Comparison of renal function and metabolic abnormalities of cystine stone patients and calcium oxalate stone patients in China

Purpose

To compare renal function and metabolic abnormalities of cystine stone patients and calcium oxalate stone patients in China.

Methods

Between 2008 and 2011, thirty cystine stone patients were involved in our study, and an equal number of age- and gender pair-matched patients with calcium oxalate stones. Non-stone forming individuals were elected as controls. The evaluation included blood chemistry studies and 24-h urine collection in both groups of patients.

Results

The cystine stone patients had higher mean values of serum blood urea nitrogen, urate and creatinine levels than patients in other two groups. With respect to urine risk factors, cystine stone patients had higher urinary citrate and lower urinary oxalate and creatinine than calcium oxalate stone patients. When compared to non-stone forming individuals, cystine stone patients had higher urinary urate excretion and lower urinary creatinine excretion. Metabolic abnormalities could be demonstrated in 80 % of the cystine stone patients and in 100 % of the calcium oxalate stone patients. We also compared urine risk factors among cystine stone patients with different urine cystine excretion (<1 mmol/24 h, 1–2 mmol/24 h and >2 mmol/24 h). No significant difference was found in urine risk factors among three groups.

Conclusions

This study suggested that cystine stone patients were at greater risk for the loss of renal function than calcium oxalate stone patients, but the risk of the formation of calcium oxalate stones was lower. Our results also indicated that urinary cystine had little or no impact on the excretion of urine chemistries in cystine stone patients.     

The predictive factors of hydronephrosis in patients with spina bifida: reports from China

Purpose

To identify the risk factors for hydronephrosis in patients with neurogenic bladder caused by spina bifida.

Methods

A retrospective analysis of 120 patients with hydronephrosis between January 2005 and 2012 was conducted. The patients were evaluated for the following factors: age, sex, voiding symptoms, experience of using clean intermittent catheterization, history of urinary tract infection (UTI), history of one or more tethered spinal cord release surgery, routine urine examination, serum creatinine, ultrasound for kidneys, ureters, bladder, and urodynamic findings by univariate and logistic regression analyses.

Results

Among the 120 patients, 45 (38 %) had unilateral or bilateral hydronephrosis. Univariate analysis indicated that detrusor hyperreflexia, poor compliance (PC), vesicoureteral reflux (VUR), urinary incontinence, high residual urine, and UTI were the significant factors in the incidence of hydronephrosis. Multivariate analysis indicated that PC, VUR, and UTI were the risk factors for hydronephrosis and that detrusor hyperreflexia and urinary incontinence were the protective factors. UTI was the most serious risk factor for hydronephrosis, with an odds ratio of 29.6. Hydronephrosis was not associated with the history of tethered spinal cord release surgery.

Conclusion

This study revealed the prognostic risk factors for hydronephrosis. The medical history of patients, imaging examination, and urodynamic parameters play key roles in identifying the risk factors for hydronephrosis.     

An audit of short- and long-term outcomes after laparoscopic removal of common bile duct stones in Finland

Background and aim

To audit short- and long-term outcomes after laparoscopic common bile duct exploration (LCBDE) and factors influencing the success of the laparoscopic treatment.

Methods

From January 1999 to December 2011, 288 patients (93 males) underwent a single-stage laparoscopic cholecystectomy combined with LCBDE in two Finnish Hospitals. Short-term outcome data were collected prospectively. Long-term outcomes were examined retrospectively. The main measures of outcome were the success of laparoscopic CBD stone clearance and recurrence of CBD stones in the long-term, with 30-day mortality, morbidity, and the length of postoperative hospital stay as secondary outcome measures.

Results

CBD stones were successfully removed by one-stage laparoscopic procedure in 232 of the 279 patients (83.2 %) with verified CBD stones and after conversion to open surgery in additional 28 patients (93.2 %). Nineteen patients (6.8 %) having residual stones after surgery were successfully treated with postoperative ERCP. On multivariate analysis, the independent factors associated with a failed laparoscopic stone clearance were stone size over 7 mm [OR 3.51 (95 % CI 1.53–8.03), p = 0.003], difficult anatomy [OR 18.01 (5.03–64.49), p < 0.001] and transcholedochal approach [OR 2.98 (1.37–4.47), p = 0.006]. Laparoscopic stone clearance also failed in all 11 patients having impacted stones at the ampulla of Vater. Cumulative long-term recurrence rate was 3.6 % at 5 years and 6.0 % at 10 years. Thirty-day mortality was 0.3 % and morbidity 12.2 %. Postoperative hospital stay was median 2 (IQR 1–3) days after transcystic CBD removal and 4 (IQR 3–7) days after transcholedochal CBD removal, p < 0.001.

