Diagnosis Of Ureteral Stones Research Articles

Predicting Sepsis in Patients with Ureteral Stones in the Emergency Department.

Background: In the absence of overt infection signs, clinical criteria for early intervention in patients with ureteral stones are poorly defined. We aimed to develop a model that can identify patients who are at risk for developing sepsis if discharged home from the emergency department (ED). Materials and Methods: We retrospectively reviewed patients between January 2010 and December 2019 who were discharged from the ED after diagnosis of ureteral stones. The primary outcome was sepsis requiring urgent surgical decompression. We used multivariable logistic regression to identify predictors of sepsis. We refined the model using backward stepwise regression with a threshold p-value of 0.05. Results: We identified 1331 patients who were discharged from the ED with ureteral stones. Of these patients, 22 (2%) subsequently developed sepsis requiring urgent decompression. In the initial multivariable model, female gender (odds ratio [OR]: 2.82, p = 0.039) and urine white blood cells (WBCs) (OR: 1.02 per cell count, p < 0.001) were predictive of sepsis. After performing backward stepwise regression, female gender, urine WBCs, and leukocytosis (WBCs >15,000/mm3) met criteria for inclusion in the model. A logistic model including these variables predicted sepsis with an internally cross-validated area under the curve (AUC) of 0.79. Among patients with urine cultures completed in the ED, rates of sepsis were 9% in patients with positive cultures and 1% in patients with negative cultures (p < 0.001). Antibiotic usage was not protective against developing sepsis. Conclusions: Sepsis is a rare complication among patients with ureteral stones selected for conservative management. The presence of elevated urine WBCs and female gender can help identify patients who are at risk of developing sepsis. Patients with risk factors should be managed with an increased index of suspicion for infection and may benefit from early intervention to reduce the risk of sepsis. Sepsis is more common in patients with positive urine cultures.

Diagnostic accuracy of kidney shear wave elastography at the diagnosis of ureteral stones

Aim: To determine the efficacy of kidney shear wave elastography (SWE) in patients diagnosed with ureteral stones.Method: Both kidneys of 30 patients were evaluated prospectively with SWE. The ureteral stone size and the degree of hydronephrosis were determined by sonographic examination. The contralateral kidney was accepted as the control parameter. Stone size, grade of hydronephrosis and kidney shear wave speed changes were noted and their relations were examined for statistical significance.Results: Affected kidney group had significantly increased SWE values than the control group. (3.87+-1.22 vs 2.06+-0.72 m/sec) (p=0.01). Neither the stone size nor the kidney SWE values showed a correlation with the gender. There was a positive correlation between the grade of hydronephrosis and the stone size (p=0.047, r=0,36). Kidneys with grade 2 hydronephrosis had significantly higher SWE values than those with grade 1 hydronephrosis.Conclusion: SWE is a promising tool to observe the parenchymal elasticity changes in patients with hydronephrosis secondary to ureteral stones. Further studies are necessary to confirm the research results.

To the diagnosis of ureteral stones

Reinecke (according to the ref. In New Khir. Arch., 1925, No. 32) draws attention to a new sign of entrapment of stones in the lower part of the ureter, namely, to a sharp increase and strong sensitivity of the inguinal lymph glands on the same side.

Low Dose Computed Tomography in Diagnosis of Ureteric Calculus in Obese Patients

Background: Standard dose computed tomography is standard imaging modality in diagnosis of urolithiasis. The introduction of low dose techniques results in decrease radiation dose without significant change in image quality. However, the image quality of low dose computed tomography is affected by skin fold thickness and subcutaneous abdominal adipose tissue. The aim of this study to evaluate stone location, size, and density using low dose computed tomography compared with standard dose computed tomography in obese population.&#x0D; Material and Methods: This non-randomized non-inferiority trial includes 120 patient having BMI≥25kg/m2 with acute ureteric colic. The low dose and standard dose computed tomography were performed accordingly. Effective radiation doses were calculated from dose-length product obtained from scan report using conversion factor of 0.015. The images were reconstructed using iterative reconstruction algorithm. Effective dose, number and size of stone, Hounsfield Unit value of stone and image quality was assessed.&#x0D; Results: Stones were located in 69 (57.5%) in right and 51 (42.5%) in left ureter. There was no statistical difference in mean diameter, number and density of stones in low dose as compared with standard dose. The radiation dose was significantly lower with low dose. (3.68 mSv) The delineation of the ureter, outline of the stones and image quality in low dose was overall sufficient for diagnosis. No images of low dose scan were subjectively rated as non-diagnostics.&#x0D; Conclusion: Low dose computed tomography with iterative reconstruction technique is as effective as standard dose in diagnosis of ureteric stones in obese patients with lower effective radiation dose.

