1 / 44

Overview of stone management in Japan

Overview of stone management in Japan. The 10 th Catholic International Urology Symposium, 2008 14 June 2008 Catholic University, Seoul. Tetsuro Matsumoto, MD, PhD Department of Urology, University of Occupational and Environmental Health. Incidence and management of stone

nayef
Download Presentation

Overview of stone management in Japan

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Overview of stone management in Japan The 10th Catholic International Urology Symposium, 2008 14 June 2008 Catholic University, Seoul Tetsuro Matsumoto, MD, PhD Department of Urology, University of Occupational and Environmental Health UOEHurology

  2. Incidence and management of stone diseases in Japan UOEHurology

  3. First diagnosis Reccurence Incidence rate (/year) Male 192.0 116.9 308.9 Female 79.3 40.3 119.6 Incidence rate of urinary stone in Japan（/100,000population） 2005 UOEHurology

  4. Incidence rate in whole life (Incidence/year x average life expectancy x 100) 1995 Male：　 122.6/100,000×76.36×100= 9.4% Female：　 49.4/100,000×82.84×100= 4.1% 2005 Male：　 192.0/100,000×78.53×100=15.1% Female：　 79.3/100,000×85.49×100= 6.8% UOEHurology

  5. Incidence rate of upper urinary tract stone Incidence (/100,000) Male Female Total Incidence after demographycal correction Male Female Total UOEHurology

  6. Chronological change of incidence rate classified by age (Every 10 years) Male Female UOEHurology

  7. Incidence of upper urinary stone classified by age (First diagnosis/Recurrence) (/100,000) Male first Female first Male recurrence Female recurrence First:Recurrence Male Female UOEHurology

  8. Constituent of upper urinary tract stone in Japam 2005 Male Female Others Urate stone Others Urate stone Cystine Infection stone Infection stone Cystine Castone Castone UOEHurology

  9. Constituent of lower urinary tract stone in Japan 2005 Male Female Cystine Cystine Urate stone Urate stone Infection stone Castone Infection stone Castone UOEHurology

  10. Chronological change of constituent of upper urinary tract stone classified by age Male Others Cystine Urate Struvite Ca stone Female UOEHurology

  11. Past history and basic disease in patients 2005 • Rate (%) Basic disease History Rate (%) Family history9.7 Hypertension21.7 Diabetes9.8 Hyperlipidemia14.1 Osteoporosis2.0 Hyperuricemia Hypercalciuria Hyperuricuria Hyperoxaluria Hypocitruria 13.7 3.1 3.2 1.5 2.0 UOEHurology

  12. Management of stone diseases in Japan ESWL + TUL ESWL only TUL only Others Total No. (%) ESWL + TUL TUL only ESWL only UOEHurology

  13. Chronological change of surgical management for upper urinary tract stones Open surgery TUL or PNL ESWL (incl. combined) % Surgical treatment % No surgical treatment UOEHurology

  14. Japanese guidelines for the management of stone diseasesDec, 2002, JUA • Renal stone • (1)<20mm; ESWL • (2)>20mmor Staghorn; PNLwith ESWL • Ureter stone • (1) Proximal;ESWLOption: (TUL, PNL) • (2)Middle;TUL or ESWL • (3)Distal;<10mm; ESWL • >10mm; TUL UOEHurology

  15. Experience in our hospital UOEHurology

  16. The UOEH urolithiasis guideline UOEH hospital Renal stones (1) 5 to 20mm; ESWL Option:(PNL or TUL) (2)20mmto 30mm ; ESWL with double-J stent Option:(PNL or TUL) (3)>30 mm; PNL (with ESWL) Option:(lithotomy) Ureter stones (A) Proximal; ESWLOption:(TUL or PNL) (B) Middle;ESWL (C) Distal; (1) 5 to 10mm; ESWL (2)>10mm; TUL UOEHurology

  17. Number of new patients in Urology service in outpatient clinic in UOEH hospital UOEH hospital Others Stones year Around 10% is stone diseases UOEHurology

  18. Location of stones UOEH hospital Bladder Ureter Kidney year UOEHurology

  19. Ureteral stone Stone Passage Rate (Meta analysis) Spontaneous passage <5mm; 68% >5mm, <10mm; 47% Medical treatment to increase passage (MET) Nifedipine (Ca channel blocker); 9% (not significant) a-blocker; 29%(significant) Tamsulosin (20% increase)> Nifedipine (significant) 2007 Guideline for the management of ureteral calculi (EAU, AUA) UOEHurology

  20. No. of patients received surgical management UOEH hospital No surgery Surgery year UOEHurology

  21. 2007 Guideline for the management of ureteral calculi (EAU, AUA) Nonpregnant adult Unilateral noncystine/nonuric acid radiopaque stone Normal contralateral renal function Healthy patient Index Patient For all index patients Standard; Bacteriuria should be treated. (IV) Blind basket catheter should not be performed.(IV) For ureteral stones <10mm Option; Observation with periodic evaluation. (1A) Standard; Should be counseled on the risks of MET. (IV) For ureteral stones >10mm Standard; Must be informed about active treatment modality. (IV) Recommendation; SWL and URS first-line treatment (1A-IV) Routine stenting is not recommended (III) Option; Stenting following uncomplicated URS is optional (1A) Percutaneous antegrade ureteroscopy is first-line treatment inselected patients (III) ; impact large stoen in upper ureter, combination with renal stone removal, ureteral stone after urinary diversion, failure of retrograde ureteral access. UOEHurology

