Low-Dose Unenhanced Computed Tomography with Iterative Reconstruction for Diagnosis of Ureter Stones

PURPOSE: To study the clinical application of low-dose unenhanced computed tomography with iterative reconstruction technique (LDCT-IR) on renal colic in the emergency department. MATERIALS AND METHODS: We conducted a prospective, single-blinded, randomized, and non-inferiority study. From March 2014 to August 2015, 112 patients with renal colic were included, and were randomized to either LDCT-IR (n=46) or standard-dose unenhanced CT (SDCT) (n=66) groups. The accuracy of urolithiasis diagnosis was the primary endpoint of this study. Radiation dose, size and location of the stone, hydronephrosis, other diseases except urolithiasis, and results of treatment were analyzed between the two groups. RESULTS: The average effective dose radiation of SDCT was approximately four times higher than that of LDCT-IR (6.52 mSv vs. 1.63 mSv, p < 0.001). There was no significant difference in the accuracy of ureteral stone diagnosis between the two groups (LDCT-IR group: 96.97% vs. SDCT group: 98.96%, p=0.392). No significant difference was observed regarding the size and location of a stone, hydronephrosis, and diagnosis of other diseases, except urolithiasis. False negative results were found in two LDCT-IR patients and in one SDCT patient. In these patients, stones were misread as vascular calcification, and were difficult to diagnose because evidence of hydronephrosis and ureteral dilatation was not found. CONCLUSION: LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and was clinically available for the evaluation of renal colic.

The Internalization of Bacillus Calmette-Guerin (BCG) in Bladder Cancer Cells May be Inhibited by Human beta-defensin 3

PURPOSE: To investigate whether secretion of human beta-defensin 3 (HBD-3) is induced by bacillus Calmette-Guerin (BCG) and to determine whether HBD-3 affects BCG internalization in bladder cancer cells. MATERIALS AND METHODS: RTPCR analysis was used to determine whether HBD-3 mRNA increases after incubation with BCG. HBD-3 proteins in 5637 and T24 human bladder cancer cell lines were assayed by ELISA. The internalization rate was evaluated by double immunofluorescence assay and confocal microscopy to test the optimal dose of HBD-3 for BCG internalization. We also investigated the difference in internalization rates and cell viability between recombinant HBD-3 protein, anti-HBD-3 antibody, and HBD-3 plus anti-HBD-3 antibody pretreatments. RESULTS: BCG induced HBD-3 mRNA expression and HBD-3 production dose and time-dependently in bladder cancer cells and affected BCG internalization. Pretreatment with recombinant HBD-3 protein lowered internalization of BCG dose-dependently. Moreover, anti-HBD-3 antibody prevented the effect of HBD-3 on BCG internalization in bladder cancer cells. The internalization rate of BCG pretreated with anti-HBD-3 antibody was higher than that in the control. The BCG internalization rate in cells pretreated with anti-HBD-3 antibody plus recombinant HBD-3 protein was higher than that in the control. BCG decreased bladder cancer cell viability, and anti-HBD-3 antibody prevented the inhibitory role of HBD-3 on the anti-proliferative effects of M. bovis BCG in bladder cancer cells. CONCLUSIONS: Bladder cancer cells produce HBD-3 when they are infected by BCG to defend themselves against BCG internalization, which plays an important role during the initiation and propagation of the immunotherapeutic response in bladder cancer cells.

