citric acid solutions, and 
5-fluorouracil also inhibited the multiplication of NB in a cidal manner.
Insights into the nature of NB, the action(s) of these drugs, and the role of NB 
in calcifying diseases may be gained by exploiting this in vitro inhibition test 
system.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12069958 [PubMed - indexed for MEDLINE]

1224: Clin Radiol. 2002 Jun;57(6):435-41.

Unenhanced helical CT in the investigation of acute flank pain.

Colistro R, Torreggiani WC, Lyburn ID, Harris AC, Al-Nakshabandi NA, Nicolaou S, 
Munk PL.

Department of Radiology, Vancouver General Hospital, University of British
Columbia, Vancouver, Canada.

Unenhanced helical CT has emerged as the imaging technique of choice for the
investigation of patients presenting with acute flank pain and suspected
nephroureteric stone disease. There are several signs identifiable on unenhanced 
CT that support a diagnosis of stone disease. However, there are many pitfalls,
that may confound a correct diagnosis. Some of the common pitfalls, together with
methods to avoid such occurrences, will be discussed. A review of some of the
common alternative diagnoses that may mimic the symptoms of nephroureteric stone 
disease is illustrated. Copyright 2002 The Royal College of Radiologists.

Publication Types: 
    Review

PMID: 12069457 [PubMed - indexed for MEDLINE]

1225: Hong Kong Med J. 2002 Jun;8(3):202-6.

Primary hyperoxaluria: a rare but important cause of nephrolithiasis.

Wong PN, Tong GM, Lo KY, Mak SK, Law EL, Wong AK.

Renal Unit, Department of Medicine and Geriatrics, Kwong Wah Hospital, 25
Waterloo Road, Hong Kong.

We report on a middle-aged man with end-stage renal failure apparently secondary 
to recurrent renal stones. He developed systemic oxalosis soon after commencing
dialysis. The diagnosis of primary hyperoxaluria type 1 was supported by the
finding of high dialysate glycolate excretion. The patient subsequently received 
an isolated cadaveric renal transplant, but the outcome was a rapid recurrence of
oxalosis and early graft failure. Although isolated liver or renal
transplantation in addition to various adjuvant measures may be considered in the
early stage, combined liver-kidney transplantation remains the only definitive
therapy for a patient with end-stage renal failure and systemic oxalosis due to
hyperoxaluria type 1. This case illustrates the possible late presentation of
primary hyperoxaluria type 1 and the poor outcome with isolated renal
transplantation after the development of systemic oxalosis. One should thus have 
a high index of suspicion in patients with recurrent renal stones of this rare,
but nevertheless important, entity.

Publication Types: 
    Case Reports

PMID: 12055367 [PubMed - indexed for MEDLINE]

1226: Exp Nephrol. 2002;10(3):176-81.

Urinary stone formation: Dent's disease moves understanding forward.

Sayer JA, Simmons NL.

Department of Physiological Sciences, University of Newcastle upon Tyne,
Newcastle, UK. j.a.sayer@ncl.ac.uk

Renal stones form in the late collecting duct in a complex milieu involving salts
and protein components of the urine together with direct interactions at the
epithelial cells lining the duct. The operation of newly discovered physiological
controls that limit crystal formation by feedback mechanisms which sense the
luminal environment are discussed. Adhesion at the epithelial surface and
intracellular processing of crystals comprise a previously unrecognised mechanism
for limiting crystal growth, which may be disrupted resulting in disease. Dent's 
disease is discussed as a paradigm of a complex renal tubular disease resulting
in renal stone formation. Defects in endosomal acidification, due to ablation of 
the CLC-5 voltage-gated Cl- channel, result in defects in both proximal and
collecting duct endosomal traffic leading to stone formation. Copyright 2002 S.
Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 12053119 [PubMed - indexed for MEDLINE]

1227: J Urol. 2002 Jul;168(1):260-5.

Predicting urinary stone composition using X-ray coherent scatter: a novel
technique with potential clinical applications.

Batchelar DL, Chun SS, Wollin TA, Tan JK, Beiko DT, Cunningham IA, Denstedt JD.

Imaging Research Laboratories, John P. Robarts Research Institute, and Department
of Medical Biophysics and Division of Urology, University of Western Ontario,
London, Ontario, Canada.

PURPOSE: Coherent scatter properties depend on the molecular structure of the
scattering medium and measured scatter patterns are often characteristic of a
chemical species. We explored the usefulness of coherent scatter analysis as a
basis for identifying urinary calculus composition. MATERIALS AND METHODS: A
laboratory system for collecting coherent scatter signals from biological
specimens was developed. This technique uses a diagnostic x-ray tube and image
intensifier, and measures coherent scatter from intact renal stones. The coherent
scatter signatures of 6 common stone components (calcium oxalate monohydrate,
calcium phosphate, calcium phosphate dihydrate, cystine, magnesium ammonium
phosphate and uric acid) were acquired from pure chemical samples and stones
identified by infrared spectroscopy as having a uniform composition. In addition,
a sample of calculus identified as containing only calcium oxalate dihydrate was 
examined. The same fragmented stone samples analyzed by infrared spectroscopy
were scanned using coherent scatter. RESULTS: In each case the scatter patterns
from powdered chemicals and fragmented stones showed circular symmetry and
consisted of a series of broad rings of various intensities. Each pure chemical
sample produced a distinct coherent scatter pattern. The signatures of the stone 
specimens closely agreed with those of the chemical samples. CONCLUSIONS: These
initial results indicate that coherent scatter analysis using diagnostic x-rays
has potential as a tool for urinary calculous composition identification. Further
developments in this technique may have the potential for determining the
composition of a calculus in vivo before therapy, thus, aiding in therapy
planning.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12050553 [PubMed - indexed for MEDLINE]

1228: J Urol. 2002 Jul;168(1):46-50.

Routine postoperative imaging is important after ureteroscopic stone
manipulation.

Weizer AZ, Auge BK, Silverstein AD, Delvecchio FC, Brizuela RM, Dahm P, Pietrow
PK, Lewis BR, Albala DM, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery,
Duke University Medical Center, Durham, North Carolina, USA.

PURPOSE: Improved fiber optics and advanced intracorporeal lithotripsy devices
have significantly decreased the incidence of complications during ureteroscopic 
procedures. Despite recent reports suggesting that radiographic imaging may not
be necessary in all individuals after routine ureteroscopy silent obstruction may
develop in some, ultimately resulting in renal damage. We determined the
incidence of postoperative silent obstruction at our institution and assessed the
need for routine functional radiographic studies after ureteroscopy. MATERIALS
AND METHODS: We retrospectively reviewed the charts of 320 patients who underwent
a total of 459 ureteroscopic procedures for renal or ureteral calculi in a 3-year
period. Complete followup with imaging was available for 241 patients (75%).
Average patient age was 47.2 years. The variables of interest reviewed included
preoperative pain, preoperative obstruction, targeted calculous site, stone-free 
rate, postoperative pain and postoperative obstruction. Mean followup was 5.4
months (range 2 to 43). RESULTS: A total of 241 patients with complete followup
were identified in this analysis. Preoperative pain was present in 202 patients
(84%) and 168 (70%) had preoperative obstruction. Overall targeted calculous
clearance was successful in 73% of the patients and an additional 15.8% had
residual fragments less than 4 mm. The renal, proximal or mid and distal ureteral
stone-free rate was 32.1%, 81.9% and 90.5%, while in an additional 46.4%, 6.3%
and 6.7% of cases, respectively, residual fragments were less than 4 mm. Of the
241 patients 30 (12.3%) had obstruction postoperatively due to residual stone in 
25 (83.3%), stricture in 3 (10%), edema of the ureteral orifice in 1 (3.3%) and a
retained encrusted stent in 1 (3.3%). Postoperatively obstruction correlated with
postoperative pain in 23 of the 30 patients (76.7%). Pain was present
postoperatively in 30 of the 211 patients (14%) without evidence of ureteral
obstruction postoperatively. However, silent obstruction developed in 7 patients 
(23.3%) or 2.9% of the total cohort. All 7 patients underwent secondary
ureteroscopy to alleviate obstruction. A single patient ultimately received
chronic hemodialysis for renal failure, 1 was lost to followup and in 5 there was
documented successful resolution of the cause of obstruction. CONCLUSIONS: Our
analysis suggests that silent obstruction remains a potentially significant
complication after stone management. Relying on postoperative pain to determine
the necessity of postoperative imaging places patients at risk for progressive
renal failure due to unrecognized obstruction. Therefore, we recommend that
imaging of the collecting system should be performed by excretory urography,
spiral computerized tomography or ultrasound within 3 months after routine
ureteroscopic stone treatment to avoid the potential complications of
unrecognized ureteral obstruction.

PMID: 12050490 [PubMed - indexed for MEDLINE]

1229: J Urol. 2002 Jul;168(1):43-5.

Ureteroscopic treatment of lower pole calculi: comparison of lithotripsy in situ 
and after displacement.

Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS Jr.

Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.

PURPOSE: Ureteroscopic management is a viable option for lower pole calculi less 
than 2 cm. Recently a technique was described to displace the calculus into a
more accessible calix using a nitinol basket or grasper before lithotripsy. We
compared the efficacy and safety of this technique with in situ treatment of
small and intermediate lower pole calculi. MATERIALS AND METHODS: We
retrospectively reviewed the records of 95 ureteroscopy cases performed at our
institution from January 1997 through August 2001 for renal calculi located only 
in the lower pole. Preoperative patient characteristics, stone size, operative
details, complications and outcomes were compared for calculi treated in situ and
those displaced before treatment. RESULTS: Adequate followup was available on 78 
patients. Patients in the displacement group were statistically older, more often
had a preoperative indwelling ureteral stent and had a mean operative time that
was 16 minutes longer (p = 0.04). Average stone diameter in the in situ and
displacement groups was 8 and 10.3 mm., respectively (p = 0.04). In patients with
radiographic followup greater than 1 month complete success was obtained for 77% 
of stones 1 cm. or less treated in situ versus 89% treated with displacement
first (p = 0.43). For calculi greater than 1 cm. complete success was obtained
for 2 of the 7 (29%) treated in situ versus all 7 (100%) treated with
displacement (p = 0.005). CONCLUSIONS: When treating lower pole calculi 1 to 2
cm. via ureteroscopy, a higher success rate can be obtained with displacement
into a more accessible calix before treatment.

PMID: 12050489 [PubMed - indexed for MEDLINE]

1230: J Urol. 2002 Jul;168(1):38-42.

Effects of extracorporeal shock wave lithotripsy on plasma levels of nitric oxide
and cyclic nucleotides in human subjects.

Park JK, Cui Y, Kim MK, Kim YG, Kim SH, Kim SZ, Cho KW.

Department of Urology, Chonbuk National University Medical School, Research
Institute of Clinical Medicine of Chonbuk National University Hospital, Chonju,
South Korea.

PURPOSE: The role of extracorporeal shock wave lithotripsy (ESWL, Dornier
Medizintechnik GmbH, Wessling Munchen, Germany) on plasma nitric oxide (NO) and
cyclic nucleotides was investigated. It is known that ESWL increased plasma
levels of vasoactive substances. MATERIALS AND METHODS: A total of 28 patients
undergoing ESWL for renal (14) and lower ureteral (14) stones participated in a
prospective study. Peripheral blood samples were analyzed for plasma nitrite, NO 
metabolite, cyclic 3', 5'-guanosine monophosphate (cGMP), cyclic 3',5'-adenosine 
monophosphate and plasma renin activity before, immediately after, 30 and 60
minutes after ESWL. Urine samples were also analyzed for nitrite before,
immediately after, 30 and 60 minutes after ESWL. Blood pressure and pulse rate
were measured before and after ESWL. RESULTS: ESWL increased mean plasma nitrite 
levels. Before, immediately after, 30 and 60 minutes after ESWL mean plasma
nitrate plus or minus standard error in patients with renal versus lower ureteral
stones was 43.6 +/- 8.5, 52.8 +/- 7.4, 54.0 +/- 8.0 and 52.2 +/- 9.1 versus 27
+/- 5.8, 24.6 +/- 4.7, 23.6 +/- 4.8 and 28.0 +/- 7.1 nM., respectively. Before,
immediately after, 30 and 60 minutes after ESWL mean plasma cGMP in patients with
renal versus lower ureteral stones was 1.21 +/- 0.1, 1.64 +/- 0.16, 1.52 +/- 0.12
and 1.58 +/- 0.14 versus 1.45 +/- 0.18, 1.52 +/- 0.13, 1.52 +/- 0.15 and 1.51 +/-
0.11 fmol., respectively. Cyclic 3',5'-adenosine monophosphate was not increased 
by ESWL in patients with renal stones. Urine nitrite increased slightly but not
significantly after ESWL. Plasma cyclic nucleotides and nitrite, and urine
nitrite were not changed by ESWL in patients with lower ureteral stones. Plasma
renin activity decreased significantly in patients with renal stones 60 minutes
after ESWL. Blood pressure and pulse rates increased mildly without statistical
significance after ESWL for renal stones. CONCLUSIONS: ESWL increases plasma
nitrite and cGMP in patients with renal stones, suggesting that shock waves
stimulate the NO-cGMP signaling pathway.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12050488 [PubMed - indexed for MEDLINE]

1231: J Urol. 2002 Jul;168(1):35-7.

Comparison of intravenous sedation versus general anesthesia on the efficacy of
the Doli 50 lithotriptor.

Sorensen C, Chandhoke P, Moore M, Wolf C, Sarram A.

Department of Surgery (Urology), University of Colorado Health Sciences Center
and Kidney Stone Center of the Rocky Mountains, Denver, Colorado, USA.

PURPOSE: We compared the impact of intravenous sedation versus general anesthesia
on the efficacy of extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: 
From November 1997 to May 1998, 295 patients with a single renal or upper
ureteral radioopaque stone of less than 2 cm. were treated with the Doli 50
lithotriptor (Dornier Medical Systems, Marietta, Georgia). The treating
anesthesiologist and patient together elected intravenous sedation or general
anesthesia. Of the 92 patients 60 (65%) treated under intravenous sedation and
126 of the 203 (62%) treated under general anesthesia had 3-month followup
records available for review. Extracorporeal shockwave lithotripsy was considered
a failure if residual stone fragments remained after 3 months, or an auxiliary
procedure or re-treatment was required. RESULTS: At 3 months the stone-free rate 
in patients treated under intravenous sedation was 55% compared with 87% in those
treated under general anesthesia (p <0.001). There was no statistically
significant difference in treatment time or the power index in the 2 groups.
Stone size (1 to 10 versus 11 to 20 mm.) did not significantly affect the
anesthesia specific stone-free rate. CONCLUSIONS: For single renal or upper
ureteral stones less than 2 cm. a significantly better 3-month stone-free rate is
achieved with the Doli 50 lithotriptor when general anesthesia is used instead of
intravenous sedation.

Publication Types: 
    Comparative Study

PMID: 12050487 [PubMed - indexed for MEDLINE]

1232: J Urol. 2002 Jul;168(1):31-4.

Prevention of spinal bone loss by potassium citrate in cases of calcium
urolithiasis.

Pak CY, Peterson RD, Poindexter J.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, Dallas, Texas, USA.

PURPOSE: We determine if potassium citrate treatment stabilizes spinal bone
density among patients with recurrent calcium oxalate nephrolithiasis. MATERIALS 
AND METHODS: We studied a group of 16 men and 5 women with stones taking
potassium citrate from 11 to 120 months. They represented all patients from the
Stone Clinic who took potassium citrate alone for at least 11 months. L2-L4 bone 
mineral density data before and after potassium citrate treatment were retrieved 
retrospectively and analyzed. RESULTS: In the combined group L2-L4 bone mineral
density increased significantly by 3.1% over mean duration of 44 months. Z score,
corrected for age matched normal values, increased significantly by 3.8%. Urinary
pH, citrate and potassium increased significantly during treatment but urinary
calcium did not change. CONCLUSIONS: Potassium citrate, a commonly used drug for 
the prevention of recurrent nephrolithiasis, may avert age dependent bone loss.
Spinal bone density increased in most patients when it normally decreases.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 12050486 [PubMed - indexed for MEDLINE]

1233: J Urol. 2002 Jul;168(1):27-30.

The impact of cystinuria on renal function.

Assimos DG, Leslie SW, Ng C, Streem SB, Hart LJ.

Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

PURPOSE: Patients with cystinuria frequently have recurrent renal calculi and may
subsequently require multiple stone removing procedures during their lifetime
which could have an impact on overall renal function. We determined the potential
impact of cystinuria and cystine stone formation on the level of renal function
compared to calcium oxalate stone formers. MATERIALS AND METHODS: Clinical data
on 40 cystinuric patients followed at 2 medical centers and 45 such individuals
in a large stone population data base were analyzed. These results were compared 
to data on 3,964 calcium oxalate stone formers enrolled in this data base.
RESULTS: Mean serum creatinine plus or minus standard deviation for stone forming
cystinuric patients was significantly higher than that of the calcium oxalate
cohort (1.13 +/- 0.28 versus 1.01 +/- 0.28 mg./100 ml., p = 0.0001). A
significantly greater percentage of cystinuric patients (5.8%) had an abnormally 
increased serum creatinine compared to the calcium oxalate stone formers (2.2%, p
= 0.046). Male gender, increasing number of open surgical stone removing
procedures and nephrectomy were significant variables associated with an
increased serum creatinine (p = 0.0010, p = 0.0038, p = 0.0133, respectively). An
increasing number of open surgical stone removing procedures had a significant
positive correlation with performance of nephrectomy in the cystinuric population
(p = 0.0166). A significantly greater percentage of cystinuric patients compared 
to the calcium oxalate cohort were subjected to nephrectomy (14.1% versus 2.9%, p
= 0.007). CONCLUSIONS: Cystinuric patients have higher serum creatinine levels
than calcium oxalate stone formers and they are at more risk for renal loss. When
stone removal is required, a minimally invasive approach is preferred.

Publication Types: 
    Comparative Study

PMID: 12050485 [PubMed - indexed for MEDLINE]

1234: J Urol. 2002 Jul;168(1):5-8.

The endourological management of complications associated with horseshoe kidney.

Yohannes P, Smith AD.

Department of Urology, Albert Einstein College of Medicine, Long Island Jewish
Medical Center Campus, New Hyde Park, New York, USA.

PURPOSE: Horseshoe kidneys are the most common renal fusion anomalies.
Ureteropelvic junction obstruction, urolithiasis and renal malignancies are the
most common complications that occur in this patient population. Endourological
management of these complications has decreased perioperative morbidity. We
identified the applications of minimally invasive surgery for treating
complications secondary to horseshoe kidney. MATERIALS AND METHODS: A
comprehensive literature review of the different endourological approaches in the
management of complications secondary to horseshoe kidney was performed using
MEDLINE. RESULTS: Ureteropelvic junction obstruction can be managed by
percutaneous endopyelotomy or laparoscopic pyeloplasty with good results. Small
stones associated with horseshoe kidney are best managed by shock wave
lithotripsy, while stones that have failed management by shock wave lithotripsy
or are greater than 2 cm. are best managed percutaneously. All patients should
undergo metabolic evaluation. Ureteroscopy or shock wave lithotripsy is
associated with a higher residual stone rate than the percutaneous approach.
Laparoscopic nephrectomy is a safe and feasible option for benign and malignant
horseshoe kidney diseases. CONCLUSIONS: Endourological techniques can be safe and
effective for treating complications secondary to horseshoe kidney.

Publication Types: 
    Review

PMID: 12050480 [PubMed - indexed for MEDLINE]

1235: Braz J Med Biol Res. 2002 Jun;35(6):669-75.

Effect of calcium intake on urinary oxalate excretion in calcium stone-forming
patients.

Nishiura JL, Martini LA, Mendonça CO, Schor N, Heilberg IP.

Disciplina de Nefrologia, Universidade Federal de São Paulo, São Paulo, SP,
Brasil.

Dietary calcium lowers the risk of nephrolithiasis due to a decreased absorption 
of dietary oxalate that is bound by intestinal calcium. The aim of the present
study was to evaluate oxaluria in normocalciuric and hypercalciuric lithiasic
patients under different calcium intake. Fifty patients (26 females and 24 males,
41 +/- 10 years old), whose 4-day dietary records revealed a regular low calcium 
intake (<or=500 mg/day), received an oral calcium load (1 g/day) for 7 days. A
24-h urine was obtained before and after load and according to the calciuria
under both diets, patients were considered as normocalciuric (NC, N = 15),
diet-dependent hypercalciuric (DDHC, N = 9) or diet-independent hypercalciuric
(DIHC, N = 26). On regular diet, mean oxaluria was 30 +/- 14 mg/24 h for all
patients. The 7-day calcium load induced a significant decrease in mean oxaluria 
compared to the regular diet in NC and DIHC (20 +/- 12 vs 26 +/- 7 and 27 +/- 18 
vs 32 +/- 15 mg/24 h, respectively, P<0.05) but not in DDHC patients (22 +/- 10
vs 23 +/- 5 mg/24 h). The lack of an oxalate decrease among DDHC patients after
the calcium load might have been due to higher calcium absorption under higher
calcium supply, with a consequent lower amount of calcium left in the intestine
to bind with oxalate. These data suggest that a long-lasting regular calcium
consumption <500 mg was not associated with high oxaluria and that a
subpopulation of hypercalciuric patients who presented a higher intestinal
calcium absorption (DDHC) tended to hyperabsorb oxalate as well, so that oxaluria
did not change under different calcium intake.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12045831 [PubMed - indexed for MEDLINE]

1236: Pediatr Nephrol. 2002 May;17(5):386-9.

Nephrolithiasis in a neonate with transient renal wasting of calcium and
magnesium.

Stoll ML, Listman JA.

SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.

Following an uneventful full-term pregnancy, a 3-day-old girl presented with a
focal seizure. Serological evaluation revealed hypomagnesemia and hypocalcemia.
Renal ultrasonography performed because of hematuria showed bilateral
nephrolithiasis. Renal wasting of calcium and magnesium was detected and urine
citrate excretion was low. The hypocalcemia was refractory to calcium therapy,
but responded briskly to magnesium supplementation. After 8 weeks of treatment
with magnesium and calcium supplementation plus potassium citrate, the
hypomagnesemia and hypocalcemia normalized spontaneously, as did the urinary
calcium, magnesium, and citrate excretion. We speculate that our patient had a
transient tubular defect in the thick ascending loop of Henle.

Publication Types: 
    Case Reports

PMID: 12042901 [PubMed - indexed for MEDLINE]

1237: J Endourol. 2002 May;16(4):229-31.

Topiramate-induced nephrolithiasis.

Kuo RL, Moran ME, Kim DH, Abrahams HM, White MD, Lingeman JE.

Clarian Health Partners, Methodist Hospital of Indiana and Indiana University
School of Medicine, Indianapolis, Indiana, USA. rkuo@iupui.edu

Topiramate is a recently developed antiepileptic medication that is becoming more
widely prescribed because of its efficacy in treating refractory seizures.
Urologists should be aware that this medication can cause metabolic acidosis in
patients secondary to inhibition of carbonic anhydrase. In addition, a distal
tubular acidification defect may result, thus impairing the normal compensatory
drop in urine pH. These factors can lead to the development of calcium phosphate 
nephrolithiasis. We report the first two cases of topiramate-induced
nephrolithiasis in the urologic literature.

Publication Types: 
    Case Reports

PMID: 12042105 [PubMed - indexed for MEDLINE]

1238: J Endourol. 2002 May;16(4):221-4.

Fluid absorption during percutaneous nephrolithotomy: does it matter?

Kukreja RA, Desai MR, Sabnis RB, Patel SH.

Department of Urology, Muljibhai Patel Urological Hospital, Gujarat, India.

BACKGROUND AND PURPOSE: Large amounts of irrigating fluid are used during
percutaneous nephrolithotomy (PCNL). This use may be associated with migrating
calculus debris, infection, and fluid absorption. This study evaluated the
presence of fluid absorption during PCNL, its clinical and biochemical
significance, and maneuvers to reduce it. PATIENTS AND METHODS: Fluid absorption 
during PCNL was evaluated in 148 patients by estimating the expired breath
ethanol concentration. Factors thought to affect the amount of fluid absorbed
were studied, including the amount of irrigating fluid used, the number of
nephrostomy tracts, the presence of a low-pressure system, the presence of
existing tracts, and complications such as bleeding or perforation of the
pelvicaliceal wall. RESULTS: Fluid absorption was evident in all patients,
although no patient had any clinical or biochemical evidence of intraoperative or
postoperative electrolyte imbalance. Creating a low-pressure system by using an
Amplatz sheath, reducing the amount of irrigating fluid used, and staging the
procedure significantly reduced the amount of fluid absorbed. CONCLUSIONS: Fluid 
absorption does take place during PCNL. This may be clinically significant in
patients with compromised cardiorespiratory or renal status and in pediatric
patients, leading to fluid overload. Using a low-pressure system, reducing the
nephroscopy time and the amount of irrigating fluid used, and staging the
procedure for large renal stone burdens, especially in the presence of
complications such as perforation of the pelvicaliceal system, reduces fluid
absorption and avoids volume overload. Fluid absorption may also be associated
with both infective and noninfective pyrexia, necessitating adequate preoperative
control of urinary infection.

PMID: 12042103 [PubMed - indexed for MEDLINE]

1239: J Endourol. 2002 May;16(4):215-20.

Is measurement of stone surface area necessary for SWL treatment of nonstaghorn
calculi?

Buchholz NP, Rhabar MH, Talati J.

United Lincolnshire Hospitals, Lincoln, United Kingdom. nielspeter@yahoo.com

BACKGROUND AND PURPOSE: The size of urinary tract stones is usually assessed by
the longest diameter (LD) alone. Logically, however, two-dimensional measurement 
of the stone surface area (SSA) susceptible to shockwaves would give more useful 
information for the planning of treatment by extracorporeal shockwave lithotripsy
(SWL). This has been shown for staghorn calculi. The aim of this study was to
determine for nonstaghorn kidney and ureter stones whether the LD alone
identifies as reliably a subgroup of patients with a stone of a certain size as
does the SSA. Furthermore, we sought to determine whether the LD alone indicates 
as reliably the number of patients who would be rendered stone free after one SWL
session within a certain subgroup as would the SSA. PATIENTS AND METHODS:
Retrospectively, SWL treatment and radiographic data of 330 patients who had
undergone SWL for a single stone were analyzed. RESULTS: Ureteral stones were
significantly smaller on average, and ureteral stone patients needed fewer SWL
treatment sessions and fewer shockwaves to become stone free. Stratification of
both kidney and ureteral stones by either LD or SSA resulted in comparable groups
of patients. There were no significant differences in patient, stone, or
treatment data. More importantly, the stone-free rates after one treatment did
not differ significantly. CONCLUSION: The LD does accurately reflect the size of 
a nonstaghorn kidney or ureteral stones. Therefore, the measurement of LD, as
generally practiced, appears clinically sufficient and appropriate for the
assessment of stone size prior to SWL in both kidney and ureteral stones.

PMID: 12042102 [PubMed - indexed for MEDLINE]

1240: Methods Find Exp Clin Pharmacol. 2002 Mar;24(2):77-9.

Modulatory effect of Cyclea peltata Lam. on stone formation induced by ethylene
glycol treatment in rats.

Christina AJ, Packia Lakshmi M, Nagarajan M, Kurian S.

Department of Pharmacology, K.M. College of Pharmacy, Tamil Nadu, India.
tinatina38@rediffmail.com

The inhibitory effect of the root of Cyclea peltata Lam. on nephrolithiasis
induced in rats by feeding with ethylene glycolated water (1%) for 35 days was
summarized. Ethylene glycol administration led to oxalate stone formation, as
indicated by its high level in urine. Complementary to this anion, the cation
calcium level in urine was elevated. These two ions may have contributed to the
formation of calcium oxalate stones. In addition to high serum potassium, a low
serum magnesium level contributed to stone formation. Simultaneous administration
of the powdered root of Cyclea peltata resulted in decreased urinary oxalate and 
calcium. Likewise, serum potassium was lowered and magnesium was elevated. These 
observations provided the basis for the conclusion that this plant inhibits the
stone formation induced by ethylene glycol treatment.

PMID: 12040886 [PubMed - indexed for MEDLINE]

1241: Urology. 2002 Jun;59(6):865-9; discussion 869.

Bone alterations in patients with idiopathic hypercalciuria and calcium
nephrolithiasis.

Tasca A, Cacciola A, Ferrarese P, Ioverno E, Visonà E, Bernardi C, Nobile M,
Giannini S.

Department of Urology, San Bortolo Hospital, Vicenza, Italy.

OBJECTIVES: To verify whether alterations in bone density and turnover in
patients with calcium nephrolithiasis and hypercalciuria are observable in
various subgroups of patients divided according to the pathogenesis of the
hypercalciuria. METHODS: Seventy patients with calcium nephrolithiasis and
idiopathic hypercalciuria, 19 to 64 years old, were assessed for spine and femur 
mineral metabolism and bone density using a Dexa evaluation system. After a low
calcium diet, the subjects were classified into two groups: fasting
hypercalciuria (FH, 39 patients) and absorptive hypercalciuria (AH, 31 patients).
RESULTS: Only in the patients with FH was the lumbar spine bone density lower
than in the controls (P <0.001). Also, only the patients with FH had higher bone 
alkaline phosphatase and urinary hydroxyproline levels than the control group (P 
<0.005 and <0.015, respectively). The blood pH levels were lower, even though
within the normal range, in the hypercalciuric patients than in the controls (P
<0.01). There was a negative correlation between the urinary hydroxyproline level
and lumbar spine and femoral neck density in patients with FH (P <0.001 and
<0.005, respectively), and the blood pH correlated positively with the lumbar
spine bone density. CONCLUSIONS: Altered bone metabolism and overall bone loss
were found only in the patients with FH. Overloading of acid valences, perhaps of
dietary origin, could be the pathogenic factor responsible.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12031370 [PubMed - indexed for MEDLINE]

1242: J Endourol. 2002 Apr;16(3):195-200.

Evaluation of superficial papillary ablation by endoscopic lasers in an ex vivo
kidney model.

Knoll T, Michel MS, Cueva-Martínez A, Spahn M, Bross S, Alken P, Köhrmann KU.

Department of Urology, University Hospital Mannheim, Germany.
thomas.knoll@uro.ma.uni-heidelberg.de

BACKGROUND AND PURPOSE: Endoscopic examinations of stone-forming kidneys show a
coincidence of plaques and microliths on the surface of and within papillary
epithelial tissue. These calcifications are thought to be precursors of calcium
oxalate urolithiasis. We hypothesized that minimally invasive endoscopic laser
ablation of microliths and necrotic cell layers enables epithelial regeneration
and prevents recurrent urolithiasis. The aim of this study was to determine the
most suitable laser type and dose intensity for selective superficial cell
ablation. MATERIALS AND METHODS: Conventional Nd:YAG (1-40 W) or Ho:YAG (0.5-3
J/single impulse) lasers were used endoscopically on an ex vivo blood-perfused
porcine kidney model. Defined doses were applied to the papillary surface in the 
contact and noncontact modes for 10 to 30 seconds. Papillae were excised after
treatment and histopathologically analyzed in continuous sections. Lesions were
microscopically assessed with the aid of a Leica Quantimed computer program.
RESULTS: Depending on the time and dose, vaporization by the Nd:YAG laser caused 
large tissue defects and coagulation necrosis at energy levels over 5 W (contact 
and noncontact mode). Lower energy levels with tissue contact produced only
superficial cell defects (<20 cell layers) but more extensive coagulation
necrosis, whereas no histologic effects were observed at the same energy level
without contact. In contrast, independent of delivered energy but dependent on
time, Ho:YAG laser application caused pure tissue loss without relevant
coagulation necrosis. The generation of small lesions (6-10 cell layers) without 
tissue contact was possible at energy levels under 2 J. CONCLUSIONS: Selective
superficial papillary cell ablation is possible. Low-energy Nd:YAG treatment in
the contact mode and Ho:YAG treatment in the noncontact mode led to superficial
vaporization with no (Ho:YAG) or minimum (Nd:YAG) coagulation defects.

PMID: 12028632 [PubMed - indexed for MEDLINE]

1243: J Intern Med. 2002 Jun;251(6):476-83.

Cardiovascular disease, hypertension and renal function in primary
hyperparathyroidism.

Hedbäck GM, Odén AS.

Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
g.hedback@home.se

OBJECTIVES: Patients with primary hyperparathyroidism run an increased risk of
death in cardiovascular disease. Long ago, hypertension was found to frequently
occur in these patients. The aim of this study was to compare the death risk
after surgery for hyperparathyroidism of hypertensive patients with that of
normotensive ones, and to investigate relations between variables of
cardiovascular disease and variables of hyperparathyroidism and renal function.
METHODS: A series of 845 patients with primary hyperparathyroidism and serum
creatinine <or=160 micromol L-1 was followed-up mean 10.2 (SD 5.7) years after
surgery. Survival and correlation tests were performed. Death risk was estimated 
using a hazard function according to Poisson. RESULTS: The death risk of
hypertensive hyperparathyroid patients was 50% higher compared with that of the
normotensive patients, but the yearly death risk decrease after surgery for the
hypertensive patients was almost doubled as compared with the decrease of the
normotensive patients. Cardiovascular disease was directly related to serum
calcium level, adenoma weight, osteitis fibrosa, and serum creatinine, and
inversely related to glomerular filtration rate and urine osmolality, but
unrelated to the symptom variables. A negative relation was found between
cardiovascular disease and renal stone disease. CONCLUSIONS: It can be concluded 
that cardiovascular disease is more a part of primary hyperparathyroidism than
just associated with it, being related to both serum calcium and adenoma weight. 
There was also a relationship between cardiovascular disease and decreased renal 
function. Death risk decrease after surgery was rather more pronounced for the
hypertensive patients compared with the normotensive ones.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 12028502 [PubMed - indexed for MEDLINE]

1244: J Nephrol. 2002 Mar-Apr;15(2):158-64.

Polymorphism of vitamin D receptor gene start codon in patients with calcium
kidney stones.

Vezzoli G, Soldati L, Proverbio MC, Adamo D, Rubinacci A, Bianchi G, Mora S.

Division of Nephrology Dialysis and Hypertension, San Raffaele Scientific
Institute, Milan, Italy. vezzoli.giuseppe@hsr.it

BACKGROUND: A linkage has been detected between vitamin D receptor (VDR) locus
and calcium kidney stone disease. In order to assess the eventual role of VDR
gene start codon polymorphisms in stone production, we analyzed the
genotype-phenotype association in a group of patients with calcium kidney stones.
METHODS: One hundred and fifty-five patients were studied. VDR genotypes were
characterized at the translation start site by restriction fragment length
polymorphism analysis, using endonuclease FokI. Phenotypes of calcium-phosphate
metabolism were compared in patients with different genotypes: strontium enteral 
absorption (used as a surrogate marker for calcium absorption), bone mineral
density (BMD), calcium and phosphate excretion were measured. RESULTS: Genotype
distribution was not different in hypercalciuric and normocalciuric stone
formers. Enteral strontium absorption, calcium excretion and BMD did not vary
with the patient's genotype. Serum concentrations of phosphate (p=0.022) and
renal threshold for phosphate excretion (p=0.026) were lower in patients with
genotype FF (homozygous for the absence of the FokI site) than in those with
genotype ff (homozygous for the presence of the FokI site). The lower
phosphatemia was confirmed in FF hypercalciuric patients, but not in
normocalciuric ones. Serum concentrations of phosphate and calcitriol in the
group of hypercalciuric patients were inversely correlated with the genotype FF. 
CONCLUSIONS: The FokI genotype does not appear to be involved in the causes of
idiopathic hypercalciuria and kidney stones. Hypercalciuric patients with FF
genotype may be a subgroup with low plasma concentrations of phosphate,
predisposed to tubular leakage of phosphate.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12018632 [PubMed - indexed for MEDLINE]

1245: BJU Int. 2002 Jun;89(9):835-41.

Risk factors for developing renal stones in inflammatory bowel disease.

McConnell N, Campbell S, Gillanders I, Rolton H, Danesh B.

Biochemistry Department and Gastroenterology Unit, Stobhill Hospital, Glasgow,
UK. niel.mcconnell@northglasgow.scot.nhs.uk

OBJECTIVE: To correlate renal calculi and other clinical factors with urinary
biochemical analytes in patients with inflammatory bowel disease, and to
investigate the relative importance of hyperoxaluria (associated with fat
malabsorption) or reduced stone inhibitors in the development of calculi in these
patients. PATIENTS, SUBJECTS AND METHODS: Samples were obtained from 25 patients 
with Crohn's disease (CD), 15 with ulcerative colitis (UC) and 17 normal subjects
(controls). Evidence for the presence of renal calculi was obtained from plain
films, ultrasonography or intravenous urography. Urine oxalate and citrate were
analysed using commercial enzymatic assays; magnesium was measured using atomic
absorption and other analytes assayed using standard methods on automated
analysers. RESULTS: Renal calculi were found in two patients with CD and in none 
with UC. Hyperoxaluria was present in 36% of patients with CD but was absent in
those with UC. Analysis of covariance showed an association between low urinary
citrate/creatinine ratio and renal stones (P=0.02), and between a combined
urinary citrate and magnesium deficit relative to calcium, as expressed in the
CMC index ((citratexmagnesium)/calcium), and renal stones (P=0.017). Changes in
urinary calcium, oxalate, urate, magnesium or the calcium oxalate index were not 
associated with the presence of stones. There was no independent relationship
between any clinical factor and the presence of stones. CONCLUSION: Lower urinary
concentrations of magnesium and citrate (stone inhibitors), relative to calcium
(stone promoter; the CMC index) may be more important in lithogenesis in
inflammatory bowel disease than is hyperoxaluria. In patients with a functioning 
colon, a low CMC index may predict likely stone-formers; this requires a
prospective evaluation. Avoiding low urinary levels of magnesium and citrate may 
aid in preventing and treating renal calculi.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial

PMID: 12010224 [PubMed - indexed for MEDLINE]

1246: BJU Int. 2002 Jun;89(9):829-34.

The effect of Phyllanthus niruri on urinary inhibitors of calcium oxalate
crystallization and other factors associated with renal stone formation.

Freitas AM, Schor N, Boim MA.

Nephrology Division, Universidade Federal de São Paulo, Escola Paulista de
Medicina, São Paulo, Brazil.

OBJECTIVE: To evaluate the effect of an aqueous extract of Phyllanthus niruri
(Pn), a plant used in folk medicine to treat lithiasis, on the urinary excretion 
of endogenous inhibitors of lithogenesis, citrate, magnesium and
glycosaminoglycans (GAGs). MATERIALS AND METHODS: The effect of chronic (42 days)
administration of Pn (1.25 mg/mL/day, orally) was evaluated in a rat model of
urolithiasis induced by the introduction of a calcium oxalate (CaOx) seed into
the bladder of adult male Wistar rats. The animals were divided into four groups:
a sham control (16 rats); a control+Pn (six); CaOx+water instead of Pn (14); and 
CaOx+Pn (22). Plasma and urine were collected after 42 days of treatment for
biochemical analysis and the determination of urinary excretion of citrate,
magnesium and GAGs. The animals were then killed and the calculi analysed.
RESULTS: The creatinine clearance or urinary and plasma concentrations of Na+,
K+, Ca2+, oxalate, phosphate and uric acid were unaffected by Pn or the induction
of lithiasis. Treatment with Pn strongly inhibited the growth of the matrix
calculus and reduced the number of stone satellites compared with the group
receiving water. The calculi were eliminated or dissolved in some treated animals
(three of 22). The urinary excretion of citrate and magnesium was unaffected by
Pn treatment. However, the mean (sd) urinary concentration of GAGs was
significantly lower in rats treated with CaOx+Pn, at 5.64 (0.86) mg/g creatinine,
than when treated with CaOx + water, at 11.78 (2.21) mg/g creatinine. In
contrast, the content of GAGs in the calculi was higher in the CaOx + Pn rats, at
48.0 (10.4) g/g calculus, than in the CaOx + water group, at 16.6 (9.6) g/g
calculus. CONCLUSION: These results show that Pn has an inhibitory effect on
crystal growth, which is independent of changes in the urinary excretion of
citrate and Mg, but might be related to the higher incorporation of GAGs into the
calculi.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12010223 [PubMed - indexed for MEDLINE]

1247: Clin Chem Lab Med. 2002 Mar;40(3):266-77.

Oxypurines, protein, glucose and the functional state of blood vasculature are
markers of renal calcium stone-forming processes? Observations in men with
idiopathic recurrent calcium urolithiasis.

Manoharan M, Schwille PO.

Mineral Metabolism and Endocrine Research Laboratory, Department of Surgery,
University of Erlangen, Germany.

In idiopathic calcium urolithiasis the relationships between oxypurines,
accompanying proteins and glucose in urine and plasma, and the associated
metabolic activity (MA) are unknown. To establish whether MA is related to these 
parameters and to calcium oxalate crystallization, or whether it reflects a
reaction of metabolism to systemic insults was the major goal of the work. One
hundred fifty one males were studied in three trials: trial 1 (n=130 patients)
and trial 2 (n=24 patients) were cross-sectional; trial 3 included 11 patients
and 14 controls). Mean age was 46 years (trials 1 and 2) and 29 years (trial 3). 
In trial 1 the stratification was based on the median urinary oxypurine
excretion, in trial 2 on the median plasma oxypurine concentration (below or
above: Low and High subgroups). No dietary restrictions were imposed, but
standardized ambulatory laboratory testing was carried out. MA was quantitated by
a score. Established analytical methods were used, except for oxypurine
measurement which was done by high performance liquid chromatography. Patients
with kidney stones tended to be overweight (body mass index >25 kg/(m)2) and to
have fasting hyperglycemia. In trial 1 severe oxypurinuria, and especially severe
xanthinuria, was associated with an increase in urinary pH, creatinine clearance,
proteins, uric acid, malonedialdehyde (indicator of lipid peroxidation), systolic
blood pressure, and with a decrease in plasma uric acid (synonymous with a
decrease of antioxidant capacity). Tubular reabsorption of proteins and
stone-forming substances was diminished but MA remained unchanged despite
slightly increased calcium oxalate crystal growth. In trial 2 high adenosine and 
xanthine coincided with elevated systolic and diastolic blood pressure, high uric
acid with high urinary malonedialdehyde, high summed oxypurines minus uric acid
with an increase of diastolic blood pressure, glycemia and MA; urinary nitrate
(indicator of systemic vasodilation) was unchanged. In trial 3 patients'
oxypurinemia and proteinuria were normal, but body mass index, glycemia and
insulinemia were increased. Urinary total protein, albumin and non-albumin
proteins were positively predicted (multivariate regression analysis) by urinary 
xanthine, glucose and pH (trial 1); MA was positively (trial 3) or negatively
(trial 2) predicted by urinary total protein. In calcium urolithiasis, a disorder
of affluence, 1) oxypurinuria and proteinuria and oxypurinemia and MA appear
causally linked, presumably via oxidant/antioxidant imbalance-induced renal
tissue damage; 2) urinary proteins may act as inhibitors or promoters of
stone-forming processes; 3) a stone-initiating role of impaired vasodilatation is
conjectural; 4) overweight, obesity, mild glucosuria and hyperdynamic blood
circulation are regular signs.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 12005217 [PubMed - indexed for MEDLINE]

1248: Urology. 2002 May;59(5):662-7.

Follow-up functional radiographic studies are not mandatory for all patients
after ureteroscopy.

Bugg CE Jr, El-Galley R, Kenney PJ, Burns JR.

Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama
35294-3296, USA.

OBJECTIVES: To evaluate the usefulness of follow-up radiographic studies after
ureteroscopy by retrospective chart review. METHODS: We reviewed the charts of
118 patients who underwent 134 ureteroscopic procedures from January 1998 to
November 1999. RESULTS: Follow-up was obtained at our institution for 87
patients. The follow-up period ranged from 3 to 34 weeks (mean 7, SE +/- 0.75).
Of 10 patients who underwent ureteroscopy for diagnostic purposes, none had
postoperative pain or obstruction on follow-up radiographic studies. Of 77
patients who underwent ureteroscopy for calculi, 12 (16%) had postoperative
obstruction. One third of patients with residual obstruction (4 of 12) complained
of persistent pain versus 6% of patients without evidence of obstruction (4 of
65) (P = 0.02). Twelve patients had residual stone fragments on their follow-up
radiographic studies; 5 (42%) of these patients complained of pain versus 3 (5%) 
of 65 patients who were stone free after surgery (P = 0.002). The use of pain to 
predict either obstruction or residual fragments had a negative and positive
predictive value of 83% and 75%, respectively. Preoperative obstruction and
postoperative pain were combined as one indicator for the presence of residual
fragments and postoperative obstruction. Patients who had preoperative
obstruction and presented with postoperative pain had a 67% chance of having
residual fragments and a 50% chance of residual obstruction, and 96% of patients 
without preoperative obstruction and no postoperative pain had no persistent
obstruction or residual fragments (P = 0.001). CONCLUSIONS: For patients who
present for ureteroscopy with no obstruction and report no pain at follow-up, a
plain radiograph may be sufficient. For patients who present with obstruction and
report pain during follow-up, functional imaging studies are recommended.

PMID: 11992836 [PubMed - indexed for MEDLINE]

1249: J Urol. 2002 Jun;167(6):2594-7.

In vitro study of ultrasound based real-time tracking for renal stones in shock
wave lithotripsy: Part II--a simulated animal experiment.

Chang CC, Manousakas I, Pu YR, Liang SM, Chen CH, Chen TS, Yu FM, Yang WH, Tong
YC, Kuo CL.

Department of Urology, Institute of Biomedical Engineering, National Cheng Kung
University and Hospital, Tainan, Taiwan, Republic of China.

PURPOSE: We have previously developed and reported an ultrasound based real-time 
tracking system for renal stones. In the current study we continued to verify the
reliability of this tracking system by a simulated animal test. MATERIALS AND
METHODS: We used 13 prerecorded ultrasound stone trajectories to test the system.
The real-time tracking system was implemented on the Litemed 9200
electrohydraulic lithotriptor (LiteMed Co., Taipei, Taiwan). An artificial stone 
and tap water were sealed in a balloon. The balloon was inserted into the pelvis 
of a pig kidney. While the kidney was affixed to and moved by a simulator, it was
immersed in a specifically designed simulated animal model tank containing tap
water. The stone was localized by ultrasound. The kidney was moved by the
simulator according to a prerecorded stone trajectory. A total of 3,000 shock
waves were delivered to the stone. For each recorded stone trajectory experiments
were done under nontracking and tracking conditions. We performed tests of the
fragment-to-weight ratio, which denotes the performance of a shock wave
lithotriptor when fragmenting a stone. RESULTS: The mean fragment-to-weight ratio
was 55.3% +/- 25.9% in the nontracking and 100% +/- 0% in the tracking group. The
difference in these 2 groups was statistically significant (paired t test p
<0.01). CONCLUSIONS: The ultrasound based real-time tracking system proved to
improve the performance of a shock wave lithotriptor significantly when
fragmenting stones in a simulated animal test. We believe that the tracking
system would greatly reduce the number of shocks and time needed for treating
renal stones.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 11992093 [PubMed - indexed for MEDLINE]

1250: J Urol. 2002 Jun;167(6):2584-93.

Changes in the oxidant-antioxidant balance in the kidney of rats with
nephrolithiasis induced by ethylene glycol.

Huang HS, Ma MC, Chen J, Chen CF.

Department of Urology, National Taiwan University Hospital, College of Medicine, 
National Taiwan University, Taipei, Taiwan, Republic of China.

PURPOSE: We investigated the possible mechanism of increased free radicals, the
role of antioxidant enzymes and their correlation with renal tubular damage in
the kidney after feeding 0.75% ethylene glycol to male Wistar rats. MATERIALS AND
METHODS: Rats were divided into 7 experimental groups according to the duration
of ethylene glycol feeding (1, 3, 5, 7, 9, 21 or 42 days) and into age matched
control groups. Chemiluminescence levels were examined in blood samples (renal
artery and vein) and in the kidney. The activities of oxidase and antioxidant
enzymes were measured in kidney homogenates. The nitroblue tetrazolium perfusion 
method and immunohistochemical stains with ED1 and CD45 were performed. Urinary
levels of alpha and mu-glutathione S-transferase (GST) were also measured and
expressed in gm. urinary creatinine. RESULTS: Chemiluminescence levels of renal
venous blood samples were elevated on days 1, 3 and 7 (p <0.05), and those of the
kidney were elevated only on days 3 and 42 (p <0.05) compared with controls. The 
infiltration of CD45 positive cells in the kidney increased on day 7 and a
further increase in these positive cells was noted on day 21. Fused ED1 positive 
cells surrounding the calcium oxalate crystals and adjacent to the nitroblue
tetrazolium positive area were found on day 42. Xanthine oxidase activity showed 
no significant change, whereas nicotinamide adenine dinucleotide dependent
oxidase activity was higher on day 5 and nicotinamide adenine dinucleotide
phosphate dependent activity was elevated in all experimental groups (p <0.05).
The activities of catalase and manganese superoxide dismutase were elevated in
the early stage. On day 42 almost all antioxidant enzyme activities were
attenuated (p <0.05) except that of catalase. The urinary levels of alpha-GST
were elevated from day 7 until day 42, whereas levels of mu-GST were elevated
from day 3 until day 42 except day 5. CONCLUSIONS: The possible mechanism that
causes free radical elevation in the kidney may be different in the course of
nephrolithiasis after ethylene glycol treatment. Initially the systemic
circulation may bring the toxic substance into the kidney and cause it to produce
free radicals. In the late stage gradually infiltrating leukocytes and decreased 
antioxidant enzyme activities may cause the kidney to remain under excessive
oxidative stress.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11992092 [PubMed - indexed for MEDLINE]

1251: J Urol. 2002 Jun;167(6):2377-9.

Comment in:
    J Urol. 2003 Jan;169(1):292-3.

Bare naked baskets: ureteroscope deflection and flow characteristics with intact 
and disassembled ureteroscopic nitinol stone baskets.

Landman J, Monga M, El-Gabry EA, Rehman J, Lee DI, Bhayani S, Sundaram CP,
Clayman RV.

Division of Urology, Department of Radiology, Mallinckrodt Institute of
Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.

PURPOSE: Lower pole renal access during flexible ureterorenoscopy is often
limited by the active deflection capabilities of the ureteroscope. Deterioration 
in the deflection and flow capabilities of ureteroscopes occurs with the passage 
of instrumentation through the working channel. We performed in vitro evaluation 
of a novel technique using unsheathed nitinol baskets to minimize the
deterioration in deflection and maximize the irrigant flow associated with
instrument passage through the working channel during flexible ureterorenoscopy. 
MATERIALS AND METHODS: Alterations in the irrigant flow and active deflection of 
4 ureteroscopes from different manufacturers were evaluated. Each ureteroscope
was evaluated with an empty working channel, and then with sheathed and
unsheathed 2.2, 3 and 3.2Fr (Cook Urological, Inc., Indianapolis, Indiana), 2.4
and 3Fr (Microvasive Urology, Natick, Massachusetts) nitinol baskets in the
working channel. RESULTS: With all baskets tested and in all ureteroscopes the
deterioration in active deflection and irrigant flow was improved with the
unsheathed baskets. The disassembled basket within the working channel allowed an
additional 15 to 20 degrees of active deflection. In addition, the disassembled
basket allowed for a 2 to 30-fold increase in irrigant flow compared with an
intact basket. CONCLUSIONS: The combination of improved deflection and irrigant
flow with this technique may improve ureteroscopic access to lower pole renal
calculi.

Publication Types: 
    In Vitro

PMID: 11992041 [PubMed - indexed for MEDLINE]

1252: J Urol. 2002 Jun;167(6):2372-6.

Influence of gender and age on calcium oxalate crystal growth inhibition by urine
from relatives of stone forming patients.

Bergsland KJ, Kinder JM, Asplin JR, Coe BJ, Coe FL.

University of Chicago and LithoLink Corp., Chicago, Illinois, USA.

PURPOSE: We define the relationships between urine inhibition of calcium oxalate 
crystal growth and age, gender, urine chemistries and stone formation among
relatives of calcium stone forming patients. MATERIALS AND METHODS: We collected 
24-hour urine samples from 366 first degree relatives of calcium stone formers.
Calcium oxalate crystal growth inhibition was studied using a constant amount of 
dialyzed urine protein in a seeded crystallization system. Standard stone risk
measurements were also performed on the urine, including supersaturation for
calcium oxalate, calcium phosphate and uric acid. RESULTS: By multivariate
analysis crystal growth inhibition is strongly inversely related to the amount of
protein excreted per day, and the age of the subject. When corrected for protein 
excretion and age, urine proteins from nonstone forming male subjects inhibited
crystal growth more strongly than those from corresponding female subjects. Among
stone formers the sex difference was not present. CONCLUSIONS: Inhibition of
calcium oxalate crystal growth is influenced by a complex combination of gender, 
age, stone formation and assay conditions. The effect of daily protein excretion 
is most likely a consequence of using a fixed amount of urine protein per assay. 
The influence of age is significant and unexplained, with the urine of young
people (less than 20 years) demonstrating a vigorous ability to inhibit
crystallization. In addition, the urine of nonstone forming male relatives
appears to have a greater ability to inhibit crystallization than that of
nonstone forming female relatives. Further use of this assay in clinical
investigations must take age and gender into proper account.

Publication Types: 
    In Vitro
    Research Support, U.S. Gov't, P.H.S.

PMID: 11992040 [PubMed - indexed for MEDLINE]

1253: Int Urol Nephrol. 2001;32(4):597-9.

Combined treatment of immobilization staghorn stones in 14-year old boy.

Slavković A, Vlajković M, Radovanović M, Sirić Z, Stefanović V.

Clinic of Pediatric Surgery, Faculty of Medicine, Nis, Yugoslavia.

We report a combined urologic treatment of bilateral staghorn stones, developed
in a boy after prolonged immobilization for limb fractures. He underwent
percutaneous nephrostolithotomy (PCNL) on the left side, and after three months
pyelolithotomy and nephrolithotomy for stasis in the right kidney, followed by
ESWL for residual calculus in the left ureter. He becomes stone free, with
apparently normal kidney function.

Publication Types: 
    Case Reports

PMID: 11989548 [PubMed - indexed for MEDLINE]

1254: Int J Urol. 2002 Jan;9(1):11-4.

Extracorporeal shock wave lithotripsy produces a lower stone-free rate in
patients with stones and renal cysts.

Deliveliotis C, Argiropoulos V, Varkarakis J, Albanis S, Skolarikos A.

University of Athens, Second Department of Urology, Sismanoglion Hospital,
Greece. nikistra@hol.gr

BACKGROUND: Renal cysts have a space-occupying effect and therefore can distort
the pelvicalyceal anatomy. This distortion often produces abnormalities in normal
urinary drainage. In the same way, it may effect the ability of the kidneys to
become stone free after extracorporeal shock wave lithotripsy (ESWL). The purpose
of the current study is to evaluate the effect of renal cysts on the outcome of
ESWL. METHODS: We studied 15 patients who had renal stones and coexistent renal
cysts. Four patients had polycystic disease, five patients had multiple cysts and
six patients has solitary ones. All cysts produced a distortion to the calyceal
system of the kidneys, a fact confirmed by intravenous urography (IVU) and
computed tomography (CT). All patients underwent ESWL and their stone-free status
was evaluated 1 month later by ultrasound and plain kidney ureter bladder (KUB)
X-ray. RESULTS: We had a total 60% (9/15) stone-free patients in our study group 
and a stone fragmentation rate of 100%. Patients with more cysts had lower
stone-free rates. Patients with polycystic kidneys had a 25% (1/4) stone-free
rate, while patients with multiple cysts and solitary cysts had, 60% (3/5) and
83.3% (5/6), respectively. These results are lower than the rates reported in
patients without renal cysts. CONCLUSIONS: We believe that renal cysts may
interfere with the passage of stone fragments, due to the impediment of drainage 
and urinary stasis from the stretching and distortion of the calyceal system by
the renal cysts.

PMID: 11972643 [PubMed - indexed for MEDLINE]

1255: BJU Int. 2002 May;89(7):653-7.

Re-auditing a regional lithotripsy service.

Parkin J, Keeley FX Jr, Timoney AG.

Department of Urology, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB,
UK. jkparkin@hotmail.com

OBJECTIVE: To assess, in a repeat audit of a regional lithotripsy service,
whether changes implemented after a regional audit in 1994 (which showed
disappointing results from shock wave lithotripsy, attributable to both poor
patient selection and an inadequate fixed-site lithotripter) have had any effect.
PATIENTS AND METHODS: A data-collection sheet was devised to gather information
on the site, size and number of stones treated, together with information on the 
lithotripsy treatment and outcome. Patients selected for the audit were the first
50 new patients treated with lithotripsy at each centre in 1999. As only one
hospital has a fixed-site lithotripsy machine, the results of mobile lithotripsy 
were grouped by machine for analysis. RESULTS: There was an overall improvement
in patient selection from the previous audits. Few stones of > 16 mm or < 4 mm
were treated. Two units treated more ureteric stones, thought to reflect first
the influence of a fixed-site lithotripter, and second a willingness to insert a 
ureteric stent and await the next mobile lithotripter visit. The stone free rates
were all disappointingly low (16.7-26.7%) but the results improved when fragments
of < 4 mm were included as "successful" giving an "overall success rate" of
45.9-66.7%. The unit with a fixed-site lithotripter appeared to perform better
(two-thirds successful) than the mobile machines (Modulith SLX, 51%; Modulith
SLK, 46%). One centre visited by both mobile machines had a success rate of 65%
but a high rate of auxiliary procedures (35% vs 16-19% vs the fixed-site).
CONCLUSION: Although these results show some improvement in patient selection for
our regional lithotripsy service, stone-free and success rates are poorer than
those reported elsewhere. This may reflect the modern lithotripsy machines that
allow day-case treatment with minimal analgesia, and confirms reports by other
authors who encourage a re-examination of success rates of shock wave
lithotripsy.

Publication Types: 
    Multicenter Study

PMID: 11966620 [PubMed - indexed for MEDLINE]

1256: J Endourol. 2002 Mar;16(2):75-8.

Percutaneous nephrolithotomy in the management of pediatric renal calculi.

Zeren S, Satar N, Bayazit Y, Bayazit AK, Payasli K, Ozkeçeli R.

Department of Urology, Cukurova University, Faculty of Medicine, Adana, Turkey.
szeren@mail.cu.edu.tr

BACKGROUND AND PURPOSES: In the era of extracorporeal shockwave lithotripsy
(SWL), there are still some patients who will require percutaneous
nephrolithotomy (PCNL). Our experience with this procedure is reviewed and
discussed. PATIENTS AND METHODS: Fifty five patients with a mean age of 7.9 years
(10 months-14 years) underwent 67 PCNL procedures on 62 renal units between
September 1997 and April 2001. Of the patients, 13 had previous open renal
surgery, 4 had a solitary kidney, 4 were SWL failures, 2 had osteogenesis
imperfecta, one had anuria secondary to bilateral calculi, 2 had poorly
functioning kidneys, and 1 had cystinuria (complete staghorn calculus). One
disabled patient with neurologic disorders who had multiple stones underwent PCNL
in order to decrease the stone burden and to improve the kidney function.
Operations were performed under the guidance of monoplane fluoroscopy. Pneumatic 
or ultrasonic lithotripsy and forceps extraction were used with a rigid
nephroscope or ureteroscope (as an alternative instrument in small-caliber
tracts). RESULTS: Excluding the patient with neurologic disorders, 53 of the
renal units (86.9%) were stone free at the time of discharge, and the success
rate was 96.7%, with six patients having insignificant residual fragments after
the procedure. In one patient, open surgery was required, and the other patient
was sent for SWL treatment. There was no contiguous organ injury, but in 16
procedures (23.9%), intraoperative hemorrhage was seen, and blood transfusions
were required. CONCLUSION: Pediatric urolithiasis is usually a result of
metabolic abnormalities and urinary tract infection, and there is always a risk
of recurrence that may necessitate multiple additional intervention. Therefore,
PCNL must be considered in selected cases by urologists who are experienced in
adult percutaneous procedures.

PMID: 11962558 [PubMed - indexed for MEDLINE]

1257: J Urol. 2002 May;167(5):2192-7.

Decreased renal expression of the putative calcium oxalate inhibitor
Tamm-Horsfall protein in the ethylene glycol rat model of calcium oxalate
urolithiasis.

Marengo SR, Chen DH, Kaung HL, Resnick MI, Yang L.

Jim and Eilleen Dicke Research Laboratory, Department of Urology and Anatomy,
School of Medicine, Case Western Reserve University-University Hospitals of
Cleveland, Cleveland, Ohio, USA.

PURPOSE: Tamm-Horsfall protein is believed to inhibit calcium oxalate
crystallization, aggregation or adhesion to the renal epithelium. We determined
whether ethylene glycol induced urolithiasis changes the expression of renal and 
urinary Tamm-Horsfall protein. For comparison the expression of another calcium
oxalate inhibitor, osteopontin, was also analyzed. MATERIALS AND METHODS: Male
rats were treated with 0.75% ethylene glycol plus an AIN-76 diet (Dyets,
Bethlehem Pennsylvania) (ethylene glycol group) or standard rat chow and water
(control group) for up to 8 weeks (6 per group for 8 weeks and 3 per group for 3 
days to 6 weeks). Kidneys and urine (8 weeks only) were harvested and analyzed by
Northern and Western blot analysis, and immunohistochemistry. RESULTS:
Tamm-Horsfall protein message and protein (membrane bound form) were decreased,
while those of osteopontin were increased in the kidneys of rats treated with
ethylene glycol for 8 weeks. As judged by immunochemistry Tamm-Horsfall protein
and osteopontin were consistently present in a few tubules in rats in the
ethylene glycol and control groups, respectively. In urine expression of the free
form of Tamm-Horsfall protein (approximately 75 kDa.) was decreased but
detectable in ethylene glycol treated rats. Although readily detected in tissue, 
osteopontin was not detected in the urine of control or ethylene glycol treated
rats. In the time course experiment Tamm-Horsfall protein did not decrease until 
4 weeks, when calcium oxalate crystals were detectable in the kidneys of treated 
rats. In contrast, osteopontin was increased, although inconsistently, beginning 
at 3 days. CONCLUSIONS: Unlike other calcium oxalate inhibitors, such as
osteopontin, renal message and protein for Tamm-Horsfall protein was decreased in
ethylene glycol treated rats. Tamm-Horsfall protein expression did not decrease
until aggregates of crystals had been deposited in the kidneys, while osteopontin
expression began to increase almost immediately. Comparisons of the data on
kidneys and urine obtained by RNA or protein blot analysis and immunochemistry
underscore the need to examine tissue and urine by multiple techniques to obtain 
the most accurate assessment of how protein expression is changed by a given
treatment.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11956477 [PubMed - indexed for MEDLINE]

1258: J Urol. 2002 May;167(5):2188-91.

Association of vitamin D receptor gene polymorphism with urolithiasis.

Nishijima S, Sugaya K, Naito A, Morozumi M, Hatano T, Ogawa Y.

Department of Urology, University of the Ryukyus, Okinawa, Japan.

PURPOSE: Recent studies suggest that allelic variations of the vitamin D receptor
(VDR) gene can influence calcium absorption and excretion. Therefore, we studied 
the association of VDR gene polymorphism with urolithiasis. SUBJECTS AND METHODS:
We studied 83 patients with urinary stones and 83 controls. Patients were scored 
for certain clinical characteristics, including long axis diameter of the largest
stone (1 point-less than 10 mm. and 2-10 mm. or greater), number of stones (1
point-1 and 2-multiple) and history of calcium stone disease (1 point-absent and 
2-present). They were classified into 3 groups according to the total score,
including low-3, intermediate-4 or 5 and high-6 points. The 2 VDR gene
polymorphisms TaqI and ApaI were detected by polymerase chain
reaction-restriction fragment length polymorphism and their relationships with
the urinary calcium level were examined. RESULTS: The incidence of TaqI Tt and tt
genotypes was significantly higher in the high score group than in controls. The 
TaqI t allele was associated with a 5.2-fold increase in the risk of severe stone
disease. The urinary calcium level in patients with the Tt and tt genotypes was
also higher than in those with the TT genotype. The rate of the ApaI genotype was
not different in the high score group and controls. CONCLUSIONS: The TaqI t
allele of the VDR gene may be a risk factor for severe stone disease and
recurrent stones.

PMID: 11956476 [PubMed - indexed for MEDLINE]

1259: J Urol. 2002 May;167(5):2164-6.

Extracorporeal shock wave lithotripsy in children.

Rodrigues Netto N Jr, Longo JA, Ikonomidis JA, Rodrigues Netto M.

Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.

PURPOSE: We analyzed the efficacy of extracorporeal shock wave lithotripsy in
children. MATERIALS AND METHODS: Between 1987 and 2000, 15,423 patients with
urinary calculi were treated at our institution, of whom 86 (0.56%) children 3 to
14 years old underwent lithotripsy using the Siemens Lithostar Plus (Siemens
Medical Systems, Iselin, New Jersey). A total of 121 calculi in 90 urinary tracts
were treated requiring 149 extracorporeal shock wave lithotripsy sessions. The
stones were caliceal in 62 cases, renal pelvic in 35, ureteral in 18 and staghorn
in 6. Followup consisted of nephrotomogram or ultrasound 1 day and 1 to 3 months 
postoperatively. RESULTS: Complete removal of all stone fragments was achieved in
97.6% of the stones after 3 months. Re-treatment was necessary in 24 patients
(27.9%). All patients were treated as outpatients with intravenous sedation in 54
(62.8%), general anesthesia in 13 (15.1%) and no anesthesia in 19 (22.1%).
Complications were present in 8 patients (10.7%) who had colic and received
medical treatment followed by uneventful recovery. CONCLUSIONS: Extracorporeal
shock wave lithotripsy using the Lithostar Plus has been demonstrated to be an
effective noninvasive procedure to treat radiopaque and even radiolucent or
slightly opaque urinary calculi in children.

Publication Types: 
    Festschrift

PMID: 11956471 [PubMed - indexed for MEDLINE]

1260: J Urol. 2002 May;167(5):1985-8.

The Dretler stone cone: a device to prevent ureteral stone migration-the initial 
clinical experience.

Desai MR, Patel SB, Desai MM, Kukreja R, Sabnis RB, Desai RM, Patel SH.

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.

PURPOSE: Retrograde stone migration during ureteroscopic lithotripsy occurs in 5%
to 40% of proximal and distal ureteral stone cases. This migration increases
morbidity and the need for auxiliary procedures. The Dretler stone cone
(Medsource, Norwell, Massachusetts) is a novel device to prevent proximal stone
migration and facilitate fragment extraction during ureteroscopic lithotripsy. We
assessed the safety and efficacy of the Dretler stone cone in the clinical
setting and compared it prospectively with a conventional flat wire basket during
ureteroscopy for ureteral calculi. MATERIALS AND METHODS: To our knowledge we
report the initial clinical use of the Dretler stone cone in 50 consecutive
patients with ureteral calculi undergoing ureteroscopic extraction. Calculi were 
situated above the sacroiliac joint in 24 cases, over the sacroiliac joint in 15 
and below the sacroiliac joint in 11. Pneumatic lithotripsy was done in 42 cases.
In the remaining 8 cases ureteroscopic (3) or fluoroscopic (5) intact stone
extraction was performed. The later 23 cases using the Dretler stone cone were
prospectively compared with 20 of ureteroscopic intracorporeal lithotripsy using 
a standard flat wire basket. RESULTS: The Dretler stone cone was successfully
placed in all 50 cases. In 41 patients it was placed via cystoscopy under
fluoroscopic guidance, while 9 impacted stones required ureteroscopic placement. 
Six patients in whom the Dretler stone cone was used had residual fragments less 
than 3 mm. No patient required auxiliary procedures. In the prospective trial no 
patients in Dretler stone cone group had residual fragments greater than 3 mm. or
required auxiliary procedures. However, in the flat wire basket group residual
stones greater than 3 mm. were present in 6 cases (30%, p <0.001), while
auxiliary procedures were required in 4 (20%, p <0.01). CONCLUSIONS: The Dretler 
stone cone represents a new generation of basketry that minimizes proximal
ureteral stone migration and allows safe extraction of fragments during
ureteroscopic lithotripsy. In our experience it is associated with a lower
incidence of significant residual fragments and fewer auxiliary procedures than
conventional flat wire baskets.

