延安地区泌尿系结石成分分析的研究

目的利用红外光谱法测定延安大学附属医院泌尿外科手术获得的泌尿系结石成分,探讨延安地区泌尿系结石成分与年龄、性别等关系,比较上、下尿路结石成分特点,分析延安地区泌尿系结石发生的流行病学情况,为临床制定有效的个体化治疗及预防措施提供参考依据。方法收集2013年1月至2017年1月在延安大学附属医院泌尿外科治疗1984例尿路结石患者的年龄、性别、结石部位等临床资料,对比分析延安地区泌尿系结石在不同年龄、不同性别、不同解剖部位的分布特点。结果在1984例泌尿系结石的患者中,按每10岁年龄大小分组排序,统计各年龄阶段泌尿系结石发病情况,男性患者有1346例,女性患者有638例,男性年龄(50.23±14.48)岁,女性年龄(47.87±14.51)岁,男、女患者比例约2.11∶1。在66~75岁年龄段,尿路结石发病率性别差异具有统计学意义(P<0.05)。结石成分以混合性结石为主,以混合性结石为主,共1582例,占79.76%。其中1665例(83.92%)为上尿路结石,上、下尿路结石的比例为5.22∶1,其余为肾结石合并膀胱结石。上尿路结石中男性1062例,女性603例,男女比例为1.76∶1;下尿路结石中男性284例,女性35例,男女比例为8.11∶1。青壮年(年龄≤45岁)泌尿系结石患者草酸钙为主结石、感染性结石多见;中老年(年龄>45岁)泌尿系结石者草酸钙为主结石、尿酸类结石多见。感染性结石患者性别差异具有统计学意义(P<0.05)。结论在延安地区男性较女性更容易患泌尿系结石。同时,不同年龄段结石构成成分具有差异。对于年龄≤45岁患者,主要以草酸钙为主结石、感染性结石多见,这与结石整体发病率基本一致;而对于年龄>45岁患者,主要以草酸钙为主结石、尿酸性结石多见。表明对于不同年龄段的结石患者,可以根据上述结果在结石的预防和治疗上综合考量,给予明确而更加合理的治疗。     

Percutaneous removal of upper urinary tract calculi: experience with ultrasonic lithotripsy

From October 1983 to March 1985, the authors removed upper urinary tract calculi percutaneously in 102 patients. In 89 patients, stones required disruption with an ultrasonic lithotriptor before removal. Fifty-two patients had a stone in the renal pelvis and 20 had calyceal stones only; 21 had stones at both sites and 9 had a stone in the upper ureter. Complete removal of all stone material was achieved in 67 of 68 patients with a solitary calculus, in 13 of 26 with multiple calculi and in 6 of 8 with ureteric calculi. Complications were minimal; three patients had pulmonary edema postoperatively as a result of excessive absorption of irrigating fluid, and one patient sustained a perforation of the descending colon. The mean postoperative hospital stay was 6.8 days and patients were able to return to work a few days after their discharge from hospital. Percutaneous stone removal is a safe and effective procedure and is the surgical procedure of choice for the removal of upper urinary tract calculi.     

Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus

Urethral calculus is a rare form of urolithiasis with an incidence lower than 0.3%. We determined the outcomes of 15 patients with urethral stone, of which 8 were pediatric, including an undiagnosed primary fossa navicularis calculus. Fifteen consecutive male patients, of whom eight were children, with urethral calculi were assessed between 2000 and 2005 with a mean of 19 months’ follow-up. All stones were fusiform in shape and solitary. Acute urinary retention, interrupted or weak stream, pain (penile, urethral, perineal) and gross hematuria were the main presenting symptoms in 7 (46.7%), 4 (26.7%), 3 (20%) and 1 (6.6%) patient, respectively. Six of them had accompanying urethral pathologies such as stenosis (primary or with hypospadias) and diverticulum. Two patients were associated with upper urinary tract calculi but none of them secondary to bladder calculi. A 50-year-old patient with a primary urethral stone disease had urethral meatal stenosis accompanied by lifelong lower urinary tract symptoms. Unlike the past reports, urethral stones secondary to bladder calculi were decreasing, especially in the pediatric population. However, the pediatric patients in their first decade are still under risk secondary to the upper urinary tract calculi or the primary ones.     