Predicting Recurrence and Progression of Non-Muscle-Invasive Bladder Cancer in Korean Patients: A Comparison of the EORTC and CUETO Models

PURPOSE: This study aimed to confirm the utility of the European Organization for Research and Treatment of Cancer (EORTC) and the Spanish Urological Club for Oncological Treatment (CUETO) scoring systems and to determine which model is preferred as a prognostic model in Korean patients with non-muscle-invasive bladder cancer. MATERIALS AND METHODS: Between 1985 and 2011, 531 patients who were treated by transurethral resection of bladder cancer were retrospectively analyzed by use of the EORTC and CUETO models. Statistically, we performed Kaplan-Meier survival analysis; calculated Harrell's concordance index, receiver operating characteristic (ROC) curve, and cutoff values; and performed univariate and multivariate Cox proportional hazards regression analyses. RESULTS: For risk of recurrence, with the use of the EORTC model, all groups had statistically significant differences except between the group with a score of 0 and the group with a score of 1-4. With the use of the CUETO model, all groups differed significantly. For risk of progression, with the use of the EORTC model, significant differences were observed between all groups except between the group with a score of 2-6 and the group with a score of 7-13. With the use of the CUETO model, a significant difference was observed between the group with a score of 0 and the other groups. The concordance index of the EORTC and CUETO models was 0.759 and 0.836 for recurrence and 0.704 and 0.745 for progression, respectively. The area under the ROC curve for the EORTC and CUETO models was 0.832 and 0.894 for recurrence and 0.722 and 0.724 for progression, respectively. CONCLUSIONS: Both scoring systems, especially the CUETO model, showed value in predicting recurrence and progression in Korean patients, which will help in individualizing treatment and follow-up schedules.

Febrile Urinary Tract Infection After Prostate Biopsy and Quinolone Resistance

PURPOSE: Complications after prostate biopsy have increased and various causes have been reported. Growing evidence of increasing quinolone resistance is of particular concern. In the current retrospective study, we evaluated the incidence of infectious complications after prostate biopsy and identified the risk factors. MATERIALS AND METHODS: The study population included 1,195 patients who underwent a prostate biopsy between January 2007 and December 2012 at Chung-Ang University Hospital. Cases of febrile UTI that occurred within 7 days were investigated. Clinical information included age, prostate-specific antigen, prostate volume, hypertension, diabetes, body mass index, and biopsy done in the quinolone-resistance era. Patients received quinolone (250 mg intravenously) before and after the procedure, and quinolone (250 mg) was orally administered twice daily for 3 days. We used univariate and multivariate analysis to investigate the predictive factors for febrile UTI. RESULTS: Febrile UTI developed in 39 cases (3.1%). Core numbers increased from 2007 (8 cores) to 2012 (12 cores) and quinolone-resistant bacteria began to appear in 2010 (quinolone-resistance era). In the univariate analysis, core number> or =12 (p=0.024), body mass index (BMI)>25 kg/m2 (p=0.004), and biopsy done in the quinolone-resistance era (p=0.014) were significant factors. However, in the multivariate analysis adjusted for core number, the results were not significant, with the exception of BMI>25 kg/m2 (p=0.011) and biopsy during the quinolone-resistance era (p=0.035), which were significantly associated with febrile UTI. CONCLUSIONS: Quinolone resistance is the main cause of postbiopsy infections in our center. We suggest that further evaluation is required to validate similar trends. Novel strategies to find alternative prophylactic agents are also necessary.

Pilot Study of Low-Dose Nonenhanced Computed Tomography With Iterative Reconstruction for Diagnosis of Urinary Stones

PURPOSE: To evaluate the efficacy of low-dose computed tomography (LDCT) for detecting urinary stones with the use of an iterative reconstruction technique for reducing radiation dose and image noise. MATERIALS AND METHODS: A total of 101 stones from 69 patients who underwent both conventional nonenhanced computed tomography (CCT) and LDCT were analyzed. Interpretations were made of the two scans according to stone characteristics (size, volume, location, Hounsfield unit [HU], and skin-to-stone distance [SSD]) and radiation dose by dose-length product (DLP), effective dose (ED), and image noise. Diagnostic performance for detecting urinary stones was assessed by statistical evaluation. RESULTS: No statistical differences were found in stone characteristics between the two scans. The average DLP and ED were 384.60+/-132.15 mGy and 5.77+/-1.98 mSv in CCT and 90.08+/-31.80 mGy and 1.34+/-0.48 mSv in LDCT, respectively. The dose reduction rate of LDCT was nearly 77% for both DLP and ED (p<0.01). The mean objective noise (standard deviation) from three different areas was 23.0+/-2.5 in CCT and 29.2+/-3.1 in LDCT with a significant difference (p<0.05); the slight increase was 21.2%. For stones located throughout the kidney and ureter, the sensitivity and specificity of LDCT remained 96.0% and 100%, with positive and negative predictive values of 100% and 96.2%, respectively. CONCLUSIONS: LDCT showed significant radiation reduction while maintaining high image quality. It is an attractive option in the diagnosis of urinary stones.

