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Treatment of Urolithiasis

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Urolithiasis in Clinical Practice

Part of the book series: In Clinical Practice ((ICP))

Abstract

This section will be approached systematically starting with the management of incidentally discovered urinary stones, then the treatment of a painful episode of urinary stones presenting in the emergency department as well as the management of obstructed kidneys with sepsis. Thereafter we will discuss the various active modalities performed when symptoms persist, or when at first glance the stone appears not to be prone for spontaneous passage. Active stone removal is also recommended when there is stone growth, de novo obstruction, or associated infection [1]. We will also develop the topic of dietary and medical preventive measures and will give a brief account on phytotherapy.

“Challenges in medicine are moving from ‘Treat the symptoms after the house is on fire’ to ‘Can we preserve the house intact?’”

Elizabeth Blackburn (1948–) (Nobel Prize in Physiology/Medicine in 2009)

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Notes

  1. 1.

    Piezoelectricity is an adjective coming from Greek words “piezein” (to press or to squeeze) and “electron” (amber: a shining fossilized tree resin). The principle of Piezoelectricity can be summarized as “production of electricity by pressure application”. Indeed when submitted to high pressure, various solid materials such as quartz, ceramics, crystals, etc. accumulate a potential energy that is instantly delivered as an alternating electric current. Piezoelectricity was reportedly discovered by the French Physicists Jacques and Pierre Curie in 1880 and its simplest example nowadays is a gas lighter. “Reverse or inverse piezoelectricity” is the faculty of the same solid materials to become mechanically stressed, i.e. deformed in shape when submitted to electricity.

  2. 2.

    The word “Steinstrasse” is a German term which means “stone street”, and its plural is “steinstrassen ”. It was coined by Chaussy C et al. [19] to refer to a post-ESWL adverse event where multiple stone fragments get jammed in the ureter eventually causing an obstruction. In a large Egyptian series of patients treated with ESWL (n = 2954), steinstrassen were observed in 4.9% of cases [38]. They mostly form in the pelvic or lower ureter (74%), then in the lumbar or upper ureter (18.5–21.7%), and rarely in the iliac or mid ureter (4.3–7.4%). Suggested risk factors for their formation are: renal stone size >2 cm, renal pelvis or upper calyceal location, a dilated system, and use of high power (>22 Kv) for disintegration [39, 40]. In the pediatric population, it is also associated with age <4 years. Some authors have proposed to classify steinstrassen into three types: type I is made up of tiny particles (≤2 mm), type II has a large leading fragment of 4–5 mm with a tail made of tiny particles, and type III is composed of large fragments [41]. Asymptomatic steinstrassen are managed conservatively, and Tamsulosin has been suggested [42]. Complicated steinstrassen (i.e associated with pain, hydronephrosis, fever) may require percutaneous nephrostomy , or ureteroscopy , or both [41, 43].

    Steinstrassen can rarely form spontaneously in patient with nephrocalcinosis associated with distal RTA [44, 45] and have also been reported even in the urethra after ESWL for a renal stone, after cystolitholapaxy in a post-renal transplant patient, in association with stricture, or de-novo in children [46,47,48,49] (Fig. 11.5).

  3. 3.

    • The Guy’s classification helps to predict the outcome of PCNL. It comprises of four grades [129]:

      • grade I: solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy

      • grade II: solitary stone in upper pole or multiple stones in a patient with simple anatomy or a solitary stone in a patient with abnormal anatomy

      • grade III: multiple stones in a patient with abnormal anatomy or stones in a caliceal diverticulum or partial staghorn calculus

      • grade IV: staghorn calculus or any stone in a patient with spina bifida or spinal injury.

    • Other stone scoring systems include the Clinical Research Office of the Endourological Society (CROES) nomogram, the S.T.O.N.E. (stone size, tract length, obstruction, number of involved calices, and essence/stone density) nephrolithometry, and the Seoul National University Renal Stone Complexity (S-ReSC) score [130].

  4. 4.

    The Spanish Professor Josep María Gil-Verne t Vila is credited with many other original urological contributions, such as a technique for renal homotransplantations [198], hypospadias correction [199], vesico-ureteral reflux correction [200], pelvic floor repair [201], complex vesico-vaginal fistula repair [202], orthotopic renal transplantation [203], etc. He is the son of the late Professor Salvador Gil-Vernet who proposed a model for the description of the prostate anatomy in 1953 [204].

  5. 5.

    Anatrophic is an adjective related to what is used in order to prevent or correct atrophy of cells, tissues, or organs. However this adjective has become almost obsolete nowadays, being merely used in the context of nephrolithotomy .

  6. 6.

    The eponym Brödel’s line is used in the USA and the UK, being given after the Germano-American medical Illustrator Max Brödel, “the man who put art into medicine” [205]. Brödel depicted this line in 1901 (Fig. 11.20a, b) [206]. However in Continental Europe and Latin America, preference is sometimes made for the eponym Hyrtl’s line, given after the Austrian anatomist Josef Hyrtl who described this line in 1882, almost 20 years earlier than Brödel [207]. Hyrtl was the first to suggest the “natürliche Teilbarkeit der Niere” (natural divisibility of the kidney) through this avascular line and Brödel credited him for this fact [206].

    Figure 11.20
    figure 20

    (a) Lateral view of left kidney, showing the location of the most advantageous incision through the parenchyma in kidneys which have a normal arterial arrangement. aa´: Lateral convex border of kidney. bb´: Position of lateral column of cortical substance containing the vessels. cc´: Best incision. (b) de: Incorrect direction of incision. cx: Correct direction of incision. From Max Brödel [206]. Original illustration 1901 Brödel Publication, reproduced with permission from the Collection of the Max Brödel Archives, in the Department of Art as Applied to Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Full size image
  7. 7.

    The percutaneous cystolithomy has been mentioned above (see section number 11.3.6).

  8. 8.

    CLU (Club della litiasi Urinaria) is the Italian expert committee for urinary lithiasis.

  9. 9.

    Citrus fruits: lemon, orange, mandarin, clementine, grapefruit, lime, sudachi, calamondin, etc.

  10. 10.

    Non-citrus fruits: melon, grapes, apricots, pears, peaches, blackberries, raspberries, plums, etc.

  11. 11.

    Febuxostat is FDA-approved since 2009.

  12. 12.

    The chelating action of Penicillamine has been used for many other medical indications: Wilson’s disease (where it binds with copper and allows its elimination with urine), arsenic poisoning etc. Penicillamine has also been used as a disease-modifying agent in scleroderma and rheumatoid arthritis. However in all these indications its use was progressively confined to exceptional cases or banned because of the potentially dangerous side effects.

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    Said Abdallah Al-Mamari

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Al-Mamari, S.A. (2017). Treatment of Urolithiasis. In: Urolithiasis in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-62437-2_11

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