Distal Ureteral Calculi Research Articles

A Multicenter, Randomized, Controlled Trial of Transureteral and Shock Wave Lithotripsy—Which is the Best Minimally Invasive Modality to Treat Distal Ureteral Calculi in Children?

Since there is insufficient evidence to determine the best treatment modality in children with distal ureteral calculi, we designed a multicenter, randomized, controlled trial to evaluate the efficacy and complications of transureteral and shock wave lithotripsy in these patients. A total of 100 children with distal ureteral calculi were included in the study. Of the patients 50 were randomized consecutively to undergo shock wave lithotripsy using a Compact Delta II lithotriptor (Dornier MedTech, Kennesaw, Georgia), and 50 were randomized to undergo transureteral lithotripsy with holmium laser and pneumatic lithotriptor between February 2007 and October 2009. Stone-free, complication and efficiency quotient rates were assessed in each group. Mean +/- SD patient age was 6.5 +/- 3.7 years (range 1 to 13). Mean stone surface was 35 mm(2) in the transureteral group and 37 mm(2) in the shock wave lithotripsy group. Stone-free rates at 2 weeks after transureteral lithotripsy and single session shock wave lithotripsy differed significantly, at 78% and 56%, respectively (p = 0.004). With 2 sessions of shock wave lithotripsy the stone-free rate increased to 72%. Efficiency quotient was significantly higher for transureteral vs shock wave lithotripsy (81% vs 62%, p = 0.001). Minor complications were comparable and negligible between the groups. Two patients (4%) who underwent transureteral lithotripsy sustained a ureteral perforation. In the short term it seems that transureteral and shock wave lithotripsy are acceptable modalities for the treatment of distal ureteral calculi in children. However, transureteral lithotripsy has a higher efficacy rate when performed meticulously by experienced hands using appropriate instruments.

What Happened to Shockwave Lithotripsy During the Past 22 Years? A Single-Center Experience

From 1985 to August 2007 we have performed 15,324 shockwave lithotripsy (SWL) treatments using the Dornier HM3 lithotripter. We studied trends in the characteristics of treatments and patients. Patient data were recorded in a computerized database. Changes in characteristics of patients and stones treated during this period were reviewed. A total of 15,324 treatments were performed on 10,734 patients. The following trends were observed: (1) Stone size: A significant increase in the proportion of patients treated for stones up to 10 mm in diameter, no change for stone size of 10 to 20 mm, and a decrease in stones larger than 20 mm in diameter. (2) Stone location: A significant increase in the proportion of patients treated for proximal and distal ureteral calculi, whereas a significant decrease in those with renal pelvic and staghorn stones. (3) Auxiliary procedures: A significant increase in the use of perioperative procedures (stents or ureteral catheters) ranging from 20% during the mid-1980s up to 60% in the year 2007. (4) Presenting symptoms: A significant increase in the percentage of patients referred with pain and a significant decrease in the percentage of patients referred with signs of infection. (5) Repeat SWL: A total of 13% of the patients required a second SWL for the same stone within 90 days of the first procedure. (6) Complication rate: This rate was relatively low, ranging from 1% to 6% per year. The evolvement of endourological procedures and techniques resulted in a decreased referral of large kidney stones for SWL. Advanced diagnostic modalities increased the diagnosis of renal colic in patients presenting with pain, and consequently their referral rate and timing for SWL treatment. The use of stents increased because of referral of patients with obstructing stones and infection or for prevention of posttreatment obstruction.

The efficacy of tamsulosin in lower ureteral calculi

Context:There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy (ESWL).Aims:Recent studies have reported excellent results with medical expulsive therapy (MET) for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain.Settings and Design:We conducted a comparative study in between watchful waiting and MET with tamsulosin.Materials and Methods:We conducted a comparative study in between watchful waiting (Group I) and MET with tamsulosin (Group II) in 60 patients, with a follow up of 28 days.Statistical Analysis:Independent 't' test and chi-square test.Results:Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly lower in Group II (P value is 0.007, 0.01 and 0.007, respectively) as compared to Group I.Conclusions:It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.

