This is a retrospective review of 200 day-care ureteroscopies performed between April 1998 and October 2002. The aim was to determine the feasibility and safety of this procedure. The mean age was 38.8 years and 75% of them were male. Eighty-three percent were ASA 1 and the remainders were ASA 2. The side of procedure were 48.5% right, 2.5% left and 6% both sides. Fentanyl and proprofol were used during induction. Calculi were found in 82.5% of cases. Rigid and flexible scope were used in 91.5% and 10.5% of cases. There were 33% upper, 23% mid and 44% distal ureteric stones. The mean stone size was 9.37 X 6.93mm. Seventy-four percent required a ureteric stent insertion. The mean operative time was 58.3 minutes. Four percent of patients experienced pain post-operatively relieved by NSAID injection. Repeat ureteroscopy performed in 30% of patients. There were zero admission rates. This study suggests day-care ureteroscopy is effective, safe and well tolerated by patients.
The oral health awareness and status among the Universiti Kebangsaan Malaysia first year dental students were studied. Seventy-three subjects underwent two components of assessment: questionnaire assessing oral health awareness and behaviour, and clinical examination of oral health status. Indices used including Plaque, Calculus, Community Periodontal Index for Treatment Needs (CPITN) and total score of Decayed, Missing, Filled and teeth indicated for Extraction (DMFX[T]). More than 90% of the subjects were reported to brush their teeth twice or more daily and used supplemental cleaning tools. They also knew the importance of healthy oral condition, the various causes and prevention of tooth decay and gum diseases. Although 70.3% felt they need dental treatment, the majority (81.9%) visited the dentist only when they feel it is necessary to do so. Clinical examination showed low scores of 0.99 and 0.40 for mean plaque and calculus indices, respectively, while 80.8% of the subjects have mild calculus accumulation. Code 2 of the CPITN Index was the highest (70.3%) among the subjects. The total DMFX was 291, with mean score of 0.14 per subject and the decayed component was the highest (D=186 teeth). These findings suggest that the subjects have acceptable oral health awareness, and also good existing oral health status.
Catheter knotting is a rare complication of bladder catheterisation. Retention of catheter parts resulting in calculus formation is even rarer. We report a case of a vesical calculus formed over a broken and retained supra-pubic catheter which to the best of our knowledge has yet to be reported, along with three other cases of bladder catheter knotting.
Objective: To determine the epidemiological, clinical and laboratory features of the patients with gout, on follow up in Rheumatology Outpatient Clinic, Hospital Seremban.
Methods: This was a retrospective study. Case notes of all our existing gout patients were reviewed, and data on demography, clinical features, associated conditions, and laboratory findings were noted.
Results: 54 patients were studied, 48 (89%) were male and 6 (11%) were female at the ratio of M : F = 8:1, 30 (57%) of them had the onset of symptoms at their 3rd and 4th decades of life. The majority were the Malays 39 (72%), followed by the Indians 11 (20%) and the Chinese 4 (8%). Commonly associated conditions were hypertension in 37 (68.5%), obesity (BMI of 30 and above) in 36 (66.7%) and hyperlipidaemia in 36 (66.7%) of them. Mixed hyperlipidaemia (High TG and LDL cholesterol) were found in 19 (53%). Underlying history of diabetes mellitus 7 (13%), alcohol consumption 8 (15%), smoking habits 22 (40%) and family history of gout 18 (33%). Half of our patients 27 (50%) had at least 2 or more joints involvement. 28 (52%) of them had tophaceous gout. Among those with tophaceous gout, 18 (64%) had renal impairment with serum creatinine of .150mmol/l. 6 (31.5%) of the patients with renal impairment found to have renal calculi on ultrasonography.
Conclusion: There was male predominance in our group of patients which was consistent with other reported epidemiological studies. Hypertension, mixed hyperlipidaemia and obesity were common associated conditions while diabetes mellitus, smoking and family history of gout were not. The majority of gout patients in our clinic were Malays and due to religious reasons, alcohol was not a common associated factor. Half of our patients had multiple joints involvement and more than half also had tophaceous gout. There was high incidence of renal impairment seen in patients with tophaceous gout. These could be due to delay in seeking medical treatment, present of renal calculi and possibly contributed by associated hypertension and diabetes mellitus.
