Multi-Institutional Assessment of Ureteroscopic Laser Papillotomy for Chronic Flank Pain Associated With Papillary Calcifications

Gdor, Yehoshua; Faddegon, Stephen; Krambeck, Amy E.; Roberts, William W.; Faerber, Gary J.; Teichman, Joel M.H.; Lingeman, James E.; Wolf, J. Stuart

doi:10.1016/j.juro.2010.08.081

Cited by 10 publications

(6 citation statements)

References 22 publications

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“…The diagnosis of NC can be suggested on ultrasound, abdominal x-ray and computed tomography however none possesses diagnostic capacity to distinguish between NC and stone 4 . Additionally, it is our experience that even when the radiologist suggests a diagnosis of NC, on numerous occasions we have found stones to be present on endoscopic evaluation and treatment 15 .…”

Section: Discussionmentioning

confidence: 93%

Nephrocalcinosis in Calcium Stone Formers Who Do Not have Systemic Disease

et al. 2015

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Introduction and Objective Nephrocalcinosis (NC) is commonly present in primary hyperparathyroidism (HPT), distal renal tubular acidosis (dRTA), and medullary sponge kidney disease (MSKD) but has not been studied in patients with CaP stones who do not have systemic disease. Methods We studied patients undergoing percutaneous nephrolithotomy (PNL) who had CaP or CaOx stones and did not have HPT, dRTA, or MSKD. On post-op (PO) day 1, all patients underwent a non-contrast CT scan. If there were no residual calcifications, the patient was categorized as not having NC. If there were residual calcifications, the patient underwent a secondary PNL. If the calcifications were found to be stones then the patient was categorized as not having NC. If the calcifications were not stones then the patient was categorized as having NC. Patients were grouped based on the type of stones they formed: hydroxyapatite (HASF), brushite (BRSF), and idiopathic calcium oxalate (ICSF). The extent of NC was quantified: 0=absence of NC and 3=extensive NC. Patients with residual calcifications on PO day 1 NCCT scan who did not undergo secondary PNL were excluded. The presence or absence of NC was correlated with metabolic studies. Results 67 patients were studied (14 HASF, 19 BRSF, and 34 ICSF). NC was present in 10/14 (71.4%), 11/19 (57.9%) and 6/34 (17.6%) for the HASF, BRSF, and ICSF groups respectively (Chi-square (X2): p=0.01) (Table 1). The extent of NC per group was 1.98, 1.32, and 0.18 for HASF, BRSF, and ICSF respectively (p=<0.001). The presence of NC was positively correlated with urine calcium excretion (287.39±112.49 v. 223.68±100.67, p=0.03). Conclusions Patients without systemic disease who form hydroxyapatite and brushite stones commonly have coexistent NC. NC can occur in calcium oxalate stone formers but the quantity and frequency of NC in this group is dramatically less.

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Section: Discussionmentioning

confidence: 93%

Nephrocalcinosis in Calcium Stone Formers Who Do Not have Systemic Disease

et al. 2015

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“…Other studies examining ureteroscopic laser papillotomy to treat stones embedded within renal papillary tissue for associated pain have shown a clinically significant reduction in pain in up to 85% of patients. [22][23][24] However, these studies primarily included patients with nephrocalcinosis or medullary sponge kidney, in contrast to the present study where these populations where excluded.…”

Section: Discussionmentioning

confidence: 95%

Prospective Multicenter Evaluation of Pain Before and After Removal of Nonobstructing Renal Calculi: A CoRE Initiative

Bhojani,

Wollin,

El Tayeb

et al. 2024

Journal of Urology

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Purpose: Flank pain associated with stone disease is typically caused by a stone that obstructs urine flow. However, it is plausible that nonobstructing kidney stones may still cause pain. We performed a multicenter, observational trial to evaluate whether treatment of small nonobstructing calyceal stones improves pain and kidney stoneespecific health-related quality of life. Materials and Methods: Patients aged 18 years or older with nonobstructing renal stone(s) up to 10 mm in longest diameter and moderate to severe pain were recruited. All participants completed 3 questionnaires: the Brief Pain Inventory (BPI), the Patient-Reported Outcomes Measurement Information System pain interference form 6a, and the Wisconsin Stone Quality of Life questionnaire. Thereafter, all participants underwent ureteroscopy for renal stone treatment. All 3 questionnaires were repeated at 2, 6 to 8, and at 12 weeks postprocedure. The primary outcomes were change in preoperative to 12-week postoperative mean BPI score and worst BPI pain score. Results: A total of 43 patients with nonobstructing kidney stones and associated flank pain were recruited. All stones were removed. Preoperatively, BPI scores for

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“…There is evidence that treating intra-papillary and sub-mucosal stones prophylactically significantly reduces chronic pain, haematuria and recurrent UTIs. [32][33][34] In a small series of six symptomatic patients with MSK (flank pain, renal colic, haematuria and UTI) treated with ureteroscopic laser lithotripsy and pappillotomy, all patients were rendered symptom free at 12 months after the procedure, albeit the majority of these patients (5/6) requiring multiple procedures. 33 Xu et al demonstrated satisfaction rates for pain improvement in 25 patients treated with laser papillotomy to be as high as 100% with a mean follow up of 17 months.…”

Section: Treatment Of Stones and Their Complicationsmentioning

confidence: 99%

“…32 In another North American series involving 17 patients with MSK who underwent ureteroscopic laser papillotomy for chronic flank pain, 73% reported significantly less pain for three months or longer with mean response duration of 29 months. 34 Stone and infective problems tend to co-exist, clearly as stones can act as a nidus for bacterial persistence and biofilms. For these reasons, as well as improvement in renal pain as shown above, JGY has prophylactically treated renal stones in MSK patients with apparently favourable results.…”

Section: Treatment Of Stones and Their Complicationsmentioning

confidence: 99%

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Medullary sponge kidney: A treatment conundrum

Kass-Iliyya¹,

Young²

2016

Journal of Clinical Urology

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Medullary sponge kidney (MSK) is a congenital kidney malformation that is characterized by dilatation of the collecting tubules in the medullary pyramids. Cyst-like areas then form which predispose to nephrocalcinosis, stone formation and recurrent urinary tract infection (UTI). There is an association with defective distal renal tubular acidification and concentration abnormalities such as hypocitraturia. MSK is generally believed to be a sporadic disorder, but an autosomal dominant inheritance is also reported. More recently genetic mutations have been recognised as a possible contributor to the aetiology of the condition. In this article we summarize the available English language literature on the subject of MSK, including its pathogenesis, diagnosis, prognosis and treatment.

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Multi-Institutional Assessment of Ureteroscopic Laser Papillotomy for Chronic Flank Pain Associated With Papillary Calcifications

Abstract: Ureteroscopic laser papillotomy is safe and effective. In patients with papillary calcifications and characteristic chronic, noncolicky pain this procedure provides significant, moderately durable symptom relief.

Cited by 10 publications

References 22 publications

Nephrocalcinosis in Calcium Stone Formers Who Do Not have Systemic Disease

Nephrocalcinosis in Calcium Stone Formers Who Do Not have Systemic Disease

Prospective Multicenter Evaluation of Pain Before and After Removal of Nonobstructing Renal Calculi: A CoRE Initiative

Medullary sponge kidney: A treatment conundrum

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