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2263 BIOCHEMICAL AND MICROANALYSIS OF PEDIATRIC URINARY CALCULI
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THE JOURNAL OF UROLOGY姞
mean serum uric acid, calcium, and phosphorus levels were 7.3⫹/ ⫺3.5, 9.5⫹/⫺1.4, and 3.8⫹/⫺1.0 mg/dL, respectively. In univariate analysis hyperuricemia (p⫽0.008), hypercalcemia (p⫽0.012), diabetes mellitus (p⬍0.001), hypertension (p⫽0.006), and diffuse large B cell lymphoma (p⫽0.029) were more common in stone formers than nonstone formers. In multivariate analysis, diabetes mellitus, hyperuricemia, and hypercalcemia at time of chemotherapy predicted development of upper tract stone. CONCLUSIONS: To our knowledge we report for the first time the incidence of nephrolithiasis in lymphoproliferative and myeloproliferative patients who have undergone chemotherapy. Moreover, we identified risk factors that may assist oncologists in identifying patients who might require medical therapy to prevent upper tract stone formation.
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
Dahlite, 4 (8.7%) Brushite, 3 (6.5%) Struvite, while 2 (4.3%) stones were Cystine. Whewellite stones were significantly higher (P⬍0.05) in children above 5 years while Weddellite stones were predominant in children ⱕ 5 years. Among the 22 analyzed heavy metals and trace elements by ICP-AES, 7 elements were found significantly high with different concentrations in stones of children ⱕ5 and ⬎5 years of age (P⬍ 0.05). In children below 5 years, Ba, Cu, K, Mn, and Na, were significantly higher in their stones than those of children over 5 years. Ca and Se were significantly higher in stones of children older (⬎ 5 years) than those ⬍ 5 years. CONCLUSIONS: Pediatric urinary stones contain heavy metals and trace elements in different concentrations. Most of the stones are mixed and the common components are Whewellite and Weddellite. Cystine stones are rare. Excess Na, and K in stones from children below 5 years, may indicate possible relation between stone formation, kidney maturation and nutrition.Heavy metals may be due to environmental pollution or food contamination or maternal factors. Source of Funding: None
Urodynamics/Incontinence/Female Urology: Urodynamics Testing Moderated Poster Session 85 Wednesday, May 8, 2013
10:30 AM-12:30 PM
2264 URODYNAMIC INVESTIGATION IN PATIENTS WITH SPINAL CORD INJURY: PAY ATTENTION TO AUTONOMIC DYSREFLEXIA! Matthias Walter*, Jens Wöllner, Marko Kozomara, Dorothee Birnböck, Stephanie Knu¨pfer, Philipp Baumeister, Ulla Sammer, Ulrich Mehnert, Martin Schubert, Thomas M Kessler, Zu¨rich, Switzerland Source of Funding: None
2263 BIOCHEMICAL AND MICROANALYSIS OF PEDIATRIC URINARY CALCULI Emad Elsobky*, Abu Dhabi, Macedonia; Sanjeev Mehta, Ahmedabad, India; Mahmoud Abdel-Gawad, Alain, United Arab Emirates INTRODUCTION AND OBJECTIVES: The underlying etiology of urinary calculi is unknown. Pediatric urolithiasis is a complex medical and urological dilemma with high rate of recurrence and morbidity. The aim of this study was to analyze and compare the micro-compositions of Pediatric urinary stones by two analytical techniques: Fourier Transform Infrared Spectroscopy (FT-IR)and Inductively Coupled PlasmaAtomic Emission Spectrometry (ICP-AES). METHODS: A total of 46 consecutive urinary calculi were collected from children below the age of 12 after endoscopic procedures. Each stone was divided into two portions. One part was analysed by Fourier Transform Infrared Spectroscopy to determine biochemical components. The second part underwent analysis by Inductively Coupled Plasma-Atomic Emission Spectrometry technique to determine the heavy metals and trace elements contents and concentration(22 elements in each stone). Data analysis by One-Way ANOVA test was performed using SPSS 15.0 software. RESULTS: Our results showed that 37 stones (80.4%) were retrieved from males and 9 (19.6%) from females. 