Effect of Low Dose Radiation Computerized Tomography Protocols on Distal Ureteral Calculus Detection

Unenhanced multidetector computerized tomography is the imaging modality of choice for urinary calculi but exposes patients to substantial radiation doses with a subsequent risk of radiation induced secondary malignancy. We compared ultra low dose and conventional computerized tomography protocols for detecting distal ureteral calculi in a cadaveric model. A total of 85 calcium oxalate stones 3 to 7 mm long were prospectively placed in 14 human cadaveric distal ureters in 56 random configurations. The intact kidneys, ureters and bladders were placed in a human cadaveric vehicle and computerized tomography was performed at 140, 100, 60, 30, 15 and 7.5 mA seconds while keeping other imaging parameters constant. Images were independently reviewed in random order by 2 blinded radiologists to determine the sensitivity and specificity of each mA second setting. Overall sensitivity and specificity were 98% and 83%, respectively. Imaging using 140, 100, 60, 30, 15 and 7.5 mA second settings resulted in 98%, 97%, 97%, 96%, 98% and 97% sensitivity, and 83%, 83%, 83%, 86%, 80% and 84% specificity, respectively. Interobserver agreement was excellent (kappa >0.87). There was no significant difference in sensitivity or specificity at any mA second settings. All false-negative results were noted for 3 mm calculi at a similar frequency at each mA second setting. Ultra low dose computerized tomography protocols detected distal ureteral calculi in a fashion similar to that of conventional computerized tomography protocols in a cadaveric model. These protocols may decrease the radiation dose up to 95%, reducing the risk of secondary malignancies.

Estudio prospectivo que compara la litotricia extracorpórea y la ureteroscopia en el tratamiento de la litiasis de uréter distal

Purpose To compare the efficacy of ureteroscopy and extracorporeal shock wave lithotripsy (ESWL) in treating distal ureteral calculi and evaluate the best treatment alternative for this disease. Material and methods A total of 104 patients with distal ureteral calculi requiring surgical intervention were enrolled and observed in a prospective follow-up. For ESWL, a Modulix SLX Storz lithotriptor was used and for ureteroscopy, a Storz 33 cm semi-rigid ureteroscope with a diameter of 7,5 to 9,5 french and a 6-degree optic. Out of the patient total, 54 patients underwent ESWL and 50 underwent ureteroscopy. 62 patients were men and 42 women; mean age in the ESWL group was 49.72, and in the ureteroscopy group, 52,16. Mean calculus size for ESWL was 8.29mm and 8,96 mm for ureteroscopy. A P<.05 was considered statistically significant. Results Mean procedure time for ESWL was 55 minutes in men and 45 minutes in women. For ureteroscopy, procedure time was 80 minutes for men and 55 minutes for women. For ESWL, the mean hospital stay was 4.8 hours (same-day discharge for all patients). Mean hospital stay for ureteroscopy patients was 22 hours. 7% of ESWL patients experienced complications compared with 7.9% of those undergoing ureteroscopy. At the 30-day follow up, 74.3% of ESWL patients were stone free, while 92,3% of the ureteroscopy patients were stone free ( P<.05). Conclusions Based on the results of this study, ureteroscopy is a better method for treating distal ureteral calculi because of its stone free rates and because the difference in complication rates was not significant.

Dextranomer/Hyaluronic Acid Copolymer Implant Calcification Mimicking Distal Ureteral Calculi on Ultrasound

We report 2 patients with a history of vesicoureteral reflux who were treated with intraureteral and/or subtrigonal injection of dextranomer/hyaluronic acid copolymer; they later developed calcification within the region of injection, as seen on ultrasound, which mimicked ureterovesical junction calculi. The radiologist reporting the studies suggested the presence of a distal ureteric calculus in the first case and a distal ureteric calcification in the second case. The ultrasound findings were incidental with no hydronephrosis and both patients were asymptomatic without hematuria. Follow-up ultrasound studies remained unchanged. Calcification of dextranomer/hyaluronic acid copolymer implants may mimic distal ureteral calculi, and careful initial observation is recommended.

