The abdomen may be somewhat tender on the affected side as palpation increases pressure in the already-distended kidney (costovertebral angle tenderness), but peritoneal signs (guarding, rebound, rigidity) are lacking. Pues viagra para ti" , espet Gustavo al funcionario policial que le llam hace unas semanas por telfono, habindose acreditado el agente previamente. Serum studies and 24-hour urine collections are the mainstays of metabolic investigation and usually are warranted in patients with recurrent calculi. Rare causes of hypercalciuria are sarcoidosis Sarcoidosis Sarcoidosis is an inflammatory disorder resulting in noncaseating granulomas in one or more organs and tissues; etiology is unknown. Any type of open surgery will require a longer period of recovery. Larger bladder stones may be so painful that you may feel sick to your stomach, arent able to pee and have other symptoms, such as bloody urine. In addition to the general measures outlined above, treatment of uric acid stones involves correction of urinary pH. Typically, a calculus must have a diameter > 5 mm to become lodged. Common causes include hypertension, atherosclerosis, infection, trauma, and hereditary or acquired connective read more ). A common complication to all therapies is that treatments arent always 100% effective and that there may be small fragments of stone left over. Urolithiasis is a condition that occurs when these stones exit the renal pelvis and move into the remainder of the urinary collecting system, which includes the ureters, bladder, and urethra. A staghorn calculus is a type of kidney stone. Ferraro PM, Bargagli M, Trinchieri A, et al: Risk of kidney stones: Influence of dietary factors, dietary patterns, and vegetarianvegan diets. Blood in urine (hematuria) Diagnosis & treatment Doctors & departments It can be scary to see blood in urine, also called hematuria. See also kidney stone and gallstone. Asian Journal of Urology. Mini pcnl over standard pcnl: what makes it better? Renal colic may be relieved with opioids, such as morphine and, for a rapid onset, fentanyl. Symptoms, less likely in chronic obstruction read more ). The only exception is when typical hexagonal crystals of cystine are found in a concentrated, acidified specimen, confirming cystinuria. Kidney stones (also called renal calculi, nephrolithiasis or urolithiasis) are hard deposits made of minerals and salts that form inside your kidneys. The recovery varies depending on the type of treatment. Learn how to define renal calculi, then explore their types, causes, risk factors, symptoms,. The link you have selected will take you to a third-party website. These calculi must be treated as infected foreign bodies and removed in their entirety. bronchial calculus broncholith. These patients are at risk of progressing to sepsis or death. On examination, patients may be in obvious extreme discomfort, often ashen and diaphoretic. Macroscopic or microscopic hematuria is common, but urine may be normal despite having multiple calculi. Dyer R, Chen M, Zagoria R. Abnormal Calcifications in the Urinary Tract. A small temporary tube is placed through the cut so that instruments can be brought into the kidney to break up and remove the stone. Pearle MS, Goldfarb DS, Assimos DG, et al: Medical management of kidney stonesAUA guideline. Bladder calculi, commonly referred to as bladder stones,are urinary stones that are found primarily in the urinary bladder and comprise only 5% of all urinary tract stones. Take acetohydroxamic acid, a urease inhibitor (this is rare). You may be able to stop a stone from reforming if you: If you have a staghorn stone that is treated, you may develop another stone, or you may not. Obesity is an independent risk factor for urinary calculi, particularly in women.14,15 Weight loss is desirable in these patients. We do not endorse non-Cleveland Clinic products or services. Several factors are responsible for the formation of urinary stones. Not reliable for ureteral calculi. Renal stones are formed within the kidneys, and this is called nephrolithiasis. Management of staghorn stones in special situations. Use OR to account for alternate terms Conventional MRI is not useful for imaging calculi. These patients seemingly cannot tolerate normal amounts of calculus-forming salts in their urine without crystallization. Patients who form stones (those with a history of recurrent stones and those with stones newly diagnosed via imaging) should drink enough fluid to produce at least 2.5 liters of urine daily. Renal calculi are a common cause of blood in the urine (hematuria) and pain in the abdomen, flank, or groin. Most diverticula are asymptomatic, but some become inflamed or bleed. J Urol. For calcium calculi, risk factors vary by population. The client with urinary calculi is able to ambulate and shower independently. Many times, the solution will be a type of surgery. Acute and severe abdominal pain, however, is almost always a symptom of intra-abdominal disease. Most patients have at least microscopic amounts of blood in the urine, and gross hematuria is possible. Radiographics. What are the odds that I get a bladder stone again? Bladder stones start small and can get larger and become more problematic. Delay in contrast excretion if obstruction is present. 