초음파 검사 상 요로결석이 자주 관찰되나요?

조영석,원태영,연제호,강보승 대한응급의학회 2007 대한응급의학회지 Vol.18 No.1

Purpose: Transabdominal sonography has been widely used in the diagnosis of suspected urinary calculi, assisted by secondary findings from urinary tract obstruction, but this method shows low specificity and relatively high incidence of false-positives. Recently, detection of stone itself with new Doppler finding and bladder distension on sonography has demonstrated high sensitivity. Methods: We performed prospective transabdominal ultrasonography for emergency department patients with acute urinary colic pain over a 3 month period. With adequate bladder distension by intravenous hydration and initial spontaneous voiding drive, stones itself could be tracked along the entire length of urinary tract by emergency physician who received short-term education course. Results: One hundred and thirty one patients enrolled; 86 received a sonographic exam and 57 showed urinary calculi. The detection rate of urinary calculi was 71.3%. The most common sonographic feature used in the diagnosis of urinary calculi was a distinct echogenic stone appearance within the dilated urinary tract with posterior acoustic shadowing. Conclusion: We concluded that detection of urinary calculi by transabdominal ultrasonography could be very useful in combination with secondary sonographic finding from urinary tract obstruction in the evaluation of suspected urinary colic.

EDAP LT-02 체외충격파쇄석기를 이용한 요로결석 치료의 임상 경험

강동일,민권식,최성협 大韓泌尿器科學會 2002 Korean Journal of Urology Vol.43 No.10

Genestone 190 체외충격파쇄석기를 이용한 요로결석 치료의 초기 경험

김민의,송윤섭,박영호,구자현 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

Shock wave lithotripsy monotherapy was performed in 180 patients with urinary calculi using Genestone 190 lithotriptor between January 1996 and April 1998. Age range of the patients was 17 to 71 years (mean of 44.7 years)and male to female ratio was 2.3:1. There were 54 cases(30%) with renal calculi and 126 cases (70%) with ureteral calculi. NO regional or general anesthesia was required, but parenteral analgesics were required in some patients. The spark voltage was from 16 to 22Kv and average numbers were 2.04 sessions and the mean number of shock per session was 2230±350. The success rates of urinary calculi below 5㎜, 6-10㎜, 11-15㎜, 16-20㎜ and over 21㎜ were 95%, 94%, 91%,75% and 50%, respectively. The success rates of renal, midureter and lower ureter calculi were 85%, 98% and 73%, respectively. There were no significant complications. We think that SWL monotherapy using Genestone 190 lithotriptor is effective and safe procedure for calculi of kidney and upper ureter and calculi below 15㎜.

Unplanned 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi

Manoj Kumar,Siddharth Pandey,Ajay Aggarwal,Deepanshu Sharma,Gaurav Garg,Samarth Agarwal,Ashish Sharma,Satyanarayan Sankhwar 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.5

Purpose: To see the 30-day unplanned readmission rates in patients underdoing endo-urological surgeries for upper urinary tract calculi we conducted this retrospective study at King George's Medical University, Lucknow, India. Unplanned readmissions not only add to healthcare costs but also are bothersome for the patients. There are many studies on 30-day unplanned readmissions in general surgical patients. Although similar studies have been done in certain urological procedures, no study has reported readmission rates or its risk factors in patients undergoing surgeries for upper urinary tract calculi. Materials and Methods: We retrospectively reviewed our prospectively maintained database from 1st January 2009 to 31st December 2017, for the patients who underwent endo-urological procedures for upper urinary tract calculi and identified the patients who were re-admitted within 30 days of discharge. Results: Out of the total 3,209 patients undergoing endo-urological procedures for upper urinary tract calculi 56 were re-admitted. The readmission rate was 1.74% over the study period. The most common etiology for readmission was sepsis followed by hematuria. The significant risk factors for readmission in bivariate analysis included male gender, age >65 years, current smoking, chronic obstructive pulmonary disease, diabetes mellitus, bleeding disorder, prior cardiac disease, and American Society of Anesthesiologists (ASA) class ≥3. In multivariate risk adjusted logistic regression analysis ASA class ≥3 was the only independent risk factor for readmission. Conclusions: The readmission rates in endo-urological procedures for urolithiasis are less compared to other procedures. ASA class ≥3 is the most important independent predictor of unplanned 30-day readmissions.