Epidemiological study on urolithiasis in Mie Prefecture. 1. Present status in 1985

To determine the present status of urolithiasis in Mie Prefecture, we analyzed the 1,314 patients of urolithiasis at 17 Departments of Urology and 2 Departments of Medicine in 1985. The ratio of male patients to female patients was 2.6 to 1. The most frequent incidence of urolithiasis was observed in Iinan county. The incidence of urolithiasis in the urban area was the same as that in the country. Most of the stones (96.9%) were in the upper urinary tract. The incidence of lower urinary tract calculi tended to be high in southern Mie Prefecture. The ratio of upper urinary tract calculi to lower urinary tract calculi in the urban area was the same as that in the country. The peak incidence in males was in the forties, while that in females was in the fifties. The average age was 44.5 years old. Ureterolithotomy was the most frequent (37.5%) surgical therapy, percutaneous nephrolithotomy and shock wave lithotomy done in 8.0% and 6.3%, respectively. The most frequent component of the urinary tract calculi was calcium oxalate and/or calcium phosphate (84.0%). The incidence increased in summer (April through September).     

The aetiological and clinical pattern of childhood urolithiasis in Saudi Arabia

The clinical and aetiological pattern in 85 stone-forming children presenting to an integrated nephrourological service in Riyadh is reviewed. All patients were below the age of 15 years, the male to female ratio being 2∶1. Only 2 children presented with bladder calculi. The remaining all had upper tract stone and, in 12 cases, these were bilateral. Of 34 calculi recovered for analysis, one-third was predominantly calcium oxalate and a further third was composed of uric acid or urate. Four patients had cystine stones and the remaining 7 presented mixed calcium stones, 6 (17.6%) being struvite and infection-related. Of the 85 patients 55 were treated successfully with extracorporeal shock wave lithotripsy, 16 underwent surgery and 7 had their stones removed by endourological procedures. In the remaining 7 children, stones dissolved or were passed spontaneously during medical therapy. Nine children (10.6%) showed a primary metabolic defect leading to their stone formation, 10 (11.8%) had a predisposing anatomical anomaly and 15 (17.6%) presented with urinary tract infection. Of the remaining 51 patients (60%) with idiopathic disease, 6 showed hypercalciuria on investigation and 2 children may have formed their stones due to prolonged recumbency.     

ESWL与输尿管镜碎石联合处理上尿路结石

目的：探讨对部分上尿路结石采用ESWI．与输尿管镜碎石联合处理的方法。方法：对70例上尿路结石患者采用ESWI。与输尿管镜下钬激光碎石（URS）联合交替治疗。其中输尿管结石48例,。肾结石22例。结果：结石总排净率为91．4％00（64／70）,其中输尿管结石排净率为95．8％（46／48）,肾结石排净率为81．8％（18／22）。3例治疗失败,其中1例输尿管结石因输尿管狭窄无法入镜;另2例肾结石,1例因交替治疗次数过多中途停止治疗,1例因结石硬度过大ESWI,不佳,均改为PCNL术。结论：ESW[。与URS联合交替进行的疗法处理上尿路结石,避免了创伤性治疗,扩大了ESWI,治疗范围,降低了URS手术难度,缩短了URS操作时间,提高了结石排净率,患者创伤微小、恢复快、并发症少,是治疗上尿路结石,特别是部分复杂性上尿路结石较理想的方法之一。     

微创经皮肾穿刺取石治疗小儿上尿路结石

目的探讨微创经皮肾穿刺取石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗小儿上尿路结石的效果。方法回顾分析35例MPCNL治疗小儿上尿路结石的临床资料,男29例,女6例,平均年龄8.5岁（4～13岁）。输尿管上段结石7例,肾结石28例,均为一侧上尿路结石。伴肾盂输尿管连接部（ureteropelvic junction obstruction,UPJ）梗阻2例。结果MPCNL治疗成功31例,成功率88.6%（31/35）,其中一期结石完全清除率87.1%（27/31）,二期结石完全清除率75%（3/4）。2例结石位于UPJ致结石下方狭窄,2例皮肾穿刺失败,改开放手术。结论MPCNL是治疗小儿肾结石和输尿管上段结石安全、有效的方法。     

Changes in kidney stones type according to sex and age in Tunisian patients

BackgroundStudies that evaluate the effect of age and gender on the stone composition are scarce. The aim of this study is to highlight the modification of epidemiological characteristics of this pathology according to patients’ sex and age.Patients and methodsWe studied 1269 urolithiasic patients ranging from 6 months to 92 years old and known as having urinary stones (752 males and 517 females). Stone analysis was performed respectively using a stereomicroscope and infrared spectroscopy to determine, respectively, the morphological type and molecular composition of each.ResultsThe annual average incidence of new stone formation was 30.25 per 100000 inhabitants. In 1041 patients (81%), calculi were located in the upper urinary tract. Children and old man were more affected by bladder stone. Calcium oxalate monohydrate remains the most frequent stone component even if its frequency fell according to age (63.2% in teenagers and 40.6% in elderly [p < 0.05]) in favour of the increase of uric acid stones (3,5% in teenagers and 41.5% in elderly [p < 0.05]). Struvite stones were rare (3.5%) and more frequent in children.ConclusionThe analysis of these data shows that urinary stones in Tunisia are tending to evolve in the same direction as in industrialized countries.     

