Medicine and Health Sciences Commons^™

A Comparison Of The Thulium Fiber Laser Versus Holmium:Yag Laser Lithotripsy Of Upper Urinary Tract Calculi: Preliminary Results Of A Randomized Prospective Clinical Trial, Eduardo Gonzalez Cuenca

Electronic Thesis and Dissertation Repository

The Holmium:yttrium-aluminium-garnet (Ho:YAG) laser has become an indispensable tool in Endourology since its introduction in 1995, due to its safe and efficient urinary stone fragmentation capabilities. The Thulium Fiber Laser (TFL), is the latest innovation with early clinical experience suggesting improvements over the Ho:YAG. This prospective, randomized controlled study aims to compare clinical outcomes of Ho:YAG versus TFL lithotripsy for upper urinary tract calculi. Patients undergoing ureteroscopy for renal stones (size 8-20mm, density >600 HU) from a single institution were prospectively recruited.

Thirty-eight patients have been recruited (Ho:YAG=20, TFL=18). The laser-on time (p=.330), total operative time (p …

Shockwave Lithotripsy Of Upper Urinary Tract Calculi - Outcomes Of A Multicentre International Prospective Observational Study, Fernanda C. Gabrigna Berto

Electronic Thesis and Dissertation Repository

Introduction

Shockwave lithotripsy (SWL) is a surgical procedure used in urolithiasis treatment. Several factors can influence its results. This study aims to evaluate “real-world” success rates and identify predictors of treatment success in patients undergoing SWL.

Methods

Adult patients undergoing SWL for urolithiasis at three institutions in Canada and Oman were prospectively enrolled. Treatment success after a maximum of two SWL sessions was assessed by post-operative imaging. Logistic regression assessed for predictors of treatment success.

Results

Between May 2021 and February 2022, 271 patients were prospectively enrolled. Overall success rate was 46.1% after one SWL session, and 58.3% after two …

An Assessment Of The Impact Of Flow Disruptions On Mental Workload And Performance Of Surgeons During Percutaneous Nephrolithotomy, Sana Hussain, Syed Muhammad Nazim, Basit Salam, Nida Zahid, Hammad Ather

Section of Urology

Objective: The aim of this study was to assess the impact of intraoperative disruptions on surgeons’ workload and performance during percutaneous nephrolithotomy (PCNL).
Materials and methods: A structured and standardized tool was used to identify disruptions and interferences that occurred during 33 PCNL procedures. The surgical steps during PCNL were divided into four phases: ureteric catheter placement (phase I), puncture and tract dilation (phase II), intra-calyceal navigation and stone fragmentation (phase III), and tube placement (phase IV). Surgeons’ workload was evaluated using a validated tool: Surgery Task Load Index (SURG-TLX), and correlated with the mean observed intraoperative disruptions. All operating …

Tamsulosin Use After Shock Wave Lithotripsy: A Systematic Review, Katherine Harte

Senior Honors Projects

Urolithiasis, or the formation of stones in the urinary tract, is a potentially painful process that impacts many people across the world. However, the results of clinical trials disagree on the proper treatment and management of kidney stones. One way to help those who have kidney stones is to perform extracorporeal shock wave lithotripsy (SWL), a medical procedure in which shock waves are directed towards kidney stones to prevent them from migrating and causing pain. Following SWL, patients are sometimes given additional medications, such as alpha blockers (e.g., tamsulosin), to aid in the passage of the stones. However, the benefits …

Design And Challenges Of A Randomized Clinical Trial Of Medical Expulsive Therapy (Tamsulosin) For Urolithiasis In The Emergency Department., Pamela K. Burrows, Judd E. Hollander, Allan B. Wolfson, Michael C. Kurz, Lorna Richards, Sara Difiore, Phillip Watts, Nivedita Patkar, Jeremy Brown, Stephen Jackman, Ziya Kirkali, John W. Kusek, Chloe Michel, Andrew C. Meltzer

Department of Emergency Medicine Faculty Papers

Urolithiasis or urinary stone disease has been estimated to affect about 1 in 11 Americans. Patients with urinary stone disease commonly present to the emergency department for management of their acute pain. In addition to providing analgesia, administration of drug (medical expulsive therapy) is often prescribed to assist passage of the urinary stone. In this methodology paper, we describe the design of a prospective, multi-center, randomized, double-blind placebo controlled clinical trial of the alpha-adrenergic blocker, tamsulosin, to evaluate its effectiveness as medical expulsive therapy. In addition, we describe the unique challenges of conducting a trial of this type within the …