Large Prostatic Calculi Causing Urethral Obstruction

백성현,윤성욱,백민기,김형곤,노용수 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.8

Although prostatic calculi are common, complications are fortunately rare. Here, we report a case of prostatic calculi causing urethral obstruction. A 66-year-old man presented with severe voiding difficulty and urge incontinence. He was found to have multiple large prostatic calculi obstructing the prostatic urethra as well as several bladder calculi. Attempts at endoscopic removal were unsuccessful, which resulted in an iatrogenic urethral diverticulum due to fragmented calculi. The residual calculi and diverticulum were removed successfully by open surgery.

Risk Factors of Sepsis and Factors Influencing the Decision to Perform Emergency Drainage in Obstructive Acute Pyelonephritis Secondary to Urinary Calculi

정영환,정승찬,백민기,류동수 대한요로생식기감염학회 2017 Urogenital Tract Infection Vol.12 No.3

Purpose: To investigate the risk factors for sepsis and analyze the criteria for emergency drainage in patients with obstructive acute pyelonephritis (APN) secondary to urinary calculi.Materials and Methods: We included 64 patients with obstructive APN secondary to urinary calculi. Patients were divided into two groups: the sepsis and non-sepsis groups. Independent risk factors for sepsis were also identified. Forty-three patients in the sepsis group were further divided into two subgroups: those who underwent emergency drainage and those who did not. A retrospective analysis was performed.Results: Of the 64 patients, 43 showed signs of sepsis. There was a lower lymphocyte count and lymphocyte percentage, as well as a higher C-reactive protein level and neutrophil-to-lymphocyte ratio (NLR) in the sepsis group compared with the non-sepsis group. Increased sepsis showed a statistically significant association with increased Charlson comorbidity index (CCI). Four out of 21 patients in the non-sepsis group underwent emergency drainage compared with 26 out of 43 patients in the sepsis group. Independent variables for sepsis in a multivariate logistic regression analysis showed positive blood culture, high NLR, and increased CCI score. Among sepsis patients, the likelihood of performing emergency drainage increased with higher creatinine, positive urine culture, and higher CCI score.Conclusions: In patients with obstructive APN secondary to urinary calculi, a high CCI score were associated with a higher probability of progression to sepsis. In patients with higher creatinine and higher CCI scores, proactive treatment is usually necessary.

Removal of Urinary Calculi by Laparoscopic-Assisted Cystoscopy in Five Dogs

이승용,박세진,진소영,김민향,석성훈,이희천,연성찬 한국임상수의학회 2014 한국임상수의학회지 Vol.31 No.5

This article describes the use of laparoscopic-assisted cystoscopy for removal of urinary calculi in five dogs. All dogs had micturition disorder due to urinary calculi. The surgical technique used was same in all cases. A urethralcatheter passed into the urinary bladder through the urethra preoperatively. A 5-mm diameter cannula was placed inthe ventral midline, 1 to 2 cm cranial to the umbilicus, and the 5-mm laparoscope was introduced via the cannula. A 10-mm diameter cannula was placed adjacent to the apex of the bladder under the visual guidance of laparoscopy. The bladder was then partially exteriorized through the 10-mm portal site, and a stab incision was performed on thebladder wall. The incisional margin of the bladder was sutured to the skin of the second portal site in 360o simplecontinuous suture. A 2.7-mm diameter cystoscope with a sheath was introduced into the bladder lumen. The cysticand urethral calculi were removed under the visual guidance of cystoscopy with continuous fluid flushing. No majorpostoperative complications were identified. During the follow up period (range 7 to 21 months), no episodes of urinarydysfunction or recurrence of clinical signs were observed.