Comparison of the effectiveness and safety of MPL 9000 and Lithostar Modularis shockwave lithotriptors: treatment results of 263 children

In this study, we aimed to compare the treatment results of two different shock wave lithotripsy (SWL) machines used in the management of pediatric urolithiasis. Between January 1993 and October 2004, Dornier MPL 9000 (electrohydraulic) had been used, and since then Siemens Lithostar Modularis (electromagnetic) has been used. The last evaluation was done 3 months after SWL treatment in terms of the success rate, use of anesthesia and complications. A total of 263 children (171 boys and 92 girls), with an age range of 9 months-14 years (mean age 8.1 +/- 3.8 years) were included in this study. Of the patients treated with the Dornier MPL 9000, 60.1% (173/104) required general anesthesia and 69 needed sedation. In contrast, for all patients treated with the Lithostar Modularis necessitated only sedo-analgesia (90 children). The hospital stay was shorter for Siemens Lithostar Modularis than those of Dornier MPL 9000 (26.2 vs. 35.5 h, P = 0.03). The success rate for the electromagnetic unit (86.5%) was almost identical that achieved with the electrohydraulic unit (85.2%) in the stones for the different location. Success rates were compared for stone burden subsets, the differences were insignificant for both lithotriptors (P > 0.05, for all). The electromagnetic unit had a significantly higher success rate for distal ureteral calculi (86.2 vs. 54.5%, P = 0.034). The efficiency quotients (EQ) for distal ureteral calculi were significantly different in favor of electromagnetic machine (56 vs. 40%). The complication rates for SWL were not significantly different for electrohydraulic and electromagnetic lithotriptors (8.7 and 6.2%, respectively). This study showed that SWL treatment was effective and safe in pediatric urolithiasis using both electrohydraulic and electromagnetic machines. Electromagnetic machine was more effective than electrohydraulic one for distal ureteral calculi. Additionally, the electromagnetic lithotriptor has significant clinical advantages over the electrohydraulic lithotriptor in terms of anesthesia requirements, hospitalization duration and fluoroscopic targeting.

Ureteroscopic management of distal ureteral stones in children: holmium: YAG laser vs. pneumatic lithotripsy

Aim: In this retrospective study, we aimed to compare the treatment results of pneumatic and holmium laser-assisted ureteroscopy in managing distal ureteral calculi in children. Materials and methods: The study group included a total of 36 children (23 boys, 13 girls) who underwent ureteroscopy between June 1998 and April 2008 due to distal ureteral calculi. Pneumatic lithotripsy was performed in 11 children and holmium:YAG laser lithotripsy in 25. Results: Their ages ranged from 18 months to 14 years (mean: 8.5 ± 3.5 years). The overall success rate for the holmium:YAG laser lithotripsy (100%) was higher than that of pneumatic lithotripsy (81.8%), but the difference was insignificant (P = 0.087). The complication rate was higher in pneumatic lithotripsy than in holmium:YAG laser lithotripsy (36.4% versus 4%, P = 0.023). Treatment time and hospital stay were shorter in the holmium:YAG laser lithotripsy group than in the pneumatic lithotripsy group (32.4 min versus 42.3 min, P = 0.041; 17.4 h versus 33.6 h, P = 0.013, respectively). Conclusion: This study showed that the success rate for holmium:YAG laser lithotripsy was almost identical with that achieved by pneumatic lithotripsy in the treatment of distal ureteral stones; ureteroscopic holmium:YAG laser lithotripsy had significant clinical advantages over pneumatic lithotripsy in terms of operative time, and hospitalization duration, stent requirements, and complication rates.

Perinephric Hematoma Following Ureteroscopy and Holmium Laser Lithotripsy

We present a case of a ureteropyeloscopy with holmium laser lithotripsy for a 5mm distal ureteral calculus that was complicated by perinephric hemorrhage despite utilization of a ureteral access sheath and the absence of any bleeding disorders. Conservative management was elected and the patient did not require transfusion of blood products. We believe this is the first case of perinephric hemorrhage under these circumstances and suggest that surgeons inform their patients of the low risk of bleeding complications with ureteroscopy.