PMID: 11956424 [PubMed - indexed for MEDLINE]

1261: J Urol. 2002 May;167(5):1981-3.

A randomized outcomes trial of ureteral stents for extracorporeal shock wave
lithotripsy of solitary kidney or proximal ureteral stones.

Chandhoke PS, Barqawi AZ, Wernecke C, Chee-Awai RA.

Divisions of Urology and Renal Diseases, University of Colorado Health Sciences
Center, Denver, Colorado, USA.

PURPOSE: Routine use of ureteral stents before extracorporeal shock wave
lithotripsy of kidney stones between 10 and 20 mm. is controversial. We conducted
a prospective randomized clinical trial to evaluate the outcome of ureteral
stents for treating solitary kidney stones between 10 and 20 mm. or solitary
proximal ureteral stones less than 20 mm. with shock wave lithotripsy. MATERIALS 
AND METHODS: A total of 97 patients who met the aforementioned criteria were
randomized between March 1994 to July 1997 into group 1-no stent, group 2-a 4.7Fr
multi-length stent and group 3-a 7Fr multi-length stent. The patients were
treated with the Dornier HM3 lithotriptor (Dornier Medical Systems, Inc.,
Marietta, Georgia) and monitored for stone-free rate, number of days lost from
work, number of patients requiring rehospitalization, emergency room visits,
irritative voiding symptom score and pain symptom score. RESULTS: Objective
outcome was obtained from 91 patients based on a followup of at least 3 months.
The overall stone-free rate was 80%, with a re-treatment rate of 7%. The number
of days lost from work was approximately 2, with no significant differences among
individual groups or subgroups. The hospitalization rate and number of emergency 
room visits in group 1 (22%) were statistically higher compared to groups 2 (7%) 
and 3 (7%). The irritative voiding symptom score was statistically higher in the 
stented groups 2 and 3 compared to the nonstented group 1. CONCLUSIONS: Although 
ureteral stents are associated with more irritative symptoms, their use resulted 
in fewer hospital readmissions and emergency room visits compared to when no
stent was used to treat solitary kidney stones of 10 to 20 mm. or solitary
proximal ureteral stones less than 20 mm. Size 4.7Fr stents may be preferable
over 7Fr stents when used in conjunction with shock wave lithotripsy.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 11956422 [PubMed - indexed for MEDLINE]

1262: J Urol. 2002 May;167(5):1968-71.

Computerized tomography attenuation value of renal calculus: can it predict
successful fragmentation of the calculus by extracorporeal shock wave
lithotripsy? A preliminary study.

Joseph P, Mandal AK, Singh SK, Mandal P, Sankhwar SN, Sharma SK.

Department of Urology, Postgraduate Institute of Medical Education and Research, 
and MRI and CT Scan Centre, Chandigarh, India.

PURPOSE: We evaluated the attenuation value of renal calculi on unenhanced axial 
computerized tomography (CT) images as a predictor of calculous fragmentation by 
extracorporeal shockwave lithotripsy (ESWL) (Dornier Medical Systems, Inc.,
Marietta, Georgia). MATERIALS AND METHODS: We included 30 patients with renal
calculi up to 20 mm. in this prospective study. Calculous attenuation value was
measured in Hounsfield units on unenhanced CT sections through the calculi.
Patients were subsequently treated with ESWL. RESULTS: Patients were grouped
according to calculous attenuation value as groups 1-less than 500, 2-500 to
1,000 and 3-greater than 1,000 Hounsfield units. Of the 30 patients 24 (80%)
underwent successful treatment. The rate of stone clearance was 100% (12 of 12
cases) in group 1, 85.7% (6 of 7) in group 2 and 54.5% (6 of 11) in group 3. The 
success rate for stones with an attenuation value of greater than 1,000
Hounsfield units was significantly lower than that for stones with a value of
less than 1,000 Hounsfield units (6 of 11 versus 18 of 19 cases, chi-square 7.07,
p <0.01). Patients in group 3 required a greater median number of shock waves for
stone fragmentation than those in groups 1 and 2 (7,300, 2,500, and 3,390,
respectively). The mean attenuation value and number of shock waves required for 
calculous fragmentation correlated significantly (r = 0.779, p <0.001).
CONCLUSIONS: The CT attenuation value of renal calculi can help to differentiate 
stones that are likely to fragment easily on ESWL from those that would require a
greater number of shock waves for fragmentation or may fail to fragment on ESWL.

PMID: 11956419 [PubMed - indexed for MEDLINE]

1263: J Urol. 2002 May;167(5):1965-7.

Urinary stone risk factors in the siblings of patients with calcium renal stones.

Kinder JM, Clark CD, Coe BJ, Asplin JR, Parks JH, Coe FL.

Litholink Corp. and Nephrology Section, University of Chicago Pritzker School of 
Medicine, Chicago, Illinois, USA.

PURPOSE: We determined which, if any, urinary stone risk factors accurately
discriminate stone forming and nonstone forming siblings of patients with calcium
renal stones. MATERIALS AND METHODS: A total of 252 siblings of stone formers
provided 2, 24-hour urine samples, which were sent overnight and analyzed at a
central laboratory. Standard stone risk factors were measured and the
supersaturation of calcium oxalate, calcium phosphate and uric acid was
calculated. RESULTS: Discriminant functions were derived for each gender by
multivariate analysis. In stone forming sisters higher urinary calcium and pH
discriminated with a success rate of 70%. In stone forming brothers higher
urinary calcium, lower urinary potassium and older age discriminated with a
success rate of 79%. CONCLUSIONS: Select urinary measurements as well as age
classify siblings into those with and without stones with fair accuracy. Calcium 
excretion and urinary pH in females, and calcium excretion, urinary potassium and
age in males are feasible identifiers of stone forming siblings. To determine
whether these measurements can be used to predict new stone onset may require
years of observation of our current cohort.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11956418 [PubMed - indexed for MEDLINE]

1264: Med Biol Eng Comput. 2002 Jan;40(1):128-36.

Pain model and fuzzy logic patient-controlled analgesia in shock-wave
lithotripsy.

Shieh JS, Chang LW, Wang MS, Sun WZ, Wang YP, Yang YP.

Department of Mechanical Engineering, Yuan Ze University, Taiwan.

Pain control in conscious patients was investigated using a push-button,
demand-driven supply of drugs. A fuzzy logic patient-controlled analgesia (PCA)
algorithm was compared with a conventional algorithm, for alfentanil
administration in extracorporeal shock-wave lithotripsy. The conventional PCA
algorithm used an initial dose of 0.25mg, a fixed infusion rate of 60 mg h(-1)
and a fixed bolus size of 0.2 mg with a 1 min lockout. The fuzzy logic PCA
algorithm used an initial dose of 0.25 mg, a changeable infusion rate and a bolus
size of 0.1 or 0.05 mg. The infusion rate was adjusted according to a look-up
table that accepted the button-pressing history over the last three lockout
intervals. The look-up table was designed using fuzzy logic. The bolus size was
adjusted according to the button-pressing history over the past two lockout
intervals. Twelve patients were treated using conventional PCA, and thirteen were
treated with PCA + fuzzy logic control (FLC). PCA + FLC patients consumed 45%
less drug. Also, PCA + FLC patients had a mean delivery/demand ratio of 82%,
compared with 60% in conventional PCA. When the pain intensity scale was
analysed, PCA + FLC patients had acceptable pain intensity at 62%, compared with 
44% in conventional PCA.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 11954700 [PubMed - indexed for MEDLINE]

1265: Southeast Asian J Trop Med Public Health. 2001 Sep;32(3):654-60.

A long-term study on the efficacy of a herbal plant, Orthosiphon grandiflorus,
and sodium potassium citrate in renal calculi treatment.

Premgamone A, Sriboonlue P, Disatapornjaroen W, Maskasem S, Sinsupan N, Apinives 
C.

Department of Community Medicine, Faculty Medicine, Khon Kaen University,
Thailand.

The study was performed to compare the efficacy of a herbal plant, Orthosiphon
grandiflorus (OG), and the drug sodium potassium citrate (SPC) in treatment of
renal calculi. Forty-eight rural stone formers identified by ultrasonography were
recruited and randomly assigned to two treatment groups (G1 and G2). For a period
up to 18 months, subjects in G1 received 2 cups of OG tea daily, each tea cup
made from an OG tea bag (contained 2.5 g dry wt), and G2 received 5-10 g of
granular SPC in solution divided into three times a day. Once every 5 to 7 weeks,
subjects were interviewed, given an additional drug supply, administered a kidney
ultrasound and had spot urine samples collected for relevant biochemical
analysis. From the recorded ultrasound images, rates of stone size reduction per 
year (ROSRPY) were calculated. The mean ROSRPY was 28.6+/-16.0% and 33.8+/-23.6% 
for G1 and G2, respectively. These two means were not significantly different.
ROSRPY values of G1 and G2 were combined and divided into three levels: Level A
(ROSRPY > mean + 0.5 SD), Level M (ROSRPY = mean +/- 0.5 SD) and Level B (ROSRPY 
< mean - 0.5 SD). Dissolution of stones was least in Level B which was related to
higher excretions of Ca and uric acid in the urine. After treatment, 90% of the
initial clinical symptoms (ie back pain, headaches and joint pain) were relieved.
Fatigue and loss of appetite were observed in 26.3% of G2 subjects. Our study
indicates that treatment of renal calculi with OG tea is an alternative means of 
management. Further investigation is needed to improve dissolution of stones with
a low ROSRPY.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11944733 [PubMed - indexed for MEDLINE]

1266: Southeast Asian J Trop Med Public Health. 2001 Sep;32(3):648-53.

Correlation between Na, K-ATPase activity and potassium and magnesium contents in
skeletal muscle of renal stone patients.

Prasongwatana V, Tavichakorntrakool R, Sriboonlue P, Wongkham C,
Bovornpadungkitti S, Premgamone A, Reungjuiy S.

Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Thailand.

Samples of external oblique muscles were surgically removed from 45 renal stone
patients and analyzed for their K, Na and Mg content. The muscle samples were
also measured for membrane Na, K-ATPase activity from the assay of its
K+-dependent 3-0-methyl fluorescein phosphatase (K+-dependent 3-0-MFPase)
activity. The results showed that the mean muscle contents +/- SEM of K, Na and
Mg were 65.2 +/- 1.7 (range, 41.1 to 86.1), 45.5 +/- 2.0 (range, 23.5 to 73.2)
and 6.3 +/- 1.0 (range, 4.1 to 8.5) micromol/g wet weight, respectively. The mean
activity +/- SEM of the K+-dependent 3-0-MFPase or the Na, K-ATPase was
calculated by subtracting the activity of the basal-form from that of the
total-3-0-MFPase, which was 113 +/- 21 (range, 11 to 177) nmol/g wet
weight/minute. The activity of the Na, K-ATPase showed a significant correlation 
with muscle K-content (r = 0.52, p<0.001) and Mg content (r = 0.45, p<0.002).
Though the external oblique muscles of renal stone patients in our study, as
compared to data from other sources, had a considerably low concentration of K
and Mg, they exhibited a good correlation with membrane-Na, K-ATPase activity.
Our results, therefore, support previous observations made by other
investigators.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11944732 [PubMed - indexed for MEDLINE]

1267: BJU Int. 2002 Apr;89(6):571-5.

Renal calcium phosphate and oxalate deposition in prolonged vitamin B6
deficiency: studies on a rat model of urolithiasis.

Di Tommaso L, Tolomelli B, Mezzini R, Marchetti M, Cenacchi G, Foschini MP,
Mancini AM.

Section of Anatomic Pathology, Department of Oncology, University of Bologna,
Bologna, Italy.

OBJECTIVE: To determine the effect on kidney oxalate-salt deposition of a
prolonged diet which induced vitamin B6 deficiency in adult rats, as there are
reports of the pathogenic involvement of vitamin B6 deficiency in the formation
of renal calcium oxalate calculi. MATERIALS AND METHODS: The study comprised 24
6-month-old male albino Wistar rats; 12 were fed with a purified vitamin
B6-deficient diet and the others provided with the same diet but supplemented
with 6 mg/kg of vitamin B6. After 12 weeks, all rats were killed, and their
kidneys fixed in formalin and routinely processed to paraffin for morphological
examination; some fragments were fixed in glutaraldehyde and prepared for
ultrastructural examination. From each rat consecutive sections of both kidneys
were cut and stained with haematoxylin and eosin, periodic-acid Schiff, Sirius
red and the Von Kossa method for calcium. Sections were examined in polarized
light and by electron microscopy. RESULTS: The histopathological and
ultrastructural features of the kidney of vitamin B6-deficient rats were those of
tubular-interstitial nephritis, characterized by tubular atrophy, interstitial
fibrosis and chronic inflammatory infiltration. Oxalate and phosphate crystals
were present in the papillary and parenchymal connective tissue. Ultrastructural 
features confirmed severe tubular epithelial lesions and the presence of an
interstitial and intraepithelial inflammatory infiltrate; there was mild
interstitial fibrosis. None of these features were apparent in the kidney of
control rats. CONCLUSIONS: Histopathological and ultrastructural data indicate
that a prolonged vitamin B6-deficient diet may contribute to the formation and
deposition of calcium phosphate and oxalate crystals, which lead to severe damage
of the renal parenchyma. This phenomenon may occur not only in growing rats,
which have more active protein metabolism and consequently higher vitamin B6
requirements, but also in adult rats.

PMID: 11942967 [PubMed - indexed for MEDLINE]

1268: Urol Res. 2002 Mar;30(1):35-47.

Calcium oxalate stone disease: role of lipid peroxidation and antioxidants.

Selvam R.

Department of Medical Biochemistry, Dr. ALM Post Graduate Institute of Basic
Medical Sciences, University of Madras, Taramani, Chennai, India.
drselvamr@hotmail.com

Membrane injury facilitated the fixation of calcium oxalate crystals and
subsequent growth into kidney stones. Oxalate-induced membrane injury was
mediated by lipid peroxidation reaction through the generation of oxygen free
radicals. In urolithic rat kidney or oxalate exposed cultured cells, both
superoxide anion and hydroxyl radicals were generated in excess, causing cellular
injury. In hyperoxaluric rat kidney, both superoxide and H2O2-generating enzymes 
such as glycolic acid oxidase (GAO) and xanthine oxidase (XO) were increased, and
hydroxyl radical and transition metal ions, iron, and copper were accumulated.
The lipid peroxidation products, thiobarbituric acid-reactive substances (TBARS),
hydroperoxides, and diene conjugates were excessively released in tissues of
urolithic rats and in plasma of rats as well as stone patients. The accumulation 
of these products was concomitant with the decrease in the antioxidant enzymes,
superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx), and glucose-6
phosphate dehydrogenase (G6PD) as well as radical scavengers, vitamin E, ascorbic
acid, reduced glutathione (GSH), and protein thiol. All the above parameters were
decreased in urolithic condition, irrespective of the agents used for the
induction of urolithiasis. Oxalate binding activity and calcium oxalate crystal
deposition were markedly pronounced, along with decreased adenosine
triphosphatase (ATPase) activity. Lipid peroxidation positively correlated with
cellular oxalate, oxalate binding, gamma-glutamyl carboxylase, and calcium level 
and negatively correlated with GSH, vitamin E. ascorbic acid, and total protein
thiol. Antioxidant therapy to urolithic rats with vitamin E, glutathione
monoester, methionine, lipoic acid, or fish oil normalised the cellular
antioxidant system, enzymes and scavengers, and interrupted membrane lipid and
protein peroxidation reaction, ATPase inactivation, and its associated calcium
accumulation. Antioxidant therapy prevented calcium oxalate precipitation in the 
rat kidney and reduced oxalate excretion in stone patients. Similarly, calcium
oxalate crystal deposition in vitro to urothelium was prevented by free radical
scavengers such as phytic acid and mannitol by protecting the membrane from free 
radical-mediated damage. All these observations were suggestive of the active
involvement of free radical-mediated lipid peroxidation-induced membrane damage
in the pathogenesis of calcium oxalate crystal deposition and retention.

Publication Types: 
    Review

PMID: 11942324 [PubMed - indexed for MEDLINE]

1269: Brain Dev. 2002 Apr;24(3):150-4.

Long-term effectiveness and side effects of acetazolamide as an adjunct to other 
anticonvulsants in the treatment of refractory epilepsies.

Katayama F, Miura H, Takanashi S.

Department of Pediatrics, Kitasato University School of Medicine, 1-15-1
Kitasato, Sagamihara, Kanagawa 228-8555, Japan. fkara@t3.rim.or.jp

The long-term effectiveness of acetazolamide (AZA) and its side effects,
especially the formation of renal calculi, were investigated in a prospective
study when AZA was used as an adjunct to other antiepileptic drugs in the
treatment of refractory epilepsies. The subjects comprised 37 patients aged from 
1 to 17 years (mean age, 8 years and 1 month) whose seizures were hard to control
with the use of two or more drugs among sodium valproate, carbamazepine and
clonazepam. Thirty-two of the 37 patients were complicated with mental
retardation. A daily dose of 10mg/kg of AZA was first administered and then the
dosage was increased up to 20mg/kg based on the clinical response and side
effects. The maintenance daily dosage of AZA (12.2+/-4.2mg/kg) produced a
steady-state plasma concentration of 6.2+/-4.5 microg/ml. Among the 37 patients, 
complete seizure control for more than 3 years was obtained in four patients.
Although there were no significant differences, all of the four patients were
classified as having symptomatic localization-related epilepsies. Seizures
recurred in five after complete remission for at least 6 months, and six showed
>50% decrease in seizure frequency for more than 6 months after the introduction 
of AZA. Twenty-eight patients, who were taking AZA for 10 months to 14 years
(mean, 6 years and 5 months), were examined for the formation of renal calculi.
None of them showed evidence of renal calculi. This study reinforces the idea
that AZA may be a useful adjunct drug in selected patients with refractory
symptomatic localization-related epilepsies.

Publication Types: 
    Clinical Trial

PMID: 11934510 [PubMed - indexed for MEDLINE]

1270: Urology. 2002 Apr;59(4):601.

Comment in:
    Urology. 2003 Jul;62(1):197; author reply 197-8.

Staghorn calculus endotoxin expression in sepsis.

McAleer IM, Kaplan GW, Bradley JS, Carroll SF.

Department of Urology, Children's Hospital and Health Center, San Diego,
California, USA.

Staghorn calculi are infrequent and generally are infected stones. Struvite or
apatite calculi are embedded with gram-negative bacteria, which can produce
endotoxin. Sepsis syndrome may occur after surgical therapy or endoscopic
manipulation of infected or staghorn calculi. Sepsis, which can occur despite
perioperative antibiotic use, may be due to bacteremia or endotoxemia. We present
a child with an infected staghorn calculus who developed overwhelming sepsis and 
died after percutaneous stone manipulation. Endotoxin assay of stone fragments
demonstrated an extremely high level of endotoxin despite low colony bacterial
culture growth. This is the first reported case in which endotoxin was
demonstrated in stone fragments from a child who died of severe sepsis syndrome
after percutaneous staghorn stone manipulation.

Publication Types: 
    Case Reports

PMID: 11927328 [PubMed - indexed for MEDLINE]

1271: Urology. 2002 Apr;59(4):527-31; discussion 531.

Tubeless percutaneous renal surgery: review of first 112 patients.

Limb J, Bellman GC.

Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California 
90027, USA.

OBJECTIVES: To assess the outcome and safety of the first 112 patients undergoing
tubeless percutaneous renal surgery. METHODS: A total of 116 renal units in 112
patients underwent tubeless percutaneous renal surgery from December 1995 to
November 2000 performed by a single urologist. The "tubeless" procedures
consisted of nephrolithotripsy or endopyelotomy. An antegrade internal ureteral
stent was placed during surgery, as was a Foley catheter for bladder drainage, in
all patients. Nephrostomy tubes were not used in any patient. The incidence of
complications, length of hospitalization, outcomes, transfusion requirements,
stone burden, and stone-free rates were obtained by chart review. RESULTS: Of the
112 patients, 86 patients underwent percutaneous stone extraction and 26 patients
underwent percutaneous antegrade endopyelotomy. In the group of patients
undergoing percutaneous stone extraction, the mean stone burden was 3.30 cm(2).
Patients stayed in the hospital an average of 1.25 days. A total of 5 patients
required postoperative transfusions. One patient was found on readmission to have
a pseudoaneurysm. A 93.0% stone-free rate was achieved. The correlations between 
transfusion rates, days of hospitalization, and outcome with stone burden were
not statistically significant (P = 0.56, 0.78, and 0.18, respectively). For the
endopyelotomy group, the mean length of hospitalization was 1.56 days. Only 1
patient required a transfusion, and 3 patients had postoperative complications.
Of the 26 patients, 88.5% had a successful outcome from their endopyelotomy.
CONCLUSIONS: Tubeless percutaneous renal surgery is a safe and effective
procedure and can be performed in patients even with a moderate stone burden.

PMID: 11927306 [PubMed - indexed for MEDLINE]

1272: Urology. 2002 Apr;59(4):522-5; discussion 525-6.

Effect of percutaneous nephrolithotomy on differential renal function as measured
by mercaptoacetyl triglycine nuclear renography.

Chatham JR, Dykes TE, Kennon WG, Schwartz BF.

Urology Service, Tripler Army Medical Center, Honolulu, Hawaii, USA.

OBJECTIVES: To determine the impact on differential renal function of
percutaneous nephrolithotomy for complex renal calculi. METHODS: From July 1999
to December 2000, 45 patients underwent percutaneous nephrolithotomy. Of these,
19 agreed to participate in the study. All patients completed a quantitative
assessment of differential renal function preoperatively and postoperatively with
technetium 99m mercaptoacetyl triglycine nuclear renography and serum creatinine 
measurements. RESULTS: The mean patient age was 49 years (range 11 to 75) for the
13 female and 6 male patients. The mean stone burden was 1432 mm(2) (range 156 to
5220). The mean surgical time was 2.57 hours (range 1.17 to 5.08). The median
hospital stay was 2.0 days (range 1 to 19). Of the 19 patients, 13 (68%) were
stone free after one procedure. Four patients underwent ureteroscopy with stone
extraction for residual fragments. One patient underwent secondary extracorporeal
shock wave lithotripsy. One patient underwent nephrectomy for poor renal
function. Renal function, for the entire group, increased from 36.8%
preoperatively to 38.5% postoperatively. Renal function was preserved in 16 (84%)
of 19 patients, including improvement of function in 7 (37%) of 19 patients.
Serum creatinine was unchanged in the two groups. CONCLUSIONS: Percutaneous
nephrolithotomy does not result in loss of renal function when treating complex
renal calculi as measured by nuclear scintigraphy. Operative and hospitalization 
times were decreased compared with historical open nephrolithotomy and stone
clearance was similar.

PMID: 11927303 [PubMed - indexed for MEDLINE]

1273: Urology. 2002 Apr;59(4):495-9.

Clinical association with urinary glycosaminoglycans and urolithiasis.

Erturk E, Kiernan M, Schoen SR.

Department of Urology, University of Rochester, Rochester, New York, USA

OBJECTIVES: To determine the clinical association between urinary
glycosaminoglycan (GAG) concentration and kidney stone disease. METHODS:
Thirty-five patients (14 women and 21 men) with a history of stone disease and 37
controls (13 women and 24 men) were evaluated for urinary GAG concentration. By
using a new dye-binding assay, the total GAG concentration in the urine was
measured and corrected to urinary creatinine levels (micrograms of GAG per
milligram creatinine). RESULTS: The mean urinary GAG concentration in those with 
stones was significantly lower (31.5 +/- 2.6 microg GAG/mg creatinine) than in
the controls (43.8 +/- 3.8 microg GAG/mg creatinine, P = 0.01). Male patients
with stones also had a significantly lower mean GAG concentration (26.1 +/- 1.8) 
than did the female patients (39.6 +/- 5.3, P = 0.009). The mean GAG
concentration between ureteral (n = 13) versus renal (n = 22), single (n = 19)
versus multiple (n = 16), family history (n = 11) versus no family history (n =
24), large (n = 13) versus small (n = 20), and the presence (n = 22) versus
absence (n = 13) of residual stones did not show any significant differences.
However, patients with recurrent stone formation (n = 21) had significantly lower
mean GAG levels (26.4 +/- 1.6) compared with those with single stone formation (n
= 14; 39.2 +/- 5.5, P = 0.01). CONCLUSIONS: Lower urinary GAG levels are more
common in patients with stone formation. This may play a more determinant role in
male patients and those with recurrent stone formation.

PMID: 11927298 [PubMed - indexed for MEDLINE]

1274: Urology. 2002 Apr;59(4):490-3; discussion 493-4.

Changing indications of open stone surgery.

Matlaga BR, Assimos DG.

Department of Urology, Wake Forest University School of Medicine, Winston-Salem, 
North Carolina 27157-1094, USA.

OBJECTIVES: To compare the current role of open stone surgery at our institution 
to previously reported data. In 1989, the indications for open surgical treatment
of urinary calculi at our institution were reviewed. In the intervening years,
tremendous advances have been made in minimally invasive treatment of urinary
calculi. METHODS: A retrospective evaluation of all patients undergoing
procedures for the purpose of stone removal or fragmentation at Wake Forest
University Baptist Medical Center between January 1, 1998 and May 31, 2001 was
conducted. This was compared with data reported from our institution describing
similar procedures in the first 19 months after introduction of the Dornier HM3
lithotriptor. RESULTS: Of 986 procedures performed for the purpose of stone
removal or fragmentation between January 1, 1998 and May 31, 2001, 0.7% were open
surgical procedures. Of these procedures, 85.8% were performed for anatomic
indications. Patients referred from other institutions for evaluation after
endoscopic treatment failure comprised the remaining 14.2% of this group. In the 
previously reported data, 893 procedures were performed for the treatment of
urinary calculi, of which 4.1% were open operations. Of these patients, 48.6%
underwent an open surgical procedure after unsuccessful endoscopic treatment of
urinary calculi, and 48.7% of these patients underwent open surgery for anatomic 
indications. CONCLUSIONS: Open surgical stone removal remains a viable treatment 
option for select patients. Technologic advances and improved surgical skills
have greatly reduced the number of patients requiring open surgery. This approach
is mainly used for patients with complex calculous disease associated with
anatomic abnormalities.

PMID: 11927296 [PubMed - indexed for MEDLINE]

1275: Clin Nephrol. 2002 Mar;57(3):183-91.

Bone involvement in idiopathic hypercalciuria.

Misael da Silva AM, dos Reis LM, Pereira RC, Futata E, Branco-Martins CT, Noronha
IL, Wajchemberg BL, Jorgetti V.

Nephrology Division, University of São Paulo Medical School, São Paulo, Brazil.
vandajor@usp.br

BACKGROUND: To evaluate bone involvement in idiopathic hypercalciuria, 40
lithiasic patients and 10 controls were studied. METHODS: According to urinary
calcium excretion, patients were first classified as hypercalciuric (Hca, n = 22)
and normocalciuric (Nca, n = 18). The Hca patients were then subclassified
according to bone densitometry (BMD) as osteopenic (HcaO, n = 10) and
non-osteopenic (HCaNO, n = 12). Routine biochemistry, dietary records, bone
histomorphometry. and cytokines (IL-1beta, IL-6, and TNF) production by
peripheral blood mononuclear cell cultures were studied. RESULTS: There were no
differences in routine biochemistry between Hca and Nca groups, except for
urinary calcium. Inadequate nutrition was observed in Hca group, showing high
protein (80.9% of the patients), carbohydrate (76.2%) and sodium (90%) intake.
Calcium intake was low in Hca (57%) and Nca (83%) groups. IL-6 and TNF were not
different between the Hca and Nca groups. IL-1beta levels were significantly high
in both groups when compared to controls. IL-6 and TNF were higher in HcaO than
Nca. BMD in femoral neck in HcaO was lower than in HcaNO and Nca groups. Eroded
surface (ES/BS) increased in 91% of the Hca group and 36% had a mineralization
defect. In the HcaO group serum PTH correlated negatively with trabecular bone
volume (BV/TV) and positively with ES/BS. 1,25(OH),D3 levels correlated
positively with osteoblastic surface. Calcium intake correlated positively with
BV/TV and inversely with ES/BS. A negative correlation was observed between IL-6 
levels and Z score of the femoral neck. CONCLUSION: Bone involvement was detected
in a young population with nephrolithiasis demonstrating that a strict follow-up 
is necessary in order to control hypercalciuria.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11926201 [PubMed - indexed for MEDLINE]

1276: J Urol. 2002 Apr;167(4):1844-7.

Urinary crystallization inhibitors do not prevent crystal binding.

Schepers MS, van der Boom BG, Romijn JC, Schröder FH, Verkoelen CF.

Department of Urology, Erasmus University Rotterdam, Rotterdam, The Netherlands.

PURPOSE: Renal stone formation requires the persistent retention of crystals in
the kidney. Calcium oxalate monohydrate (COM) crystal binding to Madin Darby
canine kidney strain I (MDCK-I), a cell line that resembles the epithelium in the
renal distal tubule/collecting duct, is developmentally regulated, while LLC-PK1 
cells (American Type Tissue Collection), which are widely used as a model of the 
renal proximal tubule, bind crystals irrespective of their stage of epithelial
development. Whereas to our knowledge the binding molecules for COM at the
surface of LLC-PK1 cells are still unknown, crystals adhere to the hyaluronan
(HA) rich pericellular matrix transiently expressed by mobile MDCK-I cells. In
the current study we investigated whether crystal binding to either cell type is 
influenced by urinary substances, including glycoprotein inhibitors of
crystallization MATERIALS AND METHODS: We studied crystal binding to MDCK-I cells
during wound repair, to confluent LLC-PK1 cells and to HA immobilized on a solid 
surface using [14C] COM pretreated or not pretreated with urine from healthy male
volunteers. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western
blot analysis were performed to assess whether the crystals became coated with
urine derived proteins RESULTS: Western blot analysis demonstrated that
pretreated COM crystals were covered with protein inhibitors of crystallization. 
However, this protein coat had no significant effect on the level of crystal
binding to either cell type. In contrast, the adherence of urine treated crystals
to immobilized HA was significantly reduced CONCLUSIONS: The adherence of
crystals to pericellular matrixes may encompass more than their simple fixation
to the polysaccharide HA. Calcium oxalate crystal retention is not prevented by
coating crystals with urinary constituents such as glycoproteins and, therefore, 
may predominantly depend on the surface properties of the renal tubular
epithelium.

PMID: 11912445 [PubMed - indexed for MEDLINE]

1277: J Urol. 2002 Apr;167(4):1813-; discussion 1815-6.

Ureteroscopy for the treatment of urolithiasis in children.

Schuster TG, Russell KY, Bloom DA, Koo HP, Faerber GJ.

Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.

PURPOSE: Ureteroscopy for treating urolithiasis in prepubertal children has
become more common with the advent of smaller instruments. We reviewed our
experience with ureteroscopy for urolithiasis in this cohort of patients as well 
as the literature using this treatment modality in children. MATERIALS AND
METHODS: Between 1994 and 2000 we performed 27 ureteroscopic stone extractions in
25 children. Ureteroscopy was done in a manner similar to that in adults.
Ureteral dilation was performed when necessary to access the ureter. A stent was 
placed postoperatively if there was significant ureteral trauma. RESULTS: Of the 
25 children 13 were male and 12 were female. Average age was 9.2 years (range 3
to 14). Stones were 2 to 12 mm. in greatest diameter (average 6). Of the 27
procedures the ureteral orifice was dilated before stone treatment in 15 (56%),
while in 19 (70%) a stent was placed afterward. No intraoperative and 2
postoperative complications were identified. Overall 92% of the children were
rendered stone-free after 1 procedure and 100% were stone-free after 2.
CONCLUSIONS: Ureteroscopy for urolithiasis in prepubertal children is safe and
effective. Routine ureteral dilation and ureteral stent placement are not always 
necessary in these patients.

Publication Types: 
    Review

PMID: 11912438 [PubMed - indexed for MEDLINE]

1278: J Urol. 2002 Apr;167(4):1607-12.

A single 24-hour urine collection is inadequate for the medical evaluation of
nephrolithiasis.

Parks JH, Goldfisher E, Asplin JR, Coe FL.

Nephrology Section, University of Chicago and LithoLink Corp., Chicago, Illinois,
USA.

PURPOSE: We determined the adequacy of a single 24-hour urine sample for
evaluating patients for medical renal stone prevention. MATERIALS AND METHODS: A 
total of 459 patients from a private urology practice specializing in the
treatment of urolithiasis and 683 from a university stone research clinic
provided 2 and 3, 24-hour urine samples, respectively. We used samples 1 and 2
from private practice patients, and 1 and 3 from university clinic patients for
analysis, and compared each to the others by correlation coefficients and
calculation of the mean difference plus or minus standard deviation (SD) of the
difference. Urine risk factors were measured by standard methods. RESULTS:
Although the correlation of urine values 1 and 2 was excellent for all stone risk
factors, SD values for the differences were large enough that within 1 SD on
either side of 0, which included 68.8% of cases, by chance urine 1 would depart
from urine 2 by clinically important amounts. These departures would be more than
sufficient to misdiagnose common metabolic disorders. CONCLUSIONS: A single
24-hour sample is not sufficient for evaluating patients before metabolic
treatment for stone prevention because misdiagnosis is common, leading to
inappropriate treatment.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11912373 [PubMed - indexed for MEDLINE]

1279: J Endourol. 2002 Feb;16(1):33-6.

Comparison of 150 simultaneous bilateral and 300 unilateral percutaneous
nephrolithotomies.

Holman E, Salah MA, Tóth C.

Semmelweis Hospital Department of Urology, Kiskunhalas, Hungary.
holmane@axelero.hu

PURPOSE: To compare the results, complications, efficiency, and safety of
simultaneous bilateral percutaneous nephrolithotomy (SBPN) and unilateral
percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: We compared the
results and complications of 150 SBPNs with those of 300 unilateral PCNLs. All
the procedures were performed by one surgeon which provides relatively constant
parameters. The success rates, preoperative and postoperative laboratory results,
and complications were compared on the basis of stone size and the number of
nephrostomy tracks. RESULTS: There were no significant differences between the
results and complications of SBPN and PCNL. The SBPN itself did not cause more
blood loss than unilateral PCNL. In both groups, the blood loss was in direct
proportion to the size of the stones and the number of nephrostomy tracks. After 
SBPN, kidney function improved >20% in 12.2% of the patients and worsened for
more than 3 days in only 4%. Temporary worsening of kidney function occurred in
the unilateral procedure group as well (8%), mostly in cases of solitary kidneys 
or bilateral stones. The SBPN was not more hazardous than unilateral PCNL
(complication rate 11.3% v 14.3%, respectively). In both groups, most of the
complications were in proportion to the size and difficulties of the stones.
CONCLUSION: Simultaneous bilateral percutaneous nephrolithotomy is a safe and
advantageous procedure that is not more hazardous than the separate PCNL in cases
of bilateral large stone burdens. To our knowledge, these are the largest
reported series of these procedures and the only comparative analysis of SBPN and
PCNL.

Publication Types: 
    Comparative Study
    Evaluation Studies

PMID: 11890448 [PubMed - indexed for MEDLINE]

1280: J Endourol. 2002 Feb;16(1):3-7.

The Dornier Compact Delta lithotripter: the first 500 renal calculi.

Lalak NJ, Moussa SA, Smith G, Tolley DA.

The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh.

BACKGROUND AND PURPOSE: Extracorporeal Shockwave Lithotripsy (SWL) is now the
best noninvasive treatment for renal calculi, rendering many patients stone free.
This prospective study was performed to evaluate the short-term results of
patients undergoing SWL with the Dornier Compact Delta lithotripter for all renal
calculi. PATIENTS AND METHODS: Between April 1999 and May 2000, there were 500
renal calculi treated in 166 female and 334 male patients with a mean age of 53
+/- 15 years. All patients who completed treatment were entered in the study and 
assessed at 1 and 3 months with a plain film of the kidneys, ureters, and
bladder. Stone-free rate and final outcome have been evaluated. Final outcome is 
defined as stone free or residual fragments 4 mm or less. Analysis has been made 
according to stone size, location, number of treatments per stone, and number of 
shocks per stone. The analgesia requirements during each treatment and
complications have also been analyzed. RESULTS: The overall stone-free rate for
stones <10 mm was 62% at 1 month and 76% at 3 months. For stones 10 to 20 mm,
these rates were 53% and 66%, while the rates for stones >20 mm were 41% and 47%,
respectively. The final outcome for stones <10 mm was 90% at 1 month and 93% at 3
months, for stones 10 to 20 mm 73% and 84%, and for stones >20 mm 57% and 67%,
respectively. The effectiveness quotient for calculi <10 mm was 60%. For calculi 
10 to 20 mm, it was 51%, and for those >20 mm, it was 31%. Oral analgesia was
given routinely; however, additional intravenous analgesia was necessary in 22%
of treatments. No serious complications have been seen. CONCLUSIONS: These
results show that with proper patient selection, good results at 1 and 3 months
can be achieved with minimal anesthesia during treatment and low retreatment
rates. We do not recommend SWL as primary therapy for stones >20 mm.

Publication Types: 
    Evaluation Studies

PMID: 11890447 [PubMed - indexed for MEDLINE]

1281: J Endourol. 2002 Feb;16(1):15-8.

Flank position ureterorenoscopy: new positional approach to aid in retrograde
caliceal stone treatment.

Herrell SD, Buchanan MG.

Division of Urologic Surgery, University of Kansas Medical Center, Kansas City
66160-7390, USA. dherrell@kumc.edu

BACKGROUND AND PURPOSE: Clearance of lower pole stones and complex maneuvers such
as basket repositioning remain challenging in ureteroscopic treatment of caliceal
stone burdens. We describe the initial use of flank position ureteroscopy (FPU)
with modifications to aid in the treatment of complex caliceal urolithiasis. We
hypothesized that gravitational force acting on caliceal stones and fragments
during holmium laser treatment would result in fragments being repositioned into 
the dependent renal pelvis, allowing enhanced treatment. PATIENTS AND METHODS:
Eleven patients with complex upper tract stone disease (aggregate stone burden
1.5-5 cm) were treated using FPU. Patients were positioned with the
stone-containing side superior. Flexible cystoscopy followed by flexible
ureterorenoscopy and intracorporeal lithotripsy were performed. We utilized
several modifications of the technique, including a radiolucent table and
rotational C-arm fluoroscopy unit. Once all stones and particles fell into the
dependent renal pelvis, additional laser fragmentation was simple. RESULTS: We
observed the expected advantage of gravitational drainage of particles and stone 
into the renal pelvis during procedures. In many cases, fragments passed
partially down the ureter during treatment. Basket repositioning of stones was
not necessary. One complication, collecting system perforation during access, was
treated with stent placement and successful delayed FPU. Seven patients were
stone free at follow-up. Four patients with stone burdens >3 cm had approximately
80% stone burden reduction, but residual asymptomatic lower-pole particles (2-6
mm) remained, with several clearing with a secondary procedure. CONCLUSIONS: The 
use of FPU for the performance of complex renal stone treatment is a useful aid. 
Further refinement and comparison with standard technique is ongoing.

PMID: 11890443 [PubMed - indexed for MEDLINE]

1282: BJU Int. 2001 Nov;88(7):675-8.

Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention
and management.

Sayed MA, el-Taher AM, Aboul-Ella HA, Shaker SE.

Urology Department, Assiut University Hospital, Egypt.
sayedmohamed_22@hotmail.com

OBJECTIVE: To determine the causes of steinstrasse, methods of prevention and
treatment strategies. PATIENTS AND METHODS: Fifty-two patients with steinstrasse 
were identified and treated: all patients were initially treated conservatively
but when there was obstruction, infection or no progression of the stone
fragments, further treatment was used, ranging from repeated extracorporeal
shockwave lithotripsy (ESWL), percutaneous nephrostomy (PCN), endoscopic
manipulations and finally open surgery, depending on the degree of obstruction,
infection, renal function and response to each kind of therapy. RESULTS:
Conservative management was successful in 25 patients (48%), repeated ESWL in 12 
(23%), PCN in 10 (19%), ureteroscopy in three (6%) and open surgery in two (4%). 
CONCLUSION: As many patients, and particularly those with larger stones, are
treated by ESWL, the risk of developing steinstrasse will increase, with
associated patient discomfort, infection or impaired renal function. The optimum 
selection of cases (aiming to pulverize the stones rather than fragment them) and
accurate stone targeting are essential to minimise the development of
steinstrasse. The meticulous follow-up of patients with steinstrasse should
prevent any loss of renal function. When there is obstruction and/or infection or
renal damage, active treatment is indicated, of which ESWL and PCN are the most
effective, with ureteroscopy and open surgery reserved for difficult cases.

PMID: 11890235 [PubMed - indexed for MEDLINE]

1283: Ann Acad Med Singapore. 2002 Jan;31(1):107-10.

Embolisation of a renal artery pseudoaneurysm in a patient with renal malrotation
and chronic aortic dissection.

Lau KY, Kan WK, Hou SM, Roebuck DJ, Fung WT.

Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man
Road, Chai Wan, Hong Kong SAR. drkylau@yahoo.com

INTRODUCTION: Renal artery pseudoaneurysms may arise as a complication of
percutaneous nephrolithotomy (PCNL). Prompt recognition and treatment is
essential to arrest haemorrhage which may be life threatening. CLINICAL PICTURE: 
A patient with chronic aortic dissection and malrotated right kidney underwent
PCNL for right renal calculus. He developed delayed gross haematuria. TREATMENT: 
Angiography showed a pseudoaneurysm arising from one of two right renal arteries,
which in turn arose from the false lumen of the aortic dissection. The supplying 
artery was successfully embolised. CONCLUSION: Renal artery pseudoaneurysms can
be successfully treated with prompt angiography and embolisation, even in the
presence of renal malrotation and aortic dissection.

Publication Types: 
    Case Reports

PMID: 11885484 [PubMed - indexed for MEDLINE]

1284: Clin Chim Acta. 2002 Apr;318(1-2):19-24.

Interference-free sample preparation for the determination of plasma oxalate
analyzed by HPLC-ER: preliminary results from calcium oxalate stone-formers and
non-stone-formers.

Hönow R, Simon A, Hesse A.

Division of Experimental Urology, Department of Urology, University of Bonn,
Klinik und Poliklinik fur Urologie, Sigmund-Freud-Str. 25, 53 105, Bonn, Germany.

BACKGROUND: Oxalate generation at pH-values above 5.0 and an oxalate-protein
binding in acidified plasma would appear to complicate the determination of
oxalate in plasma. METHODS: To avoid complex sample preparation we used a
high-performance liquid chromatographic system with an inline enzyme reactor
(HPLC-ER) containing immobilised oxalate oxidase. The detection limit was 0.68
micromol/l. Blood was drawn in lithium-heparin vessels and immediately
centrifuged at 4 degrees C. The yielded plasma was ultrafiltered using a
Centrisart-I-tube. To inhibit oxalate generation by ascorbic acid, the
ultrafiltrate was acidified with 1 mol/l hydrochloric acid during ultrafiltration
at 4 degrees C. The liquid thus yielded was used for HPLC-ER analysis. Blood
samples were obtained from 133 healthy adults (63 men, 70 women, aged 20-94
years) with no history of renal disorder and from 79 patients (53 men, 26 women, 
aged 19-77 years) with a history of calcium oxalate stone formation. RESULTS:
Mean plasma oxalate was 2.65 +/- 2.31 micromol/l for healthy subjects and 4.21
+/- 0.56 micromol/l for stone formers. CONCLUSIONS: Analysis yielded no
significant differences between males and females. A correlation between age and 
plasma oxalate was found for the healthy adults (p < 0.001).

PMID: 11880108 [PubMed - indexed for MEDLINE]

1285: Urology. 2002 Mar;59(3):344-8.

Urolithiasis in allograft kidneys.

Klingler HC, Kramer G, Lodde M, Marberger M.

Department of Urology, University of Vienna, Vienna, Austria.

OBJECTIVES: Allograft stones are an uncommon clinical problem and management is
mainly based on anecdotal experience, rather than analysis of larger series.
METHODS: In an 8-year period, 19 patients were treated for 19 renal and 3
ureteral stones. In 9 patients, stones were transplanted and 10 formed de novo
stones within a mean of 28 months (range 13 to 48) after transplantation. In 4
patients, stones were removed during transplantation. Seven patients were treated
with extracorporeal shock wave lithotripsy (ESWL), 3 patients had stones removed 
percutaneously, 1 by antegrade ureteroscopy, and 1 at the time of ureteral
reimplantation. Three patients passed stones spontaneously. RESULTS: In 3 of 4
patients with stones detected before transplantation, the procedure was completed
successfully after endoscopic stone removal. Three of 5 patients with
transplanted stones required emergency nephrostomy; 1 patient had permanent renal
impairment. Three (42.9%) of 7 patients treated with ESWL needed transient
nephrostomy; ultimately, all became stone free within a mean 15 days (range 10 to
40). Endoscopic stone removal always resulted in complete clearance without renal
impairment. All patients were stone free during a follow-up of 29 months (range
13 to 48). CONCLUSIONS: Nine (47%) of 19 stones were actually transplanted.
Therefore, intraoperative screening by ultrasonography with subsequent endoscopic
removal is advisable. Small stones (4 mm or less) may be closely followed up,
because they can pass spontaneously. ESWL is the treatment of choice for caliceal
stones sized 5 to 15 mm. However, for stones greater than 15 mm or for ureteral
stones, antegrade endoscopic procedures seem to be more favorable.

PMID: 11880067 [PubMed - indexed for MEDLINE]

1286: J Feline Med Surg. 2001 Jun;3(2):81-5.

An investigation into the effects of storage on the diagnosis of crystalluria in 
cats.

Sturgess CP, Hesford A, Owen H, Privett R.

Department of Clinical Veterinary Science, University of Bristol, Langford,
Bristol BS40 5DU, UK.

Urinalysis was performed on 41 cats with no history of urinary tract disease.
Samples were divided into aliquots, stored under differing condition and then
examined for the presence of crystalluria. Crystalluria was detected in at least 
one stored sample in 92% of cats fed a mixed wet/dry food diet compared to 24% in
the fresh sample. Crystalluria was not detected in any sample or aliquot from
cats fed all wet food diets. Copyright 2001 European Society of Feline Medicine.

Publication Types: 
    Evaluation Studies

PMID: 11876621 [PubMed - indexed for MEDLINE]

1287: Singapore Med J. 2001 Nov;42(11):540-4.

Clinics in diagnostic imaging (67). Hydronephrotic horseshoe kidneys with
multiple calculi.

Ng LG, Yip SK, Wong MY, Lau TN.

Department of Urology, Singapore General Hospital, Singapore. gurnlg@sgh.com.sg

Horseshoe kidney is the commonest congenital renal anomaly. Its inherently-poor
drainage system renders the patient prone to stone formation. A 56-year-old man
with bilateral renal stones in a horseshoe system associated with hydronephrosis 
is presented. He was treated successfully with bilateral CT-guided percutaneous
nephrostomy and percutaneous nephrolithotripsy. Various treatment options,
including ESWL, PCNL and open surgery, are discussed.

Publication Types: 
    Case Reports

PMID: 11876383 [PubMed - indexed for MEDLINE]

1288: BJU Int. 2002 Mar;89(4):334-8.

Simultaneous bilateral compared with unilateral percutaneous nephrolithotomy.

Holman E, Khan AM, Pásztor I, Tóth C.

Department of Urology, Semmelweis Hospital, Kiskunhalas, Hungary.

OBJECTIVE: To compare simultaneous bilateral percutaneous nephrolithotomy
(SBPCNL) and unilateral PCNL in separate sessions in patients with bilateral
renal stones for several variables before and after surgery. PATIENTS AND
METHODS: The results from SBPCNL carried out at two centres in different
countries on 198 patients (aged 1.25-70 years) were compared with those from 300 
patients undergoing unilateral PCNL in separate sessions. At one centre where
extracorporeal shockwave lithotripsy (ESWL) was available SBPCNL was used for
stones where at least two sessions of ESWL would have been required on each side.
Other associated procedures were also used wherever required. RESULTS: The stones
were cleared bilaterally in one session of SBPCNL in 190 patients; in eight,
fragments of < 3 mm remained but were not clinically significant. A second
session was required in six patients on one side only. Variables assessed before 
and after treatment (e.g. hospital stay, analgesia requirements and
complications) were not significantly different between SBPCNL and PCNL. The mean
(range) total operative duration for SBPCNL was 46 (20-100) min and the hospital 
stay 4.3 (3-8) days. CONCLUSION: From this experience, SBPCNL is a cost-effective
and beneficial solution for selected patients, with clear advantages over
separate unilateral PCNL in patients with bilateral stones.

Publication Types: 
    Comparative Study
    Multicenter Study

PMID: 11872019 [PubMed - indexed for MEDLINE]

1289: J Biomech Eng. 2002 Feb;124(1):133-4.

The modulus of toughness of urinary calculi.

Wang SJ, Yip MC, Hsu YS, Lai KG, Wang SY.

Department of Surgery, Veterans General Hospital-Taipei, and National Yang-Ming
University, Taiwan, ROC. wangsj@vghtpe.gov.tw

To improve the efficacy of extracorporeal shock wave lithotripsy (ESWL)
treatment, it is desirable to identify the physical properties of urinary calculi
could offer direct correlation with their fragilities during ESWL and thus could 
be used to guide treatment procedures for more effective stone fragmentation.
Thirty stone specimens removed surgically were compressed by an axial testing
system to measure the compressive strength and trace the stress-strain curve.
Image analysis software SigmaScan (Jandel Co.) was used to calculate the area
under the stress-strain curve, the modulus of toughness, for each stone. The
values of compressive strength measured were similar to those reported by other
researchers. The modulus of toughness of urinary calculi correlates with clinical
representation of the stone fragility during ESWL. The modulus of toughness could
be an index to evaluate the physical property of urinary calculi that could be
used to guide treatment procedures for more effective stone fragmentation.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11871599 [PubMed - indexed for MEDLINE]

1290: Nephron. 2002 Mar;90(3):349-51.

Reflex anuria from unilateral ureteral obstruction.

Catalano C, Comuzzi E, Davì L, Fabbian F.

Renal and Dialysis Unit, Monselice Hospital, Monselice, Padova, Italy.
carletto.c@job.pd.it

Renal function is usually normal or only marginally affected in patients with
unilateral ureteral obstruction due to the vicarious function of the
contralateral kidney. Few reports exist in which unilateral renal obstruction is 
associated with anuria (reflex anuria, RA) and acute renal failure. We report the
clinical case of a female patient who was referred to the emergency department
due to anuria of 72 h duration and acute renal failure (serum creatinine 9 mg/dl)
associated with several episodes of violent right flank pain with hematuria
following extracorporeal shock wave lithotripsy (ESWL). A few weeks before ESWL, 
urography showed a 2-cm stone located in the right pelvis whilst the left kidney 
was functionally normal. On admission, renal ultrasound documented a normal left 
kidney, whilst the right pelvis was hydronephrotic and there were two indwelling 
stones at the right pyeloureteral junction. After the patient passed a urinary
stone, diuresis restarted and acute renal failure was resolved. Thereafter,
urography confirmed that the left kidney, the left ureter and bladder were
functionally and morphologically normal. RA with acute renal failure has been so 
scarcely documented that it is considered to be legend by many clinicians. Major 
textbooks do not discuss RA with acute renal failure. Vascular or ureteral spasm 
related in part to a peculiar hyperexcitability of the autonomic nervous system
may explain RA. We suggest that nephrologists should always consider RA when
evaluating acute renal failure. On the other hand, RA might be relatively common 
and we cannot rule out that only the most severe and/or better-documented cases
have been reported in the medical literature. Copyright 2002 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 11867959 [PubMed - indexed for MEDLINE]

1291: Clin Ter. 2001 Nov-Dec;152(6):347-51.

Effect of water of Anticolana Valley on urinary sediment of renal stone formers.

Fraioli A, De Angelis Curtis S, Ricciuti G, Serio A, D'Ascenzo G.

Department of Medical Therapy, University of Rome La Sapienza, Rome, Italy.

An investigation was carried out to ascertain the effect of drinking Fiuggi water
on the microcrystalline structure of the calcium oxalate monohydrate present in
urinary sediments provided from patients suffering from recurrent idiopathic
oxalic calculosis. The experimental group was administered tap and Fiuggi water
for ten days. The control group was administered tap and Fiuggi water according
to the same procedure as for the experimental group. The comparative data show
that drinking Fiuggi water leads to a strong reduction, and sometimes even to the
elimination, of the calcium oxalate monohydrate present in the urinary sediment
reducing the risk of oxalic calculosis. Fiuggi water contains organic molecules
belonging to the fulvic acid family. These acids are capable of complexing the
calcium ions and interact preferentially with the crystal lattice of the calcium 
oxalate monohydrate via the formation of a film and behave as pumping systems by 
linking the calcium ion, demolishing the crystal lattice and dissolving calcium
and oxalate ions. Mineral water treatments must therefore be viewed as a function
of the specific composition of the water administered. The ecosystem influences
the composition of water, as a complex matrix containing a number of organic
molecules which are potentially biologically active.

PMID: 11865529 [PubMed - indexed for MEDLINE]

1292: BJU Int. 2001 Dec;88(9):854-7.

Pelvicalyceal stone load: a factor affecting the outcome of extracorporeal
shockwave lithotripsy for renal pelvic calculi.

Küpeli B, Tunç L, Alkibay T, Karaoglan U, Bozkirli I.

Department of Urology, School of Medicine, Gazi University, M. Kemal
Mah./Eskisehir Yolu, Ankara, Turkey. borakupeli@yahoo.com

OBJECTIVES: To determine the effect of variations in pelvicalyceal volume on the 
results of extracorporeal shock wave lithotripsy (ESWL) and the relationship of
stone load to estimated pelvicalyceal volume in patients with renal pelvic
stones. PATIENTS AND METHODS: In all, 204 patients with renal pelvic stones were 
treated primarily by ESWL. Exclusion criteria were radiolucent stones, dilatation
of the renal collecting system, JJ stent insertion before ESWL and an inadequate 
follow-up. The surface area of the stones and the renal collecting system were
measured using a grid of 1 mm2 divisions. The pelvicalyceal volume was calculated
as 0.6 (area)1.27. To evaluate the treatment results a pelvicalyceal stone load
(PSL) index, describing the relationship of stone load to total estimated
pelvicalyceal volume, was defined as stone volume/renal collecting system volume.
RESULTS: The mean (range) pelvicalyceal volume of the patients was 13.24
(4.12-28.47) mm3 and the mean PSL index was 26.2%. The cumulative success rates
according to the PSL decreased from 97% to 90% with increasing PSL, but remained 
at > 95% in patients with a PSL index of < 50%. In all, 184 sessions were applied
and the session/patient ratio increased from 1.41 to 3.0 with increasing PSL.
Complications were acute pyelonephritis in three and steinstrasse in five
patients. CONCLUSION: The PSL index appears to be a more accurate and
reproducible method for predicting the outcome of ESWL, and has the advantage of 
considering the effect of pelvicalyceal anatomy.

PMID: 11851602 [PubMed - indexed for MEDLINE]

1293: BJU Int. 2001 Dec;88(9):850-3.

Retrograde ureteropyeloscopic holmium laser lithotripsy for large renal calculi.

El-Anany FG, Hammouda HM, Maghraby HA, Elakkad MA.

Urology Department, Assiut University Hospital, Assiut, Egypt.
fathy_elanany@hotmail.com

OBJECTIVE: To assess the efficacy and safety of the retrograde ureteropyeloscopic
holmium laser for treating renal stones that are too large to treat with
extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHODS: Thirty
patients (22 men and eight women, mean age 43 years, range 18-62) with a renal
stone burden of > 2 cm were selected for laser treatment. The stones were in the 
renal pelvis in 16 patients, lower calyx in five, middle calyx in two, upper
calyx in one and multiple pelvic and calyceal in six. Lithotripsy was undertaken 
using a holmium laser through 550 microm and 200 microm laser fibres passed
through a semi-rigid fibre-optic long ureteroscope or the actively deflectable
flexible ureteropyeloscope, respectively. Success was defined as total
fragmentation of the stone to < 2 mm in diameter and/or clear imaging on renal
ultrasonography and plain films within the 3-month follow-up. Patients in whom
the treatment failed received either alternative therapy or complementary ESWL.
RESULTS: Endoscopic access and complete stone fragmentation was achieved in 23 of
the 30 patients (77%). The treatment failed in seven patients because of poor
visualization, the initial presence of stones in, or migration of their large
fragments to, an inaccessible calyx. There were no major intraoperative
complications. Minor complications after treatment included haematuria that
persisted for 2 days in one patient and high-grade fever in two patients; all
were treated conservatively. CONCLUSION: Large renal calculi that are not
amenable to ESWL monotherapy can be safely and effectively treated with a
retrograde endoscopic technique that seems to compete well with the more invasive
percutaneous or open surgical manoeuvres.

Publication Types: 
    Evaluation Studies

PMID: 11851601 [PubMed - indexed for MEDLINE]

1294: J Korean Med Sci. 2002 Feb;17(1):41-8.

FKBP-12 exhibits an inhibitory activity on calcium oxalate crystal growth in
vitro.

Han IS, Nakagawa Y, Park JW, Suh MH, Suh SI, Shin SW, Ahn SY, Choe BK.

Department of Immunology, Institute for Medical Science, Keimyung University,
Taegu, Korea.

Urolithiasis and calcium oxalate crystal deposition diseases are still
significant medical problems. In the course of nephrocalcin cDNA cloning, we have
identified FKBP-12 as an inhibitory molecule of calcium oxalate crystal growth.
lambdagt 11 cDNA libraries were constructed from renal carcinoma tissues and
screened for nephrocalcin cDNA clones using anti-nephrocalcin antibody as a
probe. Clones expressing recombinant proteins, which appeared to be antigenically
cross-reactive to nephrocalcin, were isolated and their DNA sequences and
inhibitory activities on the calcium oxalate crystal growth were determined. One 
of the clone lambda gt 11 #31-1 had a partial fragment (80 bp) of FKBP-12 cDNA as
an insert. Therefore, a full-length FKBP-12 cDNA was PCR-cloned from the lambda
gt 11 renal carcinoma cDNA library and was subcloned into an expression vector.
The resultant recombinant FKBP-12 exhibited an inhibitory activity on the calcium
oxalate crystal growth (Kd=10(-7) M). Physiological effect of the extracellular
FKBP-12 was investigated in terms of macrophage activation and proinflammatory
cytokine gene induction. Extracellular FKBP-12 failed to activate macrophages
even at high concentrations. FKBP-12 seems an anti-stone molecule for the oxalate
crystal deposition disease and recurrent stone diseases.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11850587 [PubMed - indexed for MEDLINE]

1295: Kidney Int. 2002 Mar;61(3):988-94.

Studies on the pathophysiology of the low urine pH in patients with uric acid
stones.

Kamel KS, Cheema-Dhadli S, Halperin ML.

Renal Division, St. Michael's Hospital, University of Toronto, 30 Bond Street,
Toronto, Ontario, Canada M5B 1A6. kamel.kamel@utoronto.ca

BACKGROUND: A very low urine pH is the major risk factor for uric acid stone
formation. METHODS: A subgroup of patients with a history of uric acid stones and
a persistently low urine pH (<5.5 for at least 12 h/day) were selected for
detailed study. Based on their relative ammonium (NH(+)(4)) and sulfate
(SO(2-)(4)) excretions, patients were divided into two groups. RESULTS: The first
group (N = 2) excreted 173 and 139% more NH(+)(4) than SO(2-)(4). Their daily
urinary unmeasured anion excretion was higher than their calculated net diet
alkali input (38 and 61 vs. 24 and 49 mEq, respectively). In the second group (N 
= 12), NH(+)(4) excretion was 69 +/- 5% that of SO(2-)(4). In 2 of 12, decreased 
renal ammoniagenesis was suspected due to a plasma potassium of 5.3 mmol/L and/or
a lower GFR (65 and 59 L/day); these patients had an extremely low citrate
excretion (3 and 1 mEq/day). In contrast, citrate excretion was not low in the
remaining 10 patients (10.4 +/- 1.3 mEq/day). CONCLUSIONS: Patients in group 1
needed a higher NH(+)(4) excretion possibly because of a H+ load from excessive
renal excretion of organic anions. We speculate that an alkaline proximal tubular
cell pH could be the basis for the low NH(+)(4) and high citrate excretions in 10
of 12 patients in group 2. Dietary factors and/or a molecular lesion may
contribute to their pathophysiology.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11849453 [PubMed - indexed for MEDLINE]

1296: Kidney Int. 2002 Mar;61(3):975-87.

Calcium oxalate stone formation in genetic hypercalciuric stone-forming rats.

Bushinsky DA, Asplin JR, Grynpas MD, Evan AP, Parker WR, Alexander KM, Coe FL.

Department of Medicine, Nephrology Unit, University of Rochester School of
Medicine, Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, NY 14642, USA.
David.Bushinsky@URMC.Rochester.edu

BACKGROUND: Over 54 generations, we have successfully bred a strain of rats that 
maximizes urinary calcium excretion. The rats now consistently excrete 8 to 10
times as much calcium as controls, uniformly form poorly crystalline calcium
phosphate kidney stones, and are termed genetic hypercalciuric stone-forming
(GHS) rats. These rats were used to test the hypothesis that increasing urinary
oxalate excretion would not only increase the supersaturation with respect to the
calcium oxalate solid phase, but also would increase the ratio of calcium
oxalate-to-calcium phosphate supersaturation and result in calcium oxalate stone 
formation. METHODS: To increase urine oxalate excretion an oxalate precursor,
hydroxyproline, was added to the diet of male GHS rats. The GHS rats were fed a
standard 1.2% calcium diet alone or with 1%, 3% or 5% trans-4-hydroxy-l-proline
(hydroxyproline). RESULTS: The addition of 1% hydroxyproline to the diet of GHS
rats led to an increase in urinary oxalate excretion, which did not increase
further with the provision of additional hydroxyproline. The addition of 1% and
3% hydroxyproline did not alter calcium excretion while the provision of 5%
hydroxyproline led to a decrease in urine calcium excretion. The addition of 1%
hydroxyproline led to an increase in urinary calcium oxalate supersaturation,
which did not further increase with additional hydroxyproline. The addition of 1%
and 3% hydroxyproline did not alter urinary supersaturation with respect to
calcium hydrogen phosphate while the addition of 5% hydroxyproline tended to
lower this supersaturation. Compared to rats fed the control and the 3%
hydroxyproline diet the addition of 5% hydroxyproline increased the ratio of
calcium oxalate supersaturation to calcium phosphate supersaturation. Virtually
all rats formed stones. In the control and 1% hydroxyproline group, all of the
stones were composed of calcium and phosphate (apatite), in the 3% hydroxyproline
group the stones were a mixture of apatite and calcium oxalate, while in the 5%
hydroxyproline group all of the stones were calcium oxalate. CONCLUSIONS: The
provision of additional dietary hydroxyproline to GHS rats increases urinary
oxalate excretion, calcium oxalate supersaturation and the ratio of calcium
oxalate-to-calcium phosphate supersaturation, resulting in the formation of
calcium oxalate kidney stones. Thus, with the addition of a common amino acid,
the GHS rats now not only model the most common metabolic abnormality found in
patients with nephrolithiasis, hypercalciuria, but form the most common type of
kidney stone, calcium oxalate.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11849452 [PubMed - indexed for MEDLINE]

1297: Am J Kidney Dis. 2002 Feb;39(2):383-91.

Dosage of potassium citrate in the correction of urinary abnormalities in
pediatric distal renal tubular acidosis patients.

Domrongkitchaiporn S, Khositseth S, Stitchantrakul W, Tapaneya-olarn W,
Radinahamed P.

Department of Medicine, Division of Nephrology, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand. rasdr@mahidol.ac.th

Potassium citrate is an alkaline agent that has been recommended for the
prevention of nephrolithiasis in distal renal tubular acidosis (RTA). Information
on the effectiveness and the optimal dose of potassium citrate in the correction 
of urinary abnormalities in pediatric distal RTA is limited, however. We
conducted this study to determine the effectiveness and the optimal dose of
potassium citrate for the correction of urinary abnormalities and the prevention 
of nephrolithiasis in children with distal RTA. Eight pediatric distal RTA
patients participated in this study. The mean +/- SEM age was 9.7 +/- 1.2 years, 
and mean body weight was 29.1 +/- 4.7 kg. After initial evaluation, all patients 
were treated with increasing dosages of potassium citrate starting from 2
mEq/kg/d in three divided doses. The dosage was increased progressively in a
stepwise fashion every 2 months from 2 mEq/kg/d to 3 mEq/kg/d, then to 4
mEq/kg/d. Blood and 8-hour overnight urine samples were obtained at baseline and 
every 2 months before increasing the dosage of potassium citrate. Urinary
saturations for calcium oxalate and calcium phosphate were estimated by using
Tiselius's indices. The basal urinary calcium-to-creatinine,
phosphate-to-creatinine, and calcium-to-citrate ratios and urinary saturation for
calcium oxalate and calcium phosphate were elevated significantly, whereas
citrate-to-creatinine ratio was reduced significantly in distal RTA patients.
These ratios were normalized gradually with the increasing dosage of potassium
citrate. All the aforementioned abnormalities were normalized only after the
dosage of potassium citrate was raised to 4 mEq/kg/d. The elevation in urinary
saturation of calcium phosphate could not be normalized throughout the study,
however. These results suggest that 4 mEq/kg/d of potassium citrate supplement
can correct successfully most of the urinary abnormalities and the elevated
urinary saturation for calcium oxalate but not for calcium phosphate in children 
with distal RTA. Monitoring of urinary calcium-to-creatinine ratio or
citrate-to-creatinine ratio is valuable to ensure adequate potassium citrate
supplementation in this group of patients. Copyright 2002 by the National Kidney 
Foundation, Inc.

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial

PMID: 11840381 [PubMed - indexed for MEDLINE]

1298: Urology. 2002 Jan;59(1):25-7.

Donor-gifted allograft urolithiasis: early percutaneous management.

Lu HF, Shekarriz B, Stoller ML.

Department of Urology, University of California, San Francisco, School of
Medicine, San Francisco, California 94143-0738, USA.

OBJECTIVES: To describe our successful early management of donor-gifted
nephrolithiasis by percutaneous nephrolithotomy. Donor-gifted nephrolithiasis is 
a rare and frustrating complication of renal transplantation. In the past,
initial conservative management with relief of obstruction and shock wave
lithotripsy has been recommended. METHODS: We treated 3 cases of donor-gifted
cadaveric kidney transplant stones by a percutaneous approach 1 to 2 months
postoperatively. Two patients presented with hydronephrosis-associated renal
deterioration and febrile urinary tract infection, and the third was diagnosed
incidentally on routine postoperative ultrasonography. RESULTS: Percutaneous
nephrolithotomy was performed with ultrasound stone fragmentation after initial
nephrostomy tube drainage in 1 patient. In the second patient, the stone was
successfully removed in a basket in an antegrade fashion. The third patient's
ureteral stone was successfully removed by antegrade ureteroscopy.
Postoperatively, no residual stones were noted on nephrostography, and renal
function returned to normal. CONCLUSIONS. Post-transplant renal calculi can be
managed successfully by percutaneous techniques in the early postoperative period
and renal function can be salvaged. Pretransplant renal sonography may be
considered to limit donor-gifted calculi.

PMID: 11796274 [PubMed - indexed for MEDLINE]

1299: Urology. 2002 Jan;59(1):20-4.

Post-ESWL, clinically insignificant residual stones: reality or myth?

