Urinary Stone Disease (eBook)

Preface 6
Contents 7
Contributors 10
About the Editors 13
I BACKGROUND 14
Stone Nomenclature and History of Instrumentation for Urinary Stone Disease 15
CONTENTS 15
INTRODUCTION 15
NOMENCLATURE OF STONES 16
Whewellite CaC2O4 · H2O 16
Weddellite CaC2O4 · 2H2O 16
Struvite MgNH4PO4 · 6H2O 17
Newberyite MgHPO4 · 3H2O 18
Apatite Ca10(PO4) · 6H2O 18
Brushite CaHPO4 · 2H2O 18
Whitlockite Ca3(PO4) 18
Lesser Known Minerals and Stones Without Eponyms 19
HISTORY OF INSTRUMENTATION 19
Lower Urinary Tract 22
Upper Urinary Tract 32
REFERENCES 36
Epidemiology and Incidence of Stone Disease 39
CONTENTS 39
TYPES OF STONES 39
INCIDENCE, PREVALENCE, AND LIFETIME PREVALENCE 40
AGE, SEX, AND RACE DEPENDENCE 40
RISK FACTORS FOR STONE DISEASE Climate and Geography 41
Diet 42
Family History 42
Hypertension 43
PEDIATRIC STONE DISEASE 43
PREGNANCY 43
STONE DISEASE IN PATIENTS WITH SPINAL CORD INJURY 44
RECURRENCE FOLLOWING SHOCKWAVE LITHOTRIPSY 44
REFERENCES 45
The Genetics of Stone Disease 47
CONTENTS 47
INTRODUCTION 47
CALCIUM CONTAINING STONES Hypercalciuria 48
Absorptive Hypercalciuria 48
X-Linked Nephrolithiasis (Dent’s Disease) 50
Renal Tubular Acidosis 51
Hypophosphatemia 52
Other Stone Diseases Related to Hypercalciuric Nephrolithiasis 52
CYSTINE-CONTAINING STONES 55
Phenotypic Subtyping of Cystinurics 56
Renal Cystine Transporters 56
Genes Coding for Renal Cystine Transporters 57
STONE FORMATION CAUSED BY ABERRATIONS IN NUCLEOTIDE METABOLISM 57
Uric Acid Stones 57
Adenine Phosphoribosyltransferase Deficiency 59
Xanthinuria 59
CONCLUSION 60
REFERENCES 60
Theories of Stone Formation 67
CONTENTS 67
INTRODUCTION 67
BASIC PHYSICAL CHEMISTRY 68
NUCLEATION 70
CRYSTAL AGGREGATION AND GROWTH 71
EPITAXY 73
MATRIX 74
INHIBITORS AND PROMOTERS 74
CRYSTAL RETENTION 75
CONCLUSIONS 76
REFERENCES 76
Structure and Compositional Analysis of Kidney Stones 81
CONTENTS 81
INTRODUCTION 81
CHEMISTRY AND STRUCTURES FOUND IN STONES 83
CRYSTALLURIA AND STONE MORPHOLOGY 84
Calcium Oxalate Monohydrate 84
Calcium Oxalate Dihydrate 85
Apatite 85
Struvite 85
Brushite 85
Uric Acid 85
Uric Acid Dihydrate 85
Cystine 86
Matrix 86
Other 86
STONE ANALYSIS 86
CONCLUSIONS AND RECOMMENDATIONS 91
ACKNOWLEDGMENTS 93
REFERENCES 93
II METABOLISM 94
Calcium Physiology 95
CONTENTS 95
INTRODUCTION 95
Calcium Metabolism Overview 96
Calcium Pathophysiology Overview 97
CALCIUM ABSORPTION FROM THE INTESTINAL TRACT Overview of Gastrointestinal Calcium Absorption 97
Paracellular Absorption of Calcium 98
Transcellular Absorption of Calcium 98
Regulation of Intestinal Calcium Absorption 100
BONY STORAGE OF CALCIUM Overview of Calcium Metabolism in Bone 100
Osteoblast Activity 101
Osteoclast Activity 101
Hormonal Regulation of Bony Calcium Stores 101
CELLULAR CALCIUM 102
Extracellular Calcium 103
CALCIUM EXCRETION FROM THE KIDNEYS Overview of Calcium Excretion 103
Glomerular Filtration of Calcium 103
Renal Reabsorption of Calcium 103
CALCIUM REGULATING HORMONES Introduction 104
Vitamin D 104
Parathyroid Hormone 106
Calcitonin 107
CALCIUM RECEPTORS AND CHANNELS 108
CONCLUSION 108
REFERENCES 108
