Renal Calculus

Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long and wide experience of the surgery of calculous disease and gives us in this volume something of the wisdom that he has gained thereby, but he has also been a pioneer in the setting up of a research department largely concerned with the investigation of this complex group of disorders, so that he is able to present in terms readily intelligible to the general medical reader the results of extensive biochemical investigation in this area.

1: Epidemiology of Urolithiasis.- I. Early Cases of Vesical Calculus.- II. Ethnic Considerations.- 1. The African Negro.- 2. The American Negro.- III. Climate.- IV. Occupation.- V. Incidence of Stone in Countries with Different Degrees of Economic Development.- 1. Great Britain.- 2. Sweden.- 3. Norway.- 4. Finland.- 5. Czechoslovakia.- 6. Israel.- 7. Turkey.- 8. Sicily.- 9. United States.- 10. India.- 11. Thailand.- VI. The Stone Wave in Central Europe.- References.- 2: Pathology of the Stone-Bearing Kidney.- I. Theories of Renal Stone Formation.- 1. Colloid Material.- 2. Crystals.- 3. Inhibitor Substances.- 4. Calcific Foci.- II. General Structure of Renal Calculi.- 1. Crystalline Content.- 2. Colloid Content.- III. Components of Renal Calculi.- 1. Calcium Oxalate.- 2. Phosphate.- 3. Rare Components.- 4. Matrix Calculi.- IV. Morbid Anatomy.- 1. Infection.- 2. Complications.- References.- 3: Intrarenal, Pararenal and Ureteric Disorders Complicated by Renal Calculi and Calcification.- I. Renal and Ureteric Stone and Obstructive Conditions in the Urinary Tract.- 1. Hydrocalycosis.- 2. Pelviureteric Hydronephrosis.- 3. Retrocaval Ureter.- 4. Horseshoe Kidney.- 5. Ureterocele.- 6. Megaureter.- 7. Ureteric Stricture from Other Causes.- 8. Renal Calyceal Diverticula.- 9. Ureteric Diverticula and Urolithiasis.- 10. Obstruction of the Lower Urinary Tract and Upper Tract Urolithiasis.- II. Renal Calculi and Cystic Conditions of the Kidney.- 1. Pyelogenic Cysts.- 2. Traumatic Cysts.- 3. Polycystic Disease.- 4. Medullary Sponge Kidney.- III. Renal and Ureteric Calculi Associated with Other Congenital Anomalies of the Urinary Tract.- IV. Metaplastic Conditions and Tumours of the Kidney, the Ureter, and Calculi.- 1. Metaplasia (Squamous and Glandular) and Leukoplakia.- 2. Carcinoma of the Renal Parenchyma.- 3. Sarcoma of the Kidney.- 4. Epithelial Tumours of the Renal Pelvis.- 5. Epithelial Tumours of the Ureter.- V. Renal Tubular Acidosis.- 1. In Infants (Lightwood’s Syndrome).- 2. In Adolescents and Adults.- 3. Acetazolamide (Diamox) and Renal Calculi.- VI. Infective Conditions of the Kidney and Calculous Disease.- 1. Renal Tuberculosis.- 2. Renal Actinomycosis.- 3. Typhoid Infections of the Kidney.- 4. Bilharziasis of the Urinary Tract.- 5. Gonococcal Infection of the Kidney.- 6. Renal Brucellosis.- 7. Hyatid Disease of the Kidney.- References.- 4: Some Extrarenal Diseases Associated with Renal Stone or Nephrocalcinosis.- I. Primary Hyperparathyroidism.- 1. Pathology.- 2. Clinical Picture.- 3. Biochemical Diagnosis.- 4. Treatment.- II. Immobilization Osteoporosis and Recumbency Urolithiasis.- 1. Incidence.- 2. Causes.- 3. Special Characteristics.- 4. Treatment.- III. Diseases of Other Ductless Glands.- 1. Cushing’s Syndrome.- 2. Acromegaly.- 3. Multiple Endocrine Adenomatosis.- IV. Sarcoidosis.- V. Paget’s Disease.- VI. Myelomatosis.- VII. Wilson’s Disease.- VIII. Ureterocolic Anastomosis, Ileal Ureterostomy and Cutaneous Ureterostomy.- IX. Renal Calculi Complicating Renal Transplants.- References.- 5: Renal Calculi and Nephrocalcinosis Contributed to by Ingestion of Certain Substances: Environmental Calculosis.- I. Silicate Calculi.- 1. In Man.- 2. In Animals.- II. The Sulphonamides.- III. Renal Papillary Necrosis: Phenacetin Addiction.- 1. Experimental Renal Papillary Necrosis.- 2. Clinical Picture.- 3. Diagnosis.- 4. Treatment.- IV. Nephrolithiasis and Chronic Peptic Ulcer.- 1. Alkalosis from Ingestion of Excess Alkali.- 2. Alkalosis from Simple or Malignant Pyloric Stenosis.- 3. Nephrolithiasis and Peptic Ulcer in the Same Patient.