Conclusion

Our results show that one-stage LC combined with LCBDE stone clearance is safe and effective in most patients thus reducing the number of additional, potentially dangerous endoscopic procedures. Moreover, large or impacted stones are a risk factor for failed stone clearance.     

High serum CA19-9 levels are associated with an increased risk of cholangiocarcinoma in patients with intrahepatic duct stones: a case–control study

Background

Hepatolithiasis is a known risk factor for cholangiocarcinoma (CC). Due to the high risk of complications that accompany endoscopic and surgical stone removal, it is often difficult to decide whether it is beneficial to remove intrahepatic ductal stones. We conducted a case–control study to determine the risk of developing CC and the benefit of stone removal in patients with hepatolithiasis.

Methods

Twenty-three patients with CC group between 2002 and 2012 were included in this study. For each patient with CC, four control patients with hepatolithiasis were enrolled based on age and sex matching. Finally, 115 patients with hepatolithiasis were enrolled.

Results

The mean length of time that intrahepatic stones were present was 116.57 (±98.77) months in the CC group and 80.56 (±101.10) months in the control group. History of gastrectomy [OR 5.756 (1.329–24.930), p = 0.019], history of choledochoenterostomy (OR 4.938 [1.129–21.595], p = 0.034), serum CA19-9 level [OR 1.001 (1.000–1.001), p = 0.022], and complete removal of stones [OR 0.167 (0.052–0.539), p = 0.003] were independent predictive factors of CC. In patients who had undergone incomplete removal of stones, the occurrence of CC was significantly reduced overall as well as in a subgroup of patients with elevated CA19-9 (p = 0.015 and p = 0.006, respectively) compared to patients with a CA19-9 of <22 U/mL (p = 0.477).

Conclusions

History of gastrectomy or choledochoenterostomy, high levels of serum CA19-9, and incomplete removal of stones were potential predictive factors of CC in patients with hepatolithiasis. Additionally, complete removal of stones may reduce the risk of CC in patients with high serum CA19-9 levels (>22 U/mL).     

Metabolic evaluation of patients with urinary system stone disease: a research of pediatric and adult patients

Objectives

To determine the metabolic risk factors in children and adults with urinary system stone disease.

Materials and methods

Between September 2008 and February 2011, 257 patients who underwent 24-h urine analysis because of urinary system stone disease were included in the present study. Group I and II include only adult patients. The first-time stone formers were named as Group I (n = 106), and recurrent stone formers were named as Group II (n = 107). Group III was occurred by pediatric patients (n = 44). Control group includes 105 people was called as Group IV. This group was divided into two subgroups. Group IVa includes 70 adult people, and Group IVb includes 35 children. The metabolic evaluation results of patients and control groups were compared.

Results

Hypercalciuria (35.8, 44.9, and 47.7 % for Group I, II, and III, respectively) and hypocitraturia (42.5, 40.2, and 50 % for Group I, II, and III, respectively) were most common risk factors for stone formation. However, unlike the literature, we have seen that hypomagnesiuria is also an important risk factor in adults and children. Hypomagnesiuria was defined at 36.4 % in Group I, 29 % in Group II, and 56.8 % in Group III (p < 0.05 for each group). These three parameters were significantly different between patient and control groups.

Conclusions

Hypomagnesiuria, hypocitraturia, and hypercalciuria are the most important risk factors for stone formation in adults and pediatric patients.     

Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy

Purpose

There is a lack of studies comparing shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) in renal stone treatment. This study compared treatment outcome, stone-free rate (SFR) and stone-free survival (SFS) with regard to stone size and localization.

