Results of urinary dissolution therapy for radiolucent calculi

Purpose In this paper we present our experience with dissolution therapy of radiolucent calculi. Materials and Methods This was a retrospective analysis of patients who were offered urinary dissolution therapy between January 2010 and June 2011. Patients were treated with tablets containing potassium citrate and magnesium oxide. Partial dissolution was defined as at least a 50% reduction in stone size. Patients with complete or partial dissolution were classified in the successful dissolution group. Patients with no change, inadequate reduction, increase in stone size and those unable to tolerate alkali therapy were classified as failures. Patient sex, stenting before alkalinization, stone size, urine pH at presentation and serum uric acid levels were analyzed using Fisher t-test for an association with successful dissolution. Results Out of 67, 48 patients reported for follow up. 10 (15%) had complete dissolution and 13 (19%) had partial dissolution. Alkalinization was unsuccessful in achieving dissolution in 25 (37%). Stenting before alkalinization, patient weight (< 60 vs. > 75kg) and serum uric acid levels (≤ 6 vs. > 6) were the only factors to significantly affected dissolution rates (p = 0.039, p 0.035, p 0.01 respectively). CONCLUSIONS A policy of offering dissolution therapy to patients with radiolucent calculi had a successful outcome in 34% of patients. .

Effect of Rowatinex on calculus clearance after extracorporeal shock wave lithotripsy

Our aim was to evaluate the effect of Rowatinex, an essential oil preparation of terpenic type, on kidney calculi clearance after extracorporeal shock wave lithotripsy [SWL]. A randomized controlled trial was performed at Hormozgan Hospital in Bandar Abbas, Iran, on 100 patients with 10-mm to 20-mm kidney calculi. They underwent SWL, and then, they were randomly assigned into 2 groups to receive Rowatinex, 100 mg, 3 times per day, or placebo after SWL. The patients were followed up with plain abdominal radiography, ultrasonography, and excretory urography [if required], 2 and 4 weeks postoperatively. Two weeks following SWL, 6 [12%] and 9 [18%] patients in the Rowatinex and control groups had fragmented calculi without clearance, 26 [52%] and 24 [48%] had less than 50% clearance, 9 [18%] and 15 [30%] had more than 50% but not total clearance, and 9 [18%] and 2 [4%] patients were stone free, respectively. Rowatinex had a significant effect on the stone-free rate [P=.02]. Four weeks post-SWL, 3 [7.3%] and 7 [14.6%] other patients in the Rowatinex and control groups became stone free, respectively. Overall, Rowatinex had no significant effect on the stone-free rate [P=.46]. No complications or differences between the two groups in symptoms and sign we reported. Rowatinex does not have a significant effect on clearance rate of kidney calculi after SWL. However, it can accelerate calculus passage after 2 weeks, and it does not have any significant adverse effects

Chemical composition of urinary tract stones at the University Hospital of the West Indies / Composición química de las piedras del tracto urinario en el Hospital Universitario de West Indies

Urinary tract stones occur frequently with the incidence being about one to fifteen per cent worldwide. Patients may be asymptomatic or sometimes they may present with haematuria. Severe lumbar pain radiating to the loin requiring immediate analgesic treatment may occur. Stones generally consist of organic and inorganic material. The organic material may be present in the nidus and can contribute up to about 2.5% of the total weight. Inorganic minerals make up the bulk of the stone. Data are presented for the inorganic minerals present in the stones seen at the University Hospital of the West Indies over a 25-year period. Six hundred and forty-one (445 males and 196 females) stones were analyzed by routine chemical methods. Calcium was the main constituent, being seen in 93.9% of the stones. This was followed by oxalate 60.1%, urate 37.0%, bicarbonate 16.5% and magnesium 8.6%. There were four cystine containing stones. Treatment includes medical management for the underlying cause and surgical methods for the removal of the stones. Chemical methods of analysis of the stones has its limitations and should be replaced by more sophisticated methods eg X-ray diffraction crystallography which would give more accurate details of the structure of the stones.

Las piedras del tracto urinario se presentan frecuentemente con una incidencia de aproximadamente uno a quince por ciento a nivel mundial. Los pacientes pueden ser asintomáticos o presentarse con hematuria. Puede producirse dolor lumbar severo que se irradia a toda la región lumbar y que requiere tratamiento analgésico inmediato. Las piedras generalmente están formadas por material orgánico e inorgánico. El material orgánico puede estar presente en el nido y puede contribuir hasta aproximadamente 2.5% del peso total. Los minerales inorgánicos constituyen la mayor parte de las piedras. Se presentan datos de los minerales inorgánicos presentes en las piedras vistas en el Hospital Universitario de West Indies en un periodo de 25 años. Seiscientos cuarenta y una (445 varones y 196 hembras) piedras fueron analizadas mediante métodos químicos de rutina. El calcio fue el constituyente principal, observándosele en el 93.9% de las piedras. El mismo fue seguido por el oxalato (60.1%), el urato (37.0%), el bicarbonato (16.5%) y el magnesio (8.6%). Había cuatro cistinas que contenían piedras. El tratamiento incluye el manejo médico de la causa subyacente y los métodos quirúrgicos para la eliminación de las piedras. Los métodos químicos de análisis de las piedras tienen sus limitaciones y deben reemplazarse por métodos más sofisticados, tales como la cristalografía por difracción de rayos X. que daría detalles más exactos de la estructura de las piedras.