Changes in the incidence of lower urinary tract stones in Japan from 1965 to 1995

BACKGROUND: The changes over time of the annual incidence of lower urinary tract stones in Japan from 1965 to 1995 were analyzed. METHODS: Data on lower urinary tract calculi were abstracted from the past three nationwide surveys of urolithiasis, which covered nearly all major hospitals and urologists in Japan and enumerated all outpatient visits diagnosed as urolithiasis in the years 1965, 1975, 1985 and 1995. Chronological changes in the sex- and age-related annual incidences of lower urinary tract stones and stone composition were estimated. RESULTS: Lower urinary tract stones were predominant in men 60 years of age or older. Between 1965 and 1995, the annual incidence has significantly decreased in men > or = 60 years of age from 37.2 to 27.0 per 100000 and significantly increased in women > or = 60 years of age from 2.4 to 4.8 per 100000. In men, an increased proportion of uric acid and calcium stones as well as a decreased frequency of infection stones is a phenomenon common to upper urinary tract stones. However, infection and calcium stones have been two major stone types in women. CONCLUSIONS: In contrast to upper urinary tract calculi, the incidence of lower urinary tract stones has decreased over the last 30 years in men > or = 60 years of age predisposed to this disease.     

Urolithiasis in Tunisian children: a study of 120 cases based on stone composition

The composition of urinary stones in children depends on socioeconomic conditions and hygiene, geographical area, and dietary habits. We analyzed urinary stones from 120 consecutive Tunisian children (81 males, 39 females) aged 5 months to 15 years. The stone was located in the upper urinary tract in 91 cases (76%). Stone analysis included both a morphological examination and an infrared analysis of the nucleus and the inner and peripheral layers. The main components of bladder calculi were whewellite (69%) and struvite (22%), whereas the main component of upper urinary tract calculi was whewellite (67%). The nucleus of bladder stones was composed of ammonium urate (45%), struvite (28%), cystine (10%), and carbapatite (7%). The nucleus of kidney and ureteral calculi was mainly composed of ammonium urate (38%), whewellite (24%), carbapatite (13%), or struvite (11%). Based on stone composition, urinary tract infection was involved in the nucleation or growth of a third of calculi. Endemic urolithiasis involving simultaneous nutritional, metabolic, and infectious factors, and defined by its nucleus composed of ammonium urate without struvite, represented 40% of cases. Exclusive metabolic factors – including genetic diseases such as primary hyperoxaluria, cystinuria, and hypercalciuria – were responsible for less than 25% of cases. Received: 6 March 1998 / Revised: 22 March 1999 / Accepted: 22 March 1999     

Electrohydraulic lithotripsy of upper urinary tract calculi

Electrohydraulic lithotripsy (EHL) was employed for the treatment of 35 patients with upper urinary tract calculi. The stones in 14 patients with renal and upper ureteral calculi were disintegrated by a 9Fr probe and the rigid nephroscope. Twelve patients with upper or middle ureteral calculi were treated using a 5Fr probe and the fiberscope. The stones in 9 patients with lower ureteral calculi were removed by a 5Fr probe and the rigid ureteroscope. Although small residual stones were observed in 15 patients (43%), all the stones were fragmented satisfactorily except in two patients. The complications due to EHL were observed in eight patients (23%). The most frequent complication was the ureteral injury which was observed in 6 patients. In 2 of these patients the stone migrated out from the ureter. However, all the cases of ureteral injury were healed by the conservative therapy such as by indwelling the stent catheter without ureteral stricture.     

Recurrence of upper urinary tract calculi

Treatment of upper urinary tract stones has changed greatly. The recurrence of calculi after the discharge was studied in the 634 patients with urolithiasis admitted to our department during the 9 years up to the end of 1984. The recurrence rate in the 325 cases followed for more than 3 months after the disappearance of the original stones, was 15.6% after 2 years, 27.6% after 5 year and 51.4% after 8 years. In recurrent stone formers, the rate of recurrence thereafter was greater than that of primary stone formers. The growth of calculi was rapid in the renal stone former concomitant with urinary tract infection together with a past history of renal surgery. In relation to the composition of the stone, uric acid calculi tended to recur more often than calculi composed of other substances. In view of recurrence, pyelolithotomy is preferred to renal parenchymal incision.     

