1
|
Giulioni C, Brocca C, Gauhar V, Somani BK, Chew BH, Traxer O, Emiliani E, Innoue T, Sarica K, Gadzhiev N, Tanidir Y, Teoh JYC, Galosi AB, Castellani D. Does age impact outcomes of retrograde intrarenal surgery in the elderly? Results from 366 patients from the FLEXible ureteroscopy outcomes registry (FLEXOR). Aging Clin Exp Res 2023; 35:2711-2719. [PMID: 37682489 PMCID: PMC10627914 DOI: 10.1007/s40520-023-02545-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND There has been a consistent increase in the last decades in prevalence of renal stones in elderly. AIMS To evaluate outcomes of retrograde intrarenal surgery (RIRS) for renal stones in elderly and factors associated with postoperative complications and residual fragments (RFs). METHODS Data from 12 centers were retrospectively reviewed. INCLUSION CRITERIA ≥ 75 years, renal stones only, normal renal anatomy. Patients were divided into three groups; Group 1: patients aged 75-79 years; Group 2: age 80-84 years; Group 3: age ≥ 85 years. Multivariable logistic regression analyses were performed to assess factors associated with perioperative complications, sepsis, and RFs. RESULTS 366 patients were included. There were 189 patients in Group 1, 113 in Group 2, and 64 in Group 3. There was no difference between groups regarding stone features and total surgical time. Median length of stay was significantly longer in Group 3 (6.0 days, vs 2.0 days in Group 2 vs 2.5 days in Group 1, p = 0.043). There was no significant difference in postoperative complications and RFs between the groups. At multivariable logistic regression analysis, female gender (OR 2.82) and maximum stone diameter (OR 1.14) were associated with higher odds of sepsis, while surgical time (OR 1.12) and the use of a reusable ureteroscope (OR 6.51) with overall complications. Stone size (OR 1.23) was associated with higher odds of RFs. CONCLUSION RIRS showed safety and efficacy for kidney stones in elderly patients. Surgical time should be kept as short as possible to avoid higher odds of postoperative complications, particularly in females.
Collapse
Affiliation(s)
- Carlo Giulioni
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60126, Ancona, Italy.
| | - Carlo Brocca
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Jurong East, Singapore
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Esteban Emiliani
- Department of Urology, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Takaki Innoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Hyogo, Japan
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey
| | - Nariman Gadzhiev
- Endourology department, Saint-Petersburg State Medical University, Saint-Petersburg, Russia
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Faculty of Medicine, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60126, Ancona, Italy
| |
Collapse
|
2
|
Khalid A, Abdulwahab-Ahmed A, Muhammad AS, Jesini G, Agwu NP, Mungadi IA. An enigma: case series of vesical calculi from prolonged and neglected indwelling catheter. J Surg Case Rep 2023; 2023:rjad018. [PMID: 36741079 PMCID: PMC9890249 DOI: 10.1093/jscr/rjad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Vesical calculus is a common condition with familiar aetiology in our environment as it is obtained in other parts of the world. Notwithstanding, uncommon aetiology of this pathology still exists though rarely encountered especially where out-of-pocket payment is the norm for accessing health care services. This is a report of three patients with varying indications for indwelling vesical catheter insertion via urethral or suprapubic route and who developed vesical calculus from prolonged and neglected indwelling vesical catheter. These cases are indeed an enigma in contemporary surgical patient care. We share our experience in the care of these patients and to underscore the extra role expected of health care providers in adequate patient education, close attention to guidance and counseling during patients' visits to health facilities.
Collapse
Affiliation(s)
- Abdullahi Khalid
- Correspondence address. Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria. E-mail:
| | - Abdullah Abdulwahab-Ahmed
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
| | - Abubakar Sadiq Muhammad
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
| | - Gamdu Jesini
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
| | - Ngwobia Peter Agwu
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
| | - Isma'ila Arzika Mungadi
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
| |
Collapse
|
3
|
Gauhar V, Castellani D, Chew BH, Smith D, Chai CA, Fong KY, Teoh JYC, Traxer O, Somani BK, Tailly T. Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group. Ther Adv Urol 2023; 15:17562872231198629. [PMID: 37701535 PMCID: PMC10493056 DOI: 10.1177/17562872231198629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. Objective To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. Design A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021). Methods Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs. Results A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p < 0.001) and after matching (43.1% versus 23.9%, p < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% versus 47.6%, p < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009-1.020, p < 0.001], stone size (OR 1.028 95% CI 1.017-1.040, p < 0.001), multiple stones (OR 1.171 95% CI 1.025-1.339, p = 0.021), lower pole stone (OR 1.853 95% CI 1.557-2.204, p < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094-7.037, p < 0.001) had significantly higher odds of having CSRFs. Conclusions CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.
Collapse
Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona 60126, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| |
Collapse
|
4
|
Safety and efficacy of flexible and semi-rigid ureteroscopy with laser lithotripsy for the management of ureteral calculi in pregnancy. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00148-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Symptomatic ureteric stone during pregnancy can present a clinical challenge because of potential risks to both the mother and foetus. Ureteroscopy with laser and stone basket extraction represents an emerging strategy for definitive stone management in pregnancy, with minor complications. We aimed to evaluate the safety and efficacy of ureteroscopy with auxiliary procedures as a primary treatment for pregnant women with symptomatic ureteric stones who have failed conservative management.