Ureteroscopic management of lower ureteric calculi: a 15‐year single‐centre experience

To review our 15-year experience with ureteroscopic treatment of distal ureteric calculi and to determine the impact of improved technology and techniques on the efficacy, success and complications of the procedure. We retrospectively reviewed the medical records of 4512 patients who underwent 5133 ureteroscopic procedures for the treatment of distal ureteric calculi at our institution from January 1991 to December 2005. The patient and stone characteristics, treatment variables and clinical outcomes were assessed. Factors such as type of ureteroscope, procedure duration, procedure success, complication rate and hospital stay were evaluated. Data obtained from a cohort of patients that underwent the procedure from 1991 to 1995 (group 1) were statistical compared with those obtained from a cohort of patients from 1996 to 2005 (group 2). Logistic regression analysis was used to identify associated factors with the major complications of ureteroscopy. Overall, the stone-free rate after the procedure was 94.6%, the mean (sd; range) operative duration was 43 (15.0; 25-120) min, the intraoperative complication rate was 6.67%, the postoperative complication rate was 9.9%, and the mean (sd) hospital stay was 1.7 (1.1) days. The clinical and radiological follow-up (mean 36.8 months) for 71.3% of eligible patients detected only 12 ureteric strictures (0.23%). On comparing group 1 with group 2, the overall success of ureteroscopic stone extraction improved from 85.7% to 97.3% (P < 0.001), significant ureteric perforation decreased from 3.3% to 0.5% (P = 0.05), ureteric avulsion decreased from 1.3 to 0.1% (P < 0.05), ureteric stricture decreased from 0.7% to 0.1% (P < 0.007), the mean (sd) procedure time significantly decreased from 75 (42.9) min to 36.5 (12.5) min (P < 0.001), and the mean hospital stay significantly decreased from 2.5 (1.6) days to 0.5 (1.2) days, with a trend toward outpatient treatment. Logistic regression analysis showed a significant association of the major ureteroscopic complications with increased operative duration, type of ureteroscope used, stone impaction, stone size and surgeon experience. The present series shows the high success rate, with minor complications, that can be achieved with ureteroscopic treatment of distal ureteric calculi. Improvements in ureteroscope design, accessories, technique and experience have led to a significant increase in the success rate and decrease in the complication rate.

Differences in Stone Size and Ureteral Dilation Between Obstructing Proximal and Distal Ureteral Calculi

To examine the differences in ureteral dilation and calculus size between obstructing proximal and distal ureteral stones. A retrospective review of computed tomography (CT) scans from 176 consecutive patients with obstructing ureteral calculi was performed. For the calculi, the axial diameter was defined as the largest stone diameter on the axial CT images, and the coronal length was defined as the cephalocaudal length of the stone measured on the coronal CT images. Univariate and multivariate statistical analyses were performed. A total of 65 proximal and 111 distal ureteral calculi were analyzed. On univariate analysis, the proximal calculi were associated with a greater degree of ureteral dilation (mean 6.1 mm vs 5.3 mm, P = .01) and had a greater coronal length (mean 9.9 mm vs 8.3 mm, P = .005) than distal calculi. This association was also true on the multivariate analysis, which controlled for age and sex (P = .0004). No statistically significant difference was found in the axial calculus diameter for the proximal and distal stones (mean 5.3 mm vs 5.0 mm, P = .29). In a subset of 50 patients whose contralateral ureters (without stones) were measured for control comparison, the ureteral dilation in the ureters with stones was significantly greater than in the control ureters (proximal ureter 6.2 mm vs 4.3 mm, P = .001; distal ureter 4.7 mm vs 3.8 mm, P = .004). For proximal calculi, 72.3% were associated with ureteral dilation of less than 7 mm, 23.1% with 7-10 mm, and 4.6% with greater than 10 mm. For the distal calculi, 90.1% were associated with ureteral dilation of less than 7 mm, 6.3% with 7-10 mm, and 3.6% with greater than 10 mm. The coronal length was the largest measured diameter in 94% of the calculi, and the mean calculus coronal length was significantly greater than the mean axial diameter (8.9 mm vs 5.1 mm, respectively, P < .001). The results of our study have shown that proximal ureteral calculi are associated with a significantly greater degree of ureteral dilation and larger coronal length than are distal calculi. These findings should guide the endoscopist in planning intracorporeal ureteroscopic lithotripsy. We suggest obtaining CT coronal images to more accurately characterize obstructing ureteral stones.