Management of Patients With Hyperoxaluria 112
CONTENTS 112
INTRODUCTION 112
OXALATE PHYSIOLOGY 112
SOURCES OF URINARY OXALATE 114
HYPEROXALURIA: DEFINITION 116
ENTERIC HYPEROXALURIA 116
Treatment 117
PRIMARY HYPEROXALURIA 118
Primary Hyperoxaluria 1 118
Primary Hyperoxaluria (PH2) 121
Idiopathic Hyperoxaluria 121
POTENTIAL FUTURE THERAPY Probiotic Therapy 122
Enzymatic Therapy 122
Phytotherapy/Complementary Medicine 123
CONCLUSIONS 123
REFERENCES 123
Renal Acid–Base Balance and Renal Tubular Acidosis 129
CONTENTS 129
INTRODUCTION 129
ACID–BASE CHEMISTRY pH 129
Buffering 130
ENDOGENOUS ACID PRODUCTION Inorganic Acids 131
Organic Acid and Carbonic Acid 131
PULMONARY AND OTHER NONRENAL ACID–BASE REGULATION Pulmonary 132
Hepatic 132
Bone 133
RENAL ACID–BASE REGULATION 133
Reclamation of Filtered Bicarbonate 133
Acid Excretion 135
URINARY PH AND ASSESSMENT OF ACID EXCRETION Determinants of Urinary pH 140
Assessment of Net Acid Excretion 141
Additional Tests 143
RENAL TUBULAR ACIDOSIS 145
Proximal Renal Tubular Acidosis 145
Distal Renal Tubular Acidosis 150
Rate-Dependent RTA 157
Incomplete RTA 157
Type 4 Renal Tubular Acidosis 158
REFERENCES 160
Urinary Stone Inhibitors 165
CONTENTS 165
INTRODUCTION 165
CITRATE Background 166
Chemistry 166
Citrate: “Normal” Levels 168
Hypocitraturia: Incidence 169
Hypocitraturia: Disease Associations 169
Citrate: Mechanism of Action? 170
Citrate: Supplementation 170
MAGNESIUM 175
CONCLUSIONS 176
REFERENCES 177
Modulators of Crystallization of Stone Salts 182
CONTENTS 182
INTRODUCTION 182
STONE MATRIX 185
MORPHOLOGY 185
Chemical Composition 186
CRYSTALLIZATION MODULATORS IN URINE 190
Low-MW Compounds 190
High MW Compounds 195
Proteins 199
Lipids and Cellular Membranes 210
SUMMARY 213
REFERENCES 214
Hormonal Influences on Nephrolithiasis 227
CONTENTS 227
INTRODUCTION 227
PARATHYROID HORMONE 227
Hyperparathyroidism 228
Secondary Hyperparathyroidism 232
VITAMIN D 232
Hypervitaminosis D 232
CALCITONIN 233
SEX HORMONAL INFLUENCES 234
Male Factors 234
Female Factors 235
OTHER HORMONAL INFLUENCES 237
Insulin 238
Growth Hormone 238
Thryoid Hormone 238
Adrenocortical Hormones 238
CONCLUSION 238
REFERENCES 239
Associated Systemic Diseases 243
CONTENTS 243
INTRODUCTION 243
INFLAMMATORY BOWEL DISEASE 244
Stone Type 244
Pathogenesis 245
Treatment 247
JEJUNOILEAL BYPASS SURGERY 249
IMMOBILIZATION SYNDROMES 252
Space Exploration 253
SARCOIDOSIS 254
VITAMIN D INTOXICATION 255
BONE DENSITY 257
CONCLUSIONS 258
REFERENCES 259
Medical Evaluation of Stone Disease 264
CONTENTS 264
INTRODUCTION 264
EVALUATION OF SINGLE STONE-FORMERS 265
Medical History 265
Laboratory Tests 266
EVALUATION OF RECURRENT STONE-FORMERS 267
Simplified Approach 267
Comprehensive Evaluation 268
MISCELLANEOUS CONSIDERATIONS Centralized vs Institutional Laboratories 270
Adequancy of Urine Collection 271
Clues to Detecting Dietary Influences From Urinary Stone Risks 271
Interpretation of Response to “Fast and Load” Test 271
CONCLUSION 271
REFERENCES 272
Pharmacologic Prophylaxis of Calcium Stones 274
CONTENTS 274
INTRODUCTION 274
PATHOPHYSIOLOGY OF HYPERCALCIURIA 275
