Urolithiasis in enterocystoplasties

The incidence of stones in patients with enterocystoplasty is reported as 12–52.5%. Most patients will have multiple physical factors such as immobility, need for self catheterisation and poor urine drainage, so that it is not certain that an intestinal reservoir is the cause of stones on its own. There is little or no evidence that mucus is an aetiological factor. Foreign bodies in the reservoir, such as staples, increase the risk of stone formation from 13% to 43%. Stones require surgical removal. Minimally invasive techniques may be used for small stones. A low velocity disintegrator is required so that fragments are not propelled into the intestinal mucosa. Stones are infective in origin in 86% of cases, but 14% are sterile. Metabolic screen shows that 80% of patients have risk factors for at least three different types of stone. All patients have raised pH (mean 6.93) and hypocitraturia. Raised serum and urinary calcium, hyperoxaluria and hyperuricosuria are found in up to 33% of patients.     

Urolithiasis im Kindesalter

Urinary stone disease is relatively rare in children with an overall incidence of 1-2 %; however, it is often associated with metabolic abnormalities that may lead to recurrent stone formation. Stone analysis and subsequent metabolic evaluation is therefore mandatory for this high-risk group after the first stone event. The objectives of stone management in children should be complete stone clearance, prevention of stone recurrence, preservation of renal function, control of urinary tract infections, correction of anatomical abnormalities and correction of the underlying metabolic disorders. The full range of minimally invasive procedures is available if active stone removal is necessary. The majority of stones in children can be managed either with extracorporeal shock wave lithotripsy which has a higher efficacy in children than in adults, percutaneous nephrolithotomy, ureterorenoscopy or a combination of these modalities while open or laparoscopic surgery is limited to well-selected cases with underlying anatomical abnormalities.     

Urolithiasis in pregnancy

The presentation of urolithiasis is often dramatic, but rarely is it more anxiety provoking than during pregnancy. The evaluation and the intervention are often approached with trepidation as the health of the mother and the fetus must be taken into account. The typical diagnostic course and surgical management used in the nonpregnant population must be reevaluated in the expectant mother. Failure to promptly diagnose and manage urolithiasis during pregnancy may have adverse consequences for mother and child. The authors present a review of the relevant anatomic and physiologic changes of pregnancy as they affect stone disease and outline options for radiologic evaluation and surgical management.     

Urolithiasis und Hyperparathyreoidismus

Zusammenfassung Der Hyperparathyreoidismus ist bei einer Beteiligung bis zu 10% an den Ursachen der Urolithiasis ein für den Urologen bedeutungsvolles, sicherlich noch zu selten diagnostiziertes Krankheitsbild. Prognostisch entscheidend ist hierbei die Frühdiagnose, weshalb auf die entsprechenden diagnostischen Möglichkeiten besonders hingewiesen wird. Nach einem kurzen Überblick über Physiologie und Pathologie der Epithelkörperchen-Überfunktion werden eingehend Verlauf, Diagnose, Differentialdiagnose und Therapie geschildert und an Hand eigener Fälle erläutert.Mit 5 TextabbildungenHerrn Prof. Dr.R. Zenker zum 60. Geburtstag.     

Urolithiasis in childhood

The management of 131 children with urinary calculi is described. Boys out-numbered girls 2:1. Five per cent of the patients had identifiable metabolic causes, while 78 per cent had infected renal lithiasis. With appropriate therapy, stone disease became inactive in 79 per cent of the children. The remaining 21 per cent continued with active disease. Stone formation may be regarded as a solitary complication or one of several manifestations of a large number of underlying disorders. Along with a thorough search for etiologic factors there must be an equally aggressive therapeutic effort. Because the disease is often sporadic, careful long-term follow-up of the patients with active as well as those with inactive stone disease is mandatory.     

Urolithiasis and phytotherapy

The effects of seven plants with suspected application to prevent and treat stone kidney formation (Verbena officinalis, Lithospermum officinale, Taraxacum officinale, Equisetum arvense. Arctostaphylos uva-ursi, Arctium lappa andSilene saxifraga) have been studied using female Wistar rats. Variations of the main urolithiasis risk factors (citraturia, calciuria, phosphaturia, pH and diuresis) have been evaluated. It can be concluded that beneficial effects caused by these herb infusions on urolithiasis can be attributed to some disinfectant action, and tentatively to the presence of saponins. Specifically, some solvent action can be postulated with respect to uric stones or heterogeneous uric nucleus, due to the basifying capacity of some herb infusions. Nevertheless, for all the mentioned beneficial effects, more effective and equally innocuous substances are well known.     

Urolithiasis in children

Relying on experiences made in connection with 103 paediatric cases, urolithiasis is discussed with reference to age, sex, and site; the significance of obstructions to urine flow and their lithogenic effect is emphasized and also urogenital infections are discussed. Surgical treatment of these anomalies is dealt with in detail. Results of stone operations are compared and the incidence of recurrences is examined. Conclusions based on clinical observations are presented.     

Urolithiasis in children

Urinary tract calculi in children are rare in the United States, with an incidence of 1 to 4 per 1000 pediatric admissions. Primary and secondary calculi are different in causation, chemical composition, and prognosis, and must be considered separately. Review of the literature in the United States and England suggests that in 60 per cent of children, as in adults, no causation will be found. Our experience with twenty-five primary and twenty-five secondary calculi in a nonendemic area, however, shows only six truly idiopathic stones. Thorough urologic and metabolic evaluation has been rewarded with an appreciable yield of metabolic or structural abnormalities. Treatment consists of standard urologic management of stones, as well as specific therapy directed at the underlying causes.