Speciality
Spotlight

 




 

Urology


 

 





Stone Disease

   

  • W-C. Chen, H.-Y. Chen, H.-F. Lu, C.-D. HSU, and F.-J. TSAI [Depts. of Urology, Obstetrics and Gynecology, and Medical Genetics, China Medical College, Taichung, and Institute of Life Science, National Tsing Hua University, Hsinchu, Taiwan]

    Association of the Vitamin D Receptor Gene Start Codon Fok I Polymorphism with Calcium Oxalate Stone Disease

    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 168-171



    A normal control of 90 healthy subjects and 146 patients with calcium oxalate stones were examined. Using polymerase chain reaction [PCR] based restriction analysis, the relationship between Fok I polymorphism and urolithiasis was evaluated. An unexcisable length of 265 bp was identified [allele CC] and 2 fragments [169 bp and 96 bp] identified as excisable lengths [allele TT].



    Results -There was a statistically significant difference between the groups [chi-square test, P<0.05] for the genotype of the Fok I start codon polymorphism. The odds ratio [ 95% confidence interval] for the C allele in those at risk of stone disease was 1.672 [1.149-2.432].



    Conclusions- These results suggest that the VDR Fok I start codon polymorphism may be a good candidate for a genetic marker in calcium oxalate stone disease.

      
  • J.-P. Mcfarlane, C. Cowan, S.J. Holt and M.J. Cowan [ Departments of ‘Urology and Radiology. The Churchill Hospital, Oxford, UK]

    Outpatient Ureteric Procedures : A New Method for Retrograde Ureteropyelography and Ureteric Stent Placement 

    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 172-176



    Patients and Methods -Procedures were undertaken using a flexible cystoscope and digital C-arm fluroscopy in outpatients under sedoanalgesia. The flexible cystoscope was used to identify the ureteric orifice, a straight 0.9 mm hydrophilic guidewire inserted and passed into the renal pelvis under fluroscopic guidance. A 4 F general purpose catheter was passed over the wire and ureteropyelography performed. Stenting was done over a ultra-stiff wire after exchange.



    Results -Of the 723 procedures, 643 were technically successful. Failure was most commonly due to failure to cannulate the ureteric orifice. Immediate complications occurred in 3%. 282 of 300 procedures were reported to be acceptable.



    Conclusion -Retrograde ureterography and ureteric stent placement may be satisfactorily undertaken with the patient under sedoanalgesia on an outpatient basis. This technique can reduce costs, hospital admissions, general anaesthetic use, demands on theatre time and complication rates.

         
  • F.X. Keeley, Jr.K. Tilling, A. Elves P. Menezes, M. Wills N, Rao and R. Feneley [Bristol Urological Institute, Southmead Hospital, Bristol, Department of public Health Sciences, king College, London and Withington Hospital, Manchester, UK]

    Preliminary Results of a randomized Controlled Trial of Prophylactic Shock Wave Lithotripsy for small Asymptomatic Renal Calyceal Stones

    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 1-8



    Patients and Methods – The study included 228 patients with small [ < 15 mm total diameter] asymptomatic calyceal stones: 113 were randomized to undergo ESWL and 115 to the control group who were kept under observation.



    Results – In the ESWL group 28 patients [28%] were stone free, compared with [17%] 16 in the observation group. 



    Additional treatment in the form of analgesics, antibiotics, ESWL, stent insertion and ureteroscopy, was required in 21 [21%] of patients in the observation group and 15[15%] in the ESWL group. 10 patients in the observation group needed invasive procedures, vs none in the ESWL group. 



    There was no difference in the symptoms, quality of life or renal functions between the arms of the trial at the final follow up.



    Conclusion – ESWL for asymptomatic or minimally symptomatic renal calyceal stones appears to offer little advantage to patients in terms of stone-free rates, renal function or quality of life; hospital admission or symptoms. A policy of observation is associated with greater intervention rates, with the risk of morbidity associated with more invasive procedures.

         
  • J. P. Kavanagh (University Department of Urology, South Manchester University Hospitals Trust, Withington, Manchester, UK)


    A Critical Appraisal of the Hypothesis That Urine is a Saturated Equilibrium with Respect to Stone-Forming Calcium Salts


    BJU Intl. May 2001 Vol. 87 (7) Pg. 589-598

          


    If the saturated equilibrium hypothesis were to be accepted as relevant for the calcium salts of most urine samples then it would have serious implications for the future direction of stone research. The nucleation of crystals would no longer be seen as a crucial trigger but would be perceived as a normal event. Crystal growth would similarly take on a lesser significance than it is currently accorded. This would seriously question the roles of nucleation promoters and growth inhibitors, which have been the focus of so much attention.

        


    Preservation of the colloidal suspension by aggregation inhibition would be seen as the defining distinction between healthy individuals and stone formers.

        


    Gyory and Ashby suggest that trivalent citrate is largely responsible for this. From their perspective, freedom from stones or formation of calculi seems to be controlled by the urine composition in terms of the simple low-molecular weight species; the biology and the role of macromolecules seem of little importance.

         


    The new hypothesis would need rigorous scrutiny. The bulk of available experimental data on crystalluria does not strongly support it, at least as a general rule.