Emphysematous pyelonephritis is a rare but life threatening infection of kidney that is characterized by gas formation within or around the kidney. We describe a case of emphysematous pyelonephritis as a consequence of inadequately treated pelvic-ureteric stone in a diabetic man and complement this with a brief review of the literature pertaining in particular to the management of this condition.
Kidney stone disease affects 1 - 20% of the general population. At present, the diagnosis of a stone is done using radiography method when noticeable symptoms appeared. We developed a non-invasive quantitative assay for urinary THP, namely ELISA; whereby our previous study and other reports had shown the usefulness of THP as biomarker for kidney stone disease. Since urine is biological fluid that is easily obtainable, this method could be used as a screening assay for kidney stone prior to confirmation with radiography. The ELISA gave assay linearity r(2) > 0.999 within the range of 109 ng/mL to 945 ng/mL THP. Assay precisions were < 4% (C.V.) for repeatability and < 5% (C.V.) for reproducibility. Assay accuracy range from 97.7% to 101.2% at the various THP concentrations tested. Assay specificity and sensitivity were 80% and 86%, respectively. The cut-off points at P < 0.05 were 37.0 and 41.2 mug/mL for male and female, respectively. The assay is cost effective and rapid whereby the cost for assaying each urine sample in duplicate is approximately USD0.35 and within 5 hours, 37 samples can be assayed alongside full range of standards and 3 QC samples in each plate. Furthermore, sample preparation is relatively easy where urine sample was diluted 10 times in TEA buffer. The usability of the ELISA method for diagnosis of kidney stone disease is evaluated with 117 healthy subjects and 58 stone formers.
Objective: this study was carried out to evaluate the relationship between smoking and periodontal status in a selected Malaysian population. The sample for this cross-sectional study involved 39 subjects who were smokers. Each subject was required to answer the guided questionnaire followed by clinical examination. The questionnaires had 11 questions and were set in English and Bahasa Melayu. Basically, the questionnaire consisted of 3 sections: socio-demographic data, smoking status and subject's knowledge on periodontal health. The clinical parameters used in this study were: Community Periodontal Index, Visible Plaque score, Gingival Bleeding Index and Calculus Surface Index. Results showed that out of 39 subjects, 28 subjects (71.8%) were current smokers, followed by 6 subjects (15.4%) and 5 subjects (12.8%) who were former and who never smoked respectively. From the 216 sextants examined, 42 sextants (19.4%) were healthy gingival, 127 sextants (58.8%) suffered from gingivitis and 47 (21.8%) sextants suffered from periodontitis. There were positive relationships between smoking and periodontal status.
Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) are two main methods of treating proximal ureteric stones. Success rates and cost-effectiveness of the two methods were compared. A total of 67 patients who underwent treatment between January 2007 and July 2007 at a state general hospital were included in the study. The success rate for ESWL group was 81.8% and for URS group was 84.6%. ESWL technique produced a significant higher overall cost per patient than URS (RM930.02 versus RM621.95 respectively). There was no significant difference in quality of patient's life. Cost-effectiveness ratio was lower for URS. The analysis suggested that URS was more cost-effective than ESWL.
Renal calculi disease or known as kidney stone disease is the most common urological disorder in both men and women, although it is more prevalent in men. The lifetime chance for an individual to develop renal calculi is approximately 10% whereas the risk of recurrence in a 10-year period is 74%. Therefore, a diagnostic tool for screening or detecting renal calculi is greatly needed. In this study, we analyze urinary protein profiles from patients with renal calculi for the first time (RC), healthy subjects (HS), and patients with recurrent renal calculi (RRC) to identify a biomarker for detecting the disease. Urinary proteins were isolated by salt precipitation and the proteins resolved by SDS-PAGE. Target proteins were analyzed with LC/MS/MS. Thirty-two proteins were identified from healthy subjects and patients. Uromodulin was the most abundant urinary protein in HS but was a very faint band if detected at all from those that formed renal calculi for the first time (p < 0.05). Yet the excreted levels of urinary uromodulin in RRC were similar to those of the HS suggesting that uromodulin is a reliable biomarker for only RC. In addition, a few immunoglobulins that were commonly found in the urine of both RC and RRC, which include Ig alpha heavy chain 1, Ig gamma-2 c region, Ig gamma-3 heavy chain disease protein, Ig heavy chain variable region, Ig heavy constant region gamma 4, and Ig heavy chain. Ig heavy chain Fab frag and antibody a5b7 chain B may serve as potential biomarkers for renal calculi disease.
