A child with a large bladder stone: A case report
Hulya Ozturk, Emine Dagistan, Ugur Uyeturk
Ped Urol Case Rep 2014;1(4):22-28
DOI: 10.14534/PUCR.201446417
This document provides an overview of pediatric urinary stones, including epidemiology, etiology, clinical presentation, diagnosis, and management. Some key points:
- Urinary stones are relatively uncommon in children but can indicate underlying metabolic or anatomical issues.
- Evaluation involves imaging like ultrasound or CT to identify stones as well as metabolic testing of urine and serum.
- Treatment depends on stone characteristics and includes conservative management, extracorporeal shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy.
- Long-term follow-up is important due to risk of recurrence from untreated metabolic abnormalities or anatomical anomalies.
The document discusses risk factors for nephrolithiasis (kidney stones) in children. It notes that the prevalence of kidney stones varies from 1-15% worldwide and 1.7-4.1% in Iran specifically. Common risk factors include geographical location within a "stone belt", nutritional deficiencies, urinary infections, anatomical abnormalities, prematurity, and various metabolic disorders like hypercalciuria and hypocitraturia. Microlithiasis, defined as small kidney stones <3mm, is also discussed along with its potential role in later childhood stone formation and appropriate metabolic evaluation.
This document discusses anatomic anomalies that are associated with kidney stone formation, including ureteropelvic junction obstruction, horseshoe kidneys, caliceal diverticula, and medullary sponge kidney. It notes that while urinary stasis from these anomalies can increase risk of stones, underlying metabolic abnormalities are also often involved. For each condition, it examines evidence for both urinary stasis and metabolic factors contributing to stone risk. The moderators and professors of the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai are also listed.
This document summarizes urinary tract stones, benign prostatic hyperplasia (BPH), and prostate cancer. It describes the presentations, investigations, and management of urinary tract stones and covers different stone types and locations. It outlines the symptoms of BPH including weak urinary stream and incomplete emptying. Medical treatments including alpha-blockers and 5-alpha-reductase inhibitors are discussed. For prostate cancer, it mentions PSA screening and biopsy according to Gleason score for diagnosis and covers staging and treatments including surgery, radiation, and hormone therapy.
The document provides information about the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It lists the professors and assistant professors in the department and provides details about the prevalence, clinical presentation, evaluation, management and treatment of kidney stones in children. It discusses various treatment options for kidney stones like conservative management, SWL, URS, PCNL and treatments for vesical calculi. It also describes complications related to different surgical procedures.
Intussusceptions occur when one segment of the gastrointestinal tract telescopes inside an adjacent segment. While rare in adults, intussusceptions account for 5% of bowel obstructions and have an identifiable underlying disorder in 90% of cases. Symptoms include abdominal pain, nausea, vomiting and bleeding, while diagnostic tools include abdominal CT, x-rays and ultrasound. Treatment involves surgical resection of the involved segment. Prognosis depends on the cause, with mortality rates varying from 8.7% for benign lesions to 52.4% for malignant cases.
Intussusception in adult population is quite uncommon. It is usually seen in the pediatric age group. A wide range of causes can predispose to intussusception in adults. Majority of them are benign especially in cases of small bowel intussusception. However malignancy is quite often encountered in cases of colonic intussusception. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Computerized tomography is diagnostic. However majority of cases in adults are diagnosed at laparotomy. Surgical resection assuming the lesion to be malignant is the treatment of choice.
This document provides an overview of pediatric urinary stones, including epidemiology, etiology, clinical presentation, diagnosis, and management. Some key points:
- Urinary stones are relatively uncommon in children but can indicate underlying metabolic or anatomical issues.
- Evaluation involves imaging like ultrasound or CT to identify stones as well as metabolic testing of urine and serum.
- Treatment depends on stone characteristics and includes conservative management, extracorporeal shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy.
- Long-term follow-up is important due to risk of recurrence from untreated metabolic abnormalities or anatomical anomalies.
The document discusses risk factors for nephrolithiasis (kidney stones) in children. It notes that the prevalence of kidney stones varies from 1-15% worldwide and 1.7-4.1% in Iran specifically. Common risk factors include geographical location within a "stone belt", nutritional deficiencies, urinary infections, anatomical abnormalities, prematurity, and various metabolic disorders like hypercalciuria and hypocitraturia. Microlithiasis, defined as small kidney stones <3mm, is also discussed along with its potential role in later childhood stone formation and appropriate metabolic evaluation.
This document discusses anatomic anomalies that are associated with kidney stone formation, including ureteropelvic junction obstruction, horseshoe kidneys, caliceal diverticula, and medullary sponge kidney. It notes that while urinary stasis from these anomalies can increase risk of stones, underlying metabolic abnormalities are also often involved. For each condition, it examines evidence for both urinary stasis and metabolic factors contributing to stone risk. The moderators and professors of the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai are also listed.
This document summarizes urinary tract stones, benign prostatic hyperplasia (BPH), and prostate cancer. It describes the presentations, investigations, and management of urinary tract stones and covers different stone types and locations. It outlines the symptoms of BPH including weak urinary stream and incomplete emptying. Medical treatments including alpha-blockers and 5-alpha-reductase inhibitors are discussed. For prostate cancer, it mentions PSA screening and biopsy according to Gleason score for diagnosis and covers staging and treatments including surgery, radiation, and hormone therapy.
The document provides information about the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It lists the professors and assistant professors in the department and provides details about the prevalence, clinical presentation, evaluation, management and treatment of kidney stones in children. It discusses various treatment options for kidney stones like conservative management, SWL, URS, PCNL and treatments for vesical calculi. It also describes complications related to different surgical procedures.
Intussusceptions occur when one segment of the gastrointestinal tract telescopes inside an adjacent segment. While rare in adults, intussusceptions account for 5% of bowel obstructions and have an identifiable underlying disorder in 90% of cases. Symptoms include abdominal pain, nausea, vomiting and bleeding, while diagnostic tools include abdominal CT, x-rays and ultrasound. Treatment involves surgical resection of the involved segment. Prognosis depends on the cause, with mortality rates varying from 8.7% for benign lesions to 52.4% for malignant cases.
