Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0451641 (urolithiasis)
 3,973 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From 1 January 1986 to 30 June 1989, 15 pregnant women were diagnosed as having urolithiasis. Patients presented in the last two trimesters with an infection of the lower part of the urinary tract (60 per cent), flank and abdominal pain (27 per cent) and hematuria (13 per cent). Ultrasonographic findings confirmed the diagnosis in 47 per cent of the patients. Other roentgenologic procedures were required in the remaining patients. Initially, therapy was conservative in all, and in 67 per cent of patients, no further intervention was necessary. Only 33 per cent required invasive measures; cystoscopic passage of an internal ureteral stent was the initial procedure of choice at our institution. Three of five patients who underwent invasive procedures had surgical intervention for relief of ureteral obstruction. Intensive care management was necessary for one of these three patients who had acute hemorrhage occur during the procedure. These data emphasize the need for the accurate diagnosis of urolithiasis during pregnancy. Ultrasonography was a valuable diagnostic technique, but a limited excretory urogram is safe and appropriate when there is uncertainty. Conservative management (hydration, analgesia and antibiotics as indicated) of obstructive uropathy was successful in the majority of instances. A specific clinical algorithm facilitated the successful management of patients necessitating operative intervention. Optimal management requires clinical suspicion and a precise diagnostic and therapeutic plan.
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PMID:An algorithm for diagnosis and therapy of management and complications of urolithiasis during pregnancy. 198 41

In January 1988 a Siemens Lithostar lithotriptor was installed in the Radboud University Hospital in Nijmegen. Over 1600 treatments have been performed since. The results of 582 treatments of the first 500 patients are discussed. After three months 51.3% of the patients were free of stones. After six months this percentage was 64.5 and in addition 25.4% of the patients were free of symptoms although residual particles were still present. In only 10.1% of the patients did the ESWL treatment not succeed. In over 50% of the cases treatment was performed on an outpatient basis. Among 90% of the patients in whom treatment was performed without auxiliary procedures only 50% needed i.v. sedation or analgesia. The other 50% did not need any form of sedation or analgesia. Major complications did not occur although 376 patients (75.2%) suffered from a short period of haematuria and many patients had a skin lesion. With the possibility of outpatient treatment, the use of less anaesthesia and a success rate of 89.9% (residual stones, less than 5 mm in diameter, which can be evacuated spontaneously) after six months, the Lithostar is an improvement in the treatment of urolithiasis.
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PMID:[The treatment of kidney and ureteral stones using a second-generation kidney stone lithotriptor]. 233 22

The Piezolith 2200 allows not only a qualitatively identical treatment of urolithiasis like the HM-Dornier systems or the Siemens Lithostar, but the application of lithotriptable urinary calculi could be extended to cardiac risk patients, to patients with skeletal deformities and to those with unusual body height and weight. As the piezolithotripsy does not cause pain, treatment is possible without anaesthesia or analgesia. Combined with internal ureteral stenting by self-retaining double-J-ureteral catheter also calculi with larger stone masses can be treated advantageously by exclusive piezolithotripsy as monotherapy. Multiple treatments by the piezolithotriptor are possible because of good focussing of the shock waves and the smaller parenchymal alteration. Lithotripsy of ureteral calculi is performed in the upper and lower part of the ureter. In small calculi the retrograde introduction of an ureteral catheter armed with an "ultrasound mirror" is necessary.
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PMID:[Extracorporeal shockwave lithotripsy in the treatment of urolithiasis--experiences from a center with the Piezolith 2200 and HM3 lithotriptors]. 338 94

The analgesic effects of high-energy extracorporeal shock wave therapy (ESWT) were discovered by chance during its application for urolithiasis and for bone pseudarthrosis. Despite the extensive use of ESWT, the mechanisms of its antinociceptive effects are still unclear. A gate control mechanism and other antinociceptive mechanisms have been postulated. The aim of this study was to investigate the possible influence of low-energy ESWT on the expression of the transmitters substance P (SP) and calcitonin gene-related peptide (CGRP) in the lumbar spinal cord of the rat. Immunohistochemical analysis of the expression of the neuropeptides CGRP and SP was performed in rats treated either once with 1000 impulses or three times with 1000 impulses, with two different energy flux densities being used (0.043 and 0.11 mJ/mm2). The animals were killed either 4 or 72 h after the ESWT. No regulatory effect of ESWT on the expression of SP or CGRP in the dorsal horns was found. Because the application of ESWT showed no significant changes in the sensory system, it is unlikely that the application of ESWT triggers the endogenous pain control system of the rat through hyperstimulation analgesia. Furthermore, these results show that low-energy ESWT had no side effects on the rat spinal cord.
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PMID:No influence of low-energy extracorporeal shock wave therapy (ESWT) on spinal nociceptive systems. 1181 40

