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López-Acevedo, Victoria, Álvaro Sánchez-Barrueco, Sol López-Andrés, José Miguel Villacampa-Aubá, Jessica Santillán-Coello, Fernando González-Galán, Gonzalo Díaz-Tapia, and Carlos Cenjor-Español. "Salivary stones crystallization. Previous study." Acta Crystallographica Section A Foundations and Advances 74, a2 (August 22, 2018): e272-e272. http://dx.doi.org/10.1107/s2053273318091076.
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Karagiannis, Andreas, Andreas Skolarikos, Emanuel Alexandrescu, Dragoslav Basic, Petrisor Geavlete, Alessandro Maletta, A. Yaser Muslumanoglu, et al. "Epidemiologic study of urolithiasis in seven countries of South-Eastern Europe: S.E.G.U.R. 1 study." Archivio Italiano di Urologia e Andrologia 89, no. 3 (October 3, 2017): 173. http://dx.doi.org/10.4081/aiua.2017.3.173.
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Objective: To investigate some epidemiological aspects of kidney stones in the South- Eastern European area. Materials and methods: From September 2015 to December 2015, 538 consecutive patients were treated and evaluated for reno-ureteral stones in eight departments in Bulgaria, Greece, Italy, FYR Macedonia, Romania, Serbia and Turkey. Results: The age of onset was lower in Turkey and higher in Italy. The rate of recurrent patients was higher in Romania and Serbia, while first renal stone formers were more frequent in Italy. The previous history of kidney stones, the characteristics of the stones and the dietary habits of the patients were different in different countries. In Bulgaria, Greece and Romania larger calculi from recurrent patients were more frequent. In Italy and Turkey smaller calculi from first renal stone formers were more frequent. Conclusions: The previous history of kidney stones, the characteristics of the stones and the dietary habits of the patients were different in different countries. A common dietary pattern associated with the formation of kidney stones was not observed, but each country showed different risk factors.
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Alkan, Erdal, Ali Saribacak, Ahmet Oguz Ozkanli, Mehmet Murad Başar, Oguz Acar, and Mevlana Derya Balbay. "Retrograde Intrarenal Surgery in Patients Who Previously Underwent Open Renal Stone Surgery." Minimally Invasive Surgery 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/198765.
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Purpose. To ascertain whether retrograde intrarenal surgery (RIRS) is as effective in patients treated previously with open renal stone surgery (ORSS) on the same kidney as in patients with no previous ORSS.Methods. There were 32 patients with renal stones who had previous ORSS and were treated with RIRS in the study group (Group 1). A total of 38 patients with renal stones who had no previous ORSS and were treated with RIRS were selected as the control group (Group 2). Recorded data regarding preoperative characteristics of the patients, stone properties, surgical parameters, outcomes, SFRs (no fragments or small fragments <4 mm), and complications between groups were compared.Results. Mean age, mean BMI, mean hospital stay, and mean operative time were not statistically different between groups. Mean stone size (10.1 ± 5.6 versus 10.3 ± 4.2;p=0.551) and mean stone burden (25.4 ± 14.7 versus 23.5 ± 9.9;p=0.504) were also similar between groups. After the second procedures, SFRs were 100% and 95% in groups 1 and 2, respectivelyp=0.496. No major perioperative complications were seen.Conclusion. RIRS can be safely and effectively performed with acceptable complication rates in patients treated previously with ORSS as in patients with no previous ORSS.
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Sawal, Zuhri, and Doddy M. Soebadi. "Impact of Stone Size, Location, and Stone Composition on the Efficacy of Extracorporeal Shock Wave Lithotripsy for Residual Stone after Percutaneous Nephrolithotomy." Folia Medica Indonesiana 56, no. 2 (August 6, 2020): 127. http://dx.doi.org/10.20473/fmi.v56i2.21231.
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This study aimed to determine the impact of stone size, location and stone composition the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the management of residual stone after percutaneous nephrolithotomy (PCNL). The design of this study was a retrospective that conducted between January 2012 until December 2016. The population in this study were all patients with residual stones post PCNL. Exclusion criteria were patients with multiple stones and patients with a history of previous treatment for residual stones such as nephroscopy, flexible ureterorenoscopy, ESWL or medical therapy). The variables studied in this study were stone size, stone location, and stone composition. Before ESWL was carried out, all patients underwent Kidney Ureter Bladder (KUB). After ESWL, all patients underwent ultrasonography (USG) and KUB to determine the stone clearance status. The sample of this study was 125 patients. The overall stone-free rate (SFR) of ESWL in managing post-PCNL residual stones is 72%. SFR based on stone size variable are 73.7% and 71.3% respectively for stones with a size = 5 mm and >5 mm (p = 0.78). SFR based on stone location variable was 67.1%, 75.8%, and 81.8% respectively for the residual stone located at the upper pole, middle pole and lower pole. There are no significant differences in the entire variable. This study concludes that ESWL can be used as effective additional management to treat post-PCNL residual stones with satisfactory SFR.
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Radfar, Mohammad Hadi, Reza Valipour, Behzad Narouie, Mehdi Sotoudeh, and Hamid Pakmanesh. "Role of the gonadal vessels on the stone lodgment in the proximal ureter: Direct observation during laparoscopic ureterolithotomy." Archivio Italiano di Urologia e Andrologia 90, no. 3 (September 30, 2018): 163–65. http://dx.doi.org/10.4081/aiua.2018.3.163.
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Introduction: Previous radiological studies revealed that stones lodge more frequently in the ureterovesical junction (UVJ) as well as the proximal ureter. Factors that prevent stone passage from the proximal ureter are not well studied. Aim: To explore the site of the lodged stones in the proximal ureter with direct observation during laparoscopic ureterolithotomy. Materials and methods: Between November 2014 and February 2015, we included 26 patients including 18 men and 8 women with stones larger than 10 millimeters in the proximal ureter who were candidate for laparoscopic ureterolithotomy. We prospectively recorded the site of the lodged stones in the ureter during laparoscopic ureterolithotomy in relation with the sites of ureteral stenosis as well as the gonadal vessels. Results: Among 26 patients with ureteral stone, in 19 cases stone was found close to the gonadal vein compared with seven cases that stone was in other locations of the ureter (p = 0.02). The characteristics of patients and stones were not different in cases that the stone was close to gonadal vessels compared with other locations. Conclusions: This study showed that most of the stones lodged in the proximal ureter were in close proximity with gonadal vessels. Gonadal vessels may be an extrinsic cause of ureteral narrowing.
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Ibrahim, El-Sayed H., Joseph G. Cernigliaro, Mellena D. Bridges, Robert A. Pooley, and William E. Haley. "The Capabilities and Limitations of Clinical Magnetic Resonance Imaging for Detecting Kidney Stones: A Retrospective Study." International Journal of Biomedical Imaging 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/4935656.
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The purpose of this work was to investigate the performance of currently available magnetic resonance imaging (MRI) for detecting kidney stones, compared to computed tomography (CT) results, and to determine the characteristics of successfully detected stones. Patients who had undergone both abdominal/pelvic CT and MRI exams within 30 days were studied. The images were reviewed by two expert radiologists blinded to the patients’ respective radiological diagnoses. The study consisted of four steps: (1) reviewing the MRI images and determining whether any kidney stone(s) are identified; (2) reviewing the corresponding CT images and confirming whether kidney stones are identified; (3) reviewing the MRI images a second time, armed with the information from the corresponding CT, noting whether any kidney stones are positively identified that were previously missed; (4) for all stones MRI-confirmed on previous steps, the radiologist experts being asked to answer whether in retrospect, with knowledge of size and location on corresponding CT, these stones would be affirmed as confidently identified on MRI or not. In this best-case scenario involving knowledge of stones and their locations on concurrent CT, radiologist experts detected 19% of kidney stones on MRI, with stone size being a major factor for stone identification.
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Anwer, S., R. Egan, N. Cross, S. Guru Naidu, and K. Somasekar. "Management of choledocholithiasis after previous gastrectomy." Annals of The Royal College of Surgeons of England 99, no. 7 (September 2017): e213-e215. http://dx.doi.org/10.1308/rcsann.2017.0129.
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Common bile duct stones in patients with a previous gastrectomy can be a technical challenge because of the altered anatomy. This paper presents the successful management of two such patients using non-traditional techniques as conventional endoscopic retrograde cholangiopancreatography was not possible.
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Huang, Ho Shiang, Pao Chi Liao, and Chan Jung Liu. "Calcium Kidney Stones are Associated with Increased Risk of Carotid Atherosclerosis: The Link between Urinary Stone Risks, Carotid Intima-Media Thickness, and Oxidative Stress Markers." Journal of Clinical Medicine 9, no. 3 (March 8, 2020): 729. http://dx.doi.org/10.3390/jcm9030729.
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Previous studies have suggested that kidney stone formers are associated with a higher risk of cardiovascular events. To our knowledge, there have been no previous examinations of the relationship between carotid intima-media thickness (IMT) and urinary stone risk factors. This study was aimed toward an investigation of the association between dyslipidemia, IMT, and 24-hour urinalysis in patients with calcium oxalate (CaOx) or calcium phosphate (CaP) stones. We prospectively enrolled 114 patients with kidney stones and 33 controls between January 2016 and August 2016. All patients were divided into four groups, according to the stone compositions—CaOx ≥ 50% group, CaP group, struvite group, and uric acid stones group. Carotid IMT and the carotid score (CS) were evaluated using extracranial carotid artery doppler ultrasonography. The results of a multivariate analysis indicated that a higher serum total cholesterol (TC) and low-density lipoprotein (LDL) were all associated with lower urinary citrate and higher CS in both the CaOx ≥ 50% and CaP groups. Higher serum TC and LDL were also associated with increased serum 8-OHdG levels in both groups. The levels of carotid IMT and CS in the CaOx ≥ 50% and CaP groups were all significantly higher than in the controls. These findings suggest a strong link between dyslipidemia, carotid atherosclerosis, and calcium kidney stone disease.
