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E117 Urolithiasis in renal transplantation: Diagnosis and management
friday 6 september 2013 / european urology supplements 12 (2013) 69–94
and body pain but also on general health, working, social and sexual activity. Urologist should limit both the use and the indwelling time of ureteral stents after uncomplicated ureteroscopies. E117 Urolithiasis in renal transplantation: Diagnosis and management E. Cicerello, F. Merlo, M. Mangano, G.D. Cova, L. Maccatrozzo. Treviso Hospital, Dept. of Urology, Treviso, Italy Introduction & Objectives: To report our experience of diagnosis and multimodal management of urolithiasis in renal transplantation. Material & Methods: From January 1995 to December 2012, 953 patients underwent renal transplantation and 10 (1%) of them developed urinary tract calculi. Their mode of presentation, investigations, treatments, complications and outcomes were recorded. Investigations included one or more of the following: Ultrasonography (US), plain abdominal X-ray, intravenous urography, nephrostogram and computed tomography. Management of these calculi involved shock wave lithotripsy (SWL), ureteroscopy (URS), percutanaeous nephrostolithotomy (PCNL) and surgical ureterolithotomy with re-do ureterocystoneostomy. Metabolic evaluation was performed to evaluate the risk factors for stone formation. Results: Seven had renal and 3 ureteral calculi. Urolithiasis was incidentally discovered on routine ultrasonography in 6 patients, 1 presented with oliguria, 1 with anuria and acute renal failure and in 2 urolithiasis was found after removing ureteral stent. Nephrostomy tube was quickly placed in 5 patients. Hypercalcemia with hyperparathyroidism was present in 5 patients and hyperuricemia in 3. Two patients were primary treated by SWL, one of them was stone free after two sessions, while the other required ureteral stent and subsequently treated by ureteroscopy. Two patients, one with multiple calculi (stone burden 3 cm.) and the other with staghorn calculus in the lower calix were treated with percutaneous nephrostolithotomy. Three patients were treated by ureteroscopy and in one of them two treatments were required. One patient had calculus impacted in the uretero-vesical anastomosis and surgical ureterolithotomy with re-do ureterocystoneostomy was performed after failure of ureteroscopy. Two patients with calculi discovered removing ureteral stent were treated by ureteroscopy. Conclusions: The incidence of urolithiasis in renal transplantation is low. Multiple mode of presentation of urolithiasis could occur. Metabolic anomalies and medical treatment after kidney transplantation may cause stone formation. Advancements in endourology and interventional radiology have influenced the management of urolithiasis that can be actually treated with these minimally invasive modalities minimizing the potential risk to the recipient and for the renal allograft. Management of these patients requires a multiple approach by renal physicians, transplantation surgeons and urologists. E119 The incidence of urolithiasis in the urinary anomalies I. Haxhiu1 , X. Quni1 , S. Hyseni1 , A. Haxhiu1 , H. Quni1 , E. Haxhiu2 . 1 Clinical Center Kosovo, Dept. of Urology, Prishtina, Kosovo; 2 University of Prishtina, Medical Faculty, Prishtina, Kosovo Introduction & Objectives: The objective is to prove the causes of interdependence between urinary congenital anomalies and the urolithiasis. Material & Methods: We have analyzed 150 patients with renal colic, infections or undefined pain. From these patients, 130 of them or 87.33%, resulted to have urolithiasis, after urologic examination of these patients.
