Prevalence of twenty-four hour urine testing in Veterans with urinary stone disease.

OBJECTIVE: The American Urological Association guidelines recommend 24-hour urine testing in patients with urinary stone disease to decrease the risk of stone recurrence; however, national practice patterns for 24-hour urine testing are not well characterized. Our objective is to determine the prevalence of 24-hour urine testing in patients with urinary stone disease in the Veterans Health Administration and examine patient-specific and facility-level factors associated with 24-hour urine testing. Identifying variations in clinical practice can inform future quality improvement efforts in the management of urinary stone disease in integrated healthcare systems. MATERIALS AND METHODS: We accessed national Veterans Health Administration data through the Corporate Data Warehouse (CDW), hosted by the Veterans Affairs Informatics and Computing Infrastructure (VINCI), to identify patients with urinary stone disease. We defined stone formers as Veterans with one inpatient ICD-9 code for kidney or ureteral stones, two or more outpatient ICD-9 codes for kidney or ureteral stones, or one or more CPT codes for kidney or ureteral stone procedures from 2007 through 2013. We defined a 24-hour urine test as a 24-hour collection for calcium, oxalate, citrate or sulfate. We used multivariable regression to assess demographic, geographic, and selected clinical factors associated with 24-hour urine testing. RESULTS: We identified 130,489 Veterans with urinary stone disease; 19,288 (14.8%) underwent 24-hour urine testing. Patients who completed 24-hour urine testing were younger, had fewer comorbidities, and were more likely to be White. Utilization of 24-hour urine testing varied widely by geography and facility, the latter ranging from 1 to 40%. CONCLUSIONS: Fewer than one in six patients with urinary stone disease complete 24-hour urine testing in the Veterans Health Administration. In addition, utilization of 24-hour urine testing varies widely by facility identifying a target area for improvement in the care of patients with urinary stone disease. Future efforts to increase utilization of 24-hour urine testing and improve clinician awareness of targeted approaches to stone prevention may be warranted to reduce the morbidity and cost of urinary stone disease.

Melamine-contaminated milk products induced urinary tract calculi in children.

BACKGROUND: Melamine is an industrial chemical used primarily as plastics stabilizer and fire retardant. On September 11, 2008, melamine-contaminated milk products were reported to be responsible for urinary tract calculi in infants and children in China. This study aimed to investigate the prevalence, lesions, risk factors, clinical features, and management of children fed with the melamine-contaminated milk products. METHODS: A total of 15 577 infants and children fed with the milk products were screened at our hospital. Ultrasonography was performed in all the infants and children. For those found with urinary tract calculion ultrasonography, urnalysis was done. Among them, 846 with detailed data screened from September 17 to 25 were enrolled for further analysis in this study. They were divided into calculus group (326 children) and non-calculus group (520 children) according to the results of ultrasonography. They included 429 boys and 417 girls, aged from 1 month to 5 years (median, 18 months). Their clinical and laboratory data, ultrasonograms, and treatment results were analyzed. RESULTS: Of the 15 577 children screened, 562 (3.61%) had urinary tract calculi. The rate was closely related to the melamine concentration in patients fed with formula. In 846 children with detailed data enrolled in this analysis, weight and head circumference Z scores in the calculus group were lower than those in the non-calculus group (P=0.048, P=0.046). Long duration of formula feeding, high melamine contained formula, and minimal water intake were the risk factors for calculi (P<0.05, respectively). Of 326 children with calculi, 281 had small calculiless than 0.5 cm in diameter, 227 had multiple calculi, and 34 had urinary tract distention. Moreover, diffuse renal lesions, renal failure and ascites were noted in 4, 3 and 2 patients, respectively. After 1-month treatment with sodium bicarbonate and Chinese traditional medicine, calculi disappeared in 49 of 54 outpatients. In 41 inpatients, 5 had calculi removed operatively and 36 had calculi minimized. CONCLUSIONS: Melamine-contaminated milk products induced urinary tract calculi, which have a good response to conservative therapy. Long-term follow-up of infants and children fed with melamine-contaminated milk products is required, and food safety should be supervised increasingly for the health of children.

Calcium oxalate stone formation risk - a case of disturbed relative concentrations of urinary components.

BACKGROUND: Although afflicted with stone formation, urolithiasis patients often present with normal renal excretions of lithogenic and inhibitory substances. In this study, crystal formation is not interpreted as the result of urinary excretions simply exceeding the static limits of normal ranges but rather as the consequence of relative combinations of such parameters which convert urine into becoming potentially lithogenic. Our model embraces different triplet combinations of fundamental urinary risk factors for calcium oxalate (CaOx) crystallization, to characterize different levels of urinary stone formation risk. METHODS: Urinalyses and BONN-Risk-Indices (BRI) were determined for CaOx patients under home conditions, after 1 week of hospitalization, and for healthy controls. The relative urinary concentrations and interdependences of, inter alia, free ionized Ca (Ca2+), bound Ca (Ca b), and oxalic acid (OA) were compared. RESULTS: Three levels of CaOx formation risk can be distinguished: (I): low stone formation risk with an increase in (Ca2+) and concomitant decrease in (Ca b), while (OA) remains almost constant, BRI increases simultaneously; (II) moderate risk at (Ca2+)/(Ca b) approximately 1; and (III) high risk with decrease in (Ca2+)/(Ca b) and simultaneous increase in (OA). CONCLUSIONS: The proposed approach of urinalysis interpretation allows complementary strategy of identification of patterns of disturbed urinary composites leading to calculus formation.

