Urinary Calculi in Aviation Pilots: What is the Best Therapeutic Approach? (2002)

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Oct 2002Urinary Calculi in Aviation Pilots: What is the Best Therapeutic Approach? Wei Zheng, Darren T. Beiko, Joseph W. Segura, Glenn M. Preminger, David M. Albala, and John D. Denstedt Wei ZhengWei Zheng , Darren T. BeikoDarren T. Beiko , Joseph W. SeguraJoseph W. Segura , Glenn M. PremingerGlenn M. Preminger , David M. AlbalaDavid M. Albala , and John D. DenstedtJohn D. Denstedt View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64444-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We reviewed treatment outcomes in a series of aviation pilots treated in the era of modern surgical techniques and provide recommendations regarding treatment in this unique group. Materials and Methods: We retrospectively analyzed the records of all aviation pilots surgically treated for urinary calculi at our 4 tertiary stone centers from January 1988 to June 2000. Preoperative data and postoperative results were evaluated. Primary outcome measures included stone-free status after initial therapy, time lost from work and overall stone-free rates. Secondary outcome measures included the need for secondary procedures and complications. Results: Of the 36 patients 17 had renal and 19 had ureteral stones. In 4 patients the stones passed spontaneously, while 17 were initially treated with extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia), 9 were initially treated with ureteroscopy and 6 were treated with percutaneous nephrolithotripsy. There was 1 complication. The stone-free rate for ESWL, percutaneous nephrolithotripsy and ureteroscopy after initial therapy was 35%, 100% and 100%, respectively. All patients were rendered stone-free after secondary therapy. Mean time lost from work for ESWL, percutaneous nephrolithotripsy and ureteroscopy was 4.7, 2.6 and 1.6 weeks, respectively. Conclusions: Aviation pilots with surgical urolithiasis are best treated with an initial endoscopic procedure. Stone-free rates can be maximized, while time lost from work can be minimized when an endoscopic approach is used initially. All pilots with urolithiasis should undergo mandatory metabolic evaluations to institute medical therapy when indicated. References 1 Guide for Aviation Medical Examiners, Office of Aviation Medicine. Washington, D.C.: U.S. Department of Transporation Federal Aviation Administration, 1999 Google Scholar 2 Aeromedical Certification Statistical Database. Washington, D.C.: United States Department of Transportation, Aeromedical Certification Division, Civil Aeromedical Institute, Federal Aviation Administration, 1997 Google Scholar 3 : The use of extracorporeal shock wave lithotripsy in aviators. Aviat Space Environ Med1987; 58: 260. Medline, Google Scholar 4 : Percutaneous nephrolithotomy and the flyer. Aviat Space Environ Med1985; 56: 1102. Medline, Google Scholar 5 : State-of-the-art management of renal stone disease in aviators and military special duty personnel. Aviat Space Environ Med1988; 59: 1066. Medline, Google Scholar 6 : Spontaneous resolution of retained renal calculi in USAF Aviators. Aviat Space Environ Med1995; 66: 1001. Medline, Google Scholar 7 : Report of the United States cooperative study of extracorporeal shock wave lithotripsy. J Urol1986; 135: 1127. Link, Google Scholar 8 : Percutaneous removal of kidney stones: review of 1,000 cases. J Urol1985; 134: 1077. Link, Google Scholar 9 : Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol1999; 162: 1904. Link, Google Scholar 10 : Clinical implications of clinically insignificant stone fragments after extracorporeal shock wave lithotripsy. J Urol1996; 155: 1186. Link, Google Scholar 11 : The natural history of asymptomatic urolithiasis. J Urol1992; 147: 319. Link, Google Scholar 12 : the Lower Pole Study Group: Prospective randomized trial of ESWL and PCNL for lower pole nephrolithiasis: financial subanalysis. J Urol1999; 161: 369. Crossref, Medline, Google Scholar 13 : Holmium: YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol2002; 