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Bianchi, Grazia, Diego Marega, Roberto Knez, Stefano Bucci, and Carlo Trombetta. "Ultrasound follow up: Is an undetected spontaneous expulsion of stone fragments a sign of extracorporeal shock wave treatment failure in kidney stones?" Archivio Italiano di Urologia e Andrologia 90, no. 3 (September 30, 2018): 166–68. http://dx.doi.org/10.4081/aiua.2018.3.166.
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Introduction. After extracorporeal lithotripsy (SWL), a spontaneous expulsion of fragments is often reported. The aim of this study is to demonstrate the presence of a stone free status or the presence of clinically insignificant residual fragments (CIRFs, defined as “asymptomatic, noninfectious, ≤ 3 mm fragments”) in people with undetected spontaneous expulsion. Materials and methods. Between May and September 2017, we performed a total of 87 treatments. The device used was a Storz Medical Modulith® SLK. All the patients were treated in prone position to reduce respiratory movements and underwent sonography before and four to eight weeks after the treatment. An in line ultrasound targeting was possible with all the stones. People lost to follow up or with ureteral stones were excluded. Patients were divided in groups according to gender, previous treatments, stone diameter and position. Results. We enrolled 73 patients. 57 patients had a single stone and 16 multiple stones. A mean number of 3044 shock waves was administered with a maximum average energy of 0.68mj/mmq. At follow up, 41 patients (56.2%) were found stone free or with CIRFs. The association between undetected expulsion and the presence of CIRFs is considered to be not statistically significant (p = 0.89). Among patients with CIRFs, 25/41 didn’t report expulsion. Taking in account the groups our population was divided in, according to gender (p = 0.36), previous treatments (p = 0.44), stone diameter (p = 0.28) and stone position (p = 0.35), the association between undetected spontaneous expulsion and presence of CIRFs was never statistically significant. Conclusions. An undetected spontaneous expulsion of stone fragments could not be considered a sign of SWL treatment failure. The association between undetected expulsion and presence of CIRFs is never statistically significant if gender of the patients, previous treatments, stone diameter and stone position are considered.
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Flannigan, Ryan K., Andrew Battison, Shubha De, Mitchell R. Humphreys, Markus Bader, Ekaterina Lellig, Manoj Monga, Ben H. Chew, and Dirk Lange. "Evaluating factors that dictate struvite stone composition: A multi-institutional clinical experience from the EDGE Research Consortium." Canadian Urological Association Journal 12, no. 4 (December 16, 2017): 131–6. http://dx.doi.org/10.5489/cuaj.4804.
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Introduction: Struvite stones account for 15% of urinary calculi and are typically associated with urease-producing urinary tract infections and carry significant morbidity. This study aims to characterize struvite stones based on purity of stone composition, bacterial speciation, risk factors, and clinical features.Methods: Retrospective data was collected from patients diagnosed with infection stones between 2008 and 2012. Stone analysis, perioperative urine cultures, bacterial speciation, and clinical data were collected and analyzed. The purity of struvite stones was determined. Statistical comparisons were made among homogeneous and heterogeneous struvite stones.Results: From the four participating centres, 121 struvite stones were identified. Only 13.2% (16/121) were homogenous struvite. Other components included calcium phosphate (42.1%), calcium oxalate (33.9%), calcium carbonate (27.3%), and uric acid (5.8%). Partial or full staghorn calculi occurred in 23.7% of cases. Ureaseproducing bacteria were only present in 30% of cases. Proteus, E. coli, and Enterococcus were the most common bacterial isolates from perioperative urine, and percutaneous nephrolithotomy was the most common modality of treatment. Only 40% of patients had a urinalysis that was nitrite-positive, indicating that urinalysis alone is not reliable for diagnosing infection stones. The study’s limitation is its retrospective nature; as such, the optimal timing of cultures with respect to stone analysis or treatment was not always possible, urine cultures were often not congruent with stone cultures in the same patient, and our findings of E. coli commonly cultured does not suggest causation.Conclusions: Struvite stones are most often heterogeneous in composition. Proteus remains a common bacterial isolate; however, E. coli and Enterococcus were also frequently identified. This new data provides evidence that patients with struvite stones can have urinary tract pathogens other than urease-producing bacteria, thus challenging previous conventional dogma.
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Viljoen, Adie, Rabia Chaudhry, and John Bycroft. "Renal stones." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 56, no. 1 (June 13, 2018): 15–27. http://dx.doi.org/10.1177/0004563218781672.
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Renal stone disease is a worldwide problem which carries significant morbidity. It frequently requires specialist urology intervention. Patients with recurrent disease and those at high risk require specialist investigations and review. Certain cases benefit from medical and surgical intervention. In this review, we discuss the pathophysiology, risk assessment, specialist investigations and various interventions, their rationale and evidence base. This review aims to provide an update of the previous publication in 2001 in this journal on this topic.
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Careddu, Nicola, Massimo Scanu, and Paolo Desogus. "Notes on the Poster “Map of Natural Stones from Sardinia (Italy)”." Key Engineering Materials 848 (June 2020): 127–36. http://dx.doi.org/10.4028/www.scientific.net/kem.848.127.
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Sardinia (Italy) produces a vast array of natural stones for ornamental use. Besides the internationally known pink and gray granites and the famous limestone known as Orosei marble, a wide range of vulcanites (basalts and “trachytes”) and phyllites - including yellow and ghiandone granites - are also produced. Orosei marbles are some of the most requested types today, which are marketed especially to China. However, there are a number of Sardinian natural stones, which have been quarried and marketed for fifty years, although no image or footage has been published yet: a mention of this natural stones has been only made in some old list of Sardinian stones. For this reason, authors suggested the publication of a poster (70 cm x 100 cm) showing a collection of natural stones quarried for ornamental purposes in Sardinia over the last fifty years. The poster includes a user-friendly map that has been adapted for school use and as a public resource in libraries. There are no previous publications showing a similar wide range of Sardinian stones. The poster offers scientific information about lithology, quarrying sites, dimension stone producing areas, quarries of historical and/or archaeological interest, historical trend in quarries output, technical properties, stone surface workability and a glossary.
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Ruoppolo, M., P. Tombolini, C. Bellorofonte, F. Beleggia, C. Zaatar, P. M. Ferri, S. Dell'Acqua, and A. Tagliaferri. "PCNL debulking: Our experience." Urologia Journal 59, no. 1_suppl (January 1992): 200–202. http://dx.doi.org/10.1177/039156039205901s65.
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Percutaneous debulking and subsequent ESWL treatment has proved a successful approach to complex stones. Out of 232 patients treated with PCNL from March 1984 to March 1992, 102 (45%) were managed by PCNL debulking and ESWL or EPL (Extracorporeal piezoelectric lithotripsy). Recently (Zingonia period 1988–1992) only 21 patients with bulky or staghorn stones were treated by combination therapy. In our series, there were 1.3 sessions of PCNL and 1.8 sessions of ESWL for each patient. We report a high frequency of retained stone fragments (45% at 3 months follow-up). Out of 21, 3 patients underwent further ESWL procedures because the fragments were conglobed. No complications occurred in present series. In the one case we observed a rise in serum creatinine. In our opinion debulking PCNL and ESWL is the treatment of choice in the following cases: burden pyelitic stones, staghorn stones larger than 3 cm. and smaller than 5 cm., partial staghorn filling renal pelvis and 1 calyx; short length of calyces; pyelitic portion exceeding caliceal mass; infected stones in working kidney, stone in solitary kidney larger than 2 cm and hard; previous surgery.
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Haque, Md Nazmul, Md Muazzam Hossan, Md Shahidul Islam, and Arif Mohammad. "Outcome of Laparoscopic Transperitoneal Ureterolithotomy for Proximal Ureteric Stones - Our Two Years Experiences." Medicine Today 30, no. 2 (August 8, 2018): 71–73. http://dx.doi.org/10.3329/medtoday.v30i2.37813.
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To evaluate the results of laparoscopic transperitoneal uteterolithotomy for management of large proximal ureteric stones. This study was performed on 24 patients having proximal ureteric stone greater than 1.5cm at the Department of Urology, Shahid Sheik Abu Naser Specialized Hospital, Khulna, Bangladesh from January 2016 to December 2017. Patients having stone size less than 1.5cm, previous abdominal surgery and sepsis were excluded from this study. Patients characteristics, stone characteristics, perioperative and follow-up data were studied. Twenty-four patients (mean age=52.9±12 years) with large upper ureteric stones (mean stone diameter=35±12) were included. Twenty-two patients had single stone and 2 patients had two stones. Mean operative time was 107±49.5 min with mean blood loss of 60.5±19.2 cc. Mean total pain score was 38.4±5.5 (100 point scale) and mean time resuming oral intake was 7.2±1 h. Mean duration of hospital stay was 2.6±1.4 days and mean time of stenting was 7.2±2 weeks. Throughout a mean duration of follow-up of 10.8±6.6 months 100% stone clearance rate was achieved with no recurrence. Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain short hospital stays and cost effective and should be considered as a choice of treatment option for such stones.Medicine Today 2018 Vol.30(2): 71-73
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Ali, Qutubuddin, Shehtaj Khan, Gambhir Patel, Kritik Jaiswal, and Krishnanand . "Medical expulsive therapy: a cost effective evidence-based definitive treatment for ureteric stones." International Surgery Journal 7, no. 9 (August 27, 2020): 2879. http://dx.doi.org/10.18203/2349-2902.isj20203508.