[The role of phytotherapy in pre- and postoperative period in patients with urolithiasis].

Effects of a biologically active food additive Prolit (PT Industry Djamu Borobudur, Indonesia) on the urinary system and metabolic status of patients with urolithiasis were studied. Total urinalysis, biochemical blood and urine tests by 12 indices, ultrasonic investigation of the kidneys, excretory and plain urography were made in 30 patients aged 23 to 70 years (7 females, 23 males). Prolit was given in a dose 1125 mg three times a day for 1-6 months. Prolit decreased hypercalciuria and urinary pH. A trend was observed to lowering of the degree of leukocyturia, hyperuricemia, hyperuria and hyperoxaluria. Urolithiasis recurrences were absent in 10 cases of 12 (83%), in 18 of 20 patients (90%) concrements did not increase in size. Prolit had no side effects.

[Factitious lithiasis: Case report from Western Algeria]. / Identification de lithiase factice: à propos d'un cas observé dans l'Ouest algérien.

A 19-year-old woman with recurrent lithiasis was admitted to the urology department for renal colic. Although radiologic examinations and laboratory tests were negative, the patient regularly brought into consultations small "stones", resembling gravel, that she said had been spontaneously expelled. These 42 samples were the object of a preliminary morphological analysis under a binocular magnifier to detect their particulate components. A non-metabolic origin was suspected from the organoleptic characteristics of their surfaces and sections. In view of the diversity of the materials of these apparently false calculi, methods of precise physical analysis were necessary to ascertain their exact origin and thereby confirm the diagnosis of factitious lithiasis. The use of two methods of physical analysis, infrared spectrophotometry and x-ray diffraction, enabled us to determine their exact chemical and mineralogical composition. The samples claimed to be of urinary origin actually consisted of exogenous products of various compositions. Some samples were made of pure calcite, others of mixed calcite and silicates. Moreover several samples of the patient's first morning urine showed no correlation between the nature of the crystalluria and the composition of these stones. These tests made it possible to direct the clinician towards useful complementary investigations. This strange case represents 0.1% of the urinary calculi analysed in Western Algeria.

Present practice and development of minimally invasive techniques, imaging and training in European urology: results of a survey of the European Society of Uro-Technology (ESUT).

OBJECTIVES: The European Society of Urological Technology (ESUT) conducted a survey in order to assess and record the current trend between European urologists with regard to the application of new technologies in BPH, stone disease and imaging and to identify differences amongst urologists. MATERIAL AND METHODS: A total of 854 certified urologists and residents coming from European countries answered the ESUT survey during the XVIth Annual EAU Meeting in Geneva in 2001. The respondents were classified according to the geographical origin (Eastern, Southern and Northern Europe), year of certification (before 1980, and every 5 years hereafter) and power of the department in beds (less than 25, 26-50, and more than 50) in order to identify any differences in the replies mainly due to economical reasons, national or hospital policy and personal attitudes. RESULTS: According to the replies, in Eastern Europe more procedures related to BPH and stones are performed comparing to Northern and Southern Europe (165.8 versus 77.1 and 100.6/month/department, respectively). However, the Northern European urologists have access to every type of lithotriptor and most of the different minimally invasive treatments for BPH in a higher percentage, followed by the Southern and the Eastern European urologists. The most widespread intracorporeal lithotriptor is the pneumatic and the most common alternative minimally invasive BPH treatment is electrovaporization (80.7% and 45.6%, respectively). Holmium laser is the most frequent choice (40.1%) when the surveyed urologists were asked to choose which of the minimally invasive techniques would like to have access to. In total 79.4% (54.1% alone and 25.3% in collaboration with the radiologists) of the respondents perform the ultrasound studies while the remaining 20.6% declare that only the radiologists do the studies. Of the surveyed urologists, 92.8%, 89.6% and 94.9% are interested in hands-on courses, simulators and live surgery, respectively. CONCLUSIONS: The data obtained from the 854 surveyed European urologists and residents can be used as a tool to highlight the disparity between European countries and to advance training of European urologists.

Sticks and stones: use of acupuncture in extracorporeal shockwave lithotripsy.

