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Kalatharan V, Jandoc R, Grewal G, Nash DM, Welk B, Sarma S, Pei Y, Garg AX. Efficacy and Safety of Surgical Kidney Stone Interventions in Autosomal Dominant Polycystic Kidney Disease: A Systematic Review. Can J Kidney Health Dis 2020; 7:2054358120940433. [PMID: 32754344 PMCID: PMC7378961 DOI: 10.1177/2054358120940433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Reduced kidney function and distorted kidney anatomy in patients with autosomal dominant polycystic kidney disease (ADPKD) may complicate stone interventions more compared with the general population. OBJECTIVES To review studies describing the safety and efficacy of the 3 main stone interventions in adults with ADPKD: shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL). DESIGN Systematic review. SETTING Any country of origin. PATIENTS Adults with ADPKD who underwent SWL, ureteroscopy, or PCNL. MEASUREMENTS Being stone free after the intervention and postoperative complications as reported by each study, which included pain, bleeding, and fever. METHODS Relevant studies published until February 2019 were identified through a comprehensive search of MEDLINE, EMBASE, Web of Science, BIOSIS PREVIEW, and CINAHL. Studies were eligible for review if they reported at least one outcome following SWL, ureteroscopy, and/or PCNL in adults with ADPKD. We then abstracted information on study characteristics, patient characteristics, intervention details, and postintervention outcomes and assessed the methodological quality of each study using a modified Downs and Black checklist. RESULTS We screened 221 citations from which we identified 24 studies that met our review criteria. We identified an additional article when manually reviewing the reference list of an included article, yielding a total of 25 studies describing 311 patients (32 SWL, 42 ureteroscopy, and 237 PCNL). The percentage of patients who were stone free after 1 session ranged from 0% to 69% after SWL, 73% to 100% after ureteroscopy, and 45% to 100% after PCNL. The percentage of patients with ADPKD that experienced at least one postoperative complication ranged from 0% to 33% for SWL, 0% to 27% for ureteroscopy, and 0% to 100% for PCNL. LIMITATIONS The number and quality of studies published to date are limited. CONCLUSIONS The efficacy and safety of stone interventions in patients with ADPKD remains uncertain, with wide-ranging estimates reported in the literature. TRIAL REGISTRATION We did not register the protocol of this systematic review.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | | | - Gary Grewal
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
| | - Danielle M. Nash
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | - Blayne Welk
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | - Sisira Sarma
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
| | - York Pei
- Division of Nephrology, University
Health Network and University of Toronto, ON, Canada
| | - Amit X. Garg
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
- ICES, London, ON, Canada
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
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Al Otay A, Sarhan O, El-Tholoth HS, Alhelaly A, Al Akrash H, Al Ghanbar M, Al Bedaiwi K, Nakshabandi Z, Obeid A. Different managements of horseshoe kidney stones, any difference in the outcome? Urol Ann 2018; 10:287-290. [PMID: 30089987 PMCID: PMC6060601 DOI: 10.4103/ua.ua_116_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose The aim is to assess the outcomes of different approaches for the management of renal stones associated with horseshoe kidneys (HSKs) in our institution over a 12-year period. Methods A retrospective review of 144 patients with HSKs who presented from 2000 to 2012 was performed. Twenty-eight patients (19.4%) were found to have renal stones. Demographic data were collected; the method of treatment and the outcomes of stone management were reviewed. We excluded patients with non-functioning moieties and associated genitourinary anomalies, and those with incomplete data. Results We included 25 patients, of which 16 males (64%) and 9 females (36%), with a mean age of 37 years. Mean serum creatinine level was 66 mmol/L. Eleven patients with a stone size <8 mm were treated expectantly with medical treatment, with only one patient requiring endoscopic intervention. Six patients (24%) with a stone size between 1 cm and ≤2 cm were treated with extracorporeal shock wave lithotripsy (ESWL) with the placement of double J stents, and seven patients (28%) with a stone size of >2 cm were treated with percutaneous nephrolithotomy. One patient with a 10 mm stone was treated using flexible ureteroscopy. No significant perioperative complications were encountered. Conclusions Indications, methods of treatment, and outcomes of management of stones associated with HSKs were comparable to those for stones associated with normal kidneys. Tailored approach based on stone size is highly recommended. ESWL accompanied with ureteric stenting is a promising strategy for the management of stones associated with HSKs in selected patients requiring intervention.