We study the outcome of 2,700 patients treated for 3,093 urinary calculi over a period of 60 months. All patients underwent Extracorporeal Shock Wave Lithotripsy (ESWL) treatment using the Storz Modulith SL20, predominantly on an outpatient basis (99.9% using intravenous pethidine for analgesia). The treatment outcome of 1,666 renal calculi and 1,427 ureteric calculi were analysed and stratified according to size and site. Follow-up status at 3 months was available for 91.8% of patients. For renal calculi, the overall success rate was 81% (re-treatment rate 29.7%). The majority of failures were stones larger than 2 cm and those situated in the lower pole of the renal calyces. The overall success rate for ureteric calculi is 85% with similar clearance rates throughout the ureter (re-treatment rate 22.8%). Failures were predominantly with stones larger than 2 cm. For the entire series, the morbidity rate requiring hospital admission was 2.9%, there was no mortality. The commonest cause for admission was for pain control (1.8%). To our knowledge, our experience with this lithotriptor is the largest to date. We have demonstrated that ESWL with Storz Modulith SL20 is safe, well tolerated and highly effective for the treatment of urolithiasis.
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PMID:Clinical experience and results of ESWL treatment for 3,093 urinary calculi with the Storz Modulith SL 20 lithotripter at the Singapore general hospital. 1248 41

Since its introduction in 1980, extracorporeal shockwave lithotripsy (SWL) has become the first therapeutic option in most cases of upper-tract urolithiasis, and the technique has been used for pediatric renal stones since the first report of success in 1986. Lithotripter effectiveness depends on the power expressed at the focal point. Closely correlated with the power is the pain produced by the shockwaves. By reducing the dimensions of the focus, it becomes possible to treat the patient without anesthesia or analgesia but at the cost of a higher re-treatment rate. Older children often tolerate SWL under intravenous sedation, and minimal anesthesia is applicable for most patients treated with second- and third-generation lithotripters. Ureteral stenting before SWL has been controversial. Current data suggest that preoperative stent placement should be reserved for a few specific cases. Stone-free rates in pediatric SWL exceed 70% at 3 months, with the rate reaching 100% in many series. Even the low-birth-weight infant can be treated with a stone-free as high as 100%. How can one explain the good results? Possible explanations include the lesser length of the child's ureter, which partially compensates for the narrower lumen. Moreover, the pediatric ureter is more elastic and distensible, which facilitates passage of stone fragments and prevents impaction. Another factor is shockwave reproduction in the body: there is a 10% to 20% damping of shockwave energy as it travels through 6 cm of body tissue, so the small body volume of the child allows the shockwaves to be transmitted with little loss of energy. There are several concerns regarding the possible detrimental effect of shockwaves on growing kidneys. Various renal injures have been documented with all type of lithotripters. On the other hand, several studies have not shown adverse effects. In general, SWL is considered to be the method of choice for managing the majority of urinary stones in children of all ages. Re-treatments improve the stone-free rate, often raising it to 100%. Among the predictors of success, stone size seems to be the most important. In the absence of guidelines, selecting the appropriate treatment modality for each child requires planning and depends on instrument availability and local expertise.
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PMID:Extracorporeal shockwave lithotripsy in pediatrics. 1817 37

In this study, we aimed to compare the treatment results of two different shock wave lithotripsy (SWL) machines used in the management of pediatric urolithiasis. Between January 1993 and October 2004, Dornier MPL 9000 (electrohydraulic) had been used, and since then Siemens Lithostar Modularis (electromagnetic) has been used. The last evaluation was done 3 months after SWL treatment in terms of the success rate, use of anesthesia and complications. A total of 263 children (171 boys and 92 girls), with an age range of 9 months-14 years (mean age 8.1 +/- 3.8 years) were included in this study. Of the patients treated with the Dornier MPL 9000, 60.1% (173/104) required general anesthesia and 69 needed sedation. In contrast, for all patients treated with the Lithostar Modularis necessitated only sedo-analgesia (90 children). The hospital stay was shorter for Siemens Lithostar Modularis than those of Dornier MPL 9000 (26.2 vs. 35.5 h, P = 0.03). The success rate for the electromagnetic unit (86.5%) was almost identical that achieved with the electrohydraulic unit (85.2%) in the stones for the different location. Success rates were compared for stone burden subsets, the differences were insignificant for both lithotriptors (P > 0.05, for all). The electromagnetic unit had a significantly higher success rate for distal ureteral calculi (86.2 vs. 54.5%, P = 0.034). The efficiency quotients (EQ) for distal ureteral calculi were significantly different in favor of electromagnetic machine (56 vs. 40%). The complication rates for SWL were not significantly different for electrohydraulic and electromagnetic lithotriptors (8.7 and 6.2%, respectively). This study showed that SWL treatment was effective and safe in pediatric urolithiasis using both electrohydraulic and electromagnetic machines. Electromagnetic machine was more effective than electrohydraulic one for distal ureteral calculi. Additionally, the electromagnetic lithotriptor has significant clinical advantages over the electrohydraulic lithotriptor in terms of anesthesia requirements, hospitalization duration and fluoroscopic targeting.
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PMID:Comparison of the effectiveness and safety of MPL 9000 and Lithostar Modularis shockwave lithotriptors: treatment results of 263 children. 1927 24

