Medical management of kidney stones

Urolithiasis is defined as a disease diagnosed by the presence of one or more stones in the urinary tract. It is one of the oldest and most widespread diseases known to man, their discovery and characterisation chronology began with the civilisation's history. This pathology has a multifactorial aetiology, very frequent worldwide with geographic and racial variation, their prevalence is increasing in lockstep with socioeconomic development. In fact, this disorder affects between 2 and 20% of the population, with an approximate recurrence rate of 30% to 50% in 5 years...

Incidence and prevalence of urolithiasis is apparently increasing worldwide, also among children and adolescents. Nevertheless, robust data have only been obtained in a few countries. In Spain, a voluntary Registry for Pediatric Renal Lithiasis has been active since 2015. Irregular participation limits its applicability, as well as its limitation to patients with a stone available for morphocompositional study, to obtain data about incidence and prevalence. On the other hand, findings about typology of stones and clinical and analytical characteristics of these subjects have been communicated in several meetings...

INTRODUCTION: The incidence of kidney stones in the United States continues to increase. Although dietary interventions have shown to be effective in reducing stone events, adherence to medical management continues to be a limiting factor. For that reason, patient education has become a focus of many physicians. TikTok, a social media application with over one billion users worldwide, has emerged as an online center for medical knowledge sharing by physicians and non-physicians alike...

INTRODUCTION: A ureteral stent is crucial for managing urinary flow obstruction, ureteral reconstructive surgeries, and iatrogenic ureteral injuries. The authors aim to report a case of forgotten double-J stent for 17 years, the longest time reported in literature in a patient with solitary kidney and no typical long-term complications as stones formation and encrustation. CASE PRESENTATION: A 58-year-old male with chronic kidney disease and solitary left kidney presented with left loin pain...

Nephrolithiasis is a globally prevalent urologic condition associated with significant morbidity and patient discomfort. Current management of kidney stones includes both surgical and pharmacologic interventions. Though surgery may be necessary under certain circumstances, pharmacologic treatment is a more affordable, readily available, and a less invasive option for patients. A comprehensive scoping review was conducted to summarize the available literature on the pharmacologic strategies for managing the predominant stone types including calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones...

The incidence of stone disease has increased significantly in the past 30 years, with a reported prevalence of 11% of the U.S. population in 2022, up from 9% in 2012 and 5.2% in 1994.1 While prevention is a vital aspect of management, many patients present with symptomatic urolithiasis requiring surgical management. Emerging advances in endoscopy and technology has led to a dynamic shift in the surgical management of stone disease. This paper will serve as a comprehensive review to inform urologic and non-urologic medical professionals alike, as well as the layperson, on the surgical treatment of nephrolithiasis, starting from the initial evaluation, laboratory and radiographic studies, and various surgical options...

Numerous imaging modalities are available to the provider when diagnosing or surveilling kidney stones. The decision to order one over the other can be nuanced and especially confusing to non-urologic practitioners. This manuscript reviews the main modalities used to image stones in the modern era - renal bladder ultrasound, Kidney Ureter Bladder plain film radiography (KUB), magnetic resonance imaging (MRI), and non-contrast computerized tomography (NCCT). While NCCT has become the most popular and familiar modality for most practitioners, particularly in the acute setting, ultrasound is a cost-effective technology that is adept at monitoring interval stone development in patients and evaluating for the presence of hydronephrosis...

Hyperoxaluria is a clinically relevant metabolic entity that portends a high morbidity burden. Primarily manifesting as kidney stone disease and chronic kidney disease, advanced hyperoxaluria can also affect major organs, including the brain, heart, liver, bone, and the skin. It is categorized based on etiology into primary and secondary hyperoxaluria. Pathology is attributed to excess de novo oxalate production in the former and multifactorial exogenous oxalate absorption or excess intake of its precursors in the latter...

Idiopathic hypercalciuria is defined as excessive urine calcium excretion in the absence of an identifiable cause. It has been strongly associated with the risk of calcium kidney stone formation. Animal and human studies have suggested excessive bone mineral loss or increased gastrointestinal calcium absorption with abnormal renal calcium excretion may contribute to this process. In this article we will review the complex pathophysiology of idiopathic hypercalciuria and discuss clinical management and challenges...

Introduction: New opioid dependency after urologic surgery is a serious adverse outcome that is well-described in the literature. Patients with stone disease often require multiple procedures because of recurrence of disease and hence are at greater risk for repeat opioid exposures. Despite this, opioid prescribing after urologic surgery remains highly variable and in an emergency setting, opioids are still used commonly in management of acute renal colic. Methods: Two literature searches were performed using PubMed...

