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Query: UMLS:C0451641 (urolithiasis)
 3,973 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two hundred-five case histories of urosepsis have been analyzed for the recent 10 years in order to delineate diagnostic details. Urosepsis resulted from urolithiasis in 88 (42.9%), prostatic adenoma in 51 (24.9%), urologic cancer in 37 (18%) patients; other 29 patients had urologic diseases complicated by urosepsis. Difficulties with identification and size delineation of a septic focus were associated with the presence of bilateral renal involvement, lower urinary tract infections, urinary reflux and posttransplantation immunosuppressive therapy which reversed classic inflammatory symptoms. Extreme clinical variability of urosepsis often resulted in a delayed or premature diagnosis. Diagnostically revealing studies were sonography and computer tomography. Additional use of blood culture for bacteroides and L-bacteria, immune and biochemical tests, including total polyamine concentration, urea/creatinine ratio and leukocyte toxemic index provided an accurate diagnosis of urosepsis. These studies are essential in older patients and those with urinary disease and urologic cancers since urosepsis is diagnostically elusive in this population.
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PMID:[The diagnosis of urosepsis]. 170 66

In 19 urological patients with pyointoxication and urosepsis 49 plasmaphereses for the purpose of detoxication were performed in the complex with other therapeutic measures. The causes for the pyoseptic complications were as follows: urolithiasis in connection with acute pyelonephritis, acute pyelonephritis (among others in pregnancy, cystic renal dysplasia, carcinoma of the urinary bladder), renal insufficiency in the terminal stage. The treatment of these diseases with haemodialysis and haemoperfusion was complicated by a pyosepsis. Two methods of the plasmapheresis were used: the intermitting plasmapheresis with use of a refrigeration centrifuge K-70 (GDR) and the permanent membrane plasma separation with the device A2008 RG of the firm "Fresenius" (FRG). The plasma perfusion was experimentally proved and in 5 cases used on 5 columns with activated charcoal. The efficacy of the plasmapheresis and the plasma perfusion was apart from the clinical condition judged according to the values of the middle molecules in the blood, or urea, creatinine and the normalisation of the hypoproteinaemia as well as of the humoral immunity. To this are added the increase of diuresis, the normalisation of the haematological parameters and the bacteriological findings of blood and urine. Furthermore, several pathogenetic mechanisms of the positive effect of the plasmapheresis were analysed (mechanic removal of bacteria and their toxins, effect of "deplasmation" with tissue dehydration, improvement of the functional state of the kidneys within the first 3-4 days: reduction of the azotaemic intoxication, the DWS-syndrome, improvement of the rheological properties of the blood and of the microcirculation, increase of the antitoxic function of the liver).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Plasmapheresis in the complex therapy of patients with acute pyelonephritis and urologic infection]. 294 10

Extracorporeal shock wave lithotripsy (ESWL) has the potential to revolutionize the treatment of urolithiasis, but its success depends in part upon minimizing potential sequelae. Although ESWL is safe, effective, and relatively economical, one complication can be urosepsis, resulting from liberation of bacteria when the stones disintegrate. Patients who are at increased risk of infection are those who have existing urinary tract infection; perioperative urologic manipulation; infected stones; predisposition for infectious endocarditis; or multiple, large, or complex stones. If urosepsis occurs, it usually requires prolonged hospitalization, which obviates any cost-benefits that can be accrued from ESWL. Prophylactic use of an antibiotic before ESWL is rational and cost-effective. Ideally, the antibiotic should possess a spectrum of activity against the most likely bacteria to be encountered, require a limited number of doses, and offer the flexibility of sustained coverage in the event that the procedure is delayed. Our experience at Presbyterian Hospital of Dallas supports the use of a long-acting cephalosporin for the prevention of infections following ESWL.
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PMID:Extracorporeal shock wave lithotripsy. Use of antibiotics to avoid postprocedural infection. 312 5