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Affiliation(s)
- Abdulhakim Al Otay
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Osama Sarhan
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hossam S El-Tholoth
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Alhelaly
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hamad Al Akrash
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mustafa Al Ghanbar
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khaled Al Bedaiwi
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ziad Nakshabandi
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali Obeid
- Division of Pediatric Urology, Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Gokce MI, Tokatli Z, Suer E, Hajiyev P, Akinci A, Esen B. Comparison of shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) for treatment of stone disease in horseshoe kidney patients. Int Braz J Urol 2017; 42:96-100. [PMID: 27136473 PMCID: PMC4811232 DOI: 10.1590/s1677-5538.ibju.2015.0023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/02/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives In this study it is aimed to compare the success and complication rates of SWL and RIRS in treatment of HSK stone disease. Materials and methods In this retrospective study data of 67 patients treated with either SWL (n=44) or RIRS (n=23) for stone disease in HSK between May 2003 to August 2014 was investigated. age, gender, stone size and multiplicity, stone free status, renal colic episodes and complication rates of the SWL and RIRS groups were compared. Results Mean age of the population was 42.5±8.2 (range: 16-78) years and mean stone size was 16.9±4.1 mm. SWL and RIRS groups were similar with regard to demographic characteristics and stone related characteristics. SFR of the SWL and RIRS groups were 47.7%(21/44 patients) and 73.9% (17/23 patients) respectively (p=0.039).Renal colic episodes were observed in 3 and 16 patients in the RIRS and SWL groups respectively (p=0.024). No statistically significant complications were observed between the SWL (8/44 patients) and RIRS (4/23) groups (p=0.936). Conclusions In HSK patients with stone disease, both SWL and RIRS are effective and safe treatment modalities. However RIRS seems to maintain higher SFRs with comparable complication rates.
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Affiliation(s)
- Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Zafer Tokatli
- Department of Urology, Doruk Hospital Ankara, Turkey
| | - Evren Suer
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Parviz Hajiyev
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Aykut Akinci
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Baris Esen
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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Ding J, Huang Y, Gu S, Chen Y, Peng J, Bai Q, Ye M, Qi J. Flexible Ureteroscopic Management of Horseshoe Kidney Renal Calculi. Int Braz J Urol 2016; 41:683-9. [PMID: 26401860 PMCID: PMC4756996 DOI: 10.1590/s1677-5538.ibju.2014.0086] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 10/23/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the clinical efficacy of flexible ureteroscope (F-URS) combined with holmium laser lithotripter in treating renal calculi in horseshoe kidney. MATERIALS AND METHODS From November 2010 to December 2013, the medical history and charts of sixteen patients (mean age 42.9 ± 11.6 years, range 26-66 years), including 13 males and 3 females were analyzed retrospectively. Mean stone burden was 29 ± 8 mm (range 17-42 mm2). Mean stone digitized surface area (DSA) was 321 ± 94 mm2 (range 180-538 mm2). Under spinal anesthesia in a modified lithotomy position with the head down, rigid ureteroscope was placed firstly into the ureter to reach the level of the pelvis, a zebra guide wire was inserted and following the removal of the rigid ureteroscope, an ureteral access sheath was positioned along the guide wire, then passed the URF P-5 flexible ureteroscope into the renal cavities over the guidewire. After locating the stones, holmium laser lithotripsy was performed. RESULTS The average operative time was 92 ± 16 minutes (range 74-127 min.). No major complications were encountered. Ten patients obtained stone-free status with one session, four obtained stone-free status after two sessions. Single session stone-free rate was 62.5%, overall stone-free rate was 87.5%. Two patients have small residual stones in the lower pole. CONCLUSIONS F-URS combined with holmium laser lithotripter and nitinol basket, is safe and effective in dealing with moderate stone diameter (<30 mm) in HSKs with high clearance rates and low complication rates.