Absorptive Hypercalciuria 275
Renal Hypercalciuria 275
Resoprtive Hypercalciuria 276
Differential Diagnosis of Hypercalciuria 277
MANAGEMENT OF HYPERCALCIURIA Sodium Cellulose Phosphate 277
Thiazides 278
Guidelines for the Use of Sodium Cellulose Phosphate or Thiazides in Absorptive Hypercalciuria Type I 279
Orthophosphate ( Including Slow- Releasing Potassium Phosphate) 279
PATHOPHYSIOLOGY OF HYPERURICOSURIC CALCIUM OXALATE NEPHROLITHIASIS 280
MANAGEMENT OF HYPERURICOSURIC CALCIUM OXALATE NEPHROLITHIASIS Allopurinol 280
Potassium Citrate 281
PATHOPHYSIOLOGY OF HYPEROXALURIA 281
Dietary Hyperoxaluria 281
Enteric Hyperoxaluria 282
Primary Hyperoxaluria 282
MANAGEMENT OF HYPEROXALURIA Dietary Hyperoxaluria 282
Enteric Hyperoxaluria 282
Primary Hyperoxaluria 283
PATHOPHYSIOLOGY OF HYPOCITRATURIC CALCIUM OXALATE NEPHROLITHIASIS 283
Distal Renal Tubular Acidosis 284
Chronic Diarrheal Syndromes 284
Thiazide-Induced Hypocitraturia 285
Idiopathic Hypocitraturia 285
PATHOPHYSIOLOGY OF HYPOMAGNESURIA 285
DRUG-INDUCED CALCIUM NEPHROLITHIASIS 286
Acetazolamide 286
Lithium 286
CONCLUSIONS 287
REFERENCES 287
Diet and Urolithiasis 290
CONTENTS 290
INTRODUCTION 290
FLUIDS 291
PROTEIN 292
CARBOHYDRATES 293
FAT 293
CALCIUM 294
OXALATE 295
SODIUM 295
VITAMINS AND SUPPLEMENTS 296
RECOMMENDATIONS FOR SPECIFIC STONE TYPES (TABLE 1) Calcium Stones 297
Uric Acid Stones 298
Cystine Stones 299
Struvite Stones 299
CONCLUSION 300
REFERENCES 301
Uric Acid Urolithiasis 304
CONTENTS 304
INTRODUCTION 304
EPIDEMIOLOGY 304
URIC ACID: PATHOPHYSIOLOGY 304
ASSOCIATED CONDITIONS 306
Gastrointestinal Conditions Associated With Uric Acid Lithiasis 306
Gout and Stones 307
Increased Catabolism 307
Enzymatic Defects Associated With Uric Acid Lithiasis 307
Diet 308
Familial 308
Idiopathic 308
DIAGNOSIS 308
TREATMENT General Measures 309
Chemolysis of Uric Acid Lithiasis 310
Oral Dissolution 310
Intravenous Dissolution 311
Direct Dissolution 311
Surgical Treatment of Uric Acid Calculi 311
CONCLUSION 311
REFERENCES 311
Struvite Stones 314
CONTENTS 314
INTRODUCTION 314
COMPOSITION 314
PATHOGENESIS 315
BACTERIOLOGY 316
EPIDEMIOLOGY 316
CLINICAL PRESENTATION Signs and Symptoms 318
Laboratory Testing 318
Radiographic Studies 318
NONSURGICAL TREATMENT 319
Diet 320
Antimicrobial Agents 320
Urease Inhibitors 321
Urinary Acidification 322
Lavage Chemolysis 322
SURGICAL MANAGEMENT 324
Percutaneous Nephrolithotomy (PCNL) 324
Shockwave Lithotripsy (SWL) 324
Combination Therapy 325
Ureteroscopy 325
PROGNOSIS 326
CONCLUSIONS 327
REFERENCES 327
Cystine Stone Disease 331
CONTENTS 331
INTRODUCTION 331
HISTORY 332
EPIDEMIOLOGY 332
RENAL AND INTESTINAL TRANSPORT OF CYSTINE AND DIBASIC AMINO ACIDS 332
MOLECULAR AND GENETIC BASIS OF CYSTINURIA 333
Type I Cystinuria 336
Non-Type I Cystinuria 337
CLINICAL PRESENTATION 338
DIAGNOSIS 340
MANAGEMENT 342
Medical Management of Cystinuria 342
Surgical Management of Cystine Stones 344
FUTURE PERSPECTIVES 346
REFERENCES 346
Urinary Stones of Unusual Etiology 349
CONTENTS 349
INTRODUCTION 349
METABOLIC STONES 2, 8- Dihydroxyadenine Stones 350
Ammonium Acid Urate Stones (Fig. 2) 352