OBJECTIVES: We enumerate the various laparoscopic strategies to resolve upper urinary tract (UUT) obstruction in the context of variations in anatomy and report their outcomes. PATIENTS AND METHODS: Retrospective review of primary laparoscopic UUT reconstructions performed between May 2012 and May 2021. Anomalies included: malrotated kidney (MRK), horseshoe kidney (HSK), duplex kidney (DK), pure intrarenal pelvis (IRP) and mid-ureteric stenosis (MUS). Success was defined by postoperative resolution of symptoms, improvement of anterior-posterior renal pelvic diameter (APD) on US and drainage on Mag3...

INTRODUCTION: Tuberous sclerosis complex (TSC) is an autosomal dominant disease that affects multiple organs. Medical therapy with the mTOR inhibitor everolimus has become the first option in patients with angiomyolipomas. But mTOR inhibitor treatment shows no effect in some patients, in the case, surgery is a suitable method for treatment. PRESENTATION OF CASE: A 30-year-old Chinese male patient received an ultrasound examination of the kidney, which showed bilateral hyperechogenic structures without stones or ureterohydronephrosis...

PURPOSE: Preventative strategies and surgical treatment for urolithiasis depend on stone composition. However, stone composition is often unknown until the stone is passed or surgically managed. Given that stone composition likely reflects the physiological parameters during its formation, we used clinical data from stone formers to predict stone composition. MATERIAL AND METHODS: Stone composition, 24-hour urine, serum biochemistry, patient demographic and medical history were prospectively collected from 777 kidney stone patients...

OBJECTIVE: Kidney stones (renal calculi) are a prevalent medical condition, causing significant pain and discomfort to patients. The existing treatment options for kidney stones include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and flexible ureteroscopy. It is crucial to evaluate the effectiveness of different treatment modalities, including flexible ureteroscopy, to ensure optimal patient outcomes. This study aims to assess the effectiveness of flexible ureteroscopy in treating renal calculi and determine its value in managing this condition...

BACKGROUND: National Institutes of Health (NIH) category II prostatitis refractory to antibiotic therapy can be challenging to treat. We present the outcomes from a case series of men who have undergone various surgical therapies to treat this condition. Additionally, we performed a scoping review of studies describing the characteristics and outcomes of patients surgically treated for chronic bacterial prostatitis (CBP). METHODS: This is a single-center retrospective case series of adult patients at Cleveland Clinic Glickman Urological and Kidney Institute with refractory NIH category II prostatitis managed with surgical intervention...

BACKGROUND: Kidney stones (also called renal stones) can be a source of pain, obstruction, and infection. Depending on size, location, composition, and other patient factors, the treatment of kidney stones can involve observation, shock wave lithotripsy, retrograde intrarenal surgery (RIRS; i.e. ureteroscopic approaches), percutaneous nephrolithotomy (PCNL), or a combination of these approaches. OBJECTIVES: To assess the effects of percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults...

INTRODUCTION AND IMPORTANCE: Double J (DJ) stents are commonly used in genitourinary procedures, but they can lead to complications including infection, hematuria, encrustation, and stone formation. The longer the duration of encrustation, the greater the risk of complications and renal dysfunction. Forgotten stents pose challenges for patients and can require endourological or open surgical procedures. CASE PRESENTATION: A 40-year-old man with hypertension and coronary artery disease had a forgotten DJ stent for 3 years, causing suprapubic pain and dysuria...

Diseases of the kidney and urinary tract impose a significant portion of the total disease burden, and linkages to high temperature exposure suggest that this burden may increase in the near future. We examined the association between climate and daily emergency department (ED) visits for kidney and urinary disease at the University of Virginia main hospital in Charlottesville, Virginia from 2005 to 2020. Generalized additive models and distributed lag nonlinear models were used to examine these associations over a 21-day lag period...

BACKGROUND: Mineral buildups called kidney stones can be free-floating or affixed to the renal papillae and occur in the renal calyces and pelvis. A major morbidity is associated with the widespread problem of renal stone disease. Open surgical lithotomy and minimally invasive endourological procedures are now the standard for the management of kidney stone symptoms. However, individualized homeopathy (iHOM) has greatly improved treatment of Multiple Renal Calculi. METHODS: In the OPD of Dr...

INTRODUCTION: American Urological Association (AUA) guidelines suggest metabolic testing via 24-h urine studies in high-risk, interested first-time stone formers, and recurrent stone formers. If metabolic testing is not available or otherwise not feasible, clinicians may need to utilize empiric therapy. Debility and social barriers, particularly in the elderly population, may limit the practicality of metabolic testing, and therefore, empiric therapy is of particular importance. The aim of this study is to identify whether unique urinary metabolic abnormality profiles exist for octogenarians with calcium oxalate kidney stones, as this may guide empiric stone prevention therapy more precisely in this population...