struvite and Ureteral-Obstruction

To assess the clinical outcome of a ferret undergoing a ureteroneocystostomy for treatment of urolithiasis.. A 10-month-old spayed female ferret.. The ferret was evaluated for straining to urinate and defecate, hematochezia, and a rectal prolapse. Plain radiographs revealed large cystic and ureteral calculi. Clinicopathologic analyses indicated the ferret was anemic with an elevated creatinine concentration. Exploratory laparotomy defined bilateral ureteral calculi that were unable to be successfully moved into the bladder. A cystotomy was performed to remove a large cystic calculus. Serial abdominal ultrasonographic examinations showed progressive hydronephrosis of the left kidney and persistent pyelectasia of the right kidney secondary to bilateral ureteral calculi. This confirmed a left ureteral obstruction secondary to the distal calculus while the right ureter remained patent.. A ureteroneocystostomy was performed to allow for left renal decompression. The ferret recovered well despite worsening hydronephrosis of the left kidney in the perioperative period. The ferret was discharged from the hospital 10 days after initial evaluation. At 3-week follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation of the left kidney and ureter.. A ureteroneocystostomy successfully allowed renal decompression and ureteral patency in a ferret with urolithiasis. To the authors' knowledge, this is the first time this procedure has been reported in a ferret for treatment of a ureteral calculus obstruction and may result in good long-term outcome.

Topics: Animals; Female; Ferrets; Hydronephrosis; Struvite; Ureter; Ureteral Calculi; Ureteral Obstruction; Urolithiasis

Any material placed in the urinary tract is susceptible to the formation of encrustations of crystalline bacterial biofilms. These biofilms cause severe complications in some cases. The strategies used so far for reduction of these complications by surface modifications of the implant material failed to show the expected results.. In this study, we investigated amorphous carbon coatings (a-C:H) for their ability to effectively reduce or to repress the progressive formation of infection-enhancing crystalline biofilms as new functional surface coatings. In nine patients suffering for several years from stenting, a-C:H-coated ureteral stents were tested in treatment attempts. The current replacement intervals amounted to a mean of 77 days; the principle cause for early replacement was massive stent encrustations associated with symptomatic urinary tract infections.. In total, 20 coated ureteral stents were tested spanning indwelling times between 3 and 4 months. No stent-related complications occurred. In all cases extraordinarily facile handling, less pain during replacement, and markedly increased tolerance were observed. Symptomatic urinary tract infections were reduced by more than 50%. The stents remained virtually free of encrustations.. a-C:H coatings are a novel strategy leading to an enhancement of long-term applicability of ureteral stents and catheters and to improved patient comfort.

Topics: Adult; Aged; Biofilms; Carbon; Coated Materials, Biocompatible; Crystallization; Female; Follow-Up Studies; Humans; Magnesium Compounds; Male; Middle Aged; Phosphates; Prosthesis Design; Prosthesis Failure; Risk Factors; Stents; Struvite; Ureteral Obstruction; Urinary Tract Infections

We determined the long-term prognosis of the pediatric patient presenting with simultaneous ureteropelvic junction obstruction and a renal calculus.. We retrospectively reviewed all individuals younger than 17 years who presented to our institutions with simultaneous ureteropelvic junction obstruction and an ipsilateral renal calculus.. Simultaneous ureteropelvic junction obstruction with nonstruvite calculi was present in 22 patients, while 6 had struvite calculi. Median age at diagnosis was 11 years (range 5 to 16). During a median followup of 9 years (range 2 to 38) renal calculi recurred in 19 patients (68%), including 10 (36%) with 1 and 9 (32%) with 2 or more recurrences. Median time to first stone recurrence was 11 years (range 2 to 38). Of the 22 patients with nonstruvite calculi 15 (68%) had recurrence. An identifiable metabolic etiology for renal lithiasis was found in 13 of these patients (87%). In contrast, only 2 of the 7 patients (29%) with nonstruvite calculi and no recurrent stones had an identifiable abnormality. This finding suggests that the presence of an identifiable metabolic abnormality significantly predisposes to recurrent nonstruvite renal lithiasis (p < 0.01).. Of the pediatric patients presenting with simultaneous ureteropelvic junction obstruction and a renal calculus 68% will have recurrent renal lithiasis. It remains to be determined whether active treatment of coexisting metabolic abnormalities could prevent or reduce the incidence of recurrent stone disease.