Intussusception in adult population is quite uncommon. It is usually seen in the pediatric age group. A wide range of causes can predispose to intussusception in adults. Majority of them are benign especially in cases of small bowel intussusception. However malignancy is quite often encountered in cases of colonic intussusception. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Computerized tomography is diagnostic. However majority of cases in adults are diagnosed at laparotomy. Surgical resection assuming the lesion to be malignant is the treatment of choice.
This document discusses obstructive uropathy in neonates. It presents a case of a preterm baby with bilateral hydronephrosis and a thick bladder wall. Key points discussed include the causes, presentations, investigations, and management of obstructive uropathy. Posterior urethral valves and ureteropelvic junction obstruction are examined in more detail. Vesicoureteric reflux is also summarized. The document emphasizes relieving obstruction, treating infection, and sorting the primary cause in managing obstructive uropathy.
Metabolic workup and medical management of urolithiasis aims to prevent recurrent stone formation through identifying underlying causes. The goals are to prevent further stone growth and extrarenal complications. Evaluation involves medical history, blood and urine tests, imaging, and stone analysis to guide targeted therapy. First-line management includes increased fluid intake, dietary modifications like reduced sodium and animal protein, and medications depending on the metabolic abnormality identified, such as thiazides for hypercalciuria. Selective long-term medical management can normalize urinary risk factors and prevent further stone episodes in many patients.
This document provides a classification and overview of the diagnostic criteria for nephrolithiasis (kidney stones). It classifies the causes of nephrolithiasis into calcium based calculi, uric acid based calculi, cystinuria, infective (struvite) calculi, and low urine volumes. For each category, it describes the underlying metabolic abnormalities and risk factors that can lead to stone formation, such as hypercalciuria, hyperoxaluria, hypocitraturia, and urinary tract infections. It also discusses specific conditions like renal tubular acidosis and cystinuria that are associated with stone formation.
Intussusception - will test the doctor and will cost the patientMohan Samarasinghe
This document discusses intussusception, a condition where one segment of the intestine folds into another segment. It provides a historical overview of discoveries about intussusception from the 17th century onwards. It then describes the typical presentation of intussusception in children ages 1-5, including abdominal pain, vomiting, and bloody stools. Diagnosis is usually made using abdominal ultrasound. Treatment options discussed include saline enema reduction guided by ultrasound, operative reduction, or observation if symptoms are mild. Early diagnosis and treatment within 12 hours of onset improves survival rates.
1. Vesicoureteral reflux (VUR) occurs when urine flows backward from the bladder into the ureters and kidneys. This document discusses the history, demography, causes, diagnosis, evaluation, natural history and management of VUR.
2. VUR is more common in younger children, males, and those with urinary tract infections. The prevalence is higher in siblings of children with VUR.
3. VUR can be primary due to structural issues or secondary due to bladder dysfunction. Grading depends on extent of reflux during cystography.
4. Management focuses on antibiotics to prevent infections while allowing for spontaneous resolution, which is more likely for lower grades of
This document summarizes guidelines for examining and managing common intestinal stoma complications in primary care. It provides guidance on examining the stoma, assessing for issues like prolapse, retraction, hernias, and high or low output. It emphasizes supporting patients by addressing psychological impacts, referring to specialty nursing as needed, and empowering patients to manage their stoma long-term. The goal is to properly identify and treat complications while helping patients adjust to life with an intestinal stoma.
This document provides a case report on a 43-year-old female patient diagnosed with ureterolithiasis in the proximal third of the right ureter. It summarizes the patient's history of present illness including previous hospital admissions for kidney stones. The patient was admitted to Vicente Sotto Memorial Medical Center with complaints of sudden sharp pain. The case report utilizes Virginia Henderson's nursing theory to assess the patient and implement nursing interventions. It aims to share information on ureterolithiasis, identify problems related to the patient's condition, and provide health teachings to prevent recurrence.
Lipoma of the Small Intestine: A Cause for Intussusception in AdultsKETAN VAGHOLKAR
This case report describes a rare case of small intestinal intussusception in a 22-year-old male patient caused by a lipoma. Imaging including ultrasound and CT scan revealed the classic signs of intussusception and identified a likely lipoma as the cause. During surgery, an ileoileocolic intussusception was found and gently reduced, finding a submucosal lipoma as the pathological lead point. The involved intestinal segment containing the lipoma was resected. Histopathological examination confirmed the diagnosis of benign submucosal lipoma. The patient recovered well with no further symptoms.
A clinical study of intussusception in childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses the evaluation of urolithiasis (urinary stones). It provides an overview of diagnostic evaluation including history, blood tests, urine analysis, imaging, and stone analysis. It describes the goals and characteristics of metabolic evaluation to prevent recurrent stone formation. Both abbreviated and extensive protocols for metabolic evaluation are outlined, including details on 24-hour urine collection and components analyzed. The roles of various imaging modalities like KUB, ultrasound, and intravenous pyelography are also summarized.
This document discusses best practices for endoscopically evaluating eosinophilic esophagitis (EoE). It recommends using the Eosinophilic Esophagitis Endoscopic Reference Score (EREFS) to systematically assess and record endoscopic features of EoE, including edema, rings, exudates, furrows, and strictures. A thorough examination is important to optimize diagnosis, assess treatment response, and monitor outcomes over time. Key steps include fully inflating the esophagus, carefully examining for subtle signs of narrowing or strictures, and obtaining multiple targeted biopsies from different locations to increase diagnostic yield.
This document discusses the evaluation and workup of patients presenting with renal stones. It outlines the importance of obtaining a detailed history regarding lifestyle, diet, medical history and risk factors. A physical exam can reveal signs of renal colic or obstruction. Metabolic testing and stone analysis help determine the stone composition and underlying abnormalities. Radiological investigations including ultrasound, CT and occasionally IVP are used to identify stones and assess for complications like hydronephrosis. Proper evaluation guides management and treatment of kidney stone disease.
This document outlines the evaluation and management of urolithiasis by the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the moderators, evaluation including history, examinations, imaging and laboratory tests. Management is covered including general measures, medical management, extracorporeal shock wave lithotripsy, endoscopic procedures like ureteroscopy and percutaneous nephrolithotomy, and open surgeries. Indications and complications of the different treatment methods are also provided.