        



 

  

Speciality Spotlight

 

 
Urology
 

 

Stone Disease
   

  • W-C. Chen, H.-Y. Chen, H.-F. Lu, C.-D. HSU, and F.-J. TSAI [Depts. of Urology, Obstetrics and Gynecology, and Medical Genetics, China Medical College, Taichung, and Institute of Life Science, National Tsing Hua University, Hsinchu, Taiwan]
    Association of the Vitamin D Receptor Gene Start Codon Fok I Polymorphism with Calcium Oxalate Stone Disease
    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 168-171

    A normal control of 90 healthy subjects and 146 patients with calcium oxalate stones were examined. Using polymerase chain reaction [PCR] based restriction analysis, the relationship between Fok I polymorphism and urolithiasis was evaluated. An unexcisable length of 265 bp was identified [allele CC] and 2 fragments [169 bp and 96 bp] identified as excisable lengths [allele TT].

    Results -There was a statistically significant difference between the groups [chi-square test, P<0.05] for the genotype of the Fok I start codon polymorphism. The odds ratio [ 95% confidence interval] for the C allele in those at risk of stone disease was 1.672 [1.149-2.432].

    Conclusions- These results suggest that the VDR Fok I start codon polymorphism may be a good candidate for a genetic marker in calcium oxalate stone disease.
      
  • J.-P. Mcfarlane, C. Cowan, S.J. Holt and M.J. Cowan [ Departments of ‘Urology and Radiology. The Churchill Hospital, Oxford, UK]
    Outpatient Ureteric Procedures : A New Method for Retrograde Ureteropyelography and Ureteric Stent Placement 
    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 172-176

    Patients and Methods -Procedures were undertaken using a flexible cystoscope and digital C-arm fluroscopy in outpatients under sedoanalgesia. The flexible cystoscope was used to identify the ureteric orifice, a straight 0.9 mm hydrophilic guidewire inserted and passed into the renal pelvis under fluroscopic guidance. A 4 F general purpose catheter was passed over the wire and ureteropyelography performed. Stenting was done over a ultra-stiff wire after exchange.

    Results -Of the 723 procedures, 643 were technically successful. Failure was most commonly due to failure to cannulate the ureteric orifice. Immediate complications occurred in 3%. 282 of 300 procedures were reported to be acceptable.

    Conclusion -Retrograde ureterography and ureteric stent placement may be satisfactorily undertaken with the patient under sedoanalgesia on an outpatient basis. This technique can reduce costs, hospital admissions, general anaesthetic use, demands on theatre time and complication rates.
         
  • F.X. Keeley, Jr.K. Tilling, A. Elves P. Menezes, M. Wills N, Rao and R. Feneley [Bristol Urological Institute, Southmead Hospital, Bristol, Department of public Health Sciences, king College, London and Withington Hospital, Manchester, UK]
    Preliminary Results of a randomized Controlled Trial of Prophylactic Shock Wave Lithotripsy for small Asymptomatic Renal Calyceal Stones
    BJU International, volume 87, Number 1, January 2001, Pg.Nos. 1-8

    Patients and Methods – The study included 228 patients with small [ < 15 mm total diameter] asymptomatic calyceal stones: 113 were randomized to undergo ESWL and 115 to the control group who were kept under observation.

    Results – In the ESWL group 28 patients [28%] were stone free, compared with [17%] 16 in the observation group. 

    Additional treatment in the form of analgesics, antibiotics, ESWL, stent insertion and ureteroscopy, was required in 21 [21%] of patients in the observation group and 15[15%] in the ESWL group. 10 patients in the observation group needed invasive procedures, vs none in the ESWL group. 

    There was no difference in the symptoms, quality of life or renal functions between the arms of the trial at the final follow up.

    Conclusion – ESWL for asymptomatic or minimally symptomatic renal calyceal stones appears to offer little advantage to patients in terms of stone-free rates, renal function or quality of life; hospital admission or symptoms. A policy of observation is associated with greater intervention rates, with the risk of morbidity associated with more invasive procedures.
         
  • J. P. Kavanagh (University Department of Urology, South Manchester University Hospitals Trust, Withington, Manchester, UK)
    A Critical Appraisal of the Hypothesis That Urine is a Saturated Equilibrium with Respect to Stone-Forming Calcium Salts
    BJU Intl. May 2001 Vol. 87 (7) Pg. 589-598
          
    If the saturated equilibrium hypothesis were to be accepted as relevant for the calcium salts of most urine samples then it would have serious implications for the future direction of stone research. The nucleation of crystals would no longer be seen as a crucial trigger but would be perceived as a normal event. Crystal growth would similarly take on a lesser significance than it is currently accorded. This would seriously question the roles of nucleation promoters and growth inhibitors, which have been the focus of so much attention.
        
    Preservation of the colloidal suspension by aggregation inhibition would be seen as the defining distinction between healthy individuals and stone formers.
        
    Gyory and Ashby suggest that trivalent citrate is largely responsible for this. From their perspective, freedom from stones or formation of calculi seems to be controlled by the urine composition in terms of the simple low-molecular weight species; the biology and the role of macromolecules seem of little importance.
         
    The new hypothesis would need rigorous scrutiny. The bulk of available experimental data on crystalluria does not strongly support it, at least as a general rule.
        

 

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