KIDNEY STONE DISEASE AND OSTEOPOROSIS - TOPIC ISSUES OF COMORBIDITY

the prevalence of kidney stone disease (KSD) and osteoporosis (OP) increases every year. In the prevention of osteoporosis, it is important to consume a sufficient amount of calcium-rich foods in the daily diet, as well as the use of calcium. One of the important reasons for the insufficient use of calcium-containing products and medicines is the anxiety not only of patients, but, very importantly, of doctors as much as possible. This has serious justification, as nephrolithiasis occurs in approximately 5% of the population, and the risk of developing kidney stones during life is 8-10%. It is believed that secondary hyperparathyroidism, which is caused by hypocalcemia due to insufficient consumption of calcium-containing products and impaired renal function, leads to increased bone resorption, formation of kidney stone disease. It is important to consider that against the background of hypertensive, atherosclerotic kidney disease, tubulo-interstitial lesions of the kidneys with decreasing glomerular filtration rate decreases the synthesis of 1α-hydroxylase - an enzyme by which 25-hydroxycholecalciferol (25 (OH) active D3, calcium) form of vitamin D3–1.25 dihydroxycholecalciferol (1.25 (OH) 2D3, calcitriol - D-hormone) and secondary hyperparathyroidism develops. In this case, the purpose of correction along with the treatment of urolithiasis (spa treatment, given the attendance of the presence of KSD, to carry out the distance lithotripsy), intake of active metabolites of vitamin D (should be started with low doses, independent of the initial PTH concentration, and then titrated based on the PTH response) conducting X-ray densitometry.

Developments in Ureteral Stent Technology

Ureteral stents have been utilized for decades in maintaining ureteral patency, most commonly after ureteroscopy in the treatment of urolithiasis. Since their initial development, ureteral stents have had many technological advances that have allowed for better patient outcomes with improvements in comfort, durability, patency, encrustation resistance, biocompatibility, ease of insertion, migration, and biofilm development. Several new ureteral stents enter the market every year, each with their own touted benefits. It is essential to understand the different advantages for each ureteral stent to provide the best available care to patients when possible. The purpose of this review is to give a brief history of ureteral stent development and summarize the recent developments in ureteral stent designs. We aim to review the data supporting the clinical advantages of the latest ureteral stents available for use by urologists.

Nephrostomy-free percutaneous nephrolithotripsy: intraoperative hemostasis methods of the percutaneous tract

Review based on the analysis of more than 40 scientific papers published in the Pubmed and Medline databases from 1984 to 2019, dedicated to intraoperative hemostasis of the percutaneous tract and its tightness during nephrostomyfree percutaneous nephrolithotomy (PCNL). The article aimed to summarize scientific data on this issue. We presented information about the history and development of percutaneous surgery in the treatment of urolithiasis. In our review, we have been demonstrated various methods of surgical and intraoperative hemostasis during nephrostomy-free PCNL.

Medicinal plants used in the phytotherapeutical treatment of urolithiasis in dogs – na integrative review

Urolithiasis is a disease in which uroliths form in the urinary tract from individual predisposing factors of each species, and with aggravation, animals can have urethral obstruction and die. In this work, an integrative review of the medicinal plants most used for the treatment of urolithiasis in dogs was carried out. The objective of this work is to collaborate with the veterinary community to expand the use of herbal medicine to treat this pathology, mainly due to its relapsing nature. Its formation can occur in breeds with more evident urinary supersaturation, genetic predisposition, age, reduced daily water intake, metabolic problems, medications that alter urinary pH, inadequate nutrition and predisposition to alterations in the urinary tract. Drug and nutritional treatment is questionable, as there are types of differences in the composition of stones and the response to these can vary a lot and, in more serious cases, surgery is needed. At high rates of recurrence, the use of medicinal plants offers options aimed at the welfare of animals. Therefore, innovative research on their use of these plants informs how they can be consumed safely and with great pharmacological effect. With this, more tutors are looking for professionals who prescribe these plants in a preventive way, avoiding surgical emergencies and possible death of your animal. Urinary system herbal medicines control inflammation and increase diuresis, preventing crystal aggregation and possible growth, in addition to favoring their elimination through the urethra.

The characteristics and optimal treatment of urolithiasis associated with tuberous sclerosis complex

Purpose The most common renal symptoms of tuberous sclerosis complex (TSC) are angiomyolipomas (AMLs) and renal cysts; however, some patients with TSC also develop urolithiasis. We retrospectively investigated the characteristics and treatment of urolithiasis associated with TSC. Methods We analyzed 142 patients who met the diagnostic criteria for TSC, of whom 20 (14.1%) had urolithiasis. We compared the patients’ characteristics, urinary specific gravity, urine pH, serum calcium and intact parathyroid hormone in the urolithiasis and non-urolithiasis groups. In the urolithiasis group, the stone characteristics and various treatments were analyzed. Results The antiepileptic drugs topiramate and zonisamide were more frequently administered to the urolithiasis group than the non-urolithiasis group (P = 0.013, P = 0.048, respectively). The urine specific gravity and urine pH levels were higher in the urolithiasis group than in the non-urolithiasis group (P = 0.005, P = 0.042, respectively). A multivariate logistic regression analysis demonstrated that urine-specific gravity (P = 0.018; odds ratio 1.471; 95% confidence interval 1.098–1.872) was a significant predictor of TSC-associated urolithiasis. Four patients could not receive extracorporeal shock wave lithotripsy due to the risk of bleeding from the AML. Conclusion Patients with TSC who have an increased urine specific gravity, alkaline urine, and a longer administration of topiramate and zonisamide tend to demonstrate an increased risk of developing urolithiasis and therefore such cases require adequate care. If urolithiasis is comorbid with TSC-associated AML, the treatment options are more limited in cases with multiple AMLs around the stone due to an increased risk of hemorrhage.

The evolution of surgical treatment of urolithiasis: from lithotomy to combined intrarenal technologies

Urolithiasis (hereinafter ICD) has a long thousand-year history, worldwide spread, frequent recurrence and occupies a leading place in the structure of surgical diseases of the urinary system. The development of urology as a clinical discipline is thorny and is associated with the stages of origin and formation as a science, oblivion and revival - as a modern field of surgery. The progress of technical thought, achievements of fundamental science, naturally led to the formation of urology and, in particular, surgery of urolithiasis on the basis of new concepts of operative capabilities, preoperative diagnostics, new methods of physical impact on the structure of the calculus. The creation and improvement of new low-traumatic techniques, their active and widespread introduction into practice, contributed to the displacement of open traumatic interventions used for centuries, and made it possible to successfully remove stones from the urinary tract with minimal complications. The work is devoted to the historical review of the formation of urolithiasis surgery, comparative characteristics of alternative minimally invasive methods of treatment of KSD. The scientific work reveals the modern achievements of percutaneous surgery, the history of the development of technical improvements and the possibilities of retrograde fiber-optic intrarenal technologies. The promising directions of development of antegrade and retrograde surgery of nephrolithiasis in the present and near future have been determined.