Alfuzosin Stone Expulsion Therapy for Distal Ureteral Calculi: A Double-Blind, Placebo Controlled Study

We evaluated the efficacy of alfuzosin as medical expulsive therapy for distal ureteral stone passage. A total of 76 patients with a distal ureteral calculus provided consent for the study. Patients were randomized between placebo and study medication, and investigators and patients were blinded to the randomization scheme. Followup was done on a weekly basis and continued until the patient was rendered stone-free. The patient blood pressure, discomfort level, stone position on imaging, number of remaining pills and any adverse events were assessed. Statistical analysis was performed with the Student t test with p <0.05 considered significant. The overall spontaneous stone passage rate was 75%, including 77.1% for placebo and 73.5% for alfuzosin (p = 0.83). Mean +/- SD time needed to pass the stone was 8.54 +/- 6.99 days for placebo vs 5.19 +/- 4.82 days for alfuzosin. (p = 0.003). There was no difference in the size or volume of stones that passed spontaneously between the placebo and alfuzosin arms, as measured on baseline computerized tomography (4.08 +/- 1.17 and 3.83 +/- 0.95 mm, p = 0.46) and by a digital caliper after stone expulsion (3.86 +/- 1.76 and 3.91 +/- 1.06 mm, respectively, p = 0.57). When comparing the improvement from the baseline pain score, the alfuzosin arm experienced a greater decrease in pain score in the days after the initial emergency department visit to the date of stone passage (p = 0.0005). Alfuzosin improves the patient discomfort associated with stone passage and decreases the time to distal ureteral stone passage but it does not increase the rate of spontaneous stone passage.

Renal Oxygenation Changes during Acute Unilateral Ureteral Obstruction: Assessment with Blood Oxygen Level–Dependent MR Imaging—Initial Experience

To prospectively determine if changes in intrarenal oxygenation during acute unilateral ureteral obstruction can be depicted with blood oxygen level-dependent (BOLD) magnetic resonance (MR) imaging. The study was approved by the local ethics committee, and written informed consent was obtained from all patients. BOLD MR imaging was performed in 10 male patients (mean age, 45 years +/- 17 [standard deviation]; range, 20-73 years) with a distal unilateral ureteral calculus and in 10 healthy age-matched male volunteers to estimate R2*, which is inversely related to tissue Po(2). R2* values were determined in the cortex and medulla of the obstructed and the contralateral nonobstructed kidneys. To reduce external effects on R2*, the R2* ratio between the medulla and cortex was also analyzed. Statistical analysis was performed with nonparametric rank tests. P < .05 was considered to indicate a significant difference. All patients had significantly lower medullary and cortical R2* values in the obstructed kidney (median R2* in medulla, 10.9 sec(-1) [range, 9.1-14.3 sec(-1)]; median R2* in cortex, 10.4 sec(-1) [range, 9.7-11.3 sec(-1)]) than in the nonobstructed kidney (median R2* in medulla, 17.2 sec(-1) [range, 14.6-23.2 sec(-1)], P = .005; median R2* in cortex, 11.7 sec(-1) [range, 11.0-14.0 sec(-1)], P = .005); values in the obstructed kidneys were also significantly lower than values in the kidneys of healthy control subjects (median R2* in medulla, 16.1 sec(-1) [range, 13.9-18.1 sec(-1)], P < .001; median R2* in cortex, 11.6 sec(-1) [range, 10.5-12.9 sec(-1)], P < .001). R2* ratios in the obstructed kidneys (median, 1.06; range, 0.85-1.27) were significantly lower than those in the nonobstructed kidneys (median, 1.49; range, 1.26-1.71; P = .005) and those in the kidneys of healthy control subjects (median, 1.38; range, 1.23-1.47; P < .001). In contrast, R2* ratios in the nonobstructed kidneys of patients were significantly higher than those in kidneys of healthy control subjects (P = .01). Increased oxygen content in the renal cortex and medulla occurs with acute unilateral ureteral obstruction, suggesting reduced function of the affected kidney.

