sodium-bicarbonate and Ureteral-Calculi

Topics: Citrates; Drug Administration Schedule; Humans; Hydrogen-Ion Concentration; Potassium Citrate; Radiography; Sodium Bicarbonate; Sodium Citrate; Ureteral Calculi; Uric Acid; Urinary Calculi

To evaluate the impact of ureteral stenting on the success rate of oral chemolysis in the management of suspected uric acid upper urinary tract (UUT) stones.. Retrospective matched-pair analysis of 172 patients treated with oral chemolysis from 01/2010 to 12/2019. Patients with low density (upon non-contrast enhanced computer tomography [NCCT]), radiolucent (on plain radiography) urinary stones, a low urine pH (< 6) and/or history of uric acid urolithiasis were included. Potassium citrate and/or sodium bicarbonate were used for alkalization (target urine pH: 6.5-7.2). Patient 1:1 matching was performed for the presence of indwelling ureteral stent, stone diameter, stone density, and stone localization. Stone-free status was evaluated after 12 weeks using NCCT. Multivariable logistic regression analysis was used to assess factors affecting the outcome.. Mean patient age was 61 years (73% males). Mean stone size was 12 mm. Overall success rates after 12-weeks of chemolysis for stones at any localization in the UUT and ureteral stones were 60.5 and 77.3%, respectively. Smaller stone size (OR = 0.94; CI 0.888-0.992; p = 0.026) and lower pre-treatment urine pH (OR = 0.131; CI 0.023-0.737; p = 0.021) significantly increased the success of oral chemolysis. Ureteral stenting did not have any impact on the efficacy of oral chemolysis.. Oral chemolysis is an effective treatment modality for patients with UUT stones suspected of uric acid content irrespective of ureteral stenting. Smaller stone diameter and lower urine pH at diagnosis increase its efficacy.

Topics: Administration, Oral; Aged; Combined Modality Therapy; Female; Humans; Kidney Calculi; Male; Middle Aged; Potassium Citrate; Retrospective Studies; Sodium Bicarbonate; Stents; Treatment Outcome; Ureteral Calculi

The formation of urinary calculi following renal transplantation is a rare event with a frequency of less than 1% (4). Although 133 cases were described up to 1988, only 5 of these had pure uric acid stones (3). We report a case in which an excessive purine-rich diet probably caused the stone formation. Three modalities of treatment were used, percutaneous nephrolithotripsy, shock wave lithotripsy (ESWL) and chemolysis.

Topics: Combined Modality Therapy; Diet; Humans; Kidney Calculi; Kidney Transplantation; Lithotripsy; Male; Middle Aged; Nephrostomy, Percutaneous; Radiography; Sodium Bicarbonate; Ureteral Calculi; Uric Acid

The dissolution of uric acid calculi can be obtained by per os or parenteral alkalinization, but this method cannot be used in case of obstructive calculi. With 3 patients, whose urinary tract was obstructed by a radio-transparent calculi at the pyelo-ureteral junction, the ureteral probe setting by endoscopic way permitted to realize the in situ alkalinization. After 5 to 11 days of treatment, the calculi have been completely dissolved. A patient also presented a slightly radio-opaque lithiasis, but it remained still. The in situ alkalinization is an effective and non invasive treatment in case of obstructive uric acid calculi, and completes the release of the urinary tract logically by ureteral probe setting.

Topics: Adult; Aged; Follow-Up Studies; Humans; Instillation, Drug; Male; Radiography; Sodium Bicarbonate; Ureteral Calculi; Uric Acid; Urinary Catheterization

ESWL and PCN have modified the urinary stones therapy. Nevertheless these therapeutic procedures are not much effective in cystine stone because of its protein structure and frequent recurrences; these procedures need to be combined to achieve the best results. In cystine stones the lithochemolysis, performed following recent technique has shown excellent results, without complications and easy to apply.

Topics: Adult; Catheterization; Citrates; Citric Acid; Cystine; Female; Humans; Kidney Calculi; Kidney Pelvis; Male; Radiography; Sodium Bicarbonate; Sodium Hydroxide; Solutions; Ureteral Calculi; Urinary Calculi

Previous in vitro experiments demonstrated the reduced microhardness of calcium oxalate monohydrate (COM) calculi, relative to dry values, when saturated with an alkaline solution (pH = 9.5). Nineteen patients with a COM calculus in the distal ureter which had been resistant to prior extracorporeal shock wave lithotripsy in situ, were treated when the stone was surrounded by alkaline urine. The urine of 14 patients was alkalinized orally by administration of acetazolamine and citrate solution; in 5 other patients direct percutaneous irrigation of sodium bicarbonate via a nephrostomy tube was carried out. The urinary pH just before lithotripsy was greater than or equal to 9 in 17/19 patients. 4,000 shock waves, averaging 18.1 kV generated by the Siemens Lithostar, were delivered onto the calculus. No significant increase of comminution rate was apparent at radiographic control immediately after the treatment and only in half of the cases was evacuation obtained within 3 months.