Disparities in care among patients presenting to the emergency department for urinary stone disease.

To determine whether patients with ureteral stones received different standard of care in the emergency department (ED) according to various sociodemographic factors. We conducted a retrospective study of patients presenting to EDs in a large tertiary-care hospital in the Bronx, New York with a diagnosis of ureteral stones. Electronic chart review was used to assess each patient's ED course and to gather socio-demographic information. The primary outcomes of interest were administration of pain medication, prescription of alpha-1 antagonists to facilitate stone passage, and whether or not patients received CT scan or ultrasound. Associations of these outcomes with age categories, sex, race/ethnicity, BMI category, socioeconomic status and insurance status were examined using multivariate logistic regression models. 1200 patients were included in this analysis of which 616 (51%) were women. A large proportion of patients were minorities: 40% Hispanic, 15% non-Hispanic Black, and 20% other/multiracial. Patients aged 55-64years and those 65 or older were less likely to receive pain medication compared to patients < 35years (OR = 0.48, 95% CI 0.27-0.86, p = 0.01 and OR = 0.46, 95% CI 0.21-1.00, p = 0.05, respectively). Women were less likely than men to undergo any form of diagnostic imaging (OR = 0.52, 95% CI 0.35-0.76, p = 0.001). Similarly, patients in the lowest quintile of SES received less imaging than patients in the highest SES group (OR = 0.50, 95% CI 0.27-0.90, p = 0.02). Finally, women were less likely to receive alpha blockade compared to men (OR = 0.68, 95% CI 0.49-0.92, p = 0.014). Multiple disparities exist among patients presenting to the emergency department for ureteral stones.

60 - Imaging modalities in the diagnosis of ureteral stones in the emergency department

60 - Imaging modalities in the diagnosis of ureteral stones in the emergency department

MP01-04 INNOVATION IN URETERAL STONE CARE DELIVERY AFTER EMERGENCY DEPARTMENT (ED) VISIT: MATCHED CONTROLLED STUDY.

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2017MP01-04 INNOVATION IN URETERAL STONE CARE DELIVERY AFTER EMERGENCY DEPARTMENT (ED) VISIT: MATCHED CONTROLLED STUDY. Abdulrahman Alruwaily, Sapan Ambani, Steven Kronick, Gary Faerber, John Hollingsworth, William Roberts, and J. Stuart Wolf Abdulrahman AlruwailyAbdulrahman Alruwaily More articles by this author , Sapan AmbaniSapan Ambani More articles by this author , Steven KronickSteven Kronick More articles by this author , Gary FaerberGary Faerber More articles by this author , John HollingsworthJohn Hollingsworth More articles by this author , William RobertsWilliam Roberts More articles by this author , and J. Stuart WolfJ. Stuart Wolf More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.079AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to improve the care of patients who were discharged from our ED with ureteral stones by decreasing the time to definitive surgical treatment, reducing subsequent ED re-use, and minimizing the loss of follow-up after ED acute care, using a new model of care involving collaboration between the ED and Endourology Division. METHODS Starting March 1, 2015, automated email notifications were sent from our ED about all patients who were discharged from the ED with a diagnosis of ureteral stones. Among them, we determined those eligible for early surgical intervention using prospectively determined criteria (stone size = 5mm, persistent pain, signs of infection, or renal function deterioration) and an Endourology provider contacted eligible patient by phone to offer them early surgical intervention without an intervening clinic visit. We compared patients in the initial email intervention period with a control group who were discharged from the ED prior to initiation of the email program. We matched intervention and control patients 1:1 by stone size, location, and gender. We then fitted a Cox Regression model to examine for differences in time to surgery between two groups, which was our primary endpoint. In addition, we compared the groups in terms of the loss of follow-up and ED revisits. RESULTS We compiled a comparison group of total 72 patients who underwent the email intervention and standard care. The groups had comparable body mass index, previous stone history, and renal function (all p>0.20). The time to surgery was much shorter in the intervention compared to the control group (8 days vs. 29 days, respectively, p-value <0.001). The new intervention was also associated with decreased proportion of patients lost to follow up (8% vs. 42%, p-value =0.001) and returning to the ED (6% vs. 25%, p-value 0=0.02). After adjusting for baseline characteristics and surgeon, using the email intervention decreased the time to surgery by 5 times that of the control group (HR=4.9, p-value <0.0001). CONCLUSIONS An automated email notification program following by a phone call to offer early surgical intervention improved the quality of care for patients with ureteral stones by decreasing the time from ED to surgery, reducing the patient care burden on the clinic, minimizing loss of follow-up, and reducing ED revisits. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e2 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Abdulrahman Alruwaily More articles by this author Sapan Ambani More articles by this author Steven Kronick More articles by this author Gary Faerber More articles by this author John Hollingsworth More articles by this author William Roberts More articles by this author J. Stuart Wolf More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Predicting ureteral stones in emergency department patients with flank pain: an external validation of the STONE score.