Khaitan A, Gupta NP, Hemal AK, Dogra PN, Seth A, Aron M.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

OBJECTIVES: To assess the significance of asymptomatic residual stone fragments
of less than 4 mm (clinically insignificant residual fragments [CIRFs]) after
extracorporeal shock wave lithotripsy (ESWL).METHODS: Eighty-one patients were
followed up for 6 to 60 months (mean 15) after ESWL to determine the fate of the 
CIRFs.RESULTS: Of the 81 patients, 6 were lost to follow-up, leaving 75 patients.
During follow-up, fragments passed spontaneously in 18 patients, remained stable 
in 13 patients, and became clinically significant in 44 patients who developed
one or more complications. For the latter patients, repeated ESWL was done in 16,
percutaneous nephrolithotomy in 3, and ureteroscopic stone removal in 4 patients.
The remaining 21 patients were treated conservatively with analgesics. We found
that 53% of the CIRFs located in the pelvis passed spontaneously, and most of the
CIRFs in caliceal location became clinically significant. Also, as the stone
burden and number of stone fragments increased, the risk of CIRFs becoming
clinically significant increased. The outcome was the same whether a metabolic
abnormality was present or not, provided the patient received appropriate
treatment. The clearance rate was highest in the first 6 months. Finally, as the 
duration of follow-up increased, the rate of complications increased.CONCLUSIONS:
Patients with residual stones after ESWL require close follow-up and timely
adjuvant therapy. As the number and size of residual fragments increased, the
risk of complications increased. A pelvic location was a favorable factor for
spontaneous passage. Metabolic defects, if treated adequately, did not increase
the regrowth rate. Although the complete clearance rate of CIRFs with repeated
ESWL was lower than for the operative interventions, most patients improved with 
this modality.

PMID: 11796273 [PubMed - indexed for MEDLINE]

1300: Maturitas. 2002 Feb 26;41(2):149-56.

Risk of calcium oxalate nephrolithiasis in postmenopausal women supplemented with
calcium or combined calcium and estrogen.

Domrongkitchaiporn S, Ongphiphadhanakul B, Stitchantrakul W, Chansirikarn S,
Puavilai G, Rajatanavin R.

Department of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6, Bangkok
10400, Thailand. rasdr@mahidol.ac.th

BACKGROUND: Recent studies showed that postmenopausal women lost less bone mass
when supplemented with calcium or estrogen therapy. However, the safety of the
treatments in terms of the risk of calcium oxalate stone formation is unknown. We
therefore conducted this study to determine the alteration in calcium oxalate
supersaturation after calcium supplement or after combined calcium and estrogen
therapy in postmenopausal osteoporotic women. METHODS: Fifty-six postmenopausal
women were enrolled in this study. All subjects were more than 10 years
postmenopausal with vertebral or femoral osteoporosis by bone mineral density
criteria. They were randomly allocated to receive either 625 mg of calcium
carbonate (250 mg of elemental calcium) at the end of a meal three times a day
(group A, n=26) or calcium carbonate in the same manner plus 0.625 mg/day of
conjugated equine estrogen and 5 mg medrogestone acetate from day 1-12 each month
(group B, n=30). The age (mean +/- S.E.M.) was 66.3 +/- 1.2 and 65.1 +/- 1.1
years, weight 54.1 +/- 1.2 and 55.3 +/- 2.1 kg, in group A and group B,
respectively. Urine specimens (24-h) were collected at baseline and 3 months
after treatment for the determination of calcium oxalate saturation by using
Tiselius's index (AP(CaOx)) and calcium/citrate ratio. RESULTS: After 3 months of
treatment, there was no significant alteration from baseline for urinary
excretion of calcium, citrate and oxalate. Urinary phosphate excretion was
significantly reduced (6.3 +/- 0.7 vs. 5.1 +/- 0.7 mmol/day for group A and 8.2
+/- 0.9 vs. 5.8 +/- 0.7 mmol/day for group B, P<0.05), whereas net alkaline
absorption was significantly elevated (10.1 +/- 3.6 vs. 20.1 +/- 4.4 meq/day for 
group A and 4.8 +/- 3.2 vs. 19.9 +/- 3.6 meq/day for group B, P<0.05).
Calcium/citrate ratio and AP(CaOx) determined at baseline were not different from
the corresponding values after treatment in both groups; calcium/citrate: 10.1
+/- 3.1 vs. 10.1 +/- 2.5 for group A and 9.3 +/- 1.8 vs. 11.9 +/- 2.5 for group B
and AP(CaOx): 1.1 +/- 0.1 vs. 1.3 +/- 0.2 for group A and 1.2 +/- 0.2 vs. 1.1 +/-
0.1 for group B. There were eight and nine patients with high AP(CaOx), or >2, at
baseline and after treatment, respectively. CONCLUSIONS: Calcium supplement with 
a meal or combined calcium supplement and estrogen therapy is not associated with
a significant increased risk of calcium oxalate stone formation in the majority
of postmenopausal osteoporotic patients. Determination of urinary saturation for 
calcium oxalate after calcium and estrogen supplements, especially at the initial
phase of treatment, may be helpful in the avoidance of nephrolithiasis.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11836046 [PubMed - indexed for MEDLINE]

1301: Urol Int. 2002;68(2):118-21.

Influence of cations and total protein of urine on the solubility and probability
of urate stone formation in kidneys.

Bilobrov VM, Bogdan NM, Bilobrov SV, Roy A.

Litvinenko Institute of Physical Organic and Coal Chemistry, National Academy of 
Sciences of the Ukraine, Donetsk, Ukraine. serge_zh@yahoo.com

The solubility of uric acid kidney stones has been studied in water solutions
containing ammonium ions, alkaline ions and alkaline earth metals. It was shown
that the solubility of uric acid stones depends on the concentration of these
cations. The shape of the dependence curve of uric acid stone solubility in
solutions containing cations of ammonium, sodium, potassium, calcium and
magnesium has an extreme character. It was shown that a maximal balanced
solubility of stones occurs in solutions in which the concentrations and ratios
of the cations concentrations are equal to their 'normal' value in the urine of
healthy persons. The solubility dependence of stones on ammonium ions does not
show any extreme and is well approximated with the exponent. Correlation analysis
of the above-mentioned cations and also of total protein in urine was carried out
in healthy people and patients with uric acid stones. The relationship was
determined between the concentrations of cations and total protein in urine, and 
the formation of uric acid stones in human kidneys. Copyright 2002 S. Karger AG, 
Basel

PMID: 11834903 [PubMed - indexed for MEDLINE]

1302: Urology. 2002 Feb;59(2):206-10.

Utility of oral dissolution therapy in the management of referred patients with
secondarily treated uric acid stones.

Moran ME, Abrahams HM, Burday DE, Greene TD.

St. Peter's Kidney Stone Center, Albany, New York 12208, USA.

OBJECTIVES: Uric acid stones are best managed by chemolysis. Some patients with
acutely symptomatic stones opt for endourologic therapies. The radiolucent nature
of these stones makes secondary interventions difficult to plan. Computed
tomography becomes the modality of choice to identify stone locations and size in
these patients. We analyzed patients with uric acid stones referred to our stone 
center after primary treatment had failed to establish the efficacy of oral
alkalinization therapy. METHODS: Eleven patients presented after one or more
failed attempts to intervene for uric acid stones. Charts were reviewed for age, 
sex, time with stone before referral, medical therapies undertaken, number of
antecedent urologic interventions, number of radiographic studies performed,
subsequent procedures performed, and outcomes with a minimal follow-up of 6
months. RESULTS: Eight patients were men and four presented with bilateral stone 
disease (overall, 15 involved upper tracts). Sixty-seven percent of patients had 
right-sided solitary calculi. All patients at presentation filled out urinary pH 
diaries. Of the 11 patients, 4 stated they had been prescribed oral alkaline
therapy but were found to be noncompliant, 4 were never prescribed this therapy, 
and 3 took the medication sporadically. All patients were counseled on
self-dosing to maintain their urinary pH between 6.0 and 6.5 and to continue the 
diaries. Computed tomography scans were done in 9 patients, and intravenous
urography and ultrasonography in the other 2 patients confirmed the stone burden.
Only 3 patients (27%) required subsequent interventions (ureteroscopic laser
lithotripsy). CONCLUSIONS: Secondarily referred patients with uric acid stones
are best treated with medical therapy. These findings suggest that the initial
medical regimens had failed because of noncompliance or lack of effective
follow-up by the primary urologist. Seventy-three percent of these patients had
dissolution of the stones, requiring no further endourologic intervention.

PMID: 11834386 [PubMed - indexed for MEDLINE]

1303: J Urol. 2002 Mar;167(3):1378-80.

Laparoscopic pyeloplasty with concomitant pyelolithotomy.

Ramakumar S, Lancini V, Chan DY, Parsons JK, Kavoussi LR, Jarrett TW.

Section of Urology, Department of Surgery, University of Arizona, Tucson,
Arizona, USA.

PURPOSE: We present our experience with laparoscopic pyeloplasty plus
pyelolithotomy in patients in whom stones were not the cause of ureteropelvic
junction obstruction. MATERIALS AND METHODS: A transperitoneal approach was used 
for laparoscopic pyeloplasty and pyelolithotomy in 19 patients (20 renal units). 
Before ureteropelvic junction repair stones were extracted through a small
pyelotomy that was eventually incorporated into the final pyeloplasty incision.
Stones in the renal pelvis were removed with rigid graspers under direct
laparoscopic vision. A flexible cystoscope introduced through a port was used to 
extract stones in the calices. The renal pelvis was reconstructed based on the
anatomy of the ureteropelvic junction. RESULTS: A median of 1 stone (range 1 to
28) was recovered. In 11, 8 and 1 patients the Anderson-Hynes dismembered
pyeloplasty, Y-V plasty and the Heinecke Mickulicz procedure were performed,
respectively. At 3 months 2 patients had residual calculi for a procedural
stone-free rate of 90%. There was no evidence of obstruction in 18 of the 20
cases (90%), as confirmed by negative diuretic scan or radiological improvement
of hydronephrosis. At a mean followup of 12 months (range 3 to 57) 2 additional
patients had recurrent stones for an overall long-term stone-free rate of 80% (16
of 20). CONCLUSIONS: Laparoscopic pyelolithotomy is feasible when combined with
pyeloplasty. Our results are comparable to those of stone removal during open
pyeloplasty or percutaneous endopyelotomy. The advantages of open surgery appear 
to be maintained in this minimally invasive approach.

PMID: 11832737 [PubMed - indexed for MEDLINE]

1304: J Urol. 2002 Mar;167(3):1248-52.

Laparoscopic management of caliceal diverticular calculi.

Miller SD, Ng CS, Streem SB, Gill IS.

Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute,
Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

PURPOSE: We describe laparoscopic techniques for the definitive management of
symptomatic caliceal diverticular stone disease. MATERIALS AND METHODS: Five
patients underwent retroperitoneoscopic management of a symptomatic, stone
bearing caliceal diverticulum. Techniques for intraoperative localization of the 
stone bearing diverticulum included retrograde injection of indigo carmine,
fluoroscopy and/or laparoscopic ultrasound. In 2 cases the patent neck of the
diverticulum was sutured via laparoscopy. RESULTS: Complete stone clearance and
obliteration of the diverticular cavity was achieved in all cases without any
open conversion. Mean operative time was 133.8 minutes. Mean estimated blood loss
was less than 50 cc in 4 cases and 150 cc in 1. Mean hospital stay was 36 hours. 
There were no laparoscopic or postoperative complications. CONCLUSIONS: The
laparoscopic approach to symptomatic caliceal diverticula represents an effective
and minimally invasive modality for complete clearance of the stone burden and
definitive management of the anatomical abnormality. However, patient selection
is paramount. We reserve the laparoscopic approach for symptomatic caliceal
diverticula with thin overlying renal parenchyma, or for anterior lesions
inaccessible to or unsuccessfully managed by endourological techniques. A
decision tree algorithm for managing symptomatic caliceal diverticular calculi is
proposed.

Publication Types: 
    Case Reports

PMID: 11832707 [PubMed - indexed for MEDLINE]

1305: J Urol. 2002 Mar;167(3):1239-42.

Comment in:
    J Urol. 2003 Jan;169(1):292.

Risk factors for the formation of a steinstrasse after extracorporeal shock wave 
lithotripsy: a statistical model.

Madbouly K, Sheir KZ, Elsobky E, Eraky I, Kenawy M.

Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

PURPOSE: We studied the various stone, renal and therapy factors that could
affect steinstrasse formation after extracorporeal shock wave lithotripsy (ESWL),
Dornier Medical Systems Inc., Marietta, Georgia to define the predictive factors 
for its formation. Thus, steinstrasse could be anticipated and prophylactically
avoided. MATERIALS AND METHODS: Between February 1989 and May 1999, 4,634
patients were treated with a Dornier MFL 5000 lithotriptor (Dornier Med Tech,
GmbH, Germany). Renal stones were encountered in 3,403 patients and ureteral
stones in 1,231. Steinstrasse were recorded in 184 patients, of whom 74 required 
intervention and formed the "complicated group." All patient data, stone and
renal characteristics, and data of ESWL were reviewed. Univariate and
multivariate statistical analyses of patients, stones and therapy characteristics
in correlation with the incidence of steinstrasse formation were performed to
assign the factors that had a significant impact on steinstrasse formation.
RESULTS: The overall incidence of steinstrasse was 3.97%. The steinstrasse was in
the pelvic ureter in 74% of the cases, lumbar ureter in 21.7% and iliac ureter in
4.3%. Steinstrasse incidence significantly correlated with stone size and site,
the power level (kV.) used during therapy and radiological renal features.
Steinstrasse was more common with renal stones more than 2 cm. in diameter in a
dilated system, especially with the use of high power (greater than 22 kV.) for
disintegration. A statistical model was constructed to estimate the risk of
steinstrasse formation accurately. CONCLUSIONS: Stone size and site, renal
morphology and shock wave energy are the significant predictive factors
controlling steinstrasse formation. If a patient has a high probability of
steinstrasse formation, close followup with early intervention or prophylactic
pre-ESWL ureteral stenting is indicated.

PMID: 11832705 [PubMed - indexed for MEDLINE]

1306: Sb Lek. 2001;102(1):23-7.

An absence of changes in kidney tissues after an enormous number of shock waves.

Benes J, Chmel J, Marecek Z, Tesar V.

Institute of Biophysics of 1st Medical Faculty of Charles University, Prague,
Czech Republic. benesjiri@cesnet.cz

Repeated sessions of unilateral extracorporeal shock wave lithotripsy (ESWL) were
performed in a patient with multiple bilateral calycolithiasis who suffered from 
Crohn's disease of long duration and from recurrent gastric ulcers. To achieve
complete clearance of stones from the left kidney it was necessary to apply
10,000 shock waves during seven sessions within five weeks. This number is
exceedingly high compared to average total doses which were applied to other
patients of our group (920 SW per one session). For the treatment was used an
electrohydraulic lithotripter (Medipo). A surgical reconstruction of the
abdominal wall which had been planned long before was made six weeks after the
last ESWL session. The postoperative course was complicated by bleeding gastric
ulcer of which the patient died despite an intensive treatment. The autopsy and
histology revealed no damage of kidney tissue or adjacent organs caused by ESWL.

Publication Types: 
    Case Reports

PMID: 11830915 [PubMed - indexed for MEDLINE]

1307: Hosp Med. 2002 Jan;63(1):34-41.

Bladder and renal stones: management and treatment.

Westenberg A, Harper M, Zafirakis H, Shah PJ.

Institute of Urology and Nephrology, Middlesex Hospital, London W1W 7EY.

The prevalence of renal tract calculi in the population is such that patients may
present acutely not only to urologists, but in the setting of any medical
specialty. This article aims to enable all practitioners to be able to recognize 
the condition and instigate early investigation and management before referring
to the urologist for definitive treatment.

Publication Types: 
    Review

PMID: 11828814 [PubMed - indexed for MEDLINE]

1308: Ann Acad Med Singapore. 2001 Nov;30(6):568-72.

Acute renal colic: value of unenhanced spiral computed tomography compared with
intravenous urography.

Wong SK, Ng LG, Tan BS, Cheng CW, Chee CT, Chan LP, Lo HG.

Department of Diagnostic Radiology, Singapore General Hospital, Outram Road,
Singapore 169608.

OBJECTIVE: The objective of this study was to compare the efficacy of plain
spiral computed tomographic (CT) scan with intravenous urography (IVU) in the
evaluation of patients with suspected urinary calculi/obstruction. MATERIALS AND 
METHODS: Twenty consecutive patients with acute signs of renal colic were
prospectively examined with unenhanced spiral CT followed by an IVU within the
same day. The CT scans were reviewed jointly by 2 radiologists blinded to the IVU
and a consensus was reached for each finding. The IVU was similarly reviewed by
another 2 separate radiologists. RESULTS: Eleven of the 20 patients had signs of 
urinary obstruction on CT and IVU. Of these 11 patients, 7 had a ureteric
calculus that was demonstrated on CT and IVU and 4 had a calculus that was
demonstrated on CT only. Two patients had a urinary calculus seen on CT and IVU
with no signs of urinary obstruction. One patient had a calculus seen on CT alone
with no urinary obstruction. Two patients only had signs of urinary obstruction
on CT. The remaining 4 cases had normal findings on CT and IVU. CONCLUSION:
Unenhanced CT is more effective than IVU in identifying ureteric calculi and is
equally effective in detecting urinary obstruction. CT is also useful in
detecting secondary signs of obstruction even in the absence of any calculus.

Publication Types: 
    Comparative Study

PMID: 11817281 [PubMed - indexed for MEDLINE]

1309: J Pediatr. 2002 Jan;140(1):103-9.

Comment in:
    J Pediatr. 2002 Oct;141(4):598; author reply 598.

Antibiotic treatment-induced tubular dysfunction as a risk factor for renal stone
formation in cystic fibrosis.

Böhles H, Gebhardt B, Beeg T, Sewell AC, Solem E, Posselt G.

Department of Pediatrics, Johann Wolfgang Goethe-University, Frankfurt am Main,
Germany.

OBJECTIVES: Our purpose was to characterize the decisive pathophysiologic factors
that lead to renal stone formation (nephrolithiasis) in patients with cystic
fibrosis (CF). METHODS: Patients with CF (n = 96) were investigated with respect 
to lithogenic and inhibitory factors of urolithiasis and compared with 30 healthy
control patients. They were subdivided into 2 groups, 86 without renal stones and
10 with renal stones. RESULTS: All stones were exclusively composed of calcium
oxalate. As a major pathogenic factor, a urinary disequilibrium between promoting
and inhibitory components of stone formation, characterized mainly by
hypercalciuria, hyperoxaluria, and hypocitraturia, was found in the patients with
nephrolithiasis. They tended to have lower plasma phosphate concentrations and an
increased urinary phosphate excretion. The citrate/calcium ratio proved to be a
valuable means to discriminate patients with renal stones from control patients. 
Patients with stones had ingested more cotrimoxazole and ceftazidim,
cumulatively, than patients without stones. There was an inverse correlation
between the amounts of antibiotics ingested and the percentage of tubular
phosphate reabsorption (r = -0.91, P <.0046). CONCLUSION: Renal stone formation
in patients with CF is caused by a disequilibrium between promoting and
inhibitory components of stone formation, which is dominated by hypercalciuria,
hyperoxaluria, and hypocitraturia. Treatment with cotrimoxazole and ceftazidim,
primarily, may lead to renal proximal tubular damage with an ensuing sequence of 
phosphate loss, increase of parathyroid hormone secretion, increased
1,25-dihydroxyvitamin D3 formation, and absorptive hypercalciuria.

PMID: 11815772 [PubMed - indexed for MEDLINE]

1310: Nephrol Dial Transplant. 2002 Feb;17(2):253-9.

High urinary excretion of uric acid combined with high excretion of calcium links
kidney stone disease to familial hypertension.

Tisler A, Pierratos A, Honey JD, Bull SB, Rosivall L, Logan AG.

First Department of Medicine, Semmelweis University, 2/a Koranyi S.u., H-1083
Budapest, Hungary. atisler@mail.matav.hu

BACKGROUND: Past studies identified an association between kidney stone disease
(KSD) and hypertension. We recently reported a high occurrence of hypertension in
families of patients with hyperuricosuric KSD. As hypercalciura frequently
coexists with hyperuricosuria and high urinary excretion of calcium is found in
patients with hypertension, we hypothesized that hyperuricosuria that is
accompanied by hypercalciuria better describes the familial association between
KSD and hypertension. METHODS: Four hundred and eighty-six KSD patients, aged
18-50 years, attending a lithotripsy unit collected a 24-h urine sample for
metabolic analysis and provided information on family history of hypertension.
The familial occurrence of hypertension was compared among four groups of
patients: those who had combined elevation of both urinary calcium and uric acid 
excretions ("combined" abnormality, n=56), those who had hyperuricosuria without 
concomitant hypercalciuria ("pure" hyperuricosuria, n=67), those who had
hypercalciuria without concomitant hyperuricosuira ("pure" hypercalciuria, n=52),
and a control KSD patient group ("other" abnormality, n=311). The prevalence of
treated hypertension in patients from the four groups was 16%, 12%, 2%, 10%,
respectively. RESULTS: Thirty-four per cent of the patients with the "combined"
abnormality had a positive family history of hypertension, defined as two or more
first-degree relatives with treated hypertension, that was significantly higher
than in patients with either "pure" hyperuricosuira (15%, P<0.02), "pure"
hypercalciuria (8%, P<0.001), or patients with "other" abnormality (10%,
P<0.001). The adjusted OR for positive family history of hypertension in the
"combined" abnormality group compared to the control KSD patient group was 5.6
(2.39-13.30). The prevalence of hypertension in siblings of patients with the
"combined" abnormality (13%) was significantly higher than in siblings of
patients with either "pure" hyperuricosuria (3%, P<0.001), "pure" hypercalciuria 
(1%, P<0.001), or siblings of control patients with "other" abnormality (4%,
P<0.001). The adjusted OR for hypertension in siblings of a patient with
"combined" abnormality compared to a control KSD patient was 3.4 (1.97-5.91).
Patients in the "combined" abnormality group were also characterized by
significantly elevated urinary sodium, phosphorus, citrate and potassium
excretions. CONCLUSIONS: Our data suggest that there is a strong, independent
association between familial occurrence of hypertension and the phenotype
characterized by combined elevation of both urinary uric acid and calcium
excretions. The association is not present in those with "pure" hyperuricosuria
or "pure" hypercalciuria. Ascertainment of patients based on this phenotype may
identify more homogeneous populations for genetic analysis of hypertension.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11812875 [PubMed - indexed for MEDLINE]

1311: Eur Urol. 2001 Dec;40(6):619-24.

Minimally invasive PCNL in patients with renal pelvic and calyceal stones.

Lahme S, Bichler KH, Strohmaier WL, Götz T.

Department of Urology, University of Tübingen, Germany.
sven.lahme@med.uni-tuebingen.de

Stones of the renal pelvis can be treated either by extracorporeal shock wave
lithotripsy (SWL) or percutaneous nephrolithotomy (PCNL). As a low-risk procedure
with a longer treatment period, SWL often leads to persistent residual stone
fragments, whereas conventional PCNL achieves a higher stone-free rate and allows
a shorter treatment period albeit with a somewhat higher surgical risk. To reduce
the invasiveness of conventional PCNL, the application of a miniaturised
instrument for PCNL (MPCNL) was evaluated. For MPCNL a rigid nephroscope with a
calibre of 12 F was developed and used in 19 patients. After puncture of the
kidney under ultrasound control and single-step dilatation, a 15 F Amplatz sheath
was placed. Data on the stone size and location, stone-free rate, blood
transfusions, operating time and complications were recorded. In all patients,
the part of the kidney afflicted by the stone was successfully punctured. On
average, retreatment rate was 0.7. The mean stone size was 2.4 cm(2). The average
operating time was 99.2 min. In every case, the absence of residual stones was
confirmed radiologically and nephroscopically. Hemorrhages requiring a blood
transfusion did not occur. A febrile pyelonephritis occurred as a postoperative
complication in one patient (= 5.3%). MPCNL represents an alternative to SWL for 
renal calculi with a size from 1 to 2 cm located in the renal pelvis and calices,
especially the lower calix. The advantages are the short treatment time, the high
stone-free rate and the accessibility of lower pole stones which are less
amenable to SWL. MPCNL is not suitable for large concrements since the limited
sheath diameter would increase the operating time. Due to this limitation, MPCNL 
represents an extension of the indication for conventional PCNL that it can in no
way replace.

Publication Types: 
    Evaluation Studies

PMID: 11805407 [PubMed - indexed for MEDLINE]

1312: Urol Int. 2002;68(1):54-9.

Quantification of proteins extracted from calcium oxalate and calcium phosphate
crystals induced in vitro in the urine of healthy controls and stone-forming
patients.

Atmani F, Khan SR.

Laboratory of Cellular Physiology and Pharmacology, Department of Biology,
Faculty of Sciences, University Mohammed the First, Oujda, Morocco.
atmani@sciences.univ-oujda.ac.ma

We have previously identified proteins extracted from calcium oxalate (CaOx) and 
calcium phosphate (CaP) crystals generated experimentally in vitro in whole urine
of healthy controls and stone formers. No significant differences were detected
between protein components in matrices of crystals obtained from both groups. The
aim of the present study was to estimate the amounts of six proteins identified
earlier in order to investigate the differences, if any, between healthy controls
and lithiasis patients. CaOx and CaP crystals were generated in the urine samples
by adding an oxalate and phosphate load, respectively. Crystals were harvested,
washed, dried, and analyzed. Crystal matrix protein was extracted by
demineralizing crystals with EDTA solution, analyzed by sodium dodecyl sulfate
polyacrylamide gel electrophoresis, and identified immunochemically using Western
blot analysis. The quantity of each protein was estimated by densitometric
analysis. The predominant proteins found in organic matrices of CaOx crystals
induced in the urine of healthy controls were prothrombin-related proteins
followed by albumin and osteopontin. In matrices of CaP crystals, the principal
proteins were Tamm-Horsfall protein followed by albumin, prothrombin-related
proteins and osteopontin. However, when crystals were induced in the urine of
stone formers, albumin was the major component of the organic matrix of both CaOx
and CaP crystals. We concluded that a subset of urinary proteins is present in
crystal matrix. Among them, albumin seems to play a crucial role in kidney stone 
formation. Copyright 2002 S. Karger AG, Basel

Publication Types: 
    Comparative Study

PMID: 11803269 [PubMed - indexed for MEDLINE]

1313: BMC Urol. 2001;1:3. Epub 2001 Dec 20.

Unpredicted spontaneous extrusion of a renal calculus in an adult male with spina
bifida and paraplegia: report of a misdiagnosis. Measures to be taken to reduce
urological errors in spinal cord injury patients.

Vaidyanathan S, Hughes PL, Soni BM, Singh G, Mansour P, Sett P.

Regional Spinal Injuries Centre, District General Hospital, Southport PR8 6PN,
UK. vaidyanathansiu@hotmail.com

BACKGROUND: A delay in diagnosis or a misdiagnosis may occur in patients with
spinal cord injury (SCI) or spinal bifida as typical symptoms of a clinical
condition may be absent because of their neurological impairment. CASE
PRESENTATION: A 29-year old male, who was born with spina bifida and
hydrocephalus, became unwell and developed a swelling and large red mark in his
left loin eighteen months ago. Pyonephrosis or perinephric abscess was suspected.
X-ray of the abdomen showed left-sided staghorn calculus. Since ultrasound scan
showed no features of pyonephrosis or perinephric abscess, he was prescribed a
prolonged course of antibiotics for infection presumed to arise from the site of 
metal implant in spine. He developed a discharging sinus, following which the
loin swelling and red mark subsided. About three months ago, he again developed a
red mark and minimal swelling in the left loin. Ultrasound scan detected no
abnormality in the renal or perinephric region. Therefore, the red mark and
swelling were attributed to pressure from the backrest of his chair. Five weeks
later, the swelling in the left loin burst open and a large stone was extruded
spontaneously. An X-ray of the abdomen showed that he had extruded the central
portion of the staghorn calculus from left kidney. With hindsight, the extruded
renal calculus could be seen lying in the subcutaneous tissue of left loin
lateral to the 10th rib in the X-ray of abdomen, which was taken when he
presented with red mark and minimal swelling. CONCLUSION: This case illustrates
how mistakes in diagnosis could occur in spinal cord injury patients, and
highlights the need for corrective measures to reduce urological errors in these 
patients. Voluntary reporting of urological errors is recommended to facilitate
learning from our mistakes. In the patients who have marked spinal curvature,
ultrasonography of kidneys and perinephric region may not be entirely reliable.
As clinical symptoms and signs may be non-specific in SCI patients, they require 
prompt, detailed and occasionally, repeated investigations. A joint team approach
by health professionals belonging to various medical disciplines, which is
strengthened by frequent, informal and honest discussions of a patient's clinical
condition, is likely to reduce urological errors in SCI patients.

Publication Types: 
    Case Reports

PMID: 11801198 [PubMed - indexed for MEDLINE]

1314: Pediatr Nephrol. 2001 Dec;16(12):1080-3.

Evaluation of lithogenic elements in urine of healthy newborns.

Cillo AC, Cattini H, Boim MA, Schor N.

Department of Pediatrics, Division of Nephrology, Pontifícia Universidade
Católica de Campinas, Campinas, Brazil.

The determination of urinary excretion of lithogenic elements in healthy newborns
involves factors ranging from urine collection and data handling to maternal
influences, which can cause difficulties in analyzing the results. The objective 
of this study was to determine normal values of parameters related to
lithogenesis, such as calcium, uric acid, citrate, and oxalate, in urine of
healthy newborns using isolated samples, focusing on variations according to
gender, weight, milk ingestion, and family history of lithiasis. Parameters
measured in isolated urine samples from 104 healthy newborns (77 males and 27
females) were corrected by creatinine. The ratios were expressed as
milligram/milligram of creatinine: calcium/creatinine of 0.10+/-0.01 (X+/-SE),
uric acid/ creatinine of 1.10+/-0.10, citrate/creatinine of 0.56+/-0.04, and
oxalate/creatinine of 0.07+/-0.01. Differences were observed between males and
females, in terms of uric acid (0.80+/-0.07 vs. 1.10+/-0.10 mg/mg, P<0.05),
citrate (0.05+/-0.06 vs. 0.17+/-0.05, P<0.05), sodium (0.17+/- 0.01 vs.
0.05+/-0.01, P<0.001), and potassium (0.05+/- 0.01 vs. 0.20+/-0.02, P<0.001).
Interestingly, the urinary concentration of protector factors such citrate and
potassium was higher in females than in males with low sodium excretion.
Artificial milk feeding leads to higher calcium (0.10+/-0.06 vs. 0.06+/-0.01),
uric acid (1.40+/-0.20 vs. 0.90+/-0.09, P<0.05), citrate (0.90+/-0.09 vs.
0.50+/-0.04, P<0.001), and oxalate (0.17+/-0.03 vs. 0.05+/-0.01, P<0.001)
excretion when compared with breast feeding. There was higher excretion of
calcium and sodium in patients under 3 kg. Children with familial antecedents
presented some differences in urinary excretion, with higher uric acid
(1.50+/-0.30 vs. 0.80+/-0.08, P<0.05) but lower calcium (0.05+/-0.02 vs.
0.10+/-0.01, P<0.05) and sodium (0.15+/-0.02 vs. 0.20+/-0.02, P<0.05) excretion, 
respectively. This report provides urinary parameters obtained in healthy
newborns and correlates them with factors that could be involved in the genesis
of osteopenia, renal stones, and/or nephrocalcinosis.

Publication Types: 
    Comparative Study

PMID: 11793105 [PubMed - indexed for MEDLINE]

1315: J Urol. 2002 Feb;167(2 Pt 1):670-3.

Clinical outcome of pediatric stone disease.

Pietrow PK, Pope JC 4th, Adams MC, Shyr Y, Brock JW 3rd.

Divisions of Pediatric Urology and Biostatistics, Department of Preventive
Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

PURPOSE: The natural history of stone disease in children is not well defined. We
evaluated the clinical outcome in children with urinary calculi. MATERIALS AND
METHODS: An 8-year retrospective review of 129 pediatric patients with primary
urinary lithiasis was performed. Age, renal versus ureteral stone location, stone
size, spontaneous passage, recurrence and metabolic evaluation were considered.
Patients were divided into groups 1-0 to 5, 2-6 to 10 and 3-11 to 18 years old.
RESULTS: Of the 25 group 1 patients 17 (68%) had renal and 8 (32%) had ureteral
stones. Of the 36 group 2 patients 13 (36%) had renal and 23 (64%) had ureteral
stones. Of the 68 group 3 patients 12 (18%) had renal and 56 (82%) had ureteral
stones. These differences in stone location according to age were not due to
chance (p <0.0001). In groups 1 to 3 renal calculi an average of 6.7, 9.2 and 6.8
mm. spontaneously passed in 24%, 8% and 50% of cases, while ureteral calculi an
average of 4.5, 3.5 and 3.2 mm. passed in 63%, 61% and 64%, respectively. The
spontaneous passage rate of ureteral stones was consistent in the 3 age groups
and for stone size up to 5 mm. Only 1 stone greater than 5 mm. passed
spontaneously at any age. The incidence of identifiable metabolic abnormalities
believed responsible for stone disease was 50% in groups 1 and 2, and 38% in
group 3. In all age groups there was symptomatic and/or radiographic stone
recurrence in a third of the patients with an identifiable metabolic abnormality,
such as hypercalciuria, hypocitruria, renal tubular acidosis and so forth. In
children 10 years or younger this incidence increased to 50%. Less than 10% of
those with no identifiable metabolic disorder have had recurrent stones to date. 
CONCLUSIONS: Younger patients are more likely to present with renal calculi and
less likely to pass these stones, probably due to the relatively larger stone
burden and location. The passage rate for ureteral calculi is surprisingly
consistent in all age groups with stones greater than 5 mm. rarely passing
spontaneously. Half of the children 10 years or younger who present with urinary 
calculi have an identifiable metabolic disorder. Thus, all children with stones
should undergo metabolic evaluation. In addition, these children are nearly
5-fold more likely to have recurrent stones than those with no identifiable
metabolic disorder. Thus, they should be followed aggressively.

PMID: 11792950 [PubMed - indexed for MEDLINE]

1316: J Urol. 2002 Feb;167(2 Pt 1):480-4.

Metabolic risk factors for stone formation in patients with cystic fibrosis.

Perez-Brayfield MR, Caplan D, Gatti JM, Smith EA, Kirsch AJ.

Division of Pediatric Urology, Department of Urology and Cystic Fibrosis Center, 
Emory University School of Medicine, Children's Healthcare of Atlanta, Georgia,
USA.

PURPOSE: Cystic fibrosis is characterized by chronic pulmonary disease,
insufficient pancreatic and digestive function, and abnormal sweat
concentrations. Patients with cystic fibrosis also have an increased incidence of
nephrolithiasis. We compared the results of metabolic evaluation in patients with
cystic fibrosis with and without nephrolithiasis. MATERIALS AND METHODS: A total 
of 496 patients were evaluated at our center, including 98 with a mean age of 25 
years who had cystic fibrosis and complete metabolic evaluation available between
1996 and 2000. Of these patients 13 (13%) had a history of nephrolithiasis. The
records were reviewed for clinical characteristics and all patients underwent
metabolic evaluation, including serum electrolyte measurement and 24-hour urine
collection. Statistical analysis was done to compare the stone versus nonstone
groups. RESULTS: The incidence of nephrolithiasis in our study was 3%. We
identified 13 patients 16 to 41 years old (mean age 27) with nephrolithiasis, of 
whom 62% had had multiple episodes. Flank pain was the presenting symptom in 9 of
the 13 cases (69%). Renal ultrasound and computerized tomography were the most
common imaging modalities. In 9 cases stones were passed without intervention,
extracorporeal shock wave lithotripsy was required in 2 and ureteroscopy with
stone extraction was done in 2. Calcium oxalate was the dominant stone
composition in the 9 patients in whom stone analysis was performed. Metabolic
evaluation of the stone versus no stone groups showed elevated urinary oxalate
(45.5 versus 42.5 mg./24 hours), relative calcium oxalate supersaturation (5.3
versus 7.2) and decreased urinary citrate in the 2 groups. There was a
statistical difference in citrate excretion with lower levels in stone formers
(102 versus 218 mg./24 hours, p = 0.0007). CONCLUSIONS: Patients with cystic
fibrosis have an increased incidence of nephrolithiasis and are at high risk for 
recurrence. Metabolic evaluation is indicated in all patients with cystic
fibrosis and urolithiasis since most have hyperoxaluria, urinary calcium oxalate 
supersaturation and decreased urinary citrate. Correcting detected stone risk
factors in these cases may decrease stone recurrence.

PMID: 11792901 [PubMed - indexed for MEDLINE]

1317: J Endourol. 2001 Dec;15(10):989-91.

Management of colonic perforation during percutaneous nephrolithotomy in
horseshoe kidney.

Goswami AK, Shrivastava P, Mukherjee A, Sharma SK.

Department of Urology, Post Graduate Institute of Medical Education & Research,
Chandigarh, India. agoswami@yahoo.com

Few cases of colonic injury during percutaneous nephrolithotomy (PCNL) have been 
reported in orthotopic kidneys and none in horseshoe kidney, and the management
protocol has not been standardized. A plain film on postoperative day 1 following
PCNL showed contrast medium in the descending colon, leading to the diagnosis of 
colonic injury in a 53-year-old male patient with horseshoe kidney and multiple
bilateral stones. He was asymptomatic and was treated successfully by minimally
invasive techniques. An asymptomatic patient with a colonic injury following PCNL
can be treated by minimal manipulations. Computed tomography imaging is necessary
prior to percutaneous surgery on a horseshoe kidney.

Publication Types: 
    Case Reports

PMID: 11789981 [PubMed - indexed for MEDLINE]

1318: Kidney Int. 2002 Jan;61(1):105-12.

Oxalate ions and calcium oxalate crystals stimulate MCP-1 expression by renal
epithelial cells.

Umekawa T, Chegini N, Khan SR.

Department of Pathology and Laboratory Medicine, University of Florida College of
Medicine, Gainesville, Florida 32610-0275, USA.

BACKGROUND: Crystals of calcium oxalate monohydrate (COM) and excess oxalate ions
(OX) stimulate an array of responses inducing localized injury and inflammation
in the kidneys. These inflammatory responses are key regulators of development of
nephrolithiasis. We propose that monocyte chemoattractant protein-1 (MCP-1), a
chemokine with potent chemotactic activity for monocytes/macrophages, is a
mediator of local inflammatory responses to COM and OX-induced injury. To test
this hypothesis, the effects of COM and OX on the expression of MCP-1 mRNA and
protein by NRK52E rat renal tubular cells were investigated. METHODS: Confluent
cultures of NRK52E cells were exposed to COM (33 to 267 microg/cm2) or OX (125 to
1000 micromol/L, estimated free oxalate levels of 65.8 to 540 micromol/L) and
catalase (400 or 2000 U/mL), a free radical scavenger that protects the cells
against detrimental effects of COM and OX, for 1 to 48 hours under serum free
conditions. The conditioned media were collected and total cellular RNA isolated 
from the cells and subjected to enzyme-linked immunosorbent assay (ELISA) and
semiquantitative polymerase chain reaction (PCR) to determine the expression of
MCP-1 protein and mRNA, respectively. RESULTS: NRK52E cells express MCP-1 mRNA
and protein, and the level of their expression significantly increases following 
treatments with COM and OX in a time and concentration dependent manner. MCP-1
mRNA expression and protein production increased more significantly after
exposure to COM than to OX. These responses were significantly reduced following 
treatments with catalase (2000 U/mL). CONCLUSIONS: NRK52E cells express MCP-1
mRNA and protein, and their levels are altered following COM and OX exposure.
Since catalase treatment reduced MCP-1 expression, free radicals may be involved 
in the up-regulation of MCP-1 production by the epithelial cells. The results
suggest that elevated expression of MCP-1, which is often associated with local
inflammatory response, may mediate similar reactions including attraction of
macrophages seen around the interstitial crystals during the early stages of
nephrolithiasis.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11786090 [PubMed - indexed for MEDLINE]

1319: J Acoust Soc Am. 2001 Dec;110(6):3283-91.

Suppression of large intraluminal bubble expansion in shock wave lithotripsy
without compromising stone comminution: methodology and in vitro experiments.

Zhong P, Zhou Y.

Department of Mechanical Engineering and Materials Science, Duke University,
Durham, North Carolina 27708, USA. pzhong@acpub.duke.edu

To reduce the potential of vascular injury without compromising the stone
comminution capability of a Dornier HM-3 lithotripter, we have devised a method
to suppress intraluminal bubble expansion via in situ pulse superposition. A thin
shell ellipsoidal reflector insert was designed and fabricated to fit snugly into
the original reflector of an HM-3 lithotripter. The inner surface of the
reflector insert shares the same first focus with the original HM-3 reflector,
but has its second focus located 5 mm proximal to the generator than that of the 
HM-3 reflector. With this modification, the original lithotripter shock wave is
partitioned into a leading lithotripter pulse (peak positive pressure of 46 MPa
and positive pulse duration of 1 micros at 24 kV) and an ensuing second
compressive wave of 10 MPa peak pressure and 2 micros pulse duration, separated
from each other by about 4 micros. Superposition of the two waves leads to a
selective truncation of the trailing tensile component of the lithotripter shock 
wave, and consequently, a reduction in the maximum bubble expansion up to 41%
compared to that produced by the original reflector. The pulse amplitude and -6
dB beam width of the leading lithotripter shock wave from the upgraded reflector 
at 24 kV are comparable to that produced by the original HM-3 reflector at 20 kV.
At the lithotripter focus, while only about 30 shocks are needed to cause a
rupture of a blood vessel phantom made of cellulose hollow fiber (i.d.=0.2 mm)
using the original HM-3 reflector at 20 kV, no rupture could be produced after
200 shocks using the upgraded reflector at 24 kV. On the other hand, after 100
shocks the upgraded reflector at 24 kV can achieve a stone comminution efficiency
of 22%, which is better than the 18% efficiency produced by the original
reflector at 20 kV (p = 0.043). All together, it has been shown in vitro that the
upgraded reflector can produce satisfactory stone comminution while significantly
reducing the potential for vessel rupture in shock wave lithotripsy.

Publication Types: 
    In Vitro
    Research Support, U.S. Gov't, P.H.S.

PMID: 11785829 [PubMed - indexed for MEDLINE]

1320: N Engl J Med. 2002 Jan 10;346(2):77-84.

Comment in:
    ACP J Club. 2002 Sep-Oct;137(2):62.    J Fam Pract. 2002 Apr;51(4):305.    N Engl J Med. 2002 Jan 10;346(2):124-5.    N Engl J Med. 2002 Jan 10;346(2):74-6.    N Engl J Med. 2002 May 23;346(21):1667-9.    N Engl J Med. 2002 May 23;346(21):1667-9.    N Engl J Med. 2002 May 23;346(21):1667-9.    N Engl J Med. 2002 May 23;346(21):1667-9.

Comparison of two diets for the prevention of recurrent stones in idiopathic
hypercalciuria.

Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U, Novarini A.

Department of Clinical Sciences, University of Parma, Parma, Italy.
loris.borghi@unipr.it

BACKGROUND: A low-calcium diet is recommended to prevent recurrent stones in
patients with idiopathic hypercalciuria, yet long-term data on the efficacy of a 
low-calcium diet are lacking. Recently, the efficacy of a low-calcium diet has
been questioned, and greater emphasis has been placed on reducing the intake of
animal protein and salt, but again, long-term data are unavailable. METHODS: We
conducted a five-year randomized trial comparing the effect of two diets in 120
men with recurrent calcium oxalate stones and hypercalciuria. Sixty men were
assigned to a diet containing a normal amount of calcium (30 mmol per day) but
reduced amounts of animal protein (52 g per day) and salt (50 mmol of sodium
chloride per day); the other 60 men were assigned to the traditional low-calcium 
diet, which contained 10 mmol of calcium per day. RESULTS: At five years, 12 of
the 60 men on the normal-calcium, low-animal-protein, low-salt diet and 23 of the
60 men on the low-calcium diet had had relapses. The unadjusted relative risk of 
a recurrence for the group on the first diet, as compared with the group on the
second diet, was 0.49 (95 percent confidence interval, 0.24 to 0.98; P=0.04).
During follow-up, urinary calcium levels dropped significantly in both groups by 
approximately 170 mg per day (4.2 mmol per day). However, urinary oxalate
excretion increased in the men on the low-calcium diet (by an average of 5.4 mg
per day [60 micromol per day]) but decreased in those on the normal-calcium,
low-animal-protein, low-salt diet (by an average of 7.2 mg per day [80 micromol
per day]). CONCLUSIONS: In men with recurrent calcium oxalate stones and
hypercalciuria, restricted intake of animal protein and salt, combined with a
normal calcium intake, provides greater protection than the traditional
low-calcium diet.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11784873 [PubMed - indexed for MEDLINE]

1321: J Endourol. 2001 Nov;15(9):919-23.

One shot: a novel method to dilate the nephrostomy access for percutaneous
lithotripsy.

Frattini A, Barbieri A, Salsi P, Sebastio N, Ferretti S, Bergamaschi E,
Cortellini P.

Division of Urology, Hospital of Parma, Italy. afrattini@ao.pr.it

BACKGROUND AND PURPOSE: The creation of the nephrostomy access is a fundamental
step of percutaneous nephrolithotripsy (PCNL). Dilation of the track is usually
achieved with multiple incremental flexible exchange dilators of the Amplatz
type, metal telescoping dilators of the Alken type, or a balloon. Currently,
balloon dilation is regarded as the most modern and safest system, though it has 
the disadvantage of relatively high cost. The aim of this study was to
demonstrate that a procedure that we named "one shot," which consists of a single
dilation of the track with a 25F or 30F Amplatz dilator, compares favorably in
terms of efficacy, costs, and length with the other techniques of track dilation,
without a significant increase in morbidity. PATIENTS AND METHODS: Seventy-eight 
consecutive patients who underwent PCNL for stone disease from June 1998 to July 
1999 were considered and divided into three groups according to the type of tract
dilation used: A (Alken telescoping dilators), B (balloon), or C (one shot).
Radiologic exposure, blood loss, and costs were evaluated. RESULTS: The one-shot 
procedure compared favorably with both of the other dilation techniques without
an increase in morbidity and with significant reductions in X-ray exposure and
costs. Indeed, significant differences in estimated blood loss were observed
between groups B and C and the minor bleeding for group C. CONCLUSION: Our
experience indicates that one-shot dilation is feasible in the majority of
patients. It is as safe and effective as the technique regarded today as the gold
standard but less time consuming and less expensive. These encouraging results
should be confirmed by further studies.

Publication Types: 
    Comparative Study

PMID: 11769847 [PubMed - indexed for MEDLINE]

1322: J Endourol. 2001 Nov;15(9):915-7.

Gas-containing renal stones treated with percutaneous nephrolithotomy: case
report.

Nilsen FS, Karlsen SJ, Gjertsen O.

Oslo Urological University Clinic, Aker Hospital, Norway.

We present a rare case of E. coli emphysematous pyelonephritis with sepsis. The
radiologic presentation consisted of multiple radiolucent gas-filled,
free-floating uric acid calculi in a hydronephrotic renal pelvis. The infection
was treated by intravenous fluids and antibiotics and percutaneous nephrostomy
drainage. The patient was rendered stone free by percutaneous nephrolithotomy and
ultrasound lithotripsy.

Publication Types: 
    Case Reports

PMID: 11769846 [PubMed - indexed for MEDLINE]

1323: Radiology. 2002 Jan;222(1):109-13.

US for detecting renal calculi with nonenhanced CT as a reference standard.

Fowler KA, Locken JA, Duchesne JH, Williamson MR.

Department of Radiology, Health Sciences Center, University of New Mexico School 
of Medicine, 2211 Lomas Blvd, Albuquerque, NM 87131, USA. keirfowler@home.com

PURPOSE: To determine the sensitivity and specificity of ultrasonography (US) for
detecting parenchymal and renal pelvis calculi and to establish the accuracy of
US for determining the size and number of calculi. MATERIALS AND METHODS: A total
of 123 US and computed tomographic (CT) examinations were compared
retrospectively for the presence of renal calculi. The sensitivity of US was
determined for individual calculi and at least one calculus per examination.
Retrospective findings were compared with the original US interpretation. The
sizes of calculi in longest axis were compared on US and CT images, and the US
detection of calculi in the left and right kidneys was compared. The use of US
for detecting the full extent of calculus burden was evaluated in patients with
multiple calculi. RESULTS: US depicted 24 of 101 calculi identified at CT,
yielding a sensitivity of 24% and a specificity of 90%. There was no substantial 
difference for the detection of calculi in the right and left kidneys. The
sensitivity of US for any calculi in a patient was 44%, equal to that of the
original US interpretation. US enabled identification of 39% of patients with
multiple calculi and demonstrated all calculi in 17% of these patients. The mean 
size of calculi detected with US was 7.1 mm +/- 1.2 (95% CI); 73% of calculi not 
visualized at US were less than 3.0 mm in size. Calculus size based on US and CT 
measurements was concordant in 79% of cases and differed by a mean of 1.5 mm +/- 
0.7. CONCLUSION: US is of limited value for detecting renal calculi.

Publication Types: 
    Comparative Study

PMID: 11756713 [PubMed - indexed for MEDLINE]

1324: Nephron. 2002 Jan;90(1):51-7.

Vitamin D receptor gene polymorphism and bone mineral density in hypercalciuric
calcium-stone-forming patients.

Heilberg IP, Teixeira SH, Martini LA, Boim MA.

Nephrology Division, Universidade Federal de São Paulo, Escola Paulista de
Medicina, São Paulo, Brazil. ipheilberg@nefo.epm.br

Reduced bone mineral density (BMD) and an increased risk of vertebral fracture
have been reported in calcium-stone-forming (CSF) patients presenting with
idiopathic hypercalciuria. We investigated the association between BsmI vitamin D
receptor (VDR) polymorphism and BMD in 68 hypercalciuric CSF patients (35 males
and 33 premenopausal females, mean age +/- SD = 39 +/- 10 years). BMD was
measured at lumbar spine (L2-L4) and femur neck sites using dual energy X-ray
absorptiometry. A 72-hour dietary record and a 24-hour urine sample were obtained
from each patient to determine calcium intake and excretion. The allelic
frequency found for the sample as a whole was 16% BB, 44% Bb and 40% bb. Mean BMD
values did not significantly differ among BB, Bb and bb patients at L2-L4 (1.162 
+/- 0.10, 1.133 +/- 0.11 and 1.194 +/- 0.19 g/cm2, mean +/- SD, respectively) or 
at neck sites (0.920 +/- 0.11, 0.931 +/- 0.15 and 0.982 +/- 0.15 g/cm2,
respectively). Calcium intake and excretion were also not significantly different
among the three genotypes. Patients were then divided into two groups, normal
BMD, T-score > or =-1 (n = 34) and low BMD, T-score <-1 (n = 34), to further
evaluate the allele influence on previous bone loss. Despite a trend for a higher
mean BMD at spine or neck sites for patients with one or two b alleles when
compared to BB patients, the difference did not reach statistical significance.
The distribution of BB, Bb and bb genotypes in the low-bone-mass group (15, 47
and 38%, respectively) was similar to that in the normal-bone-mass group (18, 41 
and 14%, respectively). These data suggest that BsmI VDR polymorphism does not
play an important role in the bone loss seen in hypercalciuric CSF patients.
Copyright 2002 S. Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11744805 [PubMed - indexed for MEDLINE]

1325: Urology. 2001 Dec;58(6):859-63.

Flexible ureteroscopy in conjunction with in situ lithotripsy for lower pole
calculi.

Hollenbeck BK, Schuster TG, Faerber GJ, Wolf JS.

Department of Urology, University of Michigan School of Medicine, Ann Arbor,
Michigan, USA

OBJECTIVES: To demonstrate the efficacy and safety of ureteroscopy as a
compromise in treating small and intermediate-size lower pole calculi. The
optimal management of lower pole calculi remains controversial. Shock wave
lithotripsy is associated with minimal morbidity but with suboptimal stone
clearance rates. Conversely, percutaneous nephrostolithotomy has greater
morbidity but stone-free rates greater than 90% regardless of size. METHODS:
Seventy-two patients underwent ureteroscopy for lower pole calculi 2 cm or less
(mean 8.7 mm) during a 3-year period. To minimize confounding, 11 patients with
additional calculi at other ipsilateral renal sites and 1 patient with large (2.4
cm each) bilateral calculi were excluded. Two patients with bilateral lower pole 
calculi and four who required a second procedure were included in the analysis.
Thus, the final cohort consisted of 60 patients who underwent 66 procedures.
RESULTS: Of patients with follow-up longer than 1 month, 79% were stone free
after a single procedure, and this improved to 88% after a second procedure in 4 
patients. All 7 patients with follow-up less than 1 month had a reduction in
stone burden after successful fragmentation. Overall, 8 patients required an
auxiliary procedure. No intraoperative complications, and 7 (11%) postoperative
complications occurred. CONCLUSIONS: Ureteroscopy for lower pole calculi is
associated with minimal morbidity and stone-free rates comparable to shock wave
lithotripsy for smaller stones. The greatest utility of ureteroscopy is in the
management of intermediate-size calculi, for which it has substantially higher
stone-free rates and lower repeated treatment rates than does shock wave
lithotripsy.

Publication Types: 
    Evaluation Studies

PMID: 11744445 [PubMed - indexed for MEDLINE]

1326: J Urol. 2002 Jan;167(1):322-6.

High resolution detection of internal structure of renal calculi by helical
computerized tomography.

Williams JC Jr, Paterson RF, Kopecky KK, Lingeman JE, McAteer JA.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Methodist Hospital, Indianapolis, IN, USA.

PURPOSE: There is considerable interest in using radiological imaging to predict 
kidney stone fragility before patient treatment. Case series of shock wave
lithotripsy show that shock wave lithotripsy is repeated and/or ancillary
procedures are done to remove shock wave resistant stones in a significant number
of cases. If the fragility of stones were predicted at diagnosis, unnecessary
shock wave treatment would be avoided. However, plain radiography allows little
discrimination of stone type and simple numerical analysis of computerized
tomography (CT) images by measuring Hounsfield units has been shown to be limited
in its ability to predict stone fragility. MATERIALS AND METHODS: Urinary stones 
of known composition were imaged by helical CT in vitro at various slice widths
and the images were assessed using a range of window settings. RESULTS:
Visualization of stone structure was greatly enhanced using bone windows and a
narrow slice width. Surface structure, such as crystalline leaves of calcium
oxalate dihydrate, and internal structure showing the heterogeneity of
composition or cracks were detected. Stones of similar mineral composition
differed dramatically in terms of CT visible structure. CONCLUSIONS: Using a
narrow slice width and bone windows greatly improves the visualization of kidney 
stone structure on helical CT. These results open up new possibilities for
determining the relationship of stone structure and fragility for shock wave
lithotripsy.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11743350 [PubMed - indexed for MEDLINE]

1327: J Endourol. 2001 Oct;15(8):835-8.

Ureteroscopic management of lower-pole renal calculi: technique of calculus
displacement.

Auge BK, Dahm P, Wu NZ, Preminger GM.

The Comprehensive Kidney Stone Center, Department of Surgery, Duke University
Medical Center, Durham, North Carolina 27710, USA.

PURPOSE: We review our technique of ureteroscopic management of lower pole renal 
calculi with Nitinol basket displacement and holmium laser stone fragmentation.
METHODS: Lower pole calculi are identified with a 7.5F flexible ureteroscope. In 
patients in whom the laser fiber reduces ureteroscopic deflection, precluding
reentry into the lower pole, a Nitinol basket or grasper is used to displace the 
calculi into an upper pole calix for easier fragmentation. RESULTS: The Nitinol
device can be passed into the lower pole through the fully deflected ureteroscope
without any loss of deflection. Irrigation is significantly reduced by the
basket, but this factor does not impede stone retrieval. CONCLUSIONS:
Ureteroscopic management of lower pole stones is a reasonable alternative to SWL 
or percutaneous nephrolithotomy in low-volume stone disease. If the stone cannot 
be fragmented in situ, Nitinol basket capture through a fully deflected
ureteroscope into a less dependent position facilitates stone fragmentation.

PMID: 11724125 [PubMed - indexed for MEDLINE]

1328: Nephron. 2001 Dec;89(4):384-90.

Prolonged dietary calcium restriction: a diagnostic approach in idiopathic
hypercalciuria.

Müller D, Eggert P.

Children's Hospital, University of Kiel, Germany.

BACKGROUND: Although frequently observed, the etiology of idiopathic
hypercalciuria (IHC) remains largely unknown. A common hypothesis postulates
intestinal hyperabsorption and/or a primary renal leak as the pathophysiological 
basis. The aim of our study was to investigate the regulation pattern of calcium 
homeostasis in patients with IHC by using a prolonged period of calcium
restriction. METHODS: Twenty-seven patients with IHC were investigated. After a
3-week run-in period (dietary calcium content 700-1,000 mg/24 h), a standard
calcium reduced diet (300 mg/24 h) was given for 4 weeks. Thereafter, the
participants received again a normal calcium-containing diet. Values for urinary 
calcium, PTH and calcitriol levels of all participants were obtained at different
phases of the study. Forty-three healthy persons served as controls. RESULTS:
During calcium restriction, two distinct groups were identified. One group
displayed an increase (n = 12) in urinary calcium excretion, the second (n = 15) 
a marked reduction, respectively. In both groups, the values during calcium
restriction were significantly different from baseline (p < 0.01). In the first
group, the increase of urinary calcium excretion was accompanied by an increase
of PTH and calcitriol. These values were also significantly different from
baseline values (p < 0.01). The control group showed decreasing calcium excretion
during oral restriction (p < 0.01). CONCLUSION: Prolonged calcium restriction
proved to be useful in distinguishing apparently two major forms of IHC. The fact
that one group displayed the same excretion pattern as the control group raises
the question if this group just represents the upper limit of a physiological
range. These findings may shed new light on diagnosis, pathogenesis and treatment
of patients with IHC. Copyright 2001 S. Karger AG, Basel

Publication Types: 
    Clinical Trial
    Controlled Clinical Trial

PMID: 11721154 [PubMed - indexed for MEDLINE]

1329: Clin Chim Acta. 2001 Dec;314(1-2):187-94.

Determination of pyrophosphate in renal calculi and urine by means of an
enzymatic method.

March JG, Simonet BM, Grases F.

Department of Chemistry, University of Balearic Islands, Campus de la UIB, Ctra. 
Valldemossa km 7.5, E 07071 Palma de Mallorca, Spain. joan.march@uib.es

An enzymatic method for the determination of pyrophosphate which has been applied
to renal calculi is described. The method involves the preconcentration of
pyrophosphate using anionic exchange resin and development of the enzymatic
reactions with the pyrophosphate retained on the resin. The study of calculi
treatment according to calculi composition is also reported. The pyrophosphate
content was dependent on the calculi composition. The highest amount of
pyrophosphate was found in hydroxyapatite calculi (of the order of 10 microg/g), 
struvite and oxalate calculi showed a lower amount (the order was 2.5 and 4.5
microg/g, respectively) and was not detected in uric acid and cystine stones. The
method was also successfully applied to the determination of pyrophosphate in
human urine. For urinary pyrophosphate determination, a modification based on a
clean-up of urine using activated carbon has been proposed. Pyrophosphate in
human urine was of the order of 4 mg l(-1).

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11718694 [PubMed - indexed for MEDLINE]

1330: Can Vet J. 2001 Nov;42(11):880-3.

Urethrolithiasis and nephrolithiasis in a horse.

Saam D.

Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon,
Saskatchewan S7N 5B4.

A 9-year-old, quarter horse gelding with obstructive urethrolithiasis was treated
with a perineal urethrostomy. The horse's condition deteriorated and
abdominocentesis confirmed septic uroperitonitis. The horse was euthanized and
postmortem examination revealed peritonitis, a tear in the lateral wall of the
bladder, and a nephrolith within the left renal pelvis.

Publication Types: 
    Case Reports

PMID: 11708209 [PubMed - indexed for MEDLINE]

1331: Anaesthesia. 2001 Nov;56(11):1103-6.

Monitoring of irrigation fluid absorption during percutaneous nephrolithotripsy: 
the use of 1% ethanol as a marker.

Malhotra SK, Khaitan A, Goswami AK, Gill KD, Dutta A.

Department of Anaesthesiology, Postgraduate Institute of Medical Education and
Research, Chandigarh-160012, India. drskmalhotra@yahoo.com

This study was performed in 32 ASA I patients undergoing percutaneous
nephrolithotripsy under general anaesthesia, using absorption of 1% ethanol as a 
marker to monitor irrigation fluid absorption. Various parameters of fluid
absorption were studied and compared, including irrigation fluid volume,
irrigation time, total volume of irrigation fluid absorbed and the rate of
irrigation. The amount of irrigant used vs. the volume absorbed and the volume
absorbed vs. total irrigation time were observed. Fluid absorption occurred in
78% of patients, and 28% absorbed volumes in excess of 1 l. The mean volume of
fluid absorbed was 696.7 ml. The maximum fluid absorption was observed when the
irrigation fluid volume, total irrigation time and irrigation rate exceeded 10 l,
30 min and 200 ml.min(-1), respectively. In conclusion, this study has shown 1%
ethanol to be a safe, simple and cost-effective marker of fluid absorption during
percutaneous nephrolithotripsy associated with minimal adverse effects.

PMID: 11703245 [PubMed - indexed for MEDLINE]

1332: Acad Radiol. 2001 Oct;8(10):982-6.

Effect of radiographic contrast material exposure on spiral CT attenuation of
renal calculi.

Monga AG, Saw KC, Williams JC, Fineberg NS, McAteer JA, Lingeman JE, Chua GT.

Department of Radiology, Clarian/Methodist Hospital of Indiana, Indianapolis
46202, USA.

RATIONALE AND OBJECTIVES: The authors performed this study to determine whether
exposure of renal calculi to radiographic contrast material has an effect on the 
attenuation values at computed tomography (CT) performed with varying collimation
widths. MATERIALS AND METHODS: Renal calculi (23 stones of various composition)
were scanned with 1-, 3-, and 10-mm collimation. Stones were then exposed to a
solution of radiographic contrast material for 5 minutes, washed with water, and 
rescanned 36 hours later. The reproducibility of the CT attenuation measurements 
on different days was evaluated by obtaining measurements in a subset of 16 renal
stones on 4 different days. RESULTS: There was no statistically significant
change in attenuation after contrast material exposure at narrow collimation. At 
wider collimation, statistically significant increases were noted in both
attenuation and standard deviation. A small amount of variability between
readings was noted on different days, with a minimal increase in attenuation each
day. Correlation between readings remained very high. CONCLUSION: Exposure of
stones to a radiographic contrast material had a statistically significant effect
on CT attenuation values only at wide collimation. This may be related to
technical factors including volume averaging. Absence of an effect at narrow
collimation suggests that the attenuation values of renal stones do not
significantly change after exposure to contrast material.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11699851 [PubMed - indexed for MEDLINE]

1333: J Endourol. 2001 Sep;15(7):687-9.

Vertebral fracture associated with shockwave lithotripsy in a patient with
granulomatous spondylitis.

Kazimoğlu H, Mungan MU, Kirkali Z.

Department of Urology, Dokuz Eylül University, School of Medicine, Inciralti,
Izmir, Turkey.

Extracorporeal shockwave lithotripsy (SWL) is an accepted treatment modality in
the treatment of urinary stone disease. Many complications have been reported
secondary to high-energy shockwaves, but the effects of SWL on the skeletal
system have rarely been investigated. We represent the first case of a burst-type
vertebral fracture after SWL in an elderly osteoporotic patient with
granulomatous spondylitis.

Publication Types: 
    Case Reports

PMID: 11697397 [PubMed - indexed for MEDLINE]

1334: J Endourol. 2001 Sep;15(7):671-3.

Operator experience and adequate anesthesia improve treatment outcome with
third-generation lithotripters.

Eichel L, Batzold P, Erturk E.

Department of Urology, University of Rochester School of Medicine, New York
14642, USA.

PURPOSE: To characterize the effect of operator experience and type of anesthesia
on treatment outcome when switching from the Dornier HM3 to the third-generation 
Dornier U/50 lithotripter. PATIENTS AND METHODS: A population of 370 consecutive 
patients treated by 15 urologists was divided into two groups. Group I (N = 225) 
included patients treated during the initial 3 months with our new lithotripter. 
Group II (N = 145) included patients treated during the last 3 months. Changes
were made during the intervening 6 months in focusing technique, anesthesia type,
coupling technique, and shockwave delivery. Information was collected regarding
success of stone treatment (defined as complete clearance of stone or fragments <
3 mm at 1 month). RESULTS: There were no differences between the two groups with 
regard to age, sex, fluoroscopic time or maximal shockwave intensity used. Group 
I had a slightly higher percentage of upper ureteral stones (20% v 13%); however,
the difference was not significant. Upper ureteral stones in Group II were on
average significantly larger (9.4 mm v 7.3 mm; P = 0.003). Intravenous sedation
was used frequently in Group I (111 patients; 49%) and not at all in Group II.
General anesthesia was used more frequently in Group II than in group I (34% v
24%; P < 0.02). Spinal anesthesia also was utilized more frequently in Group II
patients (66% v 28%; P < 0.0001). Overall, general or regional anesthesia was
received by 100% of the patients in Group II but only 52% of the patients in
group I. The success rate of stone treatment was much better for Group II than
for Group I (78% v 51%; P < 0.0001). CONCLUSION: The transition from a Dornier
HM3 lithotripter to a third-generation lithotripter can be difficult, but if
adequate anesthesia is given to minimize patient movement and balloon pressures
are optimized, stone targeting can be accurate and similar stone clearance rates 
can be obtained.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 11697394 [PubMed - indexed for MEDLINE]

1335: J Urol. 2001 Dec;166(6):2081-4; discussion 2085.

The efficacy of extracorporeal shock wave lithotripsy for isolated lower pole
calculi compared with isolated middle and upper caliceal calculi.

Obek C, Onal B, Kantay K, Kalkan M, Yalçin V, Oner A, Solok V, Tansu N.

Department of Urology, University of Istanbul Cerrahpasa School of Medicine,
Istanbul, Turkey.

PURPOSE: We assess the efficacy of extracorporeal shock wave lithotripsy
monotherapy for isolated lower pole nephrolithiasis, and compare it to that for
isolated middle and upper caliceal calculi. MATERIALS AND METHODS: We treated 714
renal units in 687 patients with isolated caliceal stones using a Lithostar
lithotriptor (Siemens Medical Systems, Erlangen, Germany). The stones were
localized in the lower, mid and upper calices in 455, 104 and 128 patients,
respectively. Stone load was recorded in cm.2. Patients were stratified into 3
groups based on stone burden. The energy and shock waves, use of anesthesia,
number of treatment sessions, auxiliary measures and complications were noted.
Patients were evaluated with intravenous urogram or plain film of kidneys,
ureters and bladder, and ultrasonography when stone-free, or clinically
significant residual fragment status, including nonobstructive and noninfectious 
insignificant fragments 4 mm. or less, was noted at the fluoroscopic control 2 to
4 weeks after the last session. Final clinically significant residual fragment
decision was made 10 to 12 weeks after the last session. Extracorporeal shock
wave lithotripsy was considered a failure if no fragmentation was noted after
session 3 and continued if fragmentation was noted. Results regarding caliceal
localization were compared. RESULTS: Complete data were available on 591 renal
units. Auxiliary procedures were used in 81 (14%) units before treatment.
Anesthesia was given to 101 (17%) patients. The mean number of shock waves and
energy used were 2,022 and 17.4 kV., respectively. The difference in shock wave, 
energy and treatment rate among 3 caliceal locations reached statistical
significance only for energy delivered to the lower and upper calices. The
effectiveness quotient of extracorporeal shock wave lithotripsy was 36%, 46% and 
41% for lower, middle and upper pole stone disease, respectively (p = 0.4). There
was a highly significant correlation between stone-free and re-treatment rates,
and stone burden. The overall stone-free rate was 66%, and 63%, 73% and 71% for
lower, middle and upper caliceal stones, respectively (p = 0.1). For the group
with stones greater than 2 cm.2 overall stone-free rate decreased to 49%, and
53%, 60% and 23% in lower, middle and upper caliceal locations, respectively.
Overall, extracorporeal shock wave lithotripsy monotherapy failed in 46 (7.7%)
renal units. Steinstrasse developed in 39 (6.5%) patients who were then treated
with repeat lithotripsy. CONCLUSIONS: Extracorporeal shock wave lithotripsy
appears to be successful for management of isolated caliceal stone disease.
Treatment efficacy was not significantly different among stones localized in
lower, middle and upper poles. We recommend it as the primary treatment of choice
for stones less than 2.0 cm.2 in all caliceal locations. Treatment should be
individualized for management of caliceal stones greater than 2.0 cm.2 until
large prospective randomized trials comparing shock wave lithotripsy and
percutaneous nephrolithotomy are available.