Methods
A prospective analysis was conducted in the Urology Department of Sulaymaniyah Teaching Hospital from June 2017 to November 2019 to evaluate pregnant patients who were treated with ureteroscopy and holmium laser lithotripsy for symptomatic ureteric stone.
Results
Twenty-six pregnant women aged between 18 and 34 years presented with renal colic (22 patients, 84.61%), severe hydronephrosis (3 patients, 11.53%), and progressive hydronephrosis (1 patient, 3.8%), suggesting ureteric stones. The diagnosis was established by abdominal ultrasonography. The mean stone size was 7.38 mm, ranging from 6–12 mm. The stones were located in the proximal ureter (n = 6, 23.1%), middle ureter (n = 0), and distal ureter (n = 20, 76.9%). Complete stone fragmentation was achieved in all patients. The overall procedure success rate was 87%, the stone-free rate was 23 out of 26 cases (88.46%), and no major obstetric or urologic complications were encountered.
Conclusions
Ureteric stone in pregnancy requires a high index of suspicion for a prompt and correct diagnosis. Ureteroscopy: flexible or semirigid endoscopy combined with holmium: YAG laser lithotripsy or with stone extraction are a preferred modality for the definitive treatment of symptomatic ureteric stone in pregnancy.
Collapse
|
5
|
Venkatesan AM, Oto A, Allen BC, Akin O, Alexander LF, Chong J, Froemming AT, Fulgham PF, Goldfarb S, Gettle LM, Maranchie JK, Patel BN, Schieda N, Schuster DM, Turkbey IB, Lockhart ME. ACR Appropriateness Criteria® Recurrent Lower Urinary Tract Infections in Females. J Am Coll Radiol 2020; 17:S487-S496. [PMID: 33153559 DOI: 10.1016/j.jacr.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Urinary tract infections (UTIs) in women are common, with an overall lifetime risk over >50%. UTIs are considered recurrent when they follow complete clinical resolution of a previous UTI and are usually defined as at least three episodes of infection within the preceding 12 months. An uncomplicated UTI is classified as a UTI without structural or functional abnormalities of the urinary tract and without relevant comorbidities. Complicated UTIs are those occurring in patients with underlying structural or medical problems. In women with recurrent uncomplicated UTIs, cystoscopy and imaging are not routinely used. In women suspected of having a recurrent complicated UTI, cystoscopy and imaging should be considered. CT urography or MR urography are usually appropriate for the evaluation of recurrent complicated lower urinary tract infections or for women who are nonresponders to conventional therapy, develop frequent reinfections or relapses, or have known underlying risk factors. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Pat F Fulgham
- Urology Clinics of North Texas, Dallas, Texas; American Urological Association
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology
| | | | | | - Bhavik N Patel
- Stanford University Medical Center, Stanford, California
| | - Nicola Schieda
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
6
|
Detection of distal ureteral stones in pregnancy using transvaginal ultrasound. J Ultrasound 2020; 24:397-402. [PMID: 32666258 PMCID: PMC8572244 DOI: 10.1007/s40477-020-00504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/26/2019] [Indexed: 10/31/2022] Open
Abstract
AIMS To determine the performance of transvaginal ultrasound for the visualization of distal ureteral stones in pregnant patients with renal colic and to evaluate the diagnostic value of secondary findings suggestive of obstructing ureteral stone disease. METHODS We retrospectively identified 129 pregnant patients with a total of 142 encounters with both abdominal and transvaginal ultrasound. Ultrasound images for each patient were reviewed recording the presence of stone with location, hydronephrosis, resistive indices (RI), and status of the ureteral jets. Patients were subcategorized into two groups based on the visualization of distal ureteral stone. RESULTS The transvaginal technique identified 94% (N = 16/17) of sonographically detected stones in the distal ureter/urethra, while the transabdominal technique identified 29% (N = 5/17). The combined imaging for initial assessment of renal colic in pregnancy demonstrated a sensitivity of 89%, specificity 100%, and negative predictive value (NPV) of 98%. The frequency of hydronephrosis was statistically greater in the visualized stone group (94% vs 51%). Mean RI was identical in both groups however the delta RI was significantly elevated in those patients with distal ureteral stones with a mean delta RI value of 0.05. The rate of absence of ureteral jets was not statistically significant. CONCLUSION The present data would suggest a utility of transvaginal ultrasound for the evaluation of the pregnant patient with 94% of distal stones being detected transvaginal versus 29% transabdominally. Additionally, there was significantly increased hydronephrosis and elevated RIs in patients with distal ureteral stones.
Collapse
|
7
|
Prezioso D, Barone B, Di Domenico D, Vitale R. Stone residual fragments: A thorny problem. Urologia 2019; 86:169-176. [DOI: 10.1177/0391560319860654] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Urolithiasis represents a widespread and common disorder among the world population, with a predicted increase in affected patients in the coming years. Treatment of renal and ureteral stones varies widely, and achieving true stone-free status in all patients is still difficult. Moreover, imaging used to assess residual fragments following procedure impacts the diagnosed stone-free rate percentage considerably. In particular, the use of computed tomography scans has led to a better evaluation of residual fragments as well as so-called clinically insignificant residual fragments, which in a considerable number of cases are, despite their definition, causes of adverse urological events, thus creating a thorny problem for both patients and urologists. Currently, there is no gold standard or validated protocol regarding the management, clearance and prevention of residual fragments. In this article, we review the current literature regarding residual fragments, clinically insignificant residual fragments and their natural history, reporting on diagnostic methods, incidence, complications and outcome with the use of less invasive procedures, taking into consideration viable treatment and management of patients affected.