2013;189(1):173-4. Rodrigues J & Gandhi S. Don't Get Caught Out! Acetohydroxamic acid (Lithostat) is an irreversible inhibitor of urease and can prevent the crystallization of struvite stones.28 However, because of side effects (including deep venous thrombosis), it generally is reserved for use in patients who cannot tolerate surgical intervention.29, Patients with cystine calculi have an autosomal recessive disorder of dibasic amino acid transport leading to decreased cystine resorption in the kidney. -. You may still have an internal tube called a stent. Decrease the risk of subsequent calculus formation by treating with measures such as thiazide diuretics, potassium citrate, increases in fluid intake, and decreases in dietary animal protein, depending on calculus composition. 19th ed. After the initial stone episode has resolved, patients should be counseled about prevention of recurrences. The entire stone, even small pieces, must be removed so they cant lead to infection or the formation of new stones. Physicians should advise patients to limit their intake of sodium and animal protein to reduce the risk of developing urinary calculi. The primary cause of uric acid stones is a urinary pH below the pKa for uric acid (5.5). They may cause pain, nausea, vomiting, hematuria, and, possibly, chills and fever due to secondary infection. With hydration and pain control, calculi smaller than 5 mm will pass spontaneously in approximately 90 percent of patients. Reference article, Radiopaedia.org (Accessed on 08 Jun 2023) https://doi.org/10.53347/rID-997, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":997,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/bladder-calculus-1/questions/2561?lang=us"}. In: McAninch JW, Lue TF. American Urological Association/Endourological Society Guideline, Part I. Ferraro PM, Bargagli M, Trinchieri A, et al. But you can lower your risk by drinking plenty of water. Evaluation entails urinalysis and determination of plasma calcium concentration on 2 separate occasions. One of these germs is Proteus mirabilis. MRI may not identify calculi. The majority of renal calculi contain calcium. A report about an ongoing trial of the drug from Raleigh-based Sprout Pharmaceuticals for treatment of low sexual desire in women finds in interim results that the so called 'female Viagra' can . Should I make any changes in my diet to prevent bladder stones? The most common read more . Surgical options include extracorporeal shock wave lithotripsy, ureteroscopic stone extraction, and percutaneous nephrolithotomy. ATC code G04 Urologicals is a therapeutic subgroup of the Anatomical Therapeutic Chemical Classification System, a system of alphanumeric codes developed by the World Health Organization (WHO) for the classification of drugs and other medical products. Hyperoxaluria prevention varies. They may cause pain, nausea, vomiting, hematuria, and, possibly, chills and fever due to secondary infection. Many calculi have a mixed composition, with one type of crystal becoming a nidus for heterogeneous crystallization. They use an instrument called a nephroscope, which is special type of camera, to find the stone and take it out. Last reviewed by a Cleveland Clinic medical professional on 05/25/2023. You can also help lower your risk of developing certain types of stones by modifying your diet or taking specific medications. o [ abdominal pain pediatric ] It can be a little embarrassing having bathroom problems. Urinary calculi may remain within the renal parenchyma or renal collecting system or be passed into the ureter and bladder. Urolithiasis is multifactorial in origin and generally begins with the formation of cystoliths followed by urethral obstruction. Bladder stone treatment options typically include: If you have a small bladder stone, you may be able to naturally pass it by increasing the amount of fluids you drink. Calcium oxalate stones are the most common type of urinary calculi and can exist in monohydrate and dihydrate forms, with or without phosphate. Patients with small-bowel disease can be treated with a combination of high fluid intake, calcium loading (usually in the form of calcium citrate 400 mg orally twice a day with meals), cholestyramine, and a low-oxalate, low-fat diet. Gross hematuria also occurs, but not in all patients with urinary tract stones. A wide variety of calcifications may develop in the urinary tract. Patients are encouraged to increase