Pilot Study of Low-Dose Nonenhanced Computed Tomography With Iterative Reconstruction for Diagnosis of Urinary Stones

PURPOSE: To evaluate the efficacy of low-dose computed tomography (LDCT) for detecting urinary stones with the use of an iterative reconstruction technique for reducing radiation dose and image noise. MATERIALS AND METHODS: A total of 101 stones from 69 patients who underwent both conventional nonenhanced computed tomography (CCT) and LDCT were analyzed. Interpretations were made of the two scans according to stone characteristics (size, volume, location, Hounsfield unit [HU], and skin-to-stone distance [SSD]) and radiation dose by dose-length product (DLP), effective dose (ED), and image noise. Diagnostic performance for detecting urinary stones was assessed by statistical evaluation. RESULTS: No statistical differences were found in stone characteristics between the two scans. The average DLP and ED were 384.60+/-132.15 mGy and 5.77+/-1.98 mSv in CCT and 90.08+/-31.80 mGy and 1.34+/-0.48 mSv in LDCT, respectively. The dose reduction rate of LDCT was nearly 77% for both DLP and ED (p<0.01). The mean objective noise (standard deviation) from three different areas was 23.0+/-2.5 in CCT and 29.2+/-3.1 in LDCT with a significant difference (p<0.05); the slight increase was 21.2%. For stones located throughout the kidney and ureter, the sensitivity and specificity of LDCT remained 96.0% and 100%, with positive and negative predictive values of 100% and 96.2%, respectively. CONCLUSIONS: LDCT showed significant radiation reduction while maintaining high image quality. It is an attractive option in the diagnosis of urinary stones.

Effectiveness of Flexible Ureteroscopic Stone Removal for Treating Ureteral and Ipsilateral Renal Stones: A Single-Center Experience

PURPOSE: The aim of this study was to evaluate the effectiveness of simultaneous flexible ureteroscopic removal of stones (URS) for ureteral and ipsilateral renal stones and to analyze the predictive factors for renal stone-free status. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent simultaneous flexible URS of ureteral and ipsilateral renal stones from January 2010 to May 2012. All operations used a flexible ureteroscope. We identified 74 cases of retrograde intrarenal surgery and 74 ureteral stones (74 patients). Stone-free status was respectively defined as no visible stones and clinically insignificant residual stones <3 mm on a postoperative image study. Predictive factors for stone-free status were evaluated. RESULTS: The immediate postoperative renal stone-free rate was 70%, which increased to 83% at 1 month after surgery. The immediate postoperative ureteral stone-free rate was 100%. Among all renal stones, 15 (20.3%) were separately located in the renal pelvis, 11 (14.8%) in the upper calyx, 15 (20.3%) in the mid calyx, and 33 (44.6%) in the lower calyx. The mean cumulative stone burden was 92.22+/-105.75 mm2. In a multivariate analysis, cumulative stone burden <100 mm2 was a significant predictive factor for postoperative renal stone-free status after 1 month (p<0.01). CONCLUSIONS: Flexible URS can be considered simultaneously for both ureteral and renal stones in selected patients. Flexible URS is a favorable option that promises high stone-free status without significant complications for patients with a stone burden <100 mm2.

