Extracorporeal shockwave lithotripsy in the management of urinary stones: New concepts and techniques to improve outcomes

Objective: Extracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving better clinical practice.Methods: A systematic review process was carried in PubMed/PMC from January 2003 to March 2023. A narrative synthesis of the most important aspects has been made.Results: The important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings, and measures aiming at reduced risk of complications are described.Conclusion: To achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.

Comparative Analysis of Kidney Stone Composition in Patients from Ghana and South Africa: Case Study of Kidney Stones from Accra and Cape Town

Background: Kidney stone disease, also termed nephrolithiasis is associated with significant morbidities such as severe colicky flank pain, haematuria, urinary tract infection and kidney failure. Kidney stone disease was perceived as uncommon in developing countries;however, the global prevalence has been rising over the past two decades due to lifestyle changes. There is very limited literature on kidney stone composition in Africa, including Ghana and South Africa. It was based on this evidence that this study was undertaken. Aim: The primary aim of this study was to describe and compare the composition of kidney stone in patients receiving treatment at the Korle-Bu Teaching Hospital (KBTH), Accra (Ghana) and Groote Schuur Hospital (GSH), Cape Town (South Africa). Methods: The study was a retrospective folder review of patients treated for nephrolithiasis at the Korle-Bu Teaching Hospital in Accra (Ghana) and Groote Schuur Hospital in Cape Town (South Africa). Patients who were treated for kidney stone disease between 1st June 2016 and 31st May 2018 were recruited, and their folder numbers were retrieved from theatre logbooks. A total of hundred and sixty-three (n = 163) folders (n = 30 KBTH;n = 133 GSH) were subsequently retrieved from the two facilities’ records department. Demographic data and kidney stone analysis results were analyzed using the R statistical software. Results: The age of KBTH patients ranged from 24 to 75 years and age of 45 years, while that of GSH ranged 19 to 77 years and median age 48 years respectively. Males were the majority stone formers for both hospitals [56.7% KBTH;59.4% GSH]. There was no statistical difference in gender (p = 0.9447) and age (p = 0.2612) between the two groups. Calcium oxalate (86.7%) and uric acid (90.0%) were the commonest components of the kidney stones analyzed from the KBTH. Calcium oxalate (66.2%) and carbonate apatite (40.6%) were the most common components stones from GSH. Brushite (3.0%), cystine (3.8%) and struvite (19.6%) stones were only found in GSH patients. All kidney stones from the KBTH were mixed stones. Pure kidney stones were only found among the GSH dataset constituting 48.9%, also female patients from GSH formed more mixed stones than their male counterparts (M:F = 40.5%:66.67%) and infection kidney stones were also predominantly found among female patients. Conclusion: The findings indicate that the two facilities’ participants are not different in terms of gender and age. However, the composition of stones was found to be different between participants from both hospitals. This suggests that kidney stone composition may be influenced by patients’ geographical location and or cultural background.

Antilithic Effects of Extracts from Urtica dentata Hand on Calcium Oxalate Urinary Stones in Rats

This study examined the potential antilithic effects of a traditional Chinese medicine Urtica dentata Hand （UDH） in experimental rats and screened the optimal extract of UDH as a possible therapeutic agent for kidney stones. The rat model of urinary calcium oxalate stones was induced by intragastric （i.g.） administration of 2 mL of 1.25% ethylene glycol （EG） and 1% ammonium chloride （AC） for 28 days and was confirmed by Color Doppler ultrasound imaging. The rats in different experimental groups were then intragastrically given petroleum ether extract （PEE）, N-butanol extract （NBE）, aqueous extract （AqE） of UDH, Jieshitong （positive control drug）, and saline, respectively. Treatment with NBE significantly reduced the elevated levels of urinary calcium, uric acid, phosphate, as well as increased urinary output. Accordingly, the increased calcium, oxalate levels and the number of calcium oxalate crystals deposits were remarkably reverted in the renal tissue of NBE-treated rats. In addition, NBE also prevented the impairment of renal function to decrease the contents of blood urea nitrogen （BUN） and creatinine. Taken together, these data suggest that NBE of UDH has a beneficial effect on calcium oxalate urinary stones in rats by flushing the stones out and protecting renal function.