Proteins In Renal Stones And Urine Of Stone Formers., Anwar A. Siddiqui, Taranum Sultana, Niels-Peter Buchholz, Mohammad A. Waqar, Jamsheer J Talati

Anwar Ali Siddiqui

Knowledge of the essential characteristics of macromolecules constituting the organic matrix of the nidus of urinary stones is required to understand the mechanism of urolithogenesis. The aim of this study was to isolate and characterise those stone nidus proteins. Using an extraction buffer containing SDS and beta-mercaptoethanol, we were able to overcome known problems of protein isolation from urinary stone matrix. These proteinswere characterised by a strong tendency to aggregate under reducing and denaturing conditions. On SDS-PAGE, their molecular weights range from < or = 12 to 66 kDa. Antisera raised against stone matrix proteins showed a cross-reactivity between proteins isolated from different stonesirrespective of their origin or mineral composition. Moreover, urinary proteins from stone formers also cross-reacted with these whereas there was no reaction with urinary proteins of non-stone formers. Western blotting confirmed these findings. Given the above summarised properties, it can be safely concluded that these proteins are prevalent in urines of stone formers, that they are selectively incorporated into renal stones of all aetiologies, and that they most likely have a role in nidus and, therefore, early stone formation.

Prospective Evaluation Of Outcome Of Percutaneous Nephrolithotomy Using The ‘Stone’ Nephrolithometry Score: A Single-Centre Experience, Muhammad Farhan, Syed M. Nazim, Basit Salam, Hammad Ather

Department of Surgery

Abstract

OBJECTIVE:

To assess the prediction of stone clearance and complications of percutaneous nephrolithotomy (PCNL) using the 'STONE' nephrolithometry score, assessing stone size, tract length (skin-to-stone distance), degree of obstruction, number of calyces involved and stone essence (density).

PATIENTS AND METHODS:

This was a prospective study of patients undergoing single-tract PCNL while prone, conducted at a university hospital. All patients had non-contrast-enhanced computed tomography within 3 weeks of the procedure. Only patients with a unilateral procedure and radio-opaque stones were included. The five variables of the STONE nephrolithometry score were calculated before the procedure. The stone-free rates were assessed with …

The Prevalence Of Silent Kidney Stones: An Ultrasonographic Screening Study, Buchholz Niels-Peter, Farhat Abbas, R Khan, Jamsheer J. Talati, M Afzal, I Rizvi

Section of Urology

Objective: Silent and not yet discovered stones of the upper urinary tract are potentially dangerous, since in due course they may cause infection, obstruction and renal damage. The aim of this study was to determine the prevalence of such silent kidney stones in a representative Pakistani population of Karachi.
Subjects and Methods: We studied 201 consecutive subjects at our hospital who underwent additional kidney screening whilst undergoing abdominal ultrasound. All these subjects did not have a history or symptoms of urolithiasis.
Results: We found silent kidney stones in 3% of subjects. All stone bearers were males. Most stones were in …

Bone And Renal Stone Disease In Patients Operated For Primary Hyperparathyroidism In Pakistan: Is The Pattern Of Disease Different From The West?, Syed Raziuddin Biyabani, Jamsheer J Talati

Section of Urology

Objective: To document the clinical presentation of primary hyperparathyroidism (PHPT) in a developing country and note differences from the West.
Setting: A tertiary care teaching hospital.
Method: The records of 37 patients operated for PHPT between January 1986 and December 1997 were reviewed. Symptoms, laboratory parameters and histopathology results were analyzed.
Results: Surgery for PHPT accounted for 0.055% of 67,566 operative procedures performed in the Department of Surgery during the 12 year period. The mean age of our patients was 38.4±13.2 years (range 17 to 73 years). Ninety percent of patients were less than 60 years old and 51% less …

Biofilm Mediated Calculus Formation In The Urinary Tract, Robert J. C. Mclean, David J. Stickler, J. Curtis Nickel

Cells and Materials

Mineralization and subsequent calculus formation is a common complication of biofilm infections. In the urinary tract, these infected calculi often arise from infections by urease-producing bacteria. Ammonia, liberated by bacterial urease activity, increases urine pH, resulting in the precipitation of Ca and Mg as carbonateapatite {Ca₁₀(PO₄,CO₃)₆(OH,CO₃)₂} and struvite (NH₄MgP0₄·6H₂O). These minerals become entrapped in the organic matrix which surrounds the infecting organisms and ultimately grow into mature calculi. When the causative organisms grow on urinary catheters and stents, the resulting mineralization can …