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Background: The lifetime risk of kidney stones is between 5% and 10% and rates of recurrence are as high as 50%. Majority of the ureteric stones (70%) are found in the lower third of the ureter. Available setup, type, size of the stone, and expertise of the surgeon are the major factors affecting the treatment modality. Medical expulsive therapy has shown promising results in previous studies. Aim of the study was to assess the efficacy of tamsulosin and deflazacort combination therapy for stone expulsion in relation with site and size of stones.Methods: A total of 97 patients with ureteric calculi of size 10 mm or less attending the urology out-patient department were included. Received medical expulsive therapy using tamsulosin (0.4 mg) and deflazacort (30 mg) for 7 days. Patients were evaluated for stone expulsion on 7th day by non-contrast computed tomography of kidney ureter bladder. Site, side and size of stones were noted.Results: Ureteric calculi was more prevalent in the age group of 21-30 years 38 (39.2%). Male preponderance was observed (76.28%) with male female ratio being 3.2:1. Lower site 64 (65.97%) ureteric calculi were most common. The majority had a stone size of 4-6 mm (42%). Stones were expelled on 7th day in 69 (71.13%) patients. Expulsion rates were highest for the stone size of 2-4 mm (94.4%) followed by 4-6 mm (88.1%). The highest expulsion rates were observed for Lower ureteric stones (84.4%).Conclusions: Medical expulsive therapy using tamsulosin and deflazacort is an effective treatment modality for the management of ureteric stones, especially those present in lower ureter and those ≤8 mm in size.
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Gumert, Michael D., and Suchinda Malaivijitnond. "Long-tailed macaques select mass of stone tools according to food type." Philosophical Transactions of the Royal Society B: Biological Sciences 368, no. 1630 (November 19, 2013): 20120413. http://dx.doi.org/10.1098/rstb.2012.0413.
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Tool selection can affect the success of a tool-based feeding task, and thus tool-using animals should select appropriate tools when processing foods. We performed a field experiment on Piak Nam Yai Island in Laem Son National Park, Thailand, to test whether Burmese long-tailed macaques ( Macaca fascicularis aurea ) selected stone tools according to food type. We baited the island's shores with stone sets (‘tool tests’) in an effort to attract macaques to use stones presented in a quasi-experimental design. Tool tests were placed at 344 locations for 126 days over a 2 year period, with each set containing four stones of different mass (categories: X, 40–60 g; S, 90–100 g; M, 150–200 g; and L, 400–1000 g). Tool tests were checked when we could access them. The number of times each tool test was checked varied (1–32), for a total of 1950 checks. We also studied 375 non-experimental stone tools that were found at naturally occurring tool-use sites. Our data were not collected by direct observation, but by inspecting stones after use. We found an association between stone mass and food type. In the tool tests, we found S-stones were chosen most often for attached oysters, and L-stones were chosen most often for unattached foods. L-stones were almost always chosen for larger unattached foods (greater than 3 cm length), while for smaller unattached foods (less than or equal to 3 cm length) selection was less skewed to L-stones and more evenly distributed between the M- and L-stone categories. In the non-experimental study, we found that mass varied significantly across five food categories (range: 16–5166 g). We reveal more detail on macaque stone tool mass than previous studies, showing that macaques select differing stone masses across a variety of tool-processed foods. Our study is the first step in investigating the behavioural and cognitive mechanisms that macaques are using during tool selection.
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Maydeo, Amit P., Rungsun Rerknimitr, James Y. Lau, Abdulrahman Aljebreen, Saad K. Niaz, Takao Itoi, Tiing Leong Ang, et al. "Cholangioscopy-guided lithotripsy for difficult bile duct stone clearance in a single session of ERCP: results from a large multinational registry demonstrate high success rates." Endoscopy 51, no. 10 (June 27, 2019): 922–29. http://dx.doi.org/10.1055/a-0942-9336.
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Abstract Background Peroral cholangioscopy (POCS) can be useful for difficult bile duct stone clearance. Large prospective multinational data on POCS-guided lithotripsy for clearing difficult bile duct stones in a single session of endoscopic retrograde cholangiopancreatography (ERCP) are missing. Methods Patients with difficult bile duct stones (defined as one or more of: largest stone diameter ≥ 15 mm, failed prior attempt at stone clearance, impacted, multiple, hepatic duct location, or located above a stricture) were enrolled at 17 centers in 10 countries. The principal endpoint was stone clearance in a single ERCP procedure using POCS. Results 156 patients underwent 174 sessions of POCS-guided electrohydraulic or laser lithotripsy. Stone clearance had failed in a previous ERCP using traditional techniques in 124/156 patients (80 %), while 32 /156 patients (21 %) were referred directly to POCS-guided therapy based on preprocedural assessment of the difficulty of stone clearance. In 101/156 patients (65 %), there were impacted stones. POCS-guided stone clearance was achieved in a single POCS procedure in 125 /156 patients (80 %, 95 % confidence interval [CI] 73 % – 86 %), and was significantly more likely for stones ≤ 30 mm compared with > 30 mm (odds ratio 7.9, 95 %CI 2.4 – 26.2; P = 0.002). Serious adverse events occurred in 3/156 patients (1.9 %, 95 %CI 0.4 % – 5.5 %), and included pancreatitis, perforation due to laser lithotripsy, and cholangitis (n = 1 each), all resolved within 1 week. Conclusion POCS-guided lithotripsy is highly effective for clearance of difficult bile duct stones in a single procedure and successfully salvages most prior treatment failures. It may also be considered first-line therapy for patients with difficult choledocholithiasis to avoid serial procedures.
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Gültekin, M. H., F. A. Turegun, B. Ozkan, N. Tansu, P. Kendigelen, A. Erozenci, and B. Onal. "Does previous stone surgery affect the outcome of SWL treatment in adults with kidney stones?" European Urology Supplements 16, no. 3 (March 2017): e67-e69. http://dx.doi.org/10.1016/s1569-9056(17)30110-0.
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Cetta, Francesco. "The Possible Role of Sphincteroplasty and Surgical Sphincterotomy in the Pathogenesis of Recurrent Common Duct Brown Stones." HPB Surgery 4, no. 4 (January 1, 1991): 261–70. http://dx.doi.org/10.1155/1991/89069.
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The hypothesis has been tested that postcholecystectomy common duct stones of the brown subtype are a consequence of three factors: bile infection, old age and previous sphincterotomy. It was found that: (i) 27 of 39 consecutive patients with recurrent common duct stones had brown stones. Nineteen of these 27 patients (70.3%) had previous sphincterotomy or sphincteroplasty: (ii) six of 15 patients with stone and bile analysis both at the time of cholecystectomy and at the second operation and who had sterile operative bile and non brown stones at the first operation, formed brown stones after T-tube drainage and after the onset of bile infection; (iii) patients with both intra and postoperative negative bile culture (n = 39 out of 137) had a lower mean age (50.5 years) and less frequently had a sphincterotomy than did individuals with a negative culture at operation, who subsequently had bile infection (n = 37; mean age 58.5 years; sphincterotomy in 88.8% of cases).In addition, in a follow up study of 105 patients with sphincterotomy and with sphincteroplasty (including ERCP or i.v. cholangiography in all cases), mean follow-up interval 6.1 years, 11.3 % of patients had brown recurrent common duct stones.It is suggested that, since brown recurrent common duct stones are secondary to bile stasis and infection and the duodenum is going to be colonized by bacteria with increasing age, sphincterotomy (and subsequent stricture), facilitating bile contamination and bacterial overgrowth, could be one of the major determinants of brown recurrent common duct stones (RCS) formation. In particular, more than 11% of the patients with a sphincterotomy are going to form in the future RCS of the brown subtype.
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Ali, Mohamed M., Mena Zarif Helmy, and Emad Gomaa. "Choledochoduodenostomy versus T-tube drainage in patients have stones in common bile duct with risk factors of post-operative missed stones." International Surgery Journal 6, no. 12 (November 26, 2019): 4343. http://dx.doi.org/10.18203/2349-2902.isj20195391.
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Background: Residual or missed stones of common bile duct (CBD) and ascending cholangitis after CBD exploration are major biliary surgery problems. Repeated biliary tract interventions for correction of complications are catastrophic on both patients and surgeons.Methods: This is a prospective study of 83 patients which compares two methods for surgical management of CBD stones between June 2016 to May 2018. Group I included 43 patients who were managed by CBD exploration followed by insertion of T tube, the risk factors of the incidence of missed retained stone in CBD were multiple stones in CBD and hugely dilated CBD (>15 mm).The second method was choledochoduodenal anastomosis for patients having the same previous risk factors (Group II) which included 40 patients. Postoperative follow up was for 12 to 18 months.Results: In group I, 6 patients developed residual stones in CBD, reoperation was required for 3 of them and endoscopic retrograde cholangiopancreatography with sphincterotomy for another 3 patients, while in the other group (group II) 2 patients suffered from ascending cholangitis and are managed conservatively. No missed or residual CBD stones were developed and no patients need reoperation.Conclusions: With choledochoduodenostomy in patients with multiple CBD stones or markedly dilated CBD the incidence of missed or retained stones in CBD was reduced.