Methods

This analysis included 482 first-time-treated patients in the period 2001–2007. Detailed clinical information, stone analysis and metabolic evaluation were evaluated retrospectively. Outcome, SFR and SFS were analyzed with regard to size (<1 vs. ≥1 cm) and localization (lower vs. non-lower pole).

Results

Higher SFRs in lower and non-lower pole stones ≥1 cm were confirmed for RIRS and MIP (p < 0.0001). A regression model confirmed a higher risk of non-lower pole stone persistence for SWL versus RIRS (OR: 2.27, p = 0.034, SWL vs. MIP (OR: 3.23, p = 0.009) and larger stone burden ≥1 versus <1 cm (OR: 2.43, p = 0.006). In accordance, a higher risk of residual stones was found in the lower pole for SWL versus RIRS (OR: 2.67, p = 0.009), SWL versus MIP (OR: 4.75, p < 0.0001) and stones ≥1 cm versus <1 cm (OR: 3.02, p = 0.0006). In RIRS and MIP patients, more complications, stenting, prolonged disability, need/duration of hospitalization and analgesia were noticed (p < 0.05). Overall SFS increased from SWL, RIRS, to MIP (p < 0.001). SWL showed lower SFS for non-lower pole (p = 0.006) and lower pole stones (p = 0.007).

Conclusions

RIRS and MIP were shown to have higher stone-free rates and SFS compared to SWL. The price for better outcome was higher, considering tolerable complication rates. Despite larger preoperative stone burden, MIP achieved high and long-term treatment success.     

Long-term follow-up study of gallbladder in situ after endoscopic common duct stone removal in Korean patients

Background

Although there has been much debate over the fate of the gallbladder (GB) after endoscopic common bile duct (CBD) stone removal, subsequent cholecystectomy is generally recommended in patients with GB stones to prevent further biliary complications. The aims of this study were to assess the natural course of the patients with GB in situ after endoscopic CBD stone removal and to evaluate the necessity of prophylactic cholecystectomy.

Methods

Four hundred sixty-one patients who had undergone CBD stone removal at Yeungnam University Hospital between January 2000 and December 2004 were retrospectively analyzed, and 232 patients were ultimately enrolled in this study.

Results

The mean duration of follow-up was 73 (range = 7–126) months in the cholecystectomy group and 66 (6–127) months in the GB in situ group (p = 0.168). Ten patients (14.7 %) in the cholecystectomy group and 31 patients (18.9 %) in the GB in situ group developed recurrent CBD stones (p = 0.295). The highest percentage of recurrent CBD stones in both groups was that for brown stones (80 and 80.6 %). In the GB in situ group, cumulative recurrence rates of CBD stones were not significantly different between patients with GB stones and without GB stones (15.9 vs. 20 %, p = 0.798). However, the incidence of acute cholecystitis was significantly higher in patients with GB stones compared to patients without GB stones (13.6 vs. 2.5 %, p = 0.003).

Conclusions

Prophylactic cholecystectomy seems to be unnecessary in patients without GB stones after endoscopic sphincterotomy. However, in patients with GB stones, elective cholecystectomy or close observation is recommended due to the higher risk of cholecystitis.     

The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones

Purpose

To evaluate the impact of a ureteral access sheath (UAS) on stone-free (SF) rate after flexible ureteroscopy for upper urinary tract stones.

Materials and methods

We retrospectively reviewed 280 patients who underwent flexible ureteroscopy (URS) for upper urinary tract stone between 2009 and 2012. Patients were divided into two groups based on whether a UAS was used (n = 157) or not (n = 123). SF rate was evaluated at one and three months after surgery by abdominal imaging. Quantitative and qualitative variables were compared with Student’s t test and χ2 test, respectively. A logistic regression model was used to determine the predictive factors of SF status.

Results

Stone size was similar in both groups (15.1 vs. 13.7 mm, p = 0.21). SF rates at one and 3 months were comparable in UAS and non-UAS groups (76 vs. 78 % and 86 vs. 87 %, p = 0.88 and 0.89, respectively). Complication rates were similar in both groups (12.7 vs. 12.1 %, p = 0.78). In multivariable analysis, stone size was the only predictive factor of SF rate (p = 0.016).

Conclusion

The routine use of a UAS did not improve SF rate in patients undergoing flexible URS for upper urinary tract calculi.     