Influence of Overweight on 24-Hour Urine Chemistry Studies and Recurrent Urolithiasis in Children

PURPOSE: We investigated the influence of overweight on 24-hour urine chemistry studies and recurrent urolithiasis (UL) in children. MATERIALS AND METHODS: A retrospective cohort study was designed to assess children who presented with UL at a pediatric institution between 1985 and 2010. We calculated body mass index percentile (BMIp) adjusted for gender and age according to the 2007 Korean Children and Adolescents Growth Chart and stratified the children into 3 BMI categories: lower body weight (LBW, BMIp or =85). Twenty-four hour urine chemistry studies (urine volume, creatinine, calcium, oxalate, citrate, and pH) were compared between the 3 BMIp groups. Univariate and multivariate analyses were performed to assess independent risk factors for stone recurrence. RESULTS: A total of 125 patients were included. The age of the patients in the NBW group was older than that of patients in the LBW group, but 24-hour urine chemistry studies did not differ significantly between the three groups. Mean urine citrate levels were lower (0.273+/-0.218 mg/mg/d vs. 0.429+/-0.299 mg/mg/d, p<0.05) and the incidence of hypocitraturia was higher (81.5% vs. 45.7%, p<0.05)) in the recurrent stone former group. In the univariate analysis, hypocitraturia and acidic urinary pH were risk factors, but in the multivariate analysis, only hypocitraturia was a risk factor for stone recurrence (hazard ratio, 3.647; 95% confidence interval, 1.047 to 12.703). In the Kaplan-Meier curve, the hypocitraturia group showed higher recurrence than did the normocitraturia group (p<0.05). CONCLUSIONS: Unlike in adults, in children, overweight adjusted for gender and age was not associated with 24-hour urine chemistry studies and was not a risk factor for recurrent UL. Hypocitraturia was the only risk factor for UL in children.

Impact of Changing Trends in Medical Therapy on Surgery for Benign Prostatic Hyperplasia Over Two Decades

PURPOSE: Following the introduction of medical therapy for benign prostatic hyperplasia (BPH), we determined the effect of the change in trends in medical therapy on the indication and outcome of surgical intervention for BPH. MATERIALS AND METHODS: We compared the basic characteristics of, weight of resected tissue of, transfusions in, and postoperative complications of patients who underwent surgery between 1985 and 1989 (before the advent of medical therapy for BPH), between 1995 and 1999 (when medical therapy was developed and became widely used as alternative treatment), and between 2005 and 2009 (when medical therapy superseded surgical intervention to become first-line treatment and when combination therapy became widely adopted). RESULTS: At our institution, the mean age and BMI of patients increased over the past two decades (p<0.001). Hypertension, operation history, and other comorbidities also increased significantly (p<0.001, p=0.005, and p<0.001, respectively). The indications for surgery in 1985 to 1989, 1995 to 1999, and 2005 to 2009 were as follows: acute urinary retention in 34.7%, 20.2%, and 15.1% of patients and symptomatic deterioration in 61.1%, 72.3%, and 73.0% of patients, respectively. Prostate volume and the weight of resected tissue increased from 34.4+/-14.5 ml to 61.3+/-32.4 ml and from 7.2+/-6.4 g to 10.8+/-7.6 g, respectively, over two decades. Patients who underwent surgery in 2005 to 2009 had their catheters removed earlier (p<0.001). Secondary hemorrhage within four postoperative weeks and repeat transurethral resection of the prostate within 1 year decreased significantly (p=0.03 and p=0.003, respectively). No statistically significant change in impaired detrusor contractility was found (p=0.523). CONCLUSIONS: Although patients who underwent surgery were older after widespread use of medical therapy for BPH, advancements in surgical techniques have benefitted these patients.

Delayed Presentation of Intravesical Bone Penetration after Pelvic Ring Fracture

Retrograde cystography and computed tomography (CT) are considered the gold standard for investigating bladder and pelvic bone injury. However, these methods can miss extraperitoneal bladder rupture caused by a penetrating bone fragment from a pelvic bone fracture. We experienced a routine conventional cystography and CT scan that failed to identify penetration of the bladder by a bone fragment, which thus delayed optimal treatment. Therefore, different diagnostic methods such as CT cystography or cystoscopy should be considered to rule out penetrating injury by a bony fragment in patients with extraperitoneal bladder rupture.

