Urolithiasis

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.