Usefulness of hounsfield unit and density in the assessment and treatment of urinary stones

Computed tomography(CT) is widely used to examine stones in the urinary system.In addition to the size and location of the stone and the overall health of the kidney,CT can also assess the density of the stone in Hounsfield units(HU).The HU,or Hounsfield density,measured by CT,is related to the density of the tissue or stone.A number of studies have assessed the use of HU in urology.HUs have been used to predict the type and opacity of stones during diagnosis,and the efficacy has been assessed using methods including extracorporeal shock wave lithotripsy(ESWL),percutaneous nephrolithotomy(PCNL),ureterorenoscopic ureterolithotripsy(URSL),and medical expulsive treatment(MET).Previous studies have focused on the success rate of HU for predicting the type of stone and of ESWL treatment.Understanding the composition of the stone plays a key role in determining the most appropriate treatment modality.The most recent reports have suggested that the HU value and its variants facilitate prediction of stone composition.However,the inclusion of data regarding urine,such as pH and presence of crystals,increases the predictive accuracy.HUs,which now form part of the clinical guidelines,allow us to predict the success of ESWL; therefore,they should be takeninto account when ESWL is considered as a treatment option.However,there are currently insufficient data available regarding the value of HU for assessing the efficacy of PCNL,URSL,and MET.Studies performed to date suggest that these values would make a significant contribution to the diagnosis and treatment of urinary system stones.However,more data are required to assess this further.

Effect of stone composition,color,size,impaction and location on the efficacy of pneumatic ureterolithotripsy

Objective:Assessment of the relationship between stone location,composition,color,size and impaction with success rate of pneumatic ureterolithotripsy.Methods:This study was performed on 440 patients who were candidate for pneumatic ureterolithotripsy admitted in an academic urology department from February 2004 to June 2006.Exclusion criteria included active urinary tract infection and pregnancy.Information such as stone composition,color,impaction,size,location and surface were recorded.Success rate was defined as stone fragmentation to < 2 mm.We used chi-square test and student t-test for statistical analysis.Results:The success rate of pneumatic ureterolithotripsy was 83.0 %.Mean stone size was 9.86 ± 3.79 mm.The stone free rates in upper,middle and lower ureter were 66.7 %,100 % and 90.7 % respectively(P<0.000 1).Stone free rate was 100 % and 69.35 % in <5 mm and >5 mm stones respectively(P<0.000 1).Impaction did not correlate significantly with stone free rate(P=0.17).The success rate was 100 % in phosphate and cystine stones.There was a significant statistical difference between success rate and stone composition(P=0.026).The most common fragmented stone color was gold(95.5 %).Stone color correlated significantly with stone free rate(P<0.000 1).Conclusion:In this series ureterolithotripsy,stone free rate had a significant correlation with stone color,size,composition and location,but it was independent of stone impaction.

Epidemiologic, Diagnostic, and Therapeutic Features of Urinary Stone Disease in Northern Benin from 2018 to 2023

Objective: To determine the epidemiologic, diagnostic, and therapeutic features of urinary in northern Benin from 2018 to 2023. Patients and Method: The study was an observational and descriptive one. We exhaustively and retrospectively collected data from the medical records of the patients that were managed from February 1, 2018 to February 1, 2023 at the Department of Surgery of “Centre Hospitalier Universitaire Départmental Borgou-Alibori or CHUD-BA”. Results: Among the 4522 patients managed, 75% or 1.7% had urinary stone disease. Their mean age was 41 years. The sex ratio was 2.75, the males being predominantly affected. Of the 75 cases of urinary stone disease, 30.7% (n = 23) were renal, 46.7% (n = 35) were ureteral, and 22.7% (n = 17) were vesical. The patients came from variable geographical areas, ethnic groups, and professional sectors. Their main complaints were pain (57.3%), hematuria (14.7%), dysuria (12%), and fever (5.3%). 15 (20%) patients, i.e., 7 renal stone and 8 ureteral stone patients, had an obstructive renal failure. The imaging tools available were ultrasonography, tomography and computed tomographic scan. 11 of the bladder stone cases (64.7%) were associated with a bladder outlet obstruction. Overall, 38.7% of the patients had either diabetes mellitus (6.7%), hypertension or high blood pressure (6.7%), benign prostate hyperplasia (8%), urinary schistosomiasis (6.7%), ureteral pelvic junction obstruction (2.7%), and prostate cancer (1.3%). Of the 19 patients whose dietary behavior was investigated 15 (79%), 11 (57.9%) et 11 (57.9%) demonstrated a diet which was respectively rich in milk, fromage and meat. 100% of bladder stones were removed through cystolithotomy. Renal stones were removed by pyelolithtomy (52.2%) and nephrolithotomy (21.7%). Ureteral stones were removed through ureterolithotomy (40%), expelled by means of alpha-blockers (40%) or managed with ureteral pigtail stent (20%). Conclusion: The hospital prevalence of urinary stone disease was 1.7%. The mean age in urinary stone-affected patients was 41 years. The urinary stone predominantly affected male patients: the sex ratio was 2.75. The stones were mainly removed through open surgery.