Evaluation of the Optimal Frequency of and Pretreatment with Shock Waves in Patients with Renal Stones

PURPOSE: Many studies have been carried out to increase the success rate of shock wave lithotripsy (SWL) and to reduce renal injury. We investigated the success rate after one session as well as urine N-acetyl-beta-d-glucosaminidase (NAG) levels for the evaluation of renal injury according to shock wave frequency and pretreatment with low-energy shock waves during SWL. MATERIALS AND METHODS: The study targeted 48 patients with renal stones who had undergone SWL. Patients were sequentially allocated into four groups according to shock wave frequency (60 or 120 shocks/min) and whether pretreatment had occurred. We documented total SWL operating number, success rate after first SWL, urine NAG, compliance, and the total cost for each patient. RESULTS: There were 32 males and 16 females with an average age of 51.6 years. The average stone size was 7.06 mm, and there was no significant difference in stone size between the groups. The data showed that patients treated with a frequency of 60 shocks/min had a lower mean number of SWL sessions, 1.36 sessions for 60 shocks/min and 2.0 sessions for 120 shocks/min, respectively, which was statistically significant (p<0.05). When comparing NAG/creatinin ratios before and after SWL between those with and without pretreatment, there was no significant difference according to pretreatment (p=0.406). CONCLUSIONS: SWL treatment at a frequency of 60 shocks/min yielded better outcomes, such as a lower number of SWL sessions, and had an increased success rate compared with SWL at 120 shocks/min. On the other hand, pretreatment did not impact renal injury. Therefore, SWL treatment at a frequency of 60 shocks/min could improve treatment efficacy more than that for SWL at 120 shocks/min.

Effect of Prostate Biopsy Hemorrhage on MRDW and MRS Imaging

PURPOSE: To retrospectively evaluate the effect of post-prostate-biopsy hemorrhage on the interpretation of magnetic resonance diffusion-weighted (MRDW) and magnetic resonance spectroscopic (MRS) imaging in the detection of prostate cancer. We also investigated the optimal timing for magnetic resonance examination after prostate biopsy. MATERIALS AND METHODS: We reviewed the records of 135 men. All patients underwent prostate magnetic resonance imaging (MRI). The prostate was divided into eight regions according to the biopsy site. Subsequently, we measured hemorrhage on apparent diffusion coefficient (ADC) values and (choline+creatinine)/citrate ([Cho+Cr]/Cit) ratios in the same regions on the MRI. We investigated the effect of hemorrhage at ADC values and (Cho+Cr)/Cit ratios on MRI and the relationship between prostate biopsy results and MRI findings. RESULTS: The mean patient age was 68.7 years and the mean time between biopsy and MRI was 23.5 days. The total hemorrhagic score demonstrated no significant associations with intervals from biopsy to MRI. Higher hemorrhagic scores were associated with higher ADC values, prostate cancer, and noncancer groups, respectively (p<0.001). ADC values were lower in tumors than in normal tissue (p<0.001), and ADC values were inversely correlated with tumor Gleason score in biopsy cores (p<0.001). However, (Cho+Cr)/Cit ratios did not exhibit any association with prostate biopsy results and hemorrhage. CONCLUSIONS: Hemorrhage had no significant associations with the interval from biopsy to MRI. ADC values may help to detect prostate cancer and predict the aggressiveness of cancer; however, it is important to consider the bias effect of hemorrhage on the interpretation of MRDW imaging given that hemorrhage affects ADC values.

