Hans-Göran Tiselius

Karolinska Institutet | KI · Department of Urology

The aim of this study was to construct the fourth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the metabolic evaluation, prevention, and follow-up of patients with urolithiasis based on the best available published literature. All recommenda...

Background Correct perioperative antibiotic strategies are crucial to prevent postoperative infections during percutaneous nephrolithotomy (PCNL). We aimed to compare the realistic antibiotic strategies applied in China with current urological guidelines. Methods Between April and May 2020, urologists from China were invited to finish an online cr...

PurposeTo explore an appropriate duration of antibiotic therapy before percutaneous nephrolithotomy (PCNL) in patients with positive urine culture.Methods From March 2016 to May 2018, consecutive patients with positive urine culture undergoing PCNL were prospectively registered. Initial preoperative antibiotics were given empirically. If needed, an...

Background It is important to understand the clinical characteristics of bacterial spectrum and antibiotic resistance of urine and stone pathogens for the prevention and treatment of urolithiasis and perioperative infection. Methods Consecutive patients with kidney stones treated by percutaneous nephrolithotomy (PCNL) from September 2016 to Septem...

Previous clinical studies have shown that Escherichia coli (E. coli) predominated in urine and stone culture from calcium oxalate (CaOx) stone disease. The characteristic and relationship between E. coli isolated from urine cultures (EUC) and stone cultures (ESC) are compared. 83 E. coli (33 EUC and 50 ESC, respectively) from 66 CaOx stone patients...

PurposeTo evaluate the distribution and dynamic trends in constituents of urinary stones in China.Materials and methodsThe composition of 23,182 stones were analyzed and then recorded between January 2011 and December 2019. The characteristics in terms of stone patient’s gender, age and calendar year were analyzed. ResultsMost stones (22,172, 95.64...

Purpose: To evaluate the chemical composition of double-J stent encrustation and to assess risk factors associated with their development. Materials and methods: Patients who had double-J stents removed between July 2016 and June 2017 were recruited for this study prospectively. The clinical features of the patients were recorded and the composi...

PurposeTo explore the safety of multiple tract percutaneous nephrolithotomy (PNL) in terms of complication and draw a nomogram to predict the possibility of significant renal function decline (SRFD).Materials and methodsPatients with complex renal calculi appropriate for PNL at our institution between August 2016 and February 2018 were included in...

Introduction: Urinary tract infection (UTI) should be treated before percutaneous nephrolithotomy (PCNL). However, the most appropriate treatment strategy in patients with negative urine culture but positive urine dipstick infection test (positive urinary leukocyte or nitrite reaction) remains unclear. Methods: From August 2016 to February 2018,...

The purpose of this study in a small group of non-stone-forming Chinese persons was to measure the levels of supersaturation with calcium oxalate and calcium phosphate and pH with the aim of confirming if any of the different short-term urine samples were better for risk evaluation than a 24-h sample. Nine normal men and 1 woman collected urine dur...

The Consensus Group deliberated on a number of questions concerning urine and stone analysis over a period of months, and then met to develop consensus. The Group concluded that analyses of urine and stones should be routine in the diagnosis and treatment of urinary stone diseases. At present, the 24-h urine is the most useful type of urine collect...

Objective To assess the relevance of urine test (UT), urine culture (UC) and stone culture (SC) for postoperative infections and to investigate the optimal perioperative antibiotic treatment strategy in association with percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Materials and methods Between September 2016 and September 20...

The objective of this study is to explore the efficacy and safety of mechanical percussion combined with changed patient position (MPPP) on elimination of residual stones/fragments in the upper urinary tract. The study was a systematic review and meta-analysis. A systematic literature review using Pubmed, Embase, Medline, and Cochrane Library was c...

The aim of the study was to report the characteristics of urolithiasis in Uyghur patients from Xinjiang, China. The composition of stones collected from 1863 patients in the Uyghur region of Xinjiang was analyzed. The median age of patients was 17 years [25th and 75th percentiles: 2, 36]. The stones were delivered by 1299 males (69.7%) and 564 fema...