Collapse
Affiliation(s)
- Domenico Prezioso
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Biagio Barone
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Dante Di Domenico
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Raffaele Vitale
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| |
Collapse
|
8
|
Abstract
Patients with nephrolithiasis are exposed to significant quantities of ionizing radiation with the potential to cause secondary malignancy. This risk is magnified by the high recurrence rate of nephrolithiasis. In this article, we identify the risks of ionizing radiation as they pertain to patients with nephrolithiasis. We then identify evidence-based techniques for mitigating patient radiation exposure in the preoperative, intraoperative, and postoperative settings. Key factors include limiting the use of computed tomographic imaging, appropriate modulation of fluoroscopy settings, and minimizing rates of stone recurrence.
Collapse
Affiliation(s)
- Todd Samuel Yecies
- Department of Urology, University of Pittsburgh Medical Center, 200 Lothrop Street, Kaufman Building, 701, Pittsburgh, PA 15213, USA
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
9
|
Abstract
Recent advances in computed tomography, X-ray-based imaging, and ultrasonography have improved the accuracy of urinary stone detection and differentiation of stone composition while minimizing radiation exposure. Dual-energy computed tomography and digital tomosynthesis show promise in predicting mineral composition to optimize medical and surgical therapy. Electromagnetic tracking may enhance the use of ultrasonography to achieve percutaneous renal access for nephrolithotomy. This article reviews innovations in imaging technology in the contemporary management of urinary stone disease.
Collapse
|
10
|
Abstract
Urinary stone disease is a highly prevalent condition affecting approximately 10% of the population, and has increased in incidence significantly over the past 20 years. Along with this, the rate of stone disease among women and children is also on the rise. The management of stone disease in specific populations, such as in children and during pregnancy can present unique challenges to the urologist. In both populations, a multi-disciplinary approach is strongly recommended given the complexities of the patients. Prompt and accurate diagnosis requires a high degree of suspicion and judicious use of diagnostic imaging given the higher risks of radiation exposure. In general, management proceeds from conservative to more invasive approaches and must be individualized to the patient with careful consideration of the potential adverse effects. However, innovations in endourologic equipment and techniques have allowed for the wider application of surgical stone treatment in these patients, and significant advancement in the field. This review covers the history and current advances in the diagnosis and management of stone disease in pregnant and pediatric populations. It is paramount for the urologist to understand the complexities of properly managing stones in these patients in order to maximize treatment efficacy, while minimizing complications and morbidity.
Collapse
Affiliation(s)
- Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, Canada
| |
Collapse
|
11
|
|
12
|
Abstract
Nephrolithiasis is a common affliction, affecting approximately 10% of adults. Potentially presenting with acute abdominal or flank pain, nausea, or emesis, it may pose as a general surgical condition. Therefore, recognition, diagnosis, and management concerns are pertinent to the general surgeon. Furthermore, the risk of nephrolithiasis is increased in common general surgical conditions, including inflammatory bowel disease, hyperparathyroidism, and short gut. Nephrolithiasis may be induced as a result of general surgical interventions, including gastric bypass and bowel resection with ileostomy. An understanding of this common disease will improve coordination of patient care between urologists and general surgeons.
Collapse
Affiliation(s)
- Johann P Ingimarsson
- Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Amy E Krambeck
- Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Vernon M Pais
- Section of Urology, Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
| |
Collapse
|
13
|
O'Kane D, Papa N, Manning T, Quinn J, Hawes A, Smith N, McClintock S, Lawrentschuk N, Bolton DM. Contemporary Accuracy of Digital Abdominal X-Ray for Follow-Up of Pure Calcium Urolithiasis: Is There Still a Role? J Endourol 2016; 30:844-9. [DOI: 10.1089/end.2016.0173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Dermot O'Kane
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Nathan Papa
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Todd Manning
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Jonathan Quinn
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Alice Hawes
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Neil Smith
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Scott McClintock
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Damien M. Bolton
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Using a three-dimensional computer assisted stone volume estimates to evaluate extracorporeal shockwave lithotripsy treatment of kidney stones. Urolithiasis 2016; 44:451-7. [PMID: 26914829 DOI: 10.1007/s00240-016-0864-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
This study describes and evaluates the use of non-contrast enhanced computerized tomography (NCCT) before and after extracorporeal shockwave lithotripsy (SWL). Computer measured stone volume was used as an exact measurement for treatment response. 81 patients received SWL of kidney stones at Herlev Hospital between April 2013 and January 2014 and follow-up was possible in 77 (95 %) patients. NCCT was used before and after treatment. Treatment response was expressed as a reduction of the stone volume. Stone characteristics as the stone volumes, HU, SSD and localization were measured by radiologist using a vendor non-specific computer program. Complications, patient characteristics and additional treatment were registered. On average, 5858 shocks were given each patient. The follow-up NCCT was performed 24 days after treatment. It was possible to calculate the stone volume in 88 % of the patients-the remaining 12 % it was not possible due to stone disintegration. The stone free rate was 22 %. The average relative reduction in stone burden was 62 %. Only 8 % of the patients were radiological non-responders. Steinstrasse was observed in 13 (17 %) and 28 (36 %) patients had additional treatment performed. Irradiation dose per NCCT was 2.6 mSv. Stone volume could be calculated in most patients. The relative reduction in stone burden after treatment was 62 %. The stone volume was redundant when evaluating stone free patients, but in cases of partial response it gave an exact quantification, to be used in the further management and follow-up of the patients.