The document summarizes recent findings regarding the anatomy and functions of the mesentery. It discusses how clarifying the shape and development of the mesentery has advanced understanding of various abdominal and systemic diseases. The mesentery provides structural support for the digestive organs and is involved in processes like immune response coordination and cellular migration. Various pathologies like cancer, ischemia, and Crohn's disease involve the mesentery. A mesenteric-based model of abdominal anatomy provides insights into disease and guides surgical and other treatment approaches.
The document discusses various causes of paediatric intestinal obstruction. It begins by outlining normal neonatal bowel gas patterns and developmental lesions of the intestinal tract that can lead to obstruction. It then describes the two main types of intestinal obstruction - upper and lower. Common causes are discussed for each type, including oesophageal atresia, hypertrophic pyloric stenosis, duodenal atresia, malrotation, and jejunal atresia. Key imaging features of common lesions are summarized.
Urinary calculi refers to stones formed in the urinary tract from crystallization of substances in urine. Common causes include dehydration, poor fluid intake, immobility, and excess vitamin D or calcium intake. Symptoms include pain at the site of blockage, cystitis, fever, nausea, and abdominal discomfort. Nursing interventions focus on pain control, encouraging fluid intake, and educating patients on prevention of recurrent stones based on their specific type of calculi. Treatment options depend on the size and location of the stones and may include shock wave lithotripsy, surgery, or managing underlying causes.
- UTI is the second most common bacterial infection in children, with E. coli being the most common causative organism. Infants under 1 year old and females over 1 year old are more susceptible to UTIs.
- Risk factors for UTI include perineal colonization by intestinal flora, dysfunctional voiding, constipation, and presence of VUR. VUR increases the risk of renal scarring from UTIs.
- Treatment of UTIs depends on whether it is cystitis or pyelonephritis. Children under 5 with a UTI should be evaluated for VUR with a cystogram. The goal is to identify reflux and reduce risk of renal scarring through prophylactic
This document summarizes a research brief about outgrower systems (also known as contract farming) and their potential role in promoting inclusive agricultural growth and combating food insecurity in Sub-Saharan Africa. The brief details the history and controversies around outgrower systems. It also outlines best practices for firms, smallholder farmers, and governments to ensure optimal outcomes. The goal is to identify practices that increase farmer bargaining power and the likelihood of positive results for both businesses and smallholders.
This document discusses obstructive uropathy in neonates. It presents a case of a preterm baby with bilateral hydronephrosis and a thick bladder wall. Key points discussed include the causes, presentations, investigations, and management of obstructive uropathy. Posterior urethral valves and ureteropelvic junction obstruction are examined in more detail. Vesicoureteric reflux is also summarized. The document emphasizes relieving obstruction, treating infection, and sorting the primary cause in managing obstructive uropathy.
Metabolic workup and medical management of urolithiasis aims to prevent recurrent stone formation through identifying underlying causes. The goals are to prevent further stone growth and extrarenal complications. Evaluation involves medical history, blood and urine tests, imaging, and stone analysis to guide targeted therapy. First-line management includes increased fluid intake, dietary modifications like reduced sodium and animal protein, and medications depending on the metabolic abnormality identified, such as thiazides for hypercalciuria. Selective long-term medical management can normalize urinary risk factors and prevent further stone episodes in many patients.
This document provides a classification and overview of the diagnostic criteria for nephrolithiasis (kidney stones). It classifies the causes of nephrolithiasis into calcium based calculi, uric acid based calculi, cystinuria, infective (struvite) calculi, and low urine volumes. For each category, it describes the underlying metabolic abnormalities and risk factors that can lead to stone formation, such as hypercalciuria, hyperoxaluria, hypocitraturia, and urinary tract infections. It also discusses specific conditions like renal tubular acidosis and cystinuria that are associated with stone formation.
Intussusception - will test the doctor and will cost the patientMohan Samarasinghe
This document discusses intussusception, a condition where one segment of the intestine folds into another segment. It provides a historical overview of discoveries about intussusception from the 17th century onwards. It then describes the typical presentation of intussusception in children ages 1-5, including abdominal pain, vomiting, and bloody stools. Diagnosis is usually made using abdominal ultrasound. Treatment options discussed include saline enema reduction guided by ultrasound, operative reduction, or observation if symptoms are mild. Early diagnosis and treatment within 12 hours of onset improves survival rates.
1. Vesicoureteral reflux (VUR) occurs when urine flows backward from the bladder into the ureters and kidneys. This document discusses the history, demography, causes, diagnosis, evaluation, natural history and management of VUR.
2. VUR is more common in younger children, males, and those with urinary tract infections. The prevalence is higher in siblings of children with VUR.
3. VUR can be primary due to structural issues or secondary due to bladder dysfunction. Grading depends on extent of reflux during cystography.
4. Management focuses on antibiotics to prevent infections while allowing for spontaneous resolution, which is more likely for lower grades of
This document summarizes guidelines for examining and managing common intestinal stoma complications in primary care. It provides guidance on examining the stoma, assessing for issues like prolapse, retraction, hernias, and high or low output. It emphasizes supporting patients by addressing psychological impacts, referring to specialty nursing as needed, and empowering patients to manage their stoma long-term. The goal is to properly identify and treat complications while helping patients adjust to life with an intestinal stoma.
This document provides a case report on a 43-year-old female patient diagnosed with ureterolithiasis in the proximal third of the right ureter. It summarizes the patient's history of present illness including previous hospital admissions for kidney stones. The patient was admitted to Vicente Sotto Memorial Medical Center with complaints of sudden sharp pain. The case report utilizes Virginia Henderson's nursing theory to assess the patient and implement nursing interventions. It aims to share information on ureterolithiasis, identify problems related to the patient's condition, and provide health teachings to prevent recurrence.