Predictors of septic shock in obstructive acute pyelonephritis

Purpose

Acute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi.

Methods

We retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis.

Results

Overall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock.

Conclusion

Patients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.     

Risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract

Purpose

To assess the risk factors for septic shock in patients with acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract.

Methods

We retrospectively reviewed the records of 48 patients who underwent emergency drainage of the upper urinary tract for sepsis associated with acute obstructive pyelonephritis at our institute. Univariate and multivariate analyses were performed to identify the risk factors.

Results

Among 54 events of sepsis, we identified 20 events of septic shock requiring vasopressor therapy. Cases with shock were more likely than those without shock to have ureteral stone (70 vs 38 %, p = 0.024) and positive blood culture results (81 vs 28 %, p = 0.006). They received drainage significantly earlier than those without shock (1.0 vs 3.5 days, p < 0.001). Univariate analysis demonstrated that acute obstructive pyelonephritis by ureteral stone, rapid progression (the occurrence of symptoms to drainage ≤1 day), positive blood culture, leukocytopenia (<4,000/mm³), thrombocytopenia (<120,000/mm³), and prothrombin time international normalized ratio ≥1.20 were correlated with septic shock. Multivariate logistic regression analysis identified thrombocytopenia (p = 0.005) and positive blood culture (p = 0.040) as independent risk factors for septic shock.

Conclusions

Thrombocytopenia and positive blood culture were independent risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage. Thrombocytopenia would be practically useful as a predictor of septic shock.     

The effect of delayed percutaneous nephrolithotomy on the risk of bacteremia and sepsis in patients with neuromuscular disorders

Purpose

To determine whether a delayed percutaneous nephrolithotomy (PCNL) reduces the rate of bacteremia/sepsis in patients with neuromuscular disorders. Patients with neuromuscular disorders are at higher risk of developing complications after PCNL. One strategy to reduce the risk of infectious complications is to place a percutaneous nephrostomy tube at least 24 h prior to performing PCNL. We analyzed the rates of bacteremia/sepsis in patients with neuromuscular disorders who had access on the day of PCNL (same-day) versus more than 24 h prior to the treatment for the stone (delayed).

Materials and methods

We identified 246 consecutive patients who underwent PCNL at our institution between 8/2003 and 8/2008, 35 of whom (14 %) had neuromuscular disorders. The primary end point was postoperative bacteremia (fever and positive blood culture) or sepsis (SIRS and documented infection), which was compared between those who had percutaneous access on the day of surgery versus those who had access at least 24 h prior to the operative event. All patients had negative urine cultures preoperatively or were treated with antibiotics for 4–7 days prior to the surgery for a positive preoperative urine culture.

Results

The neuromuscular disorders in the 35 patients were multiple sclerosis (16), spina bifida (10), quadriplegia (4), paraplegia/Guillain–Barre (3), and cerebral palsy (2). The rate of bacteremia/sepsis among patients with neuromuscular disorders was 14 %. The rate of sepsis/bacteremia was 26 % for same-day PCNL versus 0 % for delayed PCNL (OR 8.4, p = 0.05).

Conclusions

Delayed PCNL results in lower rates of bacteremia and/or sepsis in patients with neuromuscular disorders.     

Upper urinary tract and urethral recurrences following radical cystectomy: review of risk factors and outcomes between centres with different follow-up protocols

Purpose

To examine which patient-related and tumour-related characteristics predict upper urinary tract recurrence (UUTR) and urethral recurrence (UR) of bladder cancer post-radical cystectomy (RC). Secondary objective is to evaluate whether or not recurrence patterns are similar between two centres with different post-RC follow-up (F/U) protocols.

Methods

A retrospective cohort study of 574 consecutive patients undergoing radical cystectomy for urothelial carcinoma of the bladder at two tertiary centres was performed. Clinicopathological factors associated with bladder cancer recurrence and patient-related outcomes, including time to recurrence and death, were collected. Risk factors for recurrences were examined using univariate and multivariable regression analyses. Likelihood of recurrence, time to recurrence, and survival were compared.

