Laparoscopic Pyelolithotomy for Recurrent Stone in Previously Operated Ectopic Pelvic Kidney

An ectopic kidney is a rare congenital anomaly that has been associated with complications as reflux, hydronephrosis, nephrolithiasis, and sometimes renal failure. Calculous diseases in the pelvic kidney due to their anatomical characteristics pose a significant challenge to the surgeon. We herein report a case of transperitoneal laparoscopic pyelolithotomy for treatment of renal pelvis stone in an ectopic pelvic kidney who had already undergone open pyelolithotomy in past. A 34 years old man presented to our hospital with pain abdomen for five months and a history of left open pyelolithotomy done almost eleven years back. Computed tomography scan revealed severe hydronephrosis and 3.5 cm calculus in the pelvis of ectopic malrotated left kidney. The patient underwent left laparoscopic pyelolithotomy, complete stone clearance was achieved, 20 fr drain was placed with no DJ (Double J) stent. For two consecutive days there was significant drain output, subsequently cystoscopy with DJ stenting was done then drain output was reduced. On fifth postoperative day the drain was removed and he was discharged. In a patient with a malrotated pelvic kidney with recurrent stone and past surgery, proper pre-operative evaluation & the selection of the most appropriate surgical technique play a crucial role to get the best surgical outcome. Keywords: Ectopic kidney, laparoscopy, pyelolithotomy, renal pelvic calculous.

Efficacy of an Herbal Preparation Based on Lovage, Rosemary, and Centaury on Patients After Extracorporal Shockwave Lithotripsy

Study objective: to study the effect of a herbal preparation containing a standardised BNO 1040 extract* (based on lovage root, rosemary leaves and aerial parts of centaury) on the extracorporeal shockwave lithotripsy (ESWL) results in patients with urolithiasis (UL). Methodology. 150 patients with UL (aged 18–65 years) treated with ESWL method were divided into 2 equal groups. The main group (n = 75) received standard recommendations and herbal preparation (12 months). The control group (n = 75) received standard recommendations only. The following was evaluated: time and degree of elimination of fragments; the presence of pain and leukocyturia; recurrent stone formation. Results. The elimination of fragments was observed up to 14 days in 94.7 % of patients in the main group versus 76 % of patients in the control group. Renal colic was observed in 6.7 % of patients in the main group versus 10.7 % of patients in the control group; cases of leukocyturia were observed within 14 days in 10.7 % versus 22.7 %, respectively. During the year, a recurrent lithiasis was diagnosed in 6.7% of patients in the main group and in 16 % of patients in the control group. Conclusion. The use of BNO 1040 extract in combination with ESWL: contributes to more rapid and safe elimination of fragments of the calculi and reduces the risk of recurrent stone formation.

IT-medical instruments for modification of lifestyle in patients with urolithiasis

Introduction. Treatment and especially prevention of recurrent stone formation is a relevant topic for scientific research. One of the principles of metaphylaxis is lifestyle modification for example assessment and correction of food stereotypes, physical activity, sleep and rest mode, and rejection of bad habits. Materials and Methods. We analyzed the functionality of electronic tools available today for patients in the Russian Federation, such as: portable gadgets and medical devices. Results. The review presents modern technologies that allow monitoring, including remote monitoring, for patients with urolithiasis. Examples are given in the form of activity trackers, portable devices – urinary analyzers of various manufacturers, portable ultrasound devices, analyzers of the level of uric acid, nitrates, water hardness, «smart» scales. The spectrum of states in urolithiasis has been analyzed for the correct use of these devices. Conclusion. The technological innovations presented in this review open up new opportunities for increasing compliance in patients with urolithiasis. These innovations can become the basis for the implementation of the principles of «medicine 4P» on the example of urolithiasis for the implementation of promising opportunities.

Urinary Volume, Water Intake, and Stone Recurrence in Idiopathic Calcium Nephrolithiasis

This chapter reviews a pivotal trial on the role of increased water intake for secondary prevention of recurrent stone formation patients with idiopathic calcium nephrolithiasis. Patients randomized to the intervention arm were instructed to titrate their water intake to a daily urine output of at least 2 liters; patients in the control arms were not given any specific instructions. Increased water intake resulted in fewer stone recurrences, longer time to recurrence, and reduced calcium oxalate and calcium phosphate supersaturation.