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Karatag, Tuna, Ibrahim Buldu, Mehmet Kaynar, Hakan Taskapu, Erdem Tekinarslan, and Mustafa Okan Istanbulluoglu. "Treatment of Symptomatic Lower Pole Stones of a Kidney with Partial Nephrectomy Using Micropercutaneous Nephrolithotomy Technique." Case Reports in Urology 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/456714.
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We present the treatment of lower pole stones of a 62-year-old male patient with a history of open partial nephrectomy due to renal angiomyolipoma and renal stones. He was successfully treated with micropercutaneous nephrolithotomy technique under spinal anesthesia in spite of fibrotic and scar tissue due to previous open surgery. The patient was stone-free and was discharged after a 24-hour hospitalization period. There is not any published report of micropercutaneous nephrolithotomy in a partial nephrectomized kidney before. In this report, we suggest that microperc technique may be considered for challenging conditions in case of failed retrograde intrarenal surgery.
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Elgammal, Ahmed S., Mohamed H. Elmeligi, and Mostafa M. Abo Koura. "Evaluation of preoperative predictive factors for difficult laparoscopic cholecystectomy." International Surgery Journal 6, no. 9 (August 28, 2019): 3052. http://dx.doi.org/10.18203/2349-2902.isj20193639.
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Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open surgery. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. The objective of the study was to assess preoperative parameters for predicting the difficult laparoscopic cholecystectomy and its conversion.Methods: Prospective study includes 100 patients having symptomatic cholelithiasis. All patients underwent elective LC in Department of General Surgery in Menoufia University Hospital and Tala General Hospital. The collected data of preoperative factors include sex, age, previous attack, history of ERCP, obstructive jaundice, obesity (BMI), lower abdominal scar, palpable gallbladder, wall thickness of, number of stones, size of stones and impacted stone. Difficulty levels according to intraoperative parameters were easy (0–5), difficult (6–10), and conversion from laparoscopic to open surgery.Results: In this study, previous history of attacks of cholecystitis (p=0.001) and wall thickness (p=0.007) were found to be statistically significant in predicting difficult LC in both univariate and multivariate analyses. Other factors such as age (p=0.002), BMI greater than 27.5 (p=0.02), palpable GB (p=0.003), impacted stone (p=0.01) were found to be statistically significant in predicting difficult LC. Factors such as sex, and abdominal scar were not statistically significant in predicting difficult LC.Conclusions: The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and size of stones.
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Vozianov, Oleksandr. "The reasons of unsatisfactory results of extracorporeal shock wave lithotripsy in patients with ureterolithiasis." EUREKA: Health Sciences, no. 4 (July 30, 2021): 48–53. http://dx.doi.org/10.21303/2504-5679.2021.001797.
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The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone.The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy.
Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed.
Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don’t cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long–term (more than two months) ureteric stone persistence increase the risk of intramucosal “ingrowth” of the calculi greatly.
Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock–wave lithotripsy) and reduce its efficacy.
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Yassin, Musaab, Abigail Cressey, Louise Goldsmith, Ben Turney, and John Reynard. "Emergency “Hot” Shock Wave Lithotripsy." Journal of Endoluminal Endourology 3, no. 2 (May 19, 2020): e16-e19. http://dx.doi.org/10.22374/jeleu.v3i2.58.
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Ureteroscopy and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteric and pelviureteric junction (PUJ) stones. ESWL remains the only non-invasive therapy modality for the treatment of urinary stones. Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis
Ureteroscopy and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteric and pelviureteric junction (PUJ) stones. ESWL remains the only non-invasive therapy modality for the treatment of urinary stones. Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive,safe and effective treatment for urinary tract lithiasis
ObjectivesTo evaluate the effectiveness of emergency “hot” shock wave lithotripsy in treating symptomatic ureteric/ PUJ stones.
Materials and MethodsA retrospective study looking at the emergency referrals for shock wave lithotripsy to the Churchill Hos-pital between June 2013 to Dec 2017. The Lithotripsy Database and patients’ electronic records were used to complete this project. Emergency referrals triaged by the on-call urology team and go through a renal colic clinic.
ResultsIn total, 201 patients underwent emergency shock wave lithotripsy for ureteric/PUJ stones.The mean stone size was 7.7mm (SD 2.9). 12.4% (25) were PUJ, 45.3% (91) proximal and 42.3% (85) distal ureteric stones. 1% (2) were bilateral ureteric stones. 9% (18) had previous lithotripsy treatment before being referred.The number of shocks used was 4000 in 52.7%, >=3000 in 40.3%, >=2000 in 4.5% and >=1000 in 2.5%. The median shock frequency was 2 Hz. The median number of treatments for the targeted stone was 2. Stone fragmentation was visible in 27.4% (55), possible in 30.8% (62) and not visible in 41.8% (84).In terms of follow up, 48.3% (97) were discharged stone-free, while 17.4% (35) were discharged with residual fragments. 21.8% (44) had further clinic follow up while 12.4% (25) had no follow-up information available, possibly because they were referred from different hospitals. 19.9% (40) needed ureteroscopy, while 7% (14) needed further lithotripsy sessions.
ConclusionsEmergency extracorporeal lithotripsy can be offered as an effective and safe treatment for patients with symptomatic stones.
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Chondros, Kostas, Victoria Mari, Georgios Lianeris, Sevasti Hatzikosta, Marina Kalogridaki, and Konstantinos Graikos. "Accidental prostatic stone finding after urinary catheterization failure during hernia surgery." International Surgery Journal 6, no. 1 (December 27, 2018): 296. http://dx.doi.org/10.18203/2349-2902.isj20185491.
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Urethral stones represent a rare cause of urinary obstruction and they are usually symptomatic. In older patients with bladder outlet obstruction, bladder stones are commonly found and managed accordingly. Intraprostatic stone formation is also a common finding in men with benign prostate hyperplasia but rarely is it a factor for obstruction. On the contrary, large stone formation in the prostatic urethra is a rare entity, and patients present with hematuria, dysuria, infection or retention in most of the cases. Patients previously submitted to urological procedures such as prostatectomy or lithotripsy, are at high risk of developing late complications and need a long follow-up. In cases with obstruction due to urethral stones the management is straightforward but in asymptomatic patients the diagnosis is usually missed or delayed. Therefore, careful evaluation of the patient is essential in order to prevent any unwanted situation such as catheterization failure. Authors’ present a case of an 82-year-old male who accidentally diagnosed with a large stone impacted in the prostatic cavity after urinary catheterization failure during a scheduled open hernia repair surgery. The patient had a history of previous open prostatectomy and he was completely asymptomatic. An emergency cystoscopic evaluation revealed the cause of the prostatic urethral obstruction. The urinary stone was subsequently managed endoscopically on the spot.
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Li, Sujuan, Bingzhong Su, Ping Chen, and Jianyu Hao. "Risk factors for recurrence of common bile duct stones after endoscopic biliary sphincterotomy." Journal of International Medical Research 46, no. 7 (June 4, 2018): 2595–605. http://dx.doi.org/10.1177/0300060518765605.
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Objective Late complications after endoscopic biliary sphincterotomy (EST) include stone recurrence, but no definite risk factors for recurrence have been established. This study was performed to identify the predictors of recurrence and evaluate the clinical outcomes of EST for common bile duct stones. Methods In total, 345 eligible patients who successfully underwent EST were evaluated and followed up. Statistical analysis was performed on patients with recurrence or who had undergone at least 6 months of reliable follow-up to detect the risk factors for recurrence. Results A total of 57 patients (16.52%) developed recurrence of common bile duct stones. The median length of time until recurrence was 10.25 months (range, 6–54.4 months). Univariate analyses showed that the following factors were associated with recurrence: cholecystectomy prior to EST, prior biliary tract surgery, periampullary diverticulum, diameter of the common bile duct (>15 vs. ≤15 mm), quantity of stones, complete stone removal at the first session, and lithotripsy. Multivariate analysis identified two independent risk factors for recurrence: previous biliary tract surgery and lithotripsy. Conclusions EST for common bile duct stones is safe as indicated by patients’ long-term outcomes. Patients with a history of biliary surgery or lithotripsy are more prone to recurrence.
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Goldsmith, Louise, Naomi Neal, James Briggs, Charles Tapping, Phil Boardman, Ben Turney, and John Reynard. "Percutaneous cystolitholapaxy: A safe and effective alternative to open stone surgery for the management of complex bladder stones in patients with no urethral access." Journal of Clinical Urology 13, no. 2 (March 4, 2019): 106–9. http://dx.doi.org/10.1177/2051415819830191.