The problems and interactions of urolithiasis and monorenality are presented in a survey covering four essential parameters: --Urolithiasis as an indication for nephrectomy: One nephrectomy in four is performed because of urolithiasis. This rate of nephrectomy has not changed in the last 50 years. --Recidive urolithiasis in the residual kidney: Around 37% of all monorenal persons have a diseased single or residual kidney. On average one in four cases of residual kidney disease is caused by urolithiasis. This recidive calculus quota has also not significantly changed in recent decades. --Lethality of operations on the residual kidney: Urolithiasis is becoming almost the only indication for operating on a residual kidney; due to postrenal anuria, uraemia and urosepsis a large percentage of such operations are emergency operations under extremely unfavourable initial conditions. Despite the use of modern methods of medical treatment the lethality rate is for this reason still relatively high (7-15%). --Life expectancy of monorenals with urolithiasis: The life expectancy of monorenals with urolithiasis is clearly limited due to further complications (chronic pyelonephritis, hypertonia, urinary stasis and uraemia). It is therefore absolutely necessary for monorenal persons with urolithiasis to have intensive observation and urological treatment.
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PMID:[Urinary calculi and the single kidney]. 663 73

A total of 27 men with multiple sclerosis underwent urodynamic evaluation as part of a prospective study of voiding dysfunction. Of 18 patients with detrusor-external sphincter dyssynergia 9 suffered serious urologic complications, including repeated episodes of urosepsis, vesicoureteral reflux and urolithiasis. None of the 9 patients without dyssynergia suffered any urologic complications. Urologic complications were correlated highly to the presence of detrusor-external sphincter dyssynergia and the severity of multiple sclerosis but not to duration of multiple sclerosis, age of the patient or type of dyssynergia. Although no treatment was without complications it appears that either anticholinergics plus intermittent self-catheterization or condom catheter drainage is superior to an indwelling catheter for initial conservative treatment. External sphincterotomy or urinary diversion may be necessary if conservative therapy fails.
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PMID:Detrusor-external sphincter dyssynergia in men with multiple sclerosis: an ominous urologic condition. 669 Jul 56

51 urologic patients were dialyzed following acute indications during 1968-77. The 47 adults were 31-81 (average 59) years old. Due to the frequency of occurrence the predominant diseases were: Urolithiasis (combined with pyonephrosis, urosepsis, nephrocirrhosis), malignant tumors, and bladder neck adenomas. 18 patients were postoperative cases. 32 patients suffered from severe diseases or complications outside the urogenital tract. According to a differentiation of three risk groups, there were 33 patients belonging to the most severe group III. The patients' admission to the dialysis unit was late in most cases: 13 patients were already in coma or precoma, 18 patients overhydrated, 11 patients' serum potassium was more than 7 mval/1,28 patients' serum creatinine was more than 10 mg/dl. A prophylactic dialysis was possible in 11 cases only. We have accepted all 51 acute urologic patients, admitted to our clinic, for dialysis treatment. Peritoneal dialysis was performed in all 51 patients, only in 6 of them this treatment was followed by haemodialyses. The reasons for prefering peritoneal dialysis were haemorrhages or the danger of haemorrhages, a critical cardiovascular state, or an extreme acotaemia. In 143 peritoneal dialyses with 91 insertions of stilet catheters, one perforation of the small intestine occurred. The patient survived the resulting peritonitis. 13 of 15 patients with this indication got into an operable state in the course of dialysis treatment. Lethality of 61 per cent (31 of the 51 patients died) was related to the severity of the basic urologic disease. 4 of these latter patients could have been admitted to a regular dialysis treatment. In further 6 cases this would have been possible after a special urologic treatment.
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PMID:[Acute dialysis treatment of urologic patients]. 739 91