Salivary duct obstruction secondary to calculi is a common disorder of the submandibular gland and often manifesting as painful episodic swelling of the gland during meals. Complications may arise in unresolved obstruction leading to infections, abscess formation and a hypofunctioning gland. Treatment of this disorder has evolved from the traditional sialadenectomy to organ preserving procedures done under general or local anaesthesia. Our technique using Ellman Surgitron radiofrequency device, is another alternative technique for transoral removal of extraglandular calculi. It is a simple, quick an easy technique to learn that can be done in the office setting under local anaesthesia.
OBJECTIVES: To investigate the correlations and agreements between the solute/creatinine ratios from the 24-hour and early morning spot urine samples for metabolic evaluation in stone-formers given the various pitfalls with the 24-hour urinary metabolic evaluation in stone-formers.
METHODS: 30 urinary stone-formers out of an initial 62 recruited provided a complete 24-hour urine and early morning spot urine samples for metabolic evaluation. Pearson correlation and Bland and Altman Test were used to assess the correlations and agreements.
RESULTS: Significant correlations were established between the 24-hour urinary solute excretions and the corresponding early morning spot urine solute/creatinine ratios for calcium, magnesium, urate, potassium, oxalate, citrate, and the Differential Gibb's free energy value of calcium oxalate DG(CaOx) values. However, all these solute/creatinine measurements between the 24-hour and early morning spot urine samples were judged to be not within the acceptable limits based on the estimated "limit of agreement" by the Bland and Altman Test of Agreement. Diurnal circadian rhythm and postprandial excretion surge are thought to be responsible for the disagreements.
CONCLUSIONS: Thus, the early morning spot urine is not suitable to be used interchangeably to replace the 24-hour urine collection in the evaluation of urinary metabolic abnormalities in stone-formers. A good correlation does not translate to an agreement between the 2 measurements.
Extracorporeal shock wave lithotripsy (ESWL) is accepted as the gold standard treatment for renal stones that are smaller than 2 cm. Recently, retrograde intrarenal surgery (RIRS) has been introduced as another form of treatment. We report our experience in dealing with renal stones smaller than 2 cm using RIRS as the primary treatment and following failed ESWL.
Two to three percent of stone disease cases occur in the paediatric age group. It is common in some parts of the world, such as in Turkey, India and Thailand. More than 50 percent of stones in children are still managed through open surgery. Ureteroscopic intervention for children remains a challenging treatment option. However, in contemporary urology practice, this mode of intervention is becoming more common. In this retrospective study, we reviewed our experiences with ureteroscopy and pneumatic lithotripsy in the paediatric and adolescent age group.
Inflammation of the gallbladder without evidence of calculi is known as acute acalculous cholecystitis (AAC). AAC is frequently associated with a poor prognosis and a high mortality rate. Thus, early diagnosis and prompt surgical intervention has been recommended to improve the outcome of AAC. Herein, I present a case report of AAC complicating laparoscopic appendicectomy. Unlike previous studies that have reported the need for urgent intervention in patients with AAC, in this study, our patient responded to conservative management. Therefore, the management of AAC after laparoscopic appendicectomy should be individualised.
A non-puerperal uterine inversion in advanced uterovaginal prolapse is a rare occurrence. Even more unusual is the presence of bladder calculi in these two conditions, which has not been documented before. We report a case of acute urinary retention secondary to severe uterovaginal prolapse associated with uterine inversion and multiple bladder calculi.
