Ureteral stone

Unlabeled Uses Alopecia, stress incontinence, menopausal symptoms, treatment of prostatic hyperplasia, seborrhea, ureteral stones... 

Because of the severe pain, the physician (Patient 5) with exercise-induced acute renal failure (ALPE) made a self-diagnosis of acute pancreatitis. Initially, most patients are diagnosed as having ureteral stone, but some physicians diagnose lumbar pain or lumbar disc hernia. 

At the Emergency Outpatient Unit, most patients were initially diagnosed as having ureteral stone, or acute gastroenteritis based on vomiting/slight fever, or acute pancreatitis, lumbar pain, muscular pain, or lumbar disc hernia based on severe pain (Fig. 73). 

Severe loin pain persists for 5 days (mean). Because of the pain, patients are often misdiagnosed as having ureteral stone. 

Pantuck AJ, Goldsmith JW, Kuriyan JB, Weiss RE. Seizures after ureteral stone manipulation with lidocaine. J Urol 1997 157(6) 2248. 

Naturally, the composition of the stone influences its distribution in the urinary tract. The smoothness of both the uric acid and the cysteine stones facilitate their passage through the ureter, so ureteral stones of this type are rarely found. When ureteral stones develop, they occur in the pelvic portion of the organ. Examples of kidney stones are shown in Figs. 9-15 and 9-16. 

Essential oils and their components are incorporated into enterically coated capsules to prevent damage and used for treating irritable bowel syndrome (peppermint in Colpermin), a mixture of monoterpenes for treating gallstones (Rowachol) and ureteric stones (Rowatinex) these are under product licenses as medicines (Somerville et al., 1984,1985 Engelstein et al., 1992). 

Fig.20.4a,b. A 4-year-old boy with incomplete RTA and hyperoxaluria, a Sonogram of right kidney showing medullary nephrocalcinosis grade III (Dick et al. 1999). b Sonogram of bladder showing an ureteral stone on the right immediately before the ureterovesical junction... 

The comparison between non-contrast-enhanced CT and IVU in adults suspected of a ureteric obstruction by stone demonstrated that non-con-trast-enhanced CT is more effective than IVU in precisely identifying ureteric stones (Smith et al. 1995). Spiral CT underscores the concept that the radiolucent calculus is a thing of the past-virtu-ally all urinary calculi are visible on CT (Mindell and Cochran 1994). Because of the sedation and the radiation dose, spiral CT is very seldom used for detecting urinary tract stones in children, and then only in late childhood as low-dose CT (Fig. 20.7) (Kluner et al. 2006 Poletti et al. 2007). 

Fig. 20.6. An 8-year-old boy with primary hyperparathyroidism, hypercalciuria, and urinary tract infection. Abdominal plain radiograph showing a huge ureteral stone on the left immediately before the ureterovesical junction...

ESWL is now possible even in small children. Ureteral stones may also be treated by ESWL if they are not located very distally or are incrusted in the ureteral wall. Extracorporeal shock waves may damage the renal parenchyma when medullary NC is evident (Boddy et al. 1988). So-called stone streets in the ureters are very often found after successful ESWL and need specific attention (Dyer et al. 1998). 

Other procedures such as percutaneous nephrolithotomy or ureteroscopy that allow the removal of ureteral stones are also kidney-protective (Durkey 2006) and constitute good alternatives to open surgery. However, the latter is still required in a considerable proportion of pediatric patients, primarily in those with urinary tract anomalies (El-Da manhoury et al. 1991). 

For detecting urolithiasis, especially ureteral stones, low-dose CT is the method of choice. In children it is seldom necessary. The combination of high-resolution US with abdominal X-ray is usually sufficient. 

Many pelvic or ureteral stones do not require any intervention and may pass spontaneously, helped by a large urine volume, physical activity, and spasmolytics, if needed. An intervention is required in the case of persisting or severe obstruction or infection. Small calculi, smaller than 5 mm, maybe left in situ and observed. Only two kinds of stones can be dissolved chemically cystine stones by chelating agents and uric acid by alkalization and administration of allopurinol (Chow and Streem 1996). 

Based on the United States Renal Data System, which reported their retrospective records of 42,096 renal transplant recipients between 1994 and 1998, the incidence of urolithiasis was 0.11% for males and 0.15% for females (Abbott et al. 2003). At the time of calculus discovery, 67% had kidney stones and 33% ureteral stones. Uric acid stones are much less common than calcium calculi. The stones can be transplanted from cadaveric or living donors or develop de novo, favored either by metabolic disorders (tertiary hyperparathyroidism, hypercalciuria, hypocitraturia) or infection (Proteus tnirabilis), or the presence of a foreign body in the urinary tract (double-J stent) (Crook and Keoghane 2005). 

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