Effect of tamsulosin versus tamsulosin plus tadalafil on renal calculus clearance after shock wave lithotripsy:An open-labelled,randomised,prospective study

Objectives:To compare the efficacy of tamsulosin versus tamsulosin plus tadalafil in achieving clearance of fragments after shock wave lithotripsy(SWL)to treat renal calculi.Methods:Between January 2016 to December 2017,140 patients with solitary,non-branched,non-lower calyceal renal calculus and measuring less than 20 mm and treated with SWL were randomized to tamsulosin(group A)or tamsulosin plus tadalafil(group B).Therapy was given for a period of 4 weeks.Stone clearance rate,analgesic requirement,occurrence of steinstrasse,need for auxiliary procedures(endoscopic treatment),and adverse effects of drugs were recorded.Results:The overall clearance rate was 72.5%(50/69)in the group A and 90.1%(64/71)in the group B(pZ0.007).For stones up to 12 mm,the difference in the clearance rate was significant(pZ0.039)while it was not so for stones larger than 12 mm(pZ0.151).There was no statistically significant difference between the two groups with regards to analgesic requirement(pZ0.94),occurrence of steinstrasse(pZ0.101),need for auxiliary procedures(pZ0.76),and adverse effects of the drugs(pZ0.148).Conclusion:Our study shows that adjunctive medical expulsive therapy with tamsulosin and tadalafil achieves better clearance rate than tadalafil alone in patients receiving SWL for renal stones.

Comparison of the curative effect and serum indexes of ultrasonic pneumatic and holmium laser technology for percutaneous nephrolithotomy treatment of complex renal calculus

Objective:To study the differences in the curative effect and serum indexes of ultrasonic pneumatic and holmium laser technology for percutaneous nephrolithotomy treatment of complex renal calculus.Methods: A total of 78 patients with complex renal calculus who accepted surgical treatment in our hospital between May 2011 and January 2016 were collected, the operation methods and test results were reviewed, and then they were divided into the observation group (n=34) who accepted ultrasonic pneumatic treatment and the control group (n=44) who accepted holmium laser treatment.Ⅰstage stone clearance rate of two groups of patients were recorded;serum was collected, sarcosine oxidase method was used to detect serum renal function indexes, and ELISA method was used to detect the levels of inflammatory factors and stress hormones.Results: The mean lithotomy time of observation group was shorter than that of control group;differences inⅠstage stone clearance rate were not statistically significant between two groups of patients. 3 d after operation, serum renal function indexes Scr, BUN and CysC levels of observation group were lower than those of control group;serum inflammatory factors PCT, IL-1β, IL-22 and IL-13 levels of observation group were lower than those of control group while IL-4 level was higher than that of control group;serum stress hormones AngⅠ, AngⅡ, Adr and NE levels of observation group were lower than those of control group.Conclusion:Both ultrasonic pneumatic and holmium laser technology can effectively remove complex renal calculus and ultrasonic pneumatic technology has the advantages of quicker operation and less injury.

Inadvertent insertion of nephrostomy tube into the renal vein following percutaneous nephrolithotomy: A case report and literature review

Percutaneous nephrolithotomy(PCNL)is an effective and well accepted procedure for the treatment of large and complex renal calculi.We encountered a patient with a mis-placed percutaneous nephrostomy drainage tube(PNDT)into the contralateral renal vein re-sulting thrombus formation after undergoing right side PCNL.We placed a temporary filter to prevent embolism and started anti-coagulation therapy immediately and finally the PNDT was removed without bleeding.

Utility of trans-vaginal ultrasound in diagnosis and follow-up of non-pregnant sexually active females with lower ureteric calculi

objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to December 2017 including non-pregnant sexually active females with suspected ureteric calculus.Trans-abdominal ultrasound was initially done in all patients.In those patients in whom trans-abdominal ultrasound was inconclusive or there was indirect evidence of lower ureteric calculus in form of ureteral dila-tion but no calculus was evident,trans-vaginal ultrasound was done.The patients with ureteric calculi detected on trans-vaginal ultrasound and kept on conservative management were also followed up with trans-vaginal ultrasound.Non-contrast computed tomography was done in patients with inconclusive trans-vaginal ultrasound.Results:As per the study protocol,156 out of the total 468 patients evaluated by trans-abdominal ultrasound were eligible for trans-vaginal ultrasound.Trans-vaginal ultrasound was done in 149 patients,as seven patients did not give consent.Seventy-nine patients were detected with a lower ureteric calculus on trans-vaginal ultrasound and 27 patients had gyne-cologic or other cause for their symptoms.Forty-three patients had an inconclusive trans-vaginal ultrasound of which 36 underwent non-contrast computed tomography,among them only one patient had a lower ureteric calculus.Stone free status could be easily demonstrated on follow-up trans-vaginal ultrasound.

A rare triple concurrence of ureteric calculus and renal cell carcinoma in a horseshoe kidney

Horseshoe kidney is a rare anatomical variant with low clinical morbidity.However,the characteristic shape of horseshoe kidney causes significant anomalies within the vascular and collecting systems.This complicates the diagnosis and management of coexisting pathologies within the kidneys.Here,we report a rare case of concurrent diagnoses of ipsilateral ureteric calculus and renal cell carcinoma within a horseshoe kidney and describe the subsequent management rationale based on the current literature.

