Urological Research最新文献

Calcium lithiasis is the most frequently diagnosed renal lithiasis and is associated with a high percentage of patients with metabolic disorders, such as hypercalciuria, hypocitraturia, and hyperoxaluria. The present study included 50 patients with recurrent calcium lithiasis. We conducted a random urine test during nocturnal fasting and a 24-h urine test, and examined calcium, oxalate, and citrate. A study of the linear correlation between the metabolites was performed, and the receiver operator characteristic (ROC) curves were analyzed in the random urine samples to determine the cutoff values for hypercalciuria (excretion greater than 200 mg), hyperoxaluria (excretion greater than 40 mg), and hypocitraturia (excretion less than 320 mg) in the 24-h urine. Linear relationships were observed between the calcium levels in the random and 24-h urine samples (R = 0.717, p = 0.0001), the oxalate levels in the random and 24-h urine samples (R = 0.838, p = 0.0001), and the citrate levels in the random and 24-h urine samples (R = 0.799, p = 0.0001). After obtaining the ROC curves, we observed that more than 10.15 mg/dl of random calcium and more than 16.45 mg/l of random oxalate were indicative of hypercalciuria and hyperoxaluria, respectively, in the 24-h urine. In addition, we found that the presence of less than 183 mg/l of random citrate was indicative of the presence of hypocitraturia in the 24-h urine. Using the proposed values, screening for hypercalciuria, hyperoxaluria, and hypocitraturia can be performed with a random urine sample during fasting with an overall sensitivity greater than 86%.

The objective of the study is to compare the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) and mini-percutaneous nephrolithotomy (MPCNL) in treating renal stones sizing 15-25 mm in infants <3 years. Forty-six infants with renal stones sizing 15-30 mm were treated by either ESWL (22 renal units in 22 infants) using Dornier compact delta lithotripter or MPCNL (25 renal units in 24 infants) using 14F-18F renal access under general anesthesia. The operation time, stone-free rate, re-treatment rate, and complications between the two groups were compared with the χ(2), Mann-Whitney U, and Student's t tests. No significant differences in mean age and stone size were observed between the two groups. The 1- and 3-month postoperative stone-free rates were 84 and 96% in MPCNL group and were 31.8 and 86.4% in ESWL group. The re-treatment and complication rates were significantly higher in ESWL group than in MPCNL group (50 vs. 12%, P = 0.004; 16.0 vs. 45.5%, P = 0.028). The stone recurrence rate was similar between the two groups. No significant changes of serum creatinine (Cr) level and glomerular filtration rate were observed in both groups. In conclusion, MPCNL is an effective and feasible alternative monotherapy for large renal stones (15-25 mm) in infants, with a higher stone-free rate and a lower complication rate when compared with ESWL.

This investigation highlights the establishment of a real patient kidney stone library utilizing Fourier transform-infrared spectroscopy with a diamond attenuated total reflection accessory (FT-IR ATR) and the construction of a standard FT-IR ATR (sFTIRATR) library using OMNIC spectral math arithmetic operations for kidney stone analysis. This is necessary because reference spectra in commercial libraries provided with specialized software are usually complied using synthesized crystalline compounds which can exhibit changes in intensity, position and/or characteristic profile of reflectance bands when compared with authentic biological stone compositions. Currently, there is no published literature for the Republic of Ireland (RoI) on stone type and prevalence. The results obtained from the establishment of the real patient kidney stone library were a representative selection of kidney stones found in the population, and thereby provided an accurate picture of the present epidemiology of kidney stones in the RoI. The results of 188 patients were compared with those from our newly constructed sFTIRATR library and existing methods, namely wet chemical analysis, and FT-IR ATR utilizing an ATR algorithm and potassium bromide search libraries. We found that for the optimum quantitative analysis of kidney stone mixtures, FT-IR ATR spectroscopy utilizing a standard FT-IR ATR library, supported by a real patient kidney stone library, applying library searching accurately provides the molecular and crystalline species of stone constituents present in an unknown kidney stone sample, providing some predicative value in diagnosing medical conditions. Our data suggest that the epidemiology for nephrolithiasis in the RoI is similar to other Western nations.

We have tested the relative electrophoretic mobility of osteopontin (OPN) isolated from urine obtained from normal individuals (NU) against similar samples derived from the urine of stone formers (SFU) using high-resolution isoelectric focusing (isoelectric point, pI range 3.5-4.5) in 2D electrophoresis, with Western blot detection. We also report the results from competitive ELISA analyses of these samples. We demonstrated that human urinary OPN has a discrete four band separation pattern that conforms to four previously documented OPN isoforms. The lower two M(r) isoforms migrate to a greater degree toward the acidic end of the gel than do the higher two M(r) isoforms. Densitometry of the signal reveals significant difference in the migration pattern of OPN from SFU as compared to that from NU based on an analysis of the spot intensities grouped in 0.1 pI unit increments. A novel method for the calculation of a weight-averaged pI based on the relative signal strength in an OPN 2D Western blot was developed. The analysis revealed a significantly increased weight-averaged pI values for the higher M(r) forms of OPN in the stone former compared to normal population. Additionally, alkaline phosphatase-treated NU samples resulted in a significant average pI shift of 0.05 units in the alkaline direction, suggesting that a decrease in the average degree of phosphorylation could be responsible for the difference between NU and SFU pI.