Publication Types: 
    Comparative Study

PMID: 11696710 [PubMed - indexed for MEDLINE]

1336: J Urol. 2001 Dec;166(6):2072-80.

Erratum in:
    J Urol 2002 Apr;167(4):1805.

Lower pole I: a prospective randomized trial of extracorporeal shock wave
lithotripsy and percutaneous nephrostolithotomy for lower pole
nephrolithiasis-initial results.

Albala DM, Assimos DG, Clayman RV, Denstedt JD, Grasso M, Gutierrez-Aceves J,
Kahn RI, Leveillee RJ, Lingeman JE, Macaluso JN Jr, Munch LC, Nakada SY, Newman
RC, Pearle MS, Preminger GM, Teichman J, Woods JR.

PURPOSE: The efficacy of shock wave lithotripsy and percutaneous stone removal
for the treatment of symptomatic lower pole renal calculi was determined.
MATERIALS AND METHODS: A prospective randomized, multicenter clinical trial was
performed comparing shock wave lithotripsy and percutaneous stone removal for
symptomatic lower pole only renal calculi 30 mm. or less. RESULTS: Of 128
patients enrolled in the study 60 with a mean stone size of 14.43 mm. were
randomized to percutaneous stone removal (58 treated, 2 awaiting treatment) and
68 with a mean stone size of 14.03 mm. were randomized to shock wave lithotripsy 
(64 treated, 4 awaiting treatment). Followup at 3 months was available for 88% of
treated patients. The 3-month postoperative stone-free rates overall were 95% for
percutaneous removal versus 37% lithotripsy (p <0.001). Shock wave lithotripsy
results varied inversely with stone burden while percutaneous stone-free rates
were independent of stone burden. Stone clearance from the lower pole following
shock wave lithotripsy was particularly problematic for calculi greater than 10
mm. in diameter with only 7 of 33 (21%) patients becoming stone-free.
Re-treatment was necessary in 10 (16%) lithotripsy and 5 (9%) percutaneous cases.
There were 9 treatment failures in the lithotripsy group and none in the
percutaneous group. Ancillary treatment was necessary in 13% of lithotripsy and
2% percutaneous cases. Morbidity was low overall and did not differ significantly
between the groups (percutaneous stone removal 22%, shock wave lithotripsy 11%, p
=0.087). In the shock wave lithotripsy group there was no difference in lower
pole anatomical measurements between kidneys in which complete stone clearance
did or did not occur. CONCLUSIONS: Stone clearance from the lower pole following 
shock wave lithotripsy is poor, especially for stones greater than 10 mm. in
diameter. Calculi greater than 10 mm. in diameter are better managed initially
with percutaneous removal due to its high degree of efficacy and acceptably low
morbidity.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11696709 [PubMed - indexed for MEDLINE]

1337: J Urol. 2001 Dec;166(6):2065-71.

Comment in:
    J Urol. 2001 Dec;166(6):2086.

Mechanical percussion, inversion and diuresis for residual lower pole fragments
after shock wave lithotripsy: a prospective, single blind, randomized controlled 
trial.

Pace KT, Tariq N, Dyer SJ, Weir MJ, D'A Honey RJ.

St. Michael's Hospital, University of Toronto, Ontario, Canada.

PURPOSE: We compare the effectiveness of mechanical percussion and inversion with
observation for eliminating lower caliceal fragments 3 months after shock wave
lithotripsy. MATERIALS AND METHODS: At 3 months after shock wave lithotripsy 69
patients with residual lower caliceal fragments 4 mm. or less were randomized to 
receive either mechanical percussion and inversion or observation for 1 month.
The observation group then received crossover mechanical percussion and inversion
if fragments persisted. All patients were followed with plain film of the
kidneys, ureters and bladder to assess the stone area and stone-free status, and 
renal tomography or noncontrast spiral computerized tomography to confirm
stone-free status. A blinded radiologist reviewed all films. Patients were
treated with a mechanical chest percussor applied to the flank while inverted to 
greater than 60 degrees after receiving 20 mg. furosemide. RESULTS: A total of 35
patients were randomized to receive immediate mechanical percussion and inversion
therapy and 34 observation. Of the patients in the observation group 28
subsequently received mechanical percussion and inversion after completing the
observation period. The groups were not different in gender, body mass index,
side affected, stone location or renal anatomical features. The mechanical
percussion and inversion group had a substantially higher stone-free rate than
the observation group (40% versus 3%, respectively, p <0.001). The mechanical
percussion and inversion group also had a greater improvement in total stone area
than controls (-63.3% versus +2.7%, respectively, p <0.001). No significant
adverse effects were noted in the mechanical percussion and inversion group.
CONCLUSIONS: Mechanical percussion and inversion is a safe and effective
treatment option for residual lower caliceal fragments 3 months after shock wave 
lithotripsy. Nearly 50% of patients become stone-free, and stone burden is
decreased by 50% in the remainder.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11696708 [PubMed - indexed for MEDLINE]

1338: J Urol. 2001 Dec;166(6):2057-60.

Patient adherence to long-term medical treatment of kidney stones.

Parks JH, Asplin JR, Coe FL.

University of Chicago and LithoLink Corp., Chicago, Illinois, USA.

PURPOSE: We determine patient adherence to and quality of outcome of medical
kidney stone treatment during a 30-year duration at a single university based
referral clinic. We also analyze time trends in adherence and timing of followup 
measurements, and supersaturation reduction during treatment. MATERIALS AND
METHODS: Data on all patients who entered the University of Chicago Kidney Stone 
Prevention Program from 1970 to 2000 were analyzed. Fractions of new patients who
had any followup and those remaining in followup at increasing intervals were
analyzed. Timing of followup was measured. Changes in adherence during the 3
decades were also analyzed, as was reduction in supersaturation in regard to
calcium oxalate, calcium phosphate and uric acid. RESULTS: A total of 70% to 80% 
of patients were retained at each successive followup cycle with 2 physicians,
and a clinical protocol that always required 6-week followup with 24-hour urine
collection and a yearly one thereafter for stone risk factors. Retention
decreased during the last 5 years of the 1990s. Supersaturation reduction was
present by the first followup and remained constant or improved with time. Timing
of followup measurements was in accord with our protocol. CONCLUSIONS: At best,
one can retain only 70% to 80% of patients in a followup program at each
interval, and achieve supersaturation reductions that are constant and
significant during the long term. Timing of followup measurements can be close to
that of the protocol in use.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11696706 [PubMed - indexed for MEDLINE]

1339: Nephrol Dial Transplant. 2001 Nov;16(11):2232-5.

Past history of nephrolithiasis and incidence of hypertension in men: a
reappraisal based on the results of the Olivetti Prospective Heart Study.

Strazzullo P, Barba G, Vuotto P, Farinaro E, Siani A, Nunziata V, Galletti F,
Mancini M, Cappuccio FP.

Department of Clinical and Experimental Medicine, Unit of Clinical Genetics and
Pharmacology, Hypertension and Mineral Metabolism, Federico II University Medical
School, Naples, Italy. strazzul@unina.it

BACKGROUND: We have previously reported that in the Olivetti Prospective Heart
Study cohort the incidence of nephrolithiasis was higher in hypertensive
participants than in normotensive ones. As the time sequence and the mechanisms
underlying the association between nephrolithiasis and hypertension remain
controversial, we further tested the hypothesis that in a cohort of normotensive 
males a history of nephrolithiasis predicts the development of future
hypertension. METHODS: The analysis was conducted in 381 male workers at Olivetti
who were normotensive at the baseline examination and who were re-examined 8
years later. RESULTS: A past history of nephrolithiasis is associated with an
increased risk of hypertension of 1.96 (95% CI=1.25-3.07) relative to subjects
with a negative history, after adjusting for age. CONCLUSION: In this 8-year
follow-up study, a history of nephrolithiasis resulted in an increased risk of
developing hypertension in the future. As the reverse was also true, as
previously reported, a clear-cut time sequence, as well as the mechanisms linking
these two conditions, remain to be identified.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11682673 [PubMed - indexed for MEDLINE]

1340: Angiology. 2001 Oct;52(10):717-20.

Acute renal infarction secondary to left ventricular thrombus, masquerading as a 
renal calculus--a case report and brief review of literature.

Singh G, Dhawan R, Potteiger CE, Bedi A, Modesto TA, Gutknecht DR.

Department of Internal Medicine, Geisinger Medical Center, Danville, PA, USA.

Acute embolic renal infarction is an entity that is often misdiagnosed as a renal
calculus because of similar presenting symptoms. This leads to delay in the
initiation of treatment and to increased morbidity. Few case reports exist
relating cardiac emboli to acute renal infarction. The authors present a patient 
with a renal embolism secondary to left ventricular thrombus. A brief review of
the literature highlighting the importance of clinical suspicion in making an
accurate diagnosis, the utility of various diagnostic studies, and comparison of 
various treatment options is presented.

Publication Types: 
    Case Reports
    Review

PMID: 11666137 [PubMed - indexed for MEDLINE]

1341: Urol Int. 2001;67(3):252-3.

A giant renal calculus treated without nephrectomy.

Bayazit Y, Aridoğan IA, Zeren S, Payasli K, Türkyilmaz RK.

Department of Urology, Faculty of Medicine, Cukurova University, TR-01330
Balcali, Adana, Turkey. bayazit@mail.cu.edu.tr

The case of a patient with a giant renal calculus weighing 770 g in a solitary
functioning kidney is reported. A 57-year-old man presented with right lumbar
pain and macroscopic hematuria, and a giant stone was diagnosed in his right
kidney. Nine days after a percutaneous nephrostomy placement, the patient
underwent selective right renal angiography and transcatheter superselective
embolization due to a sudden gross hematuria observed from both the nephrostomy
tube and urethra. Embolization was successful. Right anatrophic nephrolithotomy
was performed after stabilization of the patient. There were no complications
during the recovery period. The case reported here is significant not only
because it is the 7th biggest and the heaviest stone in the literature but also
because it is the first giant stone reported to be in a solitary functioning
kidney and treated without nephrectomy. Copyright 2001 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 11598457 [PubMed - indexed for MEDLINE]

1342: Nephron. 2001 Nov;89(3):264-70.

The risk of renal stone formation during and after long duration space flight.

Whitson PA, Pietrzyk RA, Morukov BV, Sams CF.

Collaborators: Whitson PA.

NASA/Johnson Space Center, Houston, Tex 77058, USA. peggy.a.whitson1@jsc.nasa.gov

BACKGROUND: The formation of a renal stone during space flight may have serious
negative effects on the health of the crewmember and the success of the mission. 
Urinary biochemical factors and the influence of dietary factors associated with 
renal stone development were assessed during long duration Mir Space Station
missions. METHODS: Twenty-four-hour urine samples were collected prior to, during
and following long duration space flight. The relative urinary supersaturation of
calcium oxalate, calcium phosphate (brushite), sodium urate, struvite and uric
acid were determined. RESULTS: Changes in the urinary biochemistry of crewmembers
during long duration spaceflight demonstrated increases in the supersaturation of
the stone-forming salts. In-flight hypercalciuria was evident in a number of
individual crewmembers and 24-hour dietary fluid intake and urine volume were
significantly lower. During flight, there was a significant increase in brushite 
supersaturation. CONCLUSIONS: These data suggest acute effects of space flight
and postflight changes in the urinary biochemistry favoring increased
crystallization in the urine. The effects of dietary intake, especially fluid
intake, may have a significant impact on the potential for renal stone formation.
Efforts are now underway to assess the efficacy of a countermeasure to mitigate
the increased risk. Copyright 2001 S. Karger AG, Basel

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 11598387 [PubMed - indexed for MEDLINE]

1343: J Urol. 2001 Nov;166(5):1862-4.

Is the pediatric ureter as efficient as the adult ureter in transporting
fragments following extracorporeal shock wave lithotripsy for renal calculi
larger than 10 mm.?

Gofrit ON, Pode D, Meretyk S, Katz G, Shapiro A, Golijanin D, Wiener DP, Shenfeld
OZ, Landau EH.

Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem,
Israel.

PURPOSE: We determined whether the thin ureter of the young child transports
stone fragments after extracorporeal shockwave lithotripsy (ESWL) as efficiently 
as the adult ureter does. This determination was done by comparing the outcome
after lithotripsy of renal stones greater than 10 mm. between young children and 
adults. MATERIALS AND METHODS: Our study group consisted of 38 children 6 months 
to 6 years old (median 3 years) with renal stones greater than 10 mm. in
diameter. This group was further divided into 3 subgroups according to the
longest stone diameter on plain abdominal film. There were 21 children with a
renal stone diameter of 10 to 15 mm. (subgroup 1), 8, 16 to 20 mm. (subgroup 2)
and 9 greater than 20 mm. (subgroup 3). The control group consisted of 38 adults 
older than 20 years randomly selected from the local ESWL registry. Each adult
was matched with a child regarding stone diameter and localization. The control
group was similarly divided into subgroups 1a, 2a and 3a. ESWL was performed with
the unmodified Dornier HM-3 lithotriptor (Dornier Medical Systems, Inc.,
Marietta, Georgia). The stone-free rate, complication rate, and need for tubes,
including stent or nephrostomy, and greater than 1 ESWL session were compared.
RESULTS: The stone-free rate was 95% in the study and 78.9% in the control group 
(p = 0.086). Stone-free rates were 95%, 100% and 89% in subgroups 1, 2 and 3, and
95%, 65% and 56% in subgroups 1a, 2a and 3a, respectively. There were 10 children
and 4 adults who underwent greater than 1 ESWL session (p = 0.14). Then there
were 10 children and 6 adults who required a tube before ESWL (p = 0.04), and
almost all of them were included in subgroups 3 and 3a. Early complications were 
rare in both the study and control groups. Late complications had included 2
cases of Steinstrasse in the control and none in the study group. CONCLUSIONS:
The stone-free rate after ESWL for large renal stones is higher in young children
compared to adults with matching stone size. Renal stones greater than 20 mm.
often require more than 1 ESWL session. The pediatric ureter is at least as
efficient as the adult for transporting stone fragments after ESWL.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11586249 [PubMed - indexed for MEDLINE]

1344: J Bone Miner Res. 2001 Oct;16(10):1893-8.

Bone mineral density and fracture among prevalent kidney stone cases in the Third
National Health and Nutrition Examination Survey.

Lauderdale DS, Thisted RA, Wen M, Favus MJ.

Department of Health Studies, University of Chicago, Illinois 60637, USA.

Concern that people who form kidney stones may have reduced bone mineral density 
(BMD) and increased fracture risk has motivated clinical and population-based
studies, but findings are inconsistent. In this cross-sectional study, we use the
Third National Health and Nutrition Examination Survey (NHANES III) to determine 
whether a history of kidney stones (n = 793) is associated with lower femoral
neck BMD and whether the association is similar for men and women. We further ask
whether dietary calcium modifies the association between kidney stone history and
BMD and whether there is an association between kidney stone history and
prevalent spine or wrist fracture. We find that men with kidney stone history
have lower femoral neck BMD than men without kidney stone history after adjusting
for age, body mass index (BMI), race/ethnicity, and other potential confounders. 
The effect of kidney stone history on BMD is weaker for women. Men with kidney
stone history also are more likely to report prevalent wrist and spine fractures.
Dietary calcium, represented by usual milk consumption, is associated positively 
with BMD for both men and women and modifies the effect of kidney stone history
on BMD for men. For men who form kidney stones, milk consumption is associated
more strongly with femoral neck BMD than for men without such a history. The
effect modification is such that the difference in BMD between men with and
without kidney stone history is observed only at lower levels of milk
consumption.

PMID: 11585355 [PubMed - indexed for MEDLINE]

1345: Urol Res. 2001 Aug;29(4):238-44.

Evidence suggesting that high intake of fluoride provokes nephrolithiasis in
tribal populations.

Singh PP, Barjatiya MK, Dhing S, Bhatnagar R, Kothari S, Dhar V.

Department of Biochemistry, Darshan Dental College, Madhuvan, India.
siraj_52ali@usa.net

The present study was designed to evaluate the role of fluoride in urolithiasis
in humans. Two areas were selected for this purpose, a fluoride endemic area (EA)
and a fluoride non-endemic area (NEA). The prevalence of uroliathiasis was 4.6
times higher in EA than in NEA. Furthermore, the prevalence was almost double in 
subjects with fluorosis than without fluorosis in the endemic area. No
relationship was observed between urolithiasis and the duration of fluorosis. The
fluoride levels in drinking water ranged from 3.5 to 4.9 ppm in EA and subjects
from this area excreted more fluoride. A comparison of normal subjects (NS) from 
EA and NEA revealed that endemic subjects tend to have slightly higher mean serum
thiobarbituric acid reactive substance (TBAR) levels and excrete more oxalate and
fluoride than their non-endemic counterparts. The urinary stone formers (SF) from
the two areas showed a similar tendency, though again the difference was not
significant. Citrate excretion in SF was almost normal in the EA, but NEA SF had 
significantly lower excretion levels. Urinary stones from endemic patients had
higher fluoride, oxalate and calcium levels than those from non-endemic patients.
In vitro studies suggested that fluoride did not influence the heterogonous
mineralization of calcium oxalate. In conclusion, the data suggest that fluoride 
in vivo may behave as a mild promoter of urinary stone formation by (a) excretion
of insoluble calcium fluoride, (b) increasing oxalate excretion and (c) mildly
increasing the oxidative burden.

PMID: 11585278 [PubMed - indexed for MEDLINE]

1346: Int Urol Nephrol. 2001;32(3):337-40.

Giant pseudoaneurysm of posterior division of renal artery: a rare complication
of pyelolithotomy.

Ansari MS, Dodamani D, Seth A.

Department of Urology, All India Institute of Medical Sciences, New Delhi.

Giant renal artery pseudoaneurysm after pyelolithotomy is an uncommon but
important disorder. A case of giant pseudoaneurysm arising from the posterior
division of right renal artery following pyelolithotomy is presented. The patient
presented with a flank mass six months after pyelolithotomy. CT-scan as well as
selective renal angiography revealed a giant pseudoaneurysm arising from the
posterior division of renal artery. Nephrectomy was necessitated as selective
embolization was not possible due to its extraordinarily large size.

Publication Types: 
    Case Reports

PMID: 11583346 [PubMed - indexed for MEDLINE]

1347: Int Urol Nephrol. 2001;32(3):331-3.

The laparoscopic stylet.

Gülmez I, Demirci D, Ekmekçioğlu O.

Erciyes University, Medical Faculty, Department of Urology, Kayseri, Turkey.

A new instrument, laparoscopic stylet, developed for the laparoscopic extraction 
of the ureteral and renal pelvis calculi is described. The laparoscopic stylet is
made of chromium nickel as a modification of the classical stylet. Until now,
this instrument has been used in 11 retroperitoneoscopic ureterolithotomy
operation and found to be quite useful for the mobilisation and extraction of the
calculi from the ureters, suggesting its probable use also in the laparoscopic
pyelolithotomy procedures.

PMID: 11583344 [PubMed - indexed for MEDLINE]

1348: Int Urol Nephrol. 2001;32(3):327-9.

ESWL in the treatment of stone in child with horseshoe kidney.

Slavkovió A, Vlajković M, Radovanović M, Sirić Z, Stefanović V.

Clinic of Pediatric Surgery, Faculty of Medicine, Nis, Yugoslavia.

We report a case of struvite calculi in the child with horseshoe kidney treated
by extracorporeal shock wave lithotripsy (ESWL). Complete stone clearance was
obtained after 3 sessions using Siemens Lithostar Lithotriptor.

Publication Types: 
    Case Reports

PMID: 11583343 [PubMed - indexed for MEDLINE]

1349: Int Urol Nephrol. 2001;32(3):311-4.

Hormonal and hemodynamic changes during percutaneous nephrolithotomy.

Atici S, Zeren S, Ariboğan A.

Mersin University Department of Anesthesiology, Turkey. atici@mersin.edu.tr

The aim of this study was to investigate the hormonal and hemodynamic changes
during percutaneous nephrolithotomy (PCNL) procedure. Twenty-one patients between
15-65 years of age were included in the study. Invasive blood pressure and heart 
rate were monitored during PCNL. Serum sodium, potassium, BUN and creatinine
levels were measured before and after the operation. Sodium and potassium levels 
were also measured during the operation. Arterial blood gases, renin, aldosterone
and adrenocorticotrophic hormone (ACTH) levels were measured before and during
irrigation. The mean systolic and diastolic blood pressure levels were
significantly higher (p < 0.05) during PCNL compared to post-procedure levels
while heart rate remained constant. Serum sodium, potassium bicarbonate and
base-excess levels were decreased during the operation compared to the baseline
levels (p < 0.001). BUN and creatinine levels remained unchanged during the study
(p > 0.05). In conclusion, a tendency to hyponatremia and metabolic acidosis
developed in addition to significant increases in renin, aldosterone and ACTH
levels during PCNL procedures. These changes may be due to the invasive nature of
the intervention to the kidney and the continuous irrigation of this vital organ.
This should be taken into consideration during PCNL. More detailed studies with
larger groups are needed for more precise comments on this topic.

PMID: 11583340 [PubMed - indexed for MEDLINE]

1350: Acta Cytol. 2001 Sep-Oct;45(5):771-4.

Voided urine cytology of papillary renal cell carcinoma and renal calculus:
report of a case with emphasis on the importance of cytologic screening in
high-risk individuals.

Kawakami H, Hoshida Y, Hanai J, Uchino N, Sasaki S, Mori A, Ikegami K, Kishimoto 
T, Aozasa K.

Department of Pathology, Sakai Municipal Hospital, Japan.

BACKGROUND: Preoperative diagnosis of cases of renal calculus complicated with
papillary renal cell carcinoma (RCC) by image analysis is usually difficult.
CASE: A 50-year-old man who had a past history of renal calculus suffered from
macrohematuria and abdominal pain for one month was admitted to our hospital.
Ultrasonographic examination revealed a 4-cm tumor shadow in the right kidney; it
was hypovascular in arteriography. Papillary cell clusters with abundant
cytoplasm were found by the cytologic examination of voided urine. Their nuclei
were oval and situated eccentrically in the cytoplasm. The nuclear/cytoplasmic
ratio was increased. Fine, granular chromatin was distributed evenly, and the
nuclear membrane was thin and nearly smooth. Several small nucleoli were evident.
All these findings were indicative of a diagnosis of papillary RCC. Histology of 
nephrectomy specimens confirmed the diagnosis. CONCLUSION: Voided urine cytology 
can be useful for screening and follow-up of patients with papillary RCC.

Publication Types: 
    Case Reports

PMID: 11575659 [PubMed - indexed for MEDLINE]

1351: J Agric Food Chem. 2001 Sep;49(9):4262-6.

Oxalate content of soybean seeds (Glycine max: Leguminosae), soyfoods, and other 
edible legumes.

Massey LK, Palmer RG, Horner HT.

Department of Food Science and Human Nutrition, Washington State University,
Spokane, Washington 99201, USA. massey@wsu.edu

Consumption of soybeans and food products made from them is increasing because of
their desirable nutritional value. However, the oxalate content of seeds from 11 
cultivars of soybean showed relatively high levels of total oxalate from 0.67 to 
3.5 g/100 g of dry weight. Oxalate primarily was found as calcium oxalate
crystals. Thirteen tested commercial soyfoods contained between 16 and 638 mg of 
total oxalate per serving. These values compare to those of three other legume
foods, peanut butter, refried beans, and lentils, which contained 197, 193, and
100 mg of total oxalate per serving, respectively. After oxalate has been
absorbed from the diet, it cannot be metabolized and is excreted by the kidney
into urine, where it binds to calcium forming an insoluble salt that may
precipitate to form kidney stones. The amounts of total oxalate in soybean seeds,
soy foods, and other common legume foods exceed current recommendations for
oxalate consumption by individuals who have a history of calcium oxalate
kidney/urinary stones. This study serves as the basis to find soybean cultivars
lower in oxalate, which will have lower risk for kidney stone formation after
human consumption.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 11559120 [PubMed - indexed for MEDLINE]

1352: Emerg Med Clin North Am. 2001 Aug;19(3):633-54, viii.

Nephrolithiasis.

Manthey DE, Teichman J.

Department of Emergency Medicine, Wake Forest University Baptist Medical Center, 
Winston-Salem, North Carolina, USA.

This article covers the diagnosis and management of renal colic. New imaging
modalities will be reviewed using evidence-based medicine. The disposition of the
patient with renal colic will be addressed. Additionally, special groups with
nephrolithiasis will be discussed.

Publication Types: 
    Review

PMID: 11554279 [PubMed - indexed for MEDLINE]

1353: J Endourol. 2001 Aug;15(6):581-4; discussion 584-5.

Thoracoscopy-assisted high intercostal percutaneous renal access.

Finelli A, Honey RJ.

Division of Urology, St. Michael's Hospital, University of Toronto, ON, Canada.

PURPOSE: We describe a technique for safely accessing an upper pole calix through
a 9th or 10th intercostal puncture. PATIENTS AND METHODS: A 9th or 10th
intercostal access was used for percutaneous nephrolithotomy (PCNL) in nine
patients. Thoracoscopy via the 5th or 6th intercostal space was used to ensure
safe passage of the nephrostomy needle. RESULTS: Access was obtained in all
patients without visceral injury. Seven patients were stone free after PCNL; the 
initial two required sandwich therapy to become so. Chest tubes were inserted
routinely in the first eight cases. They were removed on postoperative day three 
and did not affect the length of hospital stay. CONCLUSIONS: Access through the
9th or 10th intercostal space is occasionally necessary and is ideal in certain
circumstances. Thoracoscopy-assisted percutaneous renal access allows access
under direct vision, thus preventing pulmonary injury.

PMID: 11552780 [PubMed - indexed for MEDLINE]

1354: Urology. 2001 Sep;58(3):345-50.

Prospective randomized study of various techniques of percutaneous
nephrolithotomy.

Feng MI, Tamaddon K, Mikhail A, Kaptein JS, Bellman GC.

Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California 
900247, USA.

OBJECTIVES: To compare the modifications of the technique of percutaneous
nephrolithotomy (PCN), including "mini-PCN" and tubeless PCN, to establish which 
technique is associated with the least morbidity and complications. METHODS: We
performed a prospective randomized trial to assess the efficacy and morbidity of 
each method of percutaneous renal access. Standard PCN involved tract dilation to
30F for passage of a 34F working sheath, and our "mini-PCN" involved tract
dilation to 22F for passage of a 26F sheath. Tubeless PCN involved the use of a
double-J stent for internal drainage without the use of a nephrostomy tube for
external drainage at termination of the procedure. Thirty patients (10 patients
in each group) were enrolled, and 27 patients completed the study. All three
groups were compared with regard to postoperative pain using a validated pain
questionnaire comprised of a visual analogue scale and a verbal rating scale. The
operative time, estimated blood loss, stone burden, procedure success rate,
stone-free rate, length of hospitalization, total procedural cost, and
complications were also compared for each technique. RESULTS: The tubeless PCN
population required less morphine use, had a decreased length of hospitalization,
and had a smaller total procedural cost compared with the other two groups. One
complication was noted in both the standard and mini-PCN groups, consisting of
renal bleeding requiring a 2 and 3-U blood transfusion in the standard and
mini-PCN groups, respectively. CONCLUSIONS: The tubeless technique is associated 
with the least amount of morbidity and the greatest cost efficiency compared with
the other techniques. No overall advantage was found for the mini-PCN versus the 
standard technique, but the mini-PCN is at a slight disadvantage because of
poorer visualization and optics and difficulty with use of the nephroscopic
graspers.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial

PMID: 11549477 [PubMed - indexed for MEDLINE]

1355: J Urol. 2001 Oct;166(4):1492-7.

Characterization of Tamm-Horsfall protein in a rat nephrolithiasis model.

Gokhale JA, Glenton PA, Khan SR.

Department of Pathology, University of Florida, Gainesville, USA.

PURPOSE: The role of Tamm-Horsfall protein in calcium oxalate stone formation is 
controversial. It is unclear whether Tamm-Horsfall protein has a role in
crystallization. If it does, does it act as an inhibitor or promoter of
crystallization? To elucidate the nature of its involvement we characterized
Tamm-Horsfall protein in a rat model of calcium oxalate nephrolithiasis by in
vivo and in vitro techniques. MATERIALS AND METHODS: Calcium oxalate
nephrolithiasis was induced in male Sprague-Dawley rats. The amino acid and
carbohydrate composition of Tamm-Horsfall protein from normal rats and those with
nephrolithiasis was determined. The Tamm-Horsfall protein gene and protein
expression in the kidneys were examined by in situ hybridization and
immunohistochemistry. Furthermore, the interaction of Tamm-Horsfall protein and
calcium oxalate crystals was assessed by an in vitro crystal aggregation assay.
RESULTS: Tamm-Horsfall protein from rats with nephrolithiasis was biochemically
similar to that from normal rats. Although Tamm-Horsfall protein was associated
with crystal deposits in the renal papillae of rats with nephrolithiasis,
Tamm-Horsfall protein messenger RNA expression in the kidneys remained unchanged.
In each group Tamm-Horsfall protein inhibited calcium oxalate crystal aggregation
by 47%, indicating no change in functional capabilities. CONCLUSIONS: The results
of this study indicate that urinary excretion, and the biochemical nature and
functional capabilities of Tamm-Horsfall protein remain unchanged during
experimental calcium oxalate nephrolithiasis. Although staining for Tamm-Horsfall
protein was evident in the papillae of rats with nephrolithiasis, the site of
Tamm-Horsfall protein synthesis remained cells of the thick ascending limbs of
the loop of Henle.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11547119 [PubMed - indexed for MEDLINE]

1356: J Urol. 2001 Oct;166(4):1242-6.

Critical analysis of supracostal access for percutaneous renal surgery.

Munver R, Delvecchio FC, Newman GE, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery,
Duke University Medical Center, Durham, North Carolina 27710, USA.

PURPOSE: Percutaneous renal surgery is currently performed for complex renal
calculi as well as for various other endourological indications. In many patients
an upper pole nephrostomy tract allows direct access to most of the intrarenal
collecting system. Upper pole percutaneous access may be obtained via the
supracostal or subcostal approach. The preferred route depends on the location
and size of the specific stone or lesion. Previously others have cautioned
against the supracostal approach above the 12th rib and many have discouraged an 
approach above the 11th rib due to concern about the increased risk of
intrathoracic complications. We retrospectively assessed the morbidity associated
with supracostal percutaneous renal surgery and compared and analyzed the
morbidity of the supracostal and subcostal approaches. MATERIALS AND METHODS: The
records of all patients who underwent upper pole percutaneous renal surgery
between November 1993 and July 1999 were retrospectively reviewed. A total of 240
patients underwent percutaneous renal procedures, including 225 for managing
symptomatic renal or ureteral stones, that is nonstaghorn calculi in 157,
staghorn calculi in 41, proximal ureteral calculi in 12, calculi within a
caliceal diverticulum in 6, calculi associated with primary ureteropelvic
junction obstruction in 5 and calculi associated with a retained ureteral stent
in 4. An additional 15 procedures were done for ureteropelvic junction
obstruction (7), intrarenal collecting system tumors (5), a caliceal diverticulum
without stones (1), a retained ureteral stent (1) and a ureteral stricture (1).
RESULTS: A total of 300 nephrostomy tracts were placed to obtain access to the
intrarenal collecting system via the supracostal approach in 98 (32.7%) cases and
the subcostal approach in 202 (67.3%). Of the supracostal approaches 72 (73.5%)
tracts were above the 12th and 26 (26.5%) were above the 11th rib. The overall
complication rate irrespective of percutaneous approach was 8.3% (16.3% for
supracostal and 4.5% for subcostal access). Complications included blood
transfusion in 7 patients, intraoperative hemothorax/hydrothorax in 5,
sepsis/bacteremia in 3, atrial fibrillation in 2, delayed nephropleural fistula
in 2, renal artery pseudoaneurysm in 2, deep venous thrombosis/pulmonary embolus 
in 2, pneumothorax in 1 and subcapsular hematoma in 1. Seven of 8 intrathoracic
complications (87.5%) developed in supracostal cases. CONCLUSIONS: Percutaneous
renal surgery remains an important option for managing complex renal calculi and 
other upper urinary tract lesions. In our experience it is generally associated
with low morbidity. The supracostal approach is often preferred for obtaining
intrarenal access to complex renal and proximal ureteral pathology. Because
supracostal access tracts are associated with significantly higher intrathoracic 
and overall complication rates compared to subcostal access tracts, this approach
must be used with caution when no other alternatives are available.

PMID: 11547050 [PubMed - indexed for MEDLINE]

1357: Am J Kidney Dis. 2001 Sep;38(3):473-80.

Clinical features and genotype of adenine phosphoribosyltransferase deficiency in
iceland.

Edvardsson V, Palsson R, Olafsson I, Hjaltadottir G, Laxdal T.

Department of Pediatrics, Landspitali-University Hospital, Reykjavik, Iceland.
vidare@landspitali.is

The purpose of this study was to characterize the clinical, diagnostic, and
prognostic features of adenine phosphoribosyltransferase (APRT) deficiency in
Icelandic patients, as well as determine their genotype. Medical records of all
known patients in Iceland were reviewed. Urinalysis and polymerase chain
reaction-based DNA mutation analysis were performed in all patients, siblings,
and living parents of index cases. Twenty-three individuals homozygous for type I
APRT deficiency were identified in 16 families from 1983 to 1998. There were 12
males and 11 females, and the median age at diagnosis was 37 years (range, 0.5 to
62 years). Seventeen patients were index cases and 6 patients were diagnosed
during screening of first-degree relatives. Eighteen patients had symptomatic
disease, 15 of whom experienced nephrolithiasis; 4 patients had mild to moderate 
renal insufficiency, 1 patient had advanced renal failure, and 1 patient died of 
uremic complications. Six patients experienced recurrent urinary tract infections
and 3 infants had a history of reddish-brown diaper stains. Five patients were
asymptomatic; 3 of these patients were diagnosed during routine urinalysis and 2 
patients were identified during family screening. Urinary 2,8-dihydroxyadenine
crystals were detected in all cases, except for the patient who died of end-stage
renal failure. All 23 patients were homozygous for the same mutation (D65V) in
the APRT gene. Allopurinol therapy successfully prevented further stone formation
and significantly improved renal function in most patients with renal
insufficiency. Our results suggest that APRT deficiency may be more common than
previously recognized and can lead to severe renal failure if left untreated.

PMID: 11532677 [PubMed - indexed for MEDLINE]

1358: Kidney Int. 2001 Sep;60(3):1097-105.

Reduction of oxaluria after an oral course of lactic acid bacteria at high
concentration.

Campieri C, Campieri M, Bertuzzi V, Swennen E, Matteuzzi D, Stefoni S, Pirovano
F, Centi C, Ulisse S, Famularo G, De Simone C.

Department of Nephrology, S. Orsola University Hospital, Bologna, Italy.

BACKGROUND: Hyperoxaluria is a major risk factor for renal stones, and in most
cases, it appears to be sustained by increased dietary load or increased
intestinal absorption. Previous studies have shown that components of the
endogenous digestive microflora, in particular Oxalobacter formigenes, utilize
oxalate in the gut, thus limiting its absorption. We tested the hypothesis of
whether oxaluria can be reduced by means of reducing intestinal absorption
through feeding a mixture of freeze-dried lactic acid bacteria. METHODS: Six
patients with idiopathic calcium-oxalate urolithiasis and mild hyperoxaluria (>40
mg/24 h) received daily a mixture containing 8 x 10(11) freeze-dried lactic acid 
bacteria (L. acidophilus, L. plantarum, L. brevis, S. thermophilus, B. infantis) 
for four weeks. The 24-hour urinary excretion of oxalate was determined at the
end of the study period and then one month after ending the treatment. The
ability of bacteria to degrade oxalate and grow in oxalate-containing media, and 
the gene expression of Ox1T, an enzyme that catalyzes the transmembrane exchange 
of oxalate, also were investigated. RESULTS: The treatment resulted in a great
reduction of the 24-hour excretion of oxalate in all six patients enrolled. Mean 
levels +/- SD were 33.5 +/- 15.9 mg/24 h at the end of the study period and 28.3 
+/- 14.6 mg/24 h one month after treatment was interrupted compared with baseline
values of 55.5 +/- 19.6 mg/24 h (P < 0.05). The treatment was associated with a
strong reduction of the fecal excretion of oxalate in the two patients tested.
Two bacterial strains among those used for the treatment (L. acidophilus and S.
thermophilus) proved in vitro to degrade oxalate effectively, but their growth
was somewhat inhibited by oxalate. One strain (B. infantis) showed a quite good
degrading activity and grew rapidly in the oxalate-containing medium. L.
plantarum and L. brevis showed a modest ability to degrade oxalate even though
they grew significantly in oxalate-containing medium. No strain expressed the
Ox1T gene. CONCLUSIONS: The urinary excretion of oxalate, a major risk factor for
renal stone formation and growth in patients with idiopathic calcium-oxalate
urolithiasis, can be greatly reduced with treatment using a high concentration of
freeze-dried lactic acid bacteria. We postulate that the biological manipulation 
of the endogenous digestive microflora can be a novel approach for the prevention
of urinary stone formation.

Publication Types: 
    Clinical Trial

PMID: 11532105 [PubMed - indexed for MEDLINE]

1359: Kidney Int. 2001 Sep;60(3):910-23.

Sequential analysis of kidney stone formation in the Aprt knockout mouse.

Evan AP, Bledsoe SB, Connors BA, Deng L, Liang L, Shao C, Fineberg NS, Grynpas
MD, Stambrook PJ, Youzhi S, Sahota A, Tischfield JA.

Department of Anatomy and Cell Biology, Indiana University School of Medicine,
Indianapolis, Indiana 46202-5120, USA. evan@anatomy.iupui.edu

BACKGROUND: We have previously shown that, as in human adenine
phosphoribosyltransferase (APRT) deficiency, Aprt knockout mice form
2,8-dihydroxyadenine (DHA) renal stones. The disease develops earlier and is more
severe in male than in female mice. To examine the biological bases for these
differences, the area occupied by DHA crystals was quantified in kidney sections 
from male and female mice (strain 129) aged one day to eight months and this
parameter was correlated with changes in renal histopathology. Aprt heterozygous 
and wild-type mice were used as controls. METHODS: Following anesthesia, the left
kidney was removed and immediately frozen in dry ice. Unstained cryosections were
examined by polarized light to determine total area of birefringent particles.
The right kidney was perfused and embedded in plastic, and stained sections were 
viewed by light microscopy to examine the histopathology and to determine the
location of the birefringent particles. A pathological score was assigned to the 
histological findings. The scores from the right kidney were compared with
crystal/particle area in the left kidney, and the data were analyzed using
two-way analysis of variance. The chemical composition of the particles was
determined by x-ray diffraction analysis. Several stone fragments from the
bladder were also examined by scanning electron microscopy (SEM). RESULTS:
Crystals were detected in kidney sections from one- to two-day-old Aprt knockout 
mice. The crystal burden remained low in both sexes throughout the study except
in males at the 120- to 240-day period. Furthermore, there was a substantial
degree of renal pathology, primarily seen as interstitial fibrosis, in those
males with a very high level of stone formation. The crystalline material was
identified as 6-amino-2,8(3,9)-purine dione, a tautomeric form of DHA. SEM
indicated that the crystals were spherical, with a diameter of 10 to 20 microm.
Tissue staining and fixation procedures dramatically reduced the amount of
birefringent material in kidney sections. Aprt heterozygotes of both sexes had
low levels of crystalline material in the kidneys and no pathology. Birefringent 
material or pathological changes were not seen in kidneys from wild-type mice.
CONCLUSIONS: Both male and female Aprt knockout mice accumulate DHA. However, the
area occupied by DHA crystals was significantly greater in 120- to 240-day-old
males compared with the females of similar age. Also, substantial renal pathology
was detected in kidneys of male mice that had very high levels of stone material.

Publication Types: 
    Comparative Study
    Research Support, U.S. Gov't, P.H.S.

PMID: 11532086 [PubMed - indexed for MEDLINE]

1360: Lancet. 2001 Aug 25;358(9282):651-6.

Comment in:
    Lancet. 2002 Jan 5;359(9300):79.    Lancet. 2002 Jan 5;359(9300):79-80.

Recurrent renal stone disease-advances in pathogenesis and clinical management.

Bihl G, Meyers A.

Addenbrookes Renal and Dialysis Centre, Addenbrookes Hospital, Cambridge, UK.
gbihl@maties.sun.ac.za

Kidney stones are common in industrialised nations: up to 15% of white men and 6%
of all women will develop one stone, with recurrence in about half these people. 
Risk factors for formation of stones include urinary promoters (calcium, urate,
cystine, and sodium) and urinary inhibitors (magnesium, citrate, and
nephrocalcin). Acute renal colic can be precipitated by dehydration and reduced
urine output, increased protein intake, heavy physical exercise, and various
medicines. Such colic manifests as severe loin pain and can be accompanied by
frequent urination, dysuria, oliguria, and haematuria. Documentation of stone
characteristics is extremely important: type, size, location, and underlying
metabolic abnormalities. Such details can be obtained with a combination of
biochemical investigations, microscopic examination of urine under polarised
light, and an intravenous pyelogram. Ultrasonography and plain abdominal
radiographs are also useful, especially for patients unable to tolerate an
intravenous pyelogram. Acute therapy includes complete pain relief, rehydration, 
and encouragement of diuresis. Long-term management encompasses education of
patients with regard to diet and fluid intake, control of calciuria, citrate
replacement, and treatment of any underlying urinary-tract infection or metabolic
abnormality. Stones smaller than 5 mm normally pass spontaneously, whereas larger
stones, as big as 2 cm, are best treated with extracorporeal shock-wave
lithotripsy. All physicians should have a clear understanding of the pathogenesis
and clinical management (acute treatment and prevention of recurrence) of renal
stone disease.

Publication Types: 
    Review

PMID: 11530173 [PubMed - indexed for MEDLINE]

1361: Br J Radiol. 2001 Jul;74(883):595-601.

Pyelocalyceal diverticulum: the imaging spectrum with emphasis on the ultrasound 
features.

Rathaus V, Konen O, Werner M, Shapiro Feinberg M, Grunebaum M, Zissin R.

Department of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Israel.

Clinical and imaging data of 11 patients with pyelocalyceal diverticulum were
retrospectively examined. Four patients suffered from ipsilateral flank pain, one
from recurrent urinary tract infection and the other six from unrelated symptoms.
All patients underwent ultrasound as the initial imaging study. In two cases
ultrasound was the only examination performed. Additional imaging studies were
obtained in the other nine patients (abdominal radiography in six cases,
intravenous urography (IVU) in five and CT in four). Ultrasound suggested the
diagnosis of pyelocalyceal diverticulum in eight cases owing to the presence of
echogenic and mobile material within the cyst-like lesion. In three cases the
ultrasound appearance was similar and indistinguishable from a simple cyst and
the diagnosis was made by another imaging study IVU in two cases and CT in one). 
We suggest that ultrasound examination is the best imaging method for the
diagnosis of a pyelocalyceal diverticulum, and no further imaging modalities are 
required when mobile echogenic material is seen. In uncertain cases, another
relatively inexpensive imaging study should be added such as abdominal
radiography or IVU.

PMID: 11509394 [PubMed - indexed for MEDLINE]

1362: Clin Imaging. 2001 Mar-Apr;25(2):122-5.

Central lucency of pelvic phleboliths: comparison of radiographs and noncontrast 
helical CT.

Kim JC.

Department of Diagnostic Radiology, Chungnam National University Hospital, 640
Daesa-dong, Jung-gu, Taejon, 301-721, South Korea. jckim@cnuh.co.kr

To compare how often the central lucency of pelvic phleboliths is seen on plain
radiographs and noncontrast helical computed tomography (CT), both images in 70
patients with renal colic were analyzed. Both images revealed the same number of 
phleboliths in all cases except one in which one of two phleboliths demonstrated 
by CT was not seen on radiographs. Radiography revealed central lucency in 95 of 
149 pelvic phleboliths (63%), but CT failed to depict a hypodense center in any
of 150 phleboliths. The presence or absence of central lucency on CT images
cannot, therefore, be used to differentiate phleboliths from distal ureteral
calculi.

Publication Types: 
    Comparative Study

PMID: 11483423 [PubMed - indexed for MEDLINE]

1363: Urol Res. 2001 Jun;29(3):194-8.

Increased calcium oxalate crystal nucleation and aggregation by peroxidized
protein of human kidney stone matrix and renal cells.

Govindaraj A, Selvam R.

Department of Medical Biochemistry, Institute of Basic Medical Sciences,
University of Madras, Chennai, Tamilnadu, India.

Kidney stone matrix protein fractions eluted from DEAE cellulose column showed
increased oxalate binding activity and had negative correlation with reduced
thiol content. Fraction I (eluted in Tris-HCl, pH 7.4) and fraction 3 (0.3 M NaCl
in buffer) showed nucleation and aggregation-promoting properties while fraction 
2 (0.05 M NaCl in buffer) showed an inhibitory effect in an in vitro
crystallization system. On peroxidation, fractions 1 and 3 showed a further
increase in the promoting effect whereas fraction 2 showed a reduction in the
inhibitory effect of nucleation and aggregation of calcium oxalate crystals.
Protein peroxidation was negatively correlated with the inhibitory activity of
the protein on calcium oxalate nucleation and aggregation. A similar promoting
effect of nucleation and aggregation was seen with mitochondria and nucleus after
peroxidation. These studies suggested that peroxidation of protein or tissue had 
greater influence on the nucleation and aggregation property of calcium oxalate
crystal growth.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11482446 [PubMed - indexed for MEDLINE]

1364: Nephron. 2001 Aug;88(4):320-8.

Study on concretions developed around urinary catheters and mechanisms of renal
calculi development.

Grases F, Söhnel O, Costa-Bauzá A, Ramis M, Wang Z.

Laboratory of Renal Lithiasis Research, Faculty of Sciences, University Illes
Balears, Palma de Mallorca, Spain. dqufgf0@ps.uib.es

AIMS: To study the structure and composition of encrustation and concretions
developed on urinary catheters to better understand their formation mechanism to 
be able to prevent them. METHODS: The surface of catheters was studied by direct 
and scanning electron microscopy observation. In vitro formation of encrustations
was performed in synthetic urine. RESULTS: The surface of catheters was covered
by a continuous layer of organic matter, on which a thin scale consisting of
crystals of calcium oxalate monohydrate (COM), uric acid anhydrous or calcium
phosphate developed. Encrustations observed on catheters generally exhibited the 
same composition as the previously developed renal calculi. In catheters
collected from patients without previous episodes of renal calculi or with
previous episodes of infected renal calculi in which infection was afterwards
eradicated, on the first organic layer, in that case plate-like COM crystals
forming a columnar layer were observed. In vitro experiments demonstrated that
COM columnar structures were only formed when normocalciuric urine containing
organic matter was used, and the presence of crystallization inhibitors, as
phytate, notably delayed their formation. CONCLUSION: Calcium oxalate was the
main crystalline phase developed on catheters inserted in patients, specially in 
the absence of urinary infection or urinary pH values <5.5 and high urinary uric 
acid levels. Thus, prophylaxis of encrustations may consist of preventive
measures usually applied in cases of recurrent idiopathic calcium oxalate
urolithiasis. Copyright 2001 S. Karger AG, Basel.

Publication Types: 
    In Vitro
    Research Support, Non-U.S. Gov't

PMID: 11474226 [PubMed - indexed for MEDLINE]

1365: Kidney Int. 2001 Aug;60(2):757-61.

Biochemical profile of idiopathic uric acid nephrolithiasis.

Pak CY, Sakhaee K, Peterson RD, Poindexter JR, Frawley WH.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, Dallas, Texas 75390-8885, USA.
charles.pak@utsouthwestern.edu

BACKGROUND: The objective of this study was to elucidate a biochemical profile of
patients with idiopathic uric acid nephrolithiasis, without secondary causes
(such as dehydration or diarrhea). Study subjects comprised 56 patients with
idiopathic uric acid nephrolithiasis (UA stone group) who underwent a full
outpatient evaluation. The control group was composed of 54 with absorptive
hypercalciuria and 2 normal subjects, matched with the UA stone group according
to age, body mass index, and gender. METHODS: Urinary pH and ammonium and serum
and urinary uric acid were measured. The fractional excretion of urate was
calculated. RESULTS: Compared with the control group, the UA stone group had a
significantly higher serum uric acid and significantly lower urinary uric acid,
pH (5.34 +/- 0.23 vs. 6.17 +/- 0.36, P < 0.001), and fractional excretion of
urate (0.052 +/- 0.028 vs. 0.080 +/- 0.029, P < 0.001), but individual values
overlapped considerably between the two groups. Discriminant analysis of the
relationship between urinary pH and fractional excretion of urate yielded a
"discriminant score," which provided a much better separation between the two
groups, with a correct classification in 95.5% of subjects. In contrast, urinary 
ammonium, citrate, sulfate, and potassium did not differ between two groups.
CONCLUSIONS: In idiopathic uric acid nephrolithiasis, urinary pH and fractional
excretion of urate are significantly lower than in control subjects, suggestive
of defects in urinary acidification and urate excretion. Since these impairments 
are believed to be associated with primary gout, the underlying disturbance in
idiopathic uric acid nephrolithiasis may be primary gout.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11473659 [PubMed - indexed for MEDLINE]

1366: Clin Sci (Lond). 2001 Aug;101(2):159-68.

A comparative study of the adsorption of amino acids on to calcium minerals found
in renal calculi.

Fleming DE, van Bronswijk W, Ryall RL.

School of Applied Chemistry, Curtin University of Technology, GPO Box U1987,
Perth, WA6845, Australia.

To assess the binding of individual amino acids to the principal calcium minerals
found in human kidney stones, the adsorption of 20 amino acids on to calcium
oxalate monohydrate, CaHPO4*2H2O, Ca3(PO4)2 and Ca5(PO4)3OH crystals was
determined over the physiological urinary pH range (pH 5-8) in aqueous solutions.
All amino acids adsorbed most strongly at pH 5, and this decreased in all cases
as the pH was increased. The amino acids which adsorbed most strongly were
aspartic acid, glutamic acid and gamma-carboxyglutamic acid, with the last
displaying the strongest affinity. All amino acids bound more avidly to calcium
oxalate monohydrate than to any of the phosphate minerals. Adsorption on to
CaHPO4*2H2O was generally higher than for Ca3(PO4)2 and Ca5(PO4)3OH, for which
all amino acids, with the exception of gamma-carboxyglutamic acid, had only a
weak affinity. The binding affinity of these acids is thought to be due to their 
zwitterions being able to adopt conformations in which two carboxyl groups, and
possibly the amino group, can interact with the mineral surface without further
rotation. The strong binding affinity of di-and tri-carboxylic acids for calcium 
stone minerals indicates that proteins rich in these amino acids are more likely 
to play a functional role in stone pathogenesis than those possessing only a few 
such residues. These findings, as well as the preferential adsorption of the
amino acids for calcium oxalate monohydrate rather than calcium phosphate
minerals, have ramifications for research aimed at discovering the true role of
proteins in stone formation and for potential application in the design of
synthetic peptides for use in stone therapy.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11473489 [PubMed - indexed for MEDLINE]

1367: J Struct Biol. 2001 Apr;134(1):5-14.

Intracrystalline proteins and the hidden ultrastructure of calcium oxalate
urinary crystals: implications for kidney stone formation.

Lyons Ryall R, Fleming DE, Doyle IR, Evans NA, Dean CJ, Marshall VR.

Department of Surgery, Flinders University School of Medicine, Bedford Park,
South Australia, 5042, Australia. rose.ryall@flinders.edu.au

The external appearance of urinary calcium oxalate (CaOx) crystals suggests that 
they are solid, homogeneous structures, despite their known association with
proteins. Our aim was to determine whether proteins comprising the organic matrix
of CaOx crystals are superficial or intracrystalline in order to clarify the role
of urinary proteins in the formation of kidney stones. CaOx crystals were
precipitated from centrifuged and filtered, or ultrafiltered, healthy human
urine. They were then treated with dilute NaOH to remove bound proteins,
partially demineralized with EDTA, or fractured and subjected to limited
proteolysis before examination by low-resolution scanning electron microscopy or 
field emission scanning electron microscopy. Crystals precipitated from
centrifuged and filtered urine had a complex interior network of protein
distributed throughout the mineral phase, which appeared to comprise closely
packed subcrystalline particles stacked in an orderly array among an amorphous
organic matrix. This ultrastructure was not evident in crystals deposited in the 
absence of macromolecules, which were completely solid. This is the first direct 
evidence that crystals generated from cell-free systems contain significant
amounts of protein distributed throughout a complex internal cribriform
ultrastructure. Combined with mineral erosion in the acidic lysosomal
environment, proteins inside CaOx crystals would render them susceptible to
attack by urinary and intracellular renal proteases and facilitate their further 
dissolution or disruption into small particles and ions for removal by
exocytosis. The findings also have broader ramifications for industry and the
materials sciences, as well as the development and resorption of crystals in
biomineralization systems throughout nature. Copyright 2001 Academic Press.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11469872 [PubMed - indexed for MEDLINE]

1368: J Endourol. 2001 Jun;15(5):525-8.

Retroperitoneoscopic pyelolithotomy via a posterior approach for large impacted
renal pelvic stone.

Yagisawa T, Ito F, Kobayashi C, Onitsuka S, Kondo T, Goto Y, Toma H.

Department of Urology, Tokyo Women's Medical University, Japan.
t-yagisawa@mvb.biglobe.ne.jp

Retroperitoneal laparoscopic pyelolithotomy via a posterior approach was
successful in a patient with a large impacted renal pelvic stone. This procedure 
is beneficial as an alternative to open surgery for stones that cannot be treated
by SWL or intracorporeal lithotripsy. This procedure may also be the initial
treatment in selected cases.

Publication Types: 
    Case Reports

PMID: 11465333 [PubMed - indexed for MEDLINE]

1369: J Endourol. 2001 Jun;15(5):493-8.

Flexible ureteroscopic lithotripsy: first-line therapy for proximal ureteral and 
renal calculi in the morbidly obese and superobese patient.

Andreoni C, Afane J, Olweny E, Clayman RV.

Department of Surgery, Washington University School of Medicine, St. Louis,
Missouri 63110, USA.

BACKGROUND AND PURPOSE: The surgical treatment of kidney and proximal ureteral
stones in morbidly obese patients (>14 kg/m2) remains difficult because shockwave
lithotripsy is precluded by weight limitations and percutaneous nephrolithotomy
is associated with difficult access and a high (9%) rate of transfusion. We
review our experience with retrograde ureteroscopic lithotripsy in morbidly obese
patients with renal and proximal ureteral stones. PATIENTS AND METHODS: Between
December 1992 and April 2000, five women and three men with a mean age of 46.5
years (range 33-68 years) and a mean body mass index of 54 (range 45-65.2)
underwent 10 independent ureteroscopic procedures for urolithiasis. The average
stone size was 11.1 mm (range 5-25 mm). Lithotripsy was performed with the
holmium laser in eight patients (60%) the electrohydraulic lithotripter in four
(30%), and the tunable-dye laser in the remaining patient. Stone-free status was 
defined as no stones visible on a plain film with nephrotomograms or CT scan at 3
months. RESULTS: The mean operation time was 101 minutes (range 45-160 minutes), 
and 60% of the procedures were done on an outpatient basis. After the initial
procedure, the stone-free rate was 70%. Two patients had fragments <4 mm, and no 
further therapy was undertaken. There was one complication: transient renal
insufficiency (serum creatinine concentration 3.7 mg/dL) secondary to
aminoglycoside toxicity. No transfusions were needed. CONCLUSION: In the morbidly
obese patient with symptomatic stones <1.5 cm, ureteroscopic lithotripsy is safe,
successful, and efficient.

PMID: 11465328 [PubMed - indexed for MEDLINE]

1370: Am J Med Sci. 2001 Jul;322(1):12-8.

Risk factors for kidney stones in older women in the southern United States.

Hall WD, Pettinger M, Oberman A, Watts NB, Johnson KC, Paskett ED, Limacher MC,
Hays J.

Emory University School of Medicine, Atlanta, Georgia, USA. whall@emory.edu

BACKGROUND: The occurrence of kidney stones is disproportionate in the southern
region of the United States. Risk factors for the occurrence of kidney stones in 
this geographic area have not been reported previously. METHODS: The Women's
Health Initiative (WHI) is an ongoing multicenter clinical investigation of
strategies for the prevention of common causes of morbidity and mortality among
postmenopausal women. A case-control ancillary study was conducted on 27,410
(white or black) women enrolled in the 9 southern WHI clinical centers. There
were 1,179 cases (4.3%) of kidney stones at the baseline evaluation. Risk factors
for stone formation were assessed in cases versus age- and race-matched control
subjects. RESULTS: Risk factors (univariate) included low dietary potassium
(2,404 versus 2,500 mg/day, P = 0.006), magnesium (243 versus 253 mg/day, P =
0.003) and oxalate (330 versus 345 mg/day, P = 0.02) intake, as well as increased
body mass index (28.5 versus 27.7 kg/m2, P = 0.001) and a history of hypertension
(42% versus 34%, P = 0.001). A slightly lower dietary calcium intake (683 versus 
711 mg/day, P = 0.04) was noted in case subjects versus control subjects, but
interpretation was confounded by the study of prevalent rather than incident
cases. Supplemental calcium intake >500 mg/day was inversely associated with
stone occurrence. CONCLUSION: Multivariate risk factors for the occurrence of
kidney stones in postmenopausal women include a history of hypertension, a low
dietary intake of magnesium, and low use of calcium supplements.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11465241 [PubMed - indexed for MEDLINE]

1371: Urol Int. 2001;67(1):49-53.

Urinary composition and lithogenic risk in normal subjects following oligomineral
versus bicarbonate-alkaline high calcium mineral water intake.

Coen G, Sardella D, Barbera G, Ferrannini M, Comegna C, Ferazzoli F, Dinnella A, 
D'Anello E, Simeoni P.

Renal Pathophysiology and Hypertension Unit, 2nd Medical Faculty, La Sapienza
University, Rome, Italy. coen.gf@flashnet.it

OBJECTIVE: A normal dietary calcium intake to reduce intestinal oxalate
absorption is essential to avoid recurrence of calcium oxalate stone formation.
It is also important in the prevention of osteopenia in idiopathic
hypercalciuria. The calcium content of waters used for hydration may vary from
very low to relatively high and is an important factor in prevention or
additional risk of stone formation. Therefore, the effect of drinking mineral
waters of different calcium concentrations on lithogenic risk factors was studied
in normal volunteers. MATERIALS AND METHODS: Normal subjects were divided into
two groups of 11 and 10 individuals each. All followed a prescribed diet with an 
average calcium content of 800 mg/day. The water intake for hydration consisted
of 2 liters of an oligomineral water with a low calcium content, <20 mg/l (group 
A) or of a bicarbonate alkaline water with a high calcium content, 370 mg/l
(group B). RESULTS: Diuresis increased similarly in both groups; urine calcium
increased by about 80 mg/day in group B. A rise in urine oxalate was observed in 
both groups, along with the increased urine volume. Osmolar excretion increased
in group B; urine osmolality decreased significantly only in group A. In spite of
the increase in calciuria in group B, Ca/citrate ratio was constant, due to an
increase in citrate excretion. Inter-group differences in terms of activity
products of calcium phosphate, calculated according with Tiselius's methods, were
found. The differences in AP(CaP) index 1 and AP(CaP) index 2 were significant,
with higher values in group B, who drank the bicarbonate alkaline mineral water. 
CONCLUSIONS: Increased water intake between meals to prevent renal stone
recurrence should preferably be achieved with a relatively low calcium water and 
calcium-rich mineral waters should be avoided. Copyright 2001 S. Karger AG, Basel

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11464116 [PubMed - indexed for MEDLINE]

1372: Eur Urol. 2001 May;39(5):586-90.

Citric acid (solution R) irrigation in the treatment of refractory infection
(struvite) stone disease: is it useful?

Joshi HB, Kumar PV, Timoney AG.

Bristol Urological Institute, Southmead Hospital, Bristol, UK.

OBJECTIVE: Citric acid, in varying concentrations, has been used in the
dissolution treatment of struvite renal calculi. Solution R (Uro-trainer), which 
contains 6% citric acid, is a solution licensed for use in the management of
struvite stone disease in the UK. We report our experience. METHODS: 23 kidneys
in 22 patients (10 male and 12 female patients, mean age 45, range 15-60 years)
underwent solution R irrigation following debulking of the stone with
percutaneous nephrolithotomy (n = 20), ureteroscopy and shock wave lithotripsy (n
= 2) combined with open procedures (n = 4) between 1994 and 1998. The original
stone configuration consisted of 14 staghorn, 4 partial staghorn and 5 large
burden stones. Irrigation was performed through a nephrostomy tube (n = 20) or in
a retrograde fashion (n = 3) using a closed infusion pump system (40 ml/h). The
response to treatment was checked using a nephrostogram and/or plain X-ray.
RESULTS: In 6 (26%) kidneys, after an average duration of 2 (1-5) days,
irrigation had to be abandoned due to loin pain, leak or sepsis. The average
duration of irrigation was 6.4 (1-20) days. At the end of irrigation, a total of 
4 (17.4%) kidneys had complete radiographic clearance, while the stone was
reduced to calyceal dust in 3 (13%). Partial response was seen in 11 (47.8%) and 
no response in 5 (21.8%) kidneys. Following additional alternative
intervention(s) in 6 (26%) kidneys (4 with partial and 2 with no response)
further clearance was achieved in 3 (13%) and calyceal dust status in 3 (13%).
The response was better if the stone was reduced to less than 10mm prior to
irrigation. At the mean follow-up of 2.44 (1-4) years, of 13 kidneys with stone
clearance or calyceal dust, 9 suffered recurrence or re-growth, 5 of which
required further interventions. Only 4 (17.4%) of 23 kidneys remained stone free.
CONCLUSIONS: In patients with complex stone disease, adjuvant solution R
irrigation can reduce the stone burden. There is a considerable potential for
side effects necessitating close monitoring for sepsis and electrolyte
abnormalities. However, the overall success rate for solution R is limited.

PMID: 11464042 [PubMed - indexed for MEDLINE]

1373: Urology. 2001 Jul;58(1):105.

Verrucous carcinoma of the renal pelvis.

Kansal NS, Rosenberg G, Han M, Richter F.

Department of Urology, University of Medicine and Dentistry New Jersey-New Jersey
Medical School and Hackensack University Medical Center, Newark, New Jersey, USA.

We report a case of a verrucous carcinoma of the renal pelvis after a long
history of a renal pelvis stone. Only 1 case of verrucous carcinoma of the renal 
pelvis has been previously reported, and ours is the first case not associated
with a horseshoe kidney.

Publication Types: 
    Case Reports

PMID: 11445495 [PubMed - indexed for MEDLINE]

1374: J Urol. 2001 Jul;166(1):268-74.

Excretion of bikunin and its fragments in the urine of patients with renal
stones.

Suzuki M, Kobayashi H, Kageyama S, Shibata K, Fujie M, Terao T.

Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine,
Hamamatsu, Japan.

PURPOSE: Bikunin is a Kunitz-type protease inhibitor found in serum and urine. It
has been implicated in urinary stone formation. This study was designed to
investigate the role of urinary bikunin in stone formation. MATERIALS AND
METHODS: Urinary concentrations of bikunin were measured in 18 male formers of
urinary stones 28 to 74 years old and in 77 healthy controls, including 39 males 
and 38 females, without urological abnormality. A sensitive competitive solid
phase enzyme immunoassay was established for urinary bikunin. Bikunin was also
qualitatively assessed by Western blot analysis. RESULTS: The mean urinary
bikunin-to-creatinine ratio plus or minus standard deviation in stone formers was
significantly elevated compared with that in healthy male and female controls
(52.9 +/- 46.0 microg./mg. creatinine versus 28.0 +/- 30.4 and 26.5 +/- 21.7, p =
0.005 and 0.006, respectively). By Western blot analysis all urine samples
contained authentic 40 kDa. bikunin species. However, a significantly higher
proportion of patients was found to have aberrant 25 kDa. bikunin species
compared with controls (10 of 18 or 55.6% versus 15 of 77 or 19.5%, p = 0.002).
Experiments on de-glycosylation with chondroitinase ABC, amino acid sequencing of
the aberrant bikunin species and calcium oxalate crystal growth inhibition assay 
demonstrated that the 25 kDa. bikunin fragment was identical to de-glycosylated
bikunin and less inhibitory on calcium oxalate crystal growth. CONCLUSIONS: If
urinary bikunin is important in the pathogenesis of urolithiasis, its effect is
probably attributable to the concentration and degree of glycosylation.

Publication Types: 
    Clinical Trial
    Comparative Study
    Controlled Clinical Trial

PMID: 11435884 [PubMed - indexed for MEDLINE]

1375: J Urol. 2001 Jul;166(1):222-4.

Short-term changes in renal function after extracorporeal shock wave lithotripsy 
in children.

Villányi KK, Székely JG, Farkas LM, Jávor E, Pusztai C.

Department of Urology, University Medical School of Pécs, Pécs, Hungary.

PURPOSE: To our knowledge despite numerous studies the biological effect of
extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc.,
Marietta, Georgia) on the function of the immature kidney has not yet been
evaluated. We determined the short-term effect of ESWL on renal function in
children. MATERIALS AND METHODS: In a 5-year period 65 children were treated for 
77 kidney stones by ESWL and followed regularly at our department. In 16 children
the short-term effect of shock wave energy was studied by measuring blood
parameters (sodium, potassium, urea, creatinine and C-reactive protein), urinary 
electrolytes (sodium, potassium and creatinine), urinary enzyme activity
(aspartate transaminase, alanine transferase, alkaline phosphatase and lactate
dehydrogenase) and the excretion of beta 2-microglobulin. Samples were obtained
immediately before and 2 hours after ESWL, and on days 1, 2, 8, 15, 30 and 90
after treatment. RESULTS: Morphological changes in the kidneys were not detected 
by ultrasound during followup. No significant changes were noted in overall renal
function, serum parameters or urine electrolytes. A significant elevation in the 
excretion of aspartate transaminase, alkaline phosphatase, lactate dehydrogenase 
and beta 2-microglobulin was observed, indicating proximal tubular dysfunction
and cell destruction. Enzyme levels returned to baseline within 15 days.
CONCLUSIONS: Our results demonstrate that shock wave energy induces transient
functional damage of tubular function in children. Minimizing the kV. and number 
of shocks may decrease the deleterious effect. When considering functional
regeneration time, the minimal interval between 2 shock wave treatments should be
at least 15 days. The long-term effect needs further investigation.

Publication Types: 
    Evaluation Studies

PMID: 11435873 [PubMed - indexed for MEDLINE]

1376: J Urol. 2001 Jul;166(1):36; discussion 36-7.

Long-term renal functional effects of shock wave lithotripsy, percutaneous
nephrolithotomy and combination therapy: a comparative study of patients with
solitary kidney.

Liou LS, Streem SB.

Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

PURPOSE: We compared the long-term impact on renal function after shock wave
lithotripsy, percutaneous nephrolithotomy or the 2 techniques combined in
patients with a solitary kidney. MATERIALS AND METHODS: A total of 45 women and
38 men 15 to 86 years old (mean age 56.1) with a solitary kidney were treated
with shock wave lithotripsy (53), percutaneous nephrolithotomy (18) or the 2
techniques combined (12). Before and after treatment serum creatinine, blood
pressure and the calculated glomerular filtration rate were determined, and raw
and calculated data were compared by the Kruskal-Wallis, Fisher exact and
Wilcoxon rank sum tests, and the Spearman correlation coefficient. Followup was 1
to 166.5 months (mean 53.0, median 46.9) overall and statistically equivalent in 
the 3 treatment arms. RESULTS: Treatment groups were comparable in regard to
patient age, sex distribution, weight, blood pressure and pretreatment serum
creatinine. There was no significant difference in any evaluated pretreatment or 
posttreatment parameters and no difference in the change in any parameter after
treatment. Stratifying patients to pretreatment serum creatinine less or greater 
than 2 mg./dl. likewise revealed no significant difference in the impact on
long-term renal function. However, pretreatment serum creatinine positively and
strongly correlated with a positive change in the glomerular filtration rate
after therapy. CONCLUSIONS: In this study there was no evidence that any of these
3 treatment modalities resulted in the deterioration of renal function even at
long-term followup. This finding implies that shock wave lithotripsy,
percutaneous nephrolithotomy and the 2 therapies combined are equally efficacious
for preserving renal function when performed in patients with a solitary kidney.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 11435817 [PubMed - indexed for MEDLINE]

1377: J Urol. 2001 Jul;166(1):28-32.