- 4. Milk-drinker’s Syndrome.- V. Chronic Glomerulonephritis and Excessive Ingestion of Milk.- VI. Beryllium Poisoning.- VII. Cadmium Poisoning.- VII. Food Emulsifiers.- References.- 6: Levels of the Principal Crystalloids in the Urine of Patients with Calcium-Containing Calculi.- I. Urinary Calcium.- Relation to Type of Stone.- II. Urinary Phosphate.- III. Urinary Oxalate.- IV. Urinary Crystalluria.- 1. Oxaluria.- 2. Phosphaturia.- References.- 7: Primary Hyperoxaluria and Related Conditions.- I. Primary Hyperoxaluria.- II. Related Conditions.- 1. Vitamin B6 Deficiency.- 2. Hyperoxaluria from Other Causes.- 3. Glycinuria; Hyperglycinemia; Calcium Oxalate Calculi.- References.- 8: Idiopathic Hypercalciuria.- I. Clinical Features and Diagnosis.- 1. Biochemical Findings.- 2. Diagnosis.- II. Pathogenesis.- 1. Renal Tubular Defect.- 2. Intestinal Absorption of Dietary Calcium.- 3. Hyperfunction of Parathyroid Glands.- 4. Summary.- III. Treatment: Measures to Reduce Urinary Calcium.- 1. Diet.- 2. Intake of Fluids.- 3. Specific Measures.- References.- 9: Chemical Substances in Urine Promoting or Preventing Renal Stone.- I. Some Chemical Substances and Their Relation to Renal Stone Formation.- 1. Citric Acid and Citrates.- 2. Urinary Magnesium.- 3. Urinary Sodium and Total Solutes.- 4. Urinary Amino Acids.- 5. Urinary Pyrophosphates and Orthophosphates.- 6. Vitamin D (Calciferol).- II. Inhibitors of Calcification.- 1. Experimental Calcification of Rachitic Rat Cartilage and of Isolated Tendon Bundles.- 2. Urinary Peptides and Crystallization Inhibitors.- 3. Metallic Inhibitors of Crystallization.- References.- 10: Clinical Picture of Renal and Ureteric Calculus.- I. Etiological Factors.- 1. Incidence of Calcium Oxalate Stone.- 2. Age and Sex.- 3. Familial Incidence.- 4. Anatomical Position.- 5. Size of Stone.- II. Clinical Course of Renal Stone Relative to Time.- 1. Duration of Symptoms.- 2. The Single-Stone-Former.- 3. Recurrence.- 4. Bilateral Stones.- III. Clinical Course of Renal Stone and Associated Factors.- IV. Clinical Symptoms of Renal and Ureteric Calculi.- 1. Silent Renal Calculi.- 2. Non-infected Calculi in the Upper Urinary Tract.- 3. Infected Calculi in the Upper Urinary Tract.- 4. Less Common Symptoms of Renal Calculi.- V. Clinical Differential Diagnosis of Renal and Ureteric Calculi.- 1. Acute Pyelonephritis.- 2. Embolism of the Renal Artery.- 3. Extrarenal Syndrome.- VI. Investigation.- 1. Blood Tests.- 2. Urine Tests.- 3. Radiodiagnosis.- 4. Cystoscopic Examination.- 5. Isotope Renography.- VII. Urolithiasis in Children.- VIII. Renal and Ureteric Calculus in Pregnancy.- 1. Clinical Picture.- 2. Treatment.- References.- 11: Some General Considerations in the Surgical Treatment of Renal and Ureteric Stone.- I. Blood Supply of the Kidney.- II. Amount of Renal Tissue Needed to Sustain Life.- III. Compensatory Hypertrophy of the Kidney Following Nephrectomy.- 1. In the Experimental Animal.- 2. In Man.- IV. Recovery of Function After Ureteric Obstruction.- 1. In the Experimental Animal.- 2. In Man.- V. Prevention of Infection.- VI. Temporary Control of Bleeding.- VII. Cooling Techniques.- 1. The Experimental Animal.- 2. In Man.- VIII. Radiography of the Exposed Kidney.- IX. Closure of the Wound.- References.- 12: The Conservative Treatment of Renal and Ureteric Calculi.- I. Conservative Treatment.- 1. Spontaneous Disappearance of Some Renal Calculi.- 2. Spontaneous Voiding of Some Renal and Ureteric Calculi.- 3. Expectant Treatment.- II. Attempted Dissolution of Renal Calculi.- 1. General Considerations.- 2. Irrigation Through an Indwelling Catheter.- 3. Sodium Citrate-Citric Acid Solution: Solution G.- 4. EDTA (Versene).- 5. Renacidin.- 6. Irrigation or Operation?.- 7. Encrusted (Alkaline) Phosphatic Cystitis.- III. Perureteral Instrumental Methods for the Treatment of Ureteric Stone.- 1. General Considerations.- 2. Passage of Ureteric Catheters and Dilators; Indwelling Catheters.- 3. Instruments for Extracting Ureteric Calculi.- 4. Stones in the Intramural Part of the Ureter and at the Ureterovesical Orifice.