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Objectives: Bladder stone management in patients with reconstructed bladders drained by Mitrofanoff catheterizable channels, with no urethral access, generates multiple challenges. Trans-Mitrofanoff access limits the size of endoscopic stone fragmenting devices, risking prolonged procedures, incomplete stone clearance and damage to the continent conduit. Access through previous surgical access sites risks bowel injury. This case series reports outcomes in patients undergoing percutaneous cystolitholapaxy (PCCL), using ultrasound-guided access and direct track closure, thereby limiting radiation exposure and avoiding suprapubic catheters (SPCs). Patients and methods: Seven PCCL procedures were performed in five patients with closed urethras. Average age 32 years, primary diagnoses: spina bifida, vertebrae, anus, trachea, esophagus, renal (VATER) syndrome, bladder exstrophy and traumatic brain injury. Four used Mitrofanoff stomas and one an SPC. Average largest stone was 18.57 mm (range 10–30 mm). Five procedures were for multiple stones (range 2–30 stones). Results: Each PCCL achieved complete stone clearance. Average operative time: 146 min (range 72–250 min). No intraoperative blood loss or bladder perforation. Postoperative median length of stay was 2 days. Conclusion: PCCL is a safe, minimally invasive alternative to open surgery for large and multiple bladder stones in individuals with complex lower urinary tract anatomy, specifically reconstructed bladders drained by Mitrofanoff catheterizable channels with no urethral access. Level of evidence: Level 4
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Sönmez, Mehmet Giray, and Cengiz Kara. "A new approach in ureteral access sheath locating in retrograde intrarenal surgery (RIRS) by endovisional technique." Archivio Italiano di Urologia e Andrologia 87, no. 4 (January 14, 2016): 286. http://dx.doi.org/10.4081/aiua.2015.4.286.
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Objective: To compare the results of patients who underwent retrograde intrarenal surgery (RIRS) using endovisional technique for ureteral sheat locating with control group in which endovisional technique was not applied. Material and Methods: Of the 41 patients who underwent RIRS treatment for kidney stone, between March 2014- August 2015, 19 patients treated with endovisional technique formed the study group and remaining 22 patients formed the control group. Patients were evaluated for age and gender, baseline and post procedural creatinine level, duration of operation, fluoroscopy and hospitalization time, size and localization of the stone, presence of multiple stones, previous shock wave lithotripsy (SWL) procedure, double J catheter requirement, complication rate, residual stone rate and absence of stone ratio. Results: There was no statistically significant difference between age, gender, location of the stone, previous SWL procedure, presence of multiple stones, baseline and postprocedural creatinine level, absence of stone ratio, double J catheter requirement and hospitalization duration between the groups. The duration of operation and fluoroscopy of the patients were significantly shorter than the control group (p = 0.036 and p < 0.001, respectively). The complication rates of the endovisional technique group was significantly lower than that of the control group (p = 0.032). Conclusion: Endovisional technique is considered to be an appropriate and useful technique in order to locate the sheath safely in patients who has difficulty in ureteral access sheath locating and to decrease the duration of operation and fluoroscopy.
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Zaidi, Saher, Jason Gandhi, Omar Seyam, Gunjan Joshi, Wayne C. Waltzer, Noel L. Smith, and Sardar Ali Khan. "Etiology, Diagnosis, and Management of Seminal Vesicle Stones." Current Urology 12, no. 3 (2018): 113–20. http://dx.doi.org/10.1159/000489429.
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Background/Aims: Seminal vesicle (SV) stones are a rare, and thus readily misdiagnosed condition in practice. Understanding the etiology, diagnosis, and management are crucial to guide a urologist's care, and are provided in this literature review. Methods: The inclusion criteria for the literature search, using the search engines MEDLINE® and PubMed was conducted using a combined query of “seminal vesicle stone” and the following keywords: calculi, hematospermia, calcification, and transrectal ultrasound (TRUS). Results: The etiology of SV stones is currently unknown where majority of the patients present with having painful ejaculation and hematospermia. However, clinicians have reported potential etiologies by categorization as an inflammatory or non-in-flammatory. A majority of the previous cases had shown multiple stones being present in the SV duct system that are typically diagnosed through radiological examination such as TRUS, MRI, or plain radiographs. Amongst the many imaging approaches, TRUS remains the primary imaging diagnoses of SV calculi. Transurethral seminal vesiculoscopy has shown to be used in an abundant of the case reports to be an ideal surgical approach for managing small SV stones. In regard to larger stones, a transperitoneal laparoscopic protocol is proper. Conclusion: The current imaging techniques have increased the case reports and diagnosis of SV calculi; however, more research is warranted for understanding the pathogenesis of the formation of SV stones. An optimal management of the extraction of SV stones depends on a number of factors such as size and location.
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Soto, R., M. Boutinguiza, F. Lusquiños, Juan Pou, F. Quintero, and Mariano Pérez Amor. "Laser Drilling of Natural Stones." Materials Science Forum 514-516 (May 2006): 734–38. http://dx.doi.org/10.4028/www.scientific.net/msf.514-516.734.
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Following previous work focused on the laser processing of natural stones, we present in this paper the results of the study carried out to verify the feasibility of the lasers to drill slate tiles and granite slabs. The two types of laser equipments most used in the industry (CO2 and Nd:YAG) have been used to fulfil a comparative study. The influence of different parameters involved in the process, such as, average power, stand-off distance, and assist gas pressure, have been studied to characterise the drilled holes size and geometry. Results from the different tests show that it is possible to obtain holes according to the required dimensions at reasonable powers ( i.e. no more than 400 W for the Nd:YAG and 1 kW for the CO2 laser). Holes up to 2 mm can be achieved in a very reduced time without breaking of the stone plates. The overall results show that the laser drilling technique could be an alternative to mechanical drilling of plates of natural stones to be used in ventilated façades or for roof fixation.
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Cooley, Will. "“Stones Run It”." Journal of Urban History 37, no. 6 (October 12, 2011): 911–32. http://dx.doi.org/10.1177/0096144211418436.
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In the 1960s and 1970s African American “supergangs” emerged in Chicago. Many scholars have touted the “prosocial” goals of these gangs but fail to contextualize them in the larger history of black organized crime. Thus, they have overlooked how gang members sought to reclaim the underground economy in their neighborhoods. Yet even as gangs drove out white organized crime figures, they often lacked the know-how to reorganize the complex informal economy. Inexperienced gang members turned to extreme violence, excessive recruitment programs, and unforgiving extortion schemes to take power over criminal activities. These methods alienated black citizens and exacerbated tensions with law enforcement. In addition, the political shelter enjoyed by the previous generation of black criminals was turned into pervasive pressure to break up street gangs. Black street gangs fulfilled their narrow goal of community control of vice. Their interactions with their neighbors, however, remained contentious.
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Zidi, S. H., F. Prat, O. Le Guen, Y. Rondeau, L. Rocher, J. Fritsch, A. D. Choury, and G. Pelletier. "Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method." Gut 44, no. 1 (January 1, 1999): 118–22. http://dx.doi.org/10.1136/gut.44.1.118.
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BackgroundMagnetic resonance cholangiography (MRC) is a new technique for non-invasive imaging of the biliary tract.AimTo assess the results of MRC in patients with suspected bile duct stones as compared with those obtained with reference imaging methods.Patients/Methods70 patients (34 men and 36 women, mean (SD) age 71 (15.5) years; median 75) with suspected bile duct stones were included (cholangitis, 33; pancreatitis, three; suspected post-cholecystectomy choledocholithiasis, nine; cholestasis, six; stones suspected on ultrasound or computed tomography scan, 19). MR cholangiograms with two dimensional turbo spin echo sequences were acquired. Endoscopic retrograde cholangiography with or without sphincterotomy (n = 63), endosonography (n = 5), or intraoperative cho- langiography (n = 2) were the reference imaging techniques used for the study and were performed within 12 hours of MRC. Radiologists were blinded to the results of endoscopic retrograde cholangiography and previous investigations.Results49 patients (70%) had bile duct stones on reference imaging (common bile duct, 44, six of which impacted in the papilla; intrahepatic, four; cystic duct stump, one). Stone size ranged from 1 to 20 mm (mean 6.1, median 5.5). Twenty seven patients (55%) had bile duct stones smaller than 6 mm. MRC diagnostic accuracy for bile duct lithiasis was: sensitivity, 57.1%; specificity, 100%; positive predictive value, 100%; negative predictive value, 50%.ConclusionsStones smaller than 6 mm are still often missed by MRC when standard equipment is used. The general introduction of new technical improvements is needed before this method can be considered reliable for the diagnosis of bile duct stones.
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Sakamoto, M., T. Shinohara, Y. Li, and T. Satoh. "WALL STONE EXTRACTION BASED ON STACKED CONDITIONAL GAN AND MULTISCALE IMAGE SEGMENTATION." ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XLIII-B2-2020 (August 14, 2020): 1491–96. http://dx.doi.org/10.5194/isprs-archives-xliii-b2-2020-1491-2020.
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Abstract. The historical castles (castellated walls), which are cultural heritages in Japan, require regular maintenance, and it is necessary to record the arrangement of individual wall stones in the maintenance work. Recently, image processing techniques are practiced to optimize maintenance and management of the infrastructure assets. In the previous study, we proposed an automatic method for efficiently extracting individual wall stone polygons by improved multiscale image segmentation technique. However, the problem has remained that wall stone polygons could not be extracted properly when there were no clear gaps or boundaries between stones. To address this problem, we improved the multiscale image segmentation technique used in our previous studies. The first improvement is that in the region growing process, selecting the best combination of a plurality of objects instead of two. The second improvement is the modification of the shape criterion to be used. Besides, we proposed three-stage Stacked cGAN for wall stone edge detection that enables us to complement areas with weak or broken boundaries of stone edges. This approach is composed of a coarse-to-fine based image-to-edges translation network. The edge images derived from this method are used as the additional channel in multiscale image segmentation with a higher weight compared to the other RGB channels. It was confirmed that the separation performance of individual wall stone polygons was improved by the proposed method. Furthermore, the proposed method is highly effective to reduce the difficulty in setting of the scale parameter, which is usually sensitive to segmentation results and requires trial and error.