Background: To retrospectively compare the composition of urinary tract stones formed by Uyghur children from the southern (Kashgar) and northern (Urumchi) parts of the Xinjiang region. Methods: The chemical composition of urinary tract calculi formed by 855 Uyghur children from the two regions in Xinjiang (366 Kashgar and 489 Urumchi) was compa...

It is well recognized that the popularity of extracorporeal shock wave lithotripsy (SWL), despite its non-invasive character, has decreased during recent years. This is partly explained by the technological achievements in endoscopy and urologists’ enthusiasm for such procedures. Another explanation is that many urologists have been insufficiently...

Objective: To investigate the impact of green tea on urinary oxalate excretion in healthy male volunteers. Materials and methods: The oxalate concentrations after different brewing times (2-60 min) of different qualities (2-8 g) of green tea were measured in in vitro experiment. In in vivo experiment, the effects on urine composition were assess...

Purpose The characteristics and resistance patterns of urine bacteriology in patients with urinary tract stones have not been extensively studied. This study aims to investigate the microbial spectrum and antibiotic resistance of uropathogens isolated from urinary tract infections in patients with urinary stones and provide a basis for appropriate...

The Objective of this study is to analyze the difference in renal stone composition between Uyghur and Han children with urolithiasis in China and possible reasons. From May 2011 to September 2013, we analyzed the stone compositions of 274 Chinese children with urolithiasis, including 151 Uyghur children from Xinjiang Province and 123 Han children...

Protein supplements are consumed for an expected increase in muscle mass and improved exercise performance, but as their impact on lithogenic parameters are unknown, we aimed to evaluate the effects of Whey protein (WP) and Albumin upon the risk factors for nephrolithiasis. WP or Albumin supplements (one scoop/day) were administered for 3 days to 1...

Urinary stones and urine composition are the first steps in the process of recurrence prevention, but data concerning the association between the two compositions are scarce in Chinese children with urolithiasis. We retrospectively analyzed the records of children (age range 0–18 years) with urolithiasis in our center between March 2004 and Decembe...

Context: The incidence of urinary tract stone disease is increasing and the risk of recurrent stone formation is high. Appropriate therapeutic procedures with the aim of counteracting the progress of stone formation are highly desirable. Metabolic work-up is considered essential as a base for optimal design and follow-up of effective recurrence pr...

Kidney stones are mineral deposits in the renal calyces and pelvis that are found free or attached to the renal papillae. They contain crystalline and organic components and are formed when the urine becomes supersaturated with respect to a mineral. Calcium oxalate is the main constituent of most stones, many of which form on a foundation of calciu...

In this review, aspects on the importance of information on urine composition and selection of the most appropriate regimen for prevention of recurrence are discussed. For patients with urolithiasis the treatment is facilitated by urine analysis with estimates of supersaturation levels. Despite lack of strong scientific evidence for the benefit of...

At a time when there is an almost unlimited enthusiasm and preference among urologists for endoscopic stone removal, we have found it essential to meet some of the frequently presented arguments on why extracorporeal shockwave lithotripsy (SWL) should not be used. We have based our considerations in this brief article on our 30-35 years' experience...

Although shock wave lithotripsy (SWL) remains an excellent non-invasive method for active removal of stones from the ureter and kidney, its popularity has decreased during recent years and the arguments for choosing endoscopic procedures rather than the only non-invasive surgical procedure are usually based on the opinion that SWL results are infer...

To evaluate how different methods for storage and preservation of urine samples affected the outcome of analysis of risk factors for stone formation. Spot urine samples were collected from 21 healthy volunteers. Each fresh urine sample was divided into ten 10-mL aliquots: 2 without preservative, 2 with thymol, 2 with toluene, 2 with hydrochloric ac...

