Primary carcinoma in situ of the upper urinary tract: a case report]

A case of primary carcinoma in situ of the upper urinary tract in a 72-year-old woman is reported. The patient who complained of left lower abdominal pain was referred for a suspicion of left ureteral stone. An excretory pyelogram showed mild left ureteral stricuture at the level of L3, but a stone was not detected in the ureter at the same level. Cytology of voided urine was positive for malignant cells several times. Cystoscopic examination revealed no abnormality in the bladder. Retrograde left pyelogram demonstrated the ureteral stricture and no lesions either of stone or tumor in the ureter. However malignant cells were detected cytologically in the left ureteral catheteral urine. Left total nephroureterectomy with the bladder cuff was carried out under the preoperative diagnosis of carcinoma in situ of the upper urinary tract. Macroscopically, the wall of the ureter at the stenotic level had induration without apparent tumor mass. The pathological diagnosis was transitional cell carcinoma in situ from the renal pelvis to the mid-ureter. The primary carcinoma in situ of the upper urinary tract is rare. To our knowledge, this case is the 26th case reported in the Japanese literature.     

Renal pelvic extravasation of urine associated with ureteral stones: report of two cases]

We report a case of spontaneous rupture of the renal pelvis and a case of spontaneous peripelvic extravasation, which were associated with ureteral stones. Case 1 was in a 73-year-old man with complaint of left flank pain. Excretory urograms showed left spontaneous rupture of the renal pelvis associated with left ureteral stone. Double-J ureteral stent was placed immediately and transurethral ureterolithotripsy (TUL) was performed after disappearance of extravasation. Case 2 was in a 34-year-old woman with complaint of left flank pain. Excretory urograms showed left ureteral stone and spontaneous peripelvic extravasation. The stone passed spontaneously and the extravasation disappeared with conservative therapy.     

Percutaneous nephrostomy for unusual complications occurring in patients with ureteral stones: a report of two cases

The first case is a 59-year-old man who had left flank pain and nausea. KUB, excretory urograms and CT scan showed a left ureteral stone at the ureterovesical junction associated with spontaneous rupture of the left renal pelvis. Percutaneous nephrostomy was performed. The ureteral stone was spontaneously discharged on the 4th postoperative day and extravasation of contrast medium from the left renal pelvis disappeared. The second case is a 42-year-old man who was admitted with bilateral flank pain, nausea and vomiting. KUB and excretory urograms showed bilateral hydronephrosis due to small bilateral ureteral stones. Serum BUN and creatinine had risen to 41 and 5.1 mg/dl, respectively, on the day after admission. Percutaneous nephrostomy to the left kidney was performed. BUN and creatinine were normalized immediately and the bilateral ureteral stones were spontaneously discharged by the 9th postoperative day. After the nephrostomy catheters were removed, no complications occurred in either case and KUB and excretory urograms showed normal findings.     

ESWL治疗尿路结石1380例报告

报告应用国产NSJ-15型水囊式碎石机治疗尿路结石1380例,其中肾结石535例,输尿管结石744例,肾伴输尿管结石90例,膀胱及后尿道结石12例。碎石率为99.06％,三个月结石排净率肾结石为92.84％,输尿管结石为92.43％。并对71例结石进行红外光谱分析以探讨结石成分与碎石效果的关系;对85例病人碎石前后尿液NAG酶测定以了解冲击波对肾脏损害情况。主张输尿管结石尽量采用原位治疗。     

A case of uretero-vaginal fistula with ureteral foreign body stone originated from the suture thread

A 32-year-old female was admitted to our hospital with the chief complaint of vaginal discharge of urine. She had undergone radical hysterectomy due to uterine cancer at another hospital by a gynecologic surgeon 5 years earlier. X-ray examination showed a stone-like shadow at the left ureter without hydronephrosis. She was diagnosed with ureterovaginal fistula with the left ureteral stone. Left ureterolithotomy and ureterovesiconeostomy was performed. The stone revealed a foreign body stone originating from the silk worm-gut which had penetrated accidentally the ureter when the vaginal wall was sutured at the previous surgery. Including our case, 15 cases of foreign body stones in the upper urinary tract were found in the Japanese literature and none of them were associated with ureterovaginal fistula.     