Lipoma of the Small Intestine: A Cause for Intussusception in AdultsKETAN VAGHOLKAR
This case report describes a rare case of small intestinal intussusception in a 22-year-old male patient caused by a lipoma. Imaging including ultrasound and CT scan revealed the classic signs of intussusception and identified a likely lipoma as the cause. During surgery, an ileoileocolic intussusception was found and gently reduced, finding a submucosal lipoma as the pathological lead point. The involved intestinal segment containing the lipoma was resected. Histopathological examination confirmed the diagnosis of benign submucosal lipoma. The patient recovered well with no further symptoms.
A clinical study of intussusception in childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses the evaluation of urolithiasis (urinary stones). It provides an overview of diagnostic evaluation including history, blood tests, urine analysis, imaging, and stone analysis. It describes the goals and characteristics of metabolic evaluation to prevent recurrent stone formation. Both abbreviated and extensive protocols for metabolic evaluation are outlined, including details on 24-hour urine collection and components analyzed. The roles of various imaging modalities like KUB, ultrasound, and intravenous pyelography are also summarized.
This document discusses best practices for endoscopically evaluating eosinophilic esophagitis (EoE). It recommends using the Eosinophilic Esophagitis Endoscopic Reference Score (EREFS) to systematically assess and record endoscopic features of EoE, including edema, rings, exudates, furrows, and strictures. A thorough examination is important to optimize diagnosis, assess treatment response, and monitor outcomes over time. Key steps include fully inflating the esophagus, carefully examining for subtle signs of narrowing or strictures, and obtaining multiple targeted biopsies from different locations to increase diagnostic yield.
This document discusses the evaluation and workup of patients presenting with renal stones. It outlines the importance of obtaining a detailed history regarding lifestyle, diet, medical history and risk factors. A physical exam can reveal signs of renal colic or obstruction. Metabolic testing and stone analysis help determine the stone composition and underlying abnormalities. Radiological investigations including ultrasound, CT and occasionally IVP are used to identify stones and assess for complications like hydronephrosis. Proper evaluation guides management and treatment of kidney stone disease.
This document outlines the evaluation and management of urolithiasis by the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses the moderators, evaluation including history, examinations, imaging and laboratory tests. Management is covered including general measures, medical management, extracorporeal shock wave lithotripsy, endoscopic procedures like ureteroscopy and percutaneous nephrolithotomy, and open surgeries. Indications and complications of the different treatment methods are also provided.
The document summarizes recent findings regarding the anatomy and functions of the mesentery. It discusses how clarifying the shape and development of the mesentery has advanced understanding of various abdominal and systemic diseases. The mesentery provides structural support for the digestive organs and is involved in processes like immune response coordination and cellular migration. Various pathologies like cancer, ischemia, and Crohn's disease involve the mesentery. A mesenteric-based model of abdominal anatomy provides insights into disease and guides surgical and other treatment approaches.
The document discusses various causes of paediatric intestinal obstruction. It begins by outlining normal neonatal bowel gas patterns and developmental lesions of the intestinal tract that can lead to obstruction. It then describes the two main types of intestinal obstruction - upper and lower. Common causes are discussed for each type, including oesophageal atresia, hypertrophic pyloric stenosis, duodenal atresia, malrotation, and jejunal atresia. Key imaging features of common lesions are summarized.
Urinary calculi refers to stones formed in the urinary tract from crystallization of substances in urine. Common causes include dehydration, poor fluid intake, immobility, and excess vitamin D or calcium intake. Symptoms include pain at the site of blockage, cystitis, fever, nausea, and abdominal discomfort. Nursing interventions focus on pain control, encouraging fluid intake, and educating patients on prevention of recurrent stones based on their specific type of calculi. Treatment options depend on the size and location of the stones and may include shock wave lithotripsy, surgery, or managing underlying causes.
- UTI is the second most common bacterial infection in children, with E. coli being the most common causative organism. Infants under 1 year old and females over 1 year old are more susceptible to UTIs.
- Risk factors for UTI include perineal colonization by intestinal flora, dysfunctional voiding, constipation, and presence of VUR. VUR increases the risk of renal scarring from UTIs.
- Treatment of UTIs depends on whether it is cystitis or pyelonephritis. Children under 5 with a UTI should be evaluated for VUR with a cystogram. The goal is to identify reflux and reduce risk of renal scarring through prophylactic
This document summarizes a research brief about outgrower systems (also known as contract farming) and their potential role in promoting inclusive agricultural growth and combating food insecurity in Sub-Saharan Africa. The brief details the history and controversies around outgrower systems. It also outlines best practices for firms, smallholder farmers, and governments to ensure optimal outcomes. The goal is to identify practices that increase farmer bargaining power and the likelihood of positive results for both businesses and smallholders.
In a distant village at the foot of 55Himalayas a farmer was walking through a mountain pass and found an eagle’s egg. He came back to his hut and put the egg in the barn to hatch with hen. The eagle egg hatched with the brood of chicks and grew up with them. All his life, the eagle did what the other chickens did, thinking he was a chicken too.
Merhaba,
Kış aylarına adım adım yaklaştığımız şu günlerde Manifesto İletişim Grubu Trend Raporu’muzun bu ayki sayısında yine dopdolu içeriklerle karşınızdayız. Yeni sayımızda sosyal medyada yaşanan yenilikleri ve yine ilginç kampanya öykülerini sizler için araştırdık. Sanatın ve sanatçının her zaman yanında olan sanat platformumuz Magnum Opus aracılığı ile sanat dünyasından derlediğimiz haberleri de yeni sayımızda keyifle okumanız dileğiyle…
Sevgiler,
Selin Bozkurt
Chief Energy Officer
Manifesto
The final verdict on merging the National Spot Exchange Ltd (NSEL) with its parent company Financial Technologies India Ltd (FTIL) was delayed by one month. The Ministry of Corporate Affairs granted both companies a hearing on July 7-8 but further hearings were postponed by four weeks. Additionally, the CLB barred FTIL from selling company assets until September 2nd, 2015 in relation to the government's petition to remove the FTIL board due to the NSEL crisis. The MCA also announced a share swap ratio of 3 FTIL shares for every 8 NSEL shares if the merger is approved.
