27 February 2005	Sunday	17 Muharram 1426

KARACHI, Feb 26: Latest technology for diagnosing kidney stones and their causative factors has improved the treatment prospects and provided the grounds for preventive measures.

This was observed during the urolithiasis symposium on Saturday, which is being organized by the Sindh Institute of Urology and Transplantation in collaboration with the Urolithiasis Society of Europe. The three-day symposium, which began on Friday, was addressed by urologists from different parts of the world.

Discussing stone composition and structure, Dr Mirza Naqi Zafar of the SIUT referred to ultra structure of amino acid stones in children between one and five years of age.

He said that these children were exposed to malnutrition and dehydration resulting in excess uric acid and ammonia in urine which favoured stone formation.

In the very session, Dr Fazil Marickar from South India said that in his region most stones were calcium oxalate followed by uric acid.

He enumerated the recent modalities for stone analysis. "Some of which are qualitative and quantitative analysis, X-ray diffraction, CT scan, Therma gravimetric analysis, petrography and optical microscopy. All are useful technologies and the results provide the basis for treatment especially prophylaxis," he said.

Talking on the basic structure of renal stone, Dr Allan Rodgers from Cape Town, South Africa, said that these stones were multi-factorial, as geography, climate and profession played important role.

Genetics, metabolic factors and infections were also very important in this regard, he added.

Dr S.R. Khan from Florida spoke on organic matrix of renal stones. He said that like other products of crystallization in biological systems, stones were composites of crystals and organic material, called Matrix. He was of the opinion that the role of matrix compounds was different in the stone centre and the subsequent layers of the stone.

During another session of the symposium, experts from overseas discussed dietary and medical management of kidney stones.

Dr A. Hesse from Germany talked on the role of nutrition in the formation of calcium oxalate stones. He made a clear distinction between neutral effect exerted by drinking water, fruit, teas and grape juice.

Inhibitory action by mineral water of high bicarbonate content and citrus juices was also discussed by the speaker who further mentioned that the lithogenic beverages like alcoholic and cola drinks, black tea and milk more than 500ml encourage stone formation. Many fruits and vegetables as spinach and rhubarb have high oxalate content and should be avoided, he suggested.

Dr Fazil Marickar presented the results of his study on dietary habits of stone formers. He concluded that dietary habits played an insignificant role but on a person with tendency to form stones, dietary habits had a marked effect on the precipitation and progression of stone disease.

In these patients, he said, dietetic prophylaxis would be successful in prevention of further stone formation. A high citrate diet was beneficial for preventing further stone formation, he added.

The session on stone research started with Dr Allan's talk on the use of finger print methods to study urolithiasis. He preferred X-ray power diffraction and infrared spectroscopy, which gave better results.

Dr S.R. Khan from Florida and Dr Gohel from Hong Kong addressed the possible mechanisms of kidney stone formation and steps to decrease the risk. They said that with the introduction of endoscopic techniques in urology, two decades ago, treatment has become less invasive, requiring a shorter hospital stay. The fact that ESWL (Lithotripsy) was now the therapy of choice for more than 90 per cent of renal stones was endorsed by Dr Hammad Zafar and Dr Murli Lal from Karachi while presenting results of their study.

Dr P.N. Rao from Manchester and Dr Zafar Hussein, Dr Zahid Khan, Dr Rana and Dr Zafar Zaidi from Karachi discussing their experience said that the PNCL was considered an important modality of treatment for complex renal calculi.

According to them, lithotripsy showed better results in staghorn calculi and upper ureteric calculi. The speakers agreed that these new techniques had minimal complications and a shorter hospital stay.

The latest imaging techniques were discussed by Dr Zahid Khan, who said that the scenario for treating urological stones had been completely changed due to a better and more accurate diagnosis and lesser need for open surgery. -APP