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Kim, Hanbaro, Suk Pyo Shin, Ji Woong Hwang, and Jung Woo Lee. "Outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography versus primary LCBDE for managing cholecystocholedocholithiasis." Journal of International Medical Research 48, no. 10 (October 2020): 030006052095756. http://dx.doi.org/10.1177/0300060520957560.
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Objective This study was performed to compare the outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography (ERCP) versus primary LCBDE for managing cholecystocholedocholithiasis. Methods We retrospectively analyzed data from 59 patients who underwent LCBDE during laparoscopic cholecystectomy (LC) for managing cholecystocholedocholithiasis from January 2013 to August 2019. The patients underwent either primary LCBDE plus LC (Group I) or LCBDE plus LC after failed ERCP (Group II). The demographics, reason for ERCP failure, perioperative details, and postoperative outcomes were evaluated. Results CBD stone removal using preoperative ERCP failed in 31 patients (Group II) because of remaining stones after ERCP (n = 9), failed cannulation (n = 6), failed sedation (n = 6), a periampullary diverticulum (n = 5), previous Billroth II gastrectomy (n = 3), a huge stone (n = 1), and an impacted stone (n = 1). The CBD stone clearance rate was >96% in both groups. The mean operative time, hospital stay, overall complication rate, and open conversion rate were not significantly different between the two groups. Conclusions When extraction of CBD stones by ERCP is likely to be difficult or fail, primary LCBDE is an acceptable alternative treatment for managing cholecystocholedocholithiasis.
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Sljivic, I., D. Chahal, R. Trasolini, and F. Donnellan. "A204 PATIENT FACTORS AND STONE FEATURES AS PROGNOSTIC PREDICTORS IN BILIARY STONE LITHOTRIPSY BY SINGLE-OPERATOR CHOLANGIOPANCREATOSCOPY." Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (March 1, 2021): 231–33. http://dx.doi.org/10.1093/jcag/gwab002.202.
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Abstract Background Single-operator cholangiopancreatoscopy (SOC) is a therapeutic modality for pancreaticobiliary stone disease that is refractory to traditional ERCP. SOC is still considered a relatively novel technology with limited access in many centers and significant associated costs. Thus, it is imperative to understand the influence patient-based factors and ancillary actions have on the outcome of SOC. Aims We hope to determine if the differences in clinical outcomes amongst cohorts suffice to indicate a re-evaluation of SOC in unfavourable patient populations. We present a series of patients who underwent SOC for biliary stone lithotripsy at a tertiary center with exploratory analysis of factors related to efficacy and adverse events. Methods This is a retrospective, descriptive case series. Cases were identified via query of the electronic medical record between March 2016 and May 2019. We evaluated patient demographics, past medical history, clinical presentation, disease characteristics, complication rates, and patient outcomes. Descriptive statistics are reported. Results 25 unique patients underwent a total of 44 SOC procedures. Mean age was 68 (range 22–88). 13 patients were male. 29 procedures involved a stone in the Common Bile Duct (CBD), 5 in the Common Hepatic & Intrahepatic Ducts (CIHD), 4 in the Pancreatic Duct (PD) and 6 in the Cystic Duct (CD). Symptomatic improvement was achieved in 100% of patients. After a single session, 22.7% of procedures resulted in complete clearance and 59.1% of cases led to partial fragmentation. CBD stones however had an 86.2% clearance rate, compared to an 88–91% success rate in literature. The total complication rate was 16% across age and sex groups. The most common complication was bacteremia in 4 (9.1%) cases. Undifferentiated complication rates were highest with CD stones, while bacteremia was most likely with PD stones. A strong trend was noticed between past SOC procedures and increasing ongoing stone burden, with repeat SOC required less often in patient’s with fewer past SOC procedures. We further observed poorer fragmentation rates for PD stones and a rising trend for repeat SOCs for proximal CBD stones. Conclusions SOC is useful against difficult biliary stones and can provide therapeutic relief without theoretical risks associated with surgery and ERCP. While our study was underpowered to provide generalizable statistics, it is one of the few studies that showed the influence certain comorbidities, stone characteristics and age have on the efficacy and safety of SOC. Our data illustrates the relative effect location and stone-size has on fragmentation and complications rates. Poorer outcomes are more frequent in those with systemic comorbidities and previous surgeries, and rates of complications and failed fragmentation are further exacerbated by age. Funding Agencies None
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Tamilselvi, P. R., and P. Thangaraj. "A Modified Watershed Segmentation Method to Segment Renal Calculi in Ultrasound Kidney Images." International Journal of Intelligent Information Technologies 8, no. 1 (January 2012): 46–61. http://dx.doi.org/10.4018/jiit.2012010104.
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Segmentation of stones from abdominal ultrasound images is a unique challenge to the researchers because these images have heavy speckle noise and attenuated artifacts. In the previous renal calculi segmentation method, the stones were segmented from the medical ultra sound kidney stone images using Adaptive Neuro Fuzzy Inference System (ANFIS). But, the method lacks in sensitivity and specificity measures. The segmentation method is inadequate in its performance in terms of these two parameters. So, to avoid these drawbacks, a new segmentation method is proposed in this paper. Here, new region indicators and new modified watershed transformation is utilized. The proposed method is comprised of four major processes, namely, preprocessing, determination of outer and inner region indictors, modified watershed segmentation with ANFIS performance. The method is implemented and the results are analyzed in terms of various statistical performance measures. The results show the effectiveness of proposed segmentation method in segmenting the kidney stones and the achieved improvement in sensitivity and specificity measures. Furthermore, the performance of the proposed technique is evaluated by comparing with the other segmentation methods.
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Lu, Jiong, Xian-Ze Xiong, Yao Cheng, Yi-Xin Lin, Rong-Xing Zhou, Zhen You, Si-Jia Wu, and Nan-Sheng Cheng. "One-stage versus Two-stage Management for Concomitant Gallbladder Stones and Common Bile Duct Stones in Patients with Obstructive Jaundice." American Surgeon 79, no. 11 (November 2013): 1142–48. http://dx.doi.org/10.1177/000313481307901115.
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No consensus exists regarding the optimal management of concomitant gallbladder stones and common bile duct stones (CBDS). Previous studies showed a significant association between the presence of obstructive jaundice and increased risk of postoperative complications and conversion to open surgery. This retrospective study evaluated the effectiveness and safety of one-stage (laparoscopic cholecystectomy [LC] plus laparoscopic common bile duct exploration) management versus two-stage (preoperative endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy 1 LC) management for patients with obstructive jaundice, concomitant gallbladder stones, and CBDS. One-stage management (n = 88) or two-stage management (n = 122) was used for 210 eligible patients between January 2009 and March 2011. Both types of management proved to be effective and safe. No significant difference was observed in terms of stone clearance from the common bile duct (CBD), postoperative morbidity, mortality, or conversion to open surgery. However, one-stage management was more cost-effective and decreased the number of procedures. In addition, postoperative hospital stay and operative time were shorter for patients who received one-stage management. Especially for patients with CBD greater than 1 cm in diameter, one-stage management is a better choice.
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Akarken, Ilker, Hüseyin Tarhan, Rahmi Gökhan Ekin, Özgür Çakmak, Gökhan Koç, Yusuf Özlem Ilbey, and Ferruh Zorlu. "Visceral obesity: A new risk factor for stone disease." Canadian Urological Association Journal 9, no. 11-12 (November 4, 2015): 795. http://dx.doi.org/10.5489/cuaj.3145.
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Introduction: We examined the relationship between stone disease and the amount of visceral adipose tissue measured with unenhanced computed tomography (CT).Methods: We included 149 patients with complaints of flank pain and kidney stones detected by CT, from August 2012 to April 2013. In addition, as the control group we included 139 healthy individuals, with flank pain within the same time period, with no previous history of urological disease and no current kidney stones identified by CT. Patients were analyzed for age, gender, body mass index, amount of visceral and subcutaneous adipose tissue, and serum level of low-density lipoprotein and triglyceride.Results: There were no differences between groups in terms of gender and age (p = 0.27 and 0.06, respectively). Respective measurements for the stone and control groups for body mass index were 29.1 and 27.6 kg/m2; for visceral fat measurement 186.0 and 120.2 cm2; and for subcutaneous fat measurements 275.9 and 261.9 cm2 (p = 0.01; 0.01 and 0.36, respectively). Using multivariate analysis, the following factors were identified as increasing the risk of kidney stone formation: hyperlipidemia (p = 0.003), hypertension (p = 0.001), and ratio of visceral fat tissue to subcutaneous fat tissue (p = 0.01). Our study has its limitations, including its retrospective nature, its small sample size, possible selection bias, and missing data. The lack of stone composition data is another major limitation of our study.Conclusion: The ratio of visceral to subcutaneous adipose tissue, in addition to obesity, hyperlipidemia, and hypertension, was identified as an emerging factor in the formation of kidney stones.
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Adanur, Senol, Tevfik Ziypak, Fevzi Bedir, Turgut Yapanoglu, Hasan Riza Aydın, Mehmet Yılmaz, Mehmet Aksoy, and Isa Ozbey. "Ureteroscopy and holmium laser lithotripsy: Is this procedure safe in pregnant women with ureteral stones at different locations?" Archivio Italiano di Urologia e Andrologia 86, no. 2 (June 30, 2014): 86. http://dx.doi.org/10.4081/aiua.2014.2.86.
