Recurrent Renal Lithiasis

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With the modern facilities now available, an early and accurate diagnosis of urinary calculi may be established and surgical intervention instituted before the kidney has suffered irreparable damage. However, the recurrent formation of calculi following operation constitutes a major problem in urologic surgery and, in view of the frequency with which this occurs, the operative procedure, per se, must be considered as but one phase in the management of patients with calculous disease.

Numerous publications have appeared in the literature concerning the experimental production of urinary calculi, the etiologic factors associated with the formation of calculi, and refinements in operative technic, but the problem of recurrence and its prevention has only recently received attention. It is essential that intensive preoperative investigation be carried out to ascertain the etiologic factors associated with the formation of the primary calculus and that correction of the underlying factors be accomplished in order to prevent and minimize the formation of recurrent calculi. To better understand the problem, the present conceptions of calculous formation must be considered.

Lesion of the Papilla

In 1912 at the meeting of the American Association of Genito-Urinary Surgeons, Caulk1 reported a case of calcareous incrustation around one of the renal papillae and the next year, he2 presented three additional cases in which a similar pathological process was found. Dr. Opie gave the following pathological description of the papillary lesion: “The section of the papilla with the incrustation showed that the tip of the papilla was covered with a homogeneous material, which. . .



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