In vitro study of ultrasound based real-time tracking of renal stones for shock
wave lithotripsy: part 1.

Chang CC, Liang SM, Pu YR, Chen CH, Manousakas I, Chen TS, Kuo CL, Yu FM, Chu ZF.

Department of Urology, ESWL Laboratory, National Cheng Kung University and
Hospital, Tainan, Taiwan, Republic of China.

PURPOSE: We developed a real-time tracking system for renal stones that decreases
the number of shock waves and treatment time of shock wave lithotripsy. MATERIALS
AND METHODS: Ultrasound images were analyzed to identify the renal stones. A
computer software module for ultrasound image processing was developed to monitor
stone location instantaneously. Another computer software module controlled
generator movement in real time for tracking the stone. We used 13 ultrasound
stone trajectories recorded from patients to test the system in vitro. Two tests 
were established to verify tracking system reliability. One test focused on
improvement in the coincidence ratio, which denotes the matching extent of the
stone within the effective focal area. The other test focused on improvement in
the efficiency ratio, that is a decrease in the number of shocks for stone
fragmentation. For each recorded stone trajectory 2 experiments were done under
tracking and nontracking conditions. RESULTS: The average coincidence and
efficiency ratios plus or minus standard deviation were 79.6% +/- 9.8% and 45.0% 
+/- 12.7% without tracking, and 97.0% +/- 3.0% and 85.5 +/- 6.8% with tracking,
respectively. All tests were statistically significant (paired t test p <0.01).
CONCLUSIONS: An ultrasound based real-time tracking system proved to be
significantly helpful for in vitro lithotripsy. It appears that the tracking
system may greatly decrease the number of shocks and treatment time for renal
stones.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11435816 [PubMed - indexed for MEDLINE]

1378: Arch Esp Urol. 2001 Apr;54(3):282-92.

Lithogenic risk factors for renal stones in patients with Crohn's disease.

Buño Soto A, Torres Jiménez R, Olveira A, Fernández-Blanco Herraiz I, Montero
García A, Mateos Antón F.

Clinical Biochemistry, La Paz University Hospital, Madrid, Spain.

OBJECTIVES: Calcium oxalate kidney stones are more common in patients with
Crohn's disease (CD). The aims of this study were to verify the prevalence of the
main risk factors for calcium oxalate nephrolithiasis in patients with CD and to 
evaluate the degree of urinary relative supersaturation for calcium oxalate
(CaOx), dihydrogen uric acid (DHUA) and monohydrogen calcium phosphate (MHCaP).
SUBJECTS AND STUDY PROTOCOL: 42 patients with CD (22 male and 20 female, aged
15-72 years) and 18 controls (8 male and 10 female, aged 26-65) were studied.
Nine patients were evaluated during an active episode and 33 in a quiescent
phase. All patients had normal glomerular filtration rate. All subjects collected
a 24-hr urine sample and fasting venous blood was drawn. Good compliance of urine
collection was assessed by the Cockcroft and Gault formula. In urine pH and
oxalate (Ox), calcium (Ca), phosphate (P), uric acid (UA), citrate (Cit),
magnesium (Mg), sulphate (Sulph), sodium, potassium and chloride concentrations
were measured and their excretions calculated. Urinary RS index was obtained
using the software EQUIL93. RESULTS: A decreased urinary volume (61.9%) was the
most frequent finding. A decreased excretion of Cit, Mg and Sulph (38.1%, 31.0%
and 31.0%, respectively) and increased excretion of P, Ox, UA and Ca (33.3%,
23.8%, 16.7% and 14.3%, respectively) were found. Thirty four patients (81.0%)
showed at least 2 lithogenic risk factors and only 2 patients showed none. Urine 
of patients had a higher urinary CaOx and DHUA relative super saturation.
Patients studied in an active episode showed a higher urinary CaOx and MHCaP RS
than those studied in the quiescent period. CONCLUSIONS: The majority of patients
with CD have a multifactorial high risk for calcium oxalate and a single patient 
usually has several metabolic disturbances which are more evident in an active
episode.

PMID: 11432047 [PubMed - indexed for MEDLINE]

1379: Curr Opin Urol. 2001 Jul;11(4):367-72.

An update on percutaneous nephrolithotomy in the management of urinary calculi.

Wong MY.

Department of Urology, Singapore General Hospital, Singapore. gurwyc@sgh.com.sg

Since its introduction in the 1970s, percutaneous nephrolithotomy has undergone
numerous refinements in both instrumentation and technique to become an
efficacious and safe procedure for the removal of renal calculi. The aim of this 
review is to discuss issues raised in publications in the year 2000 regarding
percutaneous nephrolithotomy in the management of urinary stone disease.

Publication Types: 
    Review

PMID: 11429495 [PubMed - indexed for MEDLINE]

1380: Curr Opin Urol. 2001 Jul;11(4):359-66.

Renal collecting system anatomy: its possible role in the effectiveness of renal 
stone treatment.

Sampaio FJ.

Division of Urology and Department of Anatomy, Urogenital Research Unit, State
University of Rio de Janeiro, Rio de Janeiro, Brazil. sampaio@uerj.br

The anatomy of the kidney collecting system may play a role in the selection of
the best method of kidney stone treatment for a specific patient. Also, an
analysis of the collecting-system anatomy would indicate the likely effectiveness
of each method of treatment. For stones located in the lower pole, the clearance 
rate after shockwave lithotripsy has been uniformly low relative to that of
calculi elsewhere. Some special anatomical findings suggest that retention of
what are considered to be 'passable stone fragments' (4 mm in diameter or less)
in the inferior pole might be a consequence not only of the gravity-dependent
position of lower calices but also of particular anatomical features of the
inferior pole collecting system. The aspects reviewed and discussed are the angle
formed between the main lower infundibulum and the renal pelvis (the
infundibulopelvic angle), the lower infundibula diameters, the lower infundibulum
length and height, and the lower calices spatial distribution. Also, the presence
of minor calices perpendicular to the surface of the collecting system and
drainage of superior and inferior poles are reviewed and discussed in the context
of their importance to the effectiveness of renal stone treatment.

Publication Types: 
    Review

PMID: 11429494 [PubMed - indexed for MEDLINE]

1381: Kidney Int. 2001 Jul;60(1):272-6.

Frequency of renal phosphate leak among patients with calcium nephrolithiasis.

Prié D, Ravery V, Boccon-Gibod L, Friedlander G.

Department of Physiologie Explorations Fonctionnelles, Hôpital Bichat, Paris,
France. dprie@bichat.inserm.fr

BACKGROUND: Nephrolithiasis is a frequent disorder affecting 10 to 15% of the
population in Europe and the United States. More than 80% of renal stones are
made of calcium oxalate and calcium phosphate. The main identified risks for
calcium renal stone formation are hypercalciuria and urinary saturation. A urine 
phosphate (Pi) loss is often associated with hypercalciuria; furthermore,
hyperphosphaturia increases urinary saturation. METHODS: To determine whether
urinary phosphate loss is associated with calcium urolithiasis, we measured renal
Pi threshold (TmPi) in 207 stone formers with normal parathyroid hormone (PTH)
serum concentration and in 105 control subjects. RESULTS: The TmPi followed a
normal distribution in both groups. The mean TmPi was significantly lower in
stone formers versus controls (0.72 +/- 0.13 vs. 0.87 +/- 0.18 mmol/L, P <
0.0001) because of a shift to the left of the TmPi distribution curve in the
stone former population, with no evidence for bimodal distribution. Five percent 
of the controls had a TmPi <0.63 versus 19% of the stone formers. Daily urinary
calcium excretion was significantly higher in stone formers than in controls.
Calcium excretion was also significantly higher in stone formers with TmPi <0.63 
mmol/L compared with those with TmPi > or =0.63. Serum PTH and ionized calcium
concentrations were not different in stone formers and in control subjects,
whatever the TmPi value. CONCLUSIONS:: A low TmPi is more frequently encountered 
in stone formers with a normal PTH concentration than in control subjects and is 
associated with a high urinary Ca excretion. The hypophosphatemia induced by a
renal phosphate leak may predispose the subject to calcium stone formation by
increasing the serum calcitriol level, calcium excretion, and urinary saturation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11422761 [PubMed - indexed for MEDLINE]

1382: Phytother Res. 2001 Jun;15(4):351-5.

In vitro studies on antilithiatic activity of seeds of Dolichos biflorus Linn.
and rhizomes of Bergenia ligulata Wall.

Garimella TS, Jolly CI, Narayanan S.

Department of Pharmacognosy and Phytochemistry, Prin. K. M. Kundnani College of
Pharmacy, Worli Sea Face, Mumbai, India.

Soxhlet extracts of seeds of Dolichos biflorus and rhizomes of Bergenia ligulata 
were tested for their in vitro antilithiatic/anticalcification activity by the
homogeneous precipitation method. The extracts were compared with an aqueous
extract of cystone (a marketed preparation) for their activities. Also a
combination of the extracts of the two plants was tested. Extracts of Dolichus
biflorus showed activity almost equivalent to cystone while Bergenia ligulata
showed less activity and the combination was not as active as the individual
extracts. Copyright 2001 John Wiley & Sons, Ltd.

PMID: 11406861 [PubMed - indexed for MEDLINE]

1383: Ultrasound Med Biol. 2001 May;27(5):683-93.

The mechanisms of stone fragmentation in ESWL.

Eisenmenger W.

Physikalisches Institut der Universität Stuttgart, Stuttgart, Germany.
w.eisenmenger@physik.uni-stuttgart.de

Currently, several mechanisms of kidney stone fragmentation in extracorporal
shockwave lithotripsy (ESWL) are under discussion. As a new mechanism, the
circumferential quasistatic compression or "squeezing" by evanescent waves in the
stone has been introduced. In fragmentation experiments with self-focussing
electromagnetic shock-wave generators with focal diameters comparable to or
larger than the stone diameter, we observed first cleavage surfaces either
parallel or perpendicular to the wave propagation direction. This is in agreement
with the expectation of the "squeezing" mechanism. Because, for positive pulse
pressures below 35 MPa and stones with radii of 15 mm or smaller, cleavage into
only two fragments was observed, we developed a quantitative model of binary
fragmentation by "quasistatic squeezing." This model predicts the ratio of the
number of pulses for the fragmentation to 2-mm size and of the number of pulses
required for the first cleavage into two parts. This "fragmentation-ratio"
depends linearly alone on the stone radius and on the final size of the
fragments. The experimental results for spherical artificial stones of 5 mm, 12
mm and 15 mm diameter at a pulse pressure of 11 MPa are in good agreement with
the theoretical prediction. Thus, binary fragmentation by quasistatic squeezing
in ESWL as a new efficient fragmentation mechanism is also quantitatively
verified.

Publication Types: 
    Review

PMID: 11397533 [PubMed - indexed for MEDLINE]

1384: J Chromatogr B Biomed Sci Appl. 2001 May 5;755(1-2):287-95.

Measurement of nephrolithiasis urinary markers by capillary electrophoresis.

García A, Muros M, Barbas C.

Facultad de CC Experimentales y Técnicas, Universidad S. Pablo-CEU, Urbanización 
Montepríncipe Ctra., Madrid, Spain.

A previously developed method for screening organic acidurias by capillary
electrophoresis has been validated for oxalate and citrate measurement in urine. 
Sample pretreatment is minimum, just acidification and centrifugation. Detection 
is by direct UV. Validation parameters of the method can be considered adequate. 
Response is linear for both analytes in standards and samples. The assayed ranges
were 200-1,000 mg/l for citrate and 10-200 mg/l for oxalate. Recoveries ranged
from 99.4+/-3 to 101.7+/-2.4%, maximum imprecision in oxalate concentration was
of 7.6% RSD and limits of detection in samples were 0.67 mg/l for oxalate and
25.9 mg/l for citrate, both lower than the measured values in samples.
Identification of increased glyoxylic (oxoacetic acid) and glyceric acids
(2,3-dihydroxy propanoic) are also included to facilitate the diagnosis.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11393716 [PubMed - indexed for MEDLINE]

1385: Am J Kidney Dis. 2001 Jun;37(6):1140-3.

Contributory metabolic factors in the development of nephrolithiasis in patients 
with medullary sponge kidney.

Yagisawa T, Kobayashi C, Hayashi T, Yoshida A, Toma H.

Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
t-yagisawa@mvb.biglobe.ne.jp

Whether specific metabolic abnormalities are related to nephrolithiasis in
patients with medullary sponge kidney (MSK) remains a debated issue. The purpose 
of this study is to determine metabolic disorders in patients with MSK and
nephrolithiasis compared with idiopathic calcium-stone-forming patients. One
hundred eighty-four patients with recurrent calcium-stone formations were
investigated with regard to metabolic abnormalities. Of these, 22 patients
(11.9%; 13 men, 9 women) showed MSK by radiological examination. MSK was defined 
as a kidney that presented at least three linear or round papillary opacities in 
the affected papilla on urography. Multiple stones (more than five) existed in
both kidneys in all patients with MSK. The remaining 162 patients (109 men, 53
women) were idiopathic calcium-stone formers. Frequencies of low urine volume
(urine < 1,500 mL/24 h) and hyperoxaluria (oxalate > 40 mg/24 h) were similar
between the groups. Hypercalciuria (men, calcium > 300 mg/24 h; women, calcium of
250 mg/24 h) was found less frequently in the MSK group. The frequency of
hypocitraturia (citrate < 300 mg/24 h) was significantly greater in the MSK group
than the idiopathic group (77.3% versus 33.9%, respectively). Mean 24-hour
urinary excretions of calcium, citrate, uric acid, and magnesium were
significantly less in the MSK group. No differences were found in serum calcium, 
phosphate, and parathyroid hormone levels between the groups. Low urinary
excretions of citrate and magnesium are the most typical metabolic disorders that
distinguish MSK stone patients from idiopathic calcium-stone-forming patients. In
addition to such anatomic abnormalities as ectatic collecting ducts, low levels
of urinary inhibitors of stones seem to contribute to the pathogenesis of
nephrolithiasis in patients with MSK.

PMID: 11382681 [PubMed - indexed for MEDLINE]

1386: Kidney Int. 2001 Jun;59(6):2290-8.

Twenty-four-hour urine chemistries and the risk of kidney stones among women and 
men.

Curhan GC, Willett WC, Speizer FE, Stampfer MJ.

Channing Laboratory, Department of Medicine, Brigham and Womens' Hospital,
Harvard Medical School, Boston, Massachusetts 02115, USA.
gary.curhan@channing.harvard.edu

BACKGROUND: Results of a 24-hour urine collection are integral to the selection
of the most appropriate intervention to prevent kidney stone recurrence. However,
the currently accepted definitions of normal urine values are not firmly
supported by the literature. In addition, little information is available about
the relationship between risk of stone formation and the levels of urinary
factors. Unfortunately, the majority of previous studies of 24-hour urine
chemistries were limited by the inclusion of recurrent stone formers and poorly
defined controls. METHODS: We obtained 24-hour urine collections from 807 men and
women with a history of kidney stone disease and 239 without a history who were
participants in three large ongoing cohort studies: the Nurses' Health Study I
(NHS I; mean age of 61 years), the Nurses' Health Study II (NHS II; mean age of
42 years), and the Health Professionals Follow-up Study (HPFS; mean age of 59
years). RESULTS: Mean 24-hour urine calcium excretion was higher and urine volume
was lower in cases than controls in NHS I (P < or = 0.01), NHS II (P < or = 0.13)
and HPFS (P < or = 0.01), but urine oxalate and citrate did not differ. Among
women, urine uric acid was similar in cases and controls but was lower in cases
in men (P = 0.06). The frequency of hypercalciuria was higher among the cases in 
NHS I (P = 0.26), NHS II (P = 0.03), and HPFS (P = 0.02), but 27, 17, and 14% of 
the controls, respectively, also met the definition of hypercalciuria. The
frequency of hyperoxaluria did not differ between cases and controls, but was
three times more common among men compared with women. After adjusting for the
other urinary factors, the relative risk of stone formation increased with
increasing urine calcium levels and concentration in all three cohorts but not in
a linear fashion. Compared with individuals with a urine calcium concentration of
<75 mg/L, the relative risk of stone formation among those with a urine calcium
concentration of > or =200 mg/L for NHS I was 4.34 (95% CI, 1.59 to 11.88), for
NHS II was 51.09 (4.27 to 611.1), and for HPFS was 4.30 (1.71 to 10.84). There
was substantial variation in the relative risks for stone formation for the
concentration of other urine factors within the different cohorts. CONCLUSIONS:
The traditional definitions of normal 24-hour urine values need to be reassessed,
as a substantial proportion of controls would be defined as abnormal, and the
association with risk of stone formation may be continuous rather than
dichotomous. The 24-hour urine chemistries are important for predicting risk of
stone formation, but the significance and the magnitudes of the associations
appear to differ by age and gender.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11380833 [PubMed - indexed for MEDLINE]

1387: Kidney Int. 2001 Jun;59(6):2273-81.

Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone 
formers.

Nguyen QV, Kälin A, Drouve U, Casez JP, Jaeger P.

Policlinic of Medicine, University Hospital, Berne, Switzerland.

BACKGROUND: High protein intake is an accepted risk factor for renal stone
disease. Whether meat protein intake affects oxaluria, however, remains
controversial in healthy subjects and in stone formers. This study was designed
(1) to test the oxaluric response to a meat protein load in male recurrent
idiopathic calcium stone formers (ICSFs) with and without mild metabolic
hyperoxaluria (MMH and non-MMH, respectively), as well as in healthy controls,
and (2) to seek for possible disturbed vitamin B(6) metabolism in MMH, in analogy
with primary hyperoxaluria. METHODS: Twelve MMH, 8 non-MMH, and 13 healthy males 
were studied after five days on a high meat protein diet (HPD; 700 g meat/fish
daily) following a run-in phase of five days on a moderate protein diet (MPD; 160
g meat/fish daily). In both diets, oxalate-rich nutrients were avoided, as well
as sweeteners and vitamin C-containing medicines. Twenty-four-hour urinary
excretion of oxalate was measured on the last day of each period, along with
4-pyridoxic acid (U(4PA)) and markers of protein intake, that is, urea,
phosphate, uric acid, and sulfate. Serum pyridoxal 5' phosphate (S(P5P)) was
measured after protein loading. RESULTS: Switching from MPD (0.97 +/- 0.18 g
protein/kg/day) to HPD (2.26 +/- 0.38 g protein/kg/day) led to the expected rise 
in the urinary excretion rates of all markers of protein intake in all subjects. 
Concurrently, the mean urinary excretion of oxalate increased in ICSFs taken as a
whole (+73 +/- 134 micromol/24 h, P = 0.024) as well as in the MMH subgroup (+100
+/- 144 micromol/24 h, P = 0.034) but not in controls (-17 +/- 63 micromol/24 h).
In seven ICSFs (4 MMH and 3 non-MMH) but in none of the healthy controls (P =
0.016, chi square), an increment in oxaluria was observed and considered as
significant based on the intra-assay coefficient of variation at our laboratory
(8.5%). There was no difference in S(P5P)nd U(4PA)etween the groups after protein
loading. CONCLUSION: Approximately one third of ICSFs with or without so-called
MMH are sensitive to meat protein in terms of oxalate excretion, as opposed to
healthy subjects. Mechanisms underlying this sensitivity to meat protein remain
to be elucidated and do not seem to involve vitamin B(6) deficiency.

Publication Types: 
    Clinical Trial

PMID: 11380831 [PubMed - indexed for MEDLINE]

1388: AJR Am J Roentgenol. 2001 Jun;176(6):1441-5.

Color and power Doppler twinkling artifacts from urinary stones: clinical
observations and phantom studies.

Lee JY, Kim SH, Cho JY, Han D.

Department of Radiology, Seoul National University College of Medicine, The
Institute of Radiation Medicine, 28, Yongon-dong, Chongno-ku, Seoul, 110-744,
Korea.

OBJECTIVE: The purpose of this study was to determine whether color and power
Doppler twinkling artifacts could be considered an additional diagnostic
sonographic feature of urinary stones. SUBJECTS AND METHODS: A prospective study 
was performed in 32 patients with 20 renal stones and 16 ureteral stones to
assess how often urinary stones show twinkling artifacts on Doppler sonography.
Gray-scale images and color, power, and spectral Doppler images were obtained in 
all patients. All sonographic examinations were performed with a 3.5- or 5-MHz
curvilinear phased array probe. The images were then analyzed for the presence,
appearance, and intensity of the artifacts. Phantom experiments were performed
with various kinds of urinary stones with high-megahertz linear phased array
probes. The effects on the artifacts of the composition of the stones, of the
Doppler velocity scale, and of the focal zone were investigated. RESULTS: Thirty 
(83%) of 36 urinary stones showed color and power Doppler twinkling artifacts,
which appeared as a rapidly changing color complex seen persistently behind
stones like a comet's tail. Twenty-two of 30 stones with the twinkling artifacts 
showed strong intensity artifacts. Spectra with saturated amplitude were obtained
from all 30 stones showing color Doppler artifacts. In phantom experiments, the
artifacts originated from all stones. The velocity range did not affect the
artifacts, whereas focal zone did. CONCLUSION: Color Doppler twinkling artifacts 
from urinary stones occur frequently and may be considered an additional
sonographic feature of urinary stones. The observation of these artifacts may be 
helpful in determining the presence of urinary stones.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11373210 [PubMed - indexed for MEDLINE]

1389: Biomed Sci Instrum. 2001;37:405-9.

Automatic segmentation of medical images for renal calculi and analysis.

Sridhar S, Kumaravel N.

Center for Medical Electronics, School of ECE, Anna University, Chennai-600025,
India.

Development of an automated system to identify renal calculi based on its
physical characteristics is proposed. Calculi are due to abnormal collection of
certain chemicals like oxalate, phosphate and uric arid. Renal calculi may be
present in kidney, ureter or in urinary bladder. An algorithm is proposed to
detect calculus using its shadow. The system also extracts the properties of
calculi such as size, shape and location, which are vital for reliable diagnosis.
This method has been implemented in the MATLAB/IDL platform and a considerable
success rate is obtained.

PMID: 11347425 [PubMed - indexed for MEDLINE]

1390: J Urol. 2001 May;165(5):1415-8.

Impact of lower pole renal anatomy on stone clearance after shock wave
lithotripsy: fact or fiction?

Madbouly K, Sheir KZ, Elsobky E.

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

PURPOSE: We determined whether there is a significant relationship between the
spatial anatomy of the lower pole on preoperative excretory urography and stone
fragment clearance after shock wave lithotripsy. MATERIALS AND METHODS: The
anatomical factors affecting lower pole stone clearance after shock wave
lithotripsy were evaluated retrospectively in 108 patients. Stone-free status was
assessed by renal computerized tomography with or without renal ultrasound. The
stone-free rate at 3 months was correlated with lower pole infundibular length
and width in mm. as well as with the lower pole infundibulopelvic angle in
degrees. The statistical significance of each lower pole anatomical factor as
well as other stone, renal and treatment factors were correlated with the
stone-free rate using the Mann-Whitney and chi-square tests. RESULTS: Three
months after shock wave lithotripsy 79 patients (73.1%) were free of stones. Mean
lower infundibular length plus or minus standard deviation was 20.9 +/- 6.56 mm.,
mean infundibular width was 5.65 +/- 2.34 mm. and the mean lower pole
infundibulopelvic angle was 48.33 +/- 14.84 degrees. In 49 (45.4%) and 59 (54.6%)
patients infundibular length was greater than 3 cm. and 3 cm. or less,
respectively. Infundibular width was greater than 5 mm. and 5 mm. or less in 45
(41.7%) and 63 (58.3%) patients, respectively. No obtuse infundibulopelvic angles
were noted. None of the 3 lower pole anatomical factors had any significant
impact on the stone-free rate at 3 months. Renal morphology was the only factor
significantly affecting the stone-free rate since stone clearance was
significantly less in pyelonephritic kidneys (p = 0.0009). CONCLUSIONS:
Differences in the intrarenal anatomy of the lower pole have no significant
impact on stone clearance after shock wave lithotripsy. Further examination of
the lower pole renal anatomy with a search for other contributing factors is
still warranted.

PMID: 11342888 [PubMed - indexed for MEDLINE]

1391: J Endourol. 2001 Mar;15(2):181-6.

Role of stone analysis in metabolic evaluation and medical treatment of
nephrolithiasis.

Kourambas J, Aslan P, Teh CL, Mathias BJ, Preminger GM.

Duke Comprehensive Kidney Stone Center, Department of Surgery, Duke University
Medical Center, Durham, North Carolina 27710, USA.

BACKGROUND AND PURPOSE: Comprehensive metabolic evaluation has become an
important aspect of the management of recurrent nephrolithiasis, yet the role of 
stone analysis is often neglected or perhaps underestimated. The purpose of this 
study was to determine the role of stone analysis in medical decision making in
patients with recurrent nephrolithiasis. MATERIALS AND METHODS: We evaluated 100 
consecutive stone-forming patients who had undergone compositional stone analysis
as well as comprehensive metabolic evaluation at our institution. An analysis of 
stone composition in relation to metabolic disturbances was performed. Patients
were stratified into two groups: calcium and non-calcium stone formers. RESULTS: 
Patients having non-calcium stones were found to have a metabolic analysis
reflecting specific metabolic disorders. Alternatively, patients with calcium
stones were heterogeneous with regard to metabolic disorders, but there was a
significant likelihood of renal tubular acidosis in those patients with calcium
phosphate calculi. On the basis of these results, a simplified metabolic
evaluation and nonselective medical therapy based on stone composition was
formulated to facilitate assessment, management, and monitoring of stone disease.
CONCLUSIONS: Compositional stone analysis should be an integral part of the
metabolic evaluation of patients with nephrolithiasis. Moreover, stone analysis
alone may provide guidance for therapeutic treatment and obviate a formal
metabolic evaluation.

PMID: 11325090 [PubMed - indexed for MEDLINE]

1392: Aviat Space Environ Med. 2001 Apr;72(4):368-72.

Urine volume and its effects on renal stone risk in astronauts.

Whitson PA, Pietrzyk RA, Sams CF.

Collaborators: Whitson PA.

NASA-Johnson Space Center, Astronaut Office, Houston, TX 77058, USA.
peggy.a.whitson1@jsc.nasa.gov

BACKGROUND: Urine composition in astronauts during and immediately after
spaceflight changes in ways that increase the renal stone-forming potential for
calcium oxalate, calcium phosphate, and uric acid saturation. We examined the
effect of urine volume on the risk of renal stone formation in 356 astronauts.
METHODS: Renal stone-forming risk was evaluated from 24-h urine samples collected
from astronauts before and after 4- to 17-d Space Shuttle flights. Urinary
chemistries were performed and the relative supersaturations of calcium oxalate, 
brushite, sodium urate, struvite, and uric acid saturation were calculated from
the biochemical results. RESULTS: Urinary supersaturation levels of stone-forming
salts were inversely related to urinary output both before and after spaceflight.
Urine volume > 2 L x d(-1) reduced the risk of renal-stone development without
affecting urinary citrate concentrations as compared with the increased risk
observed in those astronauts who excreted urine volumes < L x d(-1). CONCLUSION: 
Results from this study indicate that increasing daily urinary output alone is an
effective countermeasure to reduce the renal stone-forming risk immediately after
spaceflight. However, increasing urinary output during flight may not be entirely
effective in minimizing the potential risk of renal stone formation due to the
changes in the urine chemistry in astronauts exposed to microgravity. Keywords:
urine volume, spaceflight, renal calculi.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 11318017 [PubMed - indexed for MEDLINE]

1393: Urol Int. 2001;66(3):127-30.

Predictive value of radiological criteria for disintegration rates of
extracorporeal shock wave lithotripsy.

Aeberli D, Müller S, Schmutz R, Schmid HP.

Department of Urology, University of Berne, Switzerland.

OBJECTIVE: To evaluate routinely applicable criteria to predict fragmentation of 
renal calculi by extracorporeal shock wave lithotripsy (ESWL). PATIENTS and
METHODS: Two hundred and two consecutive patients (121 men, 81 women), median age
48 (range 19-81) years, were treated with the original Dornier HM-3 lithotriptor 
at a single stone center. Inclusion criteria were: solitary stones, 10-30 mm in
greatest diameter, located in renal pelvis or calyces. Based on plain
radiographs, the calculi were classified according to their size, form, location,
density (compared to the 12th rib), structure and surface. Furthermore, age of
the patient, gender and body mass index were also considered for evaluation.
Disintegration was documented on day 1 after ESWL by plain X-ray. A multivariate 
regression analysis was applied to all preoperative parameters, based on the dual
variable stone free versus residual fragments. RESULTS: The overall
disintegration rate was 95.5%; 42 patients (20.8%) were completely stone free,
and 151 patients (74.7%) had clinically insignificant residual fragments (5 mm or
smaller). 14.9% of men and 29.6% of women were stone free (p = 0.01). All other
parameters did not reach statistical significance. CONCLUSIONS: The
disintegration rate of the HM-3 is excellent for kidney stones; women did
significantly better than men. However, because of this high disintegration rate,
a much larger series would be necessary to define possible differences between
preinterventional parameters, if there were any at all. Copyright 2001 S. Karger 
AG, Basel

PMID: 11316972 [PubMed - indexed for MEDLINE]

1394: Clin Nephrol. 2001 Mar;55(3):205-11.

An evaluation of the physicochemical risk for renal stone disease during
pregnancy.

Smith CL, Kristensen C, Davis M, Abraham PA.

Department of Internal Medicine, Hennepin County Medical Center, Minneapolis,
Minnesota 55415, USA. smith156@tc.umn.edu

Seventeen subjects were studied during the third trimester of pregnancy (PG) and 
post partum (NPG) to evaluate the effect of pregnancy on the physicochemical risk
of renal stone disease. Levels of urinary saturation for calcium oxalate (CaOx), 
brushite (Br), uric acid (UA), and monosodium urate (NaU) were determined as well
as urinary excretions of stone-forming elements. In addition to urinary calcium
excretion, assessment of calcium metabolism included serum calcium and
parathyroid hormone. Urinary calcium excretion was 251 +/- 127 mg/day during
pregnancy and 121 +/- 67 mg/day post partum (p < 0.001). This was associated with
a higher intake of dietary calcium and altered renal handling of calcium with an 
increase in the filtered load and a decrease in renal tubular reabsorption. The
increase in urinary calcium resulted in a higher level of saturation of the urine
for calcium oxalate (NPG 2.1 +/- 1.0 vs PG 3.0 +/- 1.1, p < 0.02) and brushite
(NPG 1.2 +/- 0.9 vs PG 1.9 +/- 1.1, p < 0.05) compatible with an increased risk
of stone formation.

PMID: 11316240 [PubMed - indexed for MEDLINE]

1395: Am Fam Physician. 2001 Apr 1;63(7):1329-38.

Diagnosis and initial management of kidney stones.

Portis AJ, Sundaram CP.

Washington University School of Medicine, St Louis, Missouri 63110, USA.

The diagnosis and initial management of urolithiasis have undergone considerable 
evolution in recent years. The application of noncontrast helical computed
tomography (CT) in patients with suspected renal colic is one major advance. The 
superior sensitivity and specificity of helical CT allow urolithiasis to be
diagnosed or excluded definitively and expeditiously without the potential
harmful effects of contrast media. Initial management is based on three key
concepts: (1) the recognition of urgent and emergency requirements for urologic
consultation, (2) the provision of effective pain control using a combination of 
narcotics and nonsteroidal anti-inflammatory drugs in appropriate patients and
(3) an understanding of the impact of stone location and size on natural history 
and definitive urologic management. These concepts are discussed with reference
to contemporary literature, with the goal of providing tools that family
physicians can use in the emergency department or clinic.

Publication Types: 
    Review

PMID: 11310648 [PubMed - indexed for MEDLINE]

1396: Urol Res. 2001 Feb;29(1):45-9.

The relation of urinary Tamm-Horsfall-protein on CaOx-crystallization under the
scope of the Bonn-Risk-Index.

Laube N, Glatz S, Hesse A.

Division of Experimental Urology, Department of Urology, Bonn University,
Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. laube@mailer.meb.uni-bonn.de

In previous papers we introduced the Bonn-Risk Index (BRI) as a new method of
evaluating an individual's actual risk of forming calcium oxalate (CaOx). A
comparison of our results with the calculated urinary relative supersaturations
(RS) with respect to CaOx, showed that samples with similar values of RS can have
different values of BRI. We suggested that this may reflect the individual
influence of the urinary macromolecular constituents which are not taken into
account at the calculation of RS. To estimate the role of macromolecules on the
value of BRI, we examined 45 unprepared 24-h urine samples from 24 persons (16
healthy subjects, eight CaOx stone-formers) with respect to BRI, RS, and the
concentration of urinary Tamm-Horsfall-protein ([THP]). The crystallization
experiments were carried out by the use of a laser-probe. Based on the data of
BRI and RS, the effect of THP may shift from a minor promoter in stone-formers
and persons "at risk", to an inert urinary constituent in healthy subjects and
persons "without risk". However, the observed effects are small and at least in
the latter group close to zero.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11310215 [PubMed - indexed for MEDLINE]

1397: Am J Hum Genet. 2001 May;68(5):1119-29. Epub 2001 Apr 17.

Identification of a new candidate locus for uric acid nephrolithiasis.

Ombra MN, Forabosco P, Casula S, Angius A, Maestrale G, Petretto E, Casu G,
Colussi G, Usai E, Melis P, Pirastu M.

Istituto di Genetica Molecolare, CNR, 07040 Santa Maria La Palma (SS), Italy.
ombra@igm.ss.cnr.it

Renal stone formation is a common multifactorial disorder, of unknown etiology,
with an established genetic contribution. Lifetime risk for nephrolithiasis is
approximately 10% in Western populations, and uric acid stones account for 5%-10%
of all stones, depending on climatic, dietary, and ethnic differences. We studied
a small, isolated founder population in Sardinia, characterized by an increased
prevalence of uric acid stones, and performed a genomewide search in a
deep-rooted pedigree comprising many members who formed uric acid renal stones.
The pedigree was created by tracing common ancestors of affected individuals
through a genealogical database based on archival records kept by the parish
church since 1640. This genealogical information was used as the basis for the
study strategy, involving screening for alleles shared among affected
individuals, originating from common ancestors, and utilization of large
pedigrees to obtain greater power for linkage detection. We performed multistep
linkage and allele-sharing analyses. In the initial stage, 382 markers were typed
in 14 closely related affected subjects; interesting regions were subsequently
investigated in the whole sample. We identified two chromosomal regions that may 
harbor loci with susceptibility genes for uric acid stones. The strongest
evidence was observed on 10q21-q22, where a LOD score of 3.07 was obtained for
D10S1652 under an affected-only dominant model, and a LOD score of 3.90 was
obtained using a dominant pseudomarker assignment. The localization was supported
also by multipoint allele-sharing statistics and by haplotype analysis of
familial cases and of unrelated affected subjects collected from the isolate. In 
the second region on 20q13.1-13.3, multipoint nonparametric scores yielded
suggestive evidence in a approximately 20-cM region, and further analysis is
needed to confirm and fine-map this putative locus. Replication studies are
required to investigate the involvement of these regions in the genetic
contribution to uric acid stone formation.

PMID: 11309680 [PubMed - indexed for MEDLINE]

1398: Urology. 2001 Apr;57(4):639-43.

Routine placement of ureteral stents is unnecessary after ureteroscopy for
urinary calculi.

Hollenbeck BK, Schuster TG, Faerber GJ, Wolf JS Jr.

Section of Urology, Department of Surgery, University of Michigan, Ann Arbor,
Michigan 48109-0330, USA.

OBJECTIVES: To report a matched comparison of patients with and without stenting 
after ureteroscopy for calculi, including middle or proximal ureteral and renal
calculi. The elimination of routine stenting after ureteroscopy would prevent
stent pain, minimize the need for re-instrumentation, and reduce costs-as long as
efficacy and safety are not diminished. METHODS: Of 318 patients who underwent
ureteroscopy, 81 (25%) did not have a ureteral stent placed. Of those, 51 were
suitable for analysis and included patients with distal ureteral (n = 22), middle
or proximal ureteral (n = 11), and renal calculi (n = 18). This cohort was
matched to a stented group by stone size and location. RESULTS: The preoperative 
characteristics of the groups were similar. A stone-free rate of 86% and 94% was 
achieved in the stented and nonstented groups, respectively (P = 0.32).
Complications in the nonstented group were less frequent (flank pain in 3 and
postoperative nausea in 1) than in the stented group (hospital visits for flank
pain in 12, persistent nausea and vomiting in 1, sepsis in 1, perinephric
hematoma in 1, and urinary retention in 1) (total of 4 versus 16, P = 0.025).
CONCLUSIONS: Ureteroscopy for distal ureteral stones without ureteral stent
placement has been previously described. Our experience expands to include the
elimination of stent placement after ureteroscopy for middle or proximal ureteral
(22%) and renal (35%) calculi. Our data suggest that after ureteroscopies with
short operative times and minimal ureteral trauma, ureteral stents may not be
necessary, even if proximal ureteral or renal ureteroscopy has been performed.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 11306367 [PubMed - indexed for MEDLINE]

1399: Eur J Neurol. 2001 Mar;8(2):195-6.

Calculi and memory.

Kettaneh A, Gobron C, Fain O, Mohib S, Thomas M.

We describe a case of transient global amnesia related to symptomatic renal
stones. Transient global amnesia has been related to intense emotional or painful
experiences, such as sexual intercourse, cold water bathing and trigeminal
stimulation. Renal stones may be at the origin of a painful experience and thus
may induce transient global amnesia.

Publication Types: 
    Case Reports
    Letter

PMID: 11285000 [PubMed - indexed for MEDLINE]

1400: J Clin Pathol. 2001 Jan;54(1):54-62.

Why oral calcium supplements may reduce renal stone disease: report of a clinical
pilot study.

Williams CP, Child DF, Hudson PR, Davies GK, Davies MG, John R, Anandaram PS, De 
Bolla AR.

Department of Medical Biochemistry, Wrexham Maelor Hospital NHS Trust, Wrexham
LL13 7TD, UK. clive.williams@new-tr.wales.nhs.uk

AIMS: To investigate whether increasing the daily baseline of gut calcium can
cause a gradual downregulation of the active intestinal transport of calcium via 
reduced parathyroid hormone (PTH) mediated activation of vitamin D, and to
discuss why such a mechanism might prevent calcium oxalate rich stones. To
demonstrate the importance of seasonal effects upon the evaluation of such data. 
METHODS: Within an intensive 24 hour urine collection regimen, daily calcium
supplementation (500 mg) was given to five stone formers for a 10 week period
during a six month crossover study. In a further population of patients on follow
up for previous renal stone disease, observations were made on 1066 24 hour urine
samples collected over five years in respect of seasonal effects relevant to the 
interpretation of the study. RESULTS: In the group of patients on calcium
supplements the following results were found. During calcium supplementation, the
proportion of urine calcium to oxalate was higher (increased calcium to oxalate
molar ratio), the 24 hour urine product of calcium and oxalate did not rise, and 
urine oxalate was lower during the first six weeks of supplementation. Twenty
four hour urine calcium was 10.2% higher than baseline in the final four weeks of
the 10 weeks of supplementation. Twenty four hour urine phosphate was 11.4% lower
during the first six weeks of supplementation, but then rose while the patients
were still on supplementation; renal tubular reabsorption of phosphate (TmP/GFR) 
mirrored the urine phosphate changes inversely. PTH was higher after stopping
supplementation, but 1,25-(OH)2-cholecalciferol changes were not detected. In the
1066 urine samples collected over five years the following results were found.
Calcium and oxalate excretion correlated positively and not inversely. Urine
calcium and phosphate excretion were 5.5% and 2.5% higher, respectively, in
"light" months of the year compared with "dark" months. A post summer decline in 
both urine calcium and urine phosphate was relevant to the interpretation of the 
study. CONCLUSIONS: Regular calcium supplementation does not raise the product of
calcium and oxalate in urine and the proportion of oxalate to calcium is reduced.
The underlying mechanisms of the changes seen in phosphate, calcium, and PTH and 
the observations on 1,25-(OH)2-cholecalciferol are not clear. Observed changes in
phosphate could possibly be part of a calcium regulating feedback loop operating 
over a period of weeks. In evaluating these mechanisms background seasonal
effects are important. It is possible that "programming" of the gut mucosa in
terms of calcium transport is a major determinant of the relation between calcium
and oxalate concentrations in urine and their relative abundance. Increased oral 
calcium, in association with a reduction of the relative proportion absorbed, may
be pertinent to the prevention of calcium oxalate rich stones.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 11271790 [PubMed - indexed for MEDLINE]

1401: J Am Diet Assoc. 2001 Mar;101(3):326-31.

Diets with either beef or plant proteins reduce risk of calcium oxalate
precipitation in patients with a history of calcium kidney stones.

Massey LK, Kynast-Gales SA.

Food Science and Human Nutrition, Washington State University, Spokane
99201-3899, USA. massey@wsu.edu

OBJECTIVE: To determine the effect of substituting equal amounts of dietary
protein as animal protein (beef) for plant protein (legumes, seeds, nuts, and
grains) on urinary components associated with calcium oxalate precipitability
risk. DESIGN: Randomized crossover trial. SUBJECTS: Twenty-three normocalciuric
patients with a history of calcium kidney stones (8 women and 15 men, mean age
50.7+/-14.6 years) with 24-hour urinary calcium < or =10.3 micromol, 24 hour
urinary oxalate excretion between 228 and 963 micromol, and a urinary calcium
increase of < or =1.0 micromol in 4 hours after a 25 micromol oral calcium load. 
SETTING: Four-day, free-living adaptation period, followed by 2-day metabolic
unit study. INTERVENTION: The study compared consumption of 2 servings of beef
(43 g protein for women and 50 g for men) daily with an equal amount of protein
from plant foods including legumes, nuts, and grains. MAIN OUTCOME MEASURES:
Tiselius risk index (TRI) for calcium oxalate precipitability calculated from
urinary calcium, oxalate, magnesium, citrate, and volume. STATISTICAL ANALYSES:
Paired t tests. RESULTS: Urinary calcium, oxalate, magnesium, citrate,
phosphorus, volume, and TRI did not differ between diets. Urinary sodium and
potassium were higher for patients on the plant protein diet. After correcting
for variations in urinary sodium and potassium between diets, the difference in
urinary calcium remained insignificant. TRI was lower on both beef- and
plant-protein diets compared with self-selected prestudy diets for all
participants. CONCLUSION/APPLICATIONS: Balanced diets containing moderate amounts
of either beef or plant protein are equally effective in reducing calcium oxalate
kidney stone risk based on changes in urinary composition.

Publication Types: 
    Clinical Trial
    Comparative Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11269613 [PubMed - indexed for MEDLINE]

1402: AJR Am J Roentgenol. 2001 Apr;176(4):965-8.

Differences of renal parenchymal attenuation for acutely obstructed and
unobstructed kidneys on unenhanced helical CT: a useful secondary sign?

Georgiades CS, Moore CJ, Smith DP.

Department of Radiology, Johns Hopkins University School of Medicine, Johns
Hopkins Hospital, Baltimore, MD 21287, USA.

OBJECTIVE: The purpose of this study was to ascertain whether the difference in
attenuation frequently noted on unenhanced helical CT scans between a patient's
acutely obstructed kidney and the unobstructed kidney is a reliable secondary
sign of acute renal obstruction. CONCLUSION: In 95% of patients with acute renal 
obstruction, the affected kidney was less dense than the unobstructed kidney.
When visually detected by radiologists using CT, this difference in density was
at least two standard deviations above normal, making it a reliable secondary
sign for acute obstruction.

PMID: 11264090 [PubMed - indexed for MEDLINE]

1403: Braz J Med Biol Res. 2001 Mar;34(3):315-23.

ClC-5 chloride channel and kidney stones: what is the link?

Silva IV, Morales MM, Lopes AG.

Laboratório de Fisiologia Renal, Instituto de Biofísica Carlos Chagas Filho,
Universidade Federal do Rio de Janeiro, RJ, Brasil.

Nephrolithiasis is one of the most common diseases in the Western world. The
disease manifests itself with intensive pain, sporadic infections, and,
sometimes, renal failure. The symptoms are due to the appearance of urinary
stones (calculi) which are formed mainly by calcium salts. These calcium salts
precipitate in the renal papillae and/or within the collecting ducts. Inherited
forms of nephrolithiasis related to chromosome X (X-linked hypercalciuric
nephrolithiasis or XLN) have been recently described. Hypercalciuria,
nephrocalcinosis, and male predominance are the major characteristics of these
diseases. The gene responsible for the XLN forms of kidney stones was cloned and 
characterized as a chloride channel called ClC-5. The ClC-5 chloride channel
belongs to a superfamily of voltage-gated chloride channels, whose physiological 
roles are not completely understood. The objective of the present review is to
identify recent advances in the molecular pathology of nephrolithiasis, with
emphasis on XLN. We also try to establish a link between a chloride channel like 
ClC-5, hypercalciuria, failure in urine acidification and protein endocytosis,
which could explain the symptoms exhibited by XLN patients.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11262581 [PubMed - indexed for MEDLINE]

1404: Pediatr Nephrol. 2001 Feb;16(2):110-2.

A new approach to mRNA in proximal tubule cells of patients with CLCN5
channelopathy.

Morimoto T, Chiba A, Kondo Y, Takahashi S, Igarashi T, Inoue CN, Iinuma K.

Department of Pediatrics, Tohoku University, School of Medicine, Sendai, Japan.

ClC-5 is a chloride channel whose gene mutations have been reported to be
associated with X-linked nephrolithiasis (XRN), X-linked recessive
hypophosphatemic rickets (XLRH), Dent disease, and idiopathic
low-molecular-weight proteinuria (ILMWP) in Japanese children. To establish more 
efficient screening for CLCN5 abnormalities, we developed a new diagnostic method
using reverse transcription and polymerase chain reaction (RT-PCR) of cultured
renal tubular cells from the urine of patients. Using this new method, we
successfully detected microdeletion of ClC-5 mRNA in a patient and splicing
abnormality of the CLCN5 Cl channel.

PMID: 11261675 [PubMed - indexed for MEDLINE]

1405: Kidney Int. 2001 Apr;59(4):1415-23.

Effect of acidosis on urine supersaturation and stone formation in genetic
hypercalciuric stone-forming rats.

Bushinsky DA, Grynpas MD, Asplin JR.

Nephrology Unit, University of Rochester School of Medicine, Rochester, New York 
14642, USA. david_bushinsky@urmc.rochester.edu

BACKGROUND: We have successively inbred over 45 generations a strain of rats to
maximize urine calcium excretion. The rats now consistently excrete 8 to 10 times
as much calcium as controls and uniformly form poorly crystalline calcium
phosphate kidney stones. In humans with calcium nephrolithiasis, consumption of a
diet high in acid precursors is often cited as a risk factor for the development 
of calcium-based kidney stones; however, the effect of this diet on urinary
supersaturation with respect to the common solid phases found in kidney stones
has not been determined. METHODS: To determine the effect of the addition of an
acid precursor on urine ion excretion, supersaturation, and stone formation, we
fed these genetic hypercalciuric stone-forming (GHS) rats 13 g/day of a 1.2%
calcium diet with 0.0, 0.5, 1.0, or 1.5% NH4Cl in the drinking water for 14 weeks
(N = 8 for each). Urine was collected and analyzed every two weeks. RESULTS: As
expected, the addition of dietary NH4Cl led to a progressive fall in urine pH and
urine citrate, while urine ammonium increased. Urine calcium and phosphorus
increased, while urine oxalate fell. Increasing dietary NH4Cl led to a fall in
supersaturation with respect to CaHPO4 (brushite) and CaOx and a rise in
supersaturation with respect to uric acid. In spite of differences in
supersaturation, most rats in each group formed stones that contained calcium
phosphate and not calcium oxalate. CONCLUSIONS: Thus, while the provision of
additional dietary acids alters urinary ion excretion and lowers supersaturation 
with respect to CaHPO4 and CaOx, it does not change the character or rate of
stone formation in the GHS rats.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11260403 [PubMed - indexed for MEDLINE]

1406: J Urol. 2001 Apr;165(4):1268-73.

Early stage of urolithiasis formation in experimental hyperparathyroidism.

Yamaguchi S, Yachiku S, Okuyama M, Tokumitsu M, Kaneko S, Tsurukawa H.

Department of Urology, Asahikawa Medical College, Midorigaoka Higashi, Asahikawa,
Japan.

PURPOSE: We have previously noted marked acceleration in the proliferative
activity of parathyroid cells in rats with spontaneous hypercholesterolemia and
secondary hyperparathyroidism. Using this proliferative potential we investigated
whether transplantation of these enlarged parathyroids into normal rats would
induce hyperparathyroidism and renal stones. MATERIALS AND METHODS: We used
26-week-old male rats with spontaneous hypercholesterolemia as donors, and
5-week-old normal male Sprague-Dawley rats and rats with spontaneous
hypercholesterolemia as recipients. Enlarged parathyroid glands were transplanted
into group 1--Sprague-Dawley rats with no treatment, group 2--Sprague-Dawley rats
that received FK-506 as an immuno-suppressor, group 3--rats with spontaneous
hypercholesterolemia rats that underwent parathyroidectomy plus FK-506
administration and group 4--Sprague-Dawley rats that underwent parathyroidectomy 
plus FK-506 administration. Parathyroidectomy was performed in recipients before 
transplantation to ensure a low calcium condition. RESULTS: Grafts were rejected 
within 11 and 15 weeks in groups 1 and 2, respectively. In group 3, 78% of the
grafts were successful even after 19 weeks. In group 4 graft survival was 30% at 
15 weeks with complete rejection at 19 weeks. In group 3 gradually elevated serum
parathyroid hormone was observed as well as stone plaques containing calcium
oxalate and calcium phosphate in renal tubules located mainly in the
corticomedullary junction. An increased number of plaques was associated with
higher parathyroid hormone. CONCLUSIONS: Our study shows that transplanted
parathyroid glands function with an immunosuppressive agent and the maintenance
of hypocalcemic conditions, and they secrete sufficient parathyroid hormone to
demonstrate hyperparathyroidism. Plaque in these kidneys indicates an early stage
of urolithiasis caused by hyperparathyroidism.

PMID: 11257699 [PubMed - indexed for MEDLINE]

1407: BJU Int. 2001 Mar;87(4):307-11.

The influence of a high-oxalate/low-calcium diet on calcium oxalate renal stone
risk factors in non-stone-forming black and white South African subjects.

Lewandowski S, Rodgers A, Schloss I.

Department of Chemistry, and Nutrition and Dietetics Unit, University of Cape
Town, Cape Town, South Africa.

OBJECTIVE: To evaluate the influence of a high-oxalate/low-calcium diet on
calcium oxalate stone risk factors in both black South Africans (who are largely 
immune to kidney stones) and white South Africans (in whom stones are more
common). SUBJECTS AND METHODS: Urinary and dietary variables were examined in 11 
black and 11 white South African men. None of the subjects had had a kidney stone
or any metabolic illness. Their normal domestic food intake was assessed using a 
semiquantitative food frequency questionnaire. Subjects were given a standardized
high-oxalate/low-calcium diet for 3 days; 24-h urine samples were collected
before the protocol and during the final day. The samples were analysed using
routine modern laboratory techniques. The urine analysis data were used to
calculate the Tiselius risk index and the relative urinary supersaturations of
calcium oxalate, uric acid and calcium phosphate. RESULTS: Urine analysis showed 
an intriguing anomaly; black subjects had significantly higher urinary pH and
oxalate values than whites (6.50 vs 6.21 and 0.23 vs 0.14 mmol/24 h,
respectively), while their urinary citrate was lower (1.47 vs 3.69 mmol/24 h). In
addition, the Tiselius risk index and relative supersaturation of calcium oxalate
were higher in black subjects. These results are contrary to those which might
have been reasonably expected when comparing stone-free and stone-prone groups.
After the dietary protocol, the only urinary variable which changed significantly
was urinary oxalate, which increased by 57% in whites. CONCLUSION: Factors which 
are conventionally used to assess stone risk (pH, oxaluria, citraturia, relative 
supersaturation) are not helpful in identifying why South African blacks are
relatively immune to stones. We suggest that relatively lower oxalate absorption 
rates may be a physiological feature of this racial group.

PMID: 11251520 [PubMed - indexed for MEDLINE]

1408: Expert Opin Pharmacother. 2000 Mar;1(3):443-9.

Non-steroidal anti-androgens in prostate cancer--current treatment practice.

Han M, Nelson JB.

James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins
Medical Institutions, Baltimore, Maryland, USA. misop@jhmi.edu

Adenocarcinoma of the prostate is a common disease that causes significant
morbidity and mortality in the adult male population. Hormonal therapy for
prostate cancer is considered when a patient fails with initial curative therapy,
such as radical prostatectomy or definitive radiation therapy, or if he is found 
with an advanced disease. Many hormonal agents have been developed to exploit the
fact that prostate cancer growth is dependent on androgen. Non-steroidal
anti-androgens (NSAAs) block androgen at the cellular level. Numerous clinical
trials comparing monotherapy of castration and combination therapy of castration 
and NSAAs have been performed. At present, the results of the trials with regard 
to the survival of patients under therapy are conflicting. When the disease
recurs in a patient in the middle of combination androgen blockade therapy,
androgen withdrawal should be considered. The benefits of NSAA in monotherapy,
intermittent or neoadjuvant therapy are not clear at present. Better designed,
larger cohort clinical trial may be necessary to clarify the confusion.

Publication Types: 
    Review

PMID: 11249529 [PubMed - indexed for MEDLINE]

1409: Expert Opin Pharmacother. 2000 Mar;1(3):435-41.

Pharmacology for renal calculi.

Blair B, Fabrizio M.

Portsmouth Naval Hospital, Portsmouth, Virginia, USA.

Stone disease is as old as recorded history but despite advances in diagnosis and
treatment, it continues to cause significant morbidity. This review summarises
the current pharmacologic management of urinary calculi based upon the stone
type. All patients with stone disease are advised to increase fluid intake, limit
dietary protein and limit sodium. Calcium oxalate stones can be managed on a
selective or non-selective basis depending on the cause of the hypercalciuria or 
hyperoxaluria. Agents currently in use include sodium cellulose phosphate,
thiazides, orthophosphates, oral calcium supplements, pyridoxine, cholestyramine,
citrate, magnesium and allopurinol. Classically, struvite stones occur in the
presence of urea splitting organisms and are composed of magnesium, ammonium
phosphate and carbonate apatite. The goal of treatment is to make patients stone 
free as bacteria retained in stone fragments lead to stone growth. Urease
inhibitors, aluminium hydroxide gel, hemiacidrin, and Suby G and M solutions are 
infrequently used in treatment. Cystine stones are the result of an autosomal
recessive disorder. D-Penicillamine, captopril and alpha-mercaptopropionylglycine
(MPG) are all oral agents that have proven to be efficacious. As more randomised 
trials are conducted and the understanding of endogenous stone inhibitors
progresses, the medical management of stone disease will continue to improve.

Publication Types: 
    Review

PMID: 11249528 [PubMed - indexed for MEDLINE]

1410: Urology. 2001 Mar;57(3):542-5; discussion 545-6.

Ureteropelvic junction obstruction and coexisting renal calculi in children: role
of metabolic abnormalities.

Tekin A, Tekgul S, Atsu N, Ergen A, Kendi S.

Department of Urology, Hacettepe University, Ankara, Turkey

OBJECTIVES: To identify the role of metabolic risk factors in the development of 
renal calculi associated with ureteropelvic junction obstruction (UPJO) in
children. METHODS: A metabolic evaluation, including serum biochemistry and
measurement of daily urinary calcium, creatinine, oxalate, citrate, magnesium,
urate, and inorganic phosphorus, was carried out in three different populations
as follows: UPJO group, 12 children with UPJO and coexisting nephrolithiasis
(median age 6 years); calcium stone formation (CSF) group, 90 children with
normal urologic anatomy and calcium urolithiasis (median age 7 years); control
group, 24 healthy children (median age 7.3 years). The investigation data of the 
three groups were compared. RESULTS: The stone composition was calcium oxalate in
9 of the 12 children with UPJO. The investigation data of the UPJO group and CSF 
group were not significantly different. Both groups differed from the control
group in a similar manner. The UPJO and CSF groups excreted more oxalate (P =
0.067 and 0.014, respectively) and less citrate (P = 0.020 and 0.010,
respectively) than did the control subjects. CONCLUSIONS: Abnormal urinary
biochemistry seems to have an additional role in the high incidence of
nephrolithiasis in children with upper tract anatomic anomalies, and the urinary 
biochemistry should be screened in such children.

PMID: 11248635 [PubMed - indexed for MEDLINE]

1411: Nephron. 2001 Feb;87(2):170-6.

Effects of allopurinol on renal stone formation and osteopontin expression in a
rat urolithiasis model.

Yasui T, Sato M, Fujita K, Ito Y, Nomura S, Kohri K.

Department of Urology, Nagoya City University Medical School, Nagoya, Japan.
yasui@med.nagoya-cu.ac.jp

BACKGROUND: The inhibitory effect of allopurinol on calcium oxalate urolithiasis 
has been reported, but its effect on stone matrix proteins has not been studied
in vivo. To clarify the effect of allopurinol on the matrix, we investigated its 
effect on the expression of osteopontin (OPN), which we previously identified as 
an important stone matrix protein. METHODS: Control rats were not treated. Rats
of the stone group were given ethylene glycol (EG) and vitamin D(3), while the
allopurinol groups (low-dose group and high-dose group) were treated with
allopurinol in addition to receiving EG and vitamin D(3). RESULTS: The rate of
renal stone formation was lower in the allopurinol groups than in the stone
group. This was associated with a low expression of OPN mRNA in
allopurinol-treated rats relative to that in the stone group. CONCLUSION:
Allopurinol was effective in preventing calcium oxalate stone formation and
reduced OPN expression in rats. Our results suggest that allopurinol prevents
renal stone formation by acting against not only the control of oxalate but also 
OPN expression. Copyright 2001 S. Karger AG, Basel.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11244313 [PubMed - indexed for MEDLINE]

1412: Dig Surg. 2001;18(1):73-4.

Dehiscence of gastrojejunal stapled anastomosis after lithotripsy for
nephrolithiasis.

Fernández-Lobato R, Cerquella C, Serantes A, Martínez-Santos C, Díaz-Giménez LM, 
Moreno-Azcoita M.

Service of General and Digestive Surgery, Hospital de Getafe, Madrid, Spain.

We report the case of a 76-year-old woman with previous bariatric surgery and a
large renal calculus following a prolonged lithotripsy session. The patient
presented with peritonitis due to dehiscence of the gastrojejunal stapled
anastomosis.

Publication Types: 
    Case Reports

PMID: 11244264 [PubMed - indexed for MEDLINE]

1413: J Pak Med Assoc. 2000 May;50(5):145-8.

Chemical composition of upper renal tract calculi in Multan.

Rafique M, Bhutta RA, Rauf A, Chaudhry IA.

Department of Urology, Pathology, Nishtar Medical College, Multan.

OBJECTIVE: To study the chemical composition of upper renal tract (renal and
ureteric) calculi in Multan. SETTING: Department of Urology, Nishtar Hospital,
Multan. STUDY PERIOD: September 1992 to February 1999. MATERIAL AND METHODS: A
total of 700 renal and ureteric calculi were analyzed by chemical method of
Hodgkinson. RESULTS: The commonest were uric acid (28.1%) calculi, followed in
frequency by calcium oxalate calculi (26.1%), mixed calculi containing calcium
oxalate and uric acid (21.8%) and calculi containing calcium oxalate and calcium 
phosphate (10.4%). Other variety of calculi were less common. CONCLUSION: Uric
acid, calcium oxalate and mixed uric acid and calcium oxalate calculi are the
main types in Multan region (JPMA 50:145, 2000).

PMID: 11242712 [PubMed - indexed for MEDLINE]

1414: Ann Acad Med Singapore. 2001 Jan;30(1):66-70.

A case report of primary hyperparathyroidism with severe bony involvement and
nephrolithiasis.

Chan SP, Hew FL, Jayaram G, Kumar G, Chang KW, Tay A.

Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala
Lumpur, Malaysia.

INTRODUCTION: Although the majority of patients with primary hyperparathyroidism 
have a relatively asymptomatic benign disorder, there are patients who have a
more aggressive disorder. CLINICAL PICTURE: We report a case of primary
hyperparathyroidism presenting during pregnancy complicated by antepartum
haemorrhage and severe prematurity. The diagnosis was made postpartum, when her
problems rapidly progressed to result in severe neuromuscular weakness, bilateral
pathological hip fractures as well as nephrolithiasis. TREATMENT: Surgical
parathyroidectomy was performed. The underlying lesion was a large solitary
parathyroid adenoma with cystic elements. CONCLUSION: Primary hyperparathyroidism
is not an innocuous disease and can result in severe morbidity if left untreated.

Publication Types: 
    Case Reports

PMID: 11242630 [PubMed - indexed for MEDLINE]

1415: J Pediatr. 2001 Mar;138(3):378-82.

Decreased urinary citrate excretion in type 1a glycogen storage disease.

Weinstein DA, Somers MJ, Wolfsdorf JI.

Division of Endocrinology, Children's Hospital and Harvard Medical School,
Boston, Massachusetts 02115, USA.

OBJECTIVES: To quantify urinary citrate and calcium excretion and systemic
acid-base status in patients with type 1a glycogen storage disease (GSD1a) and to
investigate their relationship to renal complications. STUDY DESIGN: Fifteen
patients (7 male and 8 female; age range, 3--28 years) were studied during annual
evaluations of metabolic control. All were treated with intermittent doses of
uncooked cornstarch. Hourly blood sampling and a 24-hour urine collection were
obtained while subjects followed their usual home dietary regimen. RESULTS: All
but the youngest subject had low levels of citrate excretion (mean 2.4 +/- 1.8
mg/kg/d; 129 +/- 21 mg citrate/g creatinine). Normally, urinary citrate excretion
increases with age; however, in patients with GSD1a, a strong inverse exponential
relationship was found between age and citrate excretion (r = -0.84, P <.0001).
Urinary citrate excretion was unrelated to markers of metabolic control.
Hypercalciuria occurred in 9 of 15 patients (mean urinary calcium/creatinine
ratio, 0.27 +/- 0.15) and was also inversely correlated with age (r = -0.62, P
=.001). CONCLUSIONS: Hypocitraturia that worsens with age occurs in metabolically
compensated patients with GSD1a. The combination of low citrate excretion and
hypercalciuria appears to be important in the pathogenesis of nephrocalcinosis
and nephrolithiasis. Citrate supplementation may be beneficial in preventing or
ameliorating nephrocalcinosis and the development of urinary calculi in GSD1a.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11241046 [PubMed - indexed for MEDLINE]

1416: Curr Opin Nephrol Hypertens. 2001 Mar;10(2):203-9.

Prevention of nephrolithiasis.

Pearle MS.

Department of Urology, The University of Texas Southwestern Medical Center,
Dallas, Texas 75390-9110, USA. margaret.pearle@email.SWMED.edu

The high incidence of recurrence after an initial stone event underscores the
need for an effective medical prophylactic program. Dietary modification and drug
therapies have long been advocated to reduce the likelihood of stone recurrence. 
While the efficacy of a high fluid intake has been validated in a randomized
trial, the benefit of other dietary measures is based on modulation of urinary
stone risk factors and outcomes derived from observational studies. Several drug 
therapies have been evaluated in a limited number of prospective, randomized
trials and efficacy has been demonstrated for thiazides, allopurinol and alkali
citrate in some populations of recurrent stone formers. The role of selective
versus nonselective therapy for stone prevention awaits further study.

Publication Types: 
    Review

PMID: 11224695 [PubMed - indexed for MEDLINE]

1417: Eur Urol. 2001 Jan;39 Suppl 2:33-6; discussion 36-7.

Effect of potential renal acid load of foods on calcium metabolism of renal
calcium stone formers.

Trinchieri A, Zanetti G, Currò A, Lizzano R.

Department of Urology, IRCCS Ospedale Maggiore, Milan, Italy.
uropoli@mailserver.unimi.it

OBJECTIVES: Diet has been proposed as a causative factor of hypercalciuria in
patients with calcium stones. The aim of this study was to investigate the
influence of diet on calcium metabolism of renal stone formers. METHODS:
Thirty-five renal calcium stone formers were entered in this study. A 2-day
recall of dietary intake was obtained from each subject. The food records were
coded and computer analyzed for total energy, protein, fat, carbohydrate, sodium,
potassium, calcium, magnesium, phosphate, oxalate, vitamin C and fiber. Daily
potential renal acid load (PRAL) of the diet was calculated considering the
mineral and protein composition of foods, the mean intestinal absorption rate for
each nutrient and the metabolism of sulfur-containing amino acids. A fasting
blood sample was drawn and a 24-hour urine collection were obtained for analyses 
of calcium, phosphate and creatinine. Serum osteocalcin was also analyzed. A
fasting 2-hour urine sample was collected in the morning for hydroxyproline,
pyridinium cross-links and creatinine. RESULTS: The mean daily dietary PRAL of
renal stone formers was 22.4 +/- 15.7 (range 4.2-65.8) mEq/day. Regression
analysis demonstrated that urinary calcium excretion is dependent on daily
protein intake and dietary PRAL, whereas the urinary pyridinium
cross-links/creatinine ratio is inversely dependent on daily calcium intake. The 
urinary pyridinium cross-links/creatinine ratio was significantly lower in
patients on a low calcium diet (< 600 mg/day) than in other patients (19.5 +/-
7.8 vs. 27.3 +/- 7.5 nM/mM, p = 0.008). No significant difference was observed
between the 2 groups for daily urinary calcium (254 +/- 109 vs. 258 +/- 140
mg/day), serum osteocalcin (8.2 +/- 3.3 vs. 6.2 +/- 2.4 ng/ml) and urinary
hydroxyproline/creatinine (14.1 +/- 7.4 vs. 10.3 +/- 4 mg/g). CONCLUSIONS: The
urinary calcium excretion of renal stone formers seems to be dependent on dietary
acid load rather than dietary calcium intake. In patients consuming an acidifying
diet a restriction of calcium intake could increase bone resorption leading to a 
progressive bone loss.

PMID: 11223695 [PubMed - indexed for MEDLINE]

1418: Eur Urol. 2001 Feb;39(2):187-99.

Treatment of renal stones by extracorporeal shockwave lithotripsy: an update.

Rassweiler JJ, Renner C, Chaussy C, Thüroff S.

Department of Urology, Klinikum Heilbronn GmbH, University of Heidelberg,
Germany.

AIM: Despite the extensive experience with minimal invasive stone therapy, there 
are still different views on the ideal management of renal stones. MATERIALS AND 
METHODS: Analysis of the literature includes more than 14,000 patients. We have
compared these data with long-term results of two major stone centers in Germany.
The results have been compared concerning the anatomical kidney situation, stone 
size, stone localization and observation time. RESULTS: According to the
importance of residual fragments following extracorporeal shock wave lithotripsy 
(ESWL), we have to distinguish between clinically insignificant residual
fragments and clinically significant residual fragments (CIRF). 24 months
following ESWL stone passage occurs as a continuous process, and if there are no 
clinical symptoms, any endoscopic procedure should be considered as
overtreatment. According to these results, stone-free rates of patients increase 
in longer follow-up periods. Newer ESWL technology has increased the percentage
of CIRF. CONCLUSION: We consider ESWL in most patients with renal calculi as
first-line treatment, except in patients with renal calculi bigger than 30 mm in 
diameter.

Publication Types: 
    Comparative Study
    Multicenter Study
    Review

PMID: 11223679 [PubMed - indexed for MEDLINE]

1419: Hinyokika Kiyo. 2000 Oct;46(10):701-4.

Extracorporeal shock wave lithotripsy for upper urinary tract stones using the
Dornier Lithotripter Compact: an experience in Japan.

Kawano M, Yasumoto R, Tanaka T, Nishisaka N, Naganuma T, Kishimoto T.

Department of Urology, Osaka Municipal Juso-Shimin Hospital.