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Affiliation(s)
- Jie Ding
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunteng Huang
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siping Gu
- Micro-Invasive Surgery Center, Shishi Overseas Chinese Hospital, Fujian, China
| | - Yifan Chen
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Peng
- Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Bai
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Ye
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Qi
- Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ray AA, Ghiculete D, D'A. Honey RJ, Pace KT. Shockwave Lithotripsy in Patients with Horseshoe Kidney: Determinants of Success. J Endourol 2011; 25:487-93. [DOI: 10.1089/end.2010.0213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A. Andrew Ray
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Daniela Ghiculete
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - R. John D'A. Honey
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Kenneth T. Pace
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Affiliation(s)
- Uwais B. Mufti
- Urology Unit, NHS Lanarkshire, Monklands, Wishaw, and Hairmyres General Hospitals, Lanarkshire, United Kingdom
| | - Sarath K. Nalagatla
- Urology Unit, NHS Lanarkshire, Monklands, Wishaw, and Hairmyres General Hospitals, Lanarkshire, United Kingdom
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Masoumi A, Reed-Gitomer B, Kelleher C, Bekheirnia MR, Schrier RW. Developments in the management of autosomal dominant polycystic kidney disease. Ther Clin Risk Manag 2008; 4:393-407. [PMID: 18728845 PMCID: PMC2504069 DOI: 10.2147/tcrm.s1617] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent life- threatening, hereditary disease. ADPKD is more common than sickle cell anemia, cystic fibrosis, muscular dystrophy, hemophilia, Down's syndrome, and Huntington's disease combined. ADPKD is a multisystemic disorder characterized by the progressive development of renal cysts and marked renal enlargement. Structural and functional renal deterioration occurs in ADPKD patients and is the fourth leading cause of end-stage renal disease (ESRD) in adults. Aside from the renal manifestations, extrarenal structural abnormalities, such as liver cysts, cardiovascular abnormalities, and intracranial aneurysms may lead to morbidity and mortality. Recent studies have identified prognostic factors for progressive renal impairment including gender, race, age, proteinuria, hematuria, hypertension and increased left ventricular mass index (LVMI). Early diagnosis and better understanding of the pathophysiology of the disease provides the opportunity to aggressivly treat hypertension with renin-angiotensin-aldosterone system inhibitors and thereby potentially reduce LVMI, prevent cardiovascular morbidity and mortality and slow progression of the renal disease.
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Affiliation(s)
- Amirali Masoumi
- Department of Medicine, Health Sciences Center, University of Colorado School of Medicine Denver, CO 80262, USA
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Taub DA, Suh RS, Faerber GJ, Wolf JS. Ureteroscopic laser papillotomy to treat papillary calcifications associated with chronic flank pain. Urology 2006; 67:683-7. [PMID: 16566982 DOI: 10.1016/j.urology.2005.10.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2005] [Revised: 09/25/2005] [Accepted: 10/24/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate retrospectively the efficacy and durability of a novel approach using ureteroscopic laser papillotomy for the treatment of painful papillary calcifications. Chronic pain due to renal papillary calcifications has not been addressed by current techniques. METHODS Ureteroscopic holmium laser lithotripsy and papillotomy were performed on patients with chronic pain and radiographically visible papillary calcifications without free collecting system calculi. The papillary urothelium overlying all cystic dilations and intraductal calcifications was vaporized. Treated patients answered a telephone survey to assess pain scores, duration of response, use of narcotics, and patient satisfaction. We reviewed the medical records to evaluate for procedure-related complications and serum creatinine measurements. RESULTS Of 20 patients who underwent laser papillotomy and responded to the telephone survey, 7 had bilateral procedures, yielding 27 renal units available for analysis. "Much less pain" was reported after 85% of the procedures, with a durable improvement reported after 59% of the procedures, at a median follow-up of 14.5 months. Significant improvements in the median pain scores were seen at 1 month (1.0, P <0.001), 6 months (2.0, P <0.001), and 1 year (1.5, P <0.001) compared with a median preoperative pain score of 9.0. The mean serum creatinine was unchanged after the procedure. CONCLUSIONS Ureteroscopic laser papillotomy appears to be an effective treatment option for the chronic pain associated with papillary calcifications. Laser papillotomy offers hope to patients who would otherwise have been denied an attempt at treatment because of a lack of free calculi within the collecting system.