Xanthine Stones 355
MEDICATION-RELATED STONES Ephedrine Stones 357
Guaifenesin Stones 358
Indinavir Stones (Fig. 4) 358
Nelfinavir Stones 360
Oxypurinol Stones 360
Silicate Stones 361
Sulfa Stones 362
Topiramate Induced Stones 363
Triamterene Stones 363
PEDIATRIC STONES 364
Nephrocalcinosis in Premature Low Birth-Weight Infants 364
Stones in Children and Adolescents 365
CONCLUSIONS 366
REFERENCES 367
III PRESENTATION AND EVALUATION 372
Imaging of Urinary Stone Disease 373
CONTENTS 373
BACKGROUND 373
GENERAL CONSIDERATIONS IN THE IMAGING OF URINARY STONE DISEASE Goals of Imaging 374
Stone Characterization by Imaging 374
Noncalculous Renal Calcifications 377
Impact of Stone Location on Management 379
Urinary Tract Anomalies Associated With Stone Formation 380
Pathophysiology of Ureteral Obstruction 381
SPECIFIC IMAGING MODALITIES IN URINARY STONE DISEASE Overview: Imaging Evaluation of Acute Flank Pain 383
Plain Radiography 383
Intravenous Urography 385
Ultrasound 387
Combined Plain Radiography and Ultrasound 389
Computed Tomography 389
Magnetic Resonance Imaging 395
Retrograde Pyelography 397
IMAGING BLADDER AND URETHRAL CALCULI 398
IMAGING FLANK PAIN IN PREGNANCY 400
SUMMARY 400
ACKNOWLEDGMENT 400
REFERENCES 401
Physician Safety 404
CONTENTS 404
INTRODUCTION 404
RADIATION SAFETY GUIDELINES Radiation Effects 405
Radiation Protection Recommendations 405
Conclusion 407
INFECTION-CONTROL PRACTICES Introduction 408
Universal Precautions 408
Blood-Borne Pathogens 409
Conclusion 412
REFERENCES 412
Treatment of Acute Renal Colic 415
CONTENTS 415
PRESENTATION 415
MUNCHAUSEN’S SYNDROME 417
DIFFERENTIAL DIAGNOSIS 419
LABORATORY EVALUATION 419
RADIOLOGICAL EVALUATION 420
PREGNANCY 423
URINARY EXTRAVASATION 426
TREATMENT 427
URINARY DECOMPRESSION 428
REFERENCES 429
Anatomical Considerations in Urinary Stone Disease 433
CONTENTS 433
URETHRAL ANATOMY 433
BLADDER ANATOMY 434
URETERAL ANATOMY 435
RENAL ANATOMY Kidney Position and External Relationships 436
Internal Architecture of the Kidney and Collecting System 436
Assessment of the Lower Pole Infundibulopelvic Angle, Infundibular Length, Infundibular Width, and Calyceal Pelvic Height 438
Intrarenal Vascular Anatomy 441
IMPACT OF ANATOMY ON SELECTION OF STONE THERAPY Obstruction 443
Anatomical Variants 445
SUMMARY 449
REFERENCES 450
IV TREATMENT 454
Conservative Management of Ureteral Calculi 455
CONTENTS 455
INTRODUCTION 455
OBSERVATION OF URETERAL CALCULI 456
MEDICAL MANAGEMENT TO ENHANCE PASSAGE OF URETERAL CALCULI Pain and Nausea Treatment 457
Oral Steroids, Calcium Channel Blockers, and Beta Blockers 457
Miscellaneous Agents Studied in Conservative Stone Management 458
High Water Intake 459
RENAL INJURY DURING PERIODS OF OBSERVATION 459
OBSERVATION IN CHILDREN 460
COST 460
INDICATIONS FOR INTERVENTION 460
CONCLUSIONS 461
REFERENCES 461
Ureteral Stents 463
CONTENTS 463
INTRODUCTION 463
HISTORY OF STENTS 463
PHYSIOLOGY OF THE STENTED URETER 465
PROPERTIES OF STENT MATERIALS 465
Elasticity and Memory 466
Tensile Strength and Elongation Capacity 466
Biodurability 466
Biocompatibility 466
Coefficient of Friction 466