Possible Relationship between Metabolic Syndrome Traits and Nephrolithiasis: Incidence for 15 Years According to Gender

PURPOSE: To analyze the independent effect of metabolic syndrome (MS) on nephrolithiasis (NL) despite differences in gender compared with the known lithogenic factors. MATERIALS AND METHODS: From 1995 to 2009, 40,687 Koreans were enrolled in the study and observed for the development of NL at a health promotion center. The examination included anthropometric and biochemical measurements as well as kidney ultrasonography. A student's t-test or chi-square test was used to characterize the participants and a standard Cox proportional hazards model was used to calculate the adjusted odds ratio of lithogenic risk factors in the NL model. RESULTS: The mean age of the study cohort was 44.9 years (range, 13-100 years), and 22,540 (55.4%) of the cohort was male. The incidence of NL was 1.5% (609 participants), with males exhibiting a higher incidence than females (1.9% vs 1.0%, p<0.01). Among the total cohort, MS as well as each trait of MS were risk factors for NL. In males, high body mass index (BMI), high blood pressure, and abnormal glucose metabolism were significant lithogenic factors, whereas in females, lithogenic factors included only high BMI and abnormal glucose metabolism. CONCLUSIONS: MS is a significant lithogenic factor compared with other lithogenic factors. There was a correlated change in the prevalence of MS and NL and MS traits in Korea.

Possible Relationship between Metabolic Syndrome Traits and Nephrolithiasis: Incidence for 15 Years According to Gender

PURPOSE: To analyze the independent effect of metabolic syndrome (MS) on nephrolithiasis (NL) despite differences in gender compared with the known lithogenic factors. MATERIALS AND METHODS: From 1995 to 2009, 40,687 Koreans were enrolled in the study and observed for the development of NL at a health promotion center. The examination included anthropometric and biochemical measurements as well as kidney ultrasonography. A student's t-test or chi-square test was used to characterize the participants and a standard Cox proportional hazards model was used to calculate the adjusted odds ratio of lithogenic risk factors in the NL model. RESULTS: The mean age of the study cohort was 44.9 years (range, 13-100 years), and 22,540 (55.4%) of the cohort was male. The incidence of NL was 1.5% (609 participants), with males exhibiting a higher incidence than females (1.9% vs 1.0%, p<0.01). Among the total cohort, MS as well as each trait of MS were risk factors for NL. In males, high body mass index (BMI), high blood pressure, and abnormal glucose metabolism were significant lithogenic factors, whereas in females, lithogenic factors included only high BMI and abnormal glucose metabolism. CONCLUSIONS: MS is a significant lithogenic factor compared with other lithogenic factors. There was a correlated change in the prevalence of MS and NL and MS traits in Korea.

Predicting the Therapeutic Effect of Extracorporeal Shockwave Lithotripsy by Non-enhanced Computed Tomography in Renal Stones / 대한비뇨기과학회지

PUROSE: To evaluate the value of non-enhanced computed tomography (NECT) as a predictor of renal stone destruction by the use of extracorporeal shock wave lithotripsy(SWL). MATERIALS AND METHODS: The study included 34 patients with a renal stone diagnosed by NECT. The stone location and size, body mass index(BMI), Hounsfield units(HU) density, and skin-to-stone distance(SSD) were assessed. The SSD was calculated by averaging three distances from the skin to the stone(at 0degree, 45degree and 90degree angles) on NECT. The HU density was evaluated by measuring three different areas of the stone on NECT. Failure of disintegration was defined as no fragmentation or expulsion of the stone after three sessions of SWL. RESULTS: Failure of disintegration was observed in 14 patients(41.2%). The mean SSD was 8.70+/-0.75cm for patients where SWL failed to disintegrate the stone(failure group) versus 6.90+/-1.19cm for patients where SWL successfully disintegrated the stone(success group)(p0.05). By multivariate analysis, SSD was found to independently decrease the stone fragmentation rate of a renal stone(p=0.013; odds ratio=6.219). CONCLUSIONS: The SSD on NECT and BMI may predict the success of SWL for a renal stone.