Collapse
|
15
|
Alsinnawi M, Maan Z, Rix GH. Oral dissolution therapy for radiolucent kidney stones. An old treatment revisited. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816631856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: We present our experience using oral bicarbonate as a dissolution therapy for radiolucent kidney stones in the pre-dual energy CT era. Methods: A retrospective analysis of dissolution therapy was undertaken over a four-year period. Stones were diagnosed as radiolucent on conventional KUB X-ray in combination with either ultrasound or CT KUB. Oral bicarbonate was given at a dose of 2 g tds orally, increased to 2 g five times daily according to urinary pH. Patients monitored their own urine dipstick daily to achieve a pH of at least seven. Results: Altogether 27 patients were identified with radiolucent stones. Stone size varied from 4–40 mm. Average length of therapy was nine weeks. Of the patients, 17 had renal U/S and six had CT KUB as end point imaging. We found that 39% had complete dissolution, 18% had a partial response and 43% showed no response. A high serum uric acid level correlated with a higher incidence of dissolution. Cost-benefit analysis shows bicarbonate therapy to be more cost-effective than lithotripsy, ureteroscopy or nephrolithotomy. Conclusions: Bicarbonate therapy remains an attractive option for the treatment of radiolucent kidney stones. The presence of hyperuricaemia or hyperuricosuria appears to influence the success rate. Further prospective randomised studies are needed to identify the most tolerable and effective treatment regime as well as the optimal duration of treatment. Dual-energy CT may hold the key to identifying patients most likely to benefit from treatment.
Collapse
Affiliation(s)
- M Alsinnawi
- Urology Department, Colchester General Hospital, UK
| | - Z Maan
- Urology Department, Colchester General Hospital, UK
| | - GH Rix
- Urology Department, Colchester General Hospital, UK
| |
Collapse
|
16
|
Portis AJ, Lundquist EL, Portis JL, Glesne RE, Mercer AJ, Lundquist BA, Neises SM. Unsuccessful Medical Expulsive Therapy: A Cost to Waiting? Urology 2016; 87:25-32. [DOI: 10.1016/j.urology.2015.07.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 11/28/2022]
|
17
|
Villa L, Giusti G, Knoll T, Traxer O. Imaging for Urinary Stones: Update in 2015. Eur Urol Focus 2015; 2:122-129. [PMID: 28723526 DOI: 10.1016/j.euf.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Imaging is essential for the diagnosis and the clinical decision-making process of patients with urinary stones. OBJECTIVE To assess the benefits and limitations of various imaging techniques by specifically focusing on different phases of stone patients' management. EVIDENCE ACQUISITION PubMed and Web of Science databases were used to identify studies published in the last 10 yr on this argument. Search terms included 'urolithiasis', nephrolithiasis', or 'urinary stones' in combination (AND) with the terms 'imaging', 'computer tomography', 'ultrasonography', 'intravenous pyelogram', or 'radiation exposure'. Study selection was based on an independent peer-review process of all the authors after the structured data search. EVIDENCE SYNTHESIS Noncontrast-enhanced computer tomography (CT) provides the highest value of diagnostic accuracy for urinary stones. Stone composition can be specifically assessed through the use of dual-energy CT. When information about the anatomy of the renal collecting system is required or alternative pathologies are suspected, CT with contrast injection is recommended. Low-dose protocols allowed a drastic reduction of the effective dose administered to the patient, thus limiting the biological risk due to ionising radiations. Other strategies to contain the radiation exposure include the dual-split bolus dual energy CT and the adaptive statistical image reconstruction. Abdomen ultrasound may be a valid alternative as an initial approach since it does not change the outcome of patients compared with CT, and should be the imaging of choice in children and pregnant women. CONCLUSIONS Noncontrast-enhanced CT is the most accurate imaging technique to identify urinary stones. Abdomen ultrasound seems to be a valid alternative in the initial evaluation of urinary colic. New low-dose protocols and strategies have been developed to contain radiation exposure, which is a major issue especially in specific circumstances. PATIENT SUMMARY Noncontrast-enhanced computer tomography has been increasingly used for the diagnosis and management of urinary stones. Low-dose protocols as well as alternative imaging should be considered by clinicians in specific circumstances to minimise radiation exposure.