Ureteral calculi in children: review of 50 consecutive cases

Fifty children presenting with ureteral calculi over a twenty-year period were studied retrospectively. There were 35 boys and 15 girls, with a mean age of five and a half years. Nineteen patients had a urinary tract anomaly: 11 had an obstructed megaureter, and 8 had previously undergone urinary tract surgery. Forty-four children had infection stones and the remaining 6 oxalate calculi. Infected urine was found in 35; the infecting organism was a Proteus species in 23. Metabolic abnormalities were detected in 2 children. Operative removal of the stones was done in 39 patients, and in the remaining 11 patients the stones passed spontaneously. There were 6 recurrences, all within four years of initial presentation.     

Annual changes of the incidence and clinical characteristics of magnesium ammonium phosphate urinary stones

BACKGROUND: Magnesium ammonium phosphate (MAP) urinary stones account for the majority of staghorn stones and frequently cause a non-functioning kidney. In the present study, we examined the annual changes of the number and clinical characteristics of MAP stones. METHODS: The annual incidence of MAP stones was investigated in 2619 patients with urinary stones in whom composition of the stone was analysed at Chiba University Hospital between 1964 and 1999. In addition, the annual number of patients with MAP stones was examined at Funabashi Clinic. In a total of 644 patients with MAP stones, age and sex of the patients, location and size of the MAP stones, urinary cultures and etiological factors were analysed. RESULTS: The number of MAP stones in the lower urinary tract was relatively constant. In contrast, MAP stones in the upper urinary tract had dramatically decreased since 1989, resulting in an increase in the rate of MAP stones in the lower urinary tract. Age distribution of the MAP stone patients ranged from 10 years to > 80 years, with the majority aged 30-60 years. The proportion of larger MAP stones in the upper urinary tract increased. There was no significant difference in prevalence of urine cultures. Among etiological factors for MAP stones, difficulty on urination tended to be common in recent years. CONCLUSION: The number of MAP stones, especially in upper urinary tract, has been decreasing during the last decade. At present, treatment of urinary tract obstruction seems important for the management of MAP stones in lower urinary tract.     

组合式输尿管软镜联合钬激光治疗上尿路结石

目的评价组合式输尿管软镜联合钬激光治疗上尿路结石的安全性及临床疗效。 方法收集2015年4月至2017年4月我院采用组合式输尿管软镜治疗433例上尿路结石患者的临床资料。单发性结石178例,多发性结石255例;肾中上盏132例,肾下盏结石97例,输尿管上段及肾盂结石204例。结石直径为0.8～4.0 cm。 结果一次性进镜成功率100%,手术时间30～280 min,术后住院时间1.0～5.0 d。1例结石未寻及,改为体外冲击波碎石。3例光纤无法触及结石,均改为经皮肾镜术。其他429例均实施组合式输尿管软镜术。术后2周复查腹部平片或泌尿系CT平扫,结石排净率84.4%（362/429）,二次手术37例,最终结石清除率为89.9%（386/429）。未发生输尿管穿孔、撕脱及大出血等严重并发症。 结论组合式输尿管软镜联合钬激光治疗上尿路结石临床应用安全,疗效理想,可作为输尿管上段结石及肾结石的理想治疗方案,具有很好的临床应用价值。     

Urolithiasis in childhood: current management

During the past 12 years, 62 children with urinary stones have been treated at the Children's Hospital of Philadelphia. The most common presenting symptoms were abdominal or flank pain (45%), recurrent or persistent pyuria (35%), and gross hematuria (21%). Twenty-two patients had associated congenital urologic anomalies. Infection-related struvite stones were most common and were found in 18 children, of whom 15 were found to have anatomic abnormalities. Eighteen of 28 children evaluated for a metabolic cause were found to have an abnormality, most frequently hypercalciuria. No predisposing factors could be found in 16 of the 62 patients. Forty-four (87%) children had upper urinary tract stones. Twelve of 15 bladder stones were in children with a neuropathic bladder and all were related to infection. Treatment was directed to the correction of anatomic and metabolic predisposing causes, as well as to removing the stones. Fifteen patients passed stones ranging in size from 2 to 6 mm. Forty-six surgical procedures were performed in 43 children. Pyelolithotomy and cystolithotomy were the most frequent procedures. There were three residual stones and five recurrences. Of the 29 operations for upper urinary stones reviewed, 17 might today be considered suitable for percutaneous nephrostolithotripsy or extracorporeal shockwave lithotripsy. Possible future stone management will be discussed in light of this analysis.     