Radiopacity 467
BIOMATERIALS 467
Polyethylene 467
Silicone 467
Polyurethane 467
C-Flex 468
Silitek 468
Percuflex 468
Tecoflex 468
Other Proprietary Materials 468
Bioabsorbable Materials 469
Metals 469
Hydrophilic Coatings 469
Comparison of Biomaterials 470
STENT DESIGNS 470
Double-J or Double-Pigtail Stents 470
Multiple-Coil Stents 470
Specialty Stents 472
CLINICAL APPLICATIONS AND OUTCOMES 473
Urolithiasis 473
Pregnancy 474
Renal Transplantation 474
Obstructive Urosepsis 475
Extrinsic Ureteral Obstruction 475
Endoscopic and Open Surgery 476
Trauma 477
Fistulas 477
STENT REMOVAL 478
COMPLICATIONS 478
Symptoms and Quality of Life 478
Migration 479
Infection and Encrustation 479
Retained/Fractured Stents 480
False Passage/Erosion 484
PEARLS/TRICKS 484
FUTURE DIRECTIONS 486
SUMMARY 486
REFERENCES 486
Anesthetic Considerations for Extracorporeal Shockwave Lithotripsy, Percutaneous Nephrolithotomy, and Laser Lithotripsy 492
INTRODUCTION 492
ANESTHETIC TECHNIQUE AND PERIOPERATIVE ANALGESIA Monitored Anesthesia Care 493
Cutaneous Anesthesia 493
Nonsteroidal Anti-Inflammatory Drugs 494
Patient-Controlled Analgesia 494
Neuraxial Anesthesia 495
General Anesthesia 495
COMPLICATIONS ASSOCIATED WITH ANESTHESIA FOR SWL 496
REVIEW OF RELATIVE AND ABSOLUTE CONTRAINDICATIONS TO SWL 496
PERCUTANEOUS NEPHROLITHOTOMY Introduction 499
Patient Positioning 499
Surgical Techniques 499
Physiological Considerations and Complications of PCNL 500
Anesthetic Considerations 500
LASER LITHOTRIPSY 500
Anesthetic Options for Laser Lithotripsy 501
SPECIAL CONSIDERATIONS FOR PATIENTS WITH SPINAL CORD INJURY 501
REFERENCES 502
Complications of Urinary Stone Surgery 507
CONTENTS 507
INTRODUCTION 507
COMPLICATIONS OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY 508
Clinical Expectations 508
Stone Localization Technique 508
Factors Affecting Fragmentation 509
Complications Related To Stone Fragments 509
Stone Burden 509
Stone Location 510
Residual Stone Fragments 511
Steinstrasse and Management 511
Infection 514
Complications Secondary to Effects of SWL on Tissue: Renal Complications 515
Nonrenal Complications 519
Children 520
Hypertension 520
COMPLICATIONS OF PERCUTANEOUS NEPHROSTOLITHOTOMY 522
Factors Influencing Complications 522
Patient Positioning 523
Intraoperative Complications 523
COMPLICATIONS OF URETEROSCOPY 530
Ureteral Injury 532
Complications During Stone Manipulation 533
Complications to Adjacent Structures 533
Conclusion 533
COMPLICATIONS RELATED TO OPEN SURGERY 534
Complications of Incisions and Renal Exposure 535
Pneumothorax 536
Complications Associated With Calculus Extraction 537
CONCLUSION 539
REFERENCES 539
Extracorporeal Shockwave Lithotripsy 550
CONTENTS 550
INTRODUCTION 550
PATIENT SELECTION 550
Contraindications 551
Special Patient Conditions 551
Technical Limitations 552
OUTCOMES Evaluating the Literature 553
Renal Calculi 554
Lower Pole Renal Calculi 555
Ureteral Calculi 557
Pediatric Urolithiasis 558
COMPLICATIONS Steinstrasse 559
Perirenal Hematoma 559
New-Onset Hypertension 560
Renal Functional Effects 560
CONCLUSIONS 561
REFERENCES 561