Results

There was a 3.7 % risk of UUTR (21/574) and a 3.6 % risk of UR (18/503) for the combined cohort at a median F/U of 45 months. When controlling for the effects of all variables modelled, female gender was a significant risk factor for UUT recurrence (OR 3.2, 95 % CI 1.0–9.5, p = 0.03) and prostatic urethral involvement was a significant risk factor for urethral recurrence (OR 7.8, 95 % CI 2.2–27.6, p = 0.001). UUTR were similar (p = 0.82) between Turku (8/205) and Toronto (12/369). Urethral recurrences trended (p = 0.06) towards being more common in Turku (9/151, 6.0 %) versus Toronto (9/352, 2.6 %), but no difference in overall survival was demonstrated between sites.

Conclusion

The frequency of UUT and urethral recurrences post-cystectomy is relatively low and remained stable for the past 15 years. The ideal F/U protocol to maximize patient-survival remains unknown.     

Preoperative prognostic factors after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma

Purpose

To evaluate the clinical significance of preoperative biomarkers such as laboratory data, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and clinicopathological factors in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma.

Methods

Between 1995 and 2011, a total of 99 patients treated at our institution for upper urinary tract urothelial carcinoma were enrolled in this study. The prognostic significance of various preoperative data and clinicopathological factors were analyzed. Univariate and multivariate analyses were performed using the Kaplan–Meier method with the log-rank test and a Cox proportional hazards regression model.

Results

Median patient age was 73 years (range 44–86 years), and the median follow-up period after radical nephroureterectomy was 37.9 months (range 6.6–171.4 months). The 5-year intravesical recurrence-free survival and cancer-specific survival estimates were 47.1 and 70.0 %, respectively. On multivariate analysis, concomitant bladder carcinoma was an independent predictor of intravesical recurrence (hazard ratio 3.689; P = 0.002), and infiltration (hazard ratio 14.842; P = 0.002), preoperative serum creatinine level (hazard ratio 9.992; P = 0.005), preoperative serum hemoglobin level (hazard ratio 6.370; P = 0.018) and ECOG PS (hazard ratio 4.326; P = 0.037) were associated with worse cancer-specific survival. This study is limited by biases associated with its retrospective design.

Conclusions

This study indicates that not only clinicopathological factors, but also preoperative biomarkers, such as serum creatinine and hemoglobin levels and ECOG PS, predict a poor survival in patients with upper urinary tract urothelial carcinoma.     

Diagnostic Ureteroscopy Independently Correlates with Intravesical Recurrence after Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Background

Little is known about the effects of diagnostic ureteroscopy on intravesical recurrence after nephroureterectomy.

Methods

This study was designed to determine the effect of diagnostic ureteroscopy on intravesical recurrence after nephroureterectomy. From 2004 to 2010, 446 patients underwent nephroureterectomy for upper urinary tract cancer at our tertiary medical center. We included 115 patients who underwent preoperative diagnostic ureteroscopy and 281 patients who did not. This study analyzed the impact of the reported risk factors and diagnostic ureteroscopy for intravesical recurrence after nephroureterectomy by multivariate Cox regression model.

Results

The rates of metastasis and cancer-specific mortality did not differ significantly between the two groups. Diagnostic ureteroscopy was associated with a higher incidence of intravesical recurrence in patients with (p = 0.02) and without (p = 0.016) a previous history of bladder cancer. Ureter tumor biopsy (p = 0.272) and ureter involvement (p = 0.743) were not associated with the rate of intravesical recurrence in this study. Multivariate Cox regression analysis showed that only bladder cancer history (p < 0.001), multifocal tumor (p = 0.05), and diagnostic ureteroscopy (p = 0.05) were independently associated with intravesical recurrence.

Conclusions

Diagnostic ureteroscopy for upper urinary tract cancer was not associated with metastasis and cancer-specific mortality. However, ureteroscopy was associated with an increased incidence of intravesical tumor recurrence. Methods of prevention should be considered to decrease intravesical recurrence and avoid repeated surgical interventions or the development of advanced bladder disease in patients at risk.     

Risk factors for lower urinary tract injury at the time of hysterectomy for benign reasons

Objectives

To identify risk factors associated with lower urinary tract injury at the time of performing hysterectomy for benign indications.