- 5. Injuries of the Ureter Following Instrumentation.- 6. Ultrasonic Fragmentation of Calculi.- 7. Summary of Results of Instrumental Methods.- References.- 13: Operative Treatment of Renal and Ureteric Calculi.- I. Simple Pyelolithotomy and Its Variants.- 1. For a Calculus in a Mainly Extrarenal Pelvis.- 2. In Situ.- 3. Transparenchymal Extension.- 4. Subcapsular Pyelolithotomy.- 5. Extracapsular Extended Pyelolithotomy.- 6. Conclusion of Operation.- 7. Associated Calyceal Calculi.- 8. Anterior Pyelolithotomy.- 9. Transperitoneal Pyelolithotomy.- 10. Coagulum Pyelolithotomy.- 11. Complications.- II. Nephrolithotomy.- 1. For Calyceal Calculi.- 2. For a Small Solitary Calyceal Stone.- 3. For a Medium-sized Stone in a Dilated Calyx.- 4. For Multiple Small or Medium-sized Calyceal Stones.- 5. The Bivalve Procedure.- 6. Lateral Resection of Renal Tissue.- 7. Complications.- 8. Mortality.- III. Partial Nephrectomy.- 1. For Renal Calculous Disease.- 2. Exposure and Control of Bleeding.- 3. Wedge-Shaped Resection.- 4. Guillotine Method.- 5. Blunt Dissection.- 6. Type of Operation.- 7. Combined Procedures.- 8. Complications.- IV. Ureterolithotomy.- 1. Indications for the Operative Removal of Ureteric Calculi.- 2. Upper Third of the Ureter.- 3. Middle Third of the Ureter.- 4. Lower Third of the Ureter.- 5. Complications.- V. Nephrectomy and Nephroureterectomy.- 1. Indications for Nephrectomy.- 2. Indications for Nephroureterectomy.- 3. Extracapsular Nephrectomy.- 4. Subcapsular Nephrectomy.- 5. Transperitoneal Nephrectomy for Stone.- 6. Nephroureterectomy.- 7. Complications.- VI. Nephrostomy and Pyelostomy for Calculous Pyonephrosis.- 1. Nephrostomy.- 2. Pyelostomy.- References.- 14: Special Groups of Cases of Stone and Their Treatment.- I. Treatment of Bilateral Renal and Ureteric Calculi.- 1. Bilateral Renal Calculi.- 2. Bilateral Ureteric Calculi.- II. Treatment of Stone in a Solitary Kidney.- III. Secondary Operations for Renal and Ureteric Calculi.- 1. Recurrent Renal Calculi.- 2. Recurrent Ureteric Calculi.- IV. Recurrence of Calcium-Containing Stone in the Upper Urinary Tract After Operation.- 1. True and False Recurrence.- 2. Causes of Recurrence.- 3. Incidence of Recurrence in the Author’s Series.- V. Serious Cases of Renal Calculous Disease.- 1. Renal Failure from Advanced Calculous Disease with Pyelonephritis.- 2. Calculous Anuria.- 3. Symptomatic Relief for Patients with Rapidly Recurring Calculi.- VI. Treatment of Infection in the Calculous Urinary Tract.- VII. Medical Treatment of Calcium Phosphate-Containing Calculi.- 1. Aluminium Hydroxide.- 2. Acidogenic Diet and Ammonium Chloride.- VIII. Earlier Non-surgical Measures.- References.- 15: Uric Acid Calculi.- I. Pathology.- 1. Uric Acid Stone.- 2. The Kidney.- II. Clinical Picture.- 1. Uric Acid Calculi and Primary Gout.- 2. Uric Acid Calculi and Secondary Gout.- 3. Idiopathic Uric Acid Calculi Associated with a Family History of Stone.- 4. Uric Acid Calculi Without a History of Gout Nor a Family History of Stone.- 5. Age and Sex Incidence.- 6. Symptoms.- 7. Associated Diseases.- III. Investigation.- 1. Serum Uric Acid.- 2. Urinary Excretion of Uric Acid.- 3. Radiodiagnosis.- 4. Diagnosis.- IV. Treatment.- 1. Surgery.- 2. Conservative Treatment.- 3. Results of Treatment.- 4. Drug Treatment for Gouty Patients.- References.- 16: Cystinuria and Cystine Lithiasis.- I. Incidence of Cystinuria.- II. Cystinuria and Cystine Urolithiasis in Childhood.- III. Pathology.- 1. Cystine Stone.- 2. The Kidney.- IV. Pathogenesis and Genetics of Cystinuria.- 1. Renal Transport Defect.- 2. Intestinal Transport Defect.- 3. Genetic Considerations.- V. Clinical Picture.- 1. Spontaneous Dissolution of Cystine Calculi.- 2. Associated Diseases.- VI. Treatment.- 1. Dietary Measures.- 2. Medicinal Measures.- 3. Surgery.- VII. Cystinuria in Animals.- References.- 17: Xanthine Calculi and Xanthinuria.- I. Xanthinuria and Xanthine Oxidase.- II. Xanthine Stone.- III. Clinical Picture.- IV. Genetic Considerations.- V. Treatment.- References.