Comparison of secondary signs as shown by unenhanced helical computed tomography in patients with uric acid or calcium ureteral stones

AbstractUnenhanced helical computed tomography (UHCT) has evolved into a well-accepted diagnostic method in patients with suspected ureterolithiasis. UHCT not only shows stones within the lumen of the ureter, it also permits evaluation of the secondary signs associated with ureteral obstruction from stones. However, there we could find no data on how secondary signs might differ in relation to different compositions of ureteral stones. In this study, we compared the degree of secondary signs revealed by UHCT in uric acid stone formers and in patients forming calcium stones. We enrolled 117 patients with ureteral stones who underwent UHCT examination and Fourier transform infra-red analysis of stone samples. Clinical data were collected as follows: age, sex, estimated glomerular filtration rate (eGFR), urine pH, and radiological data on secondary signs apparent on UHCT. The uric acid stone formers had significantly lower urine pH and eGFR in comparison to calcium stone formers, and on UHCT they also had a higher percentage of the secondary signs, including rim sign (78.9% vs. 60.2%), hydroureter (94.7% vs. 89.8%), perirenal stranding (84.2% vs. 59.2%) and kidney density difference (73.7% vs. 50.0%). The radiological difference was statistically significant for perirenal stranding (p=0.041). In conclusion, we found that UHCT scanning reveals secondary signs to be more frequent in patients with uric acid ureteral stones than in patients with calcium stones, a tendency that might result from an acidic urine environment

A Genetic Polymorphism (rs17251221) in the Calcium-Sensing Receptor Gene (CASR) Is Associated with Stone Multiplicity in Calcium Nephrolithiasis

Calcium nephrolithiasis is one of the most common causes of renal stones. While the prevalence of this disease has increased steadily over the last 3 decades, its pathogenesis is still unclear. Previous studies have indicated that a genetic polymorphism (rs17251221) in the calcium-sensing receptor gene (CASR) is associated with the total serum calcium levels. In this study, we collected DNA samples from 480 Taiwanese subjects (189 calcium nephrolithiasis patients and 291 controls) for genotyping the CASR gene. Our results indicated no significant association between the CASR polymorphism (rs17251221) and the susceptibility of calcium nephrolithiasis. However, we found a significant association between rs17251221 and stone multiplicity. The risk of stone multiplicity was higher in patients with the GG+GA genotype than in those with the AA genotype (chi-square test:P = 0.008;odds ratio  =  4.79;95% confidence interval, 1.44–15.92;Yates' correction for chi-square test:P = 0.013). In conclusion, our results provide evidence supporting the genetic effects of CASR on the pathogenesis of calcium nephrolithiasis

Shock wave lithotripsy for renal stones is not associated with development of hypertension in Taiwan's Chinese population

Objective: Shock wave lithotripsy (SWL) is widely available due to its ease of use and noninvasive nature, and it is highly effective for fragmentation of stones. After SWL became widely used, a number of urinary tract complications, such as hematuria, infection, and pain due to difficulty passing fragmented stones, were also reported. Long-term complications, such as hypertension and diabetes mellitus, were also raised by the previous reports. The association between SWL and development of new hypertension has become a matter of debate due to the publication of controversial data. In the present study, we aimed to determine whether SWL led to the development of hypertension. Methods: Data were sourced from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by Taiwan National Health Insurance (NHI) from 1996 to 2010. Patients who underwent SWL were compared with controls matched for age, sex, obesity, diabetes mellitus, and hyperlipidemia using the Taiwan NHI database. Results: There was no difference in the incidence of new hypertension between SWL and comparison groups. Interestingly, the average new hypertension onset time was faster in the SWL group than in the control groups. Conclusion: On the basis of our results, SWL is a safe procedure for properly managed nephrolithiasis patients

Testicular Sparing Surgery for Bilateral Epidermoid Cysts of the Testes: A Case Report

We report the case of a 12-year-old boy with bilateral epidermoid cysts of the testes diagnosed preoperatively from ultrasonography, magnetic resonance imaging, and negative tumor markers. The cysts were treated using bilateral testicular sparing surgery through a scrotal approach after intraoperative frozen section. We also discuss the diagnosis and management of epidermoid cyst of the testis and briefly review the literature

Outcome of Hypospadias Reoperation Based on Preoperative Antimicrobial Prophylaxis

From August 1981 to June 2004, we retrospectively reviewed 66 hypospadias, treated with 123 operations, to analyze the outcome of reoperation based on preoperative antimicrobial prophylaxis. All patients received primary treatment in our hospital, and all had postoperative antimicrobial prophylaxis in all surgical procedures. We define a hypopadias repair as “corrected without fistula” if no urethrocutaneous fistula formation, or complete wound disruption is found within at least a 2-week follow-up period. Of the 123 operations, there were 66 primary repairs and 57 reoperations. The mean age at primary repair was 4.33 years. The overall rate of correction without fistula was 53.0% (35/66), with a mean of 14 months, follow-up. A total of 88 failure repairs resulted from 67 (76.0%) fistulas and 21 (24.0%) disruptions. A higher rate of correction without fistula (81.0%) was related to subcoronal hypospadias (p = 0.020) in three types. The rate of correction without fistula of two-staged repair was lowest in primary operations (12.5%), but these cases had a significantly higher rate of correction without fistula in following reoperations (66.7%, p = 0.043). Of the 123 repairs, only 46 (37%) had preoperative antibiotic prophylaxis, and these had lower early complication rates, both in primary and reoperation groups (42.3% vs 52.5% and 40.0% vs 54.1%, respectively). The differences, however, were not statistically significant (p = 0.231 and p = 0.289, respectively). In terms of rate of correction without fistula, a higher rate of correction without fistula was observed in reoperations with preoperative antibiotic prophylaxis (57.1%), compared to those without prophylaxis (23.1%). This difference was statistically significant (p = 0.031). The data from this study suggest that a lower early complication rate and a significantly higher rate of correction without fistula are related to the hypospadias reoperations with preoperative antimicrobial prophylaxis. The use of broad-spectrum antibiotics before surgery is recommended for these cases. However, more precise and prospective studies are warranted