Endoscopic papillary large balloon dilation vs endoscopic sphincterotomy for retrieval of common bile duct stones:A meta-analysis

AIM: To compare the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) with endoscopic sphincterotomy (EST) in retrieval of common bile duct stones (&#x02265; 10 mm).

The association of benign prostatic hyperplasia with lower urinary tract stones in adult men: A retrospective multicenter study

Objective:To examine the relationship between benign prostatic hyperplasia(BPH)and the presence of lower urinary tract stones.Methods:We retrospectively reviewed the records of men with lower urinary tract stones who presented to three clinical centers in Korea over a 4-year period.We divided the patients into two groups based on the location of urinary stones:Group 1(bladder calculi)and Group 2(urethral calculi).We compared the characteristics of both groups and performed univariate and multivariate analyses with a logistic regression model to investigate the relationship between BPH and lower urinary tract stones.Results:Of 221 patients,194(87.8%)had bladder calculi and 27(12.2%)had urethral calculi.The mean age of Group 1 was higher than that of Group 2(68.96
12.11 years vs.55.74
14.20 years,p<0.001).The mean prostate volume of Group 1 was higher than that of Group 2(44.47
27.14 mL vs.24.70
6.41 mL,respectively,p<0.001).Multivariate logistic regression showed that age(OR Z 1.075,95%CI:1.023e1.129)and prostate volume(OR Z 1.069,95%CI:1.017e1.123)were independently associated with increased risk for bladder calculi.Upper urinary tract stones and/or hydronephrosis conferred a 3-fold risk for urethral calculi(OR Z 3.468,95%CI:1.093e10.999).Conclusion:Age and prostate volume are independent risk factors for bladder calculi.In addition,men with upper urinary tract disease are at greater risk for urethral calculi,which may migrate from the upper urinary tract rather than from the bladder.

Neodymium:Yttrium Aluminum Garnet Laser for Mini-Percutaneous Treatment of Upper Urinary Tract Stones

To observe the efficacy and safety of mini-percutaneous nephrolithotomy with Neodymium：Yttrium Aluminum Garnet （Nd-YAG） laser in the treatment for upper urinary tract stones, from December 2005 to September 2006, 31 patients with renal stones, 15 patients with ureteral stones and 7 patients with renal and ureteral stones underwent mini-percutaneous nephrolithotomy with Nd-YAG laser by combination of rigid ureteroscope and flexible ureteroscope under B-ultrasound guidance. Clinical data including operation time, lithotripsy time, complications and stone-free rate were analyzed retrospectively. Our study showed that the percutaneous renal access （F14-F18） was successfully established under B-ultrasound guidance in all cases. Immediate phase Ⅰ lithotripsy was performed in 47 cases through single tract, and in one case through two tracts. Delayed phase Ⅱ lithotripsy was done in 5 cases of renal stones. Operation time ranged from 55 to 180 rain with an average time of 100±15 min. Lithotripsy time was from 25 to 135 min and the average lithotripsy time was 65±11 min. No severe complications occurred in our series. Complex renal stones were cleared in 34 of 38 cases （89.5 %）. All ureteral stones were completely removed in 15 cases （100 %）. It was concluded that mini-percutaneous nephrolithotomy with Nd：YAG laser for the treatment of upper urinary tract stones by combination of rigid ureteroscope and flexible ureteroscope has the advantages of effectiveness, mini-invasion, shorter operative time and safety.

Consolidation of high replacement ratio stone column-reinforced ground:Analytical solutions incorporating clogging effect

The utilization of stone columns has emerged as a popular ground improvement strategy,whereas the drainage performance can be adversely hampered by clogging effect.Despite the ample progress of calculation methods for the consolidation of stone column-improved ground,theoretical investigations into the clogging effect have not been thoroughly explored.Furthermore,it is imperative to involve the column consolidation deformation to mitigate computational error on the consolidation of composite ground with high replacement ratios.In this context,an analytical model accounting for the initial clogging and coupled time and depth-dependent clogging of stone columns is established.Then,the resulting governing equations and analytical solutions are obtained under a new flow continuity relationship to incorporate column consolidation deformation.The accuracy and reliability of the proposed model are illustrated by degradation analysis and case studies with good agreements.Subsequently,the computed results of the current study are juxtaposed against the existing models,and an in-depth assessment of the impacts of several crucial parameters on the consolidation behavior is conducted.The results reveal that ignoring column consolidation deformation leads to an overestimate of the consolidation rate,with maximum error reaching up to 16%as the replacement ratio increases.Furthermore,the initial clogging also has a significant influence on the consolidation performance.Additionally,the increment of depth and time-clogging factors a and b will induce a noticeable retardation of the consolidation process,particularly in the later stage.