25 Patients (54.3%) were ⱕ5 years of age and 21 (45.7%) were ⬎5 years. The biochemical components of stones were: 36 (78.3%) Whewellite, 28 (60.9%) Weddellite, 13 (28.3%) Ammonium Urate, 9 (19.6%) Uric acid, 5 (10.9%)
INTRODUCTION AND OBJECTIVES: Autonomic dysreflexia (AD), characterized by extreme systolic blood pressure (SBP) increase and often accompanied by heart rate (HR) decrease and corresponding clinical symptoms, is a severe and potentially life-threatening condition in patients with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) which requires immediate medical intervention to avoid severe complications, which can even lead to death. Urodynamic investigation (UDI) is the gold standard to assess SCI but this may induce AD. Thus, the aim of the present study was to investigate the incidence of AD during UDI in patients with SCI. METHODS: Overall, 258 patients (67 females, 191 males, mean age 54⫾17 years) with SCI were prospectively investigated at a single university SCI center. Non-invasive cardiovascular monitoring [i.e. SBP, diastolic blood pressure (DBP), and HR] was recorded continuously during UDI. We defined AD according to the joint committee of the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). RESULTS: The incidence of AD was 57% (148/258, i.e. 34 females, 114 males). Within the group of patients with AD, those with a complete lesion (ASIA A, 49/148) compared to those with an incomplete lesion (ASIA B-D, 99/148) presented with a significantly higher HR decrease (-15⫾16 vs. -3⫾11 beats per minute (bpm), p⬍0.001). Patients suffering from lesions at or above Th6 (84/148) showed a significantly higher SBP increase (56⫾28 vs. 41⫾23 mmHg, p⬍0.001), DBP increase (23⫾17 vs. 18⫾12 mmHg, p⬍0.05) and HR decrease (11⫾15 vs. -2⫾10 bpm, p⬍0.001) compared to those with a lesion below Th6 (64/148). In addition, patients (45/148) with a symptomatic AD (defined as SBP increase, HR decrease, and clinical symptoms) demonstrated a significantly higher SBP increase (71⫾28 vs. 40⫾20 mmHg, p⬍0.001), DBP increase (28⫾17 vs. 18⫾13 mmHg, p⬍0.001) and HR decrease (-21⫾13 vs. -1⫾10 bpm, p⬍0.001) compared to the asymptomatic AD patients (103/148).
THE JOURNAL OF UROLOGY姞
mean serum uric acid, calcium, and phosphorus levels were 7.3⫹/ ⫺3.5, 9.5⫹/⫺1.4, and 3.8⫹/⫺1.0 mg/dL, respectively. In univariate analysis hyperuricemia (p⫽0.008), hypercalcemia (p⫽0.012), diabetes mellitus (p⬍0.001), hypertension (p⫽0.006), and diffuse large B cell lymphoma (p⫽0.029) were more common in stone formers than nonstone formers. In multivariate analysis, diabetes mellitus, hyperuricemia, and hypercalcemia at time of chemotherapy predicted development of upper tract stone. CONCLUSIONS: To our knowledge we report for the first time the incidence of nephrolithiasis in lymphoproliferative and myeloproliferative patients who have undergone chemotherapy. Moreover, we identified risk factors that may assist oncologists in identifying patients who might require medical therapy to prevent upper tract stone formation.