Electiva III elementos básicos del tránsitobalzajair
Este documento resume los elementos básicos del tránsito, incluyendo usuarios (peatones, pasajeros, conductores, ciclistas), vehículos, vías, y dispositivos de control. Describe los diferentes tipos de usuarios y sus comportamientos, así como los tipos de vehículos, clasificaciones de vías, y materiales de pavimentación. El objetivo es proporcionar una introducción general a los conceptos fundamentales del tránsito.
La ingeniería de tránsito es una rama de la ingeniería civil cuyo objetivo es lograr el movimiento seguro y eficiente de peatones y vehículos a través de la creación de normas y el desarrollo de proyectos de vías terrestres. Al planificar proyectos, los ingenieros de tránsito deben considerar factores como el conductor, el peatón, el vehículo, la vía, el medio ambiente y su interrelación, así como también economía, plazos de construcción y el impacto ambiental. Un enfoque
The Michigan Wheat Program 2014-2015 Annual Report summarizes the organization's accomplishments in its strategic plan over the past year. Key accomplishments include establishing a strong research program focused on growers' needs and funding over 50 research projects; investing over $1.1 million in research; partnering with MSU on a new wheat specialist position; holding farmer events highlighting research; and establishing outreach activities including a website, newsletter, and consumer events. Moving forward, the board will continue implementing the strategic plan to support the Michigan wheat industry through research, marketing, education and communication.
Today’s branding is a function of media fragmentation: Prateek Kumarrateek KumarNeoNiche Integrated
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Vincent Downey has over 20 years of experience in business intelligence, data analytics, and database administration. He holds a BSc in Astrophysics and a Post Graduate Diploma in Data Analytics. Currently he works as a Data Analyst for the Food Safety Authority, and has previously consulted for many large companies as a Business Intelligence expert. He is skilled in technologies like Oracle, SQL, and Microsoft Office.
The document is a presentation titled "Generation Why?" about Millennials. It discusses who Millennials are and what they want. Millennials are described as impatient, irresponsible, entitled, and self-absorbed. They value flexibility, technology, new challenges, team support and feedback. The presentation concludes by saying the speaker has learned Millennials like Lilly are adaptable, curious, and accommodating.
What I Learnt About Building Great Products - Founders Institute - May 2016Ilter Dumduz
This document outlines the key steps to building a great product:
1) Define what constitutes a great product by having a clear value proposition, resonating with the target audience, and providing the simplest path between supply and demand.
2) Ideate new product ideas through listening to customers qualitatively and quantitatively, using intuition, and identifying strong use cases.
3) Prioritize ideas using an ROI framework considering impact, cost, and ease while practicing saying no and focusing on the core.
4) Execute by thinking visually, setting goals and hitting them, moving fast in the right direction, derisking, doing retrospectives, and always networking.
Brad Curtis has over 25 years of experience leading global sales and marketing for top brands. He has built sales and marketing organizations through strategic solutions that drive revenue. Some of his past roles include leading global sales at eZdia and Magento, where he exceeded quotas. He also co-founded branded entertainment companies and was VP of Sales for a SaaS ecommerce platform. Curtis has expertise in areas such as digital marketing, design, and leveraging platforms like Salesforce and Hubspot.
JEE Foundation Course for non Java professionalsamodkadam
This document outlines the organization and modules of a JEE Foundation training course. The 15 module, 6 day course covers topics related to the Java ecosystem, platforms, and technologies. It focuses on core JEE specifications including JSP, Servlets, JSF, EJBs, persistence, and web services. The course is organized into modules that will be covered over multiple half-day sessions. Participants will complete pre- and post-training assessments.
O livro de Números descreve a peregrinação de Israel no deserto após sair do Monte Sinai. Narra os dois censos realizados, as rebeliões do povo, e sua jornada até chegar às planícies de Moabe, às portas da Terra Prometida.
Nephrolithiasis, Diagnosis and Management: A Review Articlesuppubs1pubs1
Nephrolithiasis is a stone formed from mineral deposits in the bladder. When bladder stones clog the urinary tract, there will be complaints in the form of difficulty and pain when urinating, even bloody urine (hematuria). Nephrolithiasis can happen to anyone, including children. Symptoms associated with urinary tract stones depend on the location of the stone, the size of the stone, and any complications that have occurred. Usually stones in the kidney calyx are asymptomatic. When the stone falls off and descends into the narrow ureter, it becomes symptomatic. Stones generally get stuck in the narrowest part of the ureter, such as the ureteropelvic junction, when the ureter crosses the iliac vasa, and the ureterovesical junction. This article purpose is to review diagnosis and management of nephrolithiasis.
Bladder stones can be classified as primary, secondary, or migratory based on their underlying cause. Primary stones typically occur in children in endemic areas with poor nutrition. Secondary stones are associated with an underlying bladder pathology like benign prostatic hyperplasia. Migratory stones initially form in the upper urinary tract. Management options include medical dissolution, shockwave lithotripsy, transurethral lithotripsy, percutaneous cystolithotomy, open surgery, or a combination depending on factors like stone size and location. Prevention involves adequate hydration and treatment of any predisposing conditions.
Urolithiasis refers to the formation of stones in the urinary tract. Stones can form in the kidneys (nephrolithiasis), ureters (ureterolithiasis), or bladder (cystolithiasis). Risk factors include disorders of the urinary tract, liver, endocrine system, infections, and metabolic disorders. Patients may experience flank pain radiating to the groin due to obstruction. Diagnosis involves urinalysis, blood tests, imaging like ultrasounds or CT scans. Treatment depends on stone size and location but may include pain medication, increasing fluid intake, stone removal procedures like ESWL, ureteroscopy, or open surgery. Preventing recurrence involves
RENAL STONES AND ITS MANAGEMENT IN PATIENTS.pptxneeti70
Renal stones form in the kidneys and can move into the urinary tract, causing obstruction and pain. The majority are composed of calcium, though other types include uric acid and struvite stones. Risk factors include diet, medical conditions, procedures like gastric bypass. Treatment depends on stone size and location but may include pain control, medical expulsive therapy, or surgical interventions like shockwave lithotripsy. Recurrence prevention involves lifestyle modifications and medications tailored to the stone type.