Between May 1997 and February 1998, 40 cases of renal stones and 40 cases of
ureteral stones in 60 males and 20 females were treated with the Dornier
Lithotripter Compact. The size of the stones ranged from 5 mm to 80 mm. Three
patients required epidural anesthesia and 4 patients required a ureteral stent.
Fragmentation of the stones was observed in all patients. After 1 month, the
efficacy and stone free rates were 91% and 54%, respectively. After 3 months,
they were 91% and 68%, respectively. There were no serious side effects such as
pyelonephritis, perirenal hematomas, and massive hematuria. In conclusion, the
Dornier Lithotripter Compact proved to be a safe and highly effective
lithotripter for the treatment of renal and ureteral stones.

Publication Types: 
    Clinical Trial

PMID: 11215194 [PubMed - indexed for MEDLINE]

1420: Mult Scler. 2000 Dec;6(6):403-6.

Neurological worsening due to infection from renal stones in a multiple sclerosis
patient.

Hillman LJ, Burns SP, Kraft GH.

University of Washington, Department of Rehabilitation Medicine, USA.

Symptomatic bladder dysfunction occurs in the majority of patients with multiple 
sclerosis (MS). Although guidelines have been established for diagnosis and
management of bladder dysfunction in these patients, they are sometimes
overlooked in the primary care setting, leading to severe, life threatening
complications. A 64-year-old male with a 31-year history of spastic quadriparetic
MS and neurogenic bladder dysfunction managed with an indwelling catheter,
presented to the hospital with worsening neurological function. He had developed 
increased weakness and cognitive impairment several weeks after being treated for
a urinary tract infection (UTI). He had become unable to perform any activities
of daily living or drive his power wheelchair. After an extensive work-up, he was
found to have a large (14 x 18 x 30 cm) retroperitoneal abscess and multiple
renal stones, including a large obstructing calculus in the collecting system
near the ureteropelvic junction, and he underwent nephrectomy and abscess
drainage. Of note, he had been found to have multiple renal stones and
hydronephrosis on renal ultrasound 3 years earlier, but he had received no
treatment. Following drainage of the abscess, his upper extremity neurological
function returned to baseline, his cognitive status improved, and he regained the
ability to perform activities of daily living. Patients with paralysis from MS,
much like those with traumatic spinal cord injuries, are at grave risk of
mortality and morbidity from undiagnosed and under-treated urinary complications.
This case demonstrates that evaluation and appropriate treatment for
complications of neurogenic bladder should be part of routine care for patients
with MS. Current recommendations for evaluation and management of bladder
dysfunction in patients with MS will be reviewed.

Publication Types: 
    Case Reports

PMID: 11212137 [PubMed - indexed for MEDLINE]

1421: J Endourol. 2000 Dec;14(10):829-32.

Laparoscopic surgery for renal urolithiasis: pyelolithotomy, caliceal
diverticulectomy, and treatment of stones in a pelvic kidney.

Ramakumar S, Segura JW.

Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Laparoscopic techniques may be considered for the uncommon patient in whom open
stone surgery is considered. Stones in caliceal diverticula not accessible
percutaneously may be approached transperitoneally. Pelvic stones in ectopic
kidneys can be retrieved laparoscopically through a pyelotomy created with
scissors or a knife. Percutaneous nephrolithotomy under laparoscopic guidance can
be used if the stone extends beyond the renal pelvis. In the patient with
difficult stone disease, laparoscopy does not replace other minimally invasive
techniques but rather complements them. It should be the rare patient in the
future who needs open surgery for stone removal regardless of its location or the
presence of anatomic variants.

Publication Types: 
    Comparative Study

PMID: 11206616 [PubMed - indexed for MEDLINE]

1422: Scand J Urol Nephrol. 2000 Dec;34(6):381-2.

Erroneous diagnosis of chronic urinary retention in three women with pelvic
cysts.

Dunn IB, Palmer M.

Ayr Hospital, Scotland, UK.

Three cases are presented where pelvic masses were originally misdiagnosed as
cases of chronic urinary retention. In all cases the erroneous diagnosis was made
at outpatient assessment, where postmicturition ultrasound scan measurement of
residual urine volume had been performed. This investigation, while a useful
tool, must be viewed in the context of other clinical findings.

Publication Types: 
    Case Reports

PMID: 11195904 [PubMed - indexed for MEDLINE]

1423: Urology. 2001 Feb;57(2):342-6.

Unenhanced helical computed tomography for the evaluation of suspected renal
colic in the adolescent population: a pilot study.

Lumerman J, Gershbaum MD, Hines J, Nardi P, Beuchert P, Katz DS.

Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New
York, USA.

OBJECTIVES: Unenhanced helical computed tomography (UHCT) is rapidly becoming the
preferred imaging modality for the evaluation of suspected renal colic in the
adult population; however, a series addressing its use in the adolescent
population has not been previously published. We assessed the utility of UHCT in 
the evaluation of suspected renal colic in this age group. METHODS: Seventeen
patients between the ages of 8 and 18 years (mean 14.7) presented to the
emergency departments of four hospitals for evaluation of suspected renal colic. 
All patients were studied with UHCT immediately after initial evaluation. A
single helical acquisition was performed from the midpoint of T-12 vertebra to a 
point below the bladder base, using a slice thickness of 5 mm. Films were
reviewed by the institutional radiologist, and results were quantified. RESULTS: 
Of the 17 patients who underwent evaluation, no abnormality was detected in 8
patients. A stone was localized in 7 patients who were then appropriately
treated. One patient had no stone visualized, but secondary signs suggested a
recently passed stone. The final patient had no stone; however, marked bilateral 
hydroureteronephrosis was noted that led to further evaluation. A single
phlebolith was seen in only 1 patient, and no study was nondiagnostic.
CONCLUSIONS: UHCT is a safe, rapidly performed test for the evaluation of
suspected renal colic in adolescents. It is highly sensitive and specific for
renal and ureteral calculi and, more importantly, allows visualization of
alternate pathology. In addition, secondary signs are seen that aid in
determining obstruction and are helpful if no stone is visualized. Phleboliths,
which can simulate a stone, are rarely seen in adolescence. We believe UHCT
allows for rapid triage and localization of stones and should be recommended as
the primary diagnostic modality for the evaluation of adolescents with suspected 
renal colic.

Publication Types: 
    Evaluation Studies

PMID: 11182351 [PubMed - indexed for MEDLINE]

1424: Bull Exp Biol Med. 2000 Aug;130(8):802-4.

Preoperative immune status and lipid peroxidation as risk markers for
pyelonephritis attack after percutaneous nephrolithotomy.

Volchegorskii IA, Popov AN.

Chelyabinsk State Medical Academy.

Pyelonephritis attack after percutaneous nephrolithotomy can be predicted on the 
basis of immunity parameters and blood level of lipid peroxides.

PMID: 11177249 [PubMed - indexed for MEDLINE]

1425: J Urol. 2001 Mar;165(3):782-4.

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

Li J, Kennedy D, Levine M, Kumar A, Mullen J.

Division of Emergency Medicine, Mount Auburn Hospital, Harvard Medical School,
Cambridge, Massachusetts, USA.

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.

PMID: 11176467 [PubMed - indexed for MEDLINE]

1426: J Urol. 2001 Feb;165(2):378-81.

Adequacy of a single stone risk analysis in the medical evaluation of
urolithiasis.

Pak CY, Peterson R, Poindexter JR.

Center for Mineral Metabolism and Clinical Research, University of Texas
Southwestern Medical Center, Dallas, Texas 75390-8885, USA.

PURPOSE: We tested the hypothesis that a single 24-hour urine sample for stone
risk analysis would be sufficient for the simplified medical evaluation of
urolithiasis. MATERIALS AND METHODS: We retrospectively analyzed stone risk
profile data on 24-hour urine samples obtained during random and restricted diets
in 225 patients with recurrent urolithiasis. RESULTS: In 2 random samples we
noted no significant difference in urinary calcium, oxalate, uric acid, citrate, 
pH, total volume, sodium, potassium, sulfate or phosphorus. For these risk
factors there was a highly significant positive correlation in the 2 random
samples (r > or = 0.68, p <0.0003) and the value of each was abnormal or normal
in at least 81% of patients. Urinary magnesium and ammonium were significantly
lower in random sample 2 than 1, the former by 4%. After calcium, sodium and
oxalate dietary restriction mean urinary calcium and sodium plus or minus
standard deviation decreased significantly by 25% from 251 +/- 125 to 187 +/- 98 
mg. daily and by 38% from 183 +/- 87 to 113 +/- 57 mEq. daily, respectively.
Other risk factors had a slight or no significant change. Correcting random
urinary calcium for the excessive urinary excretion of sodium brought urinary
calcium to 210 +/- 108 mg. daily, similar to the value on the restricted diet.
CONCLUSIONS: The reproducibility of urinary stone risk factors is satisfactory in
repeat urine samples. A single stone risk analysis is sufficient for the
simplified medical evaluation of urolithiasis.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11176377 [PubMed - indexed for MEDLINE]

1427: Urology. 2001 Jan;57(1):168.

Calculus formation on a retained Acucise wire.

Johnson JE, Conlin M.

Oregon Health Sciences University, Portland, Oregon, USA.

We report the case of a patient who developed an obstructing calculus embedded at
the ureteropelvic junction after treatment of ureteropelvic junction obstruction 
with the Acucise cutting balloon catheter. Within the length of the stone, we
found a wire consistent with the cutting wire. To our knowledge, this is the
first report of a fractured and retained cutting wire resulting in calculus
formation.

Publication Types: 
    Case Reports

PMID: 11164172 [PubMed - indexed for MEDLINE]

1428: Urology. 2001 Jan;57(1):161-5.

Anatrophic nephrolithotomy.

Assimos DG.

Department of Urology, Wake Forest University School of Medicine, Winston-Salem, 
North Carolina, USA.

INTRODUCTION: Anatrophic nephrolithotomy is a procedure in which a parenchymal
incision is made in an intersegmental plane, allowing removal of large renal
calculi. TECHNICAL CONSIDERATIONS: A flank incision is made and the kidney
carefully mobilized. The main renal artery is isolated and the posterior
segmental artery identified. The anatrophic plane is defined by occluding the
posterior segmental artery and administering methylene blue intravenously. Renal 
hypothermic ischemia is established, and a nephrotomy is made through the
previously identified plane. The calculi are extracted, which may require
incising stenotic infundibula to facilitate removal. Intraoperative radiography
is performed to confirm complete stone removal. The collecting system is
reconstructed with absorbable suture, and special techniques are used to correct 
the infundibular stenosis. The renal capsule is closed with absorbable suture
after which the renal circulation is re-established. CONCLUSIONS: This procedure 
is currently used to treat patients with large-volume staghorn calculi and
complex collecting system anatomy.

Publication Types: 
    Review

PMID: 11164167 [PubMed - indexed for MEDLINE]

1429: Am J Kidney Dis. 2001 Feb;37(2):233-43.

Risk for renal failure in nephrolithiasis.

Gambaro G, Favaro S, D'Angelo A.

Department of Medical and Surgical Sciences, Division of Nephrology, University
of Padua School of Medicine, Padua, Italy. giga@ux1.unipd.it

Evaluation of the risk for developing renal insufficiency is generally not
considered during the clinical metabolic workup of the stone-forming patient.
This review approaches the problem of the severity of nephrolithiasis by
addressing the renal risk. Although renal stones are an infrequent cause of renal
failure, some lithiasic forms present a greater risk, such as in hereditary stone
diseases (eg, cystinuria, primary hyperoxaluria, Dent's disease), primary
struvite stones, and infection-related urolithiasis associated with anatomic and 
functional urinary tract anomalies and spinal cord injury. Recurrent bouts of
obstruction and/or crystal-specific biological effects on tubular epithelial
cells and interstitial renal cells may activate the fibrogenic cascade
responsible for the loss of renal parenchyma. In clinical terms, frequent stone
relapses, episodes of urinary tract infection and obstruction, number of
urological interventions, and size of the gravel are all significantly associated
with the risk for renal failure. Percutaneous and extracorporeal urological
methods for the treatment of renal stones may also lead to some chronic
deterioration of renal function, particularly in recurrent stone formers treated 
with multiple therapeutic sessions. Although still speculative, concerns exist
about the effect of extracorporeal shock wave lithotripsy on small or
pathological kidneys. Without doubt, the medical prevention of stones would be
more sensible.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11157364 [PubMed - indexed for MEDLINE]

1430: Mol Urol. 2000 Winter;4(4):391-402.

The hole truth: intracrystalline proteins and calcium oxalate kidney stones.

Ryall RL, Fleming DE, Grover PK, Chauvet M, Dean CJ, Marshall VR.

Department of Surgery, Flinders University School of Medicine, Flinders Medical
Centre, Bedford Park, South Australia, Australia. rose.ryall@flinders.edu.au

The ultimate aim of our research is to understand the role of macromolecules in
the formation of human kidney stones, particularly their interactions with
calcium oxalate (CaOx) crystals. The invariable association of stones with
proteins raises the possibility that proteins play a role in their formation,
similar to the role of proteins in healthy biomineralization. Do these proteins
induce mineralization? Are they merely a response to the disease process? Or are 
they protective molecules that were overwhelmed by mineral supersaturation? A
protein of particular interest is fragment 1 (F1) of prothrombin. We have shown
that mRNA for prothrombin is present in the kidney. Because the F1 fragment of
prothrombin present in urine is slightly different from that found in the blood, 
we refer to this protein as "urinary prothrombin fragment 1" (UPTF1). Available
evidence suggests that the kidney manufactures the protein for protection against
stone disease and that the protein has a directive role in stone formation. We
now have evidence that proteins are interred within CaOx crystals precipitated
from human urine, where it is distributed in continuous channels. These proteins 
could facilitate crystal deconstruction and removal after attachment to the renal
epithelium and endocytosis. We suspect that the formation of CaOx crystals in the
urine is a normal process designed to permit harmless disposal of an excess of
calcium, oxalate, or both. The incorporation of proteins provides a second line
of defense against stone formation by enabling the destruction and removal of
retained crystals. Understanding the basic molecular strategies by which plants
produce protein-containing CaOx crystals may provide insight into human CaOx
stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11156707 [PubMed - indexed for MEDLINE]

1431: Mol Urol. 2000 Winter;4(4):371-82.

Oxalate-induced changes in renal epithelial cell function: role in stone disease.

Scheid C, Honeyman T, Kohjimoto Y, Cao LC, Jonassen J.

Department of Physiology, University of Massachusetts Medical School, Worcester, 
Massachusetts 01655, USA. cheyl.scheid@umassmed.edu

Many studies on the etiology of stone disease have focused on the properties of
urine that affect crystal nucleation and growth. More recent studies have focused
on the properties of the renal epithelium and the role of injury in crystal
retention. The latter studies have shown that oxalate exposure per se can damage 
renal epithelial cells and enhance crystal binding. This overview summarizes
findings of specific biochemical and genetic alterations observed in renal
epithelial cells after exposure to oxalate. In LLC-PK1 and MDCK cells, oxalate
exposure produces marked effects on membranes, causing a redistribution of
phosphatidylserine and activation of two lipid signaling cascades, one involving 
phospholipase A(2) (PLA(2)) and one involving ceramide. Longer exposure to
oxalate leads to membrane damage and cell death. Adaptive responses are also
observed, including proliferation (for replacement of damaged cells) and
induction of various genes (for cellular replacement and repair). Many or all of 
these responses are blocked by antioxidants, and many can be mimicked by PLA(2)
agonists/products. This finding suggests links between oxalate-induced increases 
in oxidant stress, lipid signaling pathways, and subsequent molecular responses
that may eventuate in renal cell damage or death. Whether such changes play a
role in stone disease in vivo, and whether strategies to inhibit these changes
would be beneficial therapeutically, is unknown.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 11156705 [PubMed - indexed for MEDLINE]

1432: Mol Urol. 2000 Winter;4(4):365-70.

Analysis of hypophosphatemia in calcium nephrolithiasis.

Yamakawa K, Kawamura J.

Department of Urology, Mie University School of Medicine, Mie, Japan.

PURPOSE AND METHODS: To analyze the pathophysiology of hypophosphatemia in
calcium nephrolithiasis, we investigated the relation between serum phosphorus,
1,25-dihydroxyvitamin D, and parathyroid hormone (PTH) levels in 63 consecutive
patients with calcium nephrolithiasis, comparing them with 26 age-matched control
subjects. RESULTS: Serum phosphorus concentrations in normocalciuric and
absorptive hypercalciuric stone formers were significantly decreased compared
with control subjects (P<0.001 and P<0.01, respectively). The fractional
excretion (TRP) and renal threshold (TmP/GFR) of phosphorus were significantly
decreased in the subjects with nephrolithiasis (P<0.01 and P<0.001,
respectively). Serum phosphorus concentrations were inversely correlated with
serum 1, 25-dihydroxyvitamin D in control subjects and in absorptive
hypercalciuric stone formers (P<0.01 and P <0.05, respectively), suggesting that 
the physiologic relation between phosphorus and 1, 25-dihydroxyvitamin D is
maintained in these patients. Serum phosphorus concentrations in absorptive
hypercalciuric patients, although related to 1,25-dihydroxyvitamin D, were not
related to PTH even though PTH and 1,25-dihydroxyvitamin D concentrations were
directly related (P<0.05). The lack of a relation between PTH and serum
phosphorus concentrations in absorptive hypercalciuric stone formers was similar 
to that in controls. In normocalciuric stone formers, there was no relation
between serum 1,25-dihydroxyvitamin D and serum phosphorus, but PTH and
1,25-dihydroxyvitamin D were inversely correlated (P<0.05). CONCLUSIONS: Abnormal
renal tubular function with a depressed rate of renal phosphorus transport and an
abnormal 1,25-dihydroxyvitamin D concentration is common in nephrolithiasis.
Differences in the relations between phosphorus and 1,25-dihydroxyvitamin D
observed in hypercalciuric v normocalciuric subjects suggest that the
pathogenesis of proximal tubulopathy differs among patients with nephrolithiasis.

PMID: 11156704 [PubMed - indexed for MEDLINE]

1433: Mol Urol. 2000 Winter;4(4):305-12.

Nephrolithiasis: a consequence of renal epithelial cell exposure to oxalate and
calcium oxalate crystals.

Khan SR, Thamilselvan S.

Department of Pathology, College of Medicine, University of Florida, Gainesville,
Florida 32610-0275, USA. Khan@pathology.ufl.edu

PURPOSE: Formation of calcium oxalate (CaOx) kidney stones was investigated using
three approaches. MATERIALS AND METHODS: Pathogenesis of crystalluria and crystal
deposition in the kidneys was examined in vivo by inducing hyperoxaluria in rats.
Cultures of LLC-PK1 and MDCK cells were exposed to oxalate (Ox) and CaOx crystals
to examine the effect on cells in various sections of the renal tubules. The
nucleation potential of various substrates was examined by incubating them in
metastable solutions of CaOx. RESULTS: Calcium oxalate crystals and
nonphysiologic levels of Ox were injurious to renal epithelial cells. To combat
these nephrotoxins, renal epithelial cells produce a variety of macromolecules
such as bikunin and osteopontin, which are modulators of crystallization and may 
also be involved in crystal attachment to the cells. Sustained hyperoxaluria in
association with CaOx crystals induced apoptosis as well as necrosis. Cellular
degradation products induced heterogeneous nucleation of crystals at lower and
physiologic levels of oxalate. They also promoted aggregation. CONCLUSIONS:
Crystals begin to form in earlier segments of the nephron with a chance to grow
and be retained in the collecting ducts after aggregation with other large
crystals. Crystal deposits in the collecting ducts near the papillary surface,
when exposed to the renal pelvic urine, become nidi for the development of kidney
stones.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 11156696 [PubMed - indexed for MEDLINE]

1434: Clin Excell Nurse Pract. 2001;5(1):21-5.

Management of calcium oxalate stones.

Hanson KA.

Department of Urology, Mayo Foundation, MN, USA. hanson.karen2@mayo.edu

This article discusses the incidence and prevalence of calcium oxalate renal
stones. Etiology and risk factors for all renal stone formation are reviewed. The
evaluation, diagnostic procedures, and management for new and recurrent stone
formation are detailed. Management includes long-term pharmacologic and
nonpharmacologic measures for successful prevention or reduction in the frequency
of recurrent stones. Specific patient education factors, patient and family
psychological aspects, and referral resources are discussed.

Publication Types: 
    Review

PMID: 11154390 [PubMed - indexed for MEDLINE]

1435: Urol Int. 2001;66(1):46-8.

Double infundibular obliteration with abscess formation after percutaneous
nephrolithotomy.

Buchholz NP.

Erasmus Urological Stone Treatment and Research Rotterdam (EUROSTARR), Department
of Urology, Erasmus Academic Hospital, Rotterdam, The Netherlands.

A case of an unusual complication after percutaneous nephrolithotomy. After
removal of an infectious staghorn calculus followed by SWL, the patient developed
a double infundibular stricture leaving the kidney divided into three separate
compartments. In spite of the absence of clinical symptoms of infection, this was
further complicated by abscess formation and finally, function loss of the upper 
part of the kidney. Combined retro- and anterograde endoscopic surgery failed to 
re-establish the complete continuity of the uretero-caliceal system and the
patient had to undergo partial nephrectomy. Possible etiologies, contributing
factors and means of prevention for this rare complication are discussed.

Publication Types: 
    Case Reports

PMID: 11150954 [PubMed - indexed for MEDLINE]

1436: Curr Opin Urol. 2000 Nov;10(6):551-5.

2000 AD: still a role for the intravenous urogram in stone management?

Gallagher HJ, Tolley DA.

Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, UK.

The intravenous urogram (IVU) remains a useful investigation in the assessment of
upper urinary tract calculi. Helical computed tomography scanning appears to have
superseded the IVU in the diagnosis of acute flank pain due to a higher
sensitivity in diagnosis. Results of extracorporeal shockwave lithotripsy (ESWL) 
for lower calyceal stones are generally disappointing. Recent studies using the
intravenous urogram have demonstrated that an acute infundibulopelvic angle may
be a significant indicator of the likelihood of failure of ESWL. A prospective
evaluation of the role of spatial anatomy in the clearance of lower calyceal
stones by ESWL is needed. In future this parameter may be used to determine
treatment protocols for lower calyceal stones. Future imaging methods may make
the IVU redundant, but for the time being it remains an essential part of the
urologist's armamentarium.

Publication Types: 
    Review

PMID: 11148724 [PubMed - indexed for MEDLINE]

1437: Curr Opin Urol. 2000 Nov;10(6):539-44.

Changing concepts in the aetiology of renal stones.

Verkoelen CF, Schepers MS.

Department of Urology, Erasmus University Rotterdam, Josephine Nefkens Institute,
The Netherlands. verkoelen@uro.fgg.eur.nl

In the past two decades an increasing number of nephrolithiasis-related urinary
proteins have been identified. This paper focuses on two of them, namely
prothrombin fragment 1 and bikunin, members of the prothrombin and
inter-alpha-trypsin inhibitor families of proteins, respectively. Besides their
role as inhibitors of crystallization, these proteins are also involved in
inflammation-mediated tissue repair. This is the basis for the concept that the
response of renal tissue to injury might play an important role in the aetiology 
of kidney stones.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11148722 [PubMed - indexed for MEDLINE]

1438: Ann Pharmacother. 2000 Dec;34(12):1414-8.

Symptomatic crystalluria associated with indinavir.

Famularo G, Di Toro S, Moretti S, De Simone C.

Department of Emergency Medicine, San Camillo Hospital, Rome, Italy.
gfamularo@relay.uni.net

OBJECTIVE: To report a case of severe and recurrent crystalluria resulting from
the use of indinavir and to review the literature describing this adverse effect.
CASE SUMMARY: A 26-year-old HIV-positive white woman had recurrent episodes of
left-sided flank pain accompanied by dilation of the left renal collecting system
while undergoing treatment with a triple-drug regimen including indinavir 1200 mg
every 12 hours (full dosage). Typical indinavir crystalluria was observed, with
no evidence of stones. Acute episodes were treated with intravenous fluids,
diclofenac, and ciprofloxacin. Crystalluria and clinical symptoms eventually
resolved with withdrawal of indinavir and substitution with a different protease 
inhibitor. Renal function remained normal. DISCUSSION: A wide spectrum of
disorders of the urinary tract can occur in subjects taking indinavir, with
potentially severe complications caused by crystalluria and stones. Indinavir is 
excreted in the urine; the low solubility of those crystals is the critical
factor accounting for the risk of stone formation. An elevated pH with a reduced 
excretion of citric acid contributes to the low urinary solubility of indinavir. 
Pharmacokinetic interactions with other drugs, leading to elevated plasma
concentrations of indinavir, and dehydration could also increase the risk of
stone formation. The impact on renal function can be unfavorable over the
long-term period. Cornerstones of treatment and prevention are increased fluid
intake and possibly urinary acidification. Emergency drainage may be required for
patients with severe obstruction. Reducing the dosage of indinavir has been
proposed, but this carries the risk of viral mutations with development of
resistance. CONCLUSIONS: Treatment with indinavir can result in crystalluria with
potentially severe obstruction. All patients taking indinavir, not only those
with documented crystalluria or renal effects from the drug, should greatly
increase their fluid intake and have renal function checked at baseline and then 
monitored regularly. Urinalysis also should be performed regularly for
appropriate monitoring and prevention.

Publication Types: 
    Case Reports
    Review

PMID: 11144699 [PubMed - indexed for MEDLINE]

1439: Med Hypotheses. 2001 Jan;56(1):114-20.

Antidenaturant drugs for cataract and other condensation diseases.

Saso L, Silvestrini B.

Department of Pharmacology of Natural Substances and General Physiology,
University of Rome "La Sapienza", Rome, Italy.

'Condensation diseases' are heterogeneous pathological conditions in which the
primary pathogenetic step is the loss of solubility of specific substances,
resulting in the formation of a condensed phase. Typical examples are cataract,
nephrolithiasis, gallstone disease and certain rheumatic conditions in which
protein denaturation, aggregation and precipitation may occur. Since the
condensing molecules are often proteins, antidenaturant agents should be
considered rational drugs for the treatment of these diseases. Surprisingly,
however, only a few molecules with these properties are currently available for
therapeutic use, including bendazac for cataract.

PMID: 11133267 [PubMed - indexed for MEDLINE]

1440: J Nephrol. 2000 Nov-Dec;13 Suppl 3:S61-4.

Drawing up guidelines for the management of kidney stones in Italy.

Baggio B.

Department of Medical and Surgery Sciences, University of Padua, Italy.
bbaggio@auxl.unipd.it

The Italian Society of Nephrology recently proposed and published guidelines for 
the management of nephrolithiasis. This review reconsiders some aspects, and
presents the scientific background and clinical-scientific evidence that
suggested the guidelines for some of the more controversial and debated issues in
the clinical-diagnostic approach to the disease, i. e., medical management of
renal colic and the first episode of nephrolithiasis.

Publication Types: 
    Review

PMID: 11132034 [PubMed - indexed for MEDLINE]

1441: J Nephrol. 2000 Nov-Dec;13 Suppl 3:S51-60.

Renal stones: from metabolic to physicochemical abnormalities. How useful are
inhibitors?

Marangella M, Vitale C, Petrarulo M, Bagnis C, Bruno M, Ramello A.

Nephrology, Dialysis and Renal Stone Unit, Mauriziano Umberto I Hospital, Turin, 
Italy. mmarangella@mauriziano.it

Despite intensive studies in the last decades many aspects of nephrolithiasis
still remain to be elucidated. Supersaturation with respect to lithogenic
substances explains stones composed of cystine, uric acid, struvite, and calcium 
stones secondary to systemic diseases. In this subset there is a clear separation
between patients and controls, and stone activity is well related to alterations 
in the physicochemistry of the urine environment. The understanding of the
mechanisms of idiopathic calcium nephrolithiasis, on the other hand, is
controversial, because we are still unable to establish clear-cut cause-effect
relations between metabolic and physicochemical abnormalities and stone
formation. Recent studies have been centered on the kidney, not only as the end
organ of biochemical derangements due to systemic or environmental factors, but
also as a complex laboratory where some events conduct to and others defend from 
lithogenesis. Many of these phenomena occur in the proximal tubule. Molecular
biology has explained some types of hypercalciuria, which are due to genetic
mutations altering tubular function, and similar results are expected for
hypocitraturia and hyperoxaluria. The latter is conducive to stone formation
through several mechanisms including supersaturation, oxidative stress on tubular
cells, and interference with some natural inhibitors. The long list of inhibitors
includes ionic and macromolecular moieties, some being produced within the
nephron in response to lithogenic insults, and some affecting not only
crystallization but also crystal cell adherence. Crystal trapping is believed to 
anticipate a renal stone. However, much has still to be clarified on their actual
role in calcium nephrolithiasis, by what mechanisms they act, if patients and
controls differ in the excretion and structure of some inhibitors, and whether
differences are genetically determined.

Publication Types: 
    Review

PMID: 11132033 [PubMed - indexed for MEDLINE]

1442: J Nephrol. 2000 Nov-Dec;13 Suppl 3:S45-50.

Epidemiology of nephrolithiasis.

Ramello A, Vitale C, Marangella M.

Renal Stone Center, Mauriziano Umberto I Hospital, Turin, Italy.

The overall probability of forming stones differs in various parts of the world: 
1-5% in Asia, 5-9% in Europe, 13% in North America, 20% in Saudi Arabia. The
composition of stones and their location in the urinary tract, bladder or kidneys
may also significantly differ in different countries. Moreover, in the same
region, the clinical and metabolic patterns of stone disease can change over
time. We examined some epidemiological evidence about the main risk factors for
stone formation, both individual and environmental. A slightly higher rate of
renal stone disease emerged in males than in females, and in white Caucasians
than in Blacks. Stones in the upper urinary tract appear to be related to the
life-style, being more frequent among affluent people, living in developed
countries, with high animal protein consumption. Bladder stones are nowadays
mainly seen in the Third World, on account of very poor socio-economic
conditions. A high frequency of stone formation among hypertensive patients has
been reported, and among those with high body mass as well. There is no evidence 
of any rise in the risk of stone formation in relation to dietary calcium intake 
or tap water hardness.

Publication Types: 
    Review

PMID: 11132032 [PubMed - indexed for MEDLINE]

1443: BJU Int. 2001 Jan;87(1):1-8.

Preliminary results of a randomized controlled trial of prophylactic shock wave
lithotripsy for small asymptomatic renal calyceal stones.

Keeley FX Jr, Tilling K, Elves A, Menezes P, Wills M, Rao N, Feneley R.

Bristol Urological Institute, Southmead Hospital, Bristol, UK.
keeleys@wot99.freeserve.co.uk

OBJECTIVE: To report a prospective, randomized study to determine whether
prophylactic extracorporeal shockwave lithotripsy (ESWL) is justified as a
treatment for small, asymptomatic calyceal stones. PATIENTS AND METHODS: The
study included 228 patients with small (< 15 mm total diameter) asymptomatic
calyceal stones; 113 patients were randomized to undergo ESWL and 115 to the
control group who were kept under observation. Outcome measurements included the 
stone-free rate, requirement for additional treatment, symptoms, quality of life 
and renal function. RESULTS: In all, 200 patients had at least one annual
follow-up; all outcome measurements reported were those at the most recent
follow-up (mean 2.2 years, range 1-5). In the ESWL group 28 patients (28%) were
stone-free, compared with 16 (17%) in the observation group (odds ratio 1.95, 95%
confidence interval, CI, 0.97-3.89, P = 0.06). Additional treatment in the form
of analgesics, antibiotics, ESWL, stent insertion and ureteroscopy, was required 
in 21 (21%) patients in the observation group and 15 (15%) in the ESWL group
(odds ratio 0.66, 95% CI 0.32-1.37, P = 0.27). Ten patients in the observation
group required invasive procedures, vs none in the ESWL group. There was no
evidence of differences in the symptoms, quality of life or renal function tests 
between the arms of the trial at the final follow-up. CONCLUSIONS: Prophylactic
ESWL for small asymptomatic renal calyceal stones does not appear to offer any
advantage to patients in terms of stone-free rate, quality of life, renal
function, symptoms or hospital admissions. However, a policy of observation is
associated with a greater risk of requiring more invasive procedures. A longer
follow-up is required to assess the validity of these preliminary findings.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 11121982 [PubMed - indexed for MEDLINE]

1444: Hum Mol Genet. 2000 Dec 12;9(20):2937-45.

Mice lacking renal chloride channel, CLC-5, are a model for Dent's disease, a
nephrolithiasis disorder associated with defective receptor-mediated endocytosis.

Wang SS, Devuyst O, Courtoy PJ, Wang XT, Wang H, Wang Y, Thakker RV, Guggino S,
Guggino WB.

Department of Physiology, Johns Hopkins University School of Medicine, 725 North 
Wolfe Street, Baltimore, MD 21205, USA.

Nephrolithiasis (kidney stones) affects 5-10% of adults and is most commonly
associated with hypercalciuria, which may be due to monogenic renal tubular
disorders. One such hypercalciuric disorder is Dent's disease, which is
characterized by renal proximal tubular defects that include low molecular weight
proteinuria, aminoaciduria and glycosuria, together with rickets in some
patients. Dent's disease is due to inactivating mutations of the renal-specific
voltage-gated chloride channel, CLC-5, which is expressed in the proximal tubule,
thick ascending limb and collecting duct. The subcellular localization of CLC-5
to the proximal tubular endosomes has suggested a role in endocytosis, and to
facilitate in vivo investigations of CLC-5 in Dent's disease we generated mice
lacking CLC-5 by targeted gene disruption. CLC-5-deficient mice developed renal
tubular defects which included low molecular weight (<70 kDa) proteinuria,
generalized aminoaciduria that was more pronounced for neutral and polar amino
acids, and glycosuria. They also developed hypercalciuria and renal calcium
deposits and some had deformities of the spine. Furthermore, endocytosis as
assessed by horseradish peroxidase uptake in the proximal tubule was severely
impaired in CLC-5-deficient mice, thereby demonstrating a role for CLC-5 in
endosomal uptake of low molecular weight proteins. Thus, CLC-5-deficient mice
provide a model for Dent's disease and this will help in elucidating the function
of this chloride channel in endocytosis and renal calcium homeostasis.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 11115837 [PubMed - indexed for MEDLINE]

1445: Spinal Cord. 2000 Nov;38(11):661-8.

Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal
cord injury patients.

Vaidyanathan S, Singh G, Soni BM, Hughes P, Watt JW, Dundas S, Sett P, Parsons
KF.

Regional Spinal Injuries Centre, District General Hospital, Southport,
Merseyside, UK.

STUDY DESIGN: A study of four patients with spinal cord injury (SCI) in whom a
diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did 
not manifest the traditional signs and symptoms. OBJECTIVES: To learn from these 
cases as to what steps should be taken to prevent any delay in the diagnosis and 
treatment of hydronephrosis/pyonephrosis in SCI patients. SETTING: Regional
Spinal Injuries Centre, Southport, UK. METHODS: A retrospective review of cases
of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients
between 1994 and 1999, in whom there was a delay in diagnosis. RESULTS: A T-5
paraplegic patient had two episodes of urinary tract infection (UTI) which were
successfully treated with antibiotics. When he developed UTI again, an
intravenous urography (IVU) was performed. The IVU revealed a non-visualised
kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical
symptom of flank pain was absent, and the symptoms of sweating and increased
spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the
left kidney with a stone impacted in the pelviureteric junction. In two
tetraplegic patients, an obstructed kidney became infected, and there was a delay
in the diagnosis of pyonephrosis. The clinician's attention was focused on a
co-existent, serious, infective pathology elsewhere. The primary focus of sepsis 
was chest infection in one patient and a deep pressure sore in the other. The
former patient succumbed to chest infection and autopsy revealed pyonephrosis
with an abscess between the left kidney and left hemidiaphragm and
xanthogranulomatous inflammation of perinephric fatty tissue. In the latter
patient, an abdominal X-ray did not reveal any calculus but computerised axial
tomography showed the presence of renal and ureteric calculi. CONCLUSIONS: The
symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The
symptoms include feeling unwell, abdominal discomfort, increased spasms, and
autonomic dysreflexia. Physicians should be aware of the serious import of these 
symptoms in SCI patients.

Publication Types: 
    Case Reports

PMID: 11114772 [PubMed - indexed for MEDLINE]

1446: J Perianesth Nurs. 2000 Apr;15(2):94-101.

Management of the extracorporeal shock wave lithotripsy patient.

DeLeskey KL, Massi-Ventura G.

Ambulatory Surgery Department, Lahey Clinic Medical Center, Burlington, MA, USA. 
Kathleen.deleskey@gte.net

Over 2 million Americans experience kidney and urinary stone disease each year.
Early treatments resulted in high mortality and morbidity rates. With the advent 
of extracorporeal shock wave lithotripsy less than 20 years ago, treatment for
this disease has become far safer with more rapid recovery and fewer
complications. The selection of patients eligible for extracorporeal shock wave
lithotripsy is dependent on the location and size of the stones and the overall
health of the patient. This article discusses the different treatment modalities 
used for stone disease and the different methods currently available for
extracorporeal shock wave lithotripsy. Preprocedure preparation of the patient
and postoperative care for this population is reviewed in detail.

Publication Types: 
    Review

PMID: 11111524 [PubMed - indexed for MEDLINE]

1447: Eur Urol. 2000 Dec;38(6):753-7.

Arterial blood pressure following different types of urinary stone therapy.
Presented at the 8th European Symposium on Urolithiasis, Parma, Italy, 1999.

Strohmaier WL, Schmidt J, Lahme S, Bichler KH.

Department of Urology, Klinikum Coburg, Germany. lkhco.stromaier@t-online.de

OBJECTIVE: Several studies reported increased blood pressure (BP) values
following extracorporeal shock wave lithotripsy (ESWL) treatment of renal stones.
It is unclear, however, whether this is due to ESWL, since nephrolithiasis itself
increases the relative risk of developing hypertension. Therefore we
prospectively studied the BPs of stone patients undergoing different types of
treatment. METHODS: 252 stone patients (63% males, 37% females, median age 44.3, 
range 11.7-86.4 years) participated. 168 suffered from uretral stones: 50
underwent ESWL; 40 ureteroscopy, and 78 patients passed stones spontaneously
(SP). 84 had renal stones: 60 underwent ESWL; 8 percutaneous nephrolithotomy/open
surgery, and 16 no treatment. Systolic (SBP) and diastolic (DBP) BP were measured
according to Riva-Rocci prior to, immediately after, and 3, 6, 12, 18 and 24
months after stone therapy. RESULTS: Immediately after SP, SBP decreases, whereas
after active stone treatment increases (highest after ESWL) in SBP were seen. DBP
was unchanged. During the further follow-up, a gradual increase in BP was
observed in all groups. At 24 months in all groups, regardless of the stone
location and type of treatment, SBP and DBP were significantly higher than the
pretreatment levels (p = 0.000). There was no a difference between renal and
ureteral stones, or between the ESWL treatment and the other groups. CONCLUSION: 
Renal stone disease itself rather than the type of treatment significantly
increases SBP and DBP during a follow-up period of 24 months. The underlying
mechanisms remain to be elucidated.

PMID: 11111196 [PubMed - indexed for MEDLINE]

1448: J Endourol. 2000 Nov;14(9):735-7; discussion 737-8.

Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail
catheter?

Maheshwari PN, Andankar MG, Bansal M.

R.G. Stone Urological Research Institute, Mumbai, India. calgrse@bom5.vsnl.net.in

BACKGROUND AND PURPOSE: A nephrostomy tube is an integral part of any
percutaneous renal surgery. Commonly, a nephrostomy tube that is 2F to 3F smaller
than the percutaneous tract is used after percutaneous nephrolithotomy (PCNL). In
our experience, quite a few patients have pain at the nephrostomy tube site, and 
many patients complain of a prolonged urinary leak after tube removal when a
large nephrostomy tube is used. This prospective study was planned to document
whether these symptoms could be attributed to the size of the nephrostomy tube
and whether a small pigtail catheter could reduce these problems without
increasing complications. PATIENTS AND METHODS: Forty well-matched patients in
whom a one-stage PCNL was done for calculus disease were studied prospectively.
Alternate patients had a 28F nephrostomy tube or a 9F pigtail catheter placed at 
the end of the procedure. Patients were observed for the duration of hematuria,
number of analgesic injections needed, and the duration of urinary leak after
tube removal. RESULTS: The groups were comparable in the amount and duration of
hematuria after PCNL. There was a statistically significant difference in the
analgesic need and the duration of urinary leak after tube removal, both of which
were less in patients having a pigtail catheter. CONCLUSIONS: A pigtail catheter 
nephrostomy tube after PCNL reduces the hospital stay by reducing the duration of
the urinary leak. The postoperative course is smooth, as patient has less pain
and needs less analgesic support. There is no statistically significant increase 
in the postoperative bleeding secondary to use of a pigtail catheter. Second-look
nephroscopy was easy in the one patient with a pigtail nephrostomy catheter who
needed the procedure.

Publication Types: 
    Comparative Study

PMID: 11110567 [PubMed - indexed for MEDLINE]

1449: Urol Clin North Am. 2000 Nov;27(4):647-54.

Calyceal diverticula. Ureteroscopic management.

Chong TW, Bui MH, Fuchs GJ.

Department of Endourology, Wolfson College, Oxford, England.

In selected cases, RIRS management of calyceal diverticula and its related
problems has been shown to be more efficacious than ESWL monotherapy and avoids
the potential complications and discomfort of percutaneous and laparoscopic
procedures. The advent of the Holmium laser energy source, with innovations such 
as the flexible ureteroscope and the tipless stone basket, have expanded the role
of RIRS in the management of calyceal diverticula and associated problems.
Presently, RIRS is the initial treatment choice for the management of low to
moderate stone burdens that are contained in calyceal diverticula or trapped
behind any narrowed intrarenal segment (e.g., infundibular stenosis). If repair
of the stenotic segment is not successful, thereby excluding stone treatment,
then under the same anesthesia, the patient undergoes a percutaneous antegrade
renal surgery. The authors feel that the percutaneous approach as a first choice 
is more suitable for posteriorly located diverticula with a large stone burden.
In selected cases of anteriorly located diverticula with large stone burdens, the
laparoscopic approach is more expedient.

Publication Types: 
    Review

PMID: 11098763 [PubMed - indexed for MEDLINE]

1450: Urol Clin North Am. 2000 Nov;27(4):635-45.

Percutaneous management of caliceal diverticula.

Schwartz BF, Stoller ML.

Department of Endourology and Urologic Laparoscopy, Tripler Regional Medical
Center, Honolulu, Hawaii, USA.

The diagnosis of a caliceal diverticulum may be serendipitous or established
owing to patient symptoms. Once the decision to treat a diverticulum has been
made, a percutaneous approach should be considered. If stones are present,
complete stone removal and obliteration of the diverticulum should be the goals
of surgery. The authors prefer the direct puncture technique whenever possible to
limit the risk for bleeding and to facilitate stone removal. Use of a
percutaneous approach in properly selected patients affords high success rates
and results in few complications.

Publication Types: 
    Review

PMID: 11098762 [PubMed - indexed for MEDLINE]

1451: Urol Clin North Am. 2000 Nov;27(4):623-31.

Ureteropyeloscopic treatment of ureteral and intrarenal calculi.

Grasso M.

Department of Urology, New York University School of Medicine, New York, USA.
mike.grasso@nyu.med.edu

Endoscopic lithotripsy is an essential part of the armamentarium at any complete 
stone treatment center. It is first-line therapy for complicated upper urinary
tract calculi and for patients who fail primary extracorporeal shock wave
lithotripsy. In the presented series, ureteroscopy is defined as a safe and
particularly effective treatment for upper urinary tract calculi. Endoscope
miniaturization, the Holmium laser, and refined surgical technique have positive 
results. Complications are less frequent today, even with in the most complex
large stone burdens being addressed in a retrograde ureteroscopic way.

Publication Types: 
    Review

PMID: 11098761 [PubMed - indexed for MEDLINE]

1452: Urol Clin North Am. 2000 Nov;27(4):617-22.

Renal calculi. Percutaneous management.

Ramakumar S, Segura JW.

Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.

Percutaneous nephrolithotomy has established indications and is performed with
high success and minimal morbidity. Patients who have large or hard stones or
stones associated with urinary obstruction are candidates for a percutaneous
procedure. When the certainty of the final result is important, the patient
should have a PNL. In general, the best treatment for SWL failure is not more
SWL; such patients usually should have an endoscopic procedure.

Publication Types: 
    Review

PMID: 11098760 [PubMed - indexed for MEDLINE]

1453: Scand J Urol Nephrol. 2000 Aug;34(4):257-61.

Stone risk after bladder substitution with the ileal-urethral Kock reservoir.

Osther PJ, Poulsen AL, Steven K.

Department of Urology, Odense University Hospital, Denmark.
palle.osther@dadlnet.dk

OBJECTIVE: The study was carried out to compare urinary biochemical and
physicochemical environments in patients who had undergone bladder substitution
with the ileal-urethral Kock reservoir, and who had no actual urinary infection, 
with those of healthy subjects. MATERIAL AND METHODS: The participants were 23
male patients who had undergone bladder substitution with the ileal-urethral Kock
reservoir and 25 healthy men. All subjects had sterile urine at the time of urine
collection. Concentrations of calcium, magnesium, phosphorus, creatinine,
citrate, oxalate, and ammonia in 24-h urine samples were measured. Estimates of
ion activity products of calcium oxalate (CaOx), calcium phosphate (CaP),
brushite (Bru), and magnesium ammonium phosphate (MAP) in urine were calculated
according to Tiselius. RESULTS: There was no significant difference in 24-h
urinary volume between patients with a bladder substitute and the healthy
controls. For most of the other measured values the results for patients differed
significantly from those for controls. The most striking findings were markedly
lower urinary excretion rates of citrate (p < 0.0001) and higher urine pH (p <
0.0001) in patients compared with controls. These findings were reflected in
significantly higher levels of urinary supersaturation with respect to CaOx (p < 
0.0001), CaP (p <0.0001), Bru (p < 0.0001) and MAP (stuvite) (p < 0.0001) in
patients with a bladder substitute compared with healthy subjects. CONCLUSIONS:
Hypocitraturia seems to be the main risk factor for calcium stone formation in
non-infected Kock reservoir patients, and citrate supplementation appears to be
the most obvious choice for stone prophylaxis in patients with intestinal urinary
diversion and recurrent renal stone formation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11095084 [PubMed - indexed for MEDLINE]

1454: Anesthesiol Clin North America. 2000 Dec;18(4):953-71.

Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy.

Gravenstein D.

Department of Anesthesiology, University of Florida College of Medicine,
Gainesville, USA.

This article reviews the basic anesthetic considerations for ESWL and PCNL.
General principles governing the operation of lithotripters, elements of
treatment that impinge on safety, and effective intraoperative anesthesia and
complications that may be encountered in the perioperative period are discussed. 
Factors influencing blood loss and concerns arising from positioning patients
prone are addressed in the sections devoted to PCNL.

Publication Types: 
    Review

PMID: 11094699 [PubMed - indexed for MEDLINE]

1455: Indian J Chest Dis Allied Sci. 2000 Jul-Sep;42(3):189-90.

Urinothorax: a case report.

Kamble RT, Bhat SP, Joshi JM.

Department of Respiratory Medicine, T.N. Medical College, Mumbai.

A case of right sided transudative pleural effusion associated with right sided
renal calculi and moderate hydronephrosis is reported. The diagnosis of
urinothorax was confirmed by demonstrating a pleural fluid to serum creatinine
ratio of greater than one. The relief of obstructive uropathy by surgical
treatment of renal calculi resulted in resolution of the pleural effusion.

Publication Types: 
    Case Reports

PMID: 11089324 [PubMed - indexed for MEDLINE]

1456: J Urol. 2000 Dec;164(6):1895-7.

Increased prevalence and analysis of risk factors for indinavir nephrolithiasis.

Saltel E, Angel JB, Futter NG, Walsh WG, O'Rourke K, Mahoney JE.

Ottawa Hospital, General Campus, University of Ottawa, Ottawa, Ontario, Canada.

PURPOSE: Indinavir is a protease inhibitor used for treating HIV-1. The drug is
lithogenic and was thought to cause a 3% incidence of kidney stones. We evaluated
a cohort of patients positive for HIV on indinavir to determine the incidence of 
indinavir nephrolithiasis and identify risk factors for indinavir stone
formation. MATERIALS AND METHODS: Our cohort study of the prevalence of indinavir
nephrolithiasis included 155 patients with HIV for 5,732 patient-weeks. The same 
cohort was then used for a retrospective chart review to assess patient age,
weight, duration of drug use, time to stone formation, CD4 count, creatinine,
alanine transaminase, and urinary pH and specific gravity as risk factors for
stone formation. RESULTS: We estimated the cumulative incidence of indinavir
stone formation by the Kaplan-Meier product limit estimator method. At 78 weeks
43.2% of patients had stones (95% confidence interval [CI] 0.292 to 0.543).
Increasing age was the only variable that was a statistically significant
predictor of indinavair urolithiasis (relative risk 0.955, 95% CI 0.918 to 0.993,
p = 0.0159). The mean duration plus or minus standard deviation of indinavir use 
was statistically the same in each group (42.5 +/- 27. 2 and 40.3 +/- 27.1 weeks 
in those without and with stones, respectively) despite the observed mean time to
stone formation of 23.0 +/- 19.8 weeks. CONCLUSIONS: The clinical prevalence of
indinavir nephrolithiasis is much greater than initially reported.
Nephrolithiasis during indinavir use does not appear to induce patients to
withdraw from the drug.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11061951 [PubMed - indexed for MEDLINE]

1457: Int Urol Nephrol. 2000;32(1):19-27.

Kinetic versus thermodynamic factors in calcium renal lithiasis.

Grases F, Costa-Bauzá A, Königsberger E, Königsberger LC.

Laboratory of Renal Lithiasis Research, University of Illes Balears, Palma de
Mallorca, Spain. dqufgf0@ps.uib.es

Calcium renal lithiasis formation depends on the balance between thermodynamic
(supersaturation) and kinetic (inhibitors, nucleants) factors. In this paper, the
importance of both groups was evaluated using (a) the complete urine analysis
data obtained from 32 healthy volunteers and 141 active stone-formers, and (b) a 
comprehensive computer model to calculate the supersaturation values of calcium
oxalate monohydrate, hydroxyapatite and brushite in each urine sample. The
results of this evaluation were used to assess the possible effectiveness of a
given pharmacological treatment.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 11057767 [PubMed - indexed for MEDLINE]

1458: Pediatr Nephrol. 2000 Oct;14(12):1102-4.

Idiopathic hypercalciuria and hyperuricosuria: family prevalence of
nephrolithiasis.

Polito C, La Manna A, Nappi B, Villani J, Di Toro R.

Clinica Pediatrica III, Naples, Italy. bruno.nobili@unina2.it

We studied the prevalence of a history of nephrolithiasis in first- and
second-degree relatives of 74 children with hypercalciuria (HC), 61 with
hyperuricosuria (HU), and 41 with HC plus HU, and in a control population of 261 
children with different diseases. Family history of nephrolithiasis was found in 
69% of HC, 75% of HU, 78% of HC plus HU, and 22% of control patients. The
prevalence was not different among HC, HU, and HC plus HU groups, but was
significantly higher in each study group than the control group (P=0.0001). Body 
mass index >95th percentile was found in only 4.7% of the patients with HC or HC 
plus HU. Calculi (>3 mm in diameter) were present in 8.9% of the patients with a 
family history of nephrolithiasis and in 9.4% of those with no family history
(P=0.85). Microcalculi (<3 mm in diameter) were found by sonography in 56.6% of
the patients with and in 53.3% of those without a family history of
nephrolithiasis (P=0.83). Children with HC and/or HU have a strong familial
prevalence of nephrolithiasis. Obesity does not seem to affect the association of
familial nephrolithiasis and hypercalciuria in children. The presence of
nephrolithiasis in families of children with HC and/or HU is not associated with 
a higher rate of formation of calculi or microcalculi.

PMID: 11045395 [PubMed - indexed for MEDLINE]

1459: Obstet Gynecol. 2000 Nov;96(5 Pt 1):753-6.

Symptomatic nephrolithiasis complicating pregnancy.

Butler EL, Cox SM, Eberts EG, Cunningham FG.

Department of Obstetrics and Gynecology, University of Texas Southwestern Medical
Center, Dallas, Texas, USA.

OBJECTIVE: To review our experiences with diagnosis and management of symptomatic
nephrolithiasis complicating pregnancy and to ascertain the efficacy of renal
sonography for initial diagnosis compared with plain x-rays or single-shot
intravenous pyelography. METHODS: Perinatal outcomes were evaluated for all
pregnant women admitted to Parkland Hospital for nephrolithiasis from 1986 to
1999. Diagnostic studies and management of nephrolithiasis were also evaluated.
RESULTS: During the 13-year study period, 57 pregnant women had 73 admissions for
symptomatic nephrolithiasis. Symptomatic nephrolithiasis complicated 1 in 3300
(0.03%) deliveries at our institution. Only 12 women (20%) had a history of renal
calculi. Mean gestational age at diagnosis was 23 weeks. Imaging techniques
included renal ultrasonography, plain abdominal x-ray, and single-shot
intravenous pyelography. Calculi were visualized in 21 of 35 (60%) renal
ultrasonographic examinations and 4 of 7 (57%) abdominal x-ray studies when these
were performed as the initial test. In contrast, urolithiasis was discovered in
13 of 14 (93%) instances in which intravenous pyelography was performed as the
initial diagnostic test. When sonography was negative (n = 14), renal calculi
were confirmed by single-shot intravenous pyelography (n = 8). Although 43 of 57 
(75%) of symptomatic episodes responded to conservative management, 10 women
required ureteral stents, 3 needed percutaneous nephrostomy tubes, and 2
underwent ureteral laser lithotripsy for resolution. CONCLUSION: Although the
convenience and safety of ultrasonography to initially diagnose nephrolithiasis
are indisputable, 40% of calculi were missed when this method alone was used.
Thus, if nephrolithiasis is still suspected clinically despite ultrasonographic
findings, single-shot pyelography is recommended.

Publication Types: 
    Comparative Study

PMID: 11042313 [PubMed - indexed for MEDLINE]

1460: J Endourol. 2000 Sep;14(7):555-7.

CT analysis of caliceal anatomy in the supine and prone positions.

Sengupta S, Donnellan S, Vincent JM, Webb DR.

Department of Urology, Royal Melbourne Hospital and The University of Melbourne, 
Parkville, Australia.

PURPOSE: To assess the effect of patient positioning on the position of the
kidneys and their consequent projection onto plain radiographs, thus ascertaining
the need for special preoperative imaging. PATIENTS AND METHODS: Fourteen
patients were studied by obtaining fine (5-mm)-cut contrast-enhanced CT scans in 
the pyelogram phase in both the supine and prone position. The orientation of the
kidneys relative to the midsagittal plane of the body and the orientation of the 
anterior and posterior calices relative to the axis of the kidney were measured
from hardcopy images. Comparison was made between prone and supine positions for 
left and right kidneys separately, as well as overall. RESULTS: The position of
the patient had a small effect on the orientation of the kidneys, with the mean
angle changing from 56.6 degrees when supine to 61.6 degrees when prone (p <
0.05). However, no significant change in caliceal orientation or the relative
projection of the anterior and posterior calices occurred as a result.
CONCLUSION: There is no need to carry out special preoperative imaging in the
operative or prone position.

Publication Types: 
    Evaluation Studies

PMID: 11030535 [PubMed - indexed for MEDLINE]

1461: J Endourol. 2000 Sep;14(7):547-50.

Shockwave frequency affects fragmentation in a kidney stone model.

Weir MJ, Tariq N, Honey RJ.

Division of Urology, Saint Michael's Hospital and University of Toronto, Canada.

PURPOSE: To study the effect of altering shockwave frequency on the efficiency of
stone fragmentation using the MFL 5000 spark-gap lithotripter. MATERIALS AND
METHODS: Standardized solid plaster stones, 12.0 +/- 0.5 mm in diameter, were
fragmented at an energy setting of 20 kV. The shockwave frequencies tested were
60, 80, and 117 per minute. Stones were fragmented throughout the entire lifespan
of the electrode, from 0 to >100% consumption, at each frequency tested.
Electrode pressure output was studied for each frequency. RESULTS: A greater
number of shocks was required to fragment the plaster balls at higher frequencies
(regression coefficient 1.93; p < 0.003). An inverse relation was found between
the number of shocks necessary to break the stones and electrode consumption
(regression coefficient -2.16; p < 0.001). The analysis of delivered pressure
from the electrode failed to demonstrate a linear relation with frequency
(regression coefficient -0.40; p < 0.728) or consumption (regression coefficient 
-1.11; p < 0.158). CONCLUSIONS: The number of shocks required to fragment a stone
is influenced in part by the frequency at which the shockwaves are delivered.
Increasing the shockwave frequency from 60 to 117 per minute in this study caused
a significant rise in the number of shocks required to break the stone. The
pressure output of the electrode was similar at the frequencies tested, thus
making the difference in stone fragmentation secondary to the mechanism of stone 
disintegration and not the function of the electrode.

PMID: 11030533 [PubMed - indexed for MEDLINE]

1462: J Urol. 2000 Nov;164(5):1486-9.

Comment in:
    J Urol. 2001 Jul;166(1):219.

Higher urinary potassium is associated with decreased stone growth after shock
wave lithotripsy.

Pierratos A, Dharamsi N, Carr LK, Ibanez D, Jewett MA, Honey RJ.

Department of Medicine, Humber River Regional Hospital, Toronto, Ontario, Canada.

PURPOSE: We correlated serum and urinary biochemical parameters with radiological
evidence of stone growth after shock wave lithotripsy. MATERIALS AND METHODS:
Biochemical parameters in serum and 24-hour urine collections of 359 patients
were correlated with stone growth for 2 years after shock wave lithotripsy. Each 
patient underwent a minimum of 2 radiological studies at 3 and 12 months and
plain abdominal x-ray at 24 months. The presence and size of stones were
documented by a radiologist in blinded fashion. Stone growth was defined as
measurable growth of a preexisting stone or new stone formation. RESULTS: A total
of 209 patients remained stone-free or had no existing stone growth, while stone 
size decreased in 30. Of the remaining 120 patients with stone growth 72 had new 
growth and 48 had growth of preexisting stones. Urinary excretion of potassium
was significantly higher in those without than with stone growth (mean 24-hour
urine collection plus or minus standard deviation 62 +/- 27 versus 54 +/- 23
mmol., p = 0.009). The only parameter significantly associated with stone growth 
was urinary potassium. Linear regression revealed that for each 10 unit increase 
in urinary potassium there was a corresponding 2 mm. decrease in stone growth (p 
= 0.013). CONCLUSIONS: Our results indicate that increased urinary potassium
excretion correlates with a decreased risk of stone growth up to 2 years after
shock wave lithotripsy, implying that a high potassium diet may be beneficial for
preventing stone growth. The effect of potassium supplementation on stone
formation and growth must be investigated further.

PMID: 11025688 [PubMed - indexed for MEDLINE]

1463: Hepatogastroenterology. 2000 Jul-Aug;47(34):1162-3.

Common bile duct and pancreatic injury after extracorporeal shock wave
lithotripsy for renal stone.

Hung SY, Chen HM, Jan YY, Chen MF.

Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.

Common bile duct and pancreatic injury are rare complications following
extracorporeal shock wave lithotripsy. We reported a case of peripancreatic
abscess with inflammation change of common bile duct and pancreatic head
following extracorporeal shock wave lithotripsy for right renal stone. Its
anatomical location and subsequent clinical course suggest it was related to
trauma caused by the shock wave. It should be considered a relative
contraindication to apply extracorporeal shock wave lithotripsy in cases of right
renal stone associated with large gall stones.

Publication Types: 
    Case Reports

PMID: 11020904 [PubMed - indexed for MEDLINE]

1464: Exp Nephrol. 2000 Nov-Dec;8(6):351-60.

Molecular pathology of renal chloride channels in Dent's disease and Bartter's
syndrome.

Thakker RV.

Molecular Endocrinology Group, University of Oxford, John Radcliffe Hospital,
Headington, Oxford, Oxon, UK. rajesh.thakker@ndm.ox.ac.uk

Recent advances in molecular biology have characterised a new class of chloride
channels that are referred to as voltage-gated chloride channels (CLCs). To date 
9 such CLCs (CLC-1 to CLC-7, CLC-Ka and CLC-Kb which are respectively encoded by 
the genes CLCN1 to CLCN7, CLCNKa and CLCNKb) have been identified in mammals.
Mutations in 2 of these, referred to as CLC-5 and CLC-Kb, have been defined in
the hypercalciuric nephrolithiasis disorders of Dent's disease and a form of
Bartter's syndrome, respectively. In addition, other forms of Bartter's syndrome 
have been defined with mutations involving the bumetanide-sensitive
sodium-potassium-chloride co-transporter (NKCC2) and the potassium channel ROMK. 
Finally, mutations of the thiazide-sensitive sodium chloride co-transporter
(NCCT) are associated with Gitelman's syndrome, in which hypocalciuria and
hypomagnesaemia are notable features. These molecular genetic studies have
increased our understanding of the renal tubular mechanisms that regulate mineral
homeostasis. Copyright 2000 S. Karger AG, Basel

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 11014932 [PubMed - indexed for MEDLINE]

1465: Nephrol Dial Transplant. 2000 Oct;15(10):1580-7.

Determinants of urinary excretion of Tamm-Horsfall protein in non-selected kidney
stone formers and healthy subjects.

Glauser A, Hochreiter W, Jaeger P, Hess B.

Section of General Internal Medicine and. Department of Urology, Nephrology and
Rheumatology, University Hospital, Berne, Switzerland.

BACKGROUND: The aim of the study was to measure urinary excretion of
Tamm-Horsfall protein (THP), an important inhibitor of crystallization, and to
identify possible determinants of urinary THP excretion in non-selected kidney
stone formers (SF) and healthy subjects (C). METHODS: By means of a commercially 
available ELISA (Pharmacia and Upjohn/Elias, Germany), we measured THP in 24-h
urines of 104 SF (74 males/30 females, age 16-74 years) who had formed 8.7+/-2.4 
stones (range 1-240), and of 71 C (41 males/30 females, age 22-62 years). Types
of stones formed by SF were 88 calcium, eight uric acid, six infection, and two
cystine. All values are means+/-SE. RESULTS: The normal range (5th to 95th
percentile) of U(THP)xV was 9.3-35.0 mg/day in males and 9.0-36.3 mg/day in
females respectively. Mean U(THP)xV was 21.3+/-1.2 mg/day (range 3. 4-51.6) in
male and 15.2+/-1.6 mg/day (range 1.8-32.3) in female SF (P=0.008 vs male SF).
Since U(THP)xV was positively correlated with C(Crea) (r=0.312, P=0.001) in SF as
well as with U(Crea)xV (r=0.346, P=0.0001) and with body surface (r=0.271,
P=0.0003) in all study subjects, mean THP/Crea (mg/mmol) was used for all further
calculations. Overall, THP/Crea was lower in SF (1.42+/-0.07 vs 1. 68+/-0.08,
P:=0.015), mainly due to increased THP/Crea in female C (2.08+/-0.11, P=0.0036 vs
female SF, P=0.0001 vs male C and vs male calcium SF), which also explains
decreased THP/Crea values in calcium SF (1.46+/-0.08, P=0.041 vs C). In addition,
THP/Crea was reduced in uric acid SF (1.11+/-0.21, P=0.049 vs C). Whereas
THP/Crea was not related to age, urine volume, intake of dairy calcium, or
urinary markers of protein intake, either in C or in SF, it correlated
significantly with urinary Citrate/Crea, both in C (r=0.523, P=0.0001) and in SF 
(r=0.221, P=0.025). In C only, but not in SF, THP/Crea was correlated with
urinary Calcium/Crea (r=0. 572, P=0.0001) and with Oxalate/Crea (r=0.274,
P=0.022). CONCLUSIONS: Both in C and SF, urinary THP excretion is related to body
size, renal function and urinary citrate excretion, whereas dietary habits
apparently do not affect THP excretion. Uric acid and calcium stone formation
predict reduced THP excretion in comparison with C, whereas female gender goes
along with increased urinary THP excretion in C. Possibly most relevant to kidney
stone formation is the fact that THP excretion rises only in C in response to
increasing urinary calcium and oxalate concentrations, whereas this
self-protective mechanism appears to be missing in SF.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 11007825 [PubMed - indexed for MEDLINE]

1466: South Med J. 2000 Sep;93(9):933-5.

Cutaneous nephrocolonic fistula as a consequence of a kidney stone.

van Wessem KJ, van Brummelen NH, Lange JF.

Department of General Surgery and Urology, St Clara Hospital, Rotterdam, The
Netherlands.

We report an unusual case of cutaneous nephrocolonic fistula caused by a renal
calculus with perirenal infection. The diagnosis was made by fistulography and
computed tomography, after which nephrectomy and resection of the descending
colon were successful. We also review the literature on cutaneous nephrocolonic
fistulas.

Publication Types: 
    Case Reports
    Review

PMID: 11005361 [PubMed - indexed for MEDLINE]

1467: Eur J Radiol. 2000 Oct;36(1):16-9.

A new cause of curvilinear renal calcification: calcified hydrocalycosis.

Atakan IH, Pekindil G, Alagöl B, Inci O.

Department of Urology, Trakya University School of Medicine, 22030, Edirne,
Turkey.

Although many causes of curvilinear renal calcifications have been described,
calcified hydrocalycosis mimicking hydatid cyst has not previously been reported.
We report a case of hydrocalycosis which was appeared as a curvilinear calcified 
cystic lesion resulted from staghorn calculus associated with xanthogranolomatous
pyelonephritis (XGPN) on intravenous pyelography (IVU) and computed tomography
(CT).

Publication Types: 
    Case Reports

PMID: 10996753 [PubMed - indexed for MEDLINE]

1468: J Vet Med Sci. 2000 Aug;62(8):889-92.

Medical dissolution of struvite nephrolithiasis using amino acid preparation in
dogs.

Mishina M, Watanabe T, Fujii K, Maeda H, Wakao Y.

Department of Surgery, School of Veterinary Medicine, Azabu University, Kanagawa,
Japan.

A new chemolytic therapy with amino acid preparation was tried for use on
struvite renal stones in two dogs, which were admitted to Azabu University
Veterinary Teaching Hospital. No other special diet, for the purpose of
dissolving the stones, was fed during the treatment. Dissolution of the stones
began at week 1, and no stone was detected on radiography at week 4 in both
cases. The amino acid preparation thereafter has been administered every 2-3 days
to prevent formation of the stones. After 6 months from treatment, complete
dissolution was confirmed, and no relapse has been observed. Therefore, it is
concluded that chemolytic therapy with amino acid preparation might be useful for
the treatment of nephrolithiasis with struvite renal stones in dogs.

Publication Types: 
    Case Reports

PMID: 10993187 [PubMed - indexed for MEDLINE]

1469: Clin Radiol. 2000 Sep;55(9):708-10.

Comment in:
    Clin Radiol. 2001 Sep;56(9):783.    Clin Radiol. 2002 Feb;57(2):151.

The role of the plain radiograph and renal tract ultrasound in the management of 
children with renal tract calculi.

Smith SL, Somers JM, Broderick N, Halliday K.

Department of Radiology, Nottingham City Hospital, Hucknall Road, Nottingham.

AIMS: The aim of this retrospective study was to assess the relative efficacy of 
plain abdominal radiographs and detailed renal tract ultrasound (US) examination 
in the diagnosis and follow-up of children with renal tract calculi. METHODS: The
records and imaging studies of 28 paediatric patients who had presented with
proven renal tract calculi over a period of 5 years were examined. RESULTS: In 23
(82%) patients, US was the first investigation. All these patients also had plain
radiographs. Plain radiographs were the first investigation in five (18%)
patients. All renal calculi (100%) visible on plain films were demonstrated on
US. Furthermore, detailed US often provided other clinically significant findings
that were not apparent on plain films. CONCLUSION: As a result of this study it
is recommend that detailed US should be the investigation of choice in children
with suspected renal tract calculi.

Publication Types: 
    Comparative Study

PMID: 10988050 [PubMed - indexed for MEDLINE]

1470: Osteoporos Int. 2000;11(6):486-92.