Collapse
Affiliation(s)
- Luca Villa
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Guido Giusti
- Department of Urology, IRCCS Ospedale San Raffaele Ville Turro, Milan, Italy
| | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Boeblingen, University of Tuebingen, Sindelfingen, Germany
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Pierre et Marie Curie University, Paris, France
| |
Collapse
|
18
|
Chen TT, Wang C, Ferrandino MN, Scales CD, Yoshizumi TT, Preminger GM, Lipkin ME. Radiation Exposure during the Evaluation and Management of Nephrolithiasis. J Urol 2015; 194:878-85. [DOI: 10.1016/j.juro.2015.04.118] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Tony T. Chen
- School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Chu Wang
- Division of Radiation Safety, Duke University Medical Center, Durham, North Carolina
| | - Michael N. Ferrandino
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Charles D. Scales
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Terry T. Yoshizumi
- Division of Radiation Safety, Duke University Medical Center, Durham, North Carolina
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
19
|
Techniques for Minimizing Radiation Exposure During Evaluation, Surgical Treatment, and Follow-up of Urinary Lithiasis. Curr Urol Rep 2015; 16:45. [DOI: 10.1007/s11934-015-0517-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Bhatt K, Monga M, Remer EM. Low-dose computed tomography in the evaluation of urolithiasis. J Endourol 2015; 29:504-11. [PMID: 25567006 DOI: 10.1089/end.2014.0711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kavita Bhatt
- 1 Imaging Institute, Cleveland Clinic , Cleveland, Ohio
| | | | | |
Collapse
|
21
|
Kanno T, Kubota M, Sakamoto H, Nishiyama R, Okada T, Higashi Y, Yamada H. Determining the efficacy of ultrasonography for the detection of ureteral stone. Urology 2014; 84:533-7. [PMID: 25168527 DOI: 10.1016/j.urology.2014.04.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/08/2014] [Accepted: 04/26/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the efficacy of ultrasonography (US) for the detection of ureteral stone using non-contrast-enhanced computed tomography (NCCT) as a standard reference. MATERIALS AND METHODS From January 2009 to September 2011, 428 patients underwent both NCCT and US on the same day. The sensitivity and specificity of US to detect ureteral stone was evaluated. The detection rates using US imaging were examined according to location and stone size. The sizes of stones determined in the longest axis of NCCT and US were compared. We also performed group classification based on size to examine whether stone sizes measured by NCCT and US were similar. Moreover, the factors that may affect the detection of ureteral stone by US were analyzed. RESULTS Out of 856 ureters, NCCT could detect 171 stones in 169 patients, whereas US could detect 98 stones, yielding a sensitivity of 57.3% and a specificity of 97.5%. Expectedly, detection rate of US increased with stone size but was lower for distal ureter. With hydronephrosis, the sensitivity of US improved from 57.3% to 81.3%. Stone sizes measured by US correlated positively with those by computed tomography, and were concordant with those of NCCT in 68 of 98 patients (69.4%). Interestingly, stone size and the presence of hydronephrosis were factors that independently affected ureteral stone detection by US. CONCLUSION These results indicate that US may be useful as an initial imaging modality for detecting ureteral stone.
Collapse
Affiliation(s)
- Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.
| | - Masashi Kubota
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Hiromasa Sakamoto
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryuichi Nishiyama
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Takashi Okada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| |
Collapse
|
22
|
Kidney stones and imaging: what can your radiologist do for you? World J Urol 2014; 33:193-202. [PMID: 25344895 DOI: 10.1007/s00345-014-1416-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES We discuss in this review, urologists' expectations of imaging in terms of detection, characterization, pre-planning treatment and follow-up of urinary stones. MATERIALS AND METHODS Data acquisition regarding kidney stones and imaging was performed using MEDLINE searches with combinations of the following keywords: urinary stones, CT Urography, low dose CT, MRI urography, renal stones ultrasound, conventional radiography, surgery. RESULTS CT has become the gold standard for the evaluation of urinary stones. Scanning provides information regarding stone (composition, size, burden, location), collecting system and renal parenchyma. Those findings are crucial in determining appropriate treatment strategies. Because CT exposes the patient to substantial ionizing radiation, efforts have already been made to decrease the CT radiation dose for CT examination (low dose CT) and optimize image quality. Efforts also are being made to use non ionizing modalities such as ultrasound in combination with radiography particularly for the follow up of renal stones. CONCLUSION CT is the preferred method for the evaluation and treatment planning of urolithiasis. CT radiation dose reduction can be achieved with low dose CT. However, conventional radiography and ultrasound are still recommended in the follow up of renal stones.
Collapse
|
23
|
Selby MG, Vrtiska TJ, Krambeck AE, McCollough CH, Elsherbiny HE, Bergstralh EJ, Lieske JC, Rule AD. Quantification of asymptomatic kidney stone burden by computed tomography for predicting future symptomatic stone events. Urology 2014; 85:45-50. [PMID: 25440821 DOI: 10.1016/j.urology.2014.08.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/11/2014] [Accepted: 08/27/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To find the optimal characterization of asymptomatic radiographic stone burden on computed tomography (CT) scans. METHODS A survey was sent to stone formers who underwent a CT scan while asymptomatic during a stone clinic evaluation. Symptomatic stone passage events after CT scan were detected by survey and medical record review. Radiographic stone burden was quantified by number of stones, largest stone diameter, automated total stone volume (TSV), and bilateral stones and then compared as predictors of stone events. RESULTS There were 550 stone formers; 43% had a stone event for a median of 4.7 years after the CT scan. Stone burden by quartiles was 0-1, 2-3, 4-6, and ≥7 for number of stones; 0-2, 3-4, 5-7, and ≥8 mm for largest stone diameter; and 0-8, 9-78, 79-280, and ≥281 mm(3) for TSV; 48% had bilateral stones. The hazard ratios (HRs) for symptomatic event was 1.30 (P <.001) for the number of stones per quartile, 1.26 (P <.001) for largest stone diameter per quartile, 1.38 (P <.001) for TSV per quartile, and 1.80 (P <.001) for bilateral stones. On multivariate analysis, only TSV was an independent predictor of symptomatic events (HR, 1.35 per quartile; P = .01). This risk of events with TSV was also independent of demographics, urine chemistries, and stone composition. Among the 53 patients with interim events between CT scans, a rapid increase in TSV between CT scans (>570 mm(3) per year) predicted subsequent events (HR, 2.8; P = .05). CONCLUSION Automated TSV is more predictive of symptomatic events than manual methods for quantifying stone burden on CT scan.