The ability to objectively predict which emergency department patients are likely to have a ureteral stone may aid in cost-effectiveness and patient-centered diagnostic imaging decisions. We performed an external validation of the STONE score, a clinical prediction rule for the presence of uncomplicated ureteral stones in emergency department patients developed at Yale University School of Medicine. Five hundred thirty-six (536) consecutive patients evaluated in an urban tertiary care emergency department for the possible diagnosis of ureteral stone were retrospectively reviewed. The STONE score uses five factors (gender, duration of pain, race, nausea/vomiting, erythrocytes on urine dipstick) to categorize patients into low, medium, and high probability of having a ureteral stone. The total STONE score risk is 0-13 and divided into three groups: low risk=0-5, moderate risk=6-9, and high risk=10-13. Of the 536 patients evaluated for suspected ureteral stone, 257 (47.8%) had a ureteral stone. Mean patient age was 45.9years (SD 16.3), and gender distribution was 43.9% female and 56.1% male. Distribution of STONE score risk was 24.1% low, 48.1% moderate, and 27.7% high. Diagnosis of ureteral stone by STONE score risk was 14% for low-risk group, 48.3% for moderate-risk group, and 75.8% for high-risk group. This distribution is consistent with internal validation at Yale University School of Medicine, where values were 8.3-9.2% for low risk, 51.3-51.6% for moderate risk, and 88.6-89.6% for high risk. Our study validates the use of the STONE clinical score to categorize patients as low, moderate, and high risk for ureteral stone. This could help guide development of clinical decision rules for diagnostic studies and imaging in the future.

The Effect of Terpene Combination on Ureter Calculus Expulsion After Extracorporeal Shock Wave Lithotripsy

PurposeTerpene combination (Rowatinex) is known to help with the expulsion of urinary stones. The aim of this study was to determine how Rowatinex affects the expulsion of remnant stones after shock wave lithotripsy (SWL).Materials and MethodsClinical data were collected retrospectively from 499 patients with a diagnosis of ureteral stones who underwent SWL from January 2009 to August 2012. Ureteral stones were diagnosed in all patients by kidney, ureter, and bladder x-ray and abdominal computed tomography (CT). The progress of patients was documented every 2 weeks to confirm remnant stones after SWL. The patients with remnant stones underwent SWL again. Group 1 consisted of patients who were prescribed an analgesic, Tamsulosin 0.2 mg, and Rowatinex. Group 2 consisted of patients who were prescribed only an analgesic and Tamsulosin 0.2 mg. The expulsion rate of urinary stones was compared between groups.ResultsThe expulsion rate of urinary stones was not significantly different between the two groups after 2 weeks. However, after 4 weeks, group 1 had a significantly higher expulsion rate (72.2% compared with 61.1%, p=0.022). Fifteen patients (10.2%) in group 1 and 40 (11.4%) in group 2 had to undergo ureteroscopic removal of the stone (p=0.756). Acute pyelonephritis occurred in one patient (0.7%) in group 1 and in one patient (0.3%) in group 2 (p=0.503).ConclusionsThe long-term administration of Rowatinex for 4 weeks increased the expulsion rate of urinary stones after SWL.