Eta-1/Osteopontin Genetic Polymorphism is Associated with Urolithiasis in Koreans / 대한비뇨기과학회지

PURPOSE: Osteopontin(OPN) is one of the major non-collagenous bone matrix proteins produced by osteoblasts and osteolclasts, and it is also involved in the pathogenesis of urolithiasis. Single nucleotide polymorphisms(SNPs), as a tool for searching for the genetic markers of disease, have a large role in investigating the genetic markers of complex human diseases. The aim of this study is to investigate the association with this SNP at position nucleotide 9250(C-->T) in the OPN gene and the susceptibility to urolithiasis. We also compared the allele frequency of Koreans with those of Americans and Japanese. MATERIALS AND METHODS: A total of 161 urolithiasis patients and 104 healthy controls were studied. The SNPs located at position 9520 in the OPN gene were genotyped using restriction fragment length polymorphism(RFLP). The wild-type sequence contains a C while the polymorphism variant is a T(C-->T), which results in the appearance of an Alu I restriction site. RESULTS: The gene frequencies of C/C, C/T and T/T at position 9250 on the Eta-1/osteopontin gene in urolithiasis patients were 10.6%, 36.6% and 52.8%, respectively, compared with 6.7%, 27.9% and 65.8%, respectively, in the controls(p>0.05). The allele frequencies of C and T at this position in the urolithiasis patients were 28.9 and 72.1, respectively, whereas those in the controls were 20.7 and 79.3, respectively,(p<0.05). The allele frequencies found in the present study were compared with those coding SNPs described in the USA database; 60 and 39(USA) vs 20.7 and 79.3 (Korea), respectively(p<0.05). CONCLUSIONS: Those findings suggest there is no association of with Eta-1/osteopontin genetic polymorphism, but the allele frequencies were significantly associated with urolithiasis patients. We also observed difference of allele frequencies in our controls and in the USA controls and these differences may be caused by a difference in the incidence of urolithiasis patients between the two countries.

The Effect of Tamsulosin on Expulsion of Ureteral Stones after Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the effect of tamsulosin on expulsion of ureteral stones after extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: Seventy-six patients(39 with upper ureteral stones and 37 with lower ureteral stones) treated with ESWL for stones <10mm were randomly divided into two groups. Tamsulosin(0.2mg orally once daily) was administered to group 1; group 2 received no medications. All patients were evaluated with respect to the number of episodes of ureteral colic, the expulsion rates of stones after ESWL, and the mean number of sessions of ESWL until complete expulsion of stones. RESULTS: The complete expulsion rates of upper and lower ureteral stones did not differ significantly between groups 1 and 2 during each session of ESWL; however, the mean session of ESWL was lower in group 1 than in group 2. For upper ureteral stones, 1.8 sessions were necessary per patient in group 1, while 2.3 sessions were required for the patients in group 2(p=0.039). For lower ureteral stones, 2.0 sessions were necessary per patient in group 1, while 2.9 sessions were required for the patients in group 2(p=0.032). There were significant decreases in the number of episodes of pain in group 1 with lower ureteral stones(p=0.014). There were no side effects associated with tamsulosin. CONCLUSIONS: The use of tamsulosin in the treatment of upper and lower ureteral stones after ESWL can decrease the mean number of sessions of ESWL and the number of episodes of pain, but cannot improve the expulsion rate. Further research regarding the cost-effectiveness of tamsulosin after ESWL is needed.