Urolithiasis is expected to cause a considerable complication in patients with systemic mastocytosis. The aim of the present report is to demonstrate that due to pathological activation and irritability of mast cells, special features in the diagnostic investigation and therapy of urolithiasis have to be considered in patients with systemic mastocytosis. The clinical presentation, diagnostic investigation and therapeutic procedure of urolithiasis in a patient with systemic mastocytosis are described. Urolithiasis may be a significant complication of systemic mastocytosis. Non-contrast CT is the main tool for diagnosing urolithiasis after a detailed history and clinical exam. Patients with systemic mastocytosis should receive a premedication composed of a glucocorticoid and H(1)- and H(2)-histamine receptor antagonists. An increased vulnerability of mucosal tissues is expected in patients with systemic mastocytosis that may limit the options of operative and postoperative therapy. Opioids should be used cautiously for analgesia in patients with systemic mastocytosis.
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PMID:Ureteral stones due to systemic mastocytosis: diagnostic and therapeutic characteristics. 1951 6

The aim of this study was to assess the efficacy of desmopressin nasal spray compared with diclofenac given intramuscularly in patients with acute renal colic caused by urolithiasis. The study included 72 patients randomized into three different groups: group A received desmopressin (40 mg, nasal spray), group B diclofenac (75 mg) intramuscularly and group C, both desmopressin and diclofenac. Pain was assessed using a visual analogue scale at baseline, 10, 30 min and 1 h after administering the treatments. Rescue analgesia was given at 30 min if needed. On admission, the pain level was the same in all three groups (group A 85; and group B and C 90 each). At 10 min the pain decreased minimally in all the groups but more in group B and C (group A 80 and group B and C 70 each). At 30 min pain scores were 75, 37.5 and 40 for group A, B and C, respectively, indicating that there was no significant pain relief in desmopressin group. Rescue analgesic had to be given to all patients in group A and two patients in group B and three patients in group C. Pain relief in the desmopressin only group was significantly less at 1 h even after rescue analgesia (pain scores of 27.5, 15 and 20 for group A, B and C respectively). Intranasal desmopressin is not an effective analgesic in renal colic: exerts mild analgesic effect over a period of 30 min. It does not potentiate the effect of diclofenac.
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PMID:A comparative assessment of the clinical efficacy of intranasal desmopressin spray and diclofenac in the treatment of renal colic. 2123 55

Urolithiasis is a common problem with a high recurrence rate. Medical therapy directed to relieve agonizing pain, expulsion of stone, dissolution of uric acid and cystine stone and prevention of recurrence. NSAIDs are superior to opioids for renoureteral colic because their use doesn't induce vomiting and there is lesser requirement of rescue analgesia. In randomized trials, anticholinergics were not found to be beneficial. Alpha blockers, particularly tamsulosin, reduce pain and facilitate expulsion of stone and fragments of stone following extracorporeal shock wave lithotripsy (SWL) and ureterorenoscopic lithotripsy. Potassium citrate helps in chemodissolution of uric acid and cystine stones and is useful in prevention of stone recurrence in general and in those who have undergone SWL or percutaneious nephrolithotomy. Other measures for prevention of stone recurrence include fluid and dietary therapy, counteracting underlying metabolic abnormalities using suitable medications, phytotheurapeutic agents and probiotics. Once the role of nanobacteria is established in genesis of urinary stones, anti-nanobacteria therapy holds the promise of opening new horizons for prevention of urinary stones.
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PMID:Medical therapy for calculus disease. 2124 7


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