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The interdependence between urolithiasis and urinary anomalies was found in 26 patients or 17.3%. We have found that the anomalies are found in 30% of patients (45 cases); the highest percentage was found in men (66.66%); in most of the cases the anomalies were in the right side (60%); 33.33% in the left side and only 6.66% were in the both sides. Results: The incidence between urolithiasis and urinary anomalies, in our material resulted to be very high, respectively 57.7%, meanwhile anomalies take place with a percentage of 19.4% in the general number of urolithiasis. The incidence is very high in big anomalies (horseshoe shaped kidney), 66.6%. Participation of male versus female in urolithiasis is: men 69.47%; women 30.53%, meanwhile in anomalies the participation is: 66.67% men and 33.33% women. We found high compliance of gender in anomalies and urolithiasis together. Conclusions: We can conclude that a high match exists, between the urinary anomalies and urolithiasis. The incidence is twice higher in men, versus women and twice higher in the right side versus the left side. E120 Some physico-chemical and biochemical parameters of urine in the pathogenesis of urolithiasis T. Nazarov, S. Magidov, M. Ahmedov. Northwestern State Medical University, Dept. of Urology, Saint-Petersburg, Russia Material & Methods: Object of research were 60 persons in the age of from 19 till 67 years. The first group of 40 patients with the diagnosis urolithiasis and 20 healthy voluntary people in who was investigated the physical and chemical and biochemical structure of urine. Results: The received results were the following in the first group: Kinematic viscosity-1.28±0.07, superficial free energy-70.11±0.34, electroconductivity -0.020±0.005, osmolarity-862.4±48.5, crystal-inhibiting activity-1.22±0.03, ionization of calcium-31.9±3.8, ionization of magnesium22.2±1.1, diuresis-0.98±0.07. The received results in healthy people – the second group – the following: Kinematic viscosity-1.07+0.02, superficial free energy-65.3±0.32, electroconductivity -0.027±0.005, osmolarity-650.4+46.1, crystalinhibiting activity-1.45±0.03, ionization of calcium-25.5±2.2, ionization of magnesium-25.6±1.5, diuresis-1.53±0.08. Apparently from results of the research, the received results statistically authentically (p < 0.05) differ from each other. The received results have shown, that early displays urolithiasis are: Decrease total crystal forming abilities of urine, reduction of its superficial free energy by a background hyperosmia, hypodipsia, increase of ionization of calcium and decrease in ionization of magnesium of urine. The revealed changes of a degree of ionization of calcium and magnesium have important prognostic. As the level of ionization of calcium of urine reflects a saturation of active ions of calcium in unit of the investigated environment, and a level ionization of magnesium – a degree of saturation of urine active inhibiting crystallization, thus, during phase transitions of the sated solutions in the firm form the basic role will be played not summary with magnesium, and its active fraction. Carried out researches have allowed to establish essential decrease electroconductivity urine in patients of the first group. The given physical and chemical parameter wet it is caused by the sum of free ions and micelle. The part of ions of urine is in the free dissociated condition, and the others take part in formation of a double electric layer on a surface micelle. Hence, stability wet by way of its restriction crystal activity depends on number of the free ions, capable to enter electrochemical interaction under influence ionic and covalent communications. With reduction of number of free ions decreases electroconductivity urine and the risk of crystallization raises.
and body pain but also on general health, working, social and sexual activity. Urologist should limit both the use and the indwelling time of ureteral stents after uncomplicated ureteroscopies. E117 Urolithiasis in renal transplantation: Diagnosis and management E. Cicerello, F. Merlo, M. Mangano, G.D. Cova, L. Maccatrozzo. Treviso Hospital, Dept. of Urology, Treviso, Italy Introduction & Objectives: To report our experience of diagnosis and multimodal management of urolithiasis in renal transplantation. Material & Methods: From January 1995 to December 2012, 953 patients underwent renal transplantation and 10 (1%) of them developed urinary tract calculi. Their mode of presentation, investigations, treatments, complications and outcomes were recorded. Investigations included one or more of the following: Ultrasonography (US), plain abdominal X-ray, intravenous urography, nephrostogram and computed tomography. Management of these calculi involved shock wave lithotripsy (SWL), ureteroscopy (URS), percutanaeous nephrostolithotomy (PCNL) and surgical ureterolithotomy with re-do ureterocystoneostomy. Metabolic evaluation was performed to evaluate the risk factors for stone formation. Results: Seven had renal and 3 ureteral calculi. Urolithiasis was incidentally discovered on routine ultrasonography in 6 patients, 1 presented with oliguria, 1 with anuria and acute renal failure and in 2 urolithiasis was found after removing ureteral stent. Nephrostomy tube was quickly placed in 5 patients. Hypercalcemia with hyperparathyroidism was present in 5 patients and hyperuricemia in 3. Two patients were primary treated by SWL, one of them was stone free after two sessions, while the other required ureteral stent and subsequently treated by ureteroscopy. Two patients, one with multiple calculi (stone burden 3 cm.) and the other with staghorn calculus in the lower calix were treated with percutaneous nephrostolithotomy. Three patients were treated by ureteroscopy and in one of them two treatments were required. One patient had calculus impacted in the uretero-vesical anastomosis and surgical ureterolithotomy with re-do ureterocystoneostomy was performed after failure of ureteroscopy. Two patients with calculi discovered removing ureteral stent were treated by ureteroscopy. Conclusions: The incidence of urolithiasis in renal transplantation is low. Multiple mode of presentation of urolithiasis could occur. Metabolic anomalies and medical treatment after kidney transplantation may cause stone formation. Advancements in endourology and interventional radiology have influenced the management of urolithiasis that can be actually treated with these minimally invasive modalities minimizing the potential risk to the recipient and for the renal allograft. Management of these patients requires a multiple approach by renal physicians, transplantation surgeons and urologists. E119 The incidence of urolithiasis in the urinary anomalies I. Haxhiu1 , X. Quni1 , S. Hyseni1 , A. Haxhiu1 , H. Quni1 , E. Haxhiu2 . 1 Clinical Center Kosovo, Dept. of Urology, Prishtina, Kosovo; 2 University of Prishtina, Medical Faculty, Prishtina, Kosovo Introduction & Objectives: The objective is to prove the causes of interdependence between urinary congenital anomalies and the urolithiasis. Material & Methods: We have analyzed 150 patients with renal colic, infections or undefined pain. From these patients, 130 of them or 87.33%, resulted to have urolithiasis, after urologic examination of these patients.