BACKGROUND AND PURPOSE: Extracorporeal shockwave lithotripsy (SWL) is an effective noninvasive, outpatient method of stone clearance. In our unit, it is performed using a combination of oral analgesia and intravenous sedation, which allows us to treat to therapeutic levels in the vast majority of our patients. However, we have encountered patients who do not tolerate various elements of the analgesia protocol and thus cannot be treated to full effect. The options for these people are currently limited to either SWL under formal sedation or epidural or general anesthetic or the use of another technique of stone clearance, such as percutaneous nephrolithotomy, which may not be as appropriate, and again necessitates an anesthetic, an inpatient stay, or both. PATIENTS AND METHODS: We describe three patients who had previously failed SWL who received acupuncture in place of standard analgesia prior to the next treatment. RESULTS: All three patients were able to tolerate the procedure better and were treated at a higher level with more shocks than in the previous session. No side effects were noted. CONCLUSIONS: We propose that acupuncture may be considered in patients unable to take standard sedoanalgesia. It is a cost-effective, safe method of inducing sedation with analgesia and had no demonstrable side effects in our series. It provides an attractive alternative to the use of general or regional anesthetics in these patients.

[Drug-induced urinary calculi in 1999]. / Les lithiases urinaires médicamenteuses en 1999.

Drug-induced urolithiasis are observed in 1.6% of the urinary calculi in France. Drugs crystals are identified in two thirds of these stones. Other drugs are responsible for stones which have an apparent metabolic origin (one third of the cases). Stone analysis using physical methods such as infrared spectroscopy is needed to unambiguously identify stones containing drugs. The inquiry is an important step to identify lithogenetic drugs which do not crystallize in the stones. The main substances which were identified in stones over the past decade were indinavir monohydrate (31.4%), triamterene (11.1%), sulphonamides (10.5%) and amorphous silica (4.5%). The main drugs involved in the nucleation and growth of metabolic stones were calcium and vitamin D supplementation (15%) and long-term treatment with carbonic anhydrase inhibitors (8%). Stone prevention is based on drug withdrawal or change in dosage with additional measures including an increase of diuresis and, if necessary, changes in the urine pH.

[Early diagnosis of urolithiasis, assessment of its activity and composition of lithogenic urine salts (Litos system)]. / Ranniaia diagnostika urolitiaza, opredelenie stepeni ego aktivnosti i sostava kamneobrazyiushchikh solei mochi (sistema Litos).

Until recently, the diagnosis of urolithiasis has been made by its complication--an apparent calculus in the kidney. We have discovered the phenomenon of pathological crystallization of urinary lithogenetic salts. Now, basing on this phenomenon we are able to make a diagnosis of urolithiasis at its preclinical stage, i.e. before the appearance of renal calculus, to control the course of urolith formation and to find out composition of the stone. We propose a complex of original techniques (Litos system) which provides pathogenetic diagnosis of urolithiasis.

Trial of Calcium for Preeclampsia Prevention (CPEP): rationale, design, and methods.

The results of ten clinical trials suggest that supplemental calcium may prevent preeclampsia. However, methodologic problems and differences in study design limit the acceptance of the results and their relevance to other patient populations. Many of the trials were conducted in countries where, unlike the United States, the usual daily diet contained little calcium. Moreover, none of the trials has reported the outcome of systematic surveillance for urolithiasis, a potential complication of calcium supplementation. In response to the need for a thorough evaluation of the effects of calcium supplementation for the prevention of preeclampsia in the United States, the trial of Calcium for Preeclampsia Prevention (CPEP) was undertaken at five university medical centers. Healthy nulliparous patients were randomly assigned to receive either 2 g supplemental calcium daily (n = 2295) or placebo (n = 2294) in a double-blind study. Study tablets were administered beginning from 13 to 21 completed weeks of gestation and continued until the termination of pregnancy. CPEP employed detailed diagnostic criteria, standardized techniques of measurement, and systematic surveillance for the major study endpoints and for urolithiasis. The nutrient intake of each patient was assessed at randomization and at 32-33 weeks gestation. This report describes the study rationale, design, and methods.

Urolithiasis in Australian aboriginal children.

Thirty-six Australian Aboriginal children with urolithiasis were reviewed. Males dominated the series. The age distribution ranged from 8 months to 12 years and nearly 70% were 2 years or younger. Thirty-five patients had upper tract stones. Ultrasound was diagnostic in 35 patients and was falsely negative in one. Dietary factors, dehydration and recurrent diarrhoea are incriminated in the aetiology, because ammonium urate and oxalate were the main constituents of the stones. Malformations of the urinary tract were rare and known metabolic disorders were not seen. Chemical dissolution of the stones was found to be a safe and effective adjuvant in the management of urate stones.

Method and reliability of crystallographic stone analysis.

The methods of daily routine analysis of urinary stones in one laboratory, employing a combination of microscopy, spectroscopy, chemistry, and X-ray diffractometry, are described. A methodologic study indicates that these methods are complementary and no one method is sufficient. Quantitative estimates are in general best obtained by X-ray diffraction, whereas qualitative identification of depositional sequence and the quantitative determination of minor constituents must depend on microscopic and chemical methods. Components at a concentration of 1 per cent may be identified whereas those in excess of 5 per cent are rarely overlooked. Concentrations are correct within +/- 10 per cent of stone mass.