New AUA guidelines on the management of patients with kidney stones are a welcome addition to a field that, over the past few decades, has been neglected by urologists. Despite some limitations, this document is an extremely important reminder of what we can and should offer our stone-forming patients.

Prevention of recurrent calcium oxalate (CaOx) stone formation in the urinary tract is important to avoid negative effects on renal function, patient suffering and to reduce health care cost. Present shortcomings in this regard can be explained both by insufficient understanding of the mechanisms of stone formation and by poor patient compliance to...

This is an interesting and important article that clearly reflects some of the problems of shockwave lithotripsy (SWL) today. The clearly presented results show that successful SWL requires a considerable input that most certainly is difficult to achieve in a mobile lithotripter organization and with treatments carried out entirely by technicians....

To assess urine composition in Chinese patients with urolithiasis. Five hundred seven Chinese patients with urolithiasis from our center in southern China were included in this study. Analysis of stone composition was performed using infrared spectrometry. From all patients, 24-hour urine samples were collected for analysis of urinary variables. So...

Results of research carried out during recent years have shown that papillary subepithelial and intratubular deposits of calcium phosphate have important roles in the formation of calcium oxalate stones. In this article, the mechanisms of calcium oxalate stone formation are briefly reviewed and the background to formation of Randall's plaques type...

Cadmium exposure is associated with increased urinary calcium excretion. Hypercalciuria is recognised as a major risk factor for kidney stone formation. Increased prevalence of kidney stones among those occupationally exposed to cadmium has previously been suggested. Food is the main source of cadmium exposure in the general population with tobacco...

Objective: To evaluate the effects of oral sodium bicarbonate (NaBic) supplementation upon urinary citrate excretion in calcium stone formers (CSFs). Methods: Sixteen adult calcium stone formers with hypocitraturia were enrolled in a randomized, double-blind, crossover protocol using 60 mEq/day of NaBic during 3 days compared to the same period...

The purpose of this study is to derive approximate estimates of ion-activity products of CaOx (APCaOx) and CaP (APCaP) useful for spot urine or other less well defined short-term urine collections. In accordance with previously applied and described principles for estimating ion-activity products, the intention was to derive simplified estimates of...

Correspondence: Dr Åkesson, Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, 171 77 Stockholm, Sweden (Agneta.Akesson@ki.se). Published Online: February 4, 2013. doi:10.1001/jamainternmed.2013.2296 Author Contributions: Dr Thomas and Åkesson had full access to all of the data in the study...

This chapter is an overview of the biochemical evaluation of patients with urinary tract stone disease. The aim is to give practical aspects on how the search for risk factors can be carried out when stone composition is known or unknown. The physical chemistry of stone formation is superficially touched. Aspects on the importance of the medical hi...

Shock wave lithotripsy still remains the only noninvasive treatment modality for urolithiasis besides conservative stone management. Overall it has high efficacy, comfortable application without the need of general anesthesia, low rate of side effects, and high patient acceptance. To obtain the best results, careful attention has to be paid to choi...

This chapter summarizes and discusses some aspects of stone disease from an epidemiological and etiological point of view. The discussion is based on selected data that have been given in the various preceding chapters. In view of what we know so far and regarding recent findings in calcium stone formation, attempts are made to predict in which dir...

A number of considerations are necessary for an optimal result of extracorporeal shock wave lithotripsy. In this chapter, we present some examples of patients that pose specific problems that need to be identified and appropriately dealt with in order to achieve the desirable result of a satisfactory disintegration without serious complications. It...

The present review summarizes the most important considerations and steps for an optimal result of extracorporeal shockwave lithotripsy. The relationship between shockwave path, geometry and anatomical conditions is of utmost importance. Selection of appropriate treatment variables in terms of shockwave number, power and frequency, is an important...

Abstract During the past four decades there have been dramatic developments in the methods used for active stone removal from the urinary tract, and the need for open surgery has been almost entirely replaced by extracorporeal shockwave lithotripsy, percutaneous surgery, ureteroscopy and retrograde intrarenal surgery. Residual fragments and the pro...