Efficacy of an herbal preparation based on lovage, rosemary, and centaury on patients after extracorporal shockwave lithotripsy

Study objective To study the effect of a herbal preparation containing a standardised BNO 1040 extract* (based on lovage root, rosemary leaves and aerial parts of centaury) on the extracorporeal shockwave lithotripsy (ESWL) results in patients with urolithiasis (UL). Methodology 150 patients with UL (aged 18–65 years) treated with ESWL method were divided into 2 equal groups. The main group (n = 75) received standard recommendations and herbal preparation (12 months). The control group (n = 75) received standard recommendations only. The following was evaluated: time and degree of elimination of fragments; the presence of pain and leukocyturia; recurrent stone formation. Results The elimination of fragments was observed up to 14 days in 94.7% of patients in the main group versus 76% of patients in the control group. Renal colic was observed in 6.7% of patients in the main group versus 10.7% of patients in the control group; cases of leukocyturia were observed within 14 days in 10.7% versus 22.7%, respectively. During the year, a recurrent lithiasis was diagnosed in 6.7% of patients in the main group and in 16% of patients in the control group. Conclusion The use of BNO 1040 extract in combination with ESWL: contributes to more rapid and safe elimination of fragments of the calculi and reduces the risk of recurrent stone formation. Trial registration DRKS ID 00021200. Registered retrospectively in German Clinical Trial Register 27.03.2020. https://www.drks.de/

Success rate of repeat flexible ureteroscopy following previous failed access: An analysis of stent duration

Introduction: Approximately 8% of patients that undergo therapeutic or diagnostic ureteroscopy will have the procedure aborted and ureter stented due to failed access. The primary objective of this study was to assess mean stent duration prior to repeat ureteroscopy and to calculate the associated successful access rate. Methods: This retrospective, descriptive study evaluated all patients undergoing interval ureteroscopy following a failed procedure by endourologic surgeons at the University of Alberta from 2016–2018. Patients declining interval ureteroscopy, or those with malignant/known ureteral strictures were excluded from the study. The primary outcome measures were median time to salvage ureteroscopy and the rate of successful access of the repeat procedure. Results: A total of 119 patients were identified as having a failed ureteroscopy during our study period. First-time and recurrent stone formers accounted for 64 (53.8%) and 47 (39.5%) patients, respectively. Median stent duration to second procedure was 17 days (average 20, range 10–84). Most patients had their repeat ureteroscopy at 14 days or greater (81.5%); 22 (18.5%) patients had their repeat ureteroscopy between 10 and 13 days. The success rate of a second ureteroscopy after stenting was 99.2% (118/119). Conclusions: Ureteric stenting following failed ureteroscopy leads to exceedingly high rates of successful access at interval procedure (99.2%). The standard duration of ureteric stenting employed at our institution is two weeks. Of the patients that underwent an accelerated second procedure (between 10–13 days of stenting), all had successful access at their interval procedure.

Thiazide and thiazide-like diuretics in nephrolithiasis

Thiazide and thiazide-like diuretics are widely used for the management of hypercalciuria among stone-forming patients. Although the effects of different thiazides should be relatively similar in terms of prevention of stone recurrence, their potency and side effects may differ. However, there is scarce data concerning the metabolic and bone effects of these agents among recurrent nephrolithiasis patients with hypercalciuria. The aim of this update article was to compare our experience in the use of thiazide and thiazide- like diuretics with that of the current literature, concerning their anticalciuric properties and consequent reduction of recurrent stone formation. Their impact on bone mass and potential side effects were also discussed.

Prevention and management of urinary stone

The prevalence of urolithiasis is increasing not only in South Korea but also around the world. Urolithiasis has a high recurrence rate, therefore, reducing it is very important in the quality of life for stone formers. For this purpose, dietary modifications and drug therapy can be performed through stone analysis and 24-hour urine collection. Stone analysis is recommended for all stone formers, and the 24-hour urine collection is usually recommended for recurrent stone formers or high-risk groups. A general dietary modification for all stone formers includes a sufficient fluid intake, low levels of sodium, sugar, and animal protein, a normal calcium diet, as well as a high amount of citrate intake. Drug therapy should be performed in cases such as the recurrence of stones or increase of the existing ones, even after the application of preservation therapy, such as dietary modification. The ideal drug therapy should prevent the occurrence of urolithiasis, have no side effects, and have a suitable patientsʼ compliance. Follow-up should be performed periodically, through 24-hour urine collections and imaging studies. For follow-up imaging studies, a lowdose non-enhanced computed tomography is recommended, and it can be performed once a year if the patient is in a stable state. To control various and complex metabolic abnormalities in recurrent stone formers, multiple approaches may be required through diet modifications, drug therapy, treatment of the metabolic syndrome, and lifestyle modifications.