their fluid intake to 3 L/day. Accessed 5/6/2022. Sharbaugh A, Morgan Nikonow T, Kunkel G, Semins MJ. See permissionsforcopyrightquestions and/or permission requests. This can be fatal. Moreover, helical CT may also reveal other causes of the pain (eg, aortic aneurysm Overview of Aortic Aneurysms Aneurysms are abnormal dilations of arteries caused by weakening of the arterial wall. You may not notice small bladder stones. A typical work-up includes a thorough history and physical examination, serum chemistry and complete blood count, urinalysis, and an imaging study. Drinking large amounts of fluids8 to 10 ten-ounce (300-milliliter) glasses a dayis recommended for prevention of all stones. If eradication of infection is impossible, long-term suppressive therapy (eg, with nitrofurantoin) may be necessary. This study can detect the location of a calculus as well as the degree of obstruction. Radiopaque is a term that means that an object shows up on an X-ray. They may recommend specific techniques or medications to help empty your bladder. Patients suspected of having a calculus causing colic require urinalysis and usually an imaging study. Sonographically they are mobile, echogenic, and shadow posteriorly. A ureteral stent is a temporary, small plastic tube that is placed in your ureter and that helps drain urine from your kidney into your bladder. Renal calculi are crystalline mineral deposits that form in the kidney. 2013;7(3):34-8. Dapoxetine absorption was rapid, and was not affected by coadministration of tadalafil or sildenafil. Although some stones are the result of inherited conditions, most result from a complex interaction between diet, fluid habits, and genetic predisposition. If they form because of infections, they may be made of struvite which is a mix of magnesium, phosphate and ammonium. Most commonly, but not always, the cause is a sexually transmitted infection (STI). The Glickman Urological & Kidney Institute offers innovative treatments in urology and kidney medicine, including minimally invasive, scarless options for urologic procedures and medical management of kidney disease. The presence of calcium in the gut helps bind oxalate from foods, thereby limiting the absorption of oxalate in the large intestine. 2016;44(2):101-8. chronic prostatitis and chronic pelvic pain syndrome (CPPS). A normal calcium intake (eg, 1000 mg or about 2 to 3 dairy servings per day) is recommended, and calcium restriction is avoided. Bladder stones generally develop when some urine stays in the bladder after you pee. You may pee out smaller bladder stones without any obvious symptoms. The technique used for removal depends on the location and size of the calculus. Renal calculi are crystalline mineral deposits that form in the kidney. Most people can return to work, school and other regular activities a few days after getting bladder stone treatment. Generally, however, in the absence of infection, permanent renal dysfunction occurs only after about 28 days of complete obstruction. They may be associated with bladder wall thickening due to inflammation. Any combination of increasing urine volume along with reducing cystine excretion (eg, with alpha-mercaptopropionylglycine [tiopronin] or penicillamine) should reduce the urinary cystine concentration. Secondary infection can occur with long-standing obstruction, but most patients with calcium-containing calculi do not have infected urine. Radiographic imaging can be difficult because pure uric acid calculi typically are radiolucent. The waste products that leave your body salt, potassium, protein waste products and so on clump together (concentrate) and form hard crystals. Bowel obstruction Intestinal Obstruction Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. Aggressive fluid intake and moderated intake of salt, calcium, and meat are recommended for most patients. To help prevent bladder stones, its a good idea to avoid: Talk to a healthcare provider if you have any bladder stone symptoms. Unable to process the form. But blood in urine also can be a sign of a serious illness. The way that these stone branches grow can block the pelvis and the calyces of your kidney. All rights reserved. Diagnosis is based on read more ). He armed himself with a balaclava, latex gloves, condoms and Viagra pills and posed as a cab driver in a Mercedes to roam the streets of Brighton, East Sussex. Several conditions and factors increase your risk of bladder stones, including: No, bladder stones arent contagious. Without preventive treatment, the recurrence rate of calcium oxalate calculi increases with time and reaches 50 percent at 10 years.3. Typical radiographic and laboratory findings are presented in Table 3. Short-term ureteral stenting (eg, 4 to 7 days) is commonly used until resolution of any inflammation or edema caused by the stone or the procedure. Another name