요로결석 치료의 최근 요법

박영호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Many different methods have been developed for the management of urinary calculi. Such methods include Extracorporeal Shock Wave Lithotripsy(ESWL), Percutaneous Nephrolithotomy(PCNL), Ureteroscopy with or without intracorporeal lithotripsy, minimal invasive PCNL and Laparoscopic Ureterolithotomy. As a result, percentage of open surgery was reduced. It would be essential, nowadays, for the urologist to understand those method and their point & counterpoint.

Short-term Supplementation with a Trace Mineral-fortified Microbial Culture May Increase Trace Minerals in Longissimus dorsi Muscle and Prevent Incidence of Urolithiasis in Finishing Hanwoo Steers

Kim, Young Il,Ahmadi, Farhad,Lee, Sang Moo,Lee, Youn Hee,Choi, Do Young,Kwak, Wan Sup The Korean Society of Grassland and Forage Science 2016 한국초지조사료학회지 Vol.36 No.3

This study evaluated the effects of TMC (trace mineral-fortified microbial culture) supplementation on growth performance, carcass characteristics, and meat quality parameters of Hanwoo steers during the last 4 months of finishing period. The TMC was a combination of 0.4% trace minerals, 20.0% Na-bentonite, and 79.6% feedstuffs, which was inoculated with a mixed microbial culture (Enterobacter ludwigii, Bacillus cereus, B. subtilis, Lactobacillus plantarum, and Saccharomyces cerevisiae). Twenty-four steers were blocked by initial BW ($634{\pm}16kg$) and randomly allocated to one of two treatments (control vs. 3.3% TMC). The effect of TMC supplementation on the growth performance was not significant. There was no incidence of urolithiasis in TMC-fed steers. However 3 out 12 steers (25%) fed the control diet were observed to have urinary calculi. The carcass yield and meat quality parameters were not affected by TMC supplementation, however marbling score was increased in TMC-fed steers (P = 0.08). There was no effect of TMC treatment on the chemical composition of longissimus dorsi muscle (LM). The TMC supplementation increased concentrations of manganese (P < 0.01), cobalt (P = 0.02), iron, and copper (P = 0.06) in LM. In conclusion, TMC treatment did not negatively affect growth performance and meat quality parameters, and positively affected the trace minerals profile of LM.

Predictive factors and treatment outcomes of Steinstrasse following shock wave lithotripsy for ureteral calculi: A Bayesian regression model analysis

강호원,조강수,함원식,강동혁,정해도,권종규,최영득,이주용 대한비뇨의학회 2018 Investigative and Clinical Urology Vol.59 No.3

Purpose: This study aims to assess the predictive factors and treatment outcomes of Steinstrasse formation following shock wave lithotripsy (SWL) for ureter stone. Materials and Methods: The medical records of 1,418 ureter stone patients who underwent one-session SWL from November 2005 to May 2013 at our medical institute were retrospectively reviewed. Finally, 551 patients met inclusion criteria. Maximal length and location of stone, stone attenuation (Hounsfield units), and skin-to-stone distance (SSD) were determined on pretreatment non-contrast computed tomography. Results: Of 551 patients, 12 patients (2.2% of total cohort) developed Steinstrasse after one-session SWL. The Steinstrasse incidence was significantly associated with stone size, stone attenuation value, and SSD. Prophylactic ureter stenting was not a statistically significant predictor of Steinstrasse formation. After propensity-score matching, Steinstrasse group showed a significant shorter SSD compare to non-Steinstrasse group. Multivariate logistic regression and Bayesian analysis revealed that stone size, stone attenuation and SSD were significant predictor of Steinstrasse formation following SWL for ureter stone. The Steinstrasse resolved spontaneously in six patients and remaining six patients were treated by additional SWL. None of patients with Steinstrasse required ureteral stenting, percutaneous drainage, or consequent surgical intervention. Conclusions: Steinstrasse formation following SWL for ureter stone was rare event but nonnegligible. Large stone size, high stone attenuation and short SSD were significant predictors of Steinstrasse formation following SWL for ureter stone. Majority of patients with Steinstrasse formation could be treated conservatively in this clinical scenario.