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
Dahlite, 4 (8.7%) Brushite, 3 (6.5%) Struvite, while 2 (4.3%) stones were Cystine. Whewellite stones were significantly higher (P⬍0.05) in children above 5 years while Weddellite stones were predominant in children ⱕ 5 years. Among the 22 analyzed heavy metals and trace elements by ICP-AES, 7 elements were found significantly high with different concentrations in stones of children ⱕ5 and ⬎5 years of age (P⬍ 0.05). In children below 5 years, Ba, Cu, K, Mn, and Na, were significantly higher in their stones than those of children over 5 years. Ca and Se were significantly higher in stones of children older (⬎ 5 years) than those ⬍ 5 years. CONCLUSIONS: Pediatric urinary stones contain heavy metals and trace elements in different concentrations. Most of the stones are mixed and the common components are Whewellite and Weddellite. Cystine stones are rare. Excess Na, and K in stones from children below 5 years, may indicate possible relation between stone formation, kidney maturation and nutrition.Heavy metals may be due to environmental pollution or food contamination or maternal factors. Source of Funding: None
Urodynamics/Incontinence/Female Urology: Urodynamics Testing Moderated Poster Session 85 Wednesday, May 8, 2013
10:30 AM-12:30 PM
2264 URODYNAMIC INVESTIGATION IN PATIENTS WITH SPINAL CORD INJURY: PAY ATTENTION TO AUTONOMIC DYSREFLEXIA! Matthias Walter*, Jens Wöllner, Marko Kozomara, Dorothee Birnböck, Stephanie Knu¨pfer, Philipp Baumeister, Ulla Sammer, Ulrich Mehnert, Martin Schubert, Thomas M Kessler, Zu¨rich, Switzerland Source of Funding: None
2263 BIOCHEMICAL AND MICROANALYSIS OF PEDIATRIC URINARY CALCULI Emad Elsobky*, Abu Dhabi, Macedonia; Sanjeev Mehta, Ahmedabad, India; Mahmoud Abdel-Gawad, Alain, United Arab Emirates INTRODUCTION AND OBJECTIVES: The underlying etiology of urinary calculi is unknown. Pediatric urolithiasis is a complex medical and urological dilemma with high rate of recurrence and morbidity. The aim of this study was to analyze and compare the micro-compositions of Pediatric urinary stones by two analytical techniques: Fourier Transform Infrared Spectroscopy (FT-IR)and Inductively Coupled PlasmaAtomic Emission Spectrometry (ICP-AES). METHODS: A total of 46 consecutive urinary calculi were collected from children below the age of 12 after endoscopic procedures. Each stone was divided into two portions. One part was analysed by Fourier Transform Infrared Spectroscopy to determine biochemical components. The second part underwent analysis by Inductively Coupled Plasma-Atomic Emission Spectrometry technique to determine the heavy metals and trace elements contents and concentration(22 elements in each stone). Data analysis by One-Way ANOVA test was performed using SPSS 15.0 software. RESULTS: Our results showed that 37 stones (80.4%) were retrieved from males and 9 (19.6%) from females. 25 Patients (54.3%) were ⱕ5 years of age and 21 (45.7%) were ⬎5 years. The biochemical components of stones were: 36 (78.3%) Whewellite, 28 (60.9%) Weddellite, 13 (28.3%) Ammonium Urate, 9 (19.6%) Uric acid, 5 (10.9%)
INTRODUCTION AND OBJECTIVES: Autonomic dysreflexia (AD), characterized by extreme systolic blood pressure (SBP) increase and often accompanied by heart rate (HR) decrease and corresponding clinical symptoms, is a severe and potentially life-threatening condition in patients with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) which requires immediate medical intervention to avoid severe complications, which can even lead to death. Urodynamic investigation (UDI) is the gold standard to assess SCI but this may induce AD. Thus, the aim of the present study was to investigate the incidence of AD during UDI in patients with SCI. METHODS: Overall, 258 patients (67 females, 191 males, mean age 54⫾17 years) with SCI were prospectively investigated at a single university SCI center. Non-invasive cardiovascular monitoring [i.e. SBP, diastolic blood pressure (DBP), and HR] was recorded continuously during UDI. We defined AD according to the joint committee of the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). RESULTS: The incidence of AD was 57% (148/258, i.e. 34 females, 114 males). Within the group of patients with AD, those with a complete lesion (ASIA A, 49/148) compared to those with an incomplete lesion (ASIA B-D, 99/148) presented with a significantly higher HR decrease (-15⫾16 vs. -3⫾11 beats per minute (bpm), p⬍0.001). Patients suffering from lesions at or above Th6 (84/148) showed a significantly higher SBP increase (56⫾28 vs. 41⫾23 mmHg, p⬍0.001), DBP increase (23⫾17 vs. 18⫾12 mmHg, p⬍0.05) and HR decrease (11⫾15 vs. -2⫾10 bpm, p⬍0.001) compared to those with a lesion below Th6 (64/148). In addition, patients (45/148) with a symptomatic AD (defined as SBP increase, HR decrease, and clinical symptoms) demonstrated a significantly higher SBP increase (71⫾28 vs. 40⫾20 mmHg, p⬍0.001), DBP increase (28⫾17 vs. 18⫾13 mmHg, p⬍0.001) and HR decrease (-21⫾13 vs. -1⫾10 bpm, p⬍0.001) compared to the asymptomatic AD patients (103/148).