Pathophysiology and Management of Infectious Staghorn Calculi

Healy, Kelly A.; Ogan, Kenneth

doi:10.1016/j.ucl.2007.05.006

Cited by 78 publications

(59 citation statements)

References 61 publications

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“…time points. Based on these results, we surmise that invasive colonization of the bladder triggers chronic inflammation and immune dysregulation, which may be critical to struvite formation.Struvite or infection stones form as a result of complicated urinary tract infections (UTI) caused by urease-producing bacteria such as Proteus, Klebsiella, Serratia, and Ureaplasma species (5,8,9,17). Bacterial urease breaks down urea into ammonia, resulting in urine's becoming supersaturated with ammonia.…”

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confidence: 99%

“…When this occurs, the urine pH rises and the solubility of magnesium ammonium phosphate decreases, leading to crystal deposition and stone formation. Infection is always an underlying cause of struvite urolithiasis (5,9). Therefore, it is not surprising that known predisposing factors such as renal tubular acidosis, neurogenic bladder, urinary tract obstructions, and chronic use of indwelling catheters (5,9) are related to elements that increase patient susceptibility to UTI.…”

mentioning

confidence: 99%

“…Infection is always an underlying cause of struvite urolithiasis (5,9). Therefore, it is not surprising that known predisposing factors such as renal tubular acidosis, neurogenic bladder, urinary tract obstructions, and chronic use of indwelling catheters (5,9) are related to elements that increase patient susceptibility to UTI. Although infections usually induce an inflammatory response in the host, to our knowledge, the role of the host immune response as a potential predisposing factor in struvite urolithiasis has not been evaluated or considered to be important in disease pathogenesis.…”

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Complicated Urinary Tract Infection Is Associated with Uroepithelial Expression of Proinflammatory Protein S100A8

et al. 2009

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F344 rats chronically infected with Ureaplasma parvum develop two distinct profiles: asymptomatic urinary tract infection (UTI) and UTI complicated by struvite urolithiasis. To identify factors that affect disease outcome, we characterized the temporal host immune response during infection by histopathologic analysis and in situ localization of U. parvum. We also used differential quantitative proteomics to identify distinguishing host cellular responses associated with complicated UTI. In animals in which microbial colonization was limited to the mucosal surface, inflammation was indistinguishable from that which occurred in shaminoculated controls, and the inflammation resolved by 72 h postinoculation (p.i.) in both groups. However, inflammation persisted in animals with microbial colonization that extended into the deeper layers of the submucosa. Proteome profiling showed that bladder tissues from animals with complicated UTIs had significant increases (P < 0.01) in proteins involved in apoptosis, oxidative stress, and inflammation. Animals with complicated UTIs (2 weeks p.i.) had the highest concentrations of the proinflammatory protein S100A8 (P < 0.005) in bladder tissues, and the levels of S100A8 positively correlated with those of proinflammatory cytokines GRO/KC (P < 0.003) and interleukin-1␣ (P < 0.03) in urine. The bladder uroepithelium was a prominent cell source of S100A8-S100A9 in animals with complicated UTIs (2 weeks p.i.), which was not detected in animals with asymptomatic UTIs (2 weeks p.i.) or in any bladder tissues harvested at earlier p.i. time points. Based on these results, we surmise that invasive colonization of the bladder triggers chronic inflammation and immune dysregulation, which may be critical to struvite formation.Struvite or infection stones form as a result of complicated urinary tract infections (UTI) caused by urease-producing bacteria such as Proteus, Klebsiella, Serratia, and Ureaplasma species (5,8,9,17). Bacterial urease breaks down urea into ammonia, resulting in urine's becoming supersaturated with ammonia. When this occurs, the urine pH rises and the solubility of magnesium ammonium phosphate decreases, leading to crystal deposition and stone formation. Infection is always an underlying cause of struvite urolithiasis (5, 9). Therefore, it is not surprising that known predisposing factors such as renal tubular acidosis, neurogenic bladder, urinary tract obstructions, and chronic use of indwelling catheters (5, 9) are related to elements that increase patient susceptibility to UTI. Although infections usually induce an inflammatory response in the host, to our knowledge, the role of the host immune response as a potential predisposing factor in struvite urolithiasis has not been evaluated or considered to be important in disease pathogenesis. We present data suggesting that the host immune response plays a critical role in the development of struvite stones and that the proinflammatory protein S100A8-S100A9 may play a critical role in the chronic inflammation and immune...