Stone size is the sole factor in determining the outcome of eswl in children

Purpose We prospectively evaluated the role of stone location and size in the efficacy of SWL for the treatment of urinary calculi in children. Material and methods Between January 2006 and March 2007, 94 pediatric patients (108 renoureteral units) were treated by Siemens Lithostar under sedo-analgesia. There were 58 boys and 36 girls, with a mean-age of 57.4 (8- 180) months. The stones were localized in the renal pelvis, lower, middle, upper calices and ureteropelvic junction in 24, 30, 17, 7 and 10 renal units. 14 renal units had stones in multiple locations. Four patients had proximal and 2 had distal ureteral calculi. Stone free rates and efficiency quotients were assessed 3 months after SWL. Results The mean stone burden was 74.6mm2 (20-380). Sixtysix (61.1%) renal units were stone-free within 12 weeks after an average of 1.48 (1-4) SWL sessions. Stone-free rates for pelvis, lower, middle, upper pole, ureteropelvic junction, upper and lower ureter were 83.3 %, 43,%, 52.9%, 71.4%, 60%, 100% and 50% respectively. Efficiency quotients for stones <5mm, 6-10 mm, 11-15 mm and 16-20mm were 0.62, 0.42, 0.53, 0.27 respectively with an overall 0.44. Conclusions Our results indicated SWL in the treatment of pediatric urolithiasis has acceptable stone-free rates with lower efficiency quotients, the latter compensated by the minimally invasive nature of this treatment modality. Stone-size seems to be the only factor affecting the efficiency.

Efficacy of tamsulosin in medical expulsive therapy for distal ureteral calculi

To evaluate the potential role of tamsulosin in the medical treatment of distal ureteral stones. Ninety patients with symptomatic distal ureteral calculi were enrolled. They were randomly divided into two groups: Group A (n=45) received diclofenac 100 mg on demand for 4 weeks plus levofloxacin 250 mg daily for the first week and were well hydrated; and Group B (n=45) received the same therapy plus tamsulosin 0.4 mg/daily for 4 weeks. Abdominal ultrasound scans and KUB X-rays were performed weekly. Stone expulsion rates, time to expulsion, pain episodes and analgesic usage were determined. Intervention by means of shock-wave lithotripsy (SWL) or ureteroscopy was evaluated. The stone expulsion rate was 51.1% for Group A, compared to 88.9% for Group B (p=0.001). The average time to expulsion was 12.53+/-2.12 days for Group A and 7.32+/-0.78 days for Group B (p=0.04). The number of pain episodes was significantly lower in Group B and mean use of analgesics was lower for Group B (0.14+/-0.5 vials) than Group A (2.78+/-2.7 vials). Twenty-two patients in Group A failed to pass their stones after 4 weeks but only five in Group B. Of the patients who were not stone-free, 19 were treated with SWL and eight underwent ureteroscopy. Our study reveals the efficacy of tamsulosin for the treatment of distal ureteral stones. Tamsulosin should be added to the standard medical approach for treating these stones.

Predicting Factors for Spontaneous Passage of Ureteral Calculi Based on Unenhanced Helical CT Findings

Purpose: We performed a prospective study to determine whether unenhanced helical computed tomography (UHCT) findings predict the spontaneous passage of ureteral calculi. Materials and Methods: Between April 2006 and June 2007, 175 patients with a single ureteral calculus <1cm in diameter were enrolled in this study, and a UHCT was performed. All of the patients were managed conservatively for 2 weeks. Patients without spontaneous passage of ureteral calculi within 2 weeks were treated by ureteroscopy or extracorporeal shock wave lithotripsy (ESWL). The secondary signs (hydronephrosis, perinephric edema, and the tissue rim sign) were graded on a scale of 0-3. We evaluated whether spontaneous passage of ureteral calculi was associated with stone diameter, location, Hounsfield units (HU), and the degree of secondary signs. Results: Ninety-two patients (52.6%) had spontaneous passage of ureteral calculi. The mean stone diameter was significantly smaller in the passage group than the non-passage group (4.28mm vs. 6.73mm, p=0.002). The rate of spontaneous passage was significantly higher involving distal ureteral calculi (66.1%) than proximal ureteral calculi (30.3%, p<0.001). The incidences of hydronephrosis and perinephric edema were significantly lower in the spontaneous passage group than the non-passage group (8.7% vs. 73.5% and 5.4% vs. 69.9%, respectively). The grades of hydronephrosis and perinephric edema were significantly lower in the spontaneous passage group than the non-passage group (p=0.001). Although there was a tendency toward increasing grades of hydronephrosis and perinephric edema with increasing stone size, the grades were more frequent and severe in the non-passage group in patients with similarly sized stones. Conclusions: The degree of hydronephrosis and perinephric edema are useful ancillary signs in predicting the likelihood of spontaneous passage of ureteral calculi. (Korean J Urol 2008;49:1094-1099) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Shock wave lithotripsy is effective and safe for distal ureteral calculi in children