[ effectiveness of oral capsule prepared from the inner layer of hen's crop in treatment of urolithiasis]

Urolithiasis as the most common disorder of urinary tract, could be treated and prevented by different methods .In this study according to the traditioial medicine recommendations, the powder prepared from inner layer of hell's crop, in the form of oral capsules [druge] were used for elimination of urinary stones. This is a clinical trial study. In this study 60 urolithiasis patients, were diagnosed by urologist were studied in two equal case and control groups. All the patients were treated classically for urolithiasis whereas the case group was also treated by druge and control group used placebo. In both groups, the effectiveness of treatment was assessed by clinical indexes, and radiology and sonography evaluations. Data was analyzed using Man Whitney U and Kruskal Wallis tests. The results of this study showed that, there were no significant differences between case and control groups for rate and duration time of stone elimination. In spite of traditional medicine comments, the usage of inner layer of hen's crop was not effective on solubility, elimination and treatment of urolithiasis

Efeitos do tratamento cronico de ratos com o extrato de Chamaecrista nictans Irwin and Barneby na eliminacao de calculos renais / Effects of chronic treatment of rats with Chamaecrista nictans Irwin and barneby on eliminition of renal calculli

Chamaecrista nictans subs. patellaria var. ramosa Irwin and Barneby (Cassia patellaria DC), tambem conhecida pelo nome popular de peninha, e uma erva daninha originaria do Brasil cujo cha e utilizado na medicina popular para eliminacao de calculos renais. O ensaio farmacologico foi feito a fim de testar o efeito do tratamento cronico com extrato fluido da planta, na urolitiase experimental em ratos atraves da inducao de calculo vesical. Os resultados indicam que o extrato fluido da peninha nao apresentou atividade antilitiasica no modelo experimental testado

Activity of certain fractions of Tribulus terrestris fruits against experimentally induced urolithiasis in rats.

An ethanolic extract of the fruits of T. terrestris showed significant dose dependent protection against uroliths induced by glass bead implantation in albino rats. On subsequent fractionation of the ethanol extract, maximum activity was localised in the 10% aqueous methanol fraction. It provided significant protection against deposition of calculogenic material around the glass bead. It also protected leucocytosis and elevation in serum urea levels. Further, fractionation lead to decreased activity. This could be either due to loss of active compounds during fractionation, or the antiurolithiatic activity of T. terrestris being a combined effect of several constituents present in the methanolic fraction.

Effect of citrate feeding on free radical induced changes in experimental urolithiasis.

Feeding calculi producing diet (CPD) to rats for 4 weeks produced calcium oxaltate stones. Supplementation of sodium citrate to CPD (c-CPD) prevented stone formation. Except oxalate, the excretion of calcium, phosphorus and magnesium was restored to normal in c-CPD fed rats. The CPD fed rats exhibited increase in glycolic acid oxidase (GAO) and lactate dehydrogenase (LDH) activities and only GAO activity was partially restored in c-CPD fed rats. Kidney sub-cellular fractions of calculi producing diet (CPD) fed rats showed increased susceptibility for lipid peroxidation in presence of promotors. Antioxidant enzyme activities of superoxide dismutase (SOD), catalase and glutathione peroxidase and antioxidant concentrations of reduced glutathione, total thiols, ascorbic acid and vitamin E were significantly decreased while the xanthine oxidase activity, and concentrations of hydroxyl radical, diene conjugates and hydroperoxides were significantly increased in CPD fed rats. The susceptibility to lipid peroxidation, activities of antioxidant enzymes, and the concentration of antioxidants were not normalized by feeding citrate.