Methods

We conducted a multi-center case–control study of women undergoing hysterectomy for benign disease. Cases were identified via ICD-9 codes for lower urinary tract injury at the time of hysterectomy from 2007 to 2011: controls were two subsequent hysterectomies following the index case in the same institution that did not have lower urinary tract injury. Logistic regression was used to perform univariate and multivariate comparisons between groups.

Results

At 7 centers, 135 cases and 270 controls were identified. Cases comprised 118 bladder injuries and 25 ureteral injuries; 8 women had both bladder and ureteral injury. Bladder injury was associated with a history of prior cesarean section OR 2.9 (95 % CI 1.7–5), surgery by a general obstetrician and gynecologist OR 2.4 (95 % CI 1.2–5.2), and total abdominal hysterectomy OR1.9 (95%CI 1.06–3.4). Ureteral injury was more likely among women who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) OR 10.4 (95%CI 2.3–46.6) and total abdominal hysterectomy (TAH) OR 4.7 (95 % CI 1.4–15.6).

Conclusion

Bladder injury at the time of benign hysterectomy is associated with a prior history of Cesarean section and TAH as well as surgery by generalist OB-GYN; ureteral injury is associated with LAVH and TAH.     

Prevention of chronic kidney disease in spina bifida

Objective

The prevalence of progressive chronic kidney disease (CKD) in children and adults with spina bifida is considerable, rising, and entirely preventable.

Removing the cause: prevention of spina bifida

The best prevention of CKD in spina bifida is prevention of spina bifida itself through strategies that include folate supplementation, ideally before pregnancy.

The cause of CKD

Dysfunctional bladder outlet causes febrile Urinary Tract Infections (UTI), even with clean intermittent catheterization (CIC), and subsequent renal scarring. The development of secondary vesicoureteric reflux (VUR) increases the risk of renal scarring and CKD.

Finding the ideal marker for measurement of renal function in spina bifida

Creatinine-based methods are insensitive because of low muscle mass and underdeveloped musculature in the legs. Only Cystatin C?Cbased eGFR can reliably assess global renal function in these patients. However, unilateral renal damage requires nuclear medicine scans, such as ^99mTc DMSA.

(Video)Urodynamics studies (UDS)

Early treatment is recommended based on UDS with anticholinergics, CIC, and antibiotic prophylaxis when indicated. Overnight catheter drainage, Botox, and eventually augmentation cystoplasty are required for poorly compliant bladders. A continent child or one rendered continent following surgery is at a higher risk of renal damage.

Conclusion

A multidisciplinary approach is required to reduce the burden of CKD in patients with spina bifida. The right tools have to be utilized to monitor these patients, particularly if recurrent UTIs occur. Cystatin C eGFR is preferred for monitoring renal damage in these patients, and ^99mTc DMSA scans have to be used to detect unilateral renal scarring.     

Urinary Evaluation After RYGBP: a Lithogenic Profile with Early Postoperative Increase in the Incidence of Urolithiasis

Background

The objective of this study was to assess predictors for new-onset stone formers after Roux-en-Y gastric bypass (RYGBP).

Methods

One hundred and fifty-one obese patients underwent RYGBP and were followed for 1 year. The analysis comprised two study time points: preoperative (T0) and 1 year after surgery (T1). They were analyzed for urinary stones, blood tests, and 24-h urinary evaluation. Nonparametric tests, logistic regression, and multivariate analysis were conducted using SPSS 17.

Results

Median BMI decreased from 44.1 to 27.0 kg/m² (p?<?0.001) in the postoperative period. Urinary oxalate (24 versus 41 mg; p?<?0.001) and urinary uric acid (545 versus 645 mg; p?<?0.001) increased significantly postoperatively (preoperative versus postoperative, respectively). Urinary volume (1310 versus 930 ml; p?<?0.001), pH (6.3 versus 6.2; p?=?0.019), citrate (268 versus 170 mg; p?<?0.001), calcium (195 versus 105 mg; p?<?0.001), and magnesium (130 versus 95 mg; p?=?0.004) decreased significantly postoperatively (preoperative versus postoperative, respectively). Stone formers increased from 16 (10.6 %) to 27 (17.8 %) patients in the postoperative analysis (p?=?0.001). Predictors for new stone formers after RYGBP were postoperative urinary oxalate (p?=?0.015) and uric acid (p?=?0.044).