The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4 cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p > 0.05). The mean operation time was 138.40 ± 51.19 (range 70-240) min in LPL group as compared to 57.92 ± 21.12 (range 40-110) min in PNL group (p < 0.0001). There was one (3.8%) open conversion in the LPL group due to dense perirenal adhesions making the dissection difficult. The ureteropelvic junction (UPJ) obstruction concomitant to pelvic stones was successfully repaired laparoscopically in two cases. The mean drop in postoperative hemoglobin level was 0.9 ± 0.6 (range 0-2) g/dl in LPL group and 1.7 ± 1.1 (range 0-4) g/dl in PNL group (p = 0.024). Hospitalization was significantly shorter in PNL than LPL group (p = 0.0001). Stone-free rates were similar. Laparoscopic pyelolithotomy is associated with a longer operation time, is more invasive, and requires more skills when compared to PNL. However, LPL is associated with less blood loss. Laparoscopic pyelolithotomy is indicated for congenitally anomalous kidneys and especially in patients with concomitant UPJ.

Copaifera langsdorffii Desf. commonly known as "copaíba", produce a commercially valuable oil-resin that is extensively used in folk medicine for anti-inflammatory, antimicrobial and antiseptic purposes. We have found the hydroalcoholic extract of this plant leaf has the potential to treat urolithiasis, a problem affecting ~7% of the population. To isolate the functional compounds C. langsdorffii leaves were dried, ground, and macerated in a hydroalcoholic solution 7:3 to produce a 16.8% crude extract after solvent elimination. Urolithiasis was induced by introduction of a calcium oxalate pellet (CaOx) into the bladders of adult male Wistar rats. The treated groups received the crude extract by oral gavage at 20 mg/kg body weight daily for 18 days. Extract treatment started 30 days after CaOx seed implantation. To monitor renal function sodium, potassium and creatinine concentrations were analyzed in urine and plasma, and were found to be in the normal range. Analyses of pH, magnesium, phosphate, calcium, uric acid, oxalate and citrate levels were evaluated to determine whether the C. langsdorffii extract may function as a stone formation prevention agent. The HPLC analysis of the extract identified flavonoids quercitrin and afzelin as the major components. Animals treated with C. langsdorffii have increased levels of magnesium and decreased levels of uric acid in urinary excretions. Treated animals have a significant decrease in the mean number of calculi and a reduction in calculi mass. Calculi taken from extract treated animals were more brittle and fragile than calculi from untreated animals. Moreover, breaking calculi from untreated animals required twice the amount of pressure as calculi from treated animals (6.90 ± 3.45 vs. 3.00 ± 1.51). The extract is rich in flavonoid heterosides and other phenolic compounds. Therefore, we hypothesize this class of compounds might contribute significantly to the observed activity.

The aim of this study is to investigate the impact of the intentional ureteral stenting on the success rate of calculus extraction by second ureteroscopy, when the initial ureteroscopy failed. We prospectively enrolled 512 patients with ureteral calculi who underwent ureteroscopies from April 2005 to May 2011. The patients with failed initial ureteroscopies were classified into two groups depending on the stent type: the Double-J stent and the ureteral catheter group. The secondary ureteroscopies were performed in a short period (3-22 days). Data were abstracted on stone size, location, patient demographics, outcome and complications. A total of 453 patients had success after the initial ureteroscopy and the success rate was 88.5%. Of the 59 failed patients, 40 were managed by reureteroscopy with Double-J stent placement and 19 with ureteral catheters. There were no statistically significant differences between patients in Double-J stent and ureteral catheter group in the aspects of age, primary stone size, gender, stone location and stone-free rate [39/40 (97.5%) versus 19/19 (100%), p > 0.05]. Moreover, the mean stents retaining period before the second ureteroscopy was significantly shorter in the ureteral catheter group, when compared with the Double-J stent group (3.9 versus 16.9 days, p < 0.01). The complications were moderate and not significantly different between the two groups (p > 0.05). Indwelling a ureteral stent leads to a high subsequent success rate for second ureteroscopy following an initial failed procedure. In addition to Double-J stent, the ureteral catheter stent was an effective alternative with shorter retaining period, especially for impacted stones.

The effects of aqueous and ethanolic extracts of Costus igneus (stem) and isolated compounds lupeol and stigmasterol on calcium oxalate urolithiasis have been studied in male albino Wistar rats. Ethylene glycol feeding resulted in hyperoxaluria as well as increased renal excretion of calcium and oxalate. The increased deposition of stone-forming constituents in the urine, serum, and kidney homogenate of urolithic rats was significantly (p < 0.05) lowered by treatment using aqueous and ethanolic extracts of C. igneus (stem), and isolated compounds lupeol and stigmasterol. The calcium oxalate crystal deposition in the kidney was significantly greater in ethylene glycol-induced urolithic rats. After administration of aqueous and ethanolic extract of C. igneus, the deposition of calcium and oxalate was significantly lowered. Treatment with lupeol and stigmasterol significantly reduced the deposition of calcium and oxalate in the kidney, and also in the blood serum; the lipid profile serum total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels at 50 and 100 mg/kg were significantly (p < 0.05) lowered in urolithiatic rats. From this study, we conclude that both the treatments with aqueous and ethanolic extract of C. igneus (stem) and isolated compounds lupeol and stigmasterol had an inhibitory effect on calcium oxalate urinary stone. Lupeol and stigmasterol were identified from the stem of C. igneus by high-performance thin layer chromatography technique. The isolated compounds were confirmed by Fourier transform infrared (FTIR) and (13)C NMR spectra.