广东南海地区泌尿系结石患者结石成分分析(附986例报告)

【摘要】 目的 应用红外光谱法分析广东南海地区泌尿系结石患者的结石,为临床个性化防治泌尿系结石及复发提供理论依据。方法 通过自然排出、碎石后排出或手术取出获得结石样本986例,并应用红外光谱法对其行结石成分分析。结果 泌尿系结石患者男女比例为1.34∶1,51岁~60岁年龄阶段患者所占比例最高,上尿路结石发病人数明显多于下尿路结石,比例达9.49∶1。定性分析共检测出一水草酸钙、二水草酸钙、碳酸磷灰石、无水尿酸、六水磷酸镁铵和胱氨酸6种化学成分。混合成分结石647例,占总人数的65.6%;含钙结石853例,占86.51%。草酸钙检出率最高,占77.38%,其次是碳酸磷灰石(5.27%)和尿酸(13.29%)成分。结论 采用红外光谱法分析泌尿系结石成分,对于了解结石成因、预防结石形成和复发具有重要的意义。     

Clinical studies on thirty-two cases of childhood urolithiasis

We evaluated 32 patients with urinary calculi under 16 years of age over the past 14 years since the founding of the Department of Urology, Kinki University School of Medicine. They comprised 0.8% of the total urolithiasis patients. They consisted of 18 boys and 14 girls with a male-to-female ratio of 1.29. The average age was 8.7 years for boys and 10.4 years for girls without any marked peak. The most frequently chief complaint was hematuria which was present in 15 cases (47%). Although pyuria was seen in seven cases (22%), urinary bacterial culture was positive only in 5. The underlying diseases could be diagnosed in 13 cases (41%), of which eight cases (62%) developed metabolic disorder. The sites of calculi were determined in 29 cases (91%), of which 28 had stones in the upper urinary tract. Surgical treatment was performed on 16 cases in 17 sessions. Ureterolithotomy was done in as many as five cases, followed by pyeloplasty in four cases. Nephrectomy was performed in only one case. There was only one case which had been treated with extracorporeal shock-wave lithotripsy (ESWL). The composition of calculi was found in 21 cases (66%), the majority or 13 cases (57%) of which had calcium-containing stones. Nevertheless, there was no case of hypercalciuria. When compared to the previous reports in Japan, it was worthy of note that calculi in the upper urinary tract and calcium-containing stones had higher incidences. It is expected that more patients will be treated with ESWL in the future.(ABSTRACT TRUNCATED AT 250 WORDS)     

泌尿系结石成分450例分析

目的分析泌尿系结石患者的发病年龄及性别特点,探讨结石部位与患者年龄及性别的关系,根据结石不同成分采用不同预防措施。方法应用化学分析法对450例尿路结石做成分分析,结合临床资料,对尿路结石患者发病年龄、性别、结石部位及结石成分做对比分析。姑杲男性患者321例,高发年龄21～60岁;女性129例,高发年龄41～60岁;男性发病率是女性的2．49倍。发病部位肾脏结石319例（70．8％）,输尿管结石115例（25．6％）,膀胱结石16例（3．6％）;单一成分结石275例（61％）,其中单纯草酸钙结石260例（57．7％）,两种及以上混合成分结石175例（39．0％）。结论尿路结石的发病率及发病年龄存在着明显的性别差异;尿路结石发病部位主要为上尿路结石;单一成分结石以草酸钙为主,约40％的尿路结石为两种及以上混合成分结石。     

The relation between urinary tract infections and stone composition in renal stone formers

During a seven-year period (1975-1981) a total of 1325 patients hospitalized for stone disease were studied as to the occurrence of positive urine cultures. Urinary stones from 535 surgically treated patients were analyzed with infrared spectrophotometry and the relationships between stone composition, level of surgery and bacteriological strains were studied. Positive urinary cultures were found in 34% of the surgically treated patients and in 21% of those not operated upon. Among the surgically treated patients with urinary tract infection (UTI) E. coli was the most frequent microorganism (35%), followed by Proteus (28%). Patients with Proteus infection had the highest frequency of UTI episodes, most of which occurred before hospitalization. There was a higher frequency of magnesium ammonium phosphate (MAP) calculi among patients with Proteus infection than among those with non-Proteus infection, in whom no difference in stone composition was found. Patients infected with E. coli had more phosphate-containing stones (CaP+MAP) than non-infected patients. The highest frequency of oxalate calculi (CaOx+CaOx/CaP) was found among patients without infection. No E. coli infections were seen in male patients with CaP and MAP calculi. MAP stones were most often found in the kidney and oxalate stones in the ureter.