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Affiliation(s)
- David A Taub
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-0330, USA
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Abstract
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.
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Affiliation(s)
- Lutfi Tunc
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey.
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Abstract
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.
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Abstract
Pain is a common complaint in patients with autosomal-dominant polycystic kidney disease, and a systematic approach is needed to differentiate the etiology of the pain and define an approach to management. A thorough history is the best clue to the multifactorial causes of the pain, superimposed upon an understanding of the complex innervation network that supplies the kidneys. The appropriate use of diagnostic radiology (especially MRI) will assist in differentiating the mechanical low back pain caused by cyst enlargement, cyst rupture and cyst infection. Also, the increased incidence of uric acid nephrolithiasis as a factor in producing renal colic must be considered when evaluating acute pain in the population at risk. MRI is not a good technique to detect renal calculi, a frequent cause of pain in polycystic kidney disease. If stone disease is a possibility, then abdominal CT scan and/or ultrasound should be the method of radiologic investigation. Pain management is generally not approached in a systematic way in clinical practice because most physicians lack training in the principles of pain management. The first impulse to give narcotics for pain relief must be avoided. Since chronic pain cannot be "cured," an approach must include techniques that allow the patient to adapt to chronic pain so as to limit interference with their life style. A detailed stepwise approach for acute and chronic pain strategies for the patient with autosomal dominant polycystic kidney disease is outlined.
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Affiliation(s)
- Z H Bajwa
- Department of Anesthesia and Neurology, Renal Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215-5491, USA
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Demirkesen O, Yaycioglu O, Onal B, Kalkan M, Tansu N, Yalcin V, Kural AR, Solok V. Extracorporeal shockwave lithotripsy for stones in abnormal urinary tracts: analysis of results and comparison with normal urinary tracts. J Endourol 2001; 15:681-5. [PMID: 11697396 DOI: 10.1089/08927790152596235] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We reviewed our experience with SWL for stones in abnormal urinary tracts and compared the results with those in normal urinary tracts. PATIENTS AND METHODS The study group was composed of 2566 renal units (RU) treated on the Siemens Lithostar lithotripter at our SWL unit whose treatment and follow-up at 10 to 12 weeks were completed. Sixty-eight RUs (2.7%) belonged to 52 patients who had congenital upper urinary tract abnormalities. Logistic regression analysis was performed to analyze the impact of age, stone size, location, and the type of abnormality on the outcome of the SWL in the abnormal RU. The student t-, chi-square, and Fisher's exact tests were used for the comparison of stone load, number of treatment sessions, catheter placement, and success rates of the patients with normal and abnormal RU. Results of long-term follow-up for available patients (38 RU; 56%) were also evaluated. RESULTS Age, stone load, stone location, and the type of abnormality did not have a statistically significant impact on the outcome of SWL for abnormal RU. The average stone load was 2.1 +/- 2.8 cm2 in the abnormal and 1.4 +/- 1.3 cm2 in the normal RU. Thus, the stone load was significantly higher in the abnormal RU (P < 0.05). In the abnormal group, 56% of the RU became stone free, 37% had nonobstructive and noninfectious clinically insignificant residual fragments < or = 4 mm (CIRF), and SWL failed in 7%. In the normal group, 78% of the RU became stone-free, 18.5% had CIRF, and SWL failed in 4%. There was no significant difference in the success rates in the groups if success was defined as stone free and CIRF together (P > 0.05). However, there was significant a difference when stone-free, CIRF, and failure rates were evaluated separately (P < 0.05). Recurrence, regrowth, and retreatment rates in abnormal RU were 50%, 37%, and 34%, respectively. CONCLUSIONS Although the fragmentation rates were similar, clearance of the fragments was hampered in abnormal urinary tracts. Thus, especially for large stones, other endourologic treatment options should be considered. High recurrence and regrowth rates warrant careful monitoring and consideration for medical treatment during follow-up.
