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      Renal Stone Disease: The Urological Perspective

      a , b

      Nephron Clinical Practice

      S. Karger AG

      Lithotripsy, Urology, Surgery, Renal stones

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          Percutaneous nephrolithotomy, extracorporeal lithotripsy and ureteroscopy have changed the face of urolithiasis. Open surgery is becoming extremely rare today. Nevertheless, the cooperation between nephrologist and urologist remains essential and is the only way to prevent recurrence.

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          Most cited references 9

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          Recurrent renal stone disease-advances in pathogenesis and clinical management.

          Kidney stones are common in industrialised nations: up to 15% of white men and 6% of all women will develop one stone, with recurrence in about half these people. Risk factors for formation of stones include urinary promoters (calcium, urate, cystine, and sodium) and urinary inhibitors (magnesium, citrate, and nephrocalcin). Acute renal colic can be precipitated by dehydration and reduced urine output, increased protein intake, heavy physical exercise, and various medicines. Such colic manifests as severe loin pain and can be accompanied by frequent urination, dysuria, oliguria, and haematuria. Documentation of stone characteristics is extremely important: type, size, location, and underlying metabolic abnormalities. Such details can be obtained with a combination of biochemical investigations, microscopic examination of urine under polarised light, and an intravenous pyelogram. Ultrasonography and plain abdominal radiographs are also useful, especially for patients unable to tolerate an intravenous pyelogram. Acute therapy includes complete pain relief, rehydration, and encouragement of diuresis. Long-term management encompasses education of patients with regard to diet and fluid intake, control of calciuria, citrate replacement, and treatment of any underlying urinary-tract infection or metabolic abnormality. Stones smaller than 5 mm normally pass spontaneously, whereas larger stones, as big as 2 cm, are best treated with extracorporeal shock-wave lithotripsy. All physicians should have a clear understanding of the pathogenesis and clinical management (acute treatment and prevention of recurrence) of renal stone disease.
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            Flexible ureteroscopes: a single center evaluation of the durability and function of the new endoscopes smaller than 9Fr.

            Flexible ureteroscopes smaller than 9Fr are widely used in endourology. We systematically evaluated the functional durability of these instruments in the clinical setting. We performed ureteronephroscopy 92 consecutive times in 84 patients at our hospital using a flexible Storz model 11274AA,double dagger Circon-ACMI model AUR-7, section sign Wolf model 7325.172 parallel and Olympus model URF/P3 ureteroscope paragraph sign. Preoperatively and postoperatively we evaluated all flexible ureteroscopes for luminosity, irrigant flow at 100 mm. Hg, number of broken image fibers and active deflection range. During the procedure a record was kept of the duration that the endoscope remained in the urinary tract, average irrigation pressure, method of insertion, various devices used within the working channel, need for lower pole access, and surgeon overall impression of visibility and maneuverability. The luminosity and irrigant flow of all endoscopes remained relatively unchanged during consecutive applications, while active deflection deteriorated 2% to 28%. Endoscopes were used for an average of 3 to 13 hours before they needed repair. The most fragile part of these instruments was the deflection unit. Small diameter flexible ureteroscopes are effective for diagnosing and treating upper urinary tract pathology but improved durability is required. Currently they represent a highly effective but high maintenance means of achieving retrograde access to the ureter and kidney with a need for repair after only 6 to 15 uses.
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              Guidelines on Urolithiasis1


                Author and article information

                Nephron Clin Pract
                Nephron Clinical Practice
                S. Karger AG
                October 2004
                17 November 2004
                : 98
                : 2
                : c54-c58
                aFédération d’Urologie-Nephrologie et Transplantation, Centre Hospitalo-Universitaire Nice, Nice, France; bInstitute of Urology and Nephrology, University College London, London, UK
                80253 Nephron Clin Pract 2004;98:c54–c58
                © 2004 S. Karger AG, Basel

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                Page count
                Tables: 1, References: 14, Pages: 1
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                Cardiovascular Medicine, Nephrology

                Renal stones, Urology, Surgery, Lithotripsy


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