Indications and Outcomes of Ureteroscopy for Urinary Stones 565
CONTENTS 565
INTRODUCTION 565
URETEROSCOPIC MANAGEMENT OF URETERAL CALCULI 566
Distal Ureteral Calculi 566
Proximal Ureteral Calculi 570
URETEROSCOPIC MANAGEMENT OF RENAL CALCULI 573
Nonstaghorn Renal Stones 574
Staghorn Renal Calculi 578
CONCLUSIONS 579
REFERENCES 579
Ureteroscopy 583
CONTENTS 583
INTRODUCTION 583
ACCESS 583
Ureteral Dilation 586
Access Sheaths 588
Safety Wires 589
Incision 589
INSTRUMENTATION Ureteroscopes 589
Wires 593
Baskets 593
Lithotrites 594
PEARLS AND TRICKS 598
Benign Prostatic Hyperplasia Median Lobe 599
Ureteral Kinks 599
SUMMARY 600
REFERENCES 600
Percutaneous Nephrolithotomy 602
CONTENTS 602
HISTORY 602
INDICATIONS 603
CONTRAINDICATIONS 604
OUTCOMES 605
Staghorn Calculi 605
Simultaneous Bilateral Percutaneous Nephrolithotomy 606
Supracostal Access 606
Multiple Access Percutaneous Nephrolithotomy 608
Tubeless PCNL/Reduced Drainage PCNL 608
Intracorporeal Lithotriptors 609
COMPLICATIONS 610
REFERENCES 612
Percutaneous Nephrolithotomy 614
CONTENTS 614
INTRODUCTION 614
PREOPERATIVE PREPARATION 615
POSITIONING 615
RENAL ACCESS 616
Fluoroscopic Access 618
Sonographic Access 619
TRACT DILATION 619
STONE FRAGMENTATION AND EXTRACTION 620
Ultrasonic Lithotripsy 620
Lithoclast 621
Electrohydraulic Lithotripsy and Holmium:YAG laser 621
Flexible Nephroscopy 621
DRAINAGE AFTER PERCUTANEOUS NEPHROLITHOTOMY 622
COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY 623
PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH DYSMORPHIC BODIES 625
PERCUTANEOUS NEPHROLITHOTOMY IN THE TRANSPLANTED KIDNEY 627
PERCUTANEOUS NEPHROLITHOTOMY IN THE MORBIDLY OBESE 627
CONCLUSIONS 628
REFERENCES 628
Open Stone Surgery 632
CONTENTS 632
INTRODUCTION 632
INDICATIONS FOR OPEN STONE SURGERY 633
SURGICAL TECHNIQUE Incisions 635
Anatrophic Nephrolithotomy 635
Pyelolithotomy 639
Extended Pyelolithotomy 639
Ureterolithotomy 639
Postoperative Management 640
RESULTS 640
COMPLICATIONS 641
CONCLUSIONS 642
REFERENCES 642
Laparoscopic Approach to Urinary Stone Disease 644
CONTENTS 644
INTRODUCTION 644
PATIENT EVALUATION Laboratory Studies 645
Imaging Studies 645
LAPAROSCOPIC PYELOLITHOTOMY Introduction 645
Transperitoneal Laparoscopic Pyelolithotomy 646
Retroperitoneal Technique 647
Results of Laparoscopic Pyelolithotomy 647
LAPAROSCOPIC URETEROLITHOTOMY Introduction 647
Technique 648
Result 648
LAPAROSCOPIC MANAGEMENT OF CALYCEAL DIVERTICULAR CALCULI Introduction 648
Technique 649
Results 649
LAPAROSCOPIC URETEROCALICOSTOMY Introduction 650
Technique 650
LAPAROSCOPIC ANATROPHIC NEPHROLITHOTOMY Introduction 650
Technique 651
Results 651
CONCLUSION 652
REFERENCES 652
Stones of the Urethra, Prostate, Seminal Vesicle, Bladder, and Encrusted Foreign Bodies 653
CONTENTS 653
INTRODUCTION 653
URETHRAL CALCULI Etiology 654
Symptoms 654
Diagnosis 654
Treatment 656
Prevention 656
PROSTATIC CALCULI Etiology 657
Symptoms 657
Diagnosis 657
Treatment 657
Prevention 658
SEMINAL VESICLE CALCULI 658
BLADDER CALCULI Etiology 658
Symptoms 663
Diagnosis 663
Treatment 663
Prevention 665
ENCRUSTED FOREIGN BODIES 667
REFERENCES 670
Index 674