  22. Surgical management UOEH hospital Vesicolithotomy Ureterolithotomy Pyelolithotomy Vesicolithotripsy year UOEHurology

  23. Stone free rates for SWL and URS in the overall population Overall population Distal ureter Distal ureter <10mm Distal ureter >10mm Mid ureter Mid ureter <10mm Mid ureter >10mm Proximal ureter Proximal ureter <10mm Proximal ureter >10mm SWL 74% 86% 74% 73% 84% 76% 82% 90% 68% URS 94% 97% 93% 86% 91% 78% 81% 80% 79% Statistics significant significant significant ns ns ns ns ns significant 2007 Guideline for the management of ureteral calculi (EAU, AUA) UOEHurology

  24. Results of TUL（2005～2007） UOEH hospital Cases Stone free rate U1 １５ １１（73％） U2 ９ ５（56％） U3 ２４ ２２（91.6％） UOEHurology

  25. Conversion from ESWLto TUL UOEH hospital ESWLcases Conversion to TUL 2 (2.4%) 81 2005 82 7 (8.5%) 2006 2007 4 (6.6%) 60 Total 223 13 (5.8%) UOEHurology

  26. A case of problem stone Patient; 61y, Female Present illness: Recurrent UTI for 3 years & Lt hydronephrosis due to Lt ureter stone (U1) Past history;Kaiser ope 2 times. Ope for Abdominal wall hernia Complication; Obese Ope scar UOEHurology

  27. ＣＴ DIP 22×12mm Impacted stone UOEHurology

  28. Option of management (U1;Impacted stone) ESWL; High failure rate to impacted stone TUL; Difficulty of keeping optical view or push upto kidney PNL;Damage of Lt kidney Operation performed; Retroperitoneoscopic ureterolithotomy

  29. 12mmport 5mmport × × N × Retroperitoneoscopic ureterolithotomy Lt ureter Ureterotomy Stone

  30. 3months after ope 2 weeks after ope Retroperitoneal laparoscopipc ureterolithotomy is one of option for long-term impacted stone.

  31. Stone disease is infectious diseases? UOEHurology

  32. UTI and urinary stone are closely related. Urinary stone induces UTI. UTI causes urinary stone. UOEHurology

  33. All kind of human diseases is closely related with infection? Cancer: Uterine cervical cancer;Human papilloma virus Liver cancer; Hepatitis virus C Gastric cancer; Helicobacter pyroli Renal cancer; Virus? Arteriosclerosis,Myocardial infarction; Chlamydophylapneumoniae Many kinds of autoimmune diseases, Collagen diseases Benign prostatic hyperplasia etc, etc Urinary stone is also infectious disease? UOEHurology

  34. Stone diseases are infectious diseases? • Urea splitting enzyme producing-microorganism; • Struvite stone • Nanobacteria; Apatite stone • Oxalobacter formigenes; Prevent stone • formation due to diminish the • absorption and excretion of • oxalate UOEHurology

  35. Urea splitting enzyme-producing bacteria causes struvite stone UOEHurology

  36. Urease –producing bacteria Many kinds of urea splitting enzyme -producing bacteria; cause complicated UTI. Almost all producing Sometimes producing Microorganism GNR GPC Mycoplasma Fungi UOEHurology

  37. While struvite stoneis caused by UTI, Apatite stone is also caused by infection? UOEHurology

  38. Nanobacteria Kajander & Ciftcioglu (Finnish researcher, PNAS 1998) -Putative cell-walled microorganism -Low diameter; 0.2mm -Apparent culture -Partially characterized Ribosomal RNA -Isolated from human and cow blood -Microscopic mineral structure (Ca, P) =Biomineralization -Not culturable in g irradiated blood UOEHurology

  39. Nanobacteria； Small, Gram negative Proteobacteria group Needle-shaped calcium apatite cell wall UOEHurology

  40. Nanobacteria; an infectious cause for kidney stone formation；Ciftcioglu et al; Kidney Int 1999 SEM;70/72 (97.2%) stones were Nanobacteria positive. UOEHurology

  41. Nanobacteria; Controversial pathogens in nephrolithiasis and polycystic kidney disease. Kajander et al; Curr Opin Nephrol Hypertens 2001 Direct injection of nanobateria into kidney resulted in stone formation in rats and rabbits UOEHurology

  42. Nanobac Announces peer reviewed publication verifying self-propagating calcifying nanoparticles as a unique entity CNPs hypothesized to resemble prions CAL-DETOX; EDTA Nanobac Pharmaceuticals Inc. UOEHurology

  43. Controversial issue Cisar J. (NIH, FDA group；PNAS2000) -Found same structure in same condition -rRNA=Phyllobacterium mysinacearum; contamination -Resistant to almost all antimicrbials and sodium azide -Non sensitive to heat and powerful respiratory inhibitor UOEHurology

  44. Conclusion Infection is quite interesting. UOEHurology

More Related