167: 31. Link, Google Scholar 14 : Simultaneous bilateral percutaneous nephrolithotomy. J Urol1997; 158: 2065. Link, Google Scholar 15 : Critical analysis of supracostal access for percutaneous renal surgery. J Urol2001; 166: 1242. Link, Google Scholar 16 : Mini-percutaneous nephrolithotomy. J Endourol2000; 14: 269. Crossref, Medline, Google Scholar 17 : Tubeless percutaneous renal surgery. J Urol1997; 157: 1578. Link, Google Scholar 18 : Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis—initial results. J Urol2001; 166: 2072. Link, Google Scholar 19 : Renal stone risk assessment during space shuttle flights. J Urol1997; 158: 2305. Link, Google Scholar 20 : Urine volume and its effects on renal stone risk in astronauts. Aviat Space Environ Med2001; 72: 368. Medline, Google Scholar From the Division of Urology, University of Western Ontario, London, Ontario, Canada, and Departments of Urology, Mayo Clinic, Rochester, Minnesota, Duke University, Durham, North Carolina, and Loyola University Medical Center, Maywood, Illinois© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited by Geavlete P, Georgescu D, Mulţescu R, Alexandrescu E, Drăguţescu M, Stănescu F, Persu C, Moldoveanu C, Jecu M and Geavlete B (2016) Percutaneous Approach in Renal Lithiasis Percutaneous Surgery of the Upper Urinary Tract, 10.1016/B978-0-12-802404-1.00003-7, (25-103), . Fahmy N and Denstedt J (2013) Patient Selection and Informed Consent Percutaneous Renal Surgery, 10.1002/9781118670903.ch5, (46-58) Giannossi M and Summa V (2013) An Observation on the Composition of Urinary Calculi: Environmental Influence Medical Geochemistry, 10.1007/978-94-007-4372-4_5, (67-90), . Hyams E, Nelms D, Silberman W, Feng Z and Matlaga B (2011) The Incidence of Urolithiasis Among Commercial Aviation PilotsJournal of Urology, VOL. 186, NO. 3, (914-916), Online publication date: 1-Sep-2011. Probst C, Denstedt J and Razvi H (2009) Preoperative Indications for Percutaneous Nephrolithotripsy in 2009Journal of Endourology, 10.1089/end.2009.1518, VOL. 23, NO. 10, (1557-1561), Online publication date: 1-Oct-2009. Radulovic S, Vuksanovic A, Milenkovic-Petronic D and Vavic B (2008) The influence of lithotripsy methods on the incidence of auxiliary procedures after ureteric stone desintegrationVojnosanitetski pregledMilitary Medical and Pharmaceutical Journal of Serbia, 10.2298/VSP0808619R, VOL. 65, NO. 8, (619-625), . Wen C and Nakada S (2007) Treatment Selection and Outcomes: Renal CalculiUrologic Clinics of North America, 10.1016/j.ucl.2007.04.005, VOL. 34, NO. 3, (409-419), Online publication date: 1-Aug-2007. L'esperance J, Ekeruo W, Scales C, Marguet C, Springhart W, Maloney M, Albala D and Preminger G (2005) Effect of ureteral access sheath on stone-free rates in patients undergoing ureteroscopic management of renal calculiUrology, 10.1016/j.urology.2005.03.019, VOL. 66, NO. 2, (252-255), Online publication date: 1-Aug-2005. LAUBE N, HERGARTEN S, HOPPE B, SCHMIDT M and HESSE A (2018) DETERMINATION OF THE CALCIUM OXALATE CRYSTALLIZATION RISK FROM URINE SAMPLES: THE BONN RISK INDEX IN COMPARISON TO OTHER RISK FORMULASJournal of Urology, VOL. 172, NO. 1, (355-359), Online publication date: 1-Jul-2004. Lewandowski S and Rodgers A (2004) Idiopathic calcium oxalate urolithiasis: risk factors and conservative treatmentClinica Chimica Acta, 10.1016/j.cccn.2004.03.009, VOL. 345, NO. 1-2, (17-34), Online publication date: 1-Jul-2004. (2003) LiteratureWatchJournal of Endourology, 10.1089/08927790360587469, VOL. 17, NO. 2, (117-124), Online publication date: 1-Mar-2003. Volume 168Issue 4 Part 1October 2002Page: 1341-1343 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.KeywordsaviatorsurolithiasislithotripsyMetricsAuthor Information Wei Zheng More articles by this author Darren T. Beiko More articles by this author Joseph W. Segura More articles by this author Glenn M. Preminger More articles by this author David M. Albala More articles by this author John D. Denstedt More articles by this author Expand All Advertisement PDF downloadLoading ...