Topics: Bicarbonates; Calcium Oxalate; Citrates; Female; Humans; Hydrogen-Ion Concentration; Lithotripsy; Male; Middle Aged; Sodium; Sodium Bicarbonate; Ureteral Calculi

The combination of percutaneous alkaline irrigation and lithotripsy was performed in 5 cases of uric acid calculi obstructing the ureter. Shock wave lithotripsy accelerates the dissolution of uric acid stones.

Topics: Aged; Aged, 80 and over; Bicarbonates; Emergencies; Humans; Kidney Calculi; Lithotripsy; Male; Middle Aged; Nephrostomy, Percutaneous; Sodium; Sodium Bicarbonate; Ureteral Calculi; Uric Acid

Four cases with ureteral obstruction due to uric acid or cystine stones were treated successfully by percutaneous irrigation with sodium bicarbonate or tromethamine-E. These cases underwent percutaneous nephrostomy for the reason of prolonged complete obstruction (case 1), sustained pyelonephritis (case 2) or decreased renal function (case 3 and 4). Two catheters were placed through the nephrostomy tract before irrigation, 6 Fr. ureteral catheter just above the ureteral stone and 10 Fr. pigtail or 12 Fr. Malecot catheter in the renal pelvis. The ureteral stones were markedly reduced in size and passed spontaneously after 6-11 days' duration of irrigation in three cases. In case 2, the remaining stone was removed transurethrally after 14 days' duration of irrigation, and was found to be composed of organic matrix. Percutaneous dissolution is considered to be a safe and reliable method and may be an alternative way of treating uric acid or cystine stone causing acute ureteral obstruction.

Topics: Acute Disease; Adult; Bicarbonates; Cystine; Female; Humans; Male; Middle Aged; Sodium; Sodium Bicarbonate; Therapeutic Irrigation; Tromethamine; Ureteral Calculi; Ureteral Obstruction; Uric Acid; Urinary Catheterization

Dissolution of uric acid calculi could be obtained by oral or parenteral urinary alcalinization, but this method cannot apply to the case of obstructive calculi. Nineteen obstructive calculi in 18 patients were treated by in situ alcalinization through a percutaneous nephrostomy catheter (PCN). Eight patients were initially anuric, 7 of whom from an obstructed solitary kidney and 1 from a bilateral obstructive lithiasis. Fifteen calculi were located in the ureter, 3 in the uretero-pelvic junction and 1 in the pelvis. After 48 h of urinary diversion through PCN, an isotonic sodium bicarbonate solution (14 g %) was continuously infused at an average flow rate of 2.8 l/24 h, through either an unique PCN, or a 2 PCN-irrigation circuit in the 7 cases with permanently obstructive calculus. Fifteen calculi (80%) were completely dissolved after 3 to 13 days of alcalinization (average 5.8 days). One large calculus was reduced by 3/4 and further removed by percutaneous lithotripsy. Three patients underwent ureterotomy after 9 to 11 days of uneffective treatment. Local alcalinization is an effective and non invasive treatment for obstructive uric acid calculi, and is logically associated with the necessary urinary diversion.

Topics: Aged; Bicarbonates; Female; Humans; Infusions, Parenteral; Kidney Calculi; Male; Middle Aged; Nephrostomy, Percutaneous; Sodium; Sodium Bicarbonate; Ureteral Calculi; Uric Acid

We treated 14 patients with uric acid calculi in the renal pelvis and calices (10) or ureter (4) with constant intravenous infusion of a one-sixth molar lactate solution. Dissolution was successful in all but 2 cases. The success of therapy is believed to be related to the sustained urinary alkalization obtained with intravenous infusion compared to the intermittent alkalization that occurs when oral agents are used.

Topics: Adult; Bicarbonates; Citrates; Citric Acid; Female; Humans; Hydrogen-Ion Concentration; Infusions, Parenteral; Kidney Calculi; Lactates; Male; Middle Aged; Sodium Bicarbonate; Ureteral Calculi; Uric Acid

Topics: Bicarbonates; Drainage; Humans; Kidney Pelvis; Male; Middle Aged; Sodium Bicarbonate; Therapeutic Irrigation; Ureteral Calculi; Uric Acid; Urinary Catheterization