BackgroundRecently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research.DesignA steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved.ResultsStatements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients.ConclusionsThis document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified.
Objectives: To evaluate the efficacy of semirigid ureteroscopy in the management of ureteral stones located in different parts of the ureter. Methods: 1,503 patients were treated with semirigid ureteroscopy. All ureteral stones were either removed only by a basket catheter or disintegrated by pneumatic lithotripsy. Success rates, auxiliary procedures, complication rates and operation time were comparatively evaluated according to stone location. Results: Overall, mean stone size and age were 12.1 ± 3.7 mm and 43.2 ± 9.72 years, respectively. While 1,416 patients (94.2%) were completely stone-free, the procedure was unsuccessful in 87 cases (5.8%). The success rate was relatively low in the proximal ureter (71.7%) when compared with the mid (94.8%) and distal ureter (98.9%) (p = 0.021). Mean operation time was 25.4 ± 11.7 min. Longer duration of operation and higher complication rate were found in proximal ureteral calculi. Stone migration to the kidney and hematuria were the main reasons of failure in the proximal ureter and ureteral stenting was needed for 56.4% of patients with upper ureteral stone. Conclusions: Semirigid ureteroscopy can be the treatment of choice in lower and midureteral stones. However, it is an invasive and less successful treatment modality for proximal ureteral stones with relatively high complication rates.
To evaluate the degree of ischemia formation in the contralateral testicle following unilateral testicular torsion, free oxygen radical formation after detorsion or an orchiectomy procedure in terms of superoxide dismutase (SOD) and catalase activities was detected in adult male Wistar rats. Animals were divided into 4 groups and following 2 and 6 h of unilateral torsion, the orchiectomy or detorsion procedures were performed and free radical scavenger enzyme activities (SOD, catalase) were measured in the contralateral testes after 24 h, 1 week and 1 month. Evaluation of our results revealed no meaningful ischemia formation in the contralateral testes of rats undergoing 2 h of unilateral testicular torsion. However, animals undergoing 6 h of unilateral testicular torsion demonstrated a statistically significant alteration with respect to enzyme concentrations. Alterations in the contralateral testes were more prominent in animals that had undergone the detorsion procedure following 6 h of testicular torsion. Our results indicate that preservation of twisted testes through a detorsion procedure could cause further deterioration by way of reperfusion injury, indicating the importance of removal of the damaged testicle to minimize long-term histopathologic alterations in the contralateral testes.
High-power photoselective KTP laser vaporization prostatectomy is feasible and appears to be safe and effective for immediate relief of the bladder-outlet obstruction secondary to benign hyperplasia. The system is a promising alternative in all, but especially in high-risk patients receiving anticoagulant therapy.
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