Evolution of post-ESWL residual lithiasis depending on the type of calculus and urine composition.
نویسندگان
چکیده
OBJECTIVES Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures for removal of renal calculi from the upper urinary tract, but complete expulsion of the fragments generated is not always achieved. This can lead to new lithiasic episodes, and it is considered that 10-26% of fragmented calculi can undergo regrowth. This in vitro study investigated the influence of fragment and urinary composition on post-ESWL growth of fragments, with the aims of establishing the effect and importance of these parameters, and identifying effective prophylactic measures. METHODS Fragments collected from patients immediately following expulsion after ESWL treatment were selected for regrowth experiments. The particles included 24 calcium oxalate monohydrate (COM) fragments, 48 calcium oxalate dihydrate (COD), 24 hydroxyapatite (HAP), and 16 uric acid. RESULTS In all treatments, calculi fragments showed a considerable capacity to induce growth of calcium oxalate and calcium phosphate. Under normocalciuria conditions, new COM crystals formed; both COM and COD crystals developed under hypercalciuria conditions at a urinary pH < 6.0; and in hypercalciuric conditions and urinary pH > 6.0 both HAP and brushite (BRU) crystals were formed. The highest growth rates were observed for COD calculi fragments under hypercalciuria conditions and at a urinary pH of 6.5, followed by growth on COM and HAP fragments under the same conditions; growth rates under other conditions tested were similar but 10-fold lower. With regard to the role of crystallization inhibitors, phytate exhibited inhibitory effects under all assay conditions. However, citrate had little effect, even at the highest concentration tested (1,000 mg/L). CONCLUSIONS This study demonstrates the importance of avoiding heterogeneous nucleant retention (pre-existing solid microparticles) in renal cavities, as these can act as very efficient inducers of the formation of new calculi, the composition of which is mainly dependant on the urine composition.
منابع مشابه
[Extracorporeal shock-wave lithotripsy].
Concrement lithotripsy in the kidney and ureter using extracorporeal shock waves (ESWL) was performed with the aid of a 2nd-generation lithotriptor--Lithostar Siemens. Over a period of 11 months ESWL was applied in 526 patients aged 7 to 80 years, 10 of these were children. 19 patients had bilateral lithiasis so that the treatment was applied to a total of 545 renoureteral units and 698 concrem...
متن کاملAntibiotic prophylaxis in the prevention of urinary tract infection in patients with sterile urine before extracorporeal shock wave lithotripsy
Background: One of the lithotripsy complications is urinary tract infection (UTI) and sepsis after extracorporeal shock wave lithotripsy (ESWL). The aim was to study the prophylactic effect of antibiotics on UTI after ESWL. Methods: This randomized double-blind clinical trial was carried out on 600 patients admitted to Babol Clinic hospital in 2014-2015. Patients were randomly divided into tre...
متن کامل[CT SCAN as a predictor of composition and fragility of urinary lithiasis treated with extracorporeal shock wave lithotripsy in vitro].
OBJECTIVES To evaluate the ability of non contrast computed tomography (NCCT) to predict stone composition and fragility for treatment with extracorporeal shock wave lithotripsy (ESWL). METHODS 27 stones of about 10 mm from patients who had undergone different endourological procedures were collected. All patients had been evaluated with NCCT. To perform in vitro ESWL an experimental device w...
متن کاملPost-ESWL fragments as core of new kidney stones
The use of extracorporeal shockwave lithotripsy (ESWL) to treat kidney stones gives excellent fragmentation results. However, the retention of post-ESWL fragments within the kidney remains a serious health problem. A study carried out on calcium stone patients showed that only 32% of these were found to be stone free 12 months after ESWL [1]. Therefore, the persistence and the growth of fragmen...
متن کاملneW in the diagnOsis and tReatMent Of uRinaRy lithiasis?
Rev Assoc Med Bras 2009; 2010; 56(1): 723-8 *Correspondence: Rua Barata Ribeiro, No 490 Sala 25 – Bela Vista São Paulo – Sp, Brazil Cep: 01309-000 AbstrACt Objective. To review developments in the diagnosis and treatment of urinary lithiasis. MethOds. A review of the most important articles on the subject published in Medline indexed periodicals between 1979 and 2009. Results. Stones occur with...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Archivos espanoles de urologia
دوره 62 6 شماره
صفحات -
تاریخ انتشار 2009