Ureterocolonic fistula formation 12 years after a nephrectomy for renal tuberculosis with a staghorn stone

A postoperative ureterocolonic fistula is rare; only two cases have been reported in the past 38 years in the English medical literature. A 77-year-old female with left renal tuberculosis and staghorn stone received a nephrectomy and a 9-month course of antituberculous therapy. Twelve years later, she experienced repeated urinary tract infection and associated pneumaturia despite medical treatment. Cystoscopy revealed yellowish debris in the bladder, and a computed tomographic examination showed an air bubble in the bladder and a highly suspected fistula between the left ureteral stump and sigmoid colon. After a fistulectomy, she completely recovered, and follow-up urinalysis yielded normal results. This case report highlights this rare condition of urinary tract infection secondary to fistula formation from the ureteral stump even 12 years postoperatively. In addition, we compare different imaging techniques and hypothesize that a nephroureterectomy may be indicated for an inflammatory nonfunctioning kidney containing a staghorn stone.     

Left ureteral tumor five years after radical cystectomy associated with duplication of inferior vena cava: a case report

A 70-year-old male was admitted with left lumbago. He underwent a radical cystectomy five years earlier due to recurrent bladder carcinoma. Excretory urography revealed left hydronephrosis, left hydroureter and a right ureteral stone. Antegrade pyelography and urinary cytology of left kidney suggested the presence of left ureteral tumor and this was confirmed by an endoscopic work up through the nephrostomy. This patient was revealed to have a duplicated inferior vena cava by CT scan and vena cavography. A radical left nephroureterectomy was done uneventfully. M-VAC was adopted for post operative therapy.     

Silicate urolithiasis: a case report]

A 62-year-old male visited our department complaining of left flank pain and urinary retention on November 6, 1989. Intravenous pyelography showed small stone shadows in bilateral ureters and lower calyx of kidney and the left kidney was not visualized. Endoscopically, calculi were seen in bilateral ureteral orifice. An ureteral catheter could not be passed up from there bilaterally. On November 13, 1989, January 24 and 26, 1990, calculi were passed out spontaneously. Analysis of the stones revealed silica calculus. The patient had a past history of duodenal ulcers. He was administered magnesium silicate and magnesium alminometasilicate as an anti-acid drug for ten years. Sixteen cases of silica calculus in Japan are reviewed.     

Urolithiasis in renal and combined pancreas/renal transplant recipients

PURPOSE: Urological complications in renal transplant recipients will become more common with increasing numbers of transplantations as well as increased graft survival secondary to improvements in immunosuppression. Urinary stone disease may be one of those complications. We determine the current incidence of urinary stone disease in renal transplant patients based on contemporary immunosuppressive regimens. MATERIALS AND METHODS: We reviewed the records of 1,730 renal and 83 pancreas/renal transplantations performed during the cyclosporine era and identified 8 recipients (0.4%) with urinary stone disease, including 3 with renal pelvic stones, 1 with multiple ureteral stones and 4 with bladder calculi. RESULTS: Treatment ranged from conservative observation to open pyelolithotomy, and included percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. The ureteral stones were removed with antegrade and retrograde ureteroscopy. The 4 bladder stones were treated with cystolithalopaxy. No case had significant permanent graft damage. Mean followup was 68.6 months. Mean serum creatinine was 1.5 mg./dl. (normal 0.5 to 1.3) at baseline and 2.38 after followup. CONCLUSIONS: While the incidence of upper tract urinary stone disease in renal (0.23%) and pancreas/renal (1.2%) transplant recipients is not statistically significant (p <0.45), the latter have significantly higher rates of bladder stones (4.8 versus 0%, p <0.001). The diagnosis of urinary stone disease in transplant recipients can be challenging because of the lack of symptoms but the treatment approach is the same as in the normal population.     

Multiple giant prostatic urethral stones with an ureteral stone in a young patient

Giant prostatic urethral stones have been reported as a very rare entity, and the etiology of these stones is not clear. We report a case of a 40-year-old man with giant multiple prostatic urethral stones whereby the entire gland was replaced, and a big ureteral stone presented with voiding difficulty and recurrent urinary tract infections. In the literature, to our knowledge, this is the youngest case wherein giant prostatic urethral stones coexisted with a big ureteral stone. Many different-sized stones were observed endoscopically, some protruding into the urethra, and some filling different cavities on the prostate. Following cystoscopy, multiple giant prostatic stones weighing a total of 151 g were removed by the open retropubic route. We treated the big ureteral stone endoscopically.     