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Affiliation(s)
- O Demirkesen
- Department of Urology, Istanbul University, Cerrahpasa Faculty of Medicine, Turkey.
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Abstract
BACKGROUND A 63-year-old woman presented with right flank pain and macroscopic hematuria. RESULTS/METHODS A plain film showed a calcific shadow on the right iliac bone. On excretory urography, the right kidney was seen in the normal position, but the left kidney was not. Bilateral retrograde pyelogram revealed the S-shaped kidney and mild obstruction from a 12 x 5 mm calculus in the proximal ureter of the crossed kidney. The patient was successfully treated with in situ extracorporeal shock wave lithotripsy (ESWL) treatment and is stone free at 1 month follow up. CONCLUSION We believe this is the first case of successful ESWL in a crossed kidney.
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Affiliation(s)
- M Kato
- Department of Urology, Tohoku University School of Medicine, Sendai, Japan.
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Collado Serra A, Parada Moreno R, Rousaud Barón F, Monreal Garcia de Vicuña F, Rousaud Barón A, Rodriguez JV. Current management of calculi in horseshoe kidneys. Scand J Urol Nephrol 2000; 34:114-8. [PMID: 10903072 DOI: 10.1080/003655900750016724] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
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.
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Affiliation(s)
- A Collado Serra
- Fundació Puigvert, Universidad Autónoma de Barcelona, Spain.
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Abstract
BACKGROUND AND OBJECTIVE Extracorporeal shockwave lithotripsy (SWL) is accepted as first-line therapy for kidney stones. The aim of this study was to evaluate SWL therapy in patients with congenital urinary system anomalies. PATIENTS AND METHODS A total of 120 patients with congenital urinary system anomalies and kidney stones who underwent SWL treatment were evaluated. Of these patients, 44 (37%) had horseshoe kidneys, 22 (18%) had rotation anomalies, 13 (11%) had pelvic kidneys, and 41 (34%) had ureteral duplications. The mean stone size was 2.09+/-0.71 (range 0.8-4.6) cm2, and a total of 232 sessions (1.93 sessions/patient) were applied. RESULTS The overall stone-free rate after completion of the SWL treatments was 70% (84 patients). In horse shoe kidneys the stone-free rate was 68%, and sufficient fragmentation was achieved in another 21%. These values were 59% and 32%, respectively, for malrotated kidneys, 54% and 39% for pelvic kidneys, and 83% and 12% for ureteral duplications. The 10 patients in whom SWL treatment remained unsuccessful had horse-shoe kidneys (five cases), malrotated kidneys (two cases), pelvic kidney (one case), and ureteral duplication (two cases). Open surgery was performed in eight patients with renal anomalies, and ureteroendoscopic lithotripsy was performed in two patients with ureteral duplication. CONCLUSION Shockwave lithotripsy is an effective and reliable treatment method in patients with congenital urinary system anomalies, especially when the stones are <2 cm. Patients with ureteral duplication had the overall best stone-free rates. However, patients who have stones > or =3 cm in horseshoe or malrotated kidneys and duplex systems seem to be better candidates for percutaneous nephrolithotomy or open surgery.
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Affiliation(s)
- B Küpeli
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey.
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Delakas D, Daskalopoulos G, Cranidis A. Extracorporeal shockwave lithotripsy for urinary calculi in autosomal dominant polycystic kidney disease. J Endourol 1997; 11:167-70. [PMID: 9181443 DOI: 10.1089/end.1997.11.167] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited systemic disorder. Renal stones have a high rate of occurrence among patients with ADPKD and are a significant cause of morbidity in this disorder. Thirteen patients with ADPKD and symptomatic or obstructive renal stones presented to our hospital for evaluation and treatment with extracorporeal shockwave lithotripsy (SWL). A total of 16 renal units were treated. The auxiliary procedures included placement of a double-J stent in nine kidneys when the stone was larger than 8 mm in diameter. Eleven patients (85%) were stone free 3 months after lithotripsy; a second treatment was necessary in two patients. We conclude that SWL can be used as a primary management tool for renal stones in patients with ADPKD.
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Affiliation(s)
- D Delakas
- Department of Urology, University General Hospital, Heraklion, Crete, Greece
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