Ureteral calculi secondary to a gradually migrated acupuncture needle

We herein presented a case of calculi secondary to a migrated acupuncture needle.A 74-year-old woman with a history of acupuncture therapy for lumbago was referred to our hospital for treatment of ureteral and renal pelvic calculi.Abdominal multi-detector computed tomography scans showed ipsilateral hydronephrosis and two calculi secondary to a migrated acupuncture needle.First,a percutaneous nephrolithotomy was performed to extract two calculi and fine needle fragments from the pelvis.Subsequently,residual needle fragments and calculi in the ureter were then removed by flexible transurethral lithotripsy using a holmium laser.In the present case,the formation of the calculi was caused by a migrated acupuncture needle.Calculi and needle fragments were removed safely endoscopically because the whole calculi and needle fragments were located in the ureteral lumen.ª2021 Editorial Office of Asian Journal of Urology.Production and hosting by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Diagnosis and treatment of melamine-associated urinary calculus complicated with acute renal failure in infants and young children

Background Infants in some areas of China developed urinary lithiasis after being fed with powdered milk that was tainted with melamine in 2008 and very small proportion of the infants developed acute renal failure caused by urinary tract calculus obstruction. The aim of this article was to summarize clinical characteristics, diagnosis and treatment of infants with urinary calculus and acute renal failure developed after being fed with melamine tainted formula milk. Methods Data of infant patients with urinary calculus and acute renal failure due to melamine tainted formula milk admitted to the Beijing Children＇s Hospital Affiliated to the Capital Medical University and the Xuzhou Children＇s Hospital in 2008 were used to analyze the epidemiological characteristics, clinical manifestations, imaging features as well as effects of 4 types of therapies. Results All the 34 infants with urinary calculus were complicated with acute renal failure, their blood urea nitrogen （BUN） was （24.1±8.2） mmol/L and creatinine （Cr） was （384.2±201.2） umol/L. The chemical analysis on the urinary calculus sampled from 15 of the infants showed that the calculus contained melamine and acidum uricum. The time needed for the four types of therapies for returning Cr to normal was （3.5±1.9） days for cystoscopy group, （2.7±1.1） days for lithotomy group, （3.8±2.3） days for dialysis group, and （2.7±1.6） days for medical treatment group, which had no statistically significant difference （P=-0.508）. Renal failure of all the 34 infants was relieved within 1 to 7 days, averaging （3.00±1.78） days. Conclusions Melamine tainted formula milk may cause urinary calculus and obstructive acute renal failure. It is suggested that firstly the patients with urinary calculus complicated with acute renal failure should be treated with dialysis or medication to correct electrolyte disturbance, in particular hyperkalemia, and then relieve the obstruction with available medical and surgical methods as soon as possible. It was observed that the short-term prognosis was satisfactory.

Kidney inflammatory myofibroblastic tumor masquerading as metastatic malignancy: A case report and literature review

BACKGROUND Inflammatory myofibroblastic tumor(IMT) is a rare mesenchymal tumor that is characterized by spindle cells differentiated from muscle fibroblasts and infiltration of various types of inflammatory cells. IMT can occur at any age and at any anatomic site. The most common location of IMT is the bladder in the genitourinary tract. Only scarce cases of kidney IMT have been reported in the literature.CASE SUMMARY A 77-year-old woman, with a history of bilateral renal calculus for 15 years, was admitted to the Department of Urology of our hospital complaining of recurrent painless gross hematuria for one month. The treatment with cephalosporin was ineffective. Computed tomography imaging showed a mixed density and slightly heterogeneously enhanced lesion in the middle pole of the left kidney and ipsilateral adrenal enlargement. The patient underwent surgical treatment by retroperitoneoscopic left radical nephrectomy plus adrenalectomy. A large number of typical spindle cells surrounded by plasma cells and lymphocytes were observed microscopically. Immunohistochemical analyses indicated that these spindle cells were positive for vimentin, cytokeratin(CK), Ki-67, CK7,CD34, and CD31 and were focally positive for CD10 and anaplastic lymphoma kinase(ALK-1). Thus, a diagnosis of IMT was made definitively. The patient recovered well after operation, and no recurrence or metastasis was noted during the 22-mo follow-up.CONCLUSION Since kidney IMT is very rare and lacks characteristic clinical manifestation, it is easily misdiagnosed as a malignant tumor before operation. Surgery remains the best choice for diagnosis and treatment, and such cases must be followed carefully because of the uncertain biological behavior of this tumor. This report suggests that renal calculus may be one of the causes of IMT, but further investigation is necessary to prove it.

Unusual case of nephrocutaneous fistula--Our experience

A rare case of nephrococutaneous fistula due to spontaneous expulsion of renal calculi is described.A 45-year-old man presented with urinary leakage from an ulcer over the left lumbar region for the last 3 months after a history of spontaneous expulsion of stones from this area.Ultrasonography abdomen revealed a small contracted kidney with multiple calculi in the kidney and renal pelvis,sinus tract from the lower pole of the left kidney with a ruptured calyceal calculus in the sinus tract.CT urography revealed a non excreting left kidney with multiple renal calculi,with hyperdense collection in the renal parenchyma extending to the subcutaneous tissue and left lung suggesting a xenthogranulomatous pyelonephritis(XGP).We performed a left-sided simple nephrectomy with excision of the fistulous tract.Histopathological examination revealed XGP.There have been a few case reports of XGP forming nephrocutaneous fistula in the back.

肾、输尿管结石ESWL后开放手术23例临床分析

目的探讨肾、输尿管结石ESWL后开放手术的原因及手术时机。方法回顾性分析23例肾、输尿管结石ESWL后开放手术的原因、手术时机的选择及预后。结果23例患者ESWL治疗50次,平均2.2次。术中发现部分结石不同程度粉碎,部分被肾盂、输尿管黏膜增生的肉芽组织包裹,碎石后的肾、肾盂、输尿管周围组织不同程度粘连水肿。结论肾、输尿管结石在ESWL前应慎重评估,对于肾、输尿管结石病史较长、结石较大、并发肾积水,采用ESWL应慎重;对于ESWL超过2次且结石不能有效排出者,要考虑外科手术干预。