Metabolic Risk Factors and Treatment Effects of Extracorporeal Shock Wave Lithotripsy in the Medullary Sponge Kidney with Nephrocalcinosis / 대한비뇨기과학회지

PURPOSE: The medullary sponge kidney(MSK) is a congenital anomaly of the renal medulla characterized by fusiform and cystic dilatation of the collecting tubules confined to the renal pyramids. The aim of this study is to evaluate the metabolic risk factors and effect of extracorporeal shock wave lithotripsy(ESWL) and complications in an MSK with nephrocalcinosis. MATERIALS AND METHODS: We compared stone metabolic studies between 45 patients with MSK and 279 non-MSK patients. We evaluated the effect of ESWL for MSK. Group A patients received ESWL and follow-up within 3 months and Group B patients had a period of cessation for more than 6 months. The frequency of complications between group A and group B patients was compared. RESULTS: There were no statistically differences between the MSK group and non-MSK group of patients in the stone metabolic studies. Among the 45 patients with MSK, 26(58%) had one or several of the following metabolic disorders: hypocitraturia(36.7%), hypercalciuria(18.3%), hyperoxaluria(16.3%), hyperuricosuria(16.3%), low urine volume(12.4%). The percentage of patients that experienced more than 75% of a reduction of stone burden on plain films was 48.8%, 25?75% of the reduction was 35.6%, and less than 25% of the reduction was 15.6%. The most common complication was renal colic(17.7%). Renal colic and stone re-growth was shown to have a more significant association with group B patients as compared to group A patients. CONCLUSIONS: ESWL reduced the stone burden more than 75% in 48.8% of MSK patients with nephrocalcinosis, and prevented flank pain, and obstructive uropathy. Therefore, we plan to develop treatments that are more effective.

The Relationship between Obesity and the Risk Factors of Urolithiasis / 대한비뇨기과학회지

PURPOSE: The aim of this study was to assess the relationship between obesity and the metabolic risks factors for urolithiasis. MATERIALS AND METHODS: We performed stone metabolic studies on urolithiasis patients (306 men, 175 women) who were without medical or dietetical pretreatment between January 2002 and July 2006, and we classified them as being of low weight (body mass index; BMI: or =30, 16 men, 9 women). RESULTS: There was a statistically significant difference in the prevalence of obesity between the urolithiasis group and the control group (p<0.05). The correlation analysis revealed a significant positive relationship between BMI and the serum calcium, uric acid, urinary calcium, uric acid and citrate, and there was an inverse relationship between BMI and urinary pH (p<0.05). The frequency of urinary stone risk factors was increased with BMI (p<0.05). CONCLUSIONS: The positive correlation between BMI and the risk factors for urolithiasis was revealed. Therefore, we need to prospectively study the relationship between obesity and the risk factors, which will help to understand the mechanism of urolithiasis about obesity.

Clinical Significance of Hypocitraturia in Patients with Nephrolithiasis / 대한비뇨기과학회지

PURPOSE: Hypocitraturia is cited as one of the risk factors promoting stone formation or recurrence of nephrolithiasis. We estimated the relationship between hypocitraturia and other metabolic abnormalities, such as hypercalciuria, hyperuricosuria and hyperoxaluria. The effects of potassium citrate medication were also investigated. MATERIALS AND METHODS: We selected 706 renal stone patients with hypocitraturia (<320mg/day), who had received extracorporeal shock wave lithotripsy (ESWL) treatment, and examined the relationship between hypocitraturia and other metabolic abnormalities according to sex and age. We also examined the increment effect of urinary citrate and stone-free rate following potassium citrate (Urocitra(R)) medication. RESULTS: Complicated hypocitraturia (coexistence with other metabolic abnormalities) was found in 332 of the 706 patients (47.0%). Of the 706 patients, 242 (34.3%), 112 (15.9%) and 33 (4.7%) had hyperoxaluria, hyperuricosuria and hypercalciuria, respectively. Complicated hypocitraturia was higher in the male than female subjects, and was statistically significant (50.4% vs. 39.8%). In 287 (77%) of the 373 patients who received potassium citrate treatment, the urinary citrate level was increased. The mean urinary citrate level was significantly increased (142.5 vs. 336.2 mg/day) (p<0.01), but the stone free rate was not following the citrate treatment. CONCLUSIONS: Potassium citrate was effective in increasing the urinary citrate level. However, prophylactic effects of potassium citrate against recurrent nephrolithiasis must be proved by appropriate comparative studies.