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Objectives: The aim of this study was to assess the safety and effectiveness of ureteroscopy and Holmium: Yttrium-Aluminum-Garnet lithotripsy for the treatment of ureteral stones with different localizations in symptomatic pregnant women. Methods: A retrospective analysis was performed on 19 pregnant patients referred to our center between January 2005 and December 2012 with symptomatic hydronephrosis requiring surgical intervention. 7.5 F and 9.5 F semirigid ureterorenoscopy with Holmium laser lithotripsy was used for treatment in all patients. Complications were stratified according to modified Clavien criteria. Results: The mean age of patients was 25.4 (18-41) years, and the mean gestation duration was 24.8 (7-33) weeks. Six cases (31.5%) had a history of stone. Solitary kidney secondary to previous nephrectomy was observed in 2 patients and 1 patient had a hypoplastic kidney. Abdominal ultrasonography was used as the main diagnostic tool. Mean stone size was 9.2 mm (6-13). The location of the stones was the lower, middle, and upper ureter in 8 (42.1%), 5 (26.3%) and 6 (31.5%) cases, respectively. All stones were fragmented with Holmium laser lithotripsy. Of the 19 patients, 11 (57.8%) required doublr J stent insertion peroperatively. Intraoperative urological and obstetric complications were not observed. Postoperatively two complications were noted. According to Clavien criteria a complication was level 1, and the other was level 2. Conclusions: For treatment of pregnant women with symptomatic ureteral stones in every location, Holmium laser lithotripsy with a semirigid ureteroscopy can be used as judicious treatment. This approach is effective and safe with an acceptable complication rate.
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Di Florio, Damian Nicolas, Erika J. Douglass, Katelyn A. Bruno, Anneliese R. Hill, Jessica E. Mathews, William E. Haley, and DeLisa Fairweather. "3341 Sex Differences in Vitamin D and Urinary Stone Disease." Journal of Clinical and Translational Science 3, s1 (March 2019): 54. http://dx.doi.org/10.1017/cts.2019.129.
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OBJECTIVES/SPECIFIC AIMS: More men than women develop urinary stones and their prevalence alters in women with menopause suggesting a steroidal influence. In men the incidence of stones is highest during July and August suggesting that environmental factors such as Vitamin D (VitD), a steroid, may affect stone formation. Previous studies have found differences in the development of stones between men and women; however, the reasons for sex differences in stone formation and type remain unclear. METHODS/STUDY POPULATION: We examined VitD levels in men and women (n = 18,753) that had no diseases based on a lack of an ICD-9 or ICD-10 code in their electronic medical record. We found that normal, healthy women had significantly higher levels of sera VitD compared to men (p = 6x10-6). We then examined whether sex differences existed for key endpoints/data from the Mayo Clinic Urinary Stone Disease (USD) Registry, which has around 1,600 urinary stone patients that are well-phenotyped according to sex, age and stone type. RESULTS/ANTICIPATED RESULTS: Control women were found to have higher sera VitD levels than men, but the sex difference no longer exists in kidney stone disease patients. When we further separated by race, we found that differences in VitD levels reappeared; this suggests that race also plays a role in sera VitD variances. DISCUSSION/SIGNIFICANCE OF IMPACT: We are developing a disease severity score, which we will use to correlate to sera VitD levels in patients according to sex, age and race. Future analyses will take into account whether subjects had VitD and calcium supplementation. This project begins to explore the mechanism behind the sex differences known to exist in urinary stone disease, which is critically needed to provide improved diagnosis and therapy for this debilitating disease.
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Laukkarinen, Johanna, Gediminas Kiudelis, Marko Lempinen, Sari Räty, Hanna Pelli, Juhani Sand, Esko Kemppainen, Caj Haglund, and Isto Nordback. "Increased Prevalence of Subclinical Hypothyroidism in Common Bile Duct Stone Patients." Journal of Clinical Endocrinology & Metabolism 92, no. 11 (November 1, 2007): 4260–64. http://dx.doi.org/10.1210/jc.2007-1316.
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Abstract Context: Earlier, we have shown an increased prevalence of previously diagnosed hypothyroidism in common bile duct (CBD) stone patients and a delayed emptying of the biliary tract in hypothyroidism, explained partly by the missing prorelaxing effect of T4 on the sphincter of Oddi contractility. Objective: In this study, the prevalence of previously undiagnosed subclinical hypothyroidism in CBD stone patients was compared with nongallstone controls. Patients: All patients were clinically euthyreotic and without a history of thyroid function abnormalities. CBD stones were diagnosed at endoscopic retrograde cholangiopancreatography (group 1; n = 303) or ruled out by previous medical history, liver function tests, and ultrasonography (control group II; n = 142). Main Outcome Measures: Serum free FT4 and TSH (S-TSH) were analyzed; S-TSH above the normal range (>6.0 mU/liter) was considered as subclinical and S-TSH 5.0–6.0 mU/liter as borderline-subclinical hypothyroidism. Results: A total of 5.3 and 5.0% (total 10.2%; 31 of 303) of the CBD stone patients were diagnosed to have subclinical and borderline-subclinical hypothyroidism, compared with 1.4% (P = 0.05) and 1.4% (total 2.8%, four of 142; P = 0.026) in the control group, respectively. In women older than 60 yr, the prevalence of subclinical hypothyroidism was 11.4% in CBD stone and 1.8% in control patients (P = 0.032) and subclinical plus borderline-subclinical hypothyroidism 23.8% in CBD stone and 1.8% in control patients (P = 0.012). Conclusion: Subclinical hypothyroidism is more common in the CBD stone patients, compared with nongallstone controls, supporting our hypothesis that hypothyroidism might play a role in the forming of CBD stones. At minimum, women older than 60 yr with CBD stones should be screened for borderline or overt subclinical hypothyroidism.
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Liu, Chan Jung, Jin Shang Wu, and Ho Shang Huang. "Decreased Associated Risk of Gout in Diabetes Patients with Uric Acid Urolithiasis." Journal of Clinical Medicine 8, no. 10 (September 25, 2019): 1536. http://dx.doi.org/10.3390/jcm8101536.
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Uric acid urolithiasis constitutes approximately 7–10% of all urinary stones. Previous studies have revealed that patients with gout do not equally have uric acid stones. Instead, the risk of gout in patients with uric acid stones remains controversial. This study aimed to investigate whether there is different associated risk of gout for diabetes mellitus (DM) and non-diabetes patients with uric acid urolithiasis. Therefore, we examined all baseline chemistries to determine any risk factors or protective factors related to developing gout in patients with uric acid stones. Ninety-nine patients from a single medical center, who had a uric acid component in their stone specimen were enrolled and their medical records were reviewed retrospectively between January 2010 and December 2016. All patients were divided into gout and non-gout groups. Gout was confirmed in 24 patients in this study (24.2%). The proportion of DM was significantly higher in the non-gout group (34.7%) than in the gout group (4.3%, p < 0.05). Renal function was decreased and serum triglyceride was higher in patients with gout. Uric acid urolithiasis patients with DM had a lower risk for gout (adjusted odds ratio: 0.08; 95% confidence interval (CI) = 0.01–0.61, p = 0.015). In 89 patients with predominant uric acid stones (>50% uric acid composition), the risk for gout was still lower in patients with diabetes than non-diabetes (adjusted odds ratio: 0.08; 95% confidence interval (CI) = 0.01–0.61, p = 0.015). These findings suggest that decreased risk of gout is found in uric acid urolithiasis patients with diabetes. Our results imply that patients with uric acid stones should have complete diabetes evaluation before the administration of uric acid controlling medication.
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Di Mauro, Davide, Valentina Lucia La Rosa, Sebastiano Cimino, and Eugenio Di Grazia. "Clinical and psychological outcomes of patients undergoing Retrograde Intrarenal Surgery and Miniaturised Percutaneous Nephrolithotomy for kidney stones. A preliminary study." Archivio Italiano di Urologia e Andrologia 91, no. 4 (January 14, 2020): 256–60. http://dx.doi.org/10.4081/aiua.2019.4.256.
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Purpose: To assess disease-specific and health-related QoL, anxiety and depression as well as satisfaction regarding retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) intervention for kidney stones up to 2.5 cm. Secondarily, pain as well as perioperative and postoperative patient outcomes were evaluated. Methods: 60 consecutive patients with kidney stones of dimensions not exceeding 2.5 cm were enrolled in the study of which 30 underwent RIRS and 30 mPCNL. Perioperative characteristics (age, gender, body mass index (BMI), stone side and size, previous interventions for kidney stones and duration of hospitalization) and surgical outcomes (hemoglobin drop, stone-free rate, visual analogue scale (VAS), stenting time, size of ureteral access sheath (UAS) deployment, and postoperative complications) of patients were collected. Quality of life and psychological outcomes were evaluated using validated questionnaires. Results: No significant differences were found between the two groups in terms of age, gender, BMI, stone side and size (p > 0.05). Significant differences between the mPCNL and the RIRS groups were found regarding stenting time (p = 0.032) and duration of hospital stay (p < 0.001). The stone-free rates of mPCNL vs RIRS were not significantly different between the two groups (73.3% vs 66.7%, p > 0.05). Peri- and postoperative complications were not statistically different between the two groups (p > 0.05). RIRS group reported higher anxiety and depression scores compared with the mPCNL group (3 [range 0-15] vs 15 [range 6-24], p < 0.01). We found significant differences between the two groups in social (p < 0.05) and vitality (p < 0.01) scores. VAS pain score was significantly lower in the mPCNL group than in the RIRS one (p < 0.05). Conclusions: These results open new scenarios in the treatment of kidney stones up to 2.5 cm when RIRS and mPCNL have interchangeable indications. Since in our experience complications and success rate are similar, the surgical choice of switching from RIRS to mPCNL in real-time and viceversa may be proposed to the patient in the preoperative counseling.