Collapse
Affiliation(s)
- Michael G Selby
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Terri J Vrtiska
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN
| | | | | | | | - Eric J Bergstralh
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Division of Epidemiology, Mayo Clinic, Rochester, MN.
| |
Collapse
|
24
|
Tang X, Bergstralh EJ, Mehta RA, Vrtiska TJ, Milliner DS, Lieske JC. Nephrocalcinosis is a risk factor for kidney failure in primary hyperoxaluria. Kidney Int 2014; 87:623-31. [PMID: 25229337 PMCID: PMC4344931 DOI: 10.1038/ki.2014.298] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 06/12/2014] [Accepted: 07/02/2014] [Indexed: 12/14/2022]
Abstract
Stone formation and nephrocalcinosis are both very common features of primary hyperoxaluria, yet the extent of each disease varies markedly between patients. Here we studied whether kidney damage from nephrocalcinosis and/or stone related events contributed to end stage kidney disease (ESKD). Clinical information was analyzed from 348 patients enrolled in the Rare Kidney Stone Consortium Primary Hyperoxaluria registry and included demographic, laboratory and imaging features. Among all patients there were 277 with type 1, 37 with type 2, and 34 with type 3 primary hyperoxaluria. Overall, 58% passed a stone (mean 0.3/year) and one or more urologic procedures were required by 70% of patients (mean 0.15/year). Nephrocalcinosis was found in 34% of patients, including 41% with type 1 primary hyperoxaluria. High urine oxalate was associated with increased risk for both nephrocalcinosis and stone number, while low urine citrate was a risk factor for stone events and stone number. After adjustment for the type of primary hyperoxaluria, diagnosis by family screening and age at first image, the overall adjusted hazard ratio for ESKD among those with a history of nephrocalcinosis was 1.7 [95% CI 1.0–3.0], while the risk was 4.0 [1.9–8.5] for new onset nephrocalcinosis during follow-up. In contrast, the number of stones and stone events were not significantly associated with ESKD risk. Thus, nephrolithiasis and nephrocalcinosis appear to be pathophysiologically distinct entities. The presence of nephrocalcinosis implies increased risk for ESKD.
Collapse
Affiliation(s)
- Xiaojing Tang
- 1] Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA [2] Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | | | - Ramila A Mehta
- Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | | | - Dawn S Milliner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - John C Lieske
- 1] Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
25
|
Macaluso JN. Editorial Comment. Urology 2014; 84:536-7. [DOI: 10.1016/j.urology.2014.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
26
|
Huo J, Liu ZY, Wang KF, Xu ZQ. In Vivo Evaluation of Chemical Composition of Eight Types of Urinary Calculi Using Spiral Computerized Tomography in a Chinese Population. J Clin Lab Anal 2014; 29:370-4. [PMID: 25131309 DOI: 10.1002/jcla.21781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/29/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study was conducted to evaluate the chemical composition of eight types of urinary calculi using spiral computerized tomography (CT) in vivo. METHODS From October 2011 to February 2013, upper urinary tract calculi were obtained from 122 patients in the department of urinary surgery of the First Affiliated Hospital of Soochow University. All patients were scanned with a 64-detector row helical CT scanner using 6.50 mm collimation before ureterorenoscopy. Data from the preoperative spiral CT scans and postoperative chemical composition of urinary calculi were collected. RESULTS The chemical composition analysis indicates that there were five types of pure calculi and three types of mixed calculi, including 39 calcium oxalate calculi, 12 calcium phosphate calculi, 10 calcium carbonate calculi, 8 magnesium ammonium phosphate calculi, 6 carbonated apatite, 21 uric acid/ammonium urate calculi, 10 uric acid/calcium oxalate calculi, and 16 calcium oxalate/calcium phosphate calculi. There were significant differences in the mean CT values among the five types of pure calculi (P < 0.001). Furthermore, we also observed significant differences in the mean CT values among three types of mixed calculi (P < 0.001). Significant differences in the mean CT values were also found among eight types of urinary calculi (P < 0.001). However, no statistically significant difference was observed between the mean CT values of magnesium ammonium phosphate calculi and uric acid/calcium oxalate calculi (P = 0.262). CONCLUSION Our findings suggest that spiral CT could be a promising tool for determining the chemical composition of upper urinary tract calculi.
