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Difficult Renal Stones
Difficult
Stones to Diagnosis
Renal
calculus detection continues to be refined by advances in imaging
technology. Helical and spiral CT scans can identify renal and ureteral
calculi in an accurate and cost-effective manner. Three-dimensional
reconstruction images of renal calculi is highly useful in planning
PNL.
Radiolucent
calculi (uric acid, crixivan, xanthine, hypoxanthine and 2,8-dihydroxyadenine
calculi) are difficult to differentiate from other causes of radiolucent
filling defects. Noncontrast CT scan is helpful in differentiating
radiolucent stones from other pathology.
Ultrasound
imaging is helpful in finding renal stones and stones at the ureterovesical
junction. In the remainder of the ureter, ultrasound is poor for
stone localization. Lithotriptors using ultrasound as a sole imaging
device can not be used to localize ureteral stones. Intravenous
contrast during ESWL (without ureteral catheterization) can also
provide useful information for stone localization.
Suggested
readings
Hubet
J, Blum A, Cormier L, Claudon M, Regent D, Mangin P. Three-dimensional
CT-scan reconstruction of renal calculi-A new tool for mapping-out
staghorn calculi and follow-up of radiolucent stones. Eur Urol 1997,
31:3:297-301.
Lautin
R, Gerard PS, Fuksbrumer M. Asymptomatic calculous pyelnephritits
with cutaneous-renal broncho-pleural fistula. Urology 1996, 48:6:928-929.
Kim
SC, Moon YT. Experience with EDAP LT02 extracorporeal shockwave
lithotripsy in 1363 patients: Comparisons with results of LTOI SWL
in 1586 patients. J Endourol 1997, 11:2:103-111.
Wolf
JS, Bub WL, Endicott RC, Clayman RV. Use of intravenous contrast
material during in situ extracorporeal shock wave lithotripsy of
ureteral calculi. J Urol 1997, 157:1:38-41.
Low
RK, Stoller ML. Uric acid-related nephrolithiasis. Urol Clin North
Am 1997, 24:1:135-148.
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