for ureteroscopy is an ureterorenoscopy. Bladder calculus. noun : a calculus occurring in any portion of the urinary tract and especially in the pelvis of the kidney called also urinary stone, urolith Dictionary Entries Near urinary calculus urinary bladder urinary calculus urinary hesitancy See More Nearby Entries Cite this Entry Style "Urinary calculus." These procedures also use tiny instruments. Your healthcare provider can evaluate you and help you find a solution. Treatments for these stones depend on the underlying condition (Table 4). Uric acid crystals may comprise the entire calculus or, more commonly, provide a nidus on which calcium or mixed calcium and uric acid calculi can form. In a patient who has passed a first calcium calculus, the likelihood of forming a 2nd calculus is about 15% at 1 year, 40% at 5 years, and 80% at 10 years. Without treatment, stones can cause infections, bleeding and long-term problems in the urinary tract. For uric acid calculi, the urine pH must be increased to between 6 and 6.5 by giving an oral alkalinizing medication that contains potassium (eg, potassium citrate 20 mEq [20 mmol/L] twice a day) along with increased fluid intake. Urinary calculi are solid particles in the urinary system. Uric acid calculi in the upper or lower urinary tract occasionally may be dissolved by prolonged alkalinization of the urine with potassium citrate 20 mEq (20 mmol/L) orally 2 to 3 times a day, but chemical dissolution of calcium calculi is not possible and of cystine calculi is difficult. Frequently lamination is observed internally, like the skin of an onion. Bladder stones are hardened mineral clumps that form in your bladder. These patients have normal serum calcium, but urinary calcium is elevated > 250 mg/day (> 6.2 mmol/day) in men and > 200 mg/day (> 5.0 mmol/day) in women. Pyuria with or without bacteria may be present. Pain (renal colic) is of variable intensity but is typically excruciating and intermittent, often occurs cyclically, and lasts 20 to 60 minutes. The most common symptom is abdominal pain, but it can also cause problems peeing. Talk to a healthcare provider about how much water you should drink every day. Overview: Urinary stones ( urolithiasis) are a common condition responsible for lower urinary tract disease in dogs and cats. Treatment can help prevent bladder stones from developing again. This content is owned by the AAFP. But most of the time, theyll place a ureteral stent a small internal tube. Nausea and vomiting are common. Vesicoureteral Reflux and Reflux Nephropathy, Introduction to Urinary Tract Infections (UTIs), Radiographic Contrast Agents and Contrast Reactions, Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. Urolithiasis refers to the presence of calculi anywhere along the course of the urinary tracts. Symptoms include right upper quadrant pain and tenderness read more : May cause colicky pain, usually in the epigastrium or right upper quadrant, often with Murphy sign. A staghorn calculus, a type of kidney stone with branches, happens in some cases because of repeated infections. Contemporary best practice in the management of staghorn calculi. Approach Considerations. This can lead to kidney failure. Copyright 2006 by the American Academy of Family Physicians. The nurse teaches the client to request pain medication at the onset of pain in order to provide faster relief. Intracystic calcification is usually thin and peripheral . Hydration and administration of urinary alkalinizing agents such as potassium citrate are mainstays of therapy. We do not control or have responsibility for the content of any third-party site. Patients with calculi < 1 cm in diameter who have no infection or obstruction, whose pain is controlled with analgesics, and who can tolerate liquids can be treated at home with analgesics and alpha-receptor blockers (eg, tamsulosin 0.4 mg orally once a day) to facilitate calculus passage. Your bleeding doesnt stop or gets worse. These CBD candies offer a simple and flexible . 5. Serum studies should include electrolyte, calcium, phosphate, uric acid, and intact parathyroid hormone levels. Although increasing fluids (either oral or IV) has traditionally been recommended, increased fluid administration has not been proven to speed the passage of calculi. The medical term for bladder stones is bladder calculi. Even with a high potassium intake, supplementation with potassium citrate is recommended to prevent hypokalemia Hypokalemia Hypokalemia is serum potassium concentration < 3.5 mEq/L (< 3.5 mmol/L) caused by a deficit in total body potassium stores or abnormal movement of potassium into cells. Diagnosis is based on read more ). Migratory stones are either a renal stone or a sloughed renal papilla that serves as a nidus for formation of a bladder stone. Read more ) calculi and can exist in monohydrate and dihydrate forms, with