This document summarizes recurrent urinary tract infections (UTIs) in children. It defines UTIs and discusses epidemiology, clinical features, diagnosis, treatment, risk factors, complications like vesicoureteral reflux (VUR) and renal scarring, and prevention. Evaluation and long-term management of UTIs depends on identifying and addressing underlying causes like VUR, obstruction, dysfunctional voiding, or hypercalciuria.
CHOLELITHIASIS, NEPHROLITHIASIS SECONDARY HYPERTENSION, DM TYPE 2, HYDRONEPH...Jack Frost
CHOLELITHIASIS, NEPHROLITHIASIS
SECONDARY HYPERTENSION, DM TYPE 2, HYDRONEPHROSIS
This presentation contains real names of persons involve of this particular study. This names should not be copied or rewritten. Used the data of this study as basis only. All rights reserved 2009.
- The document is a literature review on nephrolithiasis (kidney stones) that discusses the urinary system, types of kidney stones, stone formation and morphology, manifestations of stones such as pain and infection, and treatment methods.
- The most common type of kidney stone is calcium stones, which constitute 80-90% of all renal stones. Other types include uric acid, struvite, and cystine stones.
- Symptoms of kidney stones include flank pain from stones moving through the ureter, as well as hematuria, urinary tract infections, and potentially loss of kidney function in severe cases. Computed tomography and ultrasound are used to diagnose stones.
This document provides a literature review on nephrolithiasis (kidney stones). It discusses the urinary system and how kidney stones form. The most common types of kidney stones are calcium-based, including calcium oxalate and calcium phosphate stones. Stones can cause symptoms when they block the ureters or kidneys. Complications include infection, obstruction, and loss of kidney function. The pathogenesis of stones involves urine becoming supersaturated due to excessive levels of stone-forming compounds like calcium, oxalate, and phosphate. This can lead to crystal formation and growth into kidney stones.
This document discusses antenatal hydronephrosis and its management. It begins by stating that fetal urinary tract dilation is the second most common prenatal anomaly detected. Antenatal hydronephrosis is diagnosed based on measurements of the anterior-posterior renal pelvic diameter. While most cases are transient and physiological, it can also indicate congenital anomalies of the kidney and urinary tract. Prenatal imaging using ultrasound is important to identify and monitor any urinary tract anomalies. Postnatal evaluation and management seeks to identify infants with clinically significant congenital anomalies of the kidney and urinary tract that may require treatment or surgery.
Investigation and treatment of Urinary tract infection in childrenFaridAlam29
- Urinary tract infections (UTIs) are common in children and can lead to serious complications if left untreated. The two main types are pyelonephritis, which involves the kidneys, and cystitis, which involves the bladder.
- Symptoms vary with age but may include fever, abdominal pain, vomiting, and abnormal urine odor or color. Physical exams can reveal costovertebral angle tenderness or abdominal tenderness.
- Diagnosis involves urinalysis, urine culture, and imaging studies like ultrasound or voiding cystourethrogram to check for vesicoureteral reflux or other abnormalities.
- Escherichia coli is the most common cause. Treatment depends
Hydronephrosis is the dilation of the renal pelvis and calyces due to partial or intermittent obstruction of urine flow. It is usually caused by blockages or reflux in the urinary tract. Common causes in children include vesicoureteral reflux, ureteropelvic junction obstruction, and posterior urethral valves. Diagnosis involves renal ultrasound and tests to assess kidney function. Treatment depends on the severity and underlying cause, ranging from observation to surgery to correct blockages or reflux. Complications can include urinary tract infections, kidney damage, and renal failure if not properly treated.
Group 3 presented on nephrolithiasis, urolithiasis, and hydronephrosis. The presentation discussed the conditions, including that nephrolithiasis involves stone formation in the kidney. Diagnostic tests including IV pyelogram, retrograde pyelogram, x-rays, and urine tests were covered. Potential complications from the conditions include UTI, hydronephrosis, stone recurrence, and kidney damage. Nursing interventions focus on relieving pain, increasing fluid intake, educating the patient, and monitoring for complications.
Megaureter ppt. Types, pathophysiology, evaluation and management.Hussain Shah
- Megaureter (MGU) is defined as a ureteral diameter greater than 7 mm. MGU can be classified based on its cause as refluxing, obstructed, both refluxing and obstructed, or nonrefluxing and nonobstructed.
- MGU is a common finding in neonates referred for urologic evaluation and accounts for up to 23% of cases of urinary tract dilatation seen on prenatal ultrasound.
- Evaluation of MGU involves ultrasound to assess anatomy and severity, VCUG to check for reflux, renal scan to evaluate function, and potentially MRI urography.
- Management depends on etiology but
This document discusses nephrolithiasis (kidney stones). It begins by providing background on the prevalence and costs of kidney stones. It then describes the types of stones (calcium, uric acid, struvite, cystine, drug-induced), risk factors, clinical presentation including renal colic, methods of diagnosis using imaging, and medical management focusing on pain control and increasing fluid intake to pass stones. It concludes by outlining principles of preventing recurrent stones through increasing urine volume and specific measures for preventing calcium stones, the most common type, which involve addressing hypercalciuria.
1. Urinary tract infections (UTI) are common in children and can lead to serious complications if left untreated, such as renal scarring and failure.
2. Symptoms of UTI in children vary depending on age but often include fever, vomiting, and abnormal urine symptoms. Diagnosis involves urinalysis and culture.
3. Treatment involves antibiotics and may require hospitalization for young infants or children appearing toxic. The goal is to prevent progression to pyelonephritis and damage to the kidneys.
This document provides an overview of the approach to congenital hydronephrosis. It defines hydronephrosis and describes the most common causes including physiologic hydronephrosis, UPJ obstruction, UVJ obstruction, VUR, Eagle-Barrett Syndrome, PUV, and MCDK. It discusses grading of fetal and neonatal hydronephrosis using RPD, SFU criteria, and UTD classification system. The document outlines the approach including physical exam, imaging studies like VCUG and diuretic renography to diagnose underlying causes and guide treatment.
This document discusses several conditions of the urinary tract:
Hydronephrosis is caused by abnormal development of the upper urinary tract or blockage in the urinary tract, which can be diagnosed using ultrasound scans or MAG3 tests. Some children may require surgery like pyeloplasty to improve drainage.
