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Kadihasanoglu M, Yucetas U, Karabay E, Sonmezay E. Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy. Int Braz J Urol 2019; 45:965-973. [PMID: 31626519 PMCID: PMC6844342 DOI: 10.1590/s1677-5538.ibju.2018.0781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/06/2019] [Indexed: 12/22/2022] Open
Abstract
Objective We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. Materials and Methods We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. Results The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). Conclusions Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.
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Affiliation(s)
| | - Ugur Yucetas
- Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey
| | - Emre Karabay
- Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey
| | - Erkan Sonmezay
- Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey
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2
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Ureteropelvic Junction Obstruction and Parathyroid Adenoma: Coincidence or Link? Case Rep Nephrol 2017; 2017:9852912. [PMID: 29181209 PMCID: PMC5664328 DOI: 10.1155/2017/9852912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/11/2017] [Accepted: 09/25/2017] [Indexed: 11/25/2022] Open
Abstract
Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of upper urinary tract obstruction in children. It is generally diagnosed in the routine work-up during antenatal period and is characterized by spontaneous recovery. It can be associated with urolithiasis; hence further investigation should be carried out. We report the case of a 15-year-old boy, who is known to have right UPJO, presented with right renal colic and discovered to have bilateral kidney stones. Further studies showed primary hyperparathyroidism and genetic analysis revealed a CDC73 mutation (initially HRPT2). We believe that association of UPJO and PHPT is a rare coincidence that can be linked. Careful work-up of children with UPJO and urolithiasis is recommended to exclude an underlying metabolic disease. Surgical correction can be evitable as treatment of the primary cause can lead to complete dissolution of kidney stones and improvement of the medical condition.
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Stasinou T, Bourdoumis A, Masood J. Forming a stone in pelviureteric junction obstruction: Cause or effect? Int Braz J Urol 2017; 43:13-19. [PMID: 28124521 PMCID: PMC5293378 DOI: 10.1590/s1677-5538.ibju.2015.0515] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 05/28/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To investigate a possible causal relationship for stone formation in pelviureteric junction obstruction and to outline management options. MATERIALS AND METHODS A literature search and evidence synthesis was conducted via electronic databases in the English language using the key words pelviureteric junction obstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy; percutaneous nephrolithotomy, alone or in combination. Relevant articles were analysed to extract conclusions. RESULTS Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasis has been reported only scarcely in the literature. Although PUJO has been extensively studied throughout the years, the presence of calculi in such a patient has not received equal attention and there is still doubt surrounding the pathophysiology and global management. CONCLUSIONS Metabolic risk factors appear to play an important role, enough to justify metabolic evaluation in these patients. Urinary stasis and infection are well known factors predisposing to lithiasis and contribute to some extent. The choice for treatment is not always straightforward. Management should be tailored according to degree of obstruction, renal function, patient symptoms and stone size. Simultaneous treatment is feasible with the aid of minimally invasive operative techniques and laparoscopy in particular.
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Affiliation(s)
- Theodora Stasinou
- South Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Andreas Bourdoumis
- North Manchester General Hospital, Acute Pennine Hospitals NHS Trust, Manchester, UK
| | - Junaid Masood
- Homerton University Hospital NHS Foundation Trust, London, UK
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Mahyar A, Dalirani R, Ayazi P, Hamzehloo S, Moshiri SA, Khoshbakht Ahmadi N, Talebi Pour Nikoo S, Yazdi Z, Esmaeily S. The association of hypercalciuria and hyperuricosuria with vesicoureteral reflux in children. Clin Exp Nephrol 2016; 21:112-116. [PMID: 26820845 DOI: 10.1007/s10157-016-1236-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES One of the important complications of vesicoureteral reflux (VUR) is the development of urolithiasis. Identifying factors involved in development of urolithiasis in children with VUR is immensely important. This study was conducted to determine the association between hypercalciuria and hyperuricosuria with VUR in children. METHODS One-hundred children with VUR (case group) were compared to 100 healthy children (control group) in terms of hypercalciuria and hyperuricosuria. To measure these markers, random morning fasting urine samples were used. Data were analyzed using statistical tests. RESULTS Hypercalciuria and hyperuricosuria frequencies, and also urine calcium/creatinine (Ca/Cr) and urine uric acid/creatinine (UA/Cr) ratios were significantly higher in the case group compared to the control group (P < 0.05). A significant difference was found between hypercalciuria and hyperuricosuria in severity of VUR (P < 0.05). A positive correlation was observed between hypercalciuria and hyperuricosuria and severity of VUR (P < 0.05). CONCLUSIONS The present study showed that there is association between hypercalciuria, hyperuricosuria and VUR in children. It is recommended to adopt measures to prevent the development of urolithiasis in VUR patients.