Collapse
Affiliation(s)
- Jun Huo
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Zhong-Yuan Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Ke-Feng Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Zhen-Qun Xu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| |
Collapse
|
27
|
Acute management of stones: When to treat or not to treat? World J Urol 2014; 33:203-11. [DOI: 10.1007/s00345-014-1353-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/16/2014] [Indexed: 11/26/2022] Open
|
28
|
Kanno T, Kubota M, Sakamoto H, Nishiyama R, Okada T, Higashi Y, Yamada H. The efficacy of ultrasonography for the detection of renal stone. Urology 2014; 84:285-8. [PMID: 24908592 DOI: 10.1016/j.urology.2014.04.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/14/2014] [Accepted: 04/05/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the efficacy of ultrasonography (US) for detecting renal stone using noncontrast enhanced computed tomography (NCCT) as a standard reference. METHODS We performed a retrospective study of 428 patients who underwent NCCT and US imaging on the same day from January 2009 to September 2011. The sensitivity of US to detect each individual stone and at least 1 stone per kidney was evaluated. The detection rates according to the location and stone size were also examined. We compared the sizes of stones determined in the longest axis of NCCT and US, and performed group classification based on size to examine whether stone sizes measured by NCCT and US were similar. RESULTS Of 856 kidneys, NCCT detected 474 stones in 361 kidneys, whereas US detected 332 stones of 474 stones detected by NCCT, yielding a sensitivity of 70.0% and a specificity of 94.4%. Similarly, US alone detected at least 1 stone in 285 kidneys, yielding a sensitivity of 78.9% and a specificity of 83.7%. Expectedly, the detection rate for the left upper calyx was lower than that for other sites (P = .002), and the detection rate increased with stone size. Furthermore, stone sizes obtained by US were positively correlated with those obtained by CT, and stone size measurement by NCCT and US was concordant in 240 of 332 cases (72%). Importantly, stone size was only a factor that affected renal stone diagnosis using US. CONCLUSION US is an effective imaging modality for detecting renal stones.
Collapse
Affiliation(s)
- Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.
| | - Masashi Kubota
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Hiromasa Sakamoto
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuichi Nishiyama
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Takashi Okada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| |
Collapse
|
29
|
Sinha M, Prabhu K, Venkatesh P, Krishnamoorthy V. Results of urinary dissolution therapy for radiolucent calculi. Int Braz J Urol 2013; 39:103-7. [PMID: 23489502 DOI: 10.1590/s1677-5538.ibju.2013.01.13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 10/16/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE In this paper we present our experience with dissolution therapy of radiolucent calculi. MATERIALS AND METHODS This was a retrospective analysis of patients who were offered urinary dissolution therapy between January 2010 and June 2011. Patients were treated with tablets containing potassium citrate and magnesium oxide. Partial dissolution was defined as at least a 50% reduction in stone size. Patients with complete or partial dissolution were classified in the successful dissolution group. Patients with no change, inadequate reduction, increase in stone size and those unable to tolerate alkali therapy were classified as failures. Patient sex, stenting before alkalinization, stone size, urine pH at presentation and serum uric acid levels were analyzed using Fisher t-test for an association with successful dissolution. RESULTS Out of 67, 48 patients reported for follow up. 10 (15%) had complete dissolution and 13 (19%) had partial dissolution. Alkalinization was unsuccessful in achieving dissolution in 25 (37%). Stenting before alkalinization, patient weight (< 60 vs. > 75kg) and serum uric acid levels (≤ 6 vs. > 6) were the only factors to significantly affected dissolution rates (p = 0.039, p 0.035, p 0.01 respectively). CONCLUSIONS A policy of offering dissolution therapy to patients with radiolucent calculi had a successful outcome in 34% of patients.
Collapse
Affiliation(s)
- Maneesh Sinha
- Department of Urology NU Hospitals, Bangalore 560070, India.
| | | | | | | |
Collapse
|
30
|
|
31
|
Sorensen MD, Bailey MR, Hsi RS, Cunitz BW, Simon JC, Wang YN, Dunmire BL, Paun M, Starr F, Lu W, Evan AP, Harper JD. Focused ultrasonic propulsion of kidney stones: review and update of preclinical technology. J Endourol 2013; 27:1183-6. [PMID: 23883117 PMCID: PMC3787400 DOI: 10.1089/end.2013.0315] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A noninvasive tool to reposition kidney stones could have significant impact in the management of stone disease. Our research group has developed a noninvasive transcutaneous ultrasound device. A review and update of the current status of this technology is provided. DISCUSSION OF TECHNOLOGY: Stone propulsion is achieved through short bursts of focused, ultrasonic pulses. The initial system consisted of an eight-element annular array transducer, computer, and separate ultrasound imager. In the current generation, imaging and therapy are completed with one ultrasound system and a commercial probe. This generation allows real-time ultrasound imaging, targeting, and propulsion. Safety and effectiveness for the relocation of calyceal stones have been demonstrated in the porcine model. ROLE IN ENDOUROLOGY: This technology may have applications in repositioning stones as an adjunct to lithotripsy, facilitating clearance of residual fragments after lithotripsy, expelling de novo stones, and potentially repositioning obstructing stones. Human trials are in preparation.