ACUPUNCTURE ANAESTHESIA IN TREATING URINARY TRACT STONE WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

The anaesthetic effect of acupuncture on 40 patients during extracorporeal shockwave lithotripsy was observed in this study.The anaesthetic rate in 20 eases under manual acupunc-ture was 85％,and that in the other 20 patients under electro-acupuncture anaesthesia was 90％.Under the anaesthesia the patients were conscious and in normal physical conditions.The observationsindicate that the electro-acupuncture anaesthesia is safe,economical and effective.Additionally.it lib-erates acupuncturists from heavy needling manipulation.The relationship between the analgesic ef-fects antI the ages is analysed as well.

Effect of urinary stone disease and its treatment on renal function

Urolithiasis is a common disease that affects urinary tract in all age groups. Both in adults and in children, stone size, location, renal anatomy, and other factors, can infuence the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones.The epoch of open treatment modalities has passed and currently there are much less invasive treatment approaches, such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery. Furthermore, advancement in imaging technics ensures substantial knowledge that permit physician to decide the most convenient treatment method for the patient. Thus, effective and rapid treatment of urinary tract stones is substantial for the preservation of the renal function. In this review, the effects of the treatment options for urinary stones on renal function have been reviewed.

Urinary stone disease and obesity: Different pathologies sharing common biochemical mechanisms

The prevalence of urolithiasis is increasing in parallel with the escalating rate of obesity worldwide. It has previously been speculated that obesity is a potential risk factor for urinary stone disease. The possibility that common biochemical mechanisms underlie both obesity and urolithiasis is remarkable. Better understanding of possible common mechanisms of these diseases could potentially lead to a better management of urinary stone prevention. The prevention of urinary stone for-mation gives clinicians an acceptable reason to encour-age lifestyle modification and weight loss through a regular diet. In this review, the association of obesity with urinary stone disease, possible common biochemi-cal mechanisms, effects of dietary habits and weight loss on stone formation, as well as diffculties in surgi-cal management of obese individuals with urolithiasis are discussed.

Numerical Analysis of the Settlement of Composite Foundation Reinforced with Crushed Stone Grouting Pile and Rigid Bearing Plate

This paper deals with a new type of crushed stone grouting pile with a rigid bearing plate. The load transfer characteristics were analyzed, and a settlement model of the composite foundation reinforced with crushed stone grouting pile and rigid bearing plate was built by FEM program. The effects of replacement ratio of capping plate, replacement ratio of pile, replacement ratio of grout diffusion zone, pile-soil modulus ratio, and serous-soil modulus ratio, on the composite foundation settlement were discussed. It is concluded that the proposed crushed stone grouting pile with a rigid bearing plate is effective in decreasing the settlement of composite foundation.

Breakdown of Kidney and Ureteral Stones Using Extracorporeal Shock Wave Lithotripsy in Zakho City

In the present study, investigation of extracorporeal shock wave lithotripsy in Zakho City for breakdown kidney and ureteral stones has been carried out. The data were collected from the center of breakdown kidney stones in Zakho hospital. A total of 34 patients (25 male and 9 female) of ages ranged from 20 - 60 years were treated with ESWL. The patient harboring 24 renal stones and 10 ureteral stones of size ranged from 7 to 23 mm of almost patients are 8 mm and composed of calcium oxalate. The study has been conducted taking in to consideration the parameters (type, sizes, composition and location of stone as well as region and ages of patients, also power, number of shock wave and session). The results show that the number of shock wave decreases nearly exponentially with the ages of patients for calcium oxalate stone of size 8 mm under constant power 4 watt while it tends to increase according to increasing stones size for the patients of ages 20 - 30 years. The size of calcium oxalate stones decreases nearly exponentially with the patients’ ages for workers in Zakho city. Also for same size 8 mm of (calcium, phosphate, and oxalate) stones and different regions of zakho city, the number of shock waves decreases according to increasing ages of patients. Contrary to that for certain size of stones 8 mm, the number of shock wave starts to increase from uric acid to maximum value for calcium oxalate stone for the adult patients of age’s 22 up to 30 years. However for elders ages 30 - 60 years and different regions, the size of renal and ureteric stones increases from the minimum value for calcium, phosphate, oxalate to maximum value for calcium oxalate stone only. Uric acid stone requires minimum power to break, while the calcium oxalate needs maximum power to fragment due to its hardness composition. Later number of session of shock wave required for crushing each stones size increases according to increasing its size while its variation due to enhancing patients ages for calcium oxalate of size 8 mm results in nearly a decreasing exponential behavior.