Risk of calcium oxalate nephrolithiasis after calcium or combined calcium and
calcitriol supplementation in postmenopausal women.

Domrongkitchaiporn S, Ongphiphadhanakul B, Stitchantrakul W, Piaseu N,
Chansirikam S, Puavilai G, Rajatanavin R.

Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand. rasdr@mahidol.ac.th

Although calcium supplementation can cause hypercalciuria, the risk of
nephrolithiasis has been shown to decrease rather than increase among subjects
who had a higher calcium intake. Hypercalciuria is also a well-established side
effect of calcitriol administration. However, the risk of nephrolithiasis is not 
well defined. The present study was undertaken to prospectively determine the
effect of calcium with or without calcitriol on physicochemical risk factors
associated with calcium oxalate nephrolithiasis in Thai postmenopausal women with
osteoporosis. Subjects consisted of 53 Thai women more than 10 years
postmenopausal who were randomly allocated to receive 750 mg of calcium carbonate
supplement alone (n = 28) or 750 mg of calcium carbonate plus 0.5 microg
calcitriol (n = 25) daily. Mean +/- SEM for age was 65.3+/-1.1 years, body weight
53.5+/-1.3 kg. Urine samples for biochemical assays were collected at baseline
and 3 months after treatment. Supersaturation for calcium oxalate stone formation
was assessed from the 24 h urine constituents by the Tiselius's index, AP(CaOx). 
Three months of calcium supplement alone resulted in a modest, but not
significant, increase in urinary calcium (baseline, 2.90+/-0.43 mmol/day; after
treatment 3.58+/-0.54 mmol/day) with no change in urinary oxalate, citrate or
magnesium. In contrast, calcium together with calcitriol caused a significant
increase in urinary calcium (baseline, 2.87+/-0.41 mmol/day; after treatment,
4.08+/-0.57 mmol/day; p < 0.05). No significant change in other urine
constituents after treatment with calcium and calcitriol was detected. Therefore,
AP(CaOx) did not significantly increase either after calcium alone (baseline,
1.17+/-0.39; after treatment, 1.36+/-0.28) or after calcium plus calcitriol
(baseline, 1.09+/-0.17; after treatment, 1.09+/-0.19). However, after treatments,
12 subjects (23%)--6 receiving calcium supplement alone and 6 receiving calcium
plus calcitriol supplement--had high AP(CaOx) values (greater than the upper
limit of 95% Cl for AP(CaOx) derived from non-stone-forming Thai women). The
post-treatment/baseline ratio was 3.21+/-0.74 for urinary calcium, 1.01+/-0.19
for urinary oxalate, and 2.23+/-0.42 (median 1.15) for AP(CaOx). The
post-treatment/baseline ratio of calcium, but not for urinary oxalate, had a
significant correlation with the post-treatment/baseline ratio of AP(CaOx). Our
findings suggest that the alteration in the risk of calcium oxalate
nephrolithiasis based on urinary composition is related to the alteration in
urinary calcium. The risk of calcium oxalate nephrolithiasis does not increase
significantly after calcium or combined calcium and calcitriol supplement in the 
majority of postmenopausal women with osteoporosis.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10982163 [PubMed - indexed for MEDLINE]

1471: Nephrol Dial Transplant. 2000 Sep;15(9):1388-93.

Abnormal arachidonic acid content of red blood cell membranes and main lithogenic
factors in stone formers.

Messa P, Londero D, Massarino F, Paganin L, Mioni G, Zattoni F, Cannella G.

Nephrology and Dialysis Division, Ospedale S. Martino, Genova, Italy.
pmessa@smartino.ge.it

BACKGROUND: Increased arachidonic acid content in red blood cell membranes of
stone formers (SF) has recently been reported and is hypothesized as representing
the underlying causal factor for both hyperoxaluria and hypercalciuria. We
performed the present study to see whether we could confirm this finding and to
test whether any relationship exists between the fatty acid composition of red
blood cell membranes and the main metabolic factors involved in stone formation. 
METHODS: In 21 SF and 40 healthy controls subjects the fatty acid composition of 
red blood cell membranes was assessed. In addition, the following parameters were
evaluated in SF: daily and fasting urinary calcium excretion, fractional
intestinal calcium absorption, 1,25-dihydroxy-vitamin D, intact parathyroid
hormone, hydroxyproline in fasting urine, daily urinary excretion of oxalate,
citrate, urate, electrolytes, urea, sulphate, relative supersaturation for
calcium oxalate monohydrate. RESULTS: The red blood cell membrane of SF had a
lower content of arachidonic acid, linoleic acid, and docosahexaenoic acid than
that of control subjects. Arachidonic acid content was not correlated with any of
the parameters studied. However, when patients were grouped according to the
degree of oxalate excretion, hyperoxaluric SF had a higher arachidonic acid
content and arachidonic/linoleic acid ratio than SF with normal oxalate
excretion. CONCLUSIONS: Our results do not confirm the finding of an increased
arachidonic acid content of red blood cell membrane in SF. On the contrary,
reduced arachidonic acid levels were found in our patients. However,
hyperoxaluric SF had a relatively higher arachidonic acid content than SF with
normal urinary oxalate excretion.

PMID: 10978396 [PubMed - indexed for MEDLINE]

1472: Mol Cell Biochem. 2000 Jul;210(1-2):109-19.

Role of biomolecules from human renal stone matrix on COM crystal growth.

Aggarwal S, Tandon CD, Forouzandeh M, Singla SK, Kiran R, Jethi RK.

Department of Biochemistry, Panjab University, Chandigarh, India.

Human renal calculi surgically removed from kidney stone patients were obtained
and chemically analysed. Stones with CaOx (calcium oxalate) as the major
component were washed in 0.15 M NaCl with gentle stirring for 48 h and then
pulverised to a fine powder. The powder was extracted with 0.05 M EGTA, 1 mM PMSF
and 1% beta-mercaptoethanol for 4 days at 4 degrees C, the suspensions and the
supernatants obtained were filtered through an Amicon Model 200 apparatus (mol.
wt. cut off of 10,000 daltons) under nitrogen at 40 p.s.i. and concentrated to a 
known volume. The method of Nakagawa et al. [7] was employed to study the ability
of > 10 kDa fractions to influence COM growth using metastable solution of CaCl2 
and Na2C2O4 containing traces of 14C-oxalic acid. Potent biomolecules having the 
ability to influence CaOx precipitation were subjected to isolation, purification
and characterization. Standard biochemical procedures, e.g. ultracentrifugation, 
ion-exchange chromatography, molecular sieve chromatography and SDS-PAGE, etc.,
were employed. Results revealed that human renal calculi extract contains
biomolecules that can inhibit as well as stimulate the growth of preformed COM
(calcium oxalate monohydrate) crystals. Most potent stimulator of CaOx growth was
found to have a molecular weight of 66 kDa.

PMID: 10976764 [PubMed - indexed for MEDLINE]

1473: Am J Kidney Dis. 2000 Sep;36(3):615-25.

Role of macrophages in nephrolithiasis in rats: an analysis of the renal
interstitium.

de Water R, Noordermeer C, Houtsmuller AB, Nigg AL, Stijnen T, Schröder FH, Kok
DJ.

Departments of Experimental Urology, Pathology, and Epidemiology & Biostatistics,
Faculty of Medicine, Erasmus University, The Netherlands. dewater@uro.fgg.eur.nl

Interstitial calcium oxalate (CaOx) crystals can be found in primary oxalosis and
in secondary hyperoxaluria. In a rat model for nephrolithiasis, we investigated
whether such crystals can be removed by the surrounding interstitial cells. CaOx 
crystals were induced by a crystal-inducing diet based on ethylene glycol (EG)
and ammonium chloride (CID). Both lithogenic compounds were added to the drinking
water. After 9 days, the animals received normal drinking water for 2 days. Using
this CID, only the interstitial crystals are retained. Subsequently, half of the 
population remained on normal drinking water (normo-oxaluria), whereas the other 
half received a low dose of EG alone (chronic hyperoxaluria). The rats were
killed at regular times thereafter. The results showed that the kidney-associated
oxalate significantly declined during normo-oxaluria, but remained high during
chronic hyperoxaluria. Interstitial cells positive for the leukocyte common
antigen (CD45; which identifies all types of leukocytes), the ED1 antigen (which 
is specific for monocytes and macrophages), and the major histocompatibility
class II antigen (MCHII), respectively, had increased in number, with minor
differences between both rat populations. The cells around the interstitial
crystals were mostly positive for ED1. Multinucleate giant cells were regularly
observed. These cells were positive for CD45 and ED1 and sometimes also for
MCHII. The crystals in these cells were moderately positive for acid phosphatase 
and carbonic anhydrase II. It is concluded that interstitial CaOx crystals can be
removed under normo-oxaluric conditions and that, in all likelihood, macrophages 
and multinucleate giant cells are involved in that process.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10977795 [PubMed - indexed for MEDLINE]

1474: Kidney Int. 2000 Sep;58(3):1278-84.

Plasma phospholipid arachidonic acid content and calcium metabolism in idiopathic
calcium nephrolithiasis.

Baggio B, Budakovic A, Nassuato MA, Vezzoli G, Manzato E, Luisetto G, Zaninotto
M.

Division of Nephrology, Department of Medical and Surgical Sciences, University
of Padua, Italy. Bbaggio@ux1.unipd.it

BACKGROUND: Reports of an increase in plasma and erythrocyte phospholipid
arachidonic acid content and in urinary prostaglandin E2 (PGE2) excretion in
patients with idiopathic calcium nephrolithiasis suggested their crucial role in 
the pathogenesis of hypercalciuria, a well-known risk factor for lithogenesis.
METHODS: To confirm this hypothesis, 15 healthy subjects and 20 nephrolithiasis
patients were evaluated for plasma phospholipid polyunsaturated fatty acid
content and PGE2 concentration, serum parathyroid hormone, 25 hydroxyvitamin D3, 
1, 25-dihydroxyvitamin D3, and bone-specific alkaline phosphatase levels, as well
as urinary excretion of calcium, biochemical markers of bone resorption
(hydroxyproline and crossLaps), and intestinal calcium absorption. Furthermore,
the effect of a 30-day fish-oil diet supplementation on the previously mentioned 
parameters was investigated in the patients. RESULTS: At baseline, patients
compared with controls showed higher levels of plasma phospholipid arachidonic
acid content (P = 0.002), PGE2 (P = 0.0004), serum 25-vitamin D3 (P = 0.001), and
1,25-vitamin D3 (P = 0.001), urinary excretion of calcium (P = 0.001),
hydroxyproline (P = 0.007), and crossLaps (P = 0.019), as well as intestinal
calcium absorption (P = 0.03 at 60 min). Fish oil supplementation induced a
reduction in the plasma phospholipid arachidonic acid level (P < 0.0001), and
except for serum concentrations of 25-vitamin D3, normalized baseline blood and
urinary parameters, including intestinal calcium absorption. A close correlation 
between plasma PGE2 and serum 1,25-vitamin D3 (P = 0.004) and between
phospholipid arachidonic acid and intestinal calcium absorption (P = 0.0002) and 
calciuria (P = 0.007) was observed, as well as between urine excretion of
crossLaps and hydroxyproline (P < 0.0001), crossLaps and calcium (P < 0.0001),
and hydroxyproline and calcium (P < 0.0001). CONCLUSIONS: These findings indicate
that the phospholipid arachidonic acid content anomaly could represent the
primary event responsible for the mosaic of metabolic and clinical alterations
that are distinctive features of renal stone formers, and suggest that a common
pathogenetic mechanism might account for the several forms of hypercalciuria
detected in idiopathic calcium nephrolithiasis.

PMID: 10972691 [PubMed - indexed for MEDLINE]

1475: Clin Nephrol. 2000 Aug;54(2):85-93.

High sodium chloride intake is associated with low bone density in calcium
stone-forming patients.

Martini LA, Cuppari L, Colugnati FA, Sigulem DM, Szejnfeld VL, Schor N, Heilberg 
IP.

Nephrology Division, Universidade Federal de São Paulo, EPM, Brasil.

BACKGROUND: Although renal stone disease has been associated with reduced bone
mass, the impact of nutrient intake on bone loss is unknown. SUBJECTS AND
METHODS: The present study was undertaken to investigate the influence of
nutrient intake on bone density of 85 calcium stone-forming (CSF) patients (47
male and 38 premenopausal females) aged 41+/-11 years (X+/-SD). Bone mineral
density (BMD) was measured using dual energy X-ray absorptiometry at the lumbar
spine (L2-L4) and femoral neck sites, and low BMD was defined as a T score < -1
(WHO criteria). A 4-day dietary record and a 24-hour urine sample were obtained
from each patient for the assessment of nutrient intake and urinary calcium
(U(Ca)), sodium (U(Na)), phosphate and creatinine excretion. RESULTS: Forty-eight
patients (56%) presented normal BMD and 37 (44%) low BMD. There were no
statistical differences regarding age, weight, height, body mass index, protein, 
calcium and phosphorus intakes between both groups. The mean U(Ca), phosphorus
and nitrogen appearance also did not differ between groups. However, there was a 
higher percentage of hypercalciuria among low vs normal BMD patients (62 vs 33%, 
p < 0.05). Low BMD patients presented a higher mean sodium chloride (NaCl) intake
and excretion (UNa) than normal BMD (14+/-5 vs 12+/-4 g/day and 246+/-85 vs
204+/-68 mEq/day, respectively p < 0.05). The percentage of patients presenting
NaCl intake > or = 16 g/day was also higher among low vs normal BMD patients (35 
vs 12%, p < 0.05). After adjustment for calcium and protein intakes, age, weight,
body mass index, urinary calcium, citrate and uric acid excretion, and duration
of stone disease, multiple-regression analysis showed that a high NaCl intake (> 
or = 16 g/day) was the single variable that was predictive of risk of low bone
density in CSF patients (odds ratio = 3.8). CONCLUSION: These data suggest that
reducing salt intake should be recommended for CSF patients presenting
hypercalciuria and osteopenia.

PMID: 10968683 [PubMed - indexed for MEDLINE]

1476: Panminerva Med. 2000 Jun;42(2):119-22.

Iodinated contrast media induced oxidative stress status in patients undergoing
urography.

Rajbala, Sane AS, Upadhyay AR, Mishra VV, Trivedi HL.

Department of Laboratory Medicine (Biochemistry), Civil Hospital Campus, Asarva, 
Ahmedabad, India. ikdrc@vsnl.com

BACKGROUND: The present investigation is an extension of our earlier work on
oxidative stress in a number of clinical situations and awareness of potential
toxicity of contrast media. It was of interest to understand the relative safety 
(in terms of balance between oxidants/antioxidants) of the usage of iodinated
contrast media in urography. METHODS: Alterations in serum levels of oxidant
lipid peroxidation and product malondialdehyde (MDA) and components of
anti-oxidant have been studied in 125 patients (with renal calculus disease) to
undergo intravenous urographic procedure before and 3 hours following intravenous
administration of Trivideo-400 (Iothalmate Sodium 40 ml: 18 gm Iodine) and
results of serum levels of MDA (nmol/ml), SOD (mu/ml), Vit-C and Vit-E (mg/dl)
were also compared with 135 appropriately age matched controls. RESULTS: The
salient features of present investigation indicated definite pattern viz.
Significant rise in serum levels of oxidant MDA (4.35 +/- 2.05) and fall in SOD
(3.04 +/- 1.04), Vit-C (0.55 +/- 0.17), Vit-E (0.67 +/- 0.20) in patients at
pre-IVU stage in comparison with those of controls viz MDA (4.35 +/- 2.05), SOD
(3.77 +/- 1.55), Vit-C (0.71 +/- 0.25) and Vit-E (0.80 +/- 0.30). There occurred 
further elevation in serum levels of MDA (5.28 +/- 2.48) and fall in SOD (3.07
+/- 0.97), Vit-C (0.52 +/- 0.16), Vit-E (0.66 +/- 0.19) showing no significant
alterations 3 hours following intravenous IVU procedure. CONCLUSIONS: It is
concluded that contrast media induced changes did remain within tolerable
physiological limits and no significant changes in anti-oxidant components Vit-E 
and SOD were suggestive of relative safety of iodinated contrast media usage.

PMID: 10965773 [PubMed - indexed for MEDLINE]

1477: Urol Int. 2000;65(1):46-8.

Three-dimensional CT scan stone reconstruction for the planning of percutaneous
surgery in a morbidly obese patient.

Buchholz NP.

Erasmus UROlogical Stone Treatment And Research Rotterdam (EUROSTARR), Department
of Urology, Erasmus University, Rotterdam, The Netherlands. nielspeter@yahoo.com

A three-dimensional spiral CT (3D CT) reconstruction of staghorn stones provides 
a precise picture of its extent and branching within the kidney. The author
reports a case of a large renal staghorn stone in a morbidly obese woman, further
complicated by malrotation and hypermobility of the kidney. Two-dimensional plain
CT was unable to provide sufficient information for a safe percutaneous approach.
This was achieved by means of 3D CT, which also was very helpful during the
procedure. Although 3D CT should by no means be routinely employed, it is a
valuable tool for pretreatment decision-making and intraoperative orientation in 
selected cases. Copyright 2000 S. Karger AG, Basel

Publication Types: 
    Case Reports

PMID: 10965302 [PubMed - indexed for MEDLINE]

1478: Scand J Urol Nephrol. 2000 Jun;34(3):162-4.

Urinary phytate in calcium oxalate stone formers and healthy people--dietary
effects on phytate excretion.

Grases F, March JG, Prieto RM, Simonet BM, Costa-Bauzá A, García-Raja A, Conte A.

Laboratory of Renal Lithiasis Research, University of Balearic Islands, Palma de 
Mallorca, Spain. dqufgf0@ps.uib.es

The phytate urinary levels in a group of active calcium oxalate stone formers
were studied and compared with those found in healthy people. Urinary phytate was
significantly lower for stone formers. If deficit of the capacity to inhibit
crystallization of calcium salts is considered an important factor related to
calcium stone formation, the excretion of low phytate amounts could be an
important risk factor in the development of this type of renal calculi. The
influence of dietary phytate on urinary excretion was also studied. Clearly
maintenance of a phytate-free diet significantly decreased the urinary excretion 
of phytate (about 50% after 36 h). This demonstrated the importance of dietary
phytate in maintaining adequate urinary levels to permit effective
crystallization inhibition of calcium salts and consequently preventing renal
stone development.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 10961468 [PubMed - indexed for MEDLINE]

1479: J Endourol. 2000 Jun;14(5):439-41.

Successful management of a large xanthine calculus by percutaneous
nephrolithotomy after failed SWL in a 5-year-old boy.

Peréz LM, Netto JM, Batista LR, Burns JR.

Department of Surgery, University of Alabama at Birmingham Children's Hospital,
35233, USA.

A 5-year-old child with a xanthine calculus resistant to SWL was made stone free 
by percutaneous ultrasonic lithotripsy.

Publication Types: 
    Case Reports

PMID: 10958567 [PubMed - indexed for MEDLINE]

1480: J Endourol. 2000 Jun;14(5):419-21.

Minipercutaneous nephorlithotomy.

Monga M, Oglevie S.

Division of Urology, University of California, San Diego 92103-8897, USA.
mmonga@ucsd.edu

PURPOSE: To evaluate the safety and efficacy of a minipercutaneous
nephrolithotomy procedure (mini-PCNL) through a 20F sheath. PATIENTS AND METHODS:
Twenty-one patients underwent a mini-PCNL from October 1997 to October 1999. The 
mean number of calculi was 1.8 (range 1-9). The mean cross-sectional area of the 
stone burden was 2.8 cm2 (range 0.72-6.5 cm2). Nephrostomy tract dilation was
performed with an 18F Cook Omega or Pursuit balloon dilation catheter (6-mm
diameter, 10-cm length; 12 or 14 atm, respectively), and a 20F nephrostomy sheath
was advanced over the inflated balloon. RESULTS: The mean operative time was 54
minutes. The mean decrease in hematocrit was 3.4%, and no patient required a
blood transfusion. The mean percutaneous tube duration was 22 hours. The mean
hospital stay was 1.1 days. The single-procedure stone-free rate was 90%. Two
patients underwent successful SWL of residual middle-caliceal calculi that could 
not be accessed through the existing tract. There were no major complications,
but there was one episode of prolonged fever secondary to atelectasis. Five
patients remain free of radiographic or symptomatic recurrence after antegrade
endopyelotomy for ureteropelvic junction obstruction after a mean of 11 months'
follow-up. CONCLUSIONS: By using a 20F sheath rather than the traditional 30F
sheath, we decreased the volume of renal parenchyma that is dilated by 56%. This 
change appears to decrease perioperative bleeding and pain as well as parenchymal
scarring.

PMID: 10958563 [PubMed - indexed for MEDLINE]

1481: J Endourol. 2000 Aug;14(6):507-10.

Metabolic and urinary risk factors associated with Randall's papillary plaques.

Low RK, Stoller ML, Schreiber CK.

Department of Urology, University of California Davis, USA.

BACKGROUND AND PURPOSE: Increasing evidence suggests that Randall's plaques
contribute to the pathogenesis of urinary stone formation. The purpose of our
study was to evaluate the urinary risk factors of stone patients who underwent
endoscopic mapping of their calices for Randall's plaques. PATIENTS AND
MATERIALS: Patients (N = 143) having endoscopic procedures to remove upper tract 
calculi or for other purposes underwent mapping of their calices for Randall's
plaques. Plaque incidence and pattern were correlated with the stone composition 
and urinary risk factors found on subsequent metabolic evaluation. RESULTS:
Papillary plaques were found more commonly in patients having calcium oxalate
stones than in patients with other stone types and patients without a history of 
stones. Papillary plaque incidence and pattern did not correlate with any
specific urinary risk factor; however, patients with plaques tended to exhibit a 
higher incidence of all risk factors. Plaque severity tended to be greater in
patients exhibiting hypercalciuria. CONCLUSIONS: Randall's plaques are found most
frequently in patients with calcium oxalate stones and are most important in the 
pathogenesis of calcium oxalate nephrolithiasis. Stone patients with papillary
plaques are more likely to exhibit abnormalities in their urinary milieu than are
patients without papillary plaques.

PMID: 10954308 [PubMed - indexed for MEDLINE]

1482: J Endourol. 2000 Aug;14(6):501-5.

Use of water jet resection in organ-sparing kidney surgery.

Basting RF, Djakovic N, Widmann P.

Department of Urology and Pediatric Urology, Kreiskrankenhaus, Alt, Neuötting,
Germany. dr.basting@t-online.de

BACKGROUND AND PURPOSE: The morbidity of organ-sparing renal surgery is related
to intraoperative hemorrhaging and secondarily to urinary fistulae and urinoma.
Various tools have been developed for gentle transection and precise control of
bleeding. Water jet technology is already established in clinical practice for
surgery of the liver and other parenchymatous organs. We report our clinical
experience with a new water jet resection device in kidney surgery and the
histologic effects of water jet resection on kidney tissue. PATIENTS AND METHODS:
A series of 24 patients underwent open surgery for renal-cell carcinoma,
nephrolithiasis, complicated cysts, or oncocytoma. In tumor patients, a partial
nephrectomy; in two stone patients, a nephrolithotomy; and in the third stone
patient, a lower-pole resection were performed. The cysts and the oncocytoma were
enucleated in toto. In one patient, an endoscopic pyeloplasty was performed
because of ureteropelvic stenosis. Tissue samples were investigated
histologically using standard light microscopy after hematoxylin-eosin staining
and compared with those subjected to thermal dissection techniques. RESULTS: The 
water jet produced a corridor in the desired dissection line without interfering 
with the intrarenal vessels and pelvicalical system. This way, precise hemostasis
was possible, and damages to the surrounding tissue was avoided. Resection took
between 14 and 40 minutes with minimal intraoperative blood loss. No significant 
postoperative complications occurred. Histologic evaluation demonstrated a sharp 
dissection line without thermal alterations or deep necrosis. Only a small
disruption zone could be seen at the margins of the dissection. CONCLUSIONS:
Water jet resection is a gentle method for dissection of kidney tissue.
Histologic examination confirmed minimal traumatic parenchymal alteration. In our
opinion, the water jet dissector is a useful device for renal transection in
organ-sparing kidney surgery.

PMID: 10954307 [PubMed - indexed for MEDLINE]

1483: J Endourol. 2000 Aug;14(6):489-92.

Ureteroscopic management of recurrent renal cystine calculi.

Kourambas J, Munver R, Preminger GM.

Department of Surgery, Duke University Medical Center, Durham, North Carolina
27710, USA.

BACKGROUND AND PURPOSE: Patients with recurrent cystine nephrolithiasis
oftentimes require multiple procedures for stone removal. As the majority of
cystine stones are resistant to the effects of shockwave lithotripsy, repeat
percutaneous surgery is often required and may cause renal damage. Moreover,
repeat percutaneous access may become more difficult as perinephric fibrosis
develops. Small-caliber ureteroscopes along with the holmium laser now enable
routine intrarenal ureteroscopic access to symptomatic renal stones. Herein, we
present our experience in managing recurrent renal cystine calculi using flexible
ureterorenoscopy and assess whether such an approach may be used as an
alternative to percutaneous surgery in selected patients. PATIENTS AND METHODS:
Three patients with large-volume (mean diameter 22 mm) renal cystine stones were 
managed with a 7.5F flexible ureterorenoscope combined with holmium laser
lithotripsy to fragment the stones completely. RESULTS: The mean treatment time
was 97 minutes, with successful fragmentation in all cases. Two of the three
patients were completely stone free on follow-up intravenous urography, with the 
third patient having only small-volume residual fragments in a lower pole calix. 
All patients are currently asymptomatic and are being maintained on high oral
fluid intake, urinary alkalization with potassium citrate, and
alpha-mercaptopropionylglycine to reduce urinary cystine excretion. CONCLUSION:
Flexible ureterorenoscopy with holmium laser lithotripsy provides a reasonable
alternative for the management for recurrent cystine calculi in patients who are 
not candidates for repeat percutaneous procedures. Although it is time consuming,
complete stone fragmentation, along with clearance of fragments, can be achieved 
in the majority of patients.

PMID: 10954304 [PubMed - indexed for MEDLINE]

1484: J Endourol. 2000 Aug;14(6):479-81.

To stent or not to stent? That is still the question.

Rane A, Cahill D, Larner T, Saleemi A, Tiptaft R.

Department of Urology, Guy's Hospital, London, UK.

BACKGROUND AND PURPOSE: Most patients are stented after ureteroscopy for stone
extraction. This practice necessitates a second procedure to remove the stent,
with its inherent morbidity. The aim of our study was to determine whether
routine stenting of the ureter is really necessary after ureteroscopy. PATIENTS
AND METHODS: This prospective study evaluated 26 men and 18 women admitted for
elective distal ureteral stone fragmentation. The stones ranged in size from 6 mm
to 1 cm. Of the series, 16 patients (10 men) had been stented prior to
ureteroscopy. A 9F semirigid ureteroscope was used in 31 cases, and a 7.5F
semirigid ureteroscope was used in the other 11 cases; there was no need for
ureteral orifice dilatation with either ureteroscope. Ballistic intracorporeal
lithotripsy was performed in all cases with the Swiss Lithoclast; all stone
fragments were retrieved with a 3F helical basket. The patients were followed up 
as inpatients for 24 hours and reviewed in the clinic 1 week later with a request
to report if they felt significant discomfort or loin pain or became feverish.
RESULTS: Only one patient (male) had to be readmitted with loin pain. Two others 
(both women) complained when they attended for follow-up of having had dull lower
abdominal pain and some frequency. CONCLUSIONS: The low incidence of
complications in this preliminary study suggests that routine stenting is not
necessary after ureteroscopy. The chief exception to this statement is patients
who had a difficult and prolonged stone fragmentation.

PMID: 10954302 [PubMed - indexed for MEDLINE]

1485: J Endourol. 2000 Aug;14(6):475-8.

Is there a simpler method for predicting lower pole stone clearance after
shockwave lithotripsy than measuring infundibulopelvic angle?

Tuckey J, Devasia A, Murthy L, Ramsden P, Thomas D.

Department of Urology, Faculty of Medicine and Health Science, University of
Auckland, New Zealand. JTuckey@ahsl.co.nz

BACKGROUND AND PURPOSE: Several anatomic factors influence the clearance of lower
pole stones treated with shockwave lithotripsy (SWL). One of these is the
infundibulopelvic angle, but its measurement is complex. METHODS: We proposed a
more simple measure of caliceal dependence, the caliceal pelvic height (CPH),
which we defined as the distance between a horizontal line from the lowermost
point of the calix containing the stone to the highest point of the lower lip of 
the renal pelvis. RESULTS: In 62 patients who had SWL for solitary lower pole
stones, a CPH < 15 mm was associated with a stone clearance rate of 92%, whereas 
with a CPH > or = 15 mm, the clearance rate was only 52% (p < 0.05). A majority
(74%) of the patients with an infundibular width of > or = 5 mm were rendered
stone free compared with 40% of those with a width of < 5 mm (p < 0.05).
CONCLUSION: Measurement of the CPH, in conjunction with other anatomic factors,
may more accurately predict the outcome of SWL in patients with lower pole
stones.

PMID: 10954301 [PubMed - indexed for MEDLINE]

1486: J Endourol. 2000 Aug;14(6):471-4.

Calcium stone fragility is predicted by helical CT attenuation values.

Saw KC, McAteer JA, Fineberg NS, Monga AG, Chua GT, Lingeman JE, Williams JC Jr.

Methodist Hospital Institute of Kidney Stone Disease, Indianapolis, Indiana, USA.

BACKGROUND AND PURPOSE: Helical CT has become the preferred method for imaging
urinary calculi, and so it would be useful if data from helical CT could also be 
used to predict the number of shockwaves (SWs) needed to break a given stone.
METHODS AND MATERIALS: We measured the number of SWs required to comminute
calcium stones in vitro. RESULTS: The SW requirement correlated with stone size
(volume, weight, diameter) and with helical CT attenuation values when the scans 
were performed at 3-mm collimation. When CT scans were performed at 1-mm
collimation, the number of SWs needed for comminution did not correlate with
helical CT attenuation values. This result indicates that the correlation with
3-mm scans was attributable to volume-averaging effects, in which smaller stones 
yield smaller attenuation values. That is, attenuation values from helical CT at 
larger beam collimation widths contain information about stone size that can be
exploited to predict the fragility of calcium stones. We observed that for
calcium stones, the number of SWs to comminution was generally less than half the
stone CT attenuation value in Hounsfield units. This "half-attenuation rule"
predicted the number of SWs needed to complete fragmentation for 95% of calcium
stones (24/24 calcium oxalate monohydrate, 13/13 hydroxyapatite, 8/10 brushite
stones). CONCLUSION: This in vitro study suggests that it may be possible to
predict effective SW dose using helical CT prior to lithotripsy.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10954300 [PubMed - indexed for MEDLINE]

1487: J Urol. 2000 Sep;164(3 Pt 1):856-63.

Solid-state 13 C and 31 P NMR analysis of urinary stones.

Bak M, Thomsen JK, Jakobsen HJ, Petersen SE, Petersen TE, Nielsen NC.

Instrument Centre for Solid-State NMR Spectroscopy, Department of Chemistry,
University of Aarhus, Denmark.

PURPOSE: We investigated the applicability of solid-state nuclear magnetic
resonance (NMR) spectroscopy to obtain information about the structure and
composition of renal calculi. MATERIALS AND METHODS: Various types urinary and
bladder stones as well as a variety of presumed constituents were investigated
using 13C and 31P magic-angle spinning (MAS) solid-state NMR. Different
experimental methods were applied to differentiate resonances from
crystalline/amorphous (immobile/mobile) as well as protonated/non-protonated
moieties. The NMR spectra were analyzed using multiple-component numerical
simulations and iterative fitting to identify and quantify the major amorphous or
crystalline organic and inorganic components. RESULTS: By comparison of the NMR
spectra for the various renal calculi with those obtained under similar
conditions for various presumed components, it is demonstrated possible to
unambiguously distinguish and quantify the major amorphous or crystalline organic
and inorganic components. The components are identified in terms of their
isotropic and anisotropic chemical shielding parameters, protonation or proximity
of protons, and the degree of crystallinity/mobility. For the calculi
investigated we have detected and quantified calcium oxalate, uric acid,
struvite, and calcium phosphates that closely resemble brushite and calcium
hydroxyapatite. CONCLUSIONS: Using 13C and 31P MAS NMR spectroscopy we have been 
able to account for 60 to 85% (by weight) of the constituents in the calculi
investigated. The ability to identify and quantify both crystalline and amorphous
components makes solid-state NMR an interesting new method for the compositional 
analysis of renal calculi.

Publication Types: 
    Comparative Study

PMID: 10953168 [PubMed - indexed for MEDLINE]

1488: Phys Med Biol. 2000 Jul;45(7):1923-40.

Fracture mechanics model of stone comminution in ESWL and implications for tissue
damage.

Lokhandwalla M, Sturtevant B.

Graduate Aeronautical Laboratories, California Institute of Technology, Pasadena 
91125, USA.

Focused shock waves administered during extracorporeal shock-wave lithotripsy
(ESWL) cause stone fragmentation. The process of stone fragmentation is described
in terms of a dynamic fracture process. As is characteristic of all brittle
materials, fragmentation requires nucleation, growth and coalescence of flaws,
caused by a tensile or shear stress. The mechanisms, operative in the stone,
inducing these stresses have been identified as spall and compression-induced
tensile microcracks, nucleating at pre-existing flaws. These mechanisms are
driven by the lithotripter-generated shock wave and possibly also by cavitation
effects in the surrounding fluid. In this paper, the spall mechanism has been
analysed, using a cohesive-zone model for the material. The influence of shock
wave parameters, and physical properties of stone, on stone comminution is
described. The analysis suggests a potential means to exploit the difference
between the stone and tissue physical properties, so as to make stone comminution
more effective, without increasing tissue damage.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10943929 [PubMed - indexed for MEDLINE]

1489: J Med Assoc Thai. 2000 Jul;83(7):756-63.

Potassium, sodium and magnesium contents in skeletal muscle of renal
stone-formers: a study in an area of low potassium intake.

Bovornpadungkitti S, Sriboonlue P, Tavichakorntrakool R, Prasongwatana V,
Suwantrai S, Predanon C, Tosukhowong P, Suntarapa S.

Khon Kaen Regional Hospital, Thailand.

Skeletal muscles surgically obtained from the stone-former group (external
oblique muscle; n = 202, 82 males & 120 females), control group I (external
oblique muscle; n = 5, all males), control group II (rectus abdominis muscle; n =
23, all females) and control group III (quadriceps femoris muscle; n = 11, all
males) were analyzed for potassium (K), sodium (Na) and magnesium (Mg) contents. 
Muscle samples were digested with 65 per cent HNO3 and determined for K, Na and
Mg by an atomic absorption spectrophotometer. The results of analysis showed the 
mean K, Na and Mg (+/- S.D.) contents in mumol per one gram of fresh tissue of
the stone-former group, control groups I, II and III were 73.5 +/- 16.6, 51.3 +/-
13.4 and 6.6 +/- 1.3, 77.5 +/- 3.9, 43.9 +/- 9.9 and 7.2 +/- 0.5, 83.8 +/- 27.5, 
49.4 +/- 24.1 and 6.7 +/- 1.8 and 85.0 +/- 17.1, 48.5 +/- 12.1 and 6.8 +/- 1.3.
Among these variables, only the K content of control group III was higher
significantly (p < 0.05) than that of the stone-former group. In the stone-former
group, regression analysis showed significant correlations between K and Mg
contents (r = 0.856, p < 0.001) and K and Na contents (r = -0.325, p < 0.001).
Due to no available data of the external oblique, we made a comparison of our
results to the soleus type of skeletal muscle of normal subjects reported by
Dorup et al and found that the external oblique muscle had lower mean contents of
K and Mg but a higher Na content than those of the soleus. Our results were
similar to the K and Mg depleted muscles obtained from the patients receiving
long-term treatment with diuretic drugs. The results suggest that most of our
subjects in both the stone-former and the 3 control groups were in a state of K
and Mg depletion. The causes may be multifactorial, for instance low intake, high
sweat loss and the existence of environmental inhibitor (s) for K transport like 
vanadium.

Publication Types: 
    Clinical Trial
    Comparative Study
    Controlled Clinical Trial
    Research Support, Non-U.S. Gov't

PMID: 10932510 [PubMed - indexed for MEDLINE]

1490: Urol Res. 2000 Jun;28(3):155-8.

Loss of regulation of circulating 1,25-dihydroxyvitamin D with paradoxically
decreased serum phosphate levels in individuals with recurrent kidney stones.

Yamakawa K, Franco-Coronel OE, Ohnishi T, Suzuki R, Satani H, Kawamura J.

Department of Urology, Mie University School of Medicine, Japan.

A low serum phosphate concentration is characteristic in individuals in whom
kidney stones form, this being related to serum 1,25-dihydroxyvitamin D,
parathyroid hormone and urinary phosphate excretion. In order to determine
whether these parameters are related to recurrence of stone formation, they were 
analyzed in single and recurrent stone formers as well as controls. An inverse
correlation between serum levels of phosphate and 1,25-dihydroxyvitamin D was
observed in control subjects, indicating that a drop in serum phosphate results
in upregulated circulating 1,25-dihydroxyvitamin D level in controls. While the
circulating low phosphate level upregulated the 1,25-dihydroxyvitamin D level in 
single stone formers, the elevation was less than expected from the drop in serum
phosphate in recurrent stone formers. The results thus suggest that loss of
upregulation of 1,25-dihydroxyvitamin D by serum levels of phosphate might be
important for stone formation. The possibility of deregulation of
1,25-dihydroxyvitamin D to maintain physiological requirements in stone formers
and prevent further nephrolithiasis therefore warrants attention.

PMID: 10929423 [PubMed - indexed for MEDLINE]

1491: J Vasc Interv Radiol. 2000 Jul-Aug;11(7):885-9.

Treatment of caliceal diverticular stones: transdiverticular percutaneous
nephrolithotomy with creation of a neoinfundibulum.

Al-Basam S, Bennett JD, Layton ZA, Denstedt JD, Razvi H.

Department of Diagnostic Radiology, St. Joseph's Health Centre, London, Ontario, 
Canada.

PURPOSE: To evaluate transdiverticular percutaneous nephrolithotomy (TDPN) with
creation of a neoinfundibulum in the treatment of caliceal diverticular stones.
PATIENTS AND METHODS: Between 1990 and 1998, 18 patients with symptomatic calculi
in caliceal diverticula underwent TDPN. Transdiverticular puncture into the renal
collecting system with creation of a neoinfundibulum was used, eliminating the
need for prolonged probing with a wire for the neck of the diverticulum. Eight
diverticula were upper polar, six were interpolar, and four were in the lower
pole. Stones were endoscopically treated with use of Lithoclast (Electromedical
Systems, Lausanne, Switzerland), graspers, ultrasound, or a combination of these 
methods. RESULTS: Sixteen kidneys (89%) were rendered stone-free at discharge.
Two kidneys (11%) were left with stone fragments of 5 mm or smaller. Hospital
stay ranged from 3 to 15 days (average, 7 days). Procedure time ranged from 45 to
169 minutes (average, 87 minutes). One patient developed a left renal-pleural
fistula, which closed 1 week after chest tube drainage. No other complications
were encountered for an overall complication rate of 6%. CONCLUSION: TDPN is a
safe and effective method for treating caliceal diverticular stones, with a
complication rate comparable to other methods.

Publication Types: 
    Evaluation Studies

PMID: 10928527 [PubMed - indexed for MEDLINE]

1492: J Nephrol. 2000 May-Jun;13(3):169-77.

Unravelling the links between calcium excretion, salt intake, hypertension,
kidney stones and bone metabolism.

Cappuccio FP, Kalaitzidis R, Duneclift S, Eastwood JB.

Department of Medicine, St George' s Hospital Medical School, London, UK.
f.cappuccio@sghms.ac.uk

Evidence from animal, clinical and epidemiological studies suggests that high
blood pressure is associated with abnormalities of calcium metabolism, leading to
increased calcium loss, secondary activation of the parathyroid gland, increased 
movement of calcium from bone and increased risk of urinary tract stones. Some of
these abnormalities are detectable in children and young people and continue
throughout adult life. The cluster of abnormalities may be due either to a
primary renal tubular defect ('renal calcium leak' hypothesis) or to the effect
of central volume expansion seen in hypertension ('central blood volume'
hypothesis). A high salt intake is known to aggravate these abnormalities and
their consequences. If substantial calcium loss related to high blood pressure is
sustained over many decades, increased excretion of calcium in the urine may
result in an increased risk of urinary tract stones, and the increased movement
of calcium from bone may result in higher rates of bone mineral loss, thereby
increasing the risk of osteoporosis. The present review summarises the evidence, 
suggests a unifying hypothesis and discusses clinical and public health
implications.

Publication Types: 
    Review

PMID: 10928292 [PubMed - indexed for MEDLINE]

1493: Curr Opin Nephrol Hypertens. 2000 Jul;9(4):349-55.

Renal cell-urinary crystal interactions.

Lieske JC, Toback FG.

Department of Medicine, The University of Chicago, Illinois 60637, USA.
jlieske@medicine.bsd.uchicago.edu

Crystals of calcium oxalate and calcium phosphate bind to anionic molecules on
the apical surface of renal collecting duct cells. Atomic arrays on crystal faces
interact stereospecifically with cell-surface anions to bind crystals that
nucleate in tubular fluid, or those that nucleate directly on the plasma
membrane. The internalization of adherent crystals, changes in gene expression,
and secretion of specific proteins ensue, and appear to be important processes in
crystal retention and kidney stone pathogenesis.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.
    Review

PMID: 10926170 [PubMed - indexed for MEDLINE]

1494: Kidney Int. 2000 Aug;58(2):528-36.

Altered gene expression in kidneys of mice with 2,8-dihydroxyadenine
nephrolithiasis.

Wang L, Raikwar N, Deng L, Yang M, Liang L, Shao C, Evan AP, Stambrook PJ, Sahota
A, Tischfield JA.

Departments of Medical and Molecular Genetics and Anatomy, Indiana University
School of Medicine, Indianapolis, USA.

BACKGROUND: We have developed a knockout mouse model for adenine
phosphoribosyltransferase (APRT) deficiency, a condition that often leads to
2,8-dihydroxyadenine (DHA) nephrolithiasis in humans. Aprt knockout male mice
develop severe renal damage by three months of age, but this is strain specific. 
Renal damage in female mice is less pronounced than in males. The gene level
changes that promote renal injury in APRT-deficient mice are not known. METHODS: 
We used mRNA differential display polymerase chain reaction (DD-PCR) to analyze
renal gene expression changes in APRT-deficient male and female mice (strain C3H)
compared with age- and sex-matched Aprt heterozygote controls. The differentially
amplified bands were reamplified, cloned, sequenced, and queried against the
National Center for Biotechnology Information nonredundant databases using the
Basic Alignment Search Tool. Relative quantitative reverse
transcription-polymerase chain reaction was used to confirm the results of DD-PCR
for a selected number of genes in one-, three-, and six-month-old male and female
mice. RESULTS: Sixty-three differentially amplified bands were identified,
including 21 for known genes, and 8 of these were examined further. In
three-month-old APRT-deficient male mice, the expression of C10 was increased
tenfold, and there was a fourfold to sevenfold increase in the expression of a
disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS-1), MGP
(matrix Gla protein), and lysyl oxidase (LOX). The expression of
cholecystokinin-A receptor (CCKAR), imprinted multimembrane-spanning polyspecific
transporter-like gene 1 (IMPT-1), and kidney androgen-regulated protein (KAP) was
diminished twofold to fourfold, but there was little or no change in the
expression of organic anion transporter (OATP). Except for a more than tenfold
increase in C10 expression and up to tenfold decrease in KAP expression,
APRT-deficient female mice did not show significant changes in gene expression
compared with controls. CONCLUSIONS: These findings suggest that (1) there are
sex-related differences in gene expression in DHA lithiasis, possibly caused by
increased deposition of DHA crystals in male compared with female kidneys; and
(2) the expression of certain genes (for example, C10) may simply be an
indication of nonspecific cellular stimulation and may not be related to renal
injury.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10916076 [PubMed - indexed for MEDLINE]

1495: Kidney Int. 2000 Aug;58(2):520-7.

Clinical and genetic studies of CLCN5 mutations in Japanese families with Dent's 
disease.

Igarashi T, Inatomi J, Ohara T, Kuwahara T, Shimadzu M, Thakker RV.

Department of Pediatrics, Faculty of Medicine, The University of Tokyo, Japan.
iga7400@mxq.mesh.ne.jp

BACKGROUND: Dent's disease is an X-linked renal tubular disorder that is
characterized by low molecular weight proteinuria, hypercalciuria,
nephrolithiasis, and renal failure. The disease is caused by inactivation of a
renal chloride channel gene, CLCN5, that encodes a 746-amino acid protein with 12
to 13 transmembrane domains. The Japanese variant of Dent's disease has been
observed to be less severe, and we have investigated two unrelated Japanese
families for CLCN5 mutations. METHODS: Six patients from two unrelated families
were studied. Leukocyte DNA from probands was used with CLCN5-specific primers
for polymerase chain reaction (PCR) amplification of the coding region and
exon-intron boundaries, and the DNA sequences of the products were determined to 
identify abnormalities in the gene. RNA extracted from the kidney, leukocytes, or
urine sediments was used to characterize further the effects of the identified
mutations. RESULTS: beta2-microglobulinuria was detected in five patients,
hypercalciuria in two patients, nephrolithiasis in three patients (2 of whom were
females), and one 51-year-old man had renal failure. Two novel CLCN5 mutations
consisting of an a to g transition at the invariant ag acceptor splice site of
intron 5 and an intragenic deletion that encompassed the region between intron 3 
and intron 6 were identified. The acceptor splice site mutation led to the
utilization of two alternative cryptic splice sites in exon 6 that resulted in a 
frameshift or skipping of the exon 6. The deletional mutation, which resulted in 
a loss of exons 4, 5, and 6, is predicted to lead to a loss of domains 1 through 
4. Both mutations predict truncated chloride channels that are likely to result
in a functional loss. CONCLUSIONS: The observations of renal failure in one male 
and nephrolithiasis in two females represent important new findings in this
Japanese variant of Dent's disease that is associated with CLCN5 mutations. In
addition, our study is the first to demonstrate the use of urinary sediment cells
and renal tissue for the detection of CLCN5 transcript abnormalities. These
results help to expand the spectrum of CLCN5 mutations associated with Dent's
disease.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10916075 [PubMed - indexed for MEDLINE]

1496: Scand J Urol Nephrol. 2000 Apr;34(2):114-8.

Current management of calculi in horseshoe kidneys.

Collado Serra A, Parada Moreno R, Rousaud Barón F, Monreal Garcia de Vicuña F,
Rousaud Barón A, Rodriguez JV.

Fundació Puigvert, Universidad Autónoma de Barcelona, Spain.
Urologia@fundacio-puigvert.es

OBJECTIVES: To assess treatment options for calculi in horseshoe kidneys and the 
impact of extracorporeal shockwave lithotripsy (ESWL) on the management of renal 
stones. MATERIAL AND METHODS: From June 1971 to January 1998, 52 patients with
horseshoe kidneys and calculi received treatment at our Urologic Stone Unit.
There were 40 men (77%) and 12 women (23%). Average patient age was 41 years
(range: 10-70 years). Clinical onset, treatment received and outcome were
evaluated retrospectively. A successful outcome was defined as a patient without 
residual calculi or with fragments <0.4 cm in size. RESULTS: Clinical onset was
mainly low back pain in 37 patients (71%). Eighty-nine stones were treated, i.e. 
an average of 1.7 treatments per patient. Before the ESWL era (May 1987), we
performed two heminephrectomies, 16 pyelolithotomies, 12 pyelolithotomies
combined with ureteropyeloplasty and one percutaneous nephrolithotomy. Since the 
advent of ESWL, seven pyelolithotomies and three pyelolithotomies combined with
ureteropyloplasty have been done. ESWL was used to treat 48 calculi. In three
cases the patient was placed in the prone position due to difficulties in stone
focusing. In 37 cases (77%) patients were either rendered stone-free or had
residual fragments <0.4 cm in size. Urinary diversion for obstruction was carried
out in two cases (4%). CONCLUSIONS: At present ESWL is the first-choice treatment
for calculi in horseshoe kidneys. It involves no significant focusing
difficulties and is associated with a low incidence of obstructive complications.
Open surgery is indicated in cases of stone-related pyeloureteral stenosis and in
the presence of calculi >2-2.5 cm in size.

PMID: 10903072 [PubMed - indexed for MEDLINE]

1497: J Urol. 2000 Aug;164(2):537-44.

Comment in:
    J Urol. 2000 Aug;164(2):273.

Acoustic and mechanical properties of artificial stones in comparison to natural 
kidney stones.

Heimbach D, Munver R, Zhong P, Jacobs J, Hesse A, Müller SC, Preminger GM.

Department of Urology, Section of Experimental Urology, University of Bonn, Bonn,
Germany.

PURPOSE: Standardized and reproducible artificial kidney stone models are
important for performing comparative studies of different lithotripsy modalities.
The acoustic and mechanical properties of renal calculi dictate the manner by
which stones interact with the mechanical stresses produced by shock wave
lithotripsy (SWL) or intracorporeal lithotripsy modalities. We have developed a
novel artificial kidney stone model that is made of natural substances found in
real kidney stones. These stone models appear to be much closer in physical
properties to natural kidney stones than previously used stone models. MATERIALS 
AND METHODS: The acoustic and mechanical properties of six groups of artificial
stone models were compared to corresponding natural stones of similar
compositions. Moreover, three groups of artificial stone models made of
plaster-of-Paris were compared to their natural counterparts. In terms of
acoustic properties, stone density was measured using a pycnometer based on
Archimedes' principle, whereas longitudinal and transverse (or shear) wave
propagation speeds were measured using an ultrasound pulse transmission
technique. These values were used to calculate wave impedance and dynamic
mechanical properties (bulk modulus, Young's modulus, and shear modulus) of the
stones. The microhardness of the stones was measured and the effect of
composition on stone fragility was evaluated. RESULTS: Artificial stones, when
compared to natural stones of similar composition, showed similar trends in
longitudinal and transverse wave speeds, wave impedance, and dynamic elastic
moduli. However, values for the artificial stones were uniformly low compared to 
those of natural stones, suggesting that these artificial stones may be more
amenable to shock wave fragmentation. The results of SWL on stone fragmentation
of artificial and natural stones also revealed similar trends with the exception 
of artificial cystine stones which were found to be the most resistant to shock
wave fragmentation. CONCLUSIONS: The results indicate that the physical
properties of artificial stones made of natural stone materials are comparable to
renal calculi of the same chemical composition. The data suggests that these
stone phantoms are suitable for performing standardized and reproducible in vitro
investigations, especially with regards to fragility of kidney stones of
different chemical compositions during SWL.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10893640 [PubMed - indexed for MEDLINE]

1498: J Urol. 2000 Aug;164(2):464-6.

Nephrolithiasis associated with the ketogenic diet.

Kielb S, Koo HP, Bloom DA, Faerber GJ.

Section of Urology, Department of Surgery, University of Michigan Medical Center,
Ann Arbor, Michigan, USA.

PURPOSE: The ketogenic diet has been used for treating seizure disorders for more
than 70 years. Nephrolithiasis is a known complication of this diet with a
reported stone rate as high as 10% but there is sparse literature detailing the
nature and treatment of these stones. We report on 4 children with
nephrolithiasis on this diet. MATERIALS AND METHODS: We describe stone treatment 
and analysis as well as metabolic and urine abnormalities in 4 children with
nephrolithiasis on the ketogenic diet who presented to our institution. RESULTS: 
All patients were treated with shock wave lithotripsy, fluid liberalization and
oral citrate. One child was ultimately withdrawn from the diet due to persistent 
stone formation. Analysis revealed 3 calcium and 1 ammonium urate stones. Three
patients had hypercalciuria, 2 elevated urinary uric acid and 1 hypocitruria.
Serum studies revealed acidosis in 3 cases. CONCLUSIONS: The ketogenic diet
induces several metabolic abnormalities that increase the propensity for stone
formation. Urologists should be aware of this potential complication. Fluid
liberalization and bicitrate are recommended as prophylaxis.

PMID: 10893623 [PubMed - indexed for MEDLINE]

1499: Spinal Cord. 2000 Jun;38(6):346-53.

Current trend and risk factors for kidney stones in persons with spinal cord
injury: a longitudinal study.

Chen Y, DeVivo MJ, Roseman JM.

Department of Physical Medicine and Rehabilitation, University of Alabama at
Birmingham, Birmingham, Alabama 35233, USA.

STUDY DESIGN: A multi-center longitudinal study. OBJECTIVES: To estimate the
current trend in the incidence of first kidney stone among persons with spinal
cord injury (SCI) and to delineate the potential contributing factors. SETTING:
Twenty-one Model SCI Care Systems throughout the United States. METHODS: A
longitudinal cohort of 8314 subjects enrolled in the National SCI Database
between 1986 and 1999 was used to estimate and compare the incidence of first
kidney stone with a previous report of 5850 SCI patients injured between 1973 and
1982. A Cox regression analysis was performed to identify risk factors for
stones, including age, race, gender, severity of injury, and method of urinary
drainage. These variables have been routinely collected, on a yearly basis, by
the collaborating SCI centers. RESULTS: During the 12 years, 6 months of case
ascertainment, 286 incident stone cases were documented. The risk was greatest
during the first 3 months after injury (31 cases per 1000 person-years), quickly 
decreasing and leveling off later (eight cases per 1000 person-years). It was
estimated that within 10 years after injury, 7% of persons with SCI would develop
their first kidney stone. There was no evidence that the risk has changed over
the past 25 years (P=0.96). During the first year post injury only, a
significantly increased risk of stones was observed in Caucasians and persons
aged 45 years or older. A positive association of the severity of injury and
requiring instrumentation for bladder emptying with kidney stones was found after
the first year post injury. The type of urinary drainage, including indwelling,
intermittent, and condom catheterization, had no significant differential effect 
on stone formation at either risk period. CONCLUSIONS: The highest risk of kidney
stones is within the first few months post injury. Little progress has been made 
in reducing this risk. Although inability to control bladder function is an
important risk factor after the first year post injury, for those who need
bladder management, the type of urinary drainage does not appear to be an
important factor in determining risk. Spinal Cord (2000) 38, 346 - 353.

Publication Types: 
    Clinical Trial
    Multicenter Study
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 10889563 [PubMed - indexed for MEDLINE]

1500: Kidney Int. 2000 Jul;58(1):38-42.

Evaluation of the calcium-sensing receptor gene in idiopathic hypercalciuria and 
calcium nephrolithiasis.

Petrucci M, Scott P, Ouimet D, Trouvé ML, Proulx Y, Valiquette L, Guay G,
Bonnardeaux A.

Center de Recherche Guy Bernier, Hôpital Maisonneuve-Rosemont, Montréal, Québec, 
Canada.

BACKGROUND: Calcium urolithiasis is in part genetically determined and associated
with idiopathic hypercalciuria. METHODS: We have used a candidate gene approach
to determine whether the calcium-sensing receptor (CaR) gene is linked to
idiopathic hypercalciuria and calcium urolithiasis in a cohort of French Canadian
sibships with multiple affected members (64 sibships from 55 pedigrees yielding
359 affected sibling pairs with > or =1 stone episode). RESULTS: Using
nonparametric linkage analysis with various intragenic and flanking markers, we
showed that the CaR gene could be excluded as a major gene for hypercalciuric
stone formation. We excluded the CaR (lod score <-2) at lambdas values of 1.5,
1.68, and 2.6 for sib pairs concordant for at least one stone passage, at least
two stone passages, and at least one stone passage and calciuria above the 75th
percentile, respectively. Quantitative trait linkage analyses did not suggest
that the CaR gene was linked to biochemical markers of idiopathic hypercalciuria.
CONCLUSIONS: This study shows that genetic variants of the CaR gene are not
associated with idiopathic hypercalciuria and calcium nephrolithiasis in this
population of French Canadians.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10886547 [PubMed - indexed for MEDLINE]

1501: Am J Kidney Dis. 2000 Jul;36(1):53-7.

Anatomic and metabolic risk factors for nephrolithiasis in patients with
autosomal dominant polycystic kidney disease.

Grampsas SA, Chandhoke PS, Fan J, Glass MA, Townsend R, Johnson AM, Gabow P.

Departments of Surgery (Urology), Medicine (Renal Diseases)/Denver Health, and
Radiology, University of Colorado Health Sciences Center, Denver, CO, USA.

The prevalence of nephrolithiasis is considerably greater in patients with
autosomal dominant polycystic kidney disease (ADPKD) than in the general
population. We evaluated anatomic and metabolic factors that may be associated
with an increased prevalence of nephrolithiasis in patients with ADPKD. We
compared anatomic parameters among ADPKD patients with or without nephrolithiasis
as diagnosed by ultrasonography, whereas metabolic factors were determined by
24-hour urinary chemical analysis. Patients with ADPKD and nephrolithiasis had
more renal cysts (P < 0.05) and a larger predominant renal cyst size (P < 0.005) 
than patients without nephrolithiasis. Concurrently, individual stone-forming
kidneys had a greater cyst number (P < 0.05) and a significantly larger
predominant cyst size (P < 0.01) compared with kidneys without stones. Patients
with ADPKD and nephrolithiasis had a significantly lower creatinine clearance
than those without nephrolithiasis (68.7 +/- 8.6 versus 94.8 +/- 5.4 mL/min,
respectively; P < 0.05). Twenty-four-hour urinary analysis showed that patients
with ADPKD and nephrolithiasis had significantly lower urinary volumes (P < 0.
05), and levels of urinary phosphate (P < 0.05), magnesium (P < 0. 005), and
potassium (P < 0.05). Although not statistically significant, patients with ADPKD
with stones tended to have lower levels of urinary citrate, and both groups
showed a high percentage (range, 49% to 60%) of patients with hypocitraturia. Our
data are consistent with the hypothesis that patients with ADPKD who develop
nephrolithiasis do so because of increased intrarenal anatomic obstruction, as
well as lower levels of such urinary inhibitors of stones as magnesium and
citrate.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10873872 [PubMed - indexed for MEDLINE]

1502: Eur Urol. 2000 Jul;38(1):104-7.

Use of water jet resection in renal surgery: early clinical experiences.

Basting RF, Corvin S, Antwerpen C, Djakovic N, Schmidt D.

Department of Urology and Pediatric Urology, Kreiskrankenhaus Alt/Neuötting,
Altötting, Germany.

OBJECTIVE: Various surgical techniques have been developed to reduce the risk of 
bleeding during dissection of renal tissue. Water jet technology has been
designed for a gentle transection of parenchymal organs. We report about first
experiences with a new water jet resection device in kidney surgery. METHODS: 7
patients underwent open surgery because of renal cell carcinoma or
nephrolithiasis. In tumor patients a partial nephrectomy, in 1 stone patient a
nephrolithotomy, and in the other 1 a lower pole resection were performed.
RESULTS: By means of water jet resection tissue was dissected effectively
avoiding damage to the vascular structures, which were then ligated selectively. 
Resection time was between 14 and 30 min with a minimal intraoperative blood
loss. No significant problem was seen postoperatively. CONCLUSIONS: The results
demonstrate that water jet technology is an applicable tool for transection of
renal parenchyma. It has been shown to reduce the risk of blood loss
significantly compared to other techniques.

Publication Types: 
    Clinical Trial

PMID: 10859451 [PubMed - indexed for MEDLINE]

1503: Urol Res. 2000 Apr;28(2):136-40.

Effects of phytate and pyrophosphate on brushite and hydroxyapatite
crystallization. Comparison with the action of other polyphosphates.

Grases F, Ramis M, Costa-Bauzá A.

Laboratory of Urolithiasis Research, Faculty of Sciences, University of Illes
Balears, Palma de Mallorca, Spain. dqufgf0@ps.uib.es

This is a comparative study of the effects of phytate and pyrophosphate and other
polyphosphates on the crystallization of hydroxyapatite and brushite, the most
frequent calcium phosphates involved in calcium oxalate urolithiasis. Brushite
and hydroxyapatite crystal formation was studied in synthetic urine, through
kinetic-turbidimetric measurements that allowed evaluation of the inhibitory
effects on crystallization of insoluble salts. The effectiveness in preventing
brushite crystallization decreases in the sequence phytate > polyphosphate >
EDTPO > etidronate > pyrophosphate > triphosphate > medronate; whereas the order 
of effectiveness in preventing hydroxyapatite crystallization was EDTPO >
etidronate = pyrophosphate > triphosphate > medronate > polyphosphate > phytate. 
Phytate, a natural inhibitor in urine, most effectively blocked brushite
precipitation (1.21x10(-5) M prevented crystallization during time periods of at 
least 1 h), and pyrophosphate was the natural inhibitor that most effectively
blocked hydroxyapatite precipitation (2.87x10(-6) M prevented crystallization
during time periods of at least 1 h). This demonstrates that low excretion of
these substances would pose a risk of renal lithiasis.

Publication Types: 
    Comparative Study
    Research Support, Non-U.S. Gov't

PMID: 10850638 [PubMed - indexed for MEDLINE]

1504: BJU Int. 2000 Jun;85(9):1143-9.

Possible biphasic changes of free radicals in ethylene glycol-induced
nephrolithiasis in rats.

Huang HS, Chen CF, Chien CT, Chen J.

Department of Urology and Clinical Research, National Taiwan University Hospital 
and Department of Physiology, College of Medicine, National Taiwan University,
Taipei, Taiwan, ROC.

OBJECTIVE: To evaluate the possible role of free radicals in nephrolithiasis in
rats induced by ethylene glycol, and to examine the correlation between the
urinary enzymes N-acetyl-beta-glucosaminidase (NAG), beta-galactosidase (GAL) and
neutral endopeptidase (NEP), and free radical production. MATERIALS AND METHODS: 
Hyperoxaluria was produced in male Wistar rats by adding ethylene glycol to their
drinking water. After 7, 21 and 42 days of treatment, urinary oxalate, creatinine
clearance and urinary enzymes (NAG, GAL and NEP) were measured. The nitroblue
tetrazolium perfusion method was used to locate the sites of free-radical
production. Ultrasensitive chemiluminescence was used to directly measure the
production of reactive oxygen species (ROS) in vivo. Vitamin E and potassium
citrate were fed to rats, in addition to ethylene glycol, to assess their effects
on free radical production. RESULTS: Urinary oxalate increased significantly and 
was associated with an increase in NAG and GAL at all sample times. However,
urinary NEP activity was unchanged on day 7, although there was four times as
much NEP on days 21 and 42 than in the control groups. Formazan particles in the 
renal cortex were scored as 3+ to 4+ in rats treated for 7 days with ethylene
glycol. Blood ROS levels were also higher in this group than in the controls (P <
0.01). After vitamin E and potassium citrate treatment, blood ROS levels were
lower than in rats treated with ethylene glycol alone. CONCLUSION: Free radicals 
may be produced in the early stages of nephrolithiasis in rats fed with ethylene 
glycol. Free radicals occurred mainly in blood and might be associated with NEP
inactivation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10848711 [PubMed - indexed for MEDLINE]

1505: Antivir Ther. 2000 Mar;5(1):3-5.

Increased incidence of indinavir nephrolithiasis in patients with hepatitis B or 
C virus infection.

Malavaud B, Dinh B, Bonnet E, Izopet J, Payen JL, Marchou B.

Department of Urology, Centre Hospital Universitaire Purpan, Toulouse, France.
malavaud.b@chu-toulouse.fr

MATERIALS AND METHODS: A HIV-1 patient database was scanned in March 1998, and
750 patients were identified who had received HAART including indinavir. Of
these, 28 cases had nephrolithiasis; and 85 asymptomatic indinavir-treated
patients were randomly selected as controls. The characteristics of cases and
controls were compared by analysis of variance for quantitative parameters and by
Fisher's exact test for classes. RESULTS: We observed a significant increase in
the incidence of nephrolithiasis in patients co-infected with HIV-1 and either
hepatitis C virus (HCV) (HCV RNA-positive) or hepatitis B virus (HBV) (HBs
antigen-positive) (odds ratio and 95% confidence intervals: 2.8 and 1.1-7.7),
whereas no significant differences were demonstrated between cases and controls
with regard to age (42.4 +/- 8.0 versus 39.8 +/- 9.8 years), sex (male patients
70.4 versus 74.1%), duration of HIV-1 infection (8.6 +/- 3.1 versus 7.7 +/- 4.0
years), duration of indinavir treatment (16.1 +/- 5.8 versus 14.1 +/- 5.4
months), AST increase > or = 1.25 of normal (29.6 versus 25.9%), or ALT increase 
> or = 1.25 of normal (33.3 versus 22.4%). In co-infected patients, ALT increase 
(> or = 1.25 of normal), but not AST increase, at the time of indinavir
initiation was statistically related to the occurrence of nephrolithiasis.
CONCLUSIONS: We found a significant increase of nephrolithiasis incidence in
patients co-infected with HIV-1 and HCV or HBV, which suggests that underlying
multifactorial hepatic damage may limit liver catabolism of indinavir, and
consequently increase its renal excretion and the risk of nephrolithiasis.
Caution is therefore advised when initiating indinavir treatment in HIV patients 
with evidence of HBV or HCV infection.

PMID: 10846585 [PubMed - indexed for MEDLINE]

1506: Int J Urol. 2000 Jun;7(6):224-30.

Complicating risk factors for pyelonephritis after extracorporeal shock wave
lithotripsy.

Fujita K, Mizuno T, Ushiyama T, Suzuki K, Hadano S, Satoh S, Kambayashi T, Mugiya
S, Nakano M.

Department of Urology, Hamamatsu University School of Medicine, Shizuoka, Japan. 
fuj3780@hama-med.ac.jp

PURPOSE: The score to predict the risk of post-extracorporeal shock wave
lithotripsy (ESWL) pyelonephritis was evaluated. The score was based on the
multivariate analysis of risk factors available pre-operatively. Stone size,
pyuria, bacteriuria, previous pyelonephritis and other adjunctive procedures had 
been selected and scored. METHODS: Three-hundred and forty-eight adult patients
without active urinary infection undergoing ESWL therapy were studied. One of
three regimens were selected by either doctor or patient: (i) no antimicrobial
treatment; (ii) one dose of levofloxacin; or (iii) 1 week course of levofloxacin.
Who and why selected it were described. Post-ESWL fever over 38 degrees C was
defined as the unfavorable event. RESULTS/CONCLUSION: With increasing score,
doctors recommend taking an antimicrobial. There were 11 bacteriuric patients and
post-ESWL pyelonephritis developed in one of them. Bacteria within the stone and 
post-ESWL ureteral obstruction caused by the stone fragments were considered to
be important in developing pyelonephritis. However, multiple factors were related
with it. Although their decision was not based simply on the score, the score was
confirmed to be useful in identifying the high-risk patients and, therefore, to
implement cost-effective antimicrobial use.

Publication Types: 
    Clinical Trial

PMID: 10843454 [PubMed - indexed for MEDLINE]

1507: J Urol. 2000 Jul;164(1):21-6.

Geographic variation and environmental risk factors for the incidence of initial 
kidney stones in patients with spinal cord injury.

Chen YY, Roseman JM, Devivo MJ, Huang CT.

Departments of Physical Medicine and Rehabilitation, and Epidemiology, School of 
Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.

PURPOSE: Although geographic variability in cases of kidney stones, primarily
calcium stones, is reported in the general population, little is known about
geographic variability in subjects with spinal cord injury, in whom struvite
stones predominate. We examined regional variation in the incidence rate of
initial kidney stones and clarified the contributing factors in a spinal cord
injury cohort. MATERIALS AND METHODS: We used data from the national spinal cord 
injury database between 1986 and 1999 on 7,784 participants from 21 spinal cord
injury centers with 24,492 person-years of followup accumulated and 286 incident 
stone cases. A multilevel Poisson model was constructed to evaluate the
ecological effects of latitude, air temperature, water hardness and sunlight
index on stone formation while controlling for individual factors, including
participant age, race, gender, severity of injury and bladder management.
RESULTS: The incidence rate was significantly greater in the southeast and tended
to increase with decreasing latitude, similar to the geographic association with 
kidney stones in the general population. This finding was not explained by
differences in individual risk factors. Decreasing water hardness had the
strongest effect on stones during year 1 after injury (relative risk 0.6, p <0.
001), whereas average annual temperature had the strongest association with
stones after year 1 (relative risk 1.1 per 1C increase, p = 0.03). The sunlight
index had no association. CONCLUSIONS: Our study implies that the increased stone
risk in spinal cord injured subjects is potentially preventable by modifying
environmental exposure. Etiological factors may be similar to those for kidney
stones in the general population.