Collapse
Affiliation(s)
- Mathew D. Sorensen
- Division of Urology, Department of Veteran Affairs Medical Center, Seattle, Washington
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Michael R. Bailey
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Ryan S. Hsi
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Bryan W. Cunitz
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Julianna C. Simon
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Yak-Nam Wang
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Barbrina L. Dunmire
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Marla Paun
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Frank Starr
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Wei Lu
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Andrew P. Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
32
|
de Swarte M, Bryan J, Zarelli M, Huuskonen V, Schneeweiss W, McAllister H. Imaging diagnosis-ultrasonographic and CT findings in a gray seal (Halichoerus grypus) with hepatic cirrhosis, pyelonephritis, and nephrolithiasis. Vet Radiol Ultrasound 2013; 54:555-9. [PMID: 23578275 DOI: 10.1111/vru.12037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/04/2013] [Accepted: 03/04/2013] [Indexed: 11/30/2022] Open
Abstract
An immature gray seal was presented with lethargy, weight loss, vomiting and hematuria. Hepatic disease and urinary tract infection were suspected. Abdominal ultrasound showed hyperechoic structures with marked acoustic shadowing spread throughout both kidneys, but incomplete visualization of the liver. Abdominal CT showed mineral densities scattered throughout both kidneys and poor delineation of the liver. Due to the poor quality of life, the seal was euthanized. Postmortem examination showed ammonium urate nephroliths, pyelonephritis, and hepatic cirrhosis. This case report emphasizes the difficulty of characterizing liver disease with conventional 2D-ultrasound and CT in a deep-chested animal with minimal intra-abdominal fat.
Collapse
Affiliation(s)
- Marie de Swarte
- University College Dublin Veterinary Hospital, School of Veterinary Medicine, UCD, Belfield, Dublin 4, Ireland
| | | | | | | | | | | |
Collapse
|
33
|
White WM, Johnson EB, Zite NB, Beddies J, Krambeck AE, Hyams E, Marien T, Shah O, Matlaga B, Pais VM. Predictive Value of Current Imaging Modalities for the Detection of Urolithiasis During Pregnancy: a Multicenter, Longitudinal Study. J Urol 2013; 189:931-4. [DOI: 10.1016/j.juro.2012.09.076] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Wesley M. White
- Division of Urologic Surgery, The University of Tennessee Medical Center, Knoxville, Tennessee
| | | | - Nikki B. Zite
- Department of Obstetrics and Gynecology, The University of Tennessee Medical Center, Knoxville, Tennessee
| | - John Beddies
- Division of Urologic Surgery, The University of Tennessee Medical Center, Knoxville, Tennessee
| | | | - Elias Hyams
- Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - Ojas Shah
- New York University, New York, New York
| | - Brian Matlaga
- Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland
| | - Vernon M. Pais
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| |
Collapse
|
34
|
|
35
|
Sorensen MD, Harper JD, Hsi RS, Shah AR, Dighe MK, Carter SJ, Moshiri M, Paun M, Lu W, Bailey MR. B-mode ultrasound versus color Doppler twinkling artifact in detecting kidney stones. J Endourol 2013; 27:149-53. [PMID: 23067207 DOI: 10.1089/end.2012.0430] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare color Doppler twinkling artifact and B-mode ultrasonography in detecting kidney stones. PATIENTS AND METHODS Nine patients with recent CT scans prospectively underwent B-mode and twinkling artifact color Doppler ultrasonography on a commercial ultrasound machine. Video segments of the upper pole, interpolar area, and lower pole were created, randomized, and independently reviewed by three radiologists. Receiver operator characteristics were determined. RESULTS There were 32 stones in 18 kidneys with a mean stone size of 8.9±7.5 mm. B-mode ultrasonography had 71% sensitivity, 48% specificity, 52% positive predictive value, and 68% negative predictive value, while twinkling artifact Doppler ultrasonography had 56% sensitivity, 74% specificity, 62% positive predictive value, and 68% negative predictive value. CONCLUSIONS When used alone, B-mode is more sensitive, but twinkling artifact is more specific in detecting kidney stones. This information may help users employ twinkling and B-mode to identify stones and developers to improve signal processing to harness the fundamental acoustic differences to ultimately improve stone detection.
Collapse
Affiliation(s)
- Mathew D Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Moore CL, Scoutt L. Sonography first for acute flank pain? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1703-1711. [PMID: 23091240 DOI: 10.7863/jum.2012.31.11.1703] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Christopher L Moore
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, USA.
| | | |
Collapse
|
37
|
Lipkin ME, Preminger GM. Imaging techniques for stone disease and methods for reducing radiation exposure. Urol Clin North Am 2012. [PMID: 23177634 DOI: 10.1016/j.ucl.2012.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Imaging plays a critical role in the evaluation of patients with urolithiasis. It is essential for the diagnosis of stones and provides important information to aide in determining the appropriate treatment of renal or ureteral calculi. Imaging for urolithiasis has evolved over the past 30 years. Currently, noncontrast computed tomography remains the first-line imaging modality for the evaluation of patients with suspected urolithiasis. Proper imaging modality selection helps to minimize radiation exposure. Following the principles of As Low As Reasonably Achievable in the operating room can help reduce the amount of radiation patients are exposed to from fluoroscopy.
Collapse
Affiliation(s)
- Michael E Lipkin
- Department of Urology, Duke University Medical Center, DUMC 3167, Durham, NC 27710, USA.
| | | |
Collapse
|
38
|
Reply to Swarnendu Mandal, Apul Goel and Dheeraj Kumar Gupta’s Letter to the Editor re: Jens J. Rassweiler, Michael Müller, Markus Fangerau, et al. iPad-Assisted Percutaneous Access to the Kidney Using Marker-Based Navigation: Initial Clinical Experience. Eur Urol 2012;61:628–31. Eur Urol 2012. [DOI: 10.1016/j.eururo.2012.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|