Determination of components in traditional Chinese medicines associated with promoting or inhibiting urinary stone formation

Objective:To measure oxalate,calcium,and sodium contents of traditional Chinese medicines(TCMs)that are commonly used to prevent and dissolve urinary stones to exclude the possibility that long-term use of such medicines promotes stone formation.The second objective was to measure citrate,potassium,and magnesium contents in the same medicines to provide possible clues about the mechanisms of prevention and dissolution of urinary stones by TCMs.Methods:Ten of the most commonly-used TCMs for preventing and dissolving urinary stones were chosen and subjected to ion chromatography(IC)to measure water-soluble and total oxalate and citrate contents.Inductively coupled plasma atomic emission spectrometry(ICPAES)was used to measure calcium,potassium,magnesium,and sodium contents in a water extract and in digestion liquid.Results:Average contents of water-soluble oxalate,calcium,and sodium in the water extract were 41.92,84.32,and 22.82 mg/100 g,respectively,far below the normal dietary intake of adults in China.The average contents of citrate and magnesium in water extracts were 268.99 and 66.65 mg/100 g,respectively,below the recommended intake for adults.These ion contents are therefore insufficient to inhibit the formation of urinary stones.The average content of potassium in the water extract was 867.71 mg/100 g,which was relatively abundant,so taking the prescription used in this experimental protocol can increase the body’s potassium content to some extent.Conclusions:Long-term use of TCMs would not increase the risk of urinary stone formation.The potassium content in TCMs is high,which is one possible reason for the prevention of urinary stones by TCMs.

Investigations of Physical and Chemical Characteristics of Masonry Stones and Bricks during Building Cleaning： Part 2. Chemical Testing

This series of study focused on analysing and assessing the Changes of the physical and chemical characteristics of the stone surfaces during the sandblasting cleaning process by conducting various physical and chemical tests. Seven masonry stones and bricks were adopted, including yellow sandstone, red sandstone, limestone, marble, granite, white clay brick and yellow clay brick. The chemical investigations included the micrographing of the stone facade and the analysis of the chemical elements and compounds on four of the seven stones and bricks before and after the cleaning using the Scanning Electron Microscope （SEM） and Energy-Dispersive X-ray Spectroscopy （EDX） techniques. In general, the chemical properties were found to vary largely during the building cleaning. The chemical tests showed that the chemical elements and compounds on the stone facade significantly varied after long term exposures to the atmosphere, mainly due to the soiling on the building fagade caused by environmental erosion and weathering.

Tsingtao li stone community management present situation analysis

In China, the country with a large population, the number of rural residents still occupies a considerable proportion. With the development of the country, reducing the living standards of the gap between urban and rural areas as soon as possible, to be able to realize urban and rural integration, a new rural community management is a very good choice. In this paper, the research aims to Tsingtao li stone community the brief analysis of the present situation of community management, research on the current situation of community management problems, and put forward the community management services to long-term healthy development of the constructive Suggestions and countermeasures.

A Brief Analysis of the Differences and Defects of Subtitling Compared to Dubbing——Harry Potter and the Philosopher’s Stone

Compared to the dubbing, the version of subtitling has many defects, including the faults purely in language translation and the inaccuracy in the cultural images. As a media of cultural communication, the translator of the subtitling has to pay enough attention to the art of language, and has to take strategies centering on the audience, promoting the cultural communication and reducing the cultural differences.

Liquefaction mitigation in silty soils using composite stone columns and dynamic compaction

The objective of this study is to develop an analytical methodology to evaluate the effectiveness of vibro stone column (S.C.) and dynamic compaction (D.C.) techniques supplemented with wick drains to densify and mitigate liquefaction in saturated sands and non-plastic silty soils. It includes the following: (i) develop numerical models to simulate and analyze soil densitication during S.C. installation and D.C. process, and (ii) identify parameters controlling post-improvement soil density in both cases, and (iii) develop design guidelines for densification of silty soils using the above techniques. An analytical procedure was developed and used to simulate soil response during S.C. and D.C. installations, and the results were compared with available case history data. Important construction design parameters and soil properties that affect the effectiveness of these techniques, and construction design choices suitable for sands and non-plastic silty soils were identified. The methodology is expected to advance the use of S.C. and D.C. in silty soils reducing the reliance on expensive field trials as a design tool. The ultimate outcome of this research will be design charts and design guidelines for using composite stone columns and composite dynamic compaction techniques in liquefaction mitigation of saturated silty soils.