Assessment of ureterovesical jet dynamics in obstructed ureter by urinary stone with color Doppler and duplex Doppler examinations

This study was designed to evaluate ureterovesical jet dynamics in obstructed ureter and to compare it with those of contralateral unobstructed side. Forty-six patients with diagnosis of ureteral stone, based on imaging findings in computed tomography were enrolled in this study. The gray-scale ultrasound exam from both kidneys and urinary bladder was performed. Then, ureterovesical jet characteristics including ureteral jet frequency, duration and peak velocity were assessed by color Doppler and duplex Doppler studies in both obstructed and unobstructed ureters by a radiologist, 15-30 min after oral hydration with 750-1,000 mL of water. When compared with contralateral normal side, the ureterovesical jet in obstructed ureter showed less frequency (0.59 vs. 3.04 jets/min; P < 0.05), shorter duration (1.24 vs. 5.26 s; P < 0.05) and lower peak velocity (5.41 vs. 32.09 cm/s; P < 0.05). The cut-off points of 1.5 jets/min, 2.5 s and 19.5 cm/s for difference of ureteral jet frequency, duration and peak velocity between obstructed and contralateral normal ureters yielded sensitivities of 97.8, 95.6 and 100 % and specificities of 87, 87.9 and 97.8 %, respectively for diagnosis of ureteral obstruction. Given the safety of Doppler study and significant differences in flow dynamics of obstructed versus unobstructed ureters, our findings demonstrated the utility of Doppler ultrasound examination as a useful adjunct to gray-scale ultrasound by improving the accuracy of ultrasound exam in diagnosis of ureteral obstruction.

Sonographic diagnosis of symptomatic ureteral calculi: usefulness of the twinkling artifact

Our aim was to analyze the value of ultrasound using the twinkling sign in the diagnosis of ureteral stones in patients with renal colic in the emergency setting. Prospective study of 100 patients with suspected renal colic who underwent an US examination, including color Doppler mode. We analyzed sensitivity, specificity, predictive values, and accuracy. We evaluated whether the stone was observed before or after the twinkling artifact, and whether the use of the Doppler color increased the examination time. US including color Doppler detected 76 of the 84 confirmed lithiasis. The sensitivity and specificity were 90 % and 100 %, respectively. The positive predictive value was 100 % and the negative 67 %. The accuracy was 92 %. A total of 59 calculi (78 %) examined by color Doppler sonography showed the twinkling artifact. Seventy percent of the twinkling-positive calculi showed the artifact before the stone itself was detected. Considering the location of the stones the twinkling sign was seen before the stone in 92 % of lithiasis located in the mid lumbar ureter (p = 0.02). The use of the twinkling artifact showed a trend to facilitate the detection of smaller calculi (<10 mm) (p = 0.08). The average examination time was 5.8 min [± 4.3] (without differences between the stones detected before or after the twinkling artifact, p = 0.75). Doppler US examination shows good sensitivity and specificity for the diagnosis of symptomatic ureteral stones. The twinkling artifact is useful for the early detection of the calculi, especially in the middle tract of the ureter, usually the most difficult place in sonographic diagnosis. It also seems helpful for the detection of smaller stones. The use of color Doppler does not increase the exploration time.

Digital Tomosynthesis in the Detection of Urolithiasis: Diagnostic Performance and Dosimetry Compared With Digital Radiography With MDCT as the Reference Standard

The purpose of this study was to evaluate the diagnostic performance of digital tomosynthesis in comparison with digital radiography in the detection of urinary stones with MDCT as the reference standard. Fifty consecutively enrolled patients (32 men, 18 women; mean age, 51.5 years; range, 19-83 years) referred for unenhanced MDCT of the abdomen with suspicion of urinary stones also underwent digital tomosynthesis and digital radiography (anteroposterior and bladder inlet views). Images from all examinations were randomly read by three blinded radiologists. The mean effective doses for digital tomosynthesis, digital radiography, and low- and high-dose MDCT were measured on a male phantom. Free-response receiver operating characteristics and receiver operating characteristics analyses were used to compare the diagnostic performance of digital radiography with that of digital tomosynthesis. Both types of analysis showed significantly better performance of tomosynthesis over digital radiography for all urinary stones (p < 0.05). No such improvement was found for ureteral stones. The gain in sensitivity with tomosynthesis was largest for stones between 2 and 5 mm in diameter. The mean effective dose was 0.5 mSv for digital radiography, 0.85 mSv for tomosynthesis, 2.5 mSv for low-dose MDCT, and 12.6 mSv for high-dose MDCT. Use of digital tomosynthesis of the abdomen results in improved detection of urinary stones in general over digital radiography with only a slight increase in effective dose. Use of tomosynthesis, however, was not associated with major improvement in the diagnosis of ureteral stones. The technique has potential as an alternative imaging technique in the detection and follow-up of urinary stones.