Megaureter is an abnormally wide ureter, over 3/8 inch, which can be caused during fetal development and diagnosed via ultrasound.
Vesicoureteral reflux is when urine flows backward from the bladder to the ureters and sometimes kidneys, most common in infants and young children.
Hypospadias is a birth defect in boys
Renal stones, also known as kidney stones, form in the urinary tract and can affect any part from the kidneys to the bladder. Risk factors include metabolic abnormalities, warm climates, certain diets, genetics, and lifestyle. The five major types of renal stones are calcium phosphate, calcium oxalate, uric acid, cysteine, and struvite. Symptoms include severe side and back pain, painful urination, hematuria, and nausea. Diagnostic tests include imaging like ultrasounds and CT scans as well as urine and blood tests. Treatment options depend on the size and location of the stone and include shockwave lithotripsy, percutaneous nephrolithotomy, ureter
Similar to A child with a large bladder stone a case report (20)
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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2. Ozturk et al. / Ped Urol Case Rep 2014;1(4):22-28 23
macroscopic hematuria in children with
bladder stones has been noted in 33-90% of
patients [4, 5]. Most bladder stones are
composed of calcium oxalate (45-65%),
followed by calcium phosphate (14-30%),
and they are usually larger than 2.5 cm in
diameter [7-10]. In this report, we present a
case of a larger-than 2.5-cm bladder stone in
a child.
CASE REPORT
A 9-year-old male child presented to our
medical service with suprapubic pain. The
patient had a history of recurrent lower
urinary tract infections. He had had urinary
frequency, urgency, difficulty voiding, small
caliber of urinary stream, lower abdominal
pain, urinary intermittency and hematuria
for one year. There was no family history of
urinary stone disease. Physical examination
revealed mild tenderness. On laboratory
studies, blood urea nitrogen and serum
creatinine levels were 98 mg/dL and 9.1
mg/dL, respectively. Hemogram showed
leukocytosis. Renal ultrasound showed
bilateral moderate-to-severe hydronephrosis.
Escherichia coli growth was confirmed by
urine culture. X-ray revealed a large, round
calcified pelvic calculus measuring 3.9 x 2.8
x 3.3 cm (Fig. 1).
Fig. 1. Plain abdominal film revealed a large stone in
the bladder.
Broad-spectrum parenteral antibiotics were
given according to culture sensitivity, and
the patient underwent open cystolithotomy.
An elliptical bladder stone was delivered
smoothly (Fig. 2).
Fig. 2. A elliptical bladder stone was extracted by
open vesicolithotomy.
3. Ozturk et al. / Ped Urol Case Rep 2014;1(4):22-28 24
The composition of the stone was reported
as magnesium ammonium phosphate. The
postoperative period was uneventful, and in
the 6 months since the operation, the patient
has remained symptom-free and has
experienced no further stone formation.
DISCUSSION
Urolithiasis in children is less commonly
due to metabolic or congenital
abnormalities. Bladder stones in developing
nations are more commonly endemic in
children because of dehydration, infection
and a low-protein diet. Calcium-based
stones in Western countries are relatively
rare in the upper tract [9]. Bladder stones are
usually rounded and may occur as singles or
multiples. They can be small, or can be large
enough to occupy the entire bladder. Bladder
stones reach up to 5 cm in diameter in some
parts of Asia. In a clinical study [11], 6.8%
of urinary stones were bladder stones.
Basaklar and Kale [5] reported that 26.5% of
urinary tract stones were bladder stones. In
120 Tunisian children with urolithiasis, 22%
of bladder stones were composed of struvite
[12].
The cause of urinary bladder stone
formation in children is a diet that is low in
animal proteins and consists mainly of
cereals. Other factors include dehydration
and a dietary phosphate deficiency. Bladder
stones develop when urine becomes
concentrated in the bladder, causing
minerals in the urine to crystallize.
Concentrated, stagnant urine is often the
result of an inability to completely empty the
bladder. Pediatric bladder stones most
commonly consist of ammonium acid urate
with or without calcium oxalate or calcium
phosphate. Certain types of infections may
cause the development of urinary stones.
These infections produce an enzyme called
urease, which causes the urine pH to
increase, favoring the formation of
magnesium ammonium phosphate (struvite)
crystals. Some calcium crystals can also
form. Frequently, large, difficult-to-treat
staghorn stones develop. Infections agents
4. Ozturk et al. / Ped Urol Case Rep 2014;1(4):22-28 25
associated with urinary stones are E. coli,
Proteus sp., Providencia sp., and some
strains of Klebsiella sp., Pseudomonas sp.,
and Enterococci [3, 10, 13, 14]. In the
present case, the urine culture grew E. coli.
Based on our patient’s family history, a
hereditary calcium oxalate metabolic
disorder was unlikely.
Recent improvements in the socio-economic
facilities of some regions have changed the
clinical appearance of all urinary stones. In
Dubai 1, calcium oxalate was found in
78% of patients with bladder calculi, and
acute urinary obstruction was a symptom of
bladder stones. In Saudi Arabia 15,
calcium oxalate stones were the most
common type, followed by uric acid and
phosphate stones. In Thailand, oxalate was
found in upper urinary tract stones, and uric
acid stones were found in the lower urinary
tract 16.
Currently, abdominopelvic planar
radiography is commonly used to identify
radiopaque stones in children. Additionally,
ultrasonography, intravenous pyelography
(IVP) and computed tomography (CT) are
used for evaluation of these stones 1,4,14.
Bladder stones are usually single, large,
rounded, and of homogeneous calcific
density and thus are evident on plain
radiograph or on excretion urography or
cystography with a contrast agent.
Ultrasonography is very helpful in
confirming or detecting bladder stones 17.
Bladder stones do not always cause signs or
symptoms and may be discovered during
tests for other problems. When symptoms do
occur, they can range from abdominal pain
to blood in the urine. If bladder stones are
small enough, they can pass on their own
with no noticeable symptoms. Left
untreated, bladder stones can cause
infection, inflammatory edema, detrusor
spasms and other complications. However,
once they become larger, bladder stones can
cause frequent urges to urinate, painful or
difficult urination and hematuria. These
stones can irritate the bladder wall, disrupt
the flow of urine out of the bladder and
cause infection 1, 17, 18.