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Complicated Urinary Tract Infection Is Associated with Uroepithelial Expression of Proinflammatory Protein S100A8

et al. 2009

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“…[2] Most authors offer PNL as the first-line treatment for complex renal stones. [5] The AUA urolithiasis guidelines demonstrated that the stone-free rates of PNL, PNL combined with SWL, SWL alone, and open surgery were 78, 66, 54, and 71%, respectively. [6] The same study showed that the mean number of sessions required to achieve a stone-free status with PNL, PNL combined with SWL, SWL alone, and open surgery were 1.9, 3.3, 3.9, and 1.4%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Giant kidney stone: multi-session percutaneous nephrolithotomy with 12 accesses

Erbin¹,

Yürük²,

Binbay³

et al. 2015

Turkish Journal of Urology

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We report a case of a 37-year-old man with a body mass index of 28 kg/m 2 who presented to our outpatient clinic with intermittent left flank pain. Non-contrast abdominopelvic computed tomography revealed a giant coralliform calculus in the left kidney. This giant kidney stone was successfully treated with 3 sessions of percutaneous nephrolithotomy (PNL) with a total 12 accesses. There was no significant reduction in the split function of the kidney after PNL.

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“…Without regarding the stone size, high stone-free rates decrease recurrence rates of stone disease. [2] Percutaneous nephrolithotomy (PNL) has stregthened its place in the management of large kidney stones with high success, and lower complication rates. [3] In recent years, minimally invasive surgical alternatives as extracorporal shock wave lithotripsy (ESWL), flexible ureteroscopy (F-URS) have been used increasingly, PNL still retains its place in the management of large kidney stones.…”

Section: Introductionmentioning

confidence: 99%

The outcome of percutaneous nephrolithotomy on ≥50 mm staghorn and multiple calyceal stones

Kaya¹,

Ebiloğlu²,

Zor³

et al. 2018

Turkish Journal of Urology

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Objective: To determine the success rate of percutaneous nephrolithotomy (PNL) in kidney stones over 50 milimeters. Material and methods:Twenty-four patients with a renal stone size of >50 mm between January 2007 and December 2016 were enrolled. Stone-free and complication rates were investigated.Results: Twenty-one (87.5%) patients were male and 3 (12.5%) were female. Fifteen (62.5%) stones were located in the right, and 9 (37.5%) in the left kidney. Twenty-one (87.5%) patients were operated using single-access, and three (12.5%) patients were double-access. Thirteen (54%) patients were found to have no stone after operation and 11 (46%) patients had residual stones. Extracorporal shock wave lithotripsy was applied to 5 of 11 patients with residual stones, while flexible ureteroscopy was applied to 6 of them. After additional treatments, 8 (33.5%) patients were observed to be stone free. The stone-free rate was 87.5%. The mean operation time was 135.43 (85-240) minutes. Hemoglobin levels before and after operation were 14.8 (12-16.7) and 12.6 (9.3-15.5), respectively (p= 0.001). The hospital stay was 6.04 (4-8) days. Complications were observed in four patients (16.6%).Conclusion: PNL has high stone-free rate on staghorn type large stones compared with multiple calyceal scattered large stones.

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Pathophysiology and Management of Infectious Staghorn Calculi

Cited by 78 publications

References 61 publications

Complicated Urinary Tract Infection Is Associated with Uroepithelial Expression of Proinflammatory Protein S100A8

Complicated Urinary Tract Infection Is Associated with Uroepithelial Expression of Proinflammatory Protein S100A8

Giant kidney stone: multi-session percutaneous nephrolithotomy with 12 accesses

The outcome of percutaneous nephrolithotomy on ≥50 mm staghorn and multiple calyceal stones

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