Ureteral calculi represent a common condition that urologists encounter in everyday practice. Several treatment options are available for calculi that do not pass spontaneously or are unlikely to do so. In this nonsystematic review, we summarize the existing data on contemporary management of ureteral stones focusing on medical expulsive therapy (M...

Since its worldwide dissemination in 1984, extracorporeal shock-wave lithotripsy (SWL) has become established as the primary treatment for stones in the kidney. There is a general agreement that almost all renal stones up to a diameter of 20 mm can be successfully treated with this method. Even larger stones can be successfully treated provided rep...

This study aimed at formulating simplified estimates of ion-activity products of calcium oxalate (AP(CaOx)) and calcium phosphate (AP(CaP)) in mouse urineto find the most important determinants in order to limit the analytical work-up. Literature data on mouse urine composition was used to determine the relative effect of each urine variable on the...

The Future of Urology has been written in times of economic downturn, with the inevitable effects on health sector spending. Nevertheless, this document aims to define a path whereby the EAU can play a pivotal role in ensuring the highest standard of care throughout Europe, and by setting standards, throughout the rest of the world. The future of u...

Epidemiologic aspects of urinary tract stone disease are presented as a background for understanding of the clinical impact of this pathologic condition. The principles for and the determinants of the formation of calcium stones, uric acid stones, infection stones, and cystine stones are briefly discussed in a way that should provide a necessary ba...

An interpretation of previous and recent observation on calcium salt crystallization and calcium stone formation provide the basis for formulation of a hypothetical series of events leading to calcium oxalate (CaOx) stone formation in the urinary tract. The various steps comprise a primary precipitation of calcium phosphate (CaP) at high nephron le...

Theoretical modeling of urinary crystallization processes affords opportunities to create and investigate scenarios which would be extremely difficult or impossible to achieve in in vivo experiments. Researchers have previously hypothesized that calcium renal stone formation commences in the nephron. In the present study, concentrations of urinary...

Treatment for patients with urinary tract stone disease includes removal of the stones and prevention of their recurrence. However, the optimal therapy for stone disease is currently debated. How far has the field advanced in terms of treatment and understanding of stone formation?

Patients with frequently recurring urinary stones have benefited over the last few decades from the many technological advances that have been made to facilitate the acute management of a symptomatic stone in a safe and minimally invasive manner. However, this does not exempt the health-care professionals from seeking out potential causes for the s...

The combined use of extracorporeal shock wave lithotripsy (SWL) and percutaneous irrigation with chemolytic agents has proven useful for providing an extremely low-invasive therapeutic approach. This form of treatment can be applied in patients with large infection stones, as well as in patients with stones composed of brushite, cystine, and uric a...

A randomised comparison was made between high and normal diuresis during the primary session of extracorporeal shock wave lithotripsy (SWL) for removal of ureteral stones. High diuresis was accomplished by pressure infusion of approximately 1 L of Ringer acetate solution together with 20 mg of furosemide during the 30–40 min treatment session (Grou...

Although the formation of cystine stones is seen in only a small fraction of all patients with urolithiasis, this disease is associated with a pronounced morbidity. The difficult clinical management of these patients, with the aim of arresting or decreasing the rate of recurrent stone formation, is well recognized. This review summarizes some recen...

Although methods of urinary stone removal are becoming evermore effective, the prevalence of urolithiasis is continuously increasing. Epidemiological studies show that 5-10% of the population suffer from urinary stones. Stone removal alone is not a curative measure. Depending on the stone composition, a recurrence rate of 60-100% must be expected....

Medical expulsive therapy (MET) for urolithiasis has gained increasing attention in the last years. It has been suggested that the administration of alpha-adrenoreceptor antagonists (alpha-blockers) or calcium channel blockers augments stone expulsion rates and reduces colic events. To evaluate the efficacy and safety of MET with alpha-blockers and...