Conclusions

RYGBP determined profound changes in urinary composition which predisposed to a lithogenic profile. The prevalence of urinary lithiasis increased almost 70 % in the postoperative period. Postoperative urinary oxalate and uric acid were the only predictors for new stone formers.     

Impact of intermittent catheterization on the quality of life of multiple sclerosis patients

Purpose

Lower urinary tract dysfunction is common in multiple sclerosis (MS). The purpose of this study was to prospectively evaluate the impact of intermittent catheterization (IC) on the quality of life of patients affected by MS.

Methods

Between 2007 and 2009, we admitted 23 patients to teach them the technique of IC. Their quality of life was evaluated before and more than 6 months after the beginning of learning the technique, when the urinary situation was stable. Two questionnaires were used: one specific for urinary disorders (QUALIVEEN^®) and one general (SF-36^®).

Results

Twenty-two patients followed this different way of bladder emptying. More than 6 months (9.3 ± 3 months on average) after first learning to use IC, the impact of urinary disorders explored by Qualiveen^® had significantly decreased (the overall quality of life; bother with limitation; fears; feelings; Wilcoxon’s test, respectively p = 0.004; 0.007; 0.02; 0.02) while the quality of life was not diminished.

Conclusion

Intermittent catheterization (IC) in association with overall urinary management, among patients affected by MS, is well accepted and reduces the impact of urinary dysfunction on their quality of life.     

Can children with spina bifida and muscular dystrophy participate in their own health status evaluations?

Background

The outcomes movement has emphasized the importance of the patient in evaluating treatment outcome. However, concern has been raised about the ability of children, particularly those with multisystem disease, to evaluate their disability.

Purpose

To determine whether children with spina bifida and muscular dystrophy and their parents agree when asked about the relative difficulty of daily activities and the severity of symptoms experienced by the child.

Methods

First, a list of symptoms and activity restrictions was generated from the literature, clinicians, and interviews with families with spina bifida and muscular dystrophy. Second, another group of parents and children with spina bifida (with hip dislocation or scoliosis) and with muscular dystrophy (with scoliosis), including those before and after surgery, independently rated the severity and importance of their objective and subjective complaints.

Results

The correlation between parents and their children was high for both objective (median Spearman’s = 0.70; standard deviation [SD] = ±0.17; range = ?0.05–1.00) and subjective (median Spearman’s = 0.76; SD = ±0.14; range = 0.13–1.00) complaints, with an overall excellent level of agreement (Kappa = 0.75; 95% confidence interval [CI]: 0.73, 0.76).

Conclusion

Children with spina bifida and muscular dystrophy are capable of understanding and assessing their disability.     

Cystoscopically guided percutaneous suprapubic cystolitholapaxy in children

Purpose

To evaluate the safety and efficacy of endoscopically guided percutaneous suprapubic artery forceps litholapaxy for pediatric vesical and posterior urethral stone <1 cm in diameter.

Materials and methods

A retrospective series study of 73 children (68 boys and 5 girls) with vesical and urethral stones less than 1 cm in diameter with an average age of 3.5 years (range 1–9 years) were included in this study. Cases with previous suprapubic surgery, stones of more than 1 cm in diameter, multiple bladder or urethral stone, anterior urethral stones and cases with neurological or anatomical abnormalities were excluded from our study. The bladder was filled and punctured suprapubically by an artery forceps under the vision of the pediatric cystoscopy then the stone is completely crushed. All intraoperative and postoperative complications were recorded. The stone-free rate status was evaluated 2 weeks postoperatively using plain X-ray/ultrasonography.

Results

All cases were successful, and the stones were completely crushed to smaller insignificant fragments in a single session. No intraoperative bladder perforation or bleeding was recorded. The mean operative time was 12.5 min (ranging from 9 to 17 min). There were no postoperative complications apart from 2 cases of persistent suprapubic leakage postoperatively for 24 h and the leakage stopped after 48 h with the insertion of 8 Fr Foley catheter. In all cases, no significant stone fragments were found 2 weeks postoperatively.

Conclusion

Our technique for management of pediatric vesical and posterior urethral stone less than 1 cm is an easy and safe with no intraoperative or postoperative significant complications.