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Swonke, Megan L., Ali M. Mahmoud, Elias J. Farran, Tamer J. Dafashy, Preston S. Kerr, Christopher D. Kosarek, and Joseph Sonstein. "Early Stone Manipulation in Urinary Tract Infection Associated with Obstructing Nephrolithiasis." Case Reports in Urology 2018 (November 25, 2018): 1–6. http://dx.doi.org/10.1155/2018/2303492.
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A urinary tract infection (UTI) and sepsis secondary to an obstructing stone are one of the few true urological emergencies. The accepted management of infected ureteral stones includes emergent decompression of the collecting system as well as antibiotic therapy. Despite this, no consensus guidelines clarify the optimal time to undergo definitive stone management following decompression. Historically, our institution has performed ureteroscopy with laser lithotripsy (URS-LL) treatment at least 1 to 2 weeks after decompression to allow for clinical improvement and completion of an antibiotic course. In this case series, we retrospectively review four cases in which patients had a documented UTI secondary to an obstructive ureteral stone. The patients underwent urgent decompression and, based on labs and clinical improvement, were subsequently treated with URS-LL. The presented patients received URS-LL within 5 days of decompression and antibiotics. The patients had no sepsis related postoperative complications from the accelerated course of treatment, resulting in discharge within 2 days following URS-LL. We provide a detailed examination of each patient presentation to describe our institution’s experience with treating infected kidney stones within days of urgent decompression in order to question the previous standard of treating an infected kidney stone with a more delayed intervention.
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Gültekin, Mehmet Hamza, Fethi Ahmet Türegün, Burak Ozkan, Beril Tülü, Gamze Gül Güleç, Nejat Tansu, Çetin Demirdağ, Pınar Kendigelen, Ahmet Erözenci, and Bülent Önal. "Does Previous Open Renal Stone Surgery Affect the Outcome of Extracorporeal Shockwave Lithotripsy Treatment in Adults with Renal Stones?" Journal of Endourology 31, no. 12 (December 2017): 1295–300. http://dx.doi.org/10.1089/end.2017.0473.
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Pastore, A. L., G. Palleschi, L. Silvestri, A. Leto, Y. Al Salhi, D. Autieri, A. Ripoli, et al. "V43 Laparoscopic treatment of urinary stones after failure of previous mini-invasive approaches." European Urology Supplements 13, no. 1 (April 2014): eV43. http://dx.doi.org/10.1016/s1569-9056(14)61172-6.
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Zhang, Fei, Kui Wang, Yaru Dang, and Guoyin Wu. "Influence of Meso-Structure Parameters on Wave Propagation in Soil-Rock Mixture." Annales de Chimie - Science des Matériaux 44, no. 5 (October 31, 2020): 365–73. http://dx.doi.org/10.18280/acsm.440510.
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The macro mechanical properties of soil-rock mixture are closely related to the meso-structure features of block stones, namely, content, size, and shape. To promote the engineering application of soil-rock mixture, it is important to explore the meso-structure of the mixture, and evaluate its constitutive properties. The previous studies have shown that the wave propagation in the mixture is highly sensitive to the rock content and compaction. To clarify the meso-structure features of soil-rock mixture, this paper establishes a discrete element model of the mixture based on Particle Flow Code (PFC), investigates the wave propagation features in the model with different meso-structure parameters, and analyzes how the meso-structure parameters affect the wave propagation. The results show that: With the growing rock content, the first wave amplitude increased, while the take-off time shortened; With the growing feature size of block stone, the first wave amplitude gradually decreased, while the take-off time gradually lengthened; The soil-rock mixture containing spherical block stones had the highest first wave amplitude and shortest take-off time, while the mixture containing rectangular block stones had the lowest first wave amplitude and longest take-off time. With the growing rock content, the maximum amplitude, dominant frequency, and spectral area all exhibited an increasing trend; With the growing feature size of block stone, the maximum amplitude, dominant frequency, and spectral area all exhibited a decreasing trend.
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Tangren, Jessica Sheehan, Camille E. Powe, Jeffrey Ecker, Kate Bramham, Elizabeth Ankers, S. Ananth Karumanchi, and Ravi Thadhani. "Metabolic and Hypertensive Complications of Pregnancy in Women with Nephrolithiasis." Clinical Journal of the American Society of Nephrology 13, no. 4 (February 22, 2018): 612–19. http://dx.doi.org/10.2215/cjn.12171017.
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Background and objectivesKidney stones are associated with future development of hypertension, diabetes, and the metabolic syndrome. Our objective was to assess whether stone formation before pregnancy was associated with metabolic and hypertensive complications in pregnancy. We hypothesized that stone formation is a marker of metabolic disease and would be associated with higher risk for maternal complications in pregnancy.Design, setting, participants, & measurementsWe conducted a retrospective cohort study of women who delivered infants at the Massachusetts General Hospital from 2006 to 2015. Women with abdominal imaging (computed tomography or ultrasound) before pregnancy were included in the analysis. Pregnancy outcomes in women with documented kidney stones on imaging (stone formers, n=166) were compared with those of women without stones on imaging (controls, n=1264). Women with preexisting CKD, hypertension, and diabetes were excluded.ResultsGestational diabetes and preeclampsia were more common in stone formers than nonstone formers (18% versus 6%, respectively; P<0.001 and 16% versus 8%, respectively; P=0.002). After multivariable adjustment, previous nephrolithiasis was associated with higher risks of gestational diabetes (adjusted odds ratio, 3.1; 95% confidence interval, 1.8 to 5.3) and preeclampsia (adjusted odds ratio, 2.2; 95% confidence interval, 1.3 to 3.6). Infants of stone formers were born earlier (38.7±2.0 versus 39.2±1.7 weeks, respectively; P=0.01); however, rates of small for gestational age offspring and neonatal intensive care admission were similar between groups (8% versus 7%, respectively; P=0.33 and 10% versus 6%, respectively; P=0.08). First trimester body mass index significantly influenced the association between stone disease and hypertensive complications of pregnancy: in a multivariable linear regression model, stone formation acted as an effect modifier of the relationship between maximum systolic BP in the third trimester and body mass index (P interaction <0.001).ConclusionsIn women without preexisting diabetes, hypertension, and CKD, a history of nephrolithiasis was associated with gestational diabetes and hypertensive disorders of pregnancy, especially in women with high first trimester body mass index.
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Kim, Min Uk, Yoontaek Lee, Jae Hwan Lee, Soo Buem Cho, Myoung Seok Lee, Young Ho So, and Young Ho Choi. "Predictive factors affecting percutaneous drainage duration in the percutaneous treatment of common bile duct stones." PLOS ONE 16, no. 3 (March 2, 2021): e0248003. http://dx.doi.org/10.1371/journal.pone.0248003.
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The duration of percutaneous transhepatic biliary drainage (PTBD) is a critical factor that determines the duration of treatment. This study aimed to evaluate factors affecting the PTBD duration in patients who underwent percutaneous treatment of common bile duct (CBD) stones. This study analyzed data of 169 patients who underwent percutaneous treatment of CBD stones from June 2009 to June 2019. Demographic data, characteristics of stone, procedure-related factors, and laboratory findings before the insertion of PTBD tubes were retrospectively evaluated. To assess the effect of confounding factors on the PTBD duration, multivariate linear regression analysis was applied, incorporating significant predictive factors identified in the univariate regression analysis. In the univariate regression analysis, the predictive factor that showed high correlation with the PTBD duration was the initial total bilirubin level (coefficient = 0.68, P < .001) followed by the short diameter of the largest stone (coefficient = 0.19, P = .056), and previous endoscopic sphincterotomy (coefficient = -2.50, P = .086). The multivariate linear regression analysis showed that the initial total bilirubin level (coefficient = 0.50, P < .001) and short diameter of the largest stone (coefficient = 0.16, P = .025) were significantly related to the PTBD duration. The total bilirubin level before PTBD tube insertion and the short diameter of the largest CBD stone were predictive factors for the PTBD duration in patients who underwent percutaneous CBD stone removal. Careful assessment of these factors might help in predicting the treatment period, thereby improving the quality of patient care.
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Bakkum, M. J., and R. J. L. F. Loffeld. "Ascending Cholangitis due to Heavy Lifting." Case Reports in Gastroenterology 11, no. 2 (August 23, 2017): 500–503. http://dx.doi.org/10.1159/000479550.
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Gallstone disease is the most common risk factor for cholangitis. In an anatomically normal bile duct system, cholangitis does not occur without the presence of stones. Endoscopic retrograde cholangiography with papillotomy and stone extraction is a well-established curative therapy for gallstones in the common bile duct. More important, papillotomy prevents recurrent episodes. The present case report describes a 73-year-old male with recurring cholangitis in a clear bile duct system after previous papillotomy. An etiology of duodenal reflux into the common bile duct due to heavy lifting is proposed.