Upper Urinary Tract Stone: Clinical, Experimental and Biochemical Studies

Sutherland, James W (1957) Upper Urinary Tract Stone: Clinical, Experimental and Biochemical Studies. PhD thesis, University of Glasgow.

Abstract

Clinical, biochemical and experimental studies in upper urinary tract stone have been carried out in more than one thousand patients. The investigation has been conducted during the last eight years in the Urological Department of the Victoria Infirmary. A broad picture of the general incidence and diagnostic findings has been presented with reference to the complete series, the numbers receiving operative and expectant treatment proving to be almost equal. A general increase in the incidence of the disease over the last thirty years has been noted. The purely clinical approach to aetiology has been disappointing, and a satisfactory cause has been shown in a very small proportion of all patients. The factors of possible and doubtful significance have been stated. lack of information about aetiology has been felt at all times to be the main obstacle to progress in prevention and treatment. The natural history of upper urinary tract stone has been studied to provide a standard or "control" series by which the results of operation may be judged, and to fill a gap which clearly exists in our understanding of the disease. The clinical progress of all stones originating in the kidney has been followed to its termination, either in operative removal or natural expulsion. Obstructive potential has been shown to be more important than size per se. Early removal of the obstructive stone has been considered to be its most conservative treatment. A plea, however, has been made for an expectant attitude, with careful supervision in a Stone Clinic in the case of (l) small symptom-free, calyceal stones with normal pyelograms, (2) large symptomless bilateral branched stones, and (3) small ureteric calculi which are making satisfactory progress in the absence of hydronephrosis. It has been shown that more than 80 per cent, of all stones which enter the ureter eventually pass, and that there is therefore no particular virtue in claiming similar results from treatment by endoscopic or open surgical procedures (if these are applied to every case encountered). The late results of operative treatment indicate a depressingly high recurrence rate. Recurrences have been graded as "mild" and "severe", depending on whether or not secondary operation has been necessary. In round figures, one out of every four patients undergoing operative treatment has developed severe recurrence, and the total figure for recurrence has been shown to be somewhere between thirty and fifty per cent. False recurrence, which has not been included in these figures, has been detected in one out of eight patients examined. The factors responsible for, or related to, recurrence have been studied at some length. Nephrolithotomy has been shown to be undesirable on account of its higher mortality rate, the incidence of pseudo- and true recurrence associated with it, and its harmful effect on renal function. Ablation of the kidney has proved to be no guarantee of immunity from recurrence on the opposite side, since the incidence of contralateral recurrence has been the same after nephrectomy and conservative procedures. There has been a steady decrease in recurrence rates in the last three decades. Urinary infection, hyperparathyroidism, hypercal-curia and uncorrected pelvi-ureteric obstruction all have much in common with recurrence, and attention to their treatment, together with complete removal of the stones, give the patient the best early chance of escaping this complication. Long-term preventive measures have been shown to depend, in our present incomplete state of knowledge, on the chemical analysis of the stone, the aim being the production of the maximum solubility of the main crystalloid present. Clinical trials on stone patients and experimental work in animals have failed to confirm that hyaluronidase is valuable in preventing recurrent stone or in reducing the size of those already present in the urinary tract. The place of oestrogens, aluminium hydroxide gel, and salicylates in the prevention of recurrence has been discussed. Comparative studies have indicated that bilateral stone is more serious than the unilateral condition, principally in respect of the post-operative mortality and the late results. (Abstract shortened by ProQuest.).

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Medicine, Biochemistry
• Date of Award: 1957
• Depositing User: Enlighten Team
• Unique ID: glathesis:1957-79189
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 31 Mar 2020 09:09
• Last Modified: 31 Mar 2020 09:09
• URI: https://theses.gla.ac.uk/id/eprint/79189