Urinary calculus disease has been a scourge on mankind since ancient times. Research in the field has been hampered by lack of funds and the lack of cachet with the public such as seen with cancer or heart disease. In recent years there have been marked changes led by urologists in the diagnosis, treatment and long-term management of calculi

Bagley, Demetrius H.

Arab Journal of Urology

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Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Urology Faculty Papers Department of Urology9-1-2012Urinary stone disease: Great progress with promisefor the future.Demetrius H. BagleyThomas Jefferson University, Demetrius.bagley@jefferson.eduLet us know how access to this document benefits youFollow this and additional works at: https://jdc.jefferson.edu/urologyfpPart of the Urology CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inDepartment of Urology Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationBagley, Demetrius H., "Urinary stone disease: Great progress with promise for the future." (2012).Department of Urology Faculty Papers. Paper 44.https://jdc.jefferson.edu/urologyfp/44EDITORIALUrinary stone disease: Great progress with promisefor the futureUrinary calculus disease has been a scourge on mankind sinceancient times. Research in the ﬁeld has been hampered by lackof funds and the lack of cachet with the public such as seenwith cancer or heart disease. In recent years there have beenmarked changes led by urologists in the diagnosis, treatmentand long-term management of calculi.The vast majority of urinary stones pass spontaneously.Another option has been added with the development of med-ical expulsive therapy. Yet, further intervention is required inmany patients with symptomatic, obstructive or enlargingstones which fail to pass.Standard techniques and studies used in the diagnosis ofcalculi have included the abdominal radiograph and excretoryurogram. Ultrasonography and computed tomography havebeen added as additional and now standard techniques. Ineach instance, it is essential to balance the diagnostic informa-tion needed and the risks from radiation exposure.The most obvious changes in stone treatment have comewith the interventional procedures. The endoscopic approacheshave changed with the introduction of small, rigid and ﬂexibleureteroscopes. Simultaneously, there has been development ofendoscopic lithotripters which are small enough to ﬁt throughthese endoscopes. Together these allow access even to intrarenalcalculi to offer another alternative in treatment.Percutaneous nephrostolithotomy has been the major tech-nique for treating large renal calculi. Various smaller instru-ments have been used in a ‘‘mini-perc’’ pattern with variableresults. The combination of fully ﬂexible and functioning ﬂexi-ble ureteroscopes with the holmium laser or the electrohy-draulic lithotripter offers a technique vying with percutaneousnephrostolithotomy for even large renal calculi.The options for treatment of ureteric and renal calculi in-clude shock wave lithotripsy, percutaneous nephrostolithoto-my and ureteroscopy. The published guidelines have ﬁnallybeen updated and recommend the use of each of these tech-niques in certain situations. They should not be consideredcompeting procedures but rather complementary for speciﬁccircumstances.Stone disease in children has become more frequent andclinically more prominent. It is no longer dismissed as consist-ing only of infectious bladder stones in under-nourished indi-viduals. It is known that there are renal and ureteric calculi,all of which may require treatment in this special group ofpatients.Studies of the metabolic basis for stones and especially inrecurrent stone-formers have begun to offer options forlong-term preventive therapy. There is a known difference inthe rates of stone disease in different parts of the world andthe many options for evaluation and for treatment can alsovary.The training of the stone surgeon must include all aspects ofstone management, from endoscopic and lithotripter tech-niques to long-term management and prevention. Open stonesurgery has become rare but must be considered as an optionin rare instances.This issue also presents the relationship, both the parallelsand the differences, between stone disease in human and veter-inary medicine. There is an opportunity for proﬁtable ex-change between these disciplines. The ﬁndings may not bedirectly comparable and transferable, but both similaritiesand differences can present a recognition for the developmentof therapeutic options.This special issue of the Arab Journal of Urology has takena leading position in presenting information on the develop-ment, present status and future trends in the diagnosis, treat-ment and management of stone disease. It is a problemworldwide which is so common that it is seen by essentiallyall urologists, internists and even the patients’ neighbours.There has been tremendous progress and there is a vast oppor-tunity for improvement in managing this disease.Peer review under responsibility of Arab Association of Urology.Production and hosting by Elsevier2090-598X  2012 Arab Association of Urology. Production andhosting by Elsevier B.V. All rights reserved.http://dx.doi.org/10.1016/j.aju.2012.07.002Arab Journal of Urology (2012) 10, 217–218Arab Journal of Urology(Ofﬁcial Journal of the Arab Association of Urology)www.sciencedirect.comDemetrius H. BagleyThomas Jefferson University, Department of Urology,Philadelphia, PA, United StatesE-mail address: demetrius.bagley@jefferson.eduAvailable online 14 August 2012218 Editorial

Urinary stone disease: Great progress with promise for the future.

Demetrius H. Bagley

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Urinary stone disease: Great progress with promise for the future

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Urinary stone disease: Great progress with promise for the future.

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