5. Ozturk et al. / Ped Urol Case Rep 2014;1(4):22-28 26
The presentation of vesical calculi ranges
from a complete absence of symptoms to the
presence of suprapubic pain in 50% of cases,
dysuria, intermittency, frequency, hesitancy,
nocturia, and urinary retention. Parents of
children with vesical calculi may notice
priapism and occasional enuresis. Other
common signs include terminal gross
hematuria in 33-90% of children and sudden
termination of voiding with some degree of
associated pain referred to the tip of the
penis, scrotum, perineum, back or hip.
Based on a literature survey of a total of 447
cases of bladder stones, management
consisted of open vesicolithotomy in 307
cases (68.7%), extracorporeal short-wave
lithotripsy in 63 cases (14.1%) and
transurethral pneumatic cystolithotripsy in
77 cases (17.2%). The decision between
endoscopic or open cystolithotomy depends
on the size and number of the stones. If the
stones are too large (>2.5 cm in diameter) or
too numerous to be removed by endoscopic
methods, open surgical removal may be
necessary. Open surgery is the preferred
treatment of choice for removing bladder
stones, and surgical intervention through
cystolithotomy can achieve satisfactory
results. Bladder outlet obstruction should be
treated simultaneously. Early diagnosis and
early treatment are necessary [8, 19-21].
In our case, the bladder stone was more than
3 cm in diameter and open vesicolithotomy
was chosen. The postoperative period was
uneventful, and in the 6 months since the
operation, the patient has remained
symptom-free and has experienced no
further stone formation.
Large bladder stones can cause severe
symptoms in children. Patients at risk for
bladder stones in endemic regions should
undergo periodic evaluation, at least with
ultrasonography. Additionally, changes in
the diet are needed to prevent the recurrence
of bladder stones. It is very important to
recognize that long-term pyuria and urinary
symptoms can lead to large bladder stones
and renal failure.
CONFLICT OF INTEREST None declared.
6. Ozturk et al. / Ped Urol Case Rep 2014;1(4):22-28 27
REFERENCES
1. Hammad FT, Kaya M, Kazım E. Bladder
calculi: did the clinical picture change?
Urology. 2006; 67:1154–8.
2. Rahman M, Uddin A, Das GC, Akanda
NI. A giant vesical calculus.
Mymensingh Med J. 2007; 16 (2
Suppl):S57–59.
3. Hızlı F, Yılmaz E. A giant bladder
struvite stone in an adolescent boy. Urol
Res. 2012; 40:273–4.
4. Gillespie RS, Stapleton FB.
Nephrolithiasis in children. Pediatr Rev.
2004;25:131−9.
5. Basaklar AC, Kale N. Experience with
childhood urolithiasis: report of 196
cases. Br J Urol. 1991;67:203−5.
6. Chow KS, Chou CY. A Boy with a
Large Bladder Stone. Pediatr Neonatol.
2008;49:150−3.
7. Erbagci A, Erbagci AB, Yilmaz M, et al.
Pediatric urolithiasis—evaluation of risk
factors in 95 children. Scand J Urol
Nephrol. 2003;37:129−33.
8. Rizvi SAH, Naqvi SA, Hussain Z, et al.
Pediatric urolithiasis: developing nation
perspectives. J Urol. 2002;168:1522−5.
9. Trinchieri A. Epidemiology of
urolithiasis: an update. Clin Cases Miner
Bone Metab. 2008;5:101-6.
10. Wei W, Wang J. A huge bladder
calculus causing acute renal failure. Urol
Res. 2010; 38:231–2.
11. Gault MH, Chafe L. Relationship of
frequency, age, sex, stone weight and
composition in 15,624 stones:
comparison of resutls for 1980 to 1983
and 1995 to 1998. J Urol. 2000;164:302-
7.
12. Kamoun A, Daudon M, Abdelmoula J,
et al. Urolithiasis in Tunisian children: a
study of 120 cases based on Stone
composition. Pediatr Nephrol.
1999;13:920− 5; discussion 926.
13. Stamey TA. Pathogenesis and treatment
of urinary tract infections. Baltimore:
Williams & Wilkins, 1980:430-474.
14. Sikora P, Glatz S, Beck BB, Stapenhorst
L, Zajaczkowska M, Hesse A, Hoppe B.
7. Ozturk et al. / Ped Urol Case Rep 2014;1(4):22-28 28
Urinary NAG in children with
urolithiasis, nephrocalcinosis, or risk of
urolithiasis. Pediatr Nephrol.
2003;18:996-9.
15. Khan AS, Rai ME, Gandapur, Pervaiz A,
et al. Epidemiological risk factors and
composition of urinary stones in Riyadh
Saudi Arabia. J Ayub Med Coll
Abbottabad. 2004;16:56-8.
16. Tanthanuch M, Apiwatgaroon A,
Pripatnanont C. Urinary tract calculi in
southern Thailand. J Med Assoc Thai.
2005;88:80-5.
17. Lebowitz RL, Vargas B. Stones in the
urinary bladder in children and young
adults. AJR Am J Roentgenol.
1987;148:491-5.
18. Ho K, Segura J. Lower Urinary Tract
Calculi. In: Wein A, Kavoussi L, Novick
A, Partin A, Peters C (eds). Campbell-
Walsh Urology. 3. 9th. Philadelphia, Pa:
Saunders Elsevier; 2007. pp. 2663-73.
19. Rodrigues Netto N Jr, Longo JA,
Ikonomidis JA, Rodrigues Netto M.
Extracorporeal shock wave lithotripsy in
children. J Urol. 2002;167:2164−6.
20. Salah MA, Holman E, Toth C.
Percutaneous suprapubic cystolithotripsy
for pediatric bladder stones in a
developing country. Eur Urol.
2001;39:466−70.
21. Smith JM, O’Flynn JD. Transurethral
removal of bladder stone: the place of
litholapaxy. Br J Urol. 1977;49:401–5.