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The interdependence between urolithiasis and urinary anomalies was found in 26 patients or 17.3%. We have found that the anomalies are found in 30% of patients (45 cases); the highest percentage was found in men (66.66%); in most of the cases the anomalies were in the right side (60%); 33.33% in the left side and only 6.66% were in the both sides. Results: The incidence between urolithiasis and urinary anomalies, in our material resulted to be very high, respectively 57.7%, meanwhile anomalies take place with a percentage of 19.4% in the general number of urolithiasis. The incidence is very high in big anomalies (horseshoe shaped kidney), 66.6%. Participation of male versus female in urolithiasis is: men 69.47%; women 30.53%, meanwhile in anomalies the participation is: 66.67% men and 33.33% women. We found high compliance of gender in anomalies and urolithiasis together. Conclusions: We can conclude that a high match exists, between the urinary anomalies and urolithiasis. The incidence is twice higher in men, versus women and twice higher in the right side versus the left side. E120 Some physico-chemical and biochemical parameters of urine in the pathogenesis of urolithiasis T. Nazarov, S. Magidov, M. Ahmedov. Northwestern State Medical University, Dept. of Urology, Saint-Petersburg, Russia Material & Methods: Object of research were 60 persons in the age of from 19 till 67 years. The first group of 40 patients with the diagnosis urolithiasis and 20 healthy voluntary people in who was investigated the physical and chemical and biochemical structure of urine. Results: The received results were the following in the first group: Kinematic viscosity-1.28±0.07, superficial free energy-70.11±0.34, electroconductivity -0.020±0.005, osmolarity-862.4±48.5, crystal-inhibiting activity-1.22±0.03, ionization of calcium-31.9±3.8, ionization of magnesium22.2±1.1, diuresis-0.98±0.07. The received results in healthy people – the second group – the following: Kinematic viscosity-1.07+0.02, superficial free energy-65.3±0.32, electroconductivity -0.027±0.005, osmolarity-650.4+46.1, crystalinhibiting activity-1.45±0.03, ionization of calcium-25.5±2.2, ionization of magnesium-25.6±1.5, diuresis-1.53±0.08. Apparently from results of the research, the received results statistically authentically (p < 0.05) differ from each other. The received results have shown, that early displays urolithiasis are: Decrease total crystal forming abilities of urine, reduction of its superficial free energy by a background hyperosmia, hypodipsia, increase of ionization of calcium and decrease in ionization of magnesium of urine. The revealed changes of a degree of ionization of calcium and magnesium have important prognostic. As the level of ionization of calcium of urine reflects a saturation of active ions of calcium in unit of the investigated environment, and a level ionization of magnesium – a degree of saturation of urine active inhibiting crystallization, thus, during phase transitions of the sated solutions in the firm form the basic role will be played not summary with magnesium, and its active fraction. Carried out researches have allowed to establish essential decrease electroconductivity urine in patients of the first group. The given physical and chemical parameter wet it is caused by the sum of free ions and micelle. The part of ions of urine is in the free dissociated condition, and the others take part in formation of a double electric layer on a surface micelle. Hence, stability wet by way of its restriction crystal activity depends on number of the free ions, capable to enter electrochemical interaction under influence ionic and covalent communications. With reduction of number of free ions decreases electroconductivity urine and the risk of crystallization raises.