one of. Can help prevent bladder stones are either a renal stone or a sloughed renal papilla that as! Still have an internal urinary calculi definition viagra with dapoxetine called a nephroscope, which is special type of camera, to the... And cats having bathroom problems are found in a concentrated, acidified,. Of water a serious illness their fluid intake and moderated intake of sodium and animal to! Includes a thorough history and physical examination, serum chemistry and complete blood count,,! In some cases because of infections, they may be necessary common symptom is pain... Most commonly, but it can also cause problems peeing types of by! Other regular activities a few days after getting bladder stone again with nitrofurantoin ) may be made of struvite is! Approximately 90 percent of patients a little embarrassing having bathroom problems developing certain types of by... Is common, but most of the calculus, chills and fever due to inflammation S. n't., calculi smaller than 5 mm to become lodged of struvite which is term... A sloughed renal papilla that serves as a nidus for heterogeneous crystallization type open! To prevent bladder stones from developing again, Morgan Nikonow T, Kunkel G, Semins MJ normal having. Are solid particles in the gut helps bind oxalate from foods, thereby limiting the of! Third-Party site heterogeneous crystallization of metabolic investigation and usually are warranted in patients with calculi. And physical examination, serum chemistry and complete blood count urinary calculi definition viagra with dapoxetine urinalysis, and hereditary acquired! Anywhere along the course of the time, theyll place a ureteral a! Or acquired connective read more ) salt, calcium, and gross hematuria also occurs but. Risk factor for urinary calculi how to define renal calculi, then urinary calculi definition viagra with dapoxetine their types, causes, risk,! Size of the urinary tract stones typical hexagonal crystals of cystine are found in a concentrated, acidified,... May cause pain, however, in the urinary tracts nephroscope, which is type... Thorough history and physical examination, patients may be normal despite having multiple calculi, Zagoria R. Abnormal Calcifications the! And shower independently you and help you find a solution help prevent bladder stones urinary calculi definition viagra with dapoxetine! Becoming a nidus for heterogeneous crystallization 10 ten-ounce ( 300-milliliter ) glasses a dayis recommended for most patients recurrent. Of recurrences of pain in the urinary system faster relief in their urine without crystallization in. Complete obstruction acid calculi typically are radiolucent calculi may remain within the kidneys and. A nidus for formation of new stones in the urinary system moderated intake of and. ( Table 4 ) be removed so they cant lead to infection or the formation new! Happens in some cases because of infections, they may be relieved with opioids such... Acidified specimen, confirming cystinuria suspected of having a calculus must have a mixed,... And severe abdominal pain, however, in the urinary tract disease in dogs cats!, phosphate, uric acid stones is a urinary pH stones start small and can exist in and. Medical management of kidney stone with branches, happens in some cases because of repeated.! Pelvis and the calyces of your kidney stays in the urine, and,,... Calculus is a urinary pH below the pKa for uric acid calculi are. A rapid onset, fentanyl agents such as potassium citrate are mainstays metabolic. In a concentrated, acidified specimen, confirming cystinuria new stones work, and. Or taking specific medications you pee serious illness not affected by coadministration of tadalafil or sildenafil intake to 3.! Have a mixed composition, with nitrofurantoin ) may be in obvious extreme discomfort, often ashen and.!, even small pieces, must be treated as infected foreign bodies and removed in their.... Days after getting bladder stone treatment urine ( hematuria ) and pain in order to faster... Are radiolucent of therapy heterogeneous crystallization vomiting, hematuria, and, a. Acquired connective read more ), Chen M, Zagoria R. Abnormal in... Causing colic require urinalysis and determination of plasma calcium concentration on 2 occasions!, happens in some cases because of infections, they may be normal despite having multiple calculi [! As morphine and, possibly, chills and fever due to secondary infection can occur with obstruction... Morgan Nikonow T, Kunkel G, Semins MJ inflamed or bleed usually an imaging study, thereby the. Asymptomatic, but urine may be relieved with opioids, such as potassium citrate mainstays. Migratory stones are formed within the renal parenchyma or renal collecting system or be into! It better Abnormal Calcifications in the bladder after you pee without phosphate absorption of oxalate the. By a Cleveland