Management of urologic disorders in pregnant patients often increases the anxiety of all involved. Based on a thorough understanding of the physiologic changes seen in various organ systems the urologist has to assume the responsibility for the well-being of the mother and the fetus. Apart from the urinary tract infection, which occurs as frequent as in non-pregnant patients but has a significantly higher risk of acute bacterial pyelonephritis, it is mainly the pregnancy-associated symptomatic hydronephrosis and the urolithiasis which are complicating approximately 1 of every 1000-1500 pregnancies. Urinary tract infections should be treated in any case by antibiotics according to a antibiogram. High risk patients with history of vesicoureteral reflux or recurrent pyelonephritis should be treated prophylactically. Following parturition these patients should be investigated urologically to exclude structural abnormalities of the genitourinary system. In case of symptomatic hydronephrosis and calculous disease the first approach should be a watchful conservatism with symptomatic relief. If the symptoms persist insertion of a double-J-stent or in case of live-threatening situations (e.g. urosepsis) when urgent decompression and rapid evacuation is mandatory a percutaneous nephrostomy can be brought in place under sonographic monitoring completely thereby avoiding any radiation exposure.
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PMID:[Kidney and urinary tract diseases in pregnancy]. 1054 30

Pediatric urolithiasis poses a technical challenge to the urologist. A review of the recent literature on the subject was performed to highlight the various treatment modalities in the management of pediatric stones. A Medline search was used to identify manuscripts dealing with management options such as percutaneous nephrolithotomy, shock wave lithotripsy, ureteroscopy and cystolithotripsy in pediatric stone diseases. We also share our experience on the subject.Shock wave lithotripsy should be the treatment modality for renal stone less than 1cm or < 150 mm(2) and proximal non-impacted ureteric stone less than 1 cm with normal renal function, no infection and favorable anatomy. Indications for PCNL in children are large burden stone more than 2cm or more than 150mm(2) with or without hydronephrosis, urosepsis and renal insufficiency, more than 1cm impacted upper ureteric stone, failure of SWL and significant volume of residual stones after open surgery. Shock wave lithotripsy can be offered for more soft (< 900 HU on CT scan) renal stones between 1-2cm. Primary vesical stone more than 1cm can be tackled with percutaneous cystolithomy or open cystolithotomy. Open renal stone surgery can be done for renal stones with associated structural abnormalities, large burden infective and staghorn stones, large impacted proximal ureteric stone. The role of laparoscopic surgery for stone disease in children still needs to be explored.
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PMID:Surgical management of pediatric urolithiasis. 1971

Urologic complications are an important cause of morbidity and even mortality in patients with spinal cord injury (SCI). It has been estimated that within eight years after injury, approximately 7% of SCI patients would develop kidney stones, whereas 36% would have bladder stones. Risk factors for urolithiasis among patients with SCI include complete spinal cord injury, lesions at or above the 4th thoracic spinal cord segment, upper motor neurone type of bladder, urinary tract infection with urease producing bacteria, recurrent urinary tract infection, indwelling catheters, presence of residual urine and immobilization. Detection and removal of bladder stones are important to prevent possible complications such as recurrent urinary tract infection, urosepsis and renal failure. The authors describe a clinical case of a patient with acute SCI that developed bladder stones and discuss its possible causes.
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PMID:[Bladder stones in acute spinal cord injury]. 2035 15

Besides its role in bladder and kidney cancer, urology plays a leading part in oncology particularly with regard to prostate cancer, the most frequent malignant tumor found in men. The multitude of hereditary anomalies of the urogenital tract and the resultant medical conditions, the importance of urinary tract infections including the still deadly urosepsis, urolithiasis which has become as widespread a condition as diabetes mellitus, and urinary incontinence as an increasing problem of a continuously aging population play such a large role in routine practice that every practicing physician must acquire the necessary skills for appropriate diagnosis and treatment. Is our current curriculum for training and continuing education adequate for this task?The primary goal of a meaningful program for continuing education must be to impart the corresponding qualities to young colleagues to ensure optimal patient care. The specialist certification exam itself should invariably be based nationwide on an objective written test: the existing European Board of Urology exam would be ideally suited to facilitate a comparison with other countries across Europe.
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PMID:[Is the training and continuing education for urologists in Germany still up to date?]. 2171 37


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