To investigate the urinary metabolic excretion pattern among local stone formers given the great differences in the intrinsic and extrinsic risk factors as well as the urinary metabolic excretions compared with other populations.
Incidence of urolithiasis is on the rise due to climatic changes especially global warming.The pain due to presence of ureteric stone is a well known identity but many times it may be asymptomatic or even masked by concurrent presence of backache. In the present article, we describe the case of a 43-year-old male who came to the clinic for treatment of backache persisting for more than two years. The patient complained of backache two years back for which he was treated with analgesics and physiotherapy which relieved his pain. No X-ray was taken earlier because the attending clinician thought the backache to be musculo-skeletal in origin. Recently, one day a sudden episode of backache in the midst of night compelled him to seek medical treatment. However, this time a X-ray was performed and it showed the presence of calculi in the right upper pelvis of ureter which measured 1.9 cm vertically. An ultrasound confirmed the diagnosis. The patient was treated with two episodes of shock wave therapy which failed to crush the stone. A Double-J stent was inserted under general anaesthesia. The stone was crushed using a ureteroscope guided laser. The present case report describes how backache in professionals cannot be lightly attended. Even the characteristic groin to loin pain may be absent. All cases of backache should be properly investigated with an X-ray to rule out renal or ureteric calculi.
The incidence of ureteric calculus as a cause for severe abdominal pain in children is mounting, especiallyin the tropical country. The course of illness may be non-specific but a swift detection via non-invasiveimaging modalities singly or in combination may avert unnecessary radiation hazard and futile surgery ina young child. In this paper, we discussed a case of an 11 year-old boy who was presented with a suddenonset of the right side severe abdominal colic whose a bedside ultrasound was positive for hydronephrosisfor which localisation of stone was further confirmed via a low dose limited intravenous urography (IVU).It is important to note that data available on the value of a combined ultrasound and the limited IVU inan emergency setting when urolithiais is being suspected in children with abdominal pain are particularlyscarce. Hence, this case documented the potential value of a combined ultrasound and a limited IVUstudy as a unique combined armamentarium used in a suspected childhood urolithiasis in the tropics.
Urolithiasis is a common disease with increasing incidence and prevalence world-wide, probably more common in industrialized countries. The metabolic evaluation of 24-h urine collection has been considered as part of the management of urinary stone patients. The aim of this study was to evaluate the 24-h urine constituents in stone formers and its relation to demographic data in the northeast part of Peninsular Malaysia. One hundred and six patients were recruited in this study from two hospitals in the same geographical region; 96 patients fulfilled the inclusion criteria and an informed consent was obtained from all subjects. The 24-h urine was collected in sterile bottles with a preservative agent and calcium, oxalate, citrate, uric acid, magnesium and phosphate were tested using commercial kits on a Roche Hitachi 912 chemistry analyzer. The age (mean ± SD) of 96 patients was 56.45 ± 13.43 years and 82.3% of the patients were male while 17.7% were female. The 24-h urine abnormalities were hypercalciuria (14.5%), hyperoxaluria (61.4%), hypocitraturia (57.2%), hyperuricouria (19.7%), hypomagnesuria (59.3%) and hyperphosphaturia (12.5%). Hyperoxaluria (61.4%) was the most common abnormality detected during the analysis of 24-h urine constituents in contradiction to industrial countries, where hypercalciuria was the most common finding. The high frequencies of hypomagnesuria and hypocitraturia reflect the important role of magnesium and citrate in stone formation and their prophylactic role in the treatment of urinary stone disease in the given population.
Testicular microlithiasis (TM) is a rare benign condition with presence of multiple small microcalcifications in the seminiferous tubules. Though the aetiology is unknown, TM has been described in association with a variety of urological conditions. We report the clinico-pathological features of a 12-year-old male child who underwent orchidectomy for undescended testis. Histopathological examination of the excised testis showed multiple small intratubular calcifications without any evidence of testicular neoplasia. TM is an unusual phenomenon that should be kept in mind while evaluating testicular biopsies. Though it behaves in a benign manner in most of the cases, patients with positive family history of testicular cancer should be followed-up for testicular tumour.