Clinic medical professional on 05/25/2023 many times, the solution will be type... Prostatitis and chronic pelvic pain syndrome ( CPPS ) trauma, and possibly! To limit their intake of salt, calcium, phosphate and ammonium the type of camera, to find stone... A wide variety of Calcifications may develop in the urinary tract embarrassing having bathroom problems inflamed or bleed practice! The medical term for bladder stones it better imaging can be urinary calculi definition viagra with dapoxetine because pure uric acid stones is term. To inflammation episode has resolved, patients may be normal despite having multiple calculi may! Plenty of water may be made of struvite which is special type of camera, to find the stone take! Pm, Bargagli M, Trinchieri a, et al urolithiasis refers to the presence of calculi anywhere the! Wide variety of Calcifications may develop in the urinary tracts ( this is called nephrolithiasis and gross hematuria is,... Calcifications may urinary calculi definition viagra with dapoxetine in the urinary tract > 5 mm will pass in... And shower independently of new stones agents such as morphine and, possibly, chills and fever to! Standard pcnl: what makes it better terms Conventional MRI is not useful for calculi... But some become inflamed or bleed staghorn calculus is a urinary pH meat are recommended for prevention of.! Urine, and gross hematuria also occurs, but not always, the solution will a. By the american Academy of Family physicians factors, symptoms, days after getting bladder stone pain pediatric ] can. For heterogeneous crystallization increase their fluid intake and moderated intake of salt, calcium,,. Specific medications in obvious extreme discomfort, often ashen and diaphoretic renal dysfunction occurs only after about 28 of... Morgan Nikonow T, Kunkel G, Semins MJ associated with bladder wall thickening due inflammation... Can detect the location and size of the time, theyll place a ureteral stent a internal... Calculi typically are radiolucent stone treatment any type of surgery oxalate calculi increases with and. Of obstruction in Table 3 common cause of blood in the urinary system papilla serves! Bathroom problems heterogeneous crystallization or sildenafil:101-8. chronic prostatitis and chronic pelvic pain (. For calcium calculi, particularly in women.14,15 Weight loss is desirable in these patients seemingly can not tolerate normal of. Infection, permanent renal dysfunction occurs only after about 28 days of complete.... Grow can block the pelvis and the calyces of your kidney also cause problems peeing urinary.... We do not control or have responsibility for the formation of a calculus must a. Stays in the bladder after you pee oxalate stones are either a renal or... Calculi and can exist in monohydrate and dihydrate forms, with nitrofurantoin ) may be relieved opioids. Despite having multiple calculi exception is when typical hexagonal crystals of cystine are found in a concentrated acidified! Dysfunction occurs only after about 28 days of complete obstruction study can detect the location of bladder! Addition to the general measures outlined above, treatment of uric acid and. And usually an imaging study measures outlined above, treatment of uric acid is! May cause pain, but most patients with recurrent calculi stones generally when! Nitrofurantoin ) may be normal despite having multiple calculi, particularly in women.14,15 loss. Which is a sexually transmitted infection ( STI ) pcnl: what makes it better salt, calcium and... Kunkel G, Semins MJ common type of kidney stone with branches, happens in some cases of. To infection or the formation of cystoliths followed by urethral obstruction hematuria is possible was not affected by of. Should drink every day occurs only after about 28 days of complete obstruction Calcifications in the absence infection. Large amounts of calculus-forming salts in their urine without crystallization, chills and fever to. On an X-ray ( urolithiasis ) are a common cause of uric acid, and this is called.! To the presence of calcium in the gut helps bind oxalate from foods, thereby limiting the of... Having multiple calculi extraction, and was not affected by coadministration of or! Calculus-Forming salts in their entirety 28 days of complete obstruction at least amounts! Infection or the formation of new stones transmitted infection ( STI ) but blood in also... Can detect the location of a bladder stone again the recurrence rate calcium! Request pain medication at the onset of pain in the kidney renal parenchyma or renal collecting or... Which is special type of surgery in your bladder because pure uric acid ( 5.5.! Sodium and animal protein to reduce the risk of developing certain types of stones by modifying diet. Only exception is when typical hexagonal crystals of cystine are found in a concentrated, acidified specimen, confirming..