Two cases of ammonium acid urate urinary stones related to anorexia nervosa and laxative abuse

We report two cases of urolithiasis related to anorexia nervosa and laxative abuse. Case 1: A 21-year-old woman was referred to our hospital because of left flank pain. A left ureteral stone, 10 x 6 mm in size, was successfully fragmented by extracorporeal shock-wave lithotripsy (ESWL), but she experienced repetitive formation of bilateral urinary stones and double J stent encrustation which required 13 sessions of ESWL, one session of transurethral ureterolithotripsy and one session of cystolithotripsy over a period of 5 years. All stones were comprised of pure ammonium acid urate. It was later revealed that she was diagnosed with anorexia nervosa at 15 years old and had suffered from laxative abuse (bisacodyl, 300-500 mg/day) ever since. Case 2: A 18-year-old woman was referred to our hospital because of left lower abdominal pain. A left renal stone, 15 x 10 mm in size, was successfully fragmented by ESWL, but she had double J stent encrustation which was managed by cystolithotripsy. All stones were comprised of pure ammonium acid urate. She was later diagnosed with anorexia nervosa and it turned out that she had suffered from an eating disorder and laxative abuse (bisacodyl, 200 mg/day) since the age of 15 years. Both patients had marked decrease in urine volume, hyponatremia and hypokalemia. Anorexia nervosa and laxative abuse should be suspected whenever a woman has an ammonium acid urate stone in sterile urine because the treatment of these disorders is crucial to the prevention of repetitive formation of urinary stones.     

Endoscopic treatment for severe encrusted ureteral stent left in place for 3 years

A 52-year-old man had bilateral ureteral stents placed before treatment for ureteral and renal stones, but did not return for treatment and follow-up. Three years later, he complained of hematuria and vertigo. An abdominal X-ray revealed large renal and ureteral stones rising from and enveloping the stent. A bilateral percutaneous nephrostomy was placed. The right ureteral stent was easily removed with a cystoscope. The left ureteral stone was separated from the stent by ureteroscopic lithotripsy (TUL) and percutaneous nephroscopic lithotripsy (PNL). The left stent was torn off and difficult to remove because of encrustation. It was finally removed through an endoscopic procedure. Right PNL and extracorporeal shock wave lithotripsy (ESWL) were performed and all stones and stents were extracted. He was stone-free at 4 months.     

Clinical experiences of renal and ureteral stones by extracorporeal shock-wave lithotripsy (ESWL). IV: 3-year clinical experience of cases treated with ESWL

We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1,225 patients (1,320 cases) underwent 1,647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected.     

Blind ending bifid ureter with stone in the blind branch: report of a case]

Blind ending bifid ureter is a rare anomaly in the urinary tract. This anomaly may result from failure of a premature branch of the ureteral bud to join with the metanephric blastema. A 21-year-old man was admitted with macroscopic hematuria and colic pain in the left flank region. Urinalysis demonstrated hematopyuria and excretory urography suggested bifid ending accessory ureter with a stone on the left side. Surgical exploration showed that the accessory ureter was bifurcated from the left ureter at about 5 mm from the bladder wall and ran parallel with the left ureter. Although dense adhesions to the surrounding tissue existed, the accessory ureter was resected at the site of the junction. It measured 3 cm in length and 1 cm in greatest diameter. The stone found at the tip of the accessory ureter was composed of calcium oxalate (24%) and calcium phosphate (76%). Histological examination revealed that the ureter had all layers of normal ureteral structure and no renal tissue was identified in the specimen resected. During a follow-up period of 22 months after the operation, he was free of urinary tract infection and abdominal pain. Of 77 cases with blind ending bifid ureter reported in the Japanese literature, a ureteral stone was found in the blind branch in only 5 cases.     

Calcium nephrolithiasis and distal tubular acidosis in type 1 glycogen storage disease

A 36-year-old man was admitted to hospital due to right flank pain as a result of ureteral stones. He had been followed up for type 1 glycogen storage disease since the age of 11 years. He had four episodes of spontaneous stone birth during the previous 2 years, and each stone was composed mainly of calcium oxalate. Intravenous pyelography showed right hydronephrosis due to ureteral stones and bilateral multiple renal stones. We carried out transurethral ureterolithotripsy (TUL) on the right ureteral stones. The composition was a mixture of calcium oxalate and calcium phosphate. Laboratory evaluation demonstrated the association of distal renal tubular acidosis (RTA). These observations suggest that hypocitraturia and distal RTA are strongly correlated to recurrence of calcium nephrolithiasis. The patient's serum uric acid and urinary citrate excretion levels normalized after allopurinol and potassium citrate administration.     