Litíase experimental em ratos: avaliaçäo do tratamento com diuréticos tiazídicos e/ou citrato de potássio / Experimental lithiasis in rats: evaluation of treatment with thiazidic diuretics and/or potassium citrate

Este trabalho tem como objetivo avaliar o efeito dos diuréticos tiazídicos e/ou citrato de potássio no crescimento de cálculos induzidos experimentalmente em ratos com cristais de oxalato de cálcio na bexiga. Foram utilizados ratos Wistar, machos, com peso entre 250 e 300g, alimentados com dieta padräo e com acesso livre a água. O protocolo, com duraçäo de 42 dias, constou de duas fases: inicial (cirurgia para introduçäo de corpo estranho na bexiga) e final (cirurgia com retirada dos cálculos), durante as quais foram coletadas as urinas de 24h para dosagens bioquímicas (creatinina, cálcio, ácido úrico, fósforo, sódio e potássio); na fase final, foram incluídas dosagens plasmáticas (creatinina, cálcio e ácido úrico). Os grupos foram dividios de acordo com a droga utilizada; G1, controle normal; G2, SHAM (cirurgia sem corpo estranho); G3, oxalato de cálcio-OxCa (animais com cálculos näo tratados); G4, hidroclorotiazida-HCTZ (dose 5mg/Kg/dia, v.o.); G5, clortalidona-CLOR (dose 5mg/Kg/dia, v.o.); G6, amilorida + hidroclorotiazida-AML + HCTZ (dose de 0,4mg/2,0mg/Kg/dia, respectivamente, v.o.); G7, citrato de potássio-CIT.K (na dose de 3mEq/Kg/dia, v.o); G8, CIT.K + HCTZ (dose de 3mEq/5mg/Kg/dia, respectivamente, v.o.). Observamos variabilidade de resultados com relaçäo às dosagens bioquímicas, o que dificultou as análises desses parâmetros. O ritmo do crescimento dos cálculos foi menor nos grupos tratados , com exceçäo do grupo CLOR, quando comparado com o grupo OxCa, sendo significante (p < 0,05) as diferenças entre o OxCa e o grupo CIT.K (X = 19,6 vs 5,7). O aparecimento de cálculos satélites foi menor nos grupos tratados, porém sem diferenças significantes. Esses dados sugerem que o citrato de potássio foi eficiente em diminuir o ritmo de crescimento dos cálculos pré-formados em ratos, provavelmente devido ao seu tipo de açäo (inibiçäo da cristalizaçäo

Biochemical changes in kidneys of normal and stone forming rats with L(+)-tartrate.

Influence of L(+)-tartrate was studied on certain enzymes, protein bound carbohydrates and lipids in the renal tissues of experimentally induced stone forming rats. The elevation in kidney LDH was moderate in the stone forming groups while tartrate had no effect. The significant increases in the activities of (Na+, K+)- and (Ca2+)-ATPases in the calculogenic group was lowered to that of normal level with tartrate administration. Acid phosphatase activity was significantly lowered in the tartrate treated groups. The significant reduction in phospholipids and elevation in sialic acid levels during stone formation are suggestive of minor alterations in the cellular structure. The changes in the transport ATPases is likely to affect the transport mechanism of nutrients and ions.

Efectos beneficiosos del glicerofosfato de magnesio como tratamiento de la litiasis oxalocálcica en pacientes hipercalciúricos / Beneficial effect the magnesium salt of phosphoglyceric how treatment the lithiasis calcium oxalate in patients hypercalciuria

Para ensayar una nueva alternativa terapéutica de la hipercalciuria con litiasis oxalocálcica recidivante, se utilizó la sal magnésica del ácido glicerofosfórico (GPMg) en 24 pacientes (12 varones y 12 mujeres) con 36 años de edad promedio (rango: 20-63). El tipo de la hipercalciuria fue absortiva (A) o tabular (T) (n= 14 y 10 respectivamente). La dosis de PGMg fue de 3g diarios divididos en dos tomas. Se efectuaron controles clínicos a los 1-3 meses (período I), a los 4-6 meses (período II), a los 7-12 meses (período III). a los 12-18 meses (período IV) con determinaciones de Ca, P, Mg, Na, K, NH4, sulfato creatinina, ácidos úricos, cítrico y oxálico, pH y volumen urinario. Se calculó la saturación urinaria en términos de energía libre para la cristalización (DG) de oxalato de calcio, brushita, estruvita, ácido úrico y urato de sodio por medio del programa de computación EQUIL-AT. En un subgrupo de 7 pacientes (5 A y 2 T) se determinaron además la parathormona (PTH) sérica y el AMP cíclico en suero y orina en condiciones basales y al mes de tratamiento con GPMg. La calciuria disminuyo significativamente en todos los períodos considerados de ambos grupos (A y T). La diuresis se incrementó progresivamente. Otros componentes urinarios no presentaron cambios significativos. La DG para el oxalato de calcio y la brushita cayeron significativamente en todos los períodos. No hubo modificación en la saturación urinaria de los restantes compuestos. No hubo evidencias de hiperparatiroidismo secundario en el subgrupo controlado con determinación de PTH sérica y AMPc nefrógeno. En 7 pacientes tratados durante dos años hubo sólo un episodio de recurrencia. La tolerancia del GPMg fue excelente.