Ultrasonographic diagnosis of ureteral stones with acute renal colic in 100 patients

Ultrasonographic diagnosis of ureteral stones with acute renal colic in 100 patients

Natural history and current concepts for the treatment of small ureteral calculi.

Six studies providing information on 2,704 patients were included into a retrospective analysis. The incidence of spontaneous passage relating both stone size and location was determined from these collated studies. The rate of spontaneous passage for stones smaller than 4 mm was 38% compared to 1.2% for those larger than 6 mm, irrespective of their position in the ureter at the time of presentation. Calculi discovered in the distal third of the ureter had a spontaneous passage rate of 45%, compared with the mid third of 22%, and the proximal third of 12%. Two thirds of all stones which passed did so within 4 weeks after the onset of symptoms. These data from the literature were compared to the treatment modalities applied for the last 100 consecutive patients treated with the diagnosis of ureteral stone at UCSF. 42% of the stones were found in the proximal, 13% in the mid and 45% in the distal third of the ureter. Treatment modalities included ureteroscopic stone extraction (36), ESWL (31) and watchful waiting for stone passage (30). Oral litholysis was performed in 2 cases and percutaneous removal of a proximal stone in 1. No calculus larger than 6 mm passed spontaneously. The passage rate from the proximal ureter was 18%, from the mid ureter 15%, and 38% from the distal ureter disregarding the size of the stones. The rate of complications reached 20% when symptoms exceeded 4 weeks in duration compared to 7% in patients with symptoms lasting less than 4 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasound and the Diagnosis of Renal and Ureteral Calculi

We retrospectively compared ultrasound examination with plain film radiography of the abdomen (KUB) in the diagnosis of renal and ureteral calcull in 13 patients. Overall, ultrasound was more sensitive than KUB (84% versus 54%) in detecting caicull. However, KUB was superior for the diagnosis of ureteral stones. No caicull were detected by intravenous urography that were not first seen on either ultrasound or KUB. Our experience suggests that the combination of ultrasound and KUB is less invasive and more sensitive than intravenous urography for the diagnosis of calcull in patients with symptoms and signs suggestive of stone disease or who are at high risk for stone formation.

Ureteral stone: Diagnosis in emergency room patients

In an attempt to identify the important factors in diagnosis of ureteral stone, a prospective study was done on 100 consecutive emergency room patients in whom the diagnosis of ureteral stone was ultimately established. Distribution of patients by age, sex, and race, and the presenting symptoms, signs, and laboratory and radiographic findings are presented. Ureteral stone was suspected on the basis of history, physical examination, and laboratory findings, but the diagnosis was established by radiographic examination in most instances. Stones located in or near the intramural ureter produced characteristic symptoms, otherwise there was no correlation between the presenting symptoms, signs, and laboratory findings, and the size and location of the ureteral stone.

THE DIAGNOSIS OF STONES IN THE BILE DUCTS BY MEANS OF THE WAX TIP

After I had seen an ensacculated obstructing stone of the common duct at necropsy, which had been overlooked in several operations for the relief of severe biliary obstruction, an aid to the diagnosis of bile duct stones occurred to me. This method is the use of the wax-tipped filiform bougie in the bile ducts and is new in this application, though heretofore it has been used in the diagnosis of ureteral stones. In consequence of an impression or scratch mark being made on the soft wax impregnated on the end of a flexible bougie or probe, the presence of a stone and its location in the bile duct may be positively diagnosed. The wax tip was first used in the diagnosis of ureteral stones through a speculum in the female bladder.1Since the passing of the tip through the modern cystoscopes exposed the wax to scratches, it was temporarily