Urolithiasis in adults with congenital megaureter

The primary presentation of congenital megaureter in adults is rare. Development of urolithiasis may lead to this unusual underlying diagnosis. Urinary tract stones can form either within the dilated ureteral segment or in a part of the upper urinary tract proximal to the abnormal ureteral segment. We report two cases of nephrolithiasis that occurred in adults found to have segmental megaureter. The first case is that of a 58-year-old man who presented with left lower quadrant pain. Computed tomography scan revealed a 2-cm stone in the distal left ureter within an area of isolated segmental distal ureteral dilation. The second case is a 48-year-old man who developed recurrent renal urolithiasis associated with isolated distal megaureter.Although a rare condition in adults, congenital megaureter may present when kidney stones develop as a result of the ureteral abnormality. Typically, stones will develop within the dilated segment of ureter. Atypically, stones may develop away from the site of the underlying abnormality. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms.     

Management of unilateral renal cystine calculi via percutaneous nephrolithotripsy in a child with a contralateral non-functional kidney--a case report

A 2-year old boy visited our clinic with a chief complaint of high fever. A past history of acute renal failure due to cystine stones and cystinuria was expressed. Abdominal rentogenograms and CT demonstrated a right ureteral stone and a left renal stone. Furthermore renogram evaluation indicated non-function of the right kidney and dysfunction in the left kidney. Since right ureteral stone moved into bladder seven days post-admission, right ureteroscopy, left PNL, and cystolithotripsy were performed. Considering that right ureteral stenosis was determined by ureteroscopy, balloon dilation against the stenotic ureteral wall was performed. Left PNL and cystolithotripsy were successfully performed. No intraoperative complications occurred and no symptoms of signs of recurrence of the underlying metabolic disease were evident four months postoperatively.     

The frequency-doubled double-pulse Neodym:YAG laser lithotripter (FREDDY) in lithotripsy of urinary stones. First clinical experience

Laser lithotripsy does not play an important role in urinary stone treatment, mostly due to ineffective fragmentation efficiency, and high purchase and maintenance costs. The aim of the following retrospective study was to show the clinical significance and efficiency of an innovative laser lithotripsy system for urinary stone treatment. Between November 1998 and October 1999, 48 patients were treated with the innovative frequency- doubled double-pulse Neodym: YAG laser lithotripter FREDDY. A total of 50 renal units were treated, 43 ureteroscopically, four ureterorenoscopically, three percutaneous-nephroscopically, and one bladder stone cystoscopically. With a median laser operation time of 5 min (range: 1-30 min) and a total procedure duration of 60 min (range: 15-180 min), a stone-free rate of upper ureteral stones of 62%, middle ureteral stones of 91% and distal ureteral stones of 100% were documented on the first day after treatment. In an observation period of 6 months, no complications were seen. In our experience Laser lithotripsy with FREDDY is an effective, simple and reliable method for the treatment of ureteral stones, with low purchase and maintenance costs. The extremely thin and highly flexible quartz fibre may extend the endoscopic spectrum to otherwise poorly accessible upper ureteral stones, the renal pelvis and renal calix stones. Therefore, a prospective validation study for comparison with ballistic lithotriptors is of great interest.     

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。     

Acute renal failure due to bilateral ureteral stone impaction in an HIV-positive patient

A 51-year-old HIV-positive man treated with atazanavir for 9 months presented with anuria following right flank pain. Laboratory examination indicated renal insufficiency, and abdominopelvic computed tomography scanning showed bilateral hydroureteronephrosis, but no stones were visualized. Endoscopic procedures were performed to investigate the causes of ureteral obstruction and, if possible, to insert Double-J stents in the ureters. A yellowish stone composed of pure atazanavir was found at the right ureteral orifice, and retrograde pyelography revealed a filling defect in the left ureter found to be caused by an atazanavir stone. The patient’s renal function recovered after removal of these stones.