Crystals of calcium phosphate (CaP) added to solutions with a composition corresponding to that at different levels of the collecting duct (CD) and with different pH were rapidly dissolved at pH 5.0, 5.25 and 5.5. Only minor or no dissolution was observed at higher pH levels. Despite this effect, CaP crystals induced nucleation or heterogeneous cry...

Extracorporeal shock-wave lithotripsy (ESWL) has been available for active stone removal for more than 25 years. The efficiency and usefulness of this method for removal of stones from the kidney as well as from the ureter have been continuously reported, and the technique has stood the test of time. Modern lithotripters seem to be at least as powe...

The major concern following minimally invasive stone removal procedures is related to the presence of residual fragments, parts of the original stone or unaffected stones. There is definitely a consensus that symptomatic residuals need to be eliminated. On the other hand, for patients with asymptomatic residuals there are different attitudes. Some...

To analyze results of extracorporeal shockwave lithotripsy (SWL) for treatment of ureteral stones with two modern lithotripters. A consecutive series of 598 patients with ureteral stones was treated with the Modulith SLX Classic and Modulith SLX-F2 lithotripters. The mean (SD) age of the patients was 54 (17) years, and the mean (SD) stone surface a...

This document is being printed as submitted without editorial review. The complete main report is available at http://www.auanet.org/guidelines/ and http:Hw-ww.uroweb.org/professional-resources/guidelines/.

Numerous factors influence the treatment result and efforts for stone removal. To summarize the important factors, our aim was to formulate a general mathematical expression of the stone-removal procedure. A mathematical expression (stone treatment index; STI) was developed for patients who became stone free (SF): STI(SF) = (Num(SF) x mean(sqrt [SA...

To study the intrarenal geometry of the lower-caliceal system in patients with and without residual fragments after extracorporeal shockwave lithotripsy (SWL) and to formulate a summarizing mathematical expression of relevant variables. In a series of patients consecutively treated by SWL, we analyzed the geometric anatomy in 47 patients with (grou...

To derive hardness factors for crystal phases of urinary tract stones and describe the hardness pattern in a stone population. In a retrospective study, recordings from patients treated with extracorporeal shock-wave lithotripsy (ESWL) (stone surface area < or = 100 mm2) were used to derive hardness factors. The number of re-treatments, the number...

One hundred consecutive patients referred for active stone removal responded to a number of questions regarding their attitude to metabolic risk evaluation and recurrence prevention. Of the 74 men and 26 women all but one were interested in the cause of their disease. While 95% of the patients were motivated to change their dietary habits, only 71%...

To evaluate the clinical use of a simple device (Hemostick) developed to enable a standardized description of the degree of macroscopic haematuria. The visual scale (Hemostick) used in this study comprised six colour fields, one yellow (blank; 0) and five with different nuances of red (1-5) selected from a colour scale according to clinical observa...

A literature review was made to obtain information on the treatment efforts required for a successful removal of ureteral stones when extracorporeal shock wave lithotripsy (ESWL) or ureteroscopic stone extraction or disintegration (URS) were used as primary procedures. Data were collected from 59 reports on ESWL and 23 on URS. The study thereby com...

Unabsorbed fat and bile acids may react with calcium in the intestinal lumen, limiting the amount of free calcium binding with oxalate and thereby raising intestinal oxalate absorption leading to hyperoxaluria. The aim of the present study was to determine whether orlistat (Xenical), a gastrointestinal lipase inhibitor, might increase urinary oxala...

Formation of urinary tract concrements is a common disease and steps should be taken in order to elucidate the underlying mechanisms and to give the patients appropriate advice and medical treatment. This present article summarizes the principles for recurrence preventive measures in patients with uric acid, infection, cystine and calcium stone dis...

The objective of this report was to derive a simplified approximate estimate of the ion-activity product of calcium oxalate (AP(CaOx)) in rat urine. The relative effect of each urine variable was assessed by means of iterative computerised approximation with the EQUIL2 program. A basic urine composition was chosen from literature and experimental d...