Topics: Adolescent; Child; Child, Preschool; Follow-Up Studies; Humans; Kidney Calculi; Kidney Pelvis; Magnesium Compounds; Phosphates; Prognosis; Recurrence; Retrospective Studies; Struvite; Time Factors; Ureteral Obstruction

We reviewed 111 patients who presented with simultaneous renal calculi and a ureteropelvic junction obstruction. Of 34 patients with ureteropelvic junction obstruction and a coexisting struvite stone 62% had recurrent calculi. The use of antibiotics significantly affected the incidence of recurrent struvite calculi. In particular, if prolonged prophylactic antibiotics (greater than 3 months) were used 15% of the patients had recurrent stones, compared to 90% if only perioperative antibiotics (less than 15 days) were used (p < 0.001). Patients with ureteropelvic junction obstruction and coexisting nonstruvite calculi were treated by either observation alone (53) or metabolic evaluation with appropriate intervention (24). Metabolic evaluation of patients with nonstruvite calculi revealed that 76% had an identifiable metabolic abnormality, treatment of which significantly decreased the incidence of recurrent renal calculi: 17% of the patients on interventional therapy had recurrent stones compared to 55% treated by observation alone (p < 0.001).

Topics: Anti-Bacterial Agents; Female; Follow-Up Studies; Humans; Kidney Calculi; Magnesium Compounds; Male; Metabolic Diseases; Phosphates; Recurrence; Struvite; Time Factors; Ureteral Obstruction

Topics: Aged; Calcium Oxalate; Clinical Competence; Combined Modality Therapy; Endoscopes; Endoscopy; Equipment Design; Female; Humans; Kidney; Lithotripsy; Magnesium Compounds; Male; Middle Aged; Phosphates; Struvite; Ureter; Ureteral Calculi; Ureteral Obstruction

The pulsed dye laser represents a new tool in the treatment of ureteral calculi. Laser energy channeled through a delicate optical fiber is used to disimpact and fragment calculi. Standard ureteroscopic instruments including graspers, baskets and dilatation balloons can be used with the laser system. Interchangeable optical fibers ranging from 200 to 400 micrometers deliver up to 120 mJ of energy to the stone's surface. For two weeks in 1989 an endourology clinic was held in upper Egypt. Eighty patients ranging in age from nine years to sixty-seven years old were evaluated and treated endoscopically. Endoscopes ranging from 6.9F to 12.5F were used to deliver the optical fiber. All stones visualized endoscopically were fragmented. Greater than 60 percent of the stones fragmented were composed of pure calcium oxalate monohydrate. Schistosoma hematobium was endemic among our study group. Bilharzial strictures of the distal ureter were noted in 30 percent of these patients. Treatment of these strictures using both balloon dilatation and graduated Teflon dilators is reviewed. Techniques in treating different types of ureteral calculi were explored. Large calcium oxalate dihydrate stones were treated most efficiently with the 3-point fragmentation technique. The shear off-center technique was used for the calcium oxalate monohydrate calculi. Variations in total energy delivered and frequency of pulsation allowed for prompt stone disimpaction as well as prevention of retrograde fragment migration. Concurrent use of stone baskets and graspers with the pulsed dye laser was explored.

Topics: Adolescent; Adult; Aged; Calcium Oxalate; Catheterization; Child; Coloring Agents; Endoscopes; Endoscopy; Humans; Kidney Calculi; Kidney Calices; Laser Therapy; Lithotripsy; Magnesium; Magnesium Compounds; Male; Middle Aged; Phosphates; Schistosomiasis; Struvite; Ureteral Calculi; Ureteral Obstruction; Uric Acid

Ten patients with complex struvite stones were treated successfully with primary extracorporeal shock wave lithotripsy followed by chemolysis with 10 per cent hemiacidrin renal irrigation. The average number of treatments per renal unit was 1.2 and an average of 2,688 shocks was administered per treatment. No patient required a blood transfusion. Ureteral obstruction did not occur in those patients receiving planned hemiacidrin irrigation immediately after extracorporeal shock wave lithotripsy. At 6-week followup 9 patients were free of residual fragments. The combination of extracorporeal shock wave lithotripsy and hemiacidrin chemolysis represents a satisfactory alternative to the traditional surgical management of complex struvite calculi.

Topics: Adult; Aged; Citrates; Female; Humans; Kidney Calculi; Lithotripsy; Magnesium; Magnesium Compounds; Male; Middle Aged; Pharmaceutic Aids; Phosphates; Radiography; Struvite; Therapeutic Irrigation; Ureteral Obstruction

Struvite calculi occurring in patients with chronic urinary tract infections consist of an inorganic component of magnesium ammonium phosphate crystals and an underlying organic mucopolysaccharide matrix. Shock waves used to destroy these stones during extracorporeal shock wave lithotripsy (ESWL) therapy may affect the inorganic and organic components of the stone differently. In a 26-year-old woman, renal obstruction resulted from retained struvite stone matrix after ESWL therapy.

Topics: Adult; Female; Humans; Kidney Calculi; Lithotripsy; Magnesium; Magnesium Compounds; Nephrostomy, Percutaneous; Phosphates; Struvite; Suction; Ureteral Obstruction