Urolithiasis: Etiology Diagnosis(17/1 Handbook of Urology)

The handbook on lithiasis edited by Kurt Boshamer and originally brought out in 1961 was for more than two decades the standard work in this field for researchers and clinicians alike. However, our knowl- edge of urolithiasis has been increased so enormously - by worldwide interdisciplinary research into the genesis of urinary calculi, by the new treatment possibilities opened up principally by advances in tech- nology, and by the success achieved in prevention of recurrence - that it is almost impossible to take in all the relevant journal articles, books chapters, monographs, and proceedings. It was therefore our aim in this, the first of two independent vol- umes, to provide a concise but comprehensive summary of current knowledge concerning the morphology and composition of calculi, epidemiology, pathogenesis, and diagnostic techniques. The most re- cent developments are described, and nothing in the world literature is ignored. A second volume will cover medical therapy, operative, in- strumental and noninvasive treatment, and prophylaxis. To have any chance of success, treatment and prophylaxis must be based on knowledge of calculus formation. Study of the composition of calculi has yielded important information regarding the conditions for formation, and this underlines once again the great value of analy- sis of urinary concretions. Evaluation of epidemiological data has im- portant consequences for the individual patient.

Table of Contents:
Morphology of Urinary Tract Concretions.- I. Definitions.- II. External Appearance of Urinary Calculi in Relation to Site of Recurrence and Type of Stone.- III. Physical Properties.- 1. Hardness.- 2. Density.- 3. X-Ray Absorption.- IV. Chemical Composition of Uroliths.- 1. Compounds.- 2. Ash and Mass Elements.- 3. Trace Elements.- V. Structural Composition of Uroliths.- 1. Aggregate Structural Description.- a) Central Region.- b) Peripheral Region.- 2. Urolithogenesis as the Basis of Aggregate Configuration.- 3. Urolith Phases.- a) Calcium Oxalate.- b) Uric Acid - Uric Acid Dihydrate.- c) Apatite.- d) Struvite.- e) Ammonium Dihydrogenurate.- f) Brushite.- g) Cystine.- h) Xanthine.- i) Organic Matrix.- VI. Urolith Analysis.- 1. Qualitative Chemical Analysis.- a) Processing of Calculous Material.- b) Analytic Procedure.- c) Discussion.- 2. Quantitative Chemical Analysis.- a) Sample Processing.- b) Analytic Procedure.- c) Discussion.- 3. X-Ray Diffraction.- a) Basic Principle.- b) Sample Processing.- c) Exposure Techniques.- d) Data Evaluation and Comparison of Techniques...- 4. Infra-Red Spectroscopy.- a) Basic Principle.- b) Sample Processing.- c) Measurement Technique and Data Evaluation...- d) Discussion.- 5. Thermoanalysis.- a) Basic Principle.- b) Sample Processing.- c) Data Evaluation.- d) Discussion.- 6. Autoradiography.- 7. Combination Techniques.- 8. Microscopy.- a) Polarizing Microscopy.- b) Transmitted Light Microscopy.- c) Phase Contrast Microscopy.- d) Scanning Electron Microscopy.- e) Combined Microscopic Technique - Laser Micro - spectroanalysis - Polarizing Microscopy - Electron Microprobe.- f) Computer Tomography.- 9. Centralising and Standardising Urolith Analysis.- a) Centralisation.- b) Standardisation.- c) Reporting, Documentation and Data Evaluation.- References.- Epidemiology of Urolithiasis.- I. Historical Overview.- II. The Frequency of Urolithiasis.- III. Type Distribution of Calculi.- 1. Geographic Distribution.- 2. Age and Sex of Stone Patients According to Type of Calculus.- 3. Distribution of Calculi in the Urinary Tract.- IV. Seasonal Variations in Incidence of Recurrent and de novo Stone Disease.- V. Race and Familial Predisposition.- VI. Occupation and Lifestyle.- VII. Constitution, Psychological Factors and Concomitant Disease.- VIII Urinary Calculi in Children.- References.- Pathogenesis of Urolithiasis.- I. Introduction.- II. Theories of Stone-Formation.- 1. Localised Lesions in the Kidney.- a) Randall's Plaques.- b) Anderson's Calcific Droplets.- c) Carr's Pouch (Stewart's Nest).- d) Anderson-Carr-Randall Progression.- e) Intranephronic Calculosis.- 2. Hyperexcretion - Crystallisation Theory.- a) General Principles.- b) Solubility Concept.- c) Saturation of Urine.- d) Crystal Nucleation.- e) Crystal Growth.- f) Crystal Aggregation.- 3. Matrix Theory.- a) General Principles.- b) Crystal Nucleation...- c) Crystal Aggregation.- d) Crystal Adhesion to Cell Walls.- e) Inhibition of Crystal Dissolution.- 4. Inhibitor Theory.- a) General Principles.- b) Inhibitors of Nucleation.- c) Inhibitors of Crystal Growth.- d) Inhibitors of Aggregation.- e) Modifiers of Inhibitory Activity.- f) Naturally Occurring Inhibitors.- g) Synthetic Inhibitors.- 5. Unified Theories.- a) General Principles.- b) "Free Particle" Theories of Stone-Formation...- c) "Fixed Particle" Theory of Stone-Formation.- III. Types of Stone Disease.- 1. Cystine Stone Disease.- a) Introduction.- b) Urinary Risk Factors.- c) Stone Disease.- d) Stone-Formation.- 2. Uric Acid Stone Disease.- a) Introduction.- b) Urinary Risk Factors.- c) Stone Disease.- d) Stone-Formation.- 3. Infected Stone Disease.- a) Introduction.- b) Urinary Risk Factors.- c) Stone Disease.- d) Stone Formation.- 4. Calcium Stone Disease.- a) Introduction... |.- b) Urinary Risk Factors.- c) Stone Disease.- d) Stone-Formation.- 5. Uncommon Stones.- a) Introduction.- References.- Diagnosis of Urinary Calculi.- I. History.- 1. Pain.- a) Incidence.- b) Intensity and Radiation.- 2. Changes in the Urine.- a) Color.- b) Volume.- c) Disorders of Micturition.- 3. Fever.- 4. Predisposing Factors.- a) First Attack or Recurrence.- b) Anatomic Anomalies and Coexisting Disease...- c) Drugs.- d) Individual Dietary History.- II. Examination.- 1. Physical Examination.- 2. Blood Pressure.- III. Imaging Studies.- 1. Ultrasound.- 2. Radiology.- a) Abdominal Plain Film.- b) Intravenous Urography.- c) Retrograde Pyelography.- d) Antegrade Pyelography.- e) Computerized Tomography.- f) Renal Angiography.- g) Micturating Cystogram.- 3. Nuclear Medical Studies.- IV. Laboratory Investigations.- 1. Basal Conditions.- 2. Sample Collection.- 3. Sample Preservation.- 4. Nature and Extent of Investigations.- a) The Basic Screen.- b) Advanced Test Panel.- c) Maximum Test Panel.- References.