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Affiliation(s)
- Abolfazl Mahyar
- Department of Pediatrics, Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Reza Dalirani
- Department of Pediatric Nephrology, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parviz Ayazi
- Department of Pediatrics, Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Samaneh Hamzehloo
- Department of Pediatrics, Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Seyed Alireza Moshiri
- Department of Pediatrics, Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Negin Khoshbakht Ahmadi
- Department of Pediatrics, Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sara Talebi Pour Nikoo
- Department of Pediatrics, Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zohreh Yazdi
- Department of Pediatrics, Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Shiva Esmaeily
- Department of Pediatrics, Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
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Skolarikos A, Dellis A, Knoll T. Ureteropelvic obstruction and renal stones: etiology and treatment. Urolithiasis 2015; 43:5-12. [PMID: 25362543 DOI: 10.1007/s00240-014-0736-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/23/2014] [Indexed: 12/20/2022]
Abstract
The simultaneous surgical management of ureteropelvic junction obstruction (UPJO) with concomitant renal stones has evolved the last 20 years; hence, the ideal minimally invasive technique is still controversial. Laparoscopic and robot-assisted laparoscopic operations allow precise surgical maneuvers and were thought to simplify the reconstruction steps of the procedure, especially in the treatment of complex cases with large stones. The aim of this study was to summarize the available perioperative and functional outcomes of minimally invasive available techniques. A non-systematic review of the literature was performed using a free-text protocol in the MEDLINE database. The terms used were "ureteropelvic junction obstruction," "renal calculi" and "renal stones." Furthermore, other significant relevant studies cited in the reference lists of the selected papers were also evaluated in the structure of this review. Currently, available evidence suggests that both laparoscopic and robotic-assisted techniques offer excellent surgical solutions in the field of UPJO reconstruction and renal stones removal. In the hands of experienced surgeons, laparoscopic and robotic pyeloplasty with concomitant stone removal is a safe procedure with high stone-free rates and UPJ patency. Minimally invasive pyeloplasty should constitute the first choice of treatment for concomitant renal stones and ureteropelvic junction obstruction.
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Affiliation(s)
- Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece
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Garcia-Nieto V, Negrete-Pedraza F, Lopez-Garcia M, Luis-Yanes MI. Are simple renal cysts in childhood associated with kidney stones? Nephrourol Mon 2012; 4:596-8. [PMID: 23573497 PMCID: PMC3614311 DOI: 10.5812/numonthly.2682] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 05/05/2012] [Accepted: 05/30/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Victor Garcia-Nieto
- Pediatric Nephrology Unit, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Corresponding author: Victor Garcia-Nieto, Pediatric Nephrology Unit, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain. Tel.: +34-922600537, Fax: +34-92600605, E-mail:
| | | | - Marta Lopez-Garcia
- Pediatrics Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Maria Isabel Luis-Yanes
- Pediatric Nephrology Unit, Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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7
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Abstract
Childhood urolithiasis is an evolving condition with an increasing incidence and prevalence over the last 2 decades. Over that time the underlying cause has shifted from predominantly infectious to metabolic in nature. This review describes the pathophysiology, underlying metabolic abnormalities, clinical presentation, evaluation, and management of childhood urolithiasis. A comprehensive metabolic evaluation is essential for all children with renal calculi, given the high rate of recurrence and the importance of excluding inherited progressive conditions.
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Affiliation(s)
- Lawrence Copelovitch
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Nephrolithiasis caused by ceftriaxone in a 3-year-old child with ureteropelvic junction obstruction. Case Rep Med 2009; 2009:365962. [PMID: 19718430 PMCID: PMC2729447 DOI: 10.1155/2009/365962] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 05/06/2009] [Indexed: 11/26/2022] Open
Abstract
We report the case of a 3-year-old boy with urinary tract malformation (left sided stenosis of the ureteropelvic junction) which was precipitating factor for ensuing nephrolithiasis of the left kidney during the therapy with ceftriaxone. The treatment with spasmolytics was initiated, together with the forced parentheral hydration. After 3 weeks, there was no evidence of calculi in the urinary tract.
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9
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Auge BK, Maloney ME, Mathias BJ, Pietrow PK, Preminger GM. Metabolic abnormalities associated with calyceal diverticular stones. BJU Int 2006; 97:1053-6. [PMID: 16643491 DOI: 10.1111/j.1464-410x.2006.06134.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Brian K Auge
- Department of Urology, Naval Medical Center, San Diego, CA, USA
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Gambaro G, Fabris A, Puliatta D, Lupo A. Lithiasis in cystic kidney disease and malformations of the urinary tract. ACTA ACUST UNITED AC 2006; 34:102-7. [PMID: 16416113 DOI: 10.1007/s00240-005-0019-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2005] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- G Gambaro
- Divisione di Nefrologia, Dipartimento di Scienze Biomediche e Chirurgiche, Università di Verona, Ospedale Maggiore, P.le Stefani 1, 37126, Verona, Italy.
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11
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Pais VM, Assimos DG. Pitfalls in the management of patients with primary hyperoxaluria: a urologist’s perspective. ACTA ACUST UNITED AC 2005; 33:390-3. [PMID: 16284885 DOI: 10.1007/s00240-005-0483-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2005] [Accepted: 03/14/2005] [Indexed: 11/25/2022]
Abstract
The primary hyperoxalurias are rare, inherited diseases which commonly manifest early in life as urolithiasis. As these patients often present to the urologic surgeon, it is imperative that urologists understand the typical presentation, diagnosis, and management of urolithiasis associated with primary hyperoxaluria. In this review, the pertinent epidemiology and pathogenesis as they relate to the diagnosis and natural history of the disease are discussed. The literature on therapeutic options for primary hyperoxaluric patients with calculi is examined, and treatment strategies are suggested.
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Affiliation(s)
- Vernon M Pais
- Department of Urology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
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Abstract
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.
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Affiliation(s)
- Jean Amiel
- Fédération d'Urologie-Nephrologie et Transplantation, Centre Hospitalo-Universitaire Nice, Nice, France.
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