Publication Types: 
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 10840416 [PubMed - indexed for MEDLINE]

1508: J Urol. 2000 Jul;164(1):18-20.

Caliceal diverticular calculi: is there a role for metabolic evaluation?

Liatsikos EN, Bernardo NO, Dinlenc CZ, Kapoor R, Smith AD.

Department of Urology, Albert Einstein College of Medicine, Long Island Jewish
Medical Center, New Hyde Park, New York, USA.

PURPOSE: We report our experience with the treatment and incidence of metabolic
abnormalities in patients presenting with caliceal diverticular stones. MATERIALS
AND METHODS: We retrospectively evaluated 49 patients with caliceal diverticular 
stones (group 1) and 44 with simple renal stones (group 2). Each group
successfully underwent percutaneous treatment. Mean stone size was 1.7 and 2.5
cm. in groups 1 and 2, respectively. Metabolic evaluation was available in 25
group 1 and 22 group 2 patients. Mean followup was 73.2 and 70. 8 months,
respectively. RESULTS: We achieved a stone-free rate of 95. 9% in group 1 and
100% in group 2. There was no metabolic abnormality in 75% of the group 1
patients, while 12% had type II absorptive hypercalciuria, 8% hyperuricosuric
hypercalciuria and 4% hyperoxaluria. There were no metabolic abnormalities in
22.7% of the group 2 patients, while 9%, 18% and 9% had types I to III absorptive
hypercalciuria, respectively, 13.6% hyperuricosuric hypercalciuria, 13.6%
hyperoxaluria, 4.5% hypocitruria and 9% type II absorptive hypercalciuria
associated with hypocitruria. CONCLUSIONS: Our results reveal a low incidence of 
associated metabolic abnormalities in patients with caliceal diverticular stones.
Thus, we believe that metabolic abnormalities do not promote caliceal
diverticular calculous formation.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10840415 [PubMed - indexed for MEDLINE]

1509: Urology. 2000 Jun;55(6):816-9.

Determination of stone composition by noncontrast spiral computed tomography in
the clinical setting.

Nakada SY, Hoff DG, Attai S, Heisey D, Blankenbaker D, Pozniak M.

Department of Surgery (Division of Urology), University of Wisconsin Medical
School, Madison, Wisconsin 53792-3236, USA.

OBJECTIVES: Several investigators have evaluated noncontrast computed tomography 
(NCCT) in predicting stone composition in vitro. We assessed NCCT in predicting
stone composition in patients presenting to our emergency room with flank pain
and stone disease. METHODS: One hundred twenty-nine patients presenting to our
university hospital with flank pain underwent renal colic protocol NCCT scans at 
the request of the emergency room physicians. A General Electric, high-speed
advantage CT scanner was used at 120 kV, 200 mA, and 1.4:1 pitch, with
collimation varying between 3 and 5 mm. Ninety-nine patients with predominantly
(greater than 50%) calcium oxalate or uric acid composition after either stone
passage or stone removal were identified. Each scan was analyzed by one of two
radiologists, who determined the predominant attenuation for each stone. Stones
once passed or retrieved were analyzed by Urocor Laboratories. The attenuation
and attenuation/size ratio (peak attenuation/size in millimeters) were compared
with the results of the stone analysis. RESULTS: Eighty-two calculi predominantly
composed of calcium oxalate and 17 calculi predominantly composed of uric acid
were identified in 99 patients. The calculi ranged in size from 1 to 28 mm. A
significant difference (P = 0.017, unpaired t test) was found between the
Hounsfield measurement of uric acid calculi (mean 344 +/- 152 HU) and the
Hounsfield measurement of calcium oxalate calculi (mean 652 +/- 490 HU). If only 
the Hounsfield units from stones 4 mm or larger were compared, the data were even
more compelling (P = 0.002). However, using an attenuation/size ratio cutoff of
greater than 80, the negative predictive value was 99% that a stone would be
predominantly calcium oxalate. CONCLUSIONS: Using peak attenuation measurements
and the attenuation/size ratio of urinary calculi from NCCT, we were able to
differentiate between uric acid and calcium oxalate stones.

PMID: 10840083 [PubMed - indexed for MEDLINE]

1510: Brain Dev. 2000 Jun;22(4):230-3.

Comment in:
    Brain Dev. 2000 Oct;22(7):460.

Zonisamide - induced urinary lithiasis in patients with intractable epilepsy.

Kubota M, Nishi-Nagase M, Sakakihara Y, Noma S, Nakamoto M, Kawaguchi H,
Yanagisawa M.

Department of Pediatrics, University of Tokyo, Japan. kubota@ped.h.u-tokyo.ac.jp

We report here three patients with intractable epilepsy who developed urinary
lithiasis during zonisamide (ZNS) treatment. Abdominal pain due to left-sided
hydronephrosis was the initial symptom in the first patient, and it was resolved 
after the excretion of a stone. The second patient, who had no specific symptoms,
was found to have a thick sludge of calcium phosphate in the bladder when he
suffered from aspiration pneumonia and dehydration. The third patient, who had a 
history of recurrent urinary obstruction, was also found to have a thick sludge
of calcium oxalate in the bladder. The urinalysis of the three patients revealed 
alkaline urine and hypercalciuria. Although their urinary lithiasis was resolved 
by discontinuation of ZNS and supportive therapy, routine examination of urine
parameters such as pH and sediments, and daily urine-output checks are thought to
be necessary during treatment with ZNS, especially for patients who are bedridden
for a long time and receive multiple antiepileptic drugs.

Publication Types: 
    Case Reports

PMID: 10838109 [PubMed - indexed for MEDLINE]

1511: Nutr Rev. 2000 Apr;58(4):111-7.

Should dietary calcium and protein be restricted in patients with
nephrolithiasis?

Martini LA, Wood RJ.

Mineral Bioavailability Laboratory, Jean Mayer USDA Human Nutrition Research
Center on Aging, Tufts University, Boston, MA 02111, USA.

Renal stone disease is a painful condition that affects 1-20% of the general
population. Therapy aimed at decreasing the incidence of recurrent stones
includes dietary advice. Dietary considerations include intake of both calcium
and protein. Calcium restriction in stone formers is not recommended because it
can have adverse effects on bone and the incidence of stones. Although a
high-protein diet can elevate urinary calcium, uric acid, and sulfate and
decrease urinary citrate, which may alter the propensity to form stones,
restriction of protein to less than the current RDA for the management of stone
disease can not be recommended at this time.

Publication Types: 
    Review

PMID: 10835901 [PubMed - indexed for MEDLINE]

1512: J Am Soc Nephrol. 2000 Jun;11(6):1138-40.

Encrusted pyelitis of native kidneys.

Hertig A, Duvic C, Chretien Y, Jungers P, Grünfeld JP, Rieu P.

Department of Nephrology, Necker Hospital, Paris, France. rieu@necker.fr

This study reports the first four cases of encrusted pyelitis involving native
kidneys. The clinical features, management, and outcome of these patients were
analyzed. Predisposing factors were underlying urologic disease and/or urologic
manipulations, debilitating diseases, hospitalization, and prolonged antibiotic
therapies. Presenting symptoms were renal failure in three patients with
ureteroileal urinary diversion and manifestations of cystitis in one patient.
Computed tomography scan of the urinary tract was critical for diagnosis.
Presence of struvite was demonstrated by crystalluria and infrared
spectrophotometry analysis of the encrusted material. Corynebacterium urealyticum
urinary infection was identified in one case. Surgery (one patient) and
palliative ureteral diversion (one patient), respectively, led to death and
end-stage renal failure. Successful dissolution of encrusted pyelitis was
obtained in two patients treated with intravenous vancomycin and local
acidification of the renal collecting system. Clinical observation shows that
encrusted pyelitis is a threatening disorder that destroys the native kidneys and
may lead to end-stage renal failure. Successful treatment of the disease by
chemolysis and antibiotics depends on correct and early diagnosis. Diagnosis
required recognition of the predisposing factors, computed tomography imaging of 
the urinary tract, crystalluria, and identification of urea-splitting bacteria
with prolonged culture on selective medium.

Publication Types: 
    Case Reports

PMID: 10820179 [PubMed - indexed for MEDLINE]

1513: J Urol. 2000 Jun;163(6):1779-82.

Internet and postal survey of endourologic practice patterns among American
urologists.

Hollowell CM, Patel RV, Bales GT, Gerber GS.

Section of Urology, Department of Surgery, University of Chicago Pritzker School 
of Medicine, Chicago, Illinois, USA.

PURPOSE: We determine endourological practice patterns among American urologists 
for the management of distal ureteral calculi, ureteropelvic junction
obstruction, staghorn calculi and the use of ureteral stents with extracorporeal 
shock wave lithotripsy (ESWLdagger). MATERIALS AND METHODS: Surveys were mailed
by the United States postal service to 1,000 American urologists selected
randomly from the American Urological Association membership roster. The same
survey was sent via the Internet to 3,065 American urologists with an electronic 
mail address listed in the roster. RESULTS: Responses were received from 1,029
urologists (postal 601, Internet 428). Ureteroscopy was the preferred treatment
for all distal ureteral calculi less than or equal to 10 mm. Acucisedouble dagger
endopyelotomy was the most frequently selected therapy for adults with
ureteropelvic junction obstruction (50.3%, 514 of 1,022). Open pyeloplasty was
recommended by a significantly greater percentage of urologists in practice
longer than 15 years compared with the remaining survey respondents (166 of 485, 
34.2% versus 92 of 427, 21.5%). For patients with renal pelvic stones 10, 15 or
20 mm. who are treated with ESWL routine stent placement was preferred by 25.3%
(259 of 1,022), 57.1% (584 of 1,022) and 87.1% (888 of 1, 019) of urologists,
respectively. Percutaneous nephrolithotomy was preferred for patients with
staghorn calculi by 80.5% (828 of 1,028) of survey respondents. CONCLUSIONS: Most
urologists follow the American Urological Association practice guidelines for
patients with distal ureteral calculi and staghorn stones. There is a significant
difference of opinion regarding the use of stents with ESWL. No clear consensus
has been reached concerning the management of adults with ureteropelvic junction 
obstruction. These data may be useful in designing physician education programs
and/or future investigations to help define standard treatment practices for
urological diseases.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10799181 [PubMed - indexed for MEDLINE]

1514: J Urol. 2000 Jun;163(6):1676-8.

Metabolic risk factors in patients with ureteropelvic junction obstruction and
renal calculi.

Matin SF, Streem SB.

Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

PURPOSE: We performed a prospective study to determine the incidence and spectrum
of metabolic abnormalities predisposing to stone formation in patients with
ureteropelvic junction obstruction and renal calculi. MATERIALS AND METHODS: A
total of 47 consecutive patients with congenital ureteropelvic junction
obstruction underwent metabolic evaluation of stone risk factors. Of these
patients 21 had associated stones (study group), while 26 did not (control
group). Logistical regression, Wilcoxon rank sum and Fisher's exact tests were
performed to determine whether there was a significant difference between these
groups in regard to the presence of metabolic risk factors. RESULTS:
Demographically and symptomatically the 2 groups were equivalent except that the 
study patients were older. The 24-hour urinary excretion of calcium was
significantly higher in study than in the control patients (p = 0.007). While the
incidence of hypercalciuria and hyperuricosuria was also higher in the study
population, these differences were not significant (p = 0.08 and 0.07,
respectively). CONCLUSIONS: Metabolic abnormalities predisposing to stone
formation are present more frequently in patients with ureteropelvic junction
obstruction who have associated stones compared to those who do not. As such,
urinary stasis alone does not explain stone formation in these cases. Rather, the
local physiological environment of urine likely has a predisposing role. In
addition to restoring unobstructed urinary flow, consideration should be given to
metabolic evaluation and prophylactic treatment for affected patients.

PMID: 10799158 [PubMed - indexed for MEDLINE]

1515: J Endourol. 2000 Apr;14(3):289-92.

Comment in:
    J Endourol. 2001 Aug;15(6):649.

Percutaneous nephrolithotripsy in ectopic kidneys.

Desai MR, Jasani A.

Muljibhai Patel Urological Hospital, Nadiad, India.

BACKGROUND: Percutaneous nephrolithotomy (PCNL), although an accepted treatment
modality in anatomically normal kidneys, is still not universally performed for
calculi in pelvic ectopic kidneys. Fear of injury to abdominal viscera makes it a
technically challenging procedure. PATIENTS AND METHODS: We have performed PCNL
in nine patients with calculi in pelvic ectopic kidneys. Technical factors which 
made this procedure safe include ultrasound-guided puncture, use of a mature
tract or an Amplatz sheath, routine postoperative double-J stenting, and
nephrostogram prior to nephrostomy tube removal. RESULTS: Complete stone
clearance was achieved in all cases. Six patients were treated in a single stage,
while three patients required two stages. Seven patients needed only one tract,
and two needed two tracts. No notable complications were encountered. The average
hospital stay was 5.2 days. CONCLUSION: With proper precautions and meticulous
technique, PCNL is a safe and effective modality to treat calculi in pelvic
ectopic kidney.

Publication Types: 
    Comparative Study

PMID: 10795621 [PubMed - indexed for MEDLINE]

1516: J Endourol. 2000 Apr;14(3):285-7.

Bilateral single-session percutaneous nephrolithotomy: a feasible and safe
treatment.

Maheshwari PN, Andankar M, Hegde S, Bansal M.

RG Stone Urological Research Institute, Mumbai, India. calrgsc@bom5.vsnl.net.in

BACKGROUND AND PURPOSE: The treatment of bilateral urinary calculus disease is
often staged, irrespective of the modality of the treatment. Bilateral
simultaneous percutaneous nephrolithotomy (PCNL) is still considered by many to
be adventurous and risky. We carried out this prospective study of bilateral PCNL
under a single anesthesia to study the feasibility, success rate, and
complications if any. PATIENTS AND METHOD: From September 1996 to May 1999, 25
consecutive medically fit patients with bilateral renal calculi needing PCNL were
subjected to bilateral PCNL under a single anesthesia. RESULTS: The PCNL could be
accomplished bilaterally in 24 patients (96%). In one patient, the second-side
PCNL was abandoned because of excessive bleeding on the first side. A total of 58
tracts and 27 sessions were required for complete treatment of the 48 renal units
in the 24 successfully treated patients. The average operating time required for 
the procedure was 122 minutes. Nineteen patients were rendered stone free in one 
session, and two more patients were made stone free in a second session. Four
renal units in three patients with residual calculi were cleared with double-J
stenting and SWL. CONCLUSION: Bilateral PCNL in a single session is feasible and 
safe and can be carried out without increased morbidity. We advocate that an
endourologist be prepared for bilateral PCNL in the patients in whom it is
indicated. The opposite-side PCNL can be done if the first-side treatment is
accomplished smoothly and in a reasonable time.

Publication Types: 
    Clinical Trial
    Comparative Study
    Multicenter Study

PMID: 10795620 [PubMed - indexed for MEDLINE]

1517: J Endourol. 2000 Apr;14(3):269-72; discussion 272-3.

Mini-percutaneous nephrolithotomy.

Chan DY, Jarrett TW.

James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions,
Baltimore, Maryland, USA.

Standard percutaneous nephrolithotomy is highly effective for the removal of
renal calculi. However, significant morbidity has been associated with this
procedure. Consequently, many urologists inappropriately defer to a less
effective procedure to reduce patient morbidity. This practice may increase the
total number of procedures needed for treatment and result in a substantial
increase in health care costs. Mini-percutaneous nephrolithotomy using a 13F
ureteroscopy sheath is described to reduce the morbidity associated with standard
percutaneous nephrolithotomy while maintaining its efficiency and effectiveness
for stone removal. The indications and technique for mini-percutaneous
nephrolithotomy and our results are summarized.

PMID: 10795617 [PubMed - indexed for MEDLINE]

1518: J Endourol. 2000 Apr;14(3):239-46.

Extracorporeal shockwave lithotripsy of 2000 urinary calculi with the modulith
SL-20: success and failure according to size and location of stones.

Coz F, Orvieto M, Bustos M, Lyng R, Stein C, Hinrichs A, San Francisco I.

Department of Urology, Military Hospital, Santiago, Chile. luiscoz@entelchile.net

PURPOSE: We analyzed the successes and failures of SWL in the treatment of 2016
urinary calculi stratified according to size and position in the urinary tract.
METHODS: All the patients were treated with a Modulith SL-20 (Storz Medical).
RESULTS: The overall stone-free rate, regardless of the size and position of the 
stone, was 87.4%. The rate was different for kidney and ureteral stones. The
stone-free rate observed for the different positions of the calculi within the
kidney was upper calix 89.2%, middle calix 90.5% lower calix 84.8%, and renal
pelvis 86.0%. For staghorn calculi, the stone-free rate was 60.0%. The stone-free
rate for the different positions of calculi within the ureter was: upper ureter
84.3%, iliac ureter 82.4%, and pelvic ureter 91.0%. For calculi >24 mm, the
retreatment rate increased, and the success rate dropped sharply. CONCLUSION:
Extracorporal shockwave lithotripsy should be the first therapeutic option for
urinary calculi of <24 mm regardless of their position in the urinary tract.

Publication Types: 
    Comparative Study

PMID: 10795612 [PubMed - indexed for MEDLINE]

1519: BJU Int. 2000 May;85(7):874-8.

Paediatric anatrophic nephrolithotomy; stone clearance - at what price?

Gough DC, Baillie CT.

Department of Paediatric Urology, Royal Manchester Children's Hospital,
Manchester, UK.

OBJECTIVE: To evaluate the functional outcome of anatrophic nephrolithotomy in
children. PATIENTS AND METHODS: All children undergoing anatrophic
nephrolithotomy for complex branching and multiple renal calculi over an 11-year 
period were studied prospectively. Demographic data, treatment details and
outcome, as assessed by X-ray, ultrasonography and isotope studies, were
recorded. Anatrophic nephrolithotomy was carried out with surface cooling of the 
kidney followed by nephrostomy drainage for 5-7 days. RESULTS: Nine children
(median age 4 years, range 7 months to 9 years) underwent anatrophic
nephrolithotomy. Predisposing factors included urinary tract infection (by
Proteus mirabilis) in all and hyper-calciuria in two children. The median (range)
total ischaemic time at operation was 25 (15-40) min and the operative duration
150 (120-200) min. Three children required a blood transfusion. Stone clearance
was incomplete in one child. There was no recurrent stone formation after a
long-term follow-up (median 32 months, range 14-107) in the other patients.
Isotope studies showed impaired split renal function (<40%) in six children
before surgery; there was a significant decline (>5%) in divided function in five
children (range 6-16%) after surgery. CONCLUSION: Anatrophic nephrolithotomy is
an effective means of rendering children with branching calculi stone-free, but
this study suggests that it leads to some further parenchymal damage.

PMID: 10792169 [PubMed - indexed for MEDLINE]

1520: Urol Clin North Am. 2000 May;27(2):347-54.

Management of residual stones.

Delvecchio FC, Preminger GM.

Department of Surgery, Duke University Medical Center, Durham, North Carolina,
USA.

Stone-free status is highly dependent on selection of the appropriate surgical
technique, which should be tailored according to the individual stone and patient
parameters. Although a stone-free state is the desired outcome of surgical
intervention of urolithiasis, the authors believe that the presence of
noninfection, nonobstructive, asymptomatic postprocedural residual fragments can 
be managed metabolically in order to prevent stone growth adequately. Further
surgical intervention in the case of residual fragments is warranted if the
clinical indications that prompted the original surgery persist.

Publication Types: 
    Review

PMID: 10778476 [PubMed - indexed for MEDLINE]

1521: Urol Clin North Am. 2000 May;27(2):275-85, viii.

Kidney stones as a manifestation of hypercalcemic disorders. Hyperparathyroidism 
and sarcoidosis.

Rodman JS, Mahler RJ.

Department of Medicine, Cornell University School of Medicine, New York, New
York, USA.

When hypercalcemia is detected in a kidney stone formation, an intact parathyroid
hormone measurement should be made. Detection of hyperparathyroidism (HPT) is
important to prevent further stone episodes and to avoid the complications of
high serum calcium in other organ systems. Stones in patients with HPT often
contain apatite salts in addition to calcium oxalate because parathyroid excess
may create a renal tubular acidosis. The calculi seen in patients with
sarcoidosis, another hypercalcemic state that may cause stone formation, however,
are usually pure calcium oxalate. Excess generation of 1,25-dihydroxyvitamin D
results in intestinal hyperabsorption of calcium and secondary hyperoxaluria.

Publication Types: 
    Review

PMID: 10778470 [PubMed - indexed for MEDLINE]

1522: Urol Clin North Am. 2000 May;27(2):203-13.

When and how to evaluate a patient with nephrolithiasis.

Rivers K, Shetty S, Menon M.

Department of Urology, Henry Ford Hospital, Detroit, Michigan, USA.

Nephrolithiasis is a common disorder that afflicts up to 12% of the population
and continues to be a significant cause of patient injury. Evaluation of these
patients should include the assessment of their comorbidities and underlying
medical conditions. Patients who form stones can undergo a streamlined
evaluation. A cause can be found in more than 90% of these patients. With medical
treatment, stone-recurrence rates can be decreased by 85% for calcium oxalate
stone formation, which affects a large proportion of patients. Introduction of
nonspecific medical therapy in uncomplicated calcium stone disease may improve
the quality of life for these patients and allow utilization a simple diagnostic 
protocol. This is in contrast to the previous recommendations of disease-specific
therapy. Because patients without complications represent the majority of those
who form stones, a simplified approach greatly reduces the cost of evaluation and
treatment. Underlying medical conditions, however, require disease-specific
therapy. The protocol represented here should aid physicians and patients in the 
approach to management of stone disease. The fasting calcium-load test is not
required, and the entire evaluation can be performed in an ambulatory setting in 
two visits. Two 24-hour urine samples should be obtained on a random and
restricted diet. Patients who form calcium stones can be subdivided into those
who form hypercalciuric and normocalciuric stones. Patients who form
normocalciuric stones are treated with conservative measures (increased fluid
intake) and potassium and magnesium citrate. Patients who form hypercalciuric
stones are treated with a combination of thiazides and potassium and magnesium
citrate.

PMID: 10778464 [PubMed - indexed for MEDLINE]

1523: J Manipulative Physiol Ther. 2000 Mar-Apr;23(3):196-201.

Nephrolithiasis with unusual initial symptoms.

Wells KA.

Diagnosis Department, Los Angeles College of Chiropractic, Whittier, Calif.
90604, USA.

OBJECTIVE: To describe a less common initial symptom of nephrolithiasis, its
diagnostic pitfalls, risk factors, and mimicry of other conditions. Intervention 
and long-term management of nephrolithiasis is also discussed. CLINICAL FEATURES:
A Caucasian man aged 25 years had sudden bilateral inguinal and occasional
periumbilical pain. The initial symptom suggested an abdominal pathologic
condition; however, costovertebral angle pain followed 1 hour later with no
radiation between the 2 anatomic sites. The initial urine dipstick result was
negative for hematuria, but a kidney, ureter, and bladder radiograph revealed a
smooth 2-mm x 3-mm stone lodged at the left: vesico-ureteral junction.
INTERVENTION AND OUTCOME: The patient was referred to a regional university
medical center to receive extracorporeal shockwave lithotripsy several days after
his initial visit. He was given pain medicine for the waiting period and received
daily lumbar spine adjustments with a mild reduction in pain. He eventually
received ureteroscopic laser lithotripsy because the shock-wave unit had
malfunctioned before his appointment. The fragment analysis showed a calcium
oxalate composition, and the patient was advised to lower his intake of oxalates.
The patient had become a vegetarian approximately 3 months before this first
stone episode. CONCLUSION: Nephrolithiasis is a condition commonly seen in
chiropractic practice. Although it is usually easy to recognize, the diagnosis
can be elusive if the typical historic factors and diagnostic results are absent 
or altered. The short-term management of nephrolithiasis is pain management,
stone elimination, and the collection of a specimen to identify the composition
and underlying metabolic abnormality. Long-term management is to prevent the
recurrence of stones. Conservative comanagement by the chiropractic physician can
be implemented through nutritional means.

Publication Types: 
    Case Reports
    Review

PMID: 10771504 [PubMed - indexed for MEDLINE]

1524: BJU Int. 2000 Apr;85(6):611-5.

Early observations of the effect of extracorporeal shockwave lithotripsy on blood
pressure: a prospective randomized control clinical trial.

Elves AW, Tilling K, Menezes P, Wills M, Rao PN, Feneley RC.

Stone Management Centre, Department of Urology, Southmead Hospital, Bristol, UK.

OBJECTIVE: To determine, in a randomized controlled clinical trial, the effect of
extracorporeal shock wave lithotripsy (ESWL) on blood pressure. PATIENTS AND
METHODS: The trial included 228 patients with small (< 15 mm) asymptomatic
calyceal stones who were randomised to undergo ESWL (113 patients) or to an
untreated (observed) control group (115 patients). Blood pressure was recorded at
randomization using a standardized protocol. Patients undergoing ESWL received a 
mean (SD) of 5281 (3462) shocks over a mean of 1.75 sessions on one of two
lithotripters. Patients were then followed annually, assessing blood pressure and
changes in medication. Data were analysed on an intention-to-treat basis.
RESULTS: At randomization, 43% of patients in the control group and 53% in the
ESWL group were hypertensive. Of the 228 randomized, 200 patients completed at
least one annual follow-up, of whom 192 (93 in the control and 99 in the ESWL
group) had their blood pressure recorded. The mean follow-up was 2.2 years; 35
(37%) patients in the control and 46 (46%) in the ESWL group were hypertensive (P
= 0.19). Seven (7%) patients in the control group and 11 (11%) in the ESWL group 
were newly diagnosed to be hypertensive (P = 0.35). CONCLUSIONS: In this
randomized controlled clinical trial there was no evidence that ESWL causes
changes in blood pressure.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

PMID: 10759650 [PubMed - indexed for MEDLINE]

1525: Scand J Urol Nephrol. 2000 Feb;34(1):36-41.

Long-term follow-up of stone formers treated with a low dose of sodium potassium 
citrate.

Jendle-Bengten C, Tiselius HG.

Department of Biomedicine and Surgery, Faculty of Health Sciences, University
Hospital, Linköping, Sweden.

We evaluated the clinical efficacy of long-term preventive treatment with a
single evening dose of alkaline citrate. Information was collected from the files
of 52 recurrent stone formers prescribed a daily intake of 3.75-5 g of sodium
potassium citrate (SPC; 14-18 mmol of citrate). The annual and cumulative rates
of stone formation and the rate of recurrence were compared before and during the
treatment. A comparison was also made between the patients with (Group R) and
without (Group NR) recurrent stone formation during treatment in terms of urine
composition and previous history of the disease. For all patients who started the
treatment, the number of stones was smaller during treatment (period tT) than
during a period of the same length immediately before treatment (period tB), but 
greater than the number formed during a corresponding period immediately after
the diagnosis (period tA). Via questionnaire we found low treatment compliance,
with only 62% of the patients reporting consistent taking of their medication
(Group T). The patients in Group T had a smaller cumulated number of stones
during period tT than that during periods tA and tB, but the Kaplan-Meier curve
of the fraction of patients remaining stone-free during treatment was almost
identical to that recorded in 446 recurrent stone formers without medical
treatment. No significant differences were recorded in terms of relevant
pretreatment urinary risk factors between Groups T(R) and T(NR), but numerically 
higher values of calcium oxalate (CaOx) supersaturation and calcium/citrate
quotients were observed in Group T(R). When 9 patients with a daily intake of SPC
and a citrate excretion below 2.5 mmol/day were compared with 16 hypocitraturic
patients only given drinking advice, the cumulated percentages of patients
without recurrent stone formation in the 2 groups after 3 years were 44% and 48%,
respectively. Although the number of patients in this study was small, our
results indicate poor long-term protection from recurrent calcium stone formation
when a single evening dose of only 3.75-5 g of SPC was taken. The rate of stone
formation was apparently slightly reduced, but the fraction of patients free of
recurrence was no different from that in patients without medical treatment.

PMID: 10757268 [PubMed - indexed for MEDLINE]

1526: J Urol. 2000 Apr;163(4):1343-8.

Role of anionic proteins in kidney stone formation: interaction between model
anionic polypeptides and calcium oxalate crystals.

Wesson JA, Worcester EM, Kleinman JG.

Medical College of Wisconsin and the Department of Veterans Affairs Medical
Center, Milwaukee 53295, USA.

PURPOSE: We tested the effect of molecular weight and amino acid composition
(aspartate versus glutamate) in model peptides on calcium oxalate dihydrate (COD)
formation to understand how known urinary inhibitor proteins might control
spontaneous crystallization. MATERIALS AND METHODS: Supersaturated solutions of
CaCl2 and Na2C2O4 in HEPES buffered saline solution were prepared at various
calcium (Ca) to oxalate (Ox) ratios, but constant supersaturation, in the
presence of protein inhibitors (polyaspartic acid molecular weight series or
polyglutamic acid). The resulting crystals were collected and evaluated with
optical microscopy. RESULTS: With no added inhibitors, the crystal size increased
with Ca to Ox ratio, while the number of crystals decreased. With protein
inhibitors at equivalent mass concentrations, intermediate molecular weight
proteins produced a greater proportion of COD in Ca rich conditions than did
either extreme. In Ox rich conditions, the proportion of COD was directly related
to protein molecular weight. However, at equivalent molar concentrations, the
proportion of COD produced was directly related to molecular weight under all
conditions. Larger protein concentrations were required to produce COD at high Ox
conditions, in proportion to the increased number of crystals produced.
Polyglutamic acid had a much weaker effect on crystal structure, but it changed
the COM morphology. CONCLUSIONS: The results suggest that a discrete number of
protein molecules per crystal were required to direct crystallization toward COD,
and that a characteristic size of polypeptide chain can be defined. The charge of
the side group was not the sole determinant of this effect, as polyglutamic and
polyaspartic acids behaved differently. Calcium oxalate crystal nucleation rates 
appeared to increase with Ox content.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 10737541 [PubMed - indexed for MEDLINE]

1527: Hosp Pract (Minneap). 2000 Mar 15;35(3):49-50, 53-6, 62-3 passim.

New insights into causes and treatments of kidney stones.

Scheinman SJ.

Division of Nephrology, State University of New York Health Science Center at
Syracuse College of Medicine, USA.

Recent findings have provided insight into the molecular basis of kidney stone
formation and entirely changed our approach to management of calcium stones.
Understanding the role of genetic factors and the various promotors and
inhibitors of stone formation should lead to more effective prophylaxis and
treatment of other types of stones as well.

Publication Types: 
    Review

PMID: 10737240 [PubMed - indexed for MEDLINE]

1528: Clin Sci (Lond). 2000 Mar;98(3):313-9.

Does a high concentration of calcium in the urine cause an important renal
concentrating defect in human subjects?

Lam GS, Asplin JR, Halperin ML.

Renal Division, St. Michael's Hospital, University of Toronto, Toronto, Ontario
M5B 1A6, Canada.

The objective of this study was to evaluate the hypothesis that a high
concentration of ionized calcium in the lumen of the medullary collecting duct
causes an osmole-free water diuresis. The urine flow rate and osmolality were
measured in normal human subjects, as well as in patients with a history of
nephrolithiasis who excreted more than 5 mmol of calcium per 24 h. There was an
inverse relationship between the concentration of calcium in the urine and the 24
h urine volume both in normal subjects and in patients with a history of
nephrolithiasis. When the concentration of calcium in the urine was greater than 
5 mmol/l, the urine volume was less than 1 litre per day in the majority of
subjects. After 16 h of water deprivation, when the concentration of calcium in
the urine was as high as 17 mmol/l (ionized calcium 7.4 mmol/l), urine osmolality
was 1258 mOsm/kg of water and the urine flow rate was 0.30 ml/min. We conclude
that, although a calcium receptor may be present in the lumen of the medullary
collecting duct in human subjects, an extremely high concentration of urinary
total and ionized calcium does not cause a clinically important defect in the
renal concentrating process.

PMID: 10677390 [PubMed - indexed for MEDLINE]

1529: Kidney Int. 2000 Mar;57(3):1115-23.

Effects of low animal protein or high-fiber diets on urine composition in calcium
nephrolithiasis.

Rotily M, Léonetti F, Iovanna C, Berthezene P, Dupuy P, Vazi A, Berland Y.

Centre d'Investigations Clinique, Sainte Marguerite, APHM-INSERM, Marseille,
France. rotily@marseille.inserm.fr

BACKGROUND: The purpose of this article is to evaluate the impact of low protein 
and high fiber intakes on risk factors of stone recurrence in idiopathic calcium 
stone formers (ICSFs). METHODS: Ninety-six ICSFs were randomly assigned a low
animal protein diet (< 10% of total energy), a high-fiber diet (> 25 g/day), or a
usual diet (control group); all patients were recommended to increase their fluid
intake. Their daily urine compositions were analyzed at baseline and at four
months. Compliance with dietary recommendations was checked by validated food
frequency questionnaires. Compliance with total and animal protein intakes was
assessed by 24-hour urea and sulfate outputs, respectively. The nutritional
intervention (oral instructions, written leaflet, phoning) and food assessment
were carried out by a research dietitian. RESULTS: At baseline, diets and the
daily urine composition did not differ between the three groups. At four months, 
while diets differed significantly, the 24-hour output of calcium and oxalate did
not differ significantly within and between groups after adjustment for potential
confounders (age, sex, and personal and family history of calcium stones) and
baseline values. However, as many as 12 out of 31 ICSFs (95% CI, 22 to 58%)
assigned to a low animal protein diet achieved a reduction in the urine urea
excretion rate of more than 50 mmol/day and also exhibited a significant decrease
in urinary calcium excretion that averaged 1.8 mmol/day. A significant
correlation between urea and calcium outputs was observed only among patients
with hypercalciuria. CONCLUSIONS: These results show that only ICSFs who markedly
decrease their animal protein intake, especially those with hypercalciuria, can
expect to benefit from dietary recommendations.

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 10720964 [PubMed - indexed for MEDLINE]

1530: Kidney Int. 2000 Mar;57(3):787-93.

Pathogenesis of Dent's disease and related syndromes of X-linked nephrolithiasis.

Thakker RV.

Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe
Hospital, England, United Kingdom. rajesh.thakker@ndm.ox.ac.uk

Renal stone disease, which affects 12% of males and 5% of females by the seventh 
decade, occurs as an inherited disorder in 45% of patients and is most commonly
associated with hypercalciuria. The biochemical basis for hereditary
nephrolithiasis and hypercalciuria is unknown, and this has therefore been
investigated by a "positional cloning" approach. As a first step in this
approach, the chromosomal locations of two disorders referred to as Dent's
disease and X-linked recessive nephrolithiasis (XRN) were determined. These two
disorders, which represent unusual forms of the renal Fanconi syndrome, are
characterized by a low molecular weight proteinuria, hypercalciuria,
nephrocalcinosis, nephrolithiasis and renal failure. An X-linked inheritance for 
XRN was established by studies of a North American kindred, and a similar
inheritance for Dent's disease was indicated by the observation of a greater
disease severity in males and an absence of male-to-male transmission in five
British families. X-linked polymorphic genetic markers were used in linkage
studies of these families, and the genes causing Dent's disease and XRN were
mapped to Xp11. In addition, in one family with Dent's disease, a microdeletion
involving the DNA probe M27 beta was identified. This microdeletion was further
characterized by using yeast artificial chromosomes (YACs) and its size was
estimated to be 515 Kb. A search for renal-expressed genes from this region
identified a novel gene encoding a chloride channel (CLCN5) with similarities to 
a family of voltage-gated chloride channels. Molecular genetic studies of CLCN5
demonstrated that mutations, which resulted in a functional loss, were associated
with Dent's disease and XRN. In addition, such CLCN5 mutations that would result 
in a functional loss have also been demonstrated in Japanese children with
idiopathic low molecular weight proteinuria, hypercalciuria and nephrocalcinosis,
and an Italian kindred with X-linked recessive hypophosphatemic rickets (XLRH)
and hypercalciuria. Thus, four hereditary disorders of nephrolithiasis are due to
mutations of the novel chloride channel, CLCN5.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Review

PMID: 10720930 [PubMed - indexed for MEDLINE]

1531: Eur Urol. 2000 Mar;37(3):331-3.

Local anesthesia for extracorporeal shock wave lithotripsy: a double-blind,
prospective, randomized study.

Türker AK, Ozgen S.

Department of Anesthesiology, Hacettepe University Medical School, Ankara,
Turkey. arzuturker@hotmail.com

OBJECTIVE: The efficacy of local anesthesia in decreasing intravenous analgesic
requirements during extracorporeal shock wave lithotripsy with a
second-generation lithotriptor was studied. METHODS: Subcutaneous infiltration
was performed before the procedure. Sixty-nine patients (ASA I-II) were randomly 
allocated into four groups. Lidocaine 1% plus epinephrine (5 microg/ml) were
infiltrated subcutaneously in a group of patients with ureteral stones (group
UL), and a group with renal stones (group RL). The same amount of saline was
administered to a group of patients with ureteral stones (group UC), and a group 
with renal stones (group RC). RESULTS: Patients with ureteral stones needed
higher doses of intravenous analgesic. Neither patients with renal stones nor
patients with ureteral stones administered local anesthetic required less
intravenous analgesic than patients given placebo. CONCLUSION: Local anesthesia
did not decrease the requirement of intravenous doses of analgesics in patients
treated with a second-generation lithotriptor (Dornier MPL 9000).

Publication Types: 
    Clinical Trial
    Randomized Controlled Trial

PMID: 10720861 [PubMed - indexed for MEDLINE]

1532: Int J Urol. 2000 Feb;7(2):65-8.

Acute pancreatitis caused by extracorporeal shock wave lithotripsy for bilateral 
renal pelvic calculi.

Abe H, Nisimura T, Osawa S, Miura T, Oka F.

Department of Urology, Chiba Hokuso Hospital, Nippon Medical School, Inba-gun,
Japan.

An elderly woman with a history of cholecystectomy and a re-operation for
postoperative peritonitis underwent extracorporeal shock wave lithotripsy (ESWL) 
for right and left renal pelvic calculi, 11 x 6 and 12 x 5 mm in size, to which
2400 and 1400 shots at 20 kV were given, respectively, on the same day. During
the evening after the operation, the patient started to complain of upper
abdominal pain. Laboratory examination on the next day revealed elevations in
blood and urine amylase levels and a diagnosis of pancreatitis was made.
Conservative treatment, including administration of protease inhibitor, did not
improve her symptoms; abdominal distension became marked and she underwent
laparotomy. Necrosection and indwelling of several drain tubes in abdomen were
performed with an operative diagnosis of acute necrotic pancreatitis. With daily 
irrigation of drain tubes and treatment for methicillin-resistant Staphyloococcus
aureus infection of the lungs and abdominal cavity, septicemia and duodenal
fistula, the patient gradually recovered and was discharged on postoperative day 
151. It was suggested that ESWL was responsible for the acute pancreatitis.
Either an obstruction of the pancreatic duct by fragments of common duct stone,
or mechanical injury of the pancreas due to adhesion between the pancreas and
surrounding tissue caused by the lapalotomy, was considered as a possible cause
of pancreatitis. To our knowledge, there has been no previous report of severe
acute pancreatitis and the present case suggests that ESWL may cause severe
pancreatic even in cases without stone shadow in the bile, common duct or
pancreatic duct.

Publication Types: 
    Case Reports

PMID: 10710251 [PubMed - indexed for MEDLINE]

1533: Tech Urol. 2000 Mar;6(1):37-8.

Inline tug on a through-and-through glidewire to reposition open-ended catheter
during percutaneous nephrolithotomy.

Maheshwari PN, Andankar M, Khera R, Mehta SV, Bansal M.

R. G. Stone Urological Research Institute, Mumbai, India.

We present a simple technique to reposition an open-ended ureteric catheter in
the pelvicalyceal system during percutaneous nephrolithotomy. A
through-and-through glidewire is straightened using a stone-grasping forceps. The
open-ended catheter is advanced in the pelvicalyceal system over this taut
glidewire.

PMID: 10708147 [PubMed - indexed for MEDLINE]

1534: Eur Urol. 2000 Feb;37(2):140-4.

Effect of dietary intake on urinary oxalate excretion in calcium oxalate stone
formers in their forties.

Naya Y, Ito H, Masai M, Yamaguchi K.

Yokohama Rosai Hospital, Yokohama, Japan.

PURPOSE: To examine the influence of dietary intake on urinary oxalate excretion 
in calcium oxalate stone formers in their forties. PATIENTS AND METHODS: Dietary 
intake was recorded by using the dietary-record method in 58 idiopathic stone
formers in their forties. The patients collected their urine for 24 h at home and
their urinary oxalate excretion was measured. The relationship between the
dietary intake of various nutrients and urinary oxalate excretion was examined by
mono- and multivariate analysis. RESULTS: The intake of animal fat was correlated
with urinary oxalate excretion by monovariate analysis, but that of total
protein, animal protein, calcium and carbohydrate were not. By multivariate
analysis, the intake of animal fat was correlated with urinary oxalate excretion 
and the intake of calcium was inversely correlated with urinary oxalate
excretion. CONCLUSION: The intake of animal fat was positively and the intake of 
calcium was negatively correlated with the urinary oxalate excretion in stone
formers in their forties. It was shown that animal fat plays an important role in
urinary oxalate excretion.

PMID: 10705190 [PubMed - indexed for MEDLINE]

1535: Nephrol Dial Transplant. 2000 Mar;15(3):366-74.

Citrate determines calcium oxalate crystallization kinetics and crystal
morphology-studies in the presence of Tamm-Horsfall protein of a healthy subject 
and a severely recurrent calcium stone former.

Hess B, Jordi S, Zipperle L, Ettinger E, Giovanoli R.

Department of Medicine and Laboratory of Electron Microscopy, University of
Berne, Berne, Switzerland.

BACKGROUND: The aim of this study was to measure the effects of normal (nTHP) and
abnormal stone former Tamm-Horsfall protein (SF-THP) on calcium oxalate (CaOx)
nucleation and aggregation as well as on crystal morphology, in presence or
absence of citrate. METHODS: Nucleation and aggregation of CaOx crystals from a
supersaturated, stirred solution (200 mM NaCl, 10 mM Na-acetate, pH 5.70, 5 mM Ca
and 0.5 mM Ox) were studied by spectrophotometric time-course measurements of OD 
at 620 nm (OD(620)). Measured parameters were induction time t(I) (time to induce
formation of detectable particles), S(N), (slope of increase of OD(620), mainly
due to crystal nucleation), and S(A), (slope of decrease of OD(620) after
equilibrium has been reached, due to crystal aggregation). Effects of citrate,
nTHP and SF-THP on these parameters were measured, and scanning electron
microscopy (SEM) was performed. RESULTS: At 1.5, 2.5 and 3.5 mM, citrate
increased t(I) and inhibited crystal nucleation (by 78-87%) as well as
aggregation (by 63-70%), and smaller CaOx crystals (length/width ratio 1.7+/-0.1)
than under standard conditions (length/width 3.9+/-0.5) were visible (P<0.001).
Normal THP at 30 and 40 mg/l inhibited crystal nucleation and, more strongly,
aggregation (inhibition 76-81%). SEM revealed a decrease in length/width ratio to
2.6+/-0.4 (P=0.051 vs standard conditions) and less aggregation than without
nTHP. At all concentrations tested, SF-THP reduced t(I) (P=0.0001 vs standard
conditions) and promoted aggregation (inhibition -48 to -33%); crystals were
elongated with a length/width ratio of 4.3+/-0.6 (P<0. 05 vs nTHP). When
simultaneously present with nTHP, citrate enhanced the inhibitory effects of
nTHP, producing the smallest (length/width 1.5+/-0.1) and least aggregated
crystals. Finally, 3.5 mM citrate turned promotory SF-THP into a crystallization 
inhibitor with abundant small and clustered, but not aggregated crystals.
CONCLUSION: Citrate appears to be the main determinant of CaOx crystallization
rates and crystal morphology in the presence of nTHP as well as SF-THP. Its
effects appear to predominate over those of THP, since even promotory SF-THP is
turned into a crystallization inhibitor in the presence of citrate. This
re-emphasizes at a morphological level what has been concluded from functional as
well from clinical studies, namely that citrate is needed in urine at equimolar
concentrations to calcium in order to prevent the formation of large crystal
aggregates in presence of abnormal THP.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 10692522 [PubMed - indexed for MEDLINE]

1536: J Urol. 2000 Mar;163(3):726-9.

Nephrolithiasis associated with autosomal dominant polycystic kidney disease:
contemporary urological management.

Ng CS, Yost A, Streem SB.

Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.

PURPOSE: We evaluate the role of contemporary urological intervention in patients
with nephrolithiasis associated with autosomal dominant polycystic kidney
disease. MATERIALS AND METHODS: Intervention for upper tract stones associated
with autosomal dominant polycystic kidney disease was performed in 5 women and 2 
men 29 to 65 years old (mean age 47). Indications for intervention consisted of
flank pain in 6 patients and/or hematuria in 2. A total of 12 procedures (mean
1.7 per patient) were performed, including shock wave lithotripsy in 6 patients, 
percutaneous nephrolithotomy in 2, retrograde endoscopy or manipulation in 3 and 
extended pyelonephrolithotomy in 1. RESULTS: All patients were rendered
stone-free or had only residual "dust." Hospital stay for 5 patients was 1 night 
or less and there were no complications. Renal function for each patient was
stable or improved as measured by serum creatinine. CONCLUSIONS: Most patients
with autosomal dominant polycystic kidney disease who require intervention for
nephrolithiasis can be safely and effectively treated with essentially any or all
contemporary, minimally invasive techniques. The choice of intervention can be
based primarily on size and location of the upper tract stones rather than the
associated presence of polycystic kidneys.

PMID: 10687965 [PubMed - indexed for MEDLINE]

1537: J Urol. 2000 Mar;163(3):721-5.

Variation in clinical outcome following shock wave lithotripsy.

Logarakis NF, Jewett MA, Luymes J, Honey RJ.

Urolithiasis Program, Division of Urology, The University of Toronto, Ontario,
Canada.

PURPOSE: We measure and compare operator specific success rates of extracorporeal
shock wave lithotripsy (ESWL) performed by 12 urologists in 1 unit to determine
interoperator variation. MATERIALS AND METHODS: From January 1, 1994 to September
1, 1997 a total of 5,769 renal and ureteral stones received 9,607 ESWL treatments
by 15 urologists with a Dornier MFL 5000 lithotriptor. The 3-month followup data 
are available for 4,409 stones. Outcome measures consisted of patient
demographics, stone characteristics, technical details of lithotripsy, and
stone-free and success rates by treating urologists. RESULTS: Treatment results
were analyzed for 12 urologists (surgeons A to L) who treated more than 100
stones each, totaling 4,244 with followup information available. Mean stone-free 
and success rates were 50.6% and 72.3%, respectively. Surgeon A had significantly
higher stone-free and success rates of 56.2% and 76.7%, respectively (p<0.05),
with treatment results from 877 stones, which was a significantly higher number
than others (p<0.05). Significant differences existed in mean number of shocks
delivered among urologists (p = 0.0001), with surgeons A and J delivering the
highest mean numbers (2,317 and 2,801, respectively). There was no difference in 
treatment duration (p = 0.75) but variation existed among urologists in terms of 
mean maximum treatment voltage (p = 0.0001). Mean fluoroscopy time at 4.1 minutes
was higher for surgeon A than others (p<0.05). Mean complication rate following
ESWL was 4.9% with no difference among urologists (p = 0.175). Re-treatment was
required in 21.7% of cases and surgeon A had the lowest rate (15.9%, p<0.05).
CONCLUSIONS: We demonstrated clinically and statistically significant
intra-institutional differences in success rates following ESWL. The best results
were obtained by the urologist who treated the greatest number of patients, used 
a high number of shocks and had the longest fluoroscopy time. Accurate targeting 
is crucial when using a lithotriptor, such as the Dornier MFL 5000, with a narrow
focal zone of 6.5 mm. in diameter. Other centers should be encouraged to develop 
similar programs of outcome analysis in an attempt to improve performance.

Publication Types: 
    Clinical Trial
    Comparative Study

PMID: 10687964 [PubMed - indexed for MEDLINE]

1538: Urology. 2000 Feb;55(2):204-6.

Mechanical percussion inversion can result in relocation of lower pole stone
fragments after shock wave lithotripsy.

D'a Honey RJ, Luymes J, Weir MJ, Kodama R, Tariq N.

Division of Urology, Saint Michael's Hospital, Sunnybrook and Women's College
Health Sciences Centre, Toronto, Ontario, Canada.

OBJECTIVES: To determine whether mechanical percussion combined with inversion
(MPI) therapy and forced diuresis can move stone fragments out of the lower pole 
of the kidney. METHODS: Twelve patients with lower pole residual stone fragments 
at least 2 weeks after shock wave lithotripsy were treated using the following
protocol. Eleven patients received 20 mg of furosemide before MPI therapy.
Patients were treated in the prone Trendelenberg position on a pivoting stretcher
and given 10 minutes of percussion over the flank using a mechanical chest
physiotherapy percussor. Stone location was documented with plain abdominal
radiographs before, immediately after, and 2 weeks following MPI therapy. Voided 
urine was strained immediately after MPI therapy and throughout the study period.
RESULTS: Abdominal radiographs before and after treatment demonstrated movement
of fragments out of the lower pole in 11 patients. In 8 patients, the lower pole 
appeared entirely clear of fragments on the immediate post-treatment film. Four
patients passed stone fragments in their first voided urine. Ten patients passed 
stone fragments during the 2-week follow-up period. CONCLUSIONS: MPI therapy
combined with diuresis can effectively mobilize stone fragments out of the lower 
pole calyces and appears to aid in the passage of fragments.

PMID: 10688079 [PubMed - indexed for MEDLINE]

1539: BJU Int. 2000 Feb;85(3):311-5.

The efficacy and parenchymal consequences of extracorporeal shock wave
lithotripsy in infants.

Lottmann HB, Archambaud F, Traxer O, Mercier-Pageyral B, Helal B.

Departments of Paediatric Urology and Radiology, Fondation Hôpital Saint Joseph, 
Paris, France. uro.inf@worldnet.fr

OBJECTIVES: To determine the efficacy of extracorporeal shock-wave lithotripsy
(ESWL) in young children and to evaluate, using renal scintigraphy, any possible 
adverse effects on renal parenchyma. PATIENTS AND METHODS: From January 1991 to
October 1998, 19 infants (aged 5-24 months) underwent ESWL for kidney
urolithiasis using a Sonolith 3000 (14 kV, Technomed Corp, Lyon, France) or a
Nova (14-20 kV, Direx Medical Systems, Paris, France) lithotripter. The treatment
and its effects were evaluated using a physical examination, conventional imaging
(plain abdominal X-ray and ultrasonography) and renal scintigraphy 24 h before
ESWL and again at least 6 months after the last session of treatment. RESULTS:
Ten children were rendered stone-free by ESWL after one session and 18 after two 
sessions. At the follow-up (8 months to 8 years, mean 36 months) no hypertension 
was recorded and no acquired parenchymal damage was detected with conventional
imaging. No scars or significant variation of differential function attributable 
to ESWL were identified on renal scintigraphy. CONCLUSION: ESWL is clearly
effective for treating infant urolithiasis. There were no renal parenchymal
lesions associated with ESWL, even in previously damaged kidneys or after the
treatment of staghorn calculi. A long-term follow-up (assessing blood pressure)
is mandatory and renal scintigraphy before and 6 months after ESWL in infants is 
recommended to confirm these results in a larger series.

PMID: 10671889 [PubMed - indexed for MEDLINE]

1540: Eur Urol. 2000 Jan;37(1):23-5.

Increase in the prevalence of symptomatic upper urinary tract stones during the
last ten years.

Trinchieri A, Coppi F, Montanari E, Del Nero A, Zanetti G, Pisani E.

Istituto di Urologia, IRCC Ospedale Maggiore di Milano, Italia.
uropoli@imiucca.csi.it

PURPOSE: In industrialized countries the prevalence of upper urinary tract stones
has continually increased during the 20th century, but there are considerable
differences between countries and also within the same country. To study whether 
there is still an increase in the frequency of renal stones, an investigation was
undertaken to determine the prevalence of stone formers in a village near Milan, 
Italy, during two time periods, with an interval of 12 years. MATERIALS AND
METHODS: Questionnaires were administered in 1986 and 1998 to all adult (age >25 
years) occupants of two random samples of households in the village. Participants
were asked whether they had experienced a kidney stone during their lifetime.
RESULTS: The overall prevalence of stone formers among males was 6.8% in 1986 and
10.1% in 1998; that among females was 4.9% in 1986 and 5.8% in 1998. In all age
classes, the respondents in the 1998 survey more frequently reported a history of
stones than in 1986, but the prevalence of renal stones was significantly higher 
in 1998 than in 1986 only among males aged 31-40 and 51-60 years. The yearly
incidence was estimated at 0.4%, with 0.6 and 0.18% in men and women,
respectively. CONCLUSIONS: This marked increase in renal stones could be the
result of environmental factors such as dietary habits and lifestyle, in
particular the influence of an increased consumption of animal protein should be 
considered.

Publication Types: 
    Comparative Study

PMID: 10671780 [PubMed - indexed for MEDLINE]

1541: Eur Urol. 2000 Jan;37(1):18-22.

Natural history of residual renal stone fragments after ESWL.

Candau C, Saussine C, Lang H, Roy C, Faure F, Jacqmin D.

Urology, University Hospital, Strasbourg, France.

OBJECTIVE: After extracorporeal shock wave lithotripsy (ESWL), residual fragments
(RF) 4 mm or less are usually considered as clinically insignificant. We
retrospectively reviewed the natural history and clinical significance of 97
noninfected and isolated RF (4 mm or less) observed 3 months after the last ESWL 
session on renal tomography. PATIENTS AND METHODS: They represented 83 among 1,
216 patients treated by ESWL over a 9-year period (1989-1997). These RF were
mostly localized in the inferior calyx (62%). Median follow-up was 40.6 months
(range: 7-96 months). Renal tomography was always performed at the end of
follow-up. RESULTS: Stone-free status, or a decreased, stable or increased amount
of residual stone occurred in 27 (33%), 1 (1%), 24 (29%) and 31 (37%) of the 83
patients, respectively. During this study, 18 patients (22%) were proposed for a 
complementary treatment related to a size increase of the residual fragments (13 
ESWL, 1 retrograde endoscopy, 3 percutaneous nephrolithotomy, and 1 polar
inferior nephrectomy). CONCLUSION: The term clinically insignificant should not
be employed to describe RF after ESWL. Efforts should be performed to obtain true
stone-free status after ESWL.

PMID: 10671779 [PubMed - indexed for MEDLINE]

1542: Kidney Int. 2000 Feb;57(2):550-60.

Calcium phosphate supersaturation regulates stone formation in genetic
hypercalciuric stone-forming rats.

Bushinsky DA, Parker WR, Asplin JR.

Nephrology Unit, University of Rochester School of Medicine, Rochester, NY 14642,
USA. David_Bushinsky@URMC.Rochester.edu

BACKGROUND: Hypercalciuria is the most common metabolic abnormality observed in
patients with nephrolithiasis. Hypercalciuria raises urine supersaturation with
respect to the solid phases of calcium oxalate and calcium phosphate, leading to 
an enhanced probability for nucleation and growth of crystals into clinically
significant stones. However, there is little direct proof that supersaturation
itself regulates stone formation. Through successive inbreeding of the most
hypercalciuric progeny of hypercalciuric Sprague-Dawley rats, we have established
a strain of rats, each of which excrete abnormally large amounts of urinary
calcium and each of which forms calcium phosphate kidney stones. We used these
hypercalciuric (GHS) rats to test the hypothesis that an isolated reduction in
urine supersaturation, achieved by decreasing urine phosphorus excretion, would
decrease stone formation in these rats. METHODS: Thirty 44th-generation female
GHS rats were randomly divided into three groups. Ten rats received a
high-phosphorus diet (0.565% phosphorus), 10 a medium-phosphorus diet (0.395%
phosphorus), and 10 a low-phosphorus diet (0.225% phosphorus) for a total of 18
weeks. The lowered dietary phosphorus would be expected to result in a decrease
in urine phosphorus excretion and a decrease in urinary supersaturation with
respect to the calcium phosphate solid phase. Every two weeks, 24-hour urine
collections were obtained. All relevant ions were measured, and supersaturation
with respect to calcium oxalate and calcium hydrogen phosphate were determined.
At the conclusion of the experiment, each rat was killed, and the kidneys,
ureters, and bladder were dissected en block and x-rayed to determine whether any
stones formed. A decrease in stone formation with a reduction in urinary
supersaturation would support the hypothesis that supersaturation alone can
regulate stone formation. RESULTS: Decreasing the dietary phosphorus intake led
to a progressive decrease in urine phosphorus excretion and an increase in urine 
calcium excretion, the latter presumably caused by decreased intestinal calcium
phosphate binding and increased calcium absorption. With decreasing dietary
phosphorus intake, there was a progressive decrease in saturation with respect to
the calcium phosphate solid phase. Fifteen of the 20 kidneys from the 10 rats fed
the high-phosphorus diet had radiographic evidence of kidney stone formation,
whereas no kidneys from the rats fed either the medium- or low-phosphorus diet
developed kidney stones. CONCLUSIONS: A decrease in urine phosphorus excretion
not only led to a decrease in urine supersaturation with respect to the calcium
phosphate solid phase but to an elimination of renal stone formation. The results
of this study support the hypothesis that variation in supersaturation alone can 
regulate renal stone formation. Whether a reduction of dietary phosphorus will
alter stone formation in humans with calcium phosphate nephrolithiasis remains to
be determined.

Publication Types: 
    Research Support, U.S. Gov't, P.H.S.

PMID: 10652032 [PubMed - indexed for MEDLINE]

1543: Curr Opin Urol. 2000 Jan;10(1):35-8.

Role of bacteria in the development of kidney stones.

Kramer G, Klingler HC, Steiner GE.

Department of Urology, University of Vienna.

Currently, only struvite stones are regarded as deriving from bacteria. Recent
work has suggested that calcium-based stones might also have an infectious
origin. Nanobacteria, small intracellular bacteria found in human kidney stones, 
are capable of forming a calcium phosphate shell, and thus could serve as
crystallization centres for renal calculi formation. Until now, however, all
trials performed to confirm the presence of nanobacteria in human calculi, serum 
or urine have failed. In a hyperoxaluric rat model, tissue-residing macrophages
were able to remove interstitial crystals and thus may not be primarily engaged
in defending against micro-organisms, if present.

Publication Types: 
    Review

PMID: 10650513 [PubMed - indexed for MEDLINE]

1544: Urology. 2000 Dec 20;56(6):1057.

Simultaneous bilateral tubeless percutaneous nephrolithotomy.

Weld KJ, Wake RW.

Department of Urology, University of Tennessee, Memphis, Memphis, Tennessee, USA.

We present what is to our knowledge the first reported case of simultaneous
bilateral tubeless (no nephrostomy tube) percutaneous nephrolithotomy. The
64-year-old man was rendered stone free with a single general anesthetic and
discharged within 24 hours. The role, indications, and potential benefits of this
novel technique are discussed.

Publication Types: 
    Case Reports

PMID: 11113766 [PubMed - indexed for MEDLINE]

1545: Urology. 2000 Dec 20;56(6):1056.

Lesch-Nyhan syndrome presenting as acute renal failure secondary to obstructive
uropathy.

Ankem M, Glazier DB, Barone JG.

Division of Urology, Robert Wood Johnson Medical School, New Brunswick, New
Jersey, USA.

Lesch-Nyhan syndrome is a rare genetic disorder characterized by mental
retardation, self-mutilation, choreoathetosis, and hyperuricemia. The disease is 
caused by a mutation in the hypoxanthine-guanine phosphoribosyltransferase gene
and is transmitted as a sex-linked recessive disorder. Since hyperuricemia is the
primary metabolic problem caused by a hypoxanthine-guanine
phosphoribosyltransferase mutation, urologic evaluation and treatment is often
necessary for children with this disease. We report a 3-year-old boy who
presented with anuric renal failure secondary to bilateral obstructing uric acid 
calculi. The evaluation of T lymphocytes revealed a hypoxanthine-guanine
phosphoribosyltransferase mutation consistent with Lesch-Nyhan syndrome. The
diagnosis and urologic management of this disorder is discussed.

Publication Types: 
    Case Reports

PMID: 11113762 [PubMed - indexed for MEDLINE]

1546: Urology. 2000 Dec 20;56(6):1056.

Percutaneous management of stones in a patient with sacral agenesis.

Limb J, Bellman GC.

Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California,
USA.

We report a case of a patient with sacral agenesis and nephrolithiasis in whom
percutaneous nephrostolithotomy was used to treat the stone disease. Sacral
agenesis is an uncommon congenital anomaly involving the lower vertebral bodies
and is associated with urinary tract dysfunction. Nephrolithiasis in a patient
with sacral agenesis poses a problem in access for percutaneous
nephrostolithotomy because of the associated presence of renal ectopia. We
describe our technique and the special considerations necessary for successful
access.

Publication Types: 
    Case Reports

PMID: 11113761 [PubMed - indexed for MEDLINE]

1547: Urology. 2000 Dec 20;56(6):935-9.

Nitinol stone retrieval-assisted ureteroscopic management of lower pole renal
calculi.

Kourambas J, Delvecchio FC, Munver R, Preminger GM.

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery,
Duke University Medical Center, Durham, North Carolina, USA.

OBJECTIVES: Current ureteroscopic intracorporeal lithotripsy devices and stone
retrieval technology allow for the treatment of calculi located throughout the
intrarenal collecting system. Difficulty accessing lower pole calculi, especially
when the holmium laser fiber is used, is often encountered. We retrospectively
reviewed our experience with cases in which lower pole renal calculi were
ureteroscopically managed by holmium laser fragmentation, either in situ or by
first displacing the stone into a less dependent position with the aid of a
nitinol stone retrieval device. METHODS: Thirty-four patients (36 renal units)
underwent ureteroscopic treatment of lower pole renal calculi between April 1998 
and November 1999. Lower pole stones less than 20 mm were primarily treated by
ureteroscopic means in patients who were obese, in patients who had a bleeding
diathesis, in patients with stones resistant to shock wave lithotripsy, and in
patients with complicated intrarenal anatomy, or as a salvage procedure after
failed shock wave lithotripsy. Lower pole calculi were fragmented with a
200-micrometer holmium laser fiber by way of a 7.5F flexible ureteroscope. For
those patients in whom the laser fiber reduced the ureteroscopic deflection,
precluding re-entry into the lower pole calix, a 3.2F nitinol basket or a 2.6F
nitinol grasper was used to displace the lower pole calculus into a more
favorable position, allowing easier fragmentation. RESULTS: In 26 renal units,
routine in situ holmium laser fragmentation was successfully performed. In the
remaining 10 renal units, a nitinol device was passed into the lower pole,
through the ureteroscope, for stone displacement. Only a minimal loss of
deflection was seen. Irrigation was significantly reduced by the 3.2F nitinol
basket, but improved with the use of the 2.6F nitinol grasper. This factor did
not impede stone retrieval in any of the patients. At 3 months, 85% of patients
were stone free by intravenous urography or computed tomography. CONCLUSIONS:
Ureteroscopic management of lower pole calculi is a reasonable alternative to
shock wave lithotripsy or percutaneous nephrolithotomy in patients with
low-volume stone disease. If the stone cannot be fragmented in situ, nitinol
basket or grasper retrieval, through a fully deflected ureteroscope, allows one
to reposition the stone into a less dependent position, thus facilitating stone
fragmentation.

PMID: 11113736 [PubMed - indexed for MEDLINE]

1548: Urology. 2000 Dec 20;56(6):915-20.

Metabolic investigation of recurrent nephrolithiasis: compliance with
recommendations.

Krepinsky J, Ingram AJ, Churchill DN.

University of Western Ontario, London, Ontario, Canada.

OBJECTIVES: Nephrolithiasis is a recurrent condition with significant associated 
morbidity and economic impact. Although urologic intervention addresses
symptomatic stone episodes, prevention of recurrences with proven medical therapy
is indicated. METHODS: This retrospective study examined 97 patients who
presented in 1997 and 1998 with recurrent nephrolithiasis in a large tertiary
care center for the presence of an appropriate metabolic investigation as
recommended by the National Institutes of Health Consensus Conference. Complete
data were abstracted from the hospital and private clinic charts. RESULTS: The
average patient age was 50.5 years; 61.9% of patients were men. The mean number
of stones per patient was 5.6 (range 2 to 62), with stone analysis performed for 
78 patients. Fifty-eight stones (74.4%) were calcium oxalate and/or phosphate, 14
(17.9%) urate, 8 (10.3%) struvite, and 3 (3.8%) cystine. Five patients had two
stone types on different occasions. Either lithotripsy or a urologic procedure
was required for at least one stone presentation in 89 patients (91.8%). An
investigation for stone disease was pending in 54 patients (55.7%). A complete
evaluation, satisfying the preset criteria, was performed in 34 patients (35.1%).
Six patients who did not undergo evaluation were lost to follow-up. Univariate
analysis revealed that referral to a nephrologist (P = 0.001), treatment with
medications used for stone disease (P = 0.008), and urate stones (P = 0.005) were
associated with a complete investigation. Similarly, these were independently
associated with a complete evaluation in regression analysis of 77 complete data 
sets, with odds ratios of 24.4 (nephrology referral), 4.9 (medication use), and
5.6 (urate stones). CONCLUSIONS: The results of this study demonstrate that a
significant proportion of patients with recurrent nephrolithiasis do not undergo 
appropriate metabolic investigations. Efforts should be made to improve the
evaluation of these patients.

PMID: 11113730 [PubMed - indexed for MEDLINE]

1549: J Urol. 2000 Jan;163(1):24-7.

Infundibulopelvic anatomy and clearance of inferior caliceal calculi with shock
wave lithotripsy.

Gupta NP, Singh DV, Hemal AK, Mandal S.

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

PURPOSE: We evaluate the significance of inferior caliceal radiographic anatomy
and determine its influence on successful fragmentation and clearance of inferior
caliceal calculi with extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND
METHODS: Between November 1996 and February 1998, 88 patients and 90 renal units 
with single or multiple inferior caliceal calculi of all sizes and composition
were treated with ESWL. The size, number and area of calculi, length and width of
the stone bearing inferior calix and infundibulopelvic angle were determined on
pretreatment excretory urography. The infundibulopelvic angle was measured by 2
methods using the angle between the inferior caliceal infundibular and ureteral
axes (angle 1), and between the infundibular and ureteropelvic axes (angle 2).
Cases with residual fragments not clearing within 6 months of satisfactory
fragmentation after lithotripsy were considered failures. RESULTS: Overall stone 
clearance at 6 months was achieved in about 72% of the renal units. Infundibular 
length was 30 mm. or less in 77% of successful cases and in 64% of failures.
Similarly, the smallest infundibular width of 5 mm. or more was found in 75% of
successful cases compared to 41% of failures. Angle 1 of 35 degrees or more was
observed in 73% of cases with compared to 18% without clearance. Angle 2 of 45
degrees or more was seen in 71% of successful cases compared to 9% of failures.
The chances of a patient becoming stone-free with all favorable criteria of
infundibular length 30 mm. or less, infundibular width 5 mm. or greater and
infundibular ureteropelvic angle 45 degrees or greater was 100% (23 patients).
CONCLUSIONS: Radiographic features of a stone bearing inferior calix and its
relation to the renal pelvis can be easily measured on standard excretory
urography. An infundibular width of 5 mm. or more and infundibulopelvic angle 1
of 35 degrees or more or angle 2 of 45 degrees or more were statistically
significant factors of radiographic anatomy in stone clearance following ESWL.
Inferior caliceal length was not statistically significant, although length of 30
mm. or less appeared to be more favorable for stone clearance. The ideal
treatment of inferior caliceal calculi in patients with all 3 favorable criteria 
is ESWL.

PMID: 10604306 [PubMed - indexed for MEDLINE]