We evaluated the effectiveness of the Siemens Lithostar Modularis lithotriptor for the management of distal ureteric calculi in children. Between 2004 and 2006, 29 children with distal ureteric calculi were treated in our stone center with the Siemens Lithostar Modularis (Siemens Medical Solutions, Inc.) Effectiveness of lithotripsy, retreatment and efficacy quotient rates, and complications were assessed. The series consisted of 18 (62%) boys and 11 (38%) girls with an age range of 1-13 years (average age 7.0 +/- 3.5). Under fluoroscopic guidance, children were treated with a maximum 3,000 shocks at an average of 2.2 +/- 0.3 kV. Mean stone size was 8.2 +/- 3.2 mm (range 4-18). Success was defined as the lack of any visible stone fragments on posttreatment radiological evaluation. The mean number of sessions required was 1.5 +/- 0.8/patient (range 1-4). Complete clearance rate at 3 months was 86.2%. Re-treatment and efficacy quotient rates for distal ureteral stones were 41.4 and 55.6%, respectively. Complications such as urinary tract infection or steinstrasse occurred in 2 (6.9%) patients. Minor complications included petechial skin hemorrhage at the site of entry of shock waves in all patients. Our results show that shock wave lithotripsy for distal ureteral calculi with the Siemens Lithostar Modularis lithotriptor has a high success rate (86.2%) and efficacy quotient (55.6%) with negligible complications in children.

According to researchers from the US, ??-adrenoceptor antagonists [??-blockers] are effective for promoting the spontaneous expulsion of distal ureteral calculi.

According to researchers from the US, ??-adrenoceptor antagonists [??-blockers] are effective for promoting the spontaneous expulsion of distal ureteral calculi.

Value of 3‐Dimensional Transrectal/ Transvaginal Sonography in Diagnosis of Distal Ureteral Calculi

In a prospective study, the feasibility of 3-dimensional (3D) transrectal/transvaginal sonography in comparison with transabdominal sonography and intravenous urography (IVU) in identifying distal ureteral calculi was evaluated. Sixty-two patients in the urologic clinic with clinical suspicion of distal ureteral calculi were included. The patients consisted of 44 men and 18 women with a mean age +/- SD of 44 +/- 17 years. These patients underwent 3D transrectal/transvaginal sonography, transabdominal sonography with IVU, and, finally, ureterorenoscopy. Fifty-nine patients were confirmed to have distal ureteral calculi on the basis of urologic intervention (ureterorenoscopy). Three patients had a spontaneous stone passage immediately after imaging completion. The median size of the calculi was 3.7 +/- 2.00 mm. Transabdominal sonography detected 34 of the 62 patients with calculi (sensitivity, 55%). The median size of the calculi was calculated as 5.0 +/- 2.4 mm. The examination time was 6.5 +/- 2.7 minutes. Intravenous urography detected 44 of the 62 patients with ureterolithiasis (sensitivity, 71%). Herein, the median stone size was measured as 3.9 +/- 1.9 mm, and the examination time was 38 +/- 17 minutes. The combination of transabdominal sonography and IVU in visualization of ureterolithiasis raised the sensitivity to 81% (50 of 62 patients). Three-dimensional transrectal/transvaginal sonography showed ureterolithiasis in all 62 patients confirmed to have distal ureteral calculi (sensitivity and specificity, 100%). The median size of the calculi was calculated as 4.4 +/- 2.2 mm, and the examination took 1.9 +/- 0.6 minutes. The data in our prospective study show that transrectal/transvaginal sonography with 3D image assessment is superior to IVU and abdominal sonography for diagnosing distal ureteral calculi.

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for the treatment of distal ureteral calculi with respect to patient satisfaction. This is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with ESWL (n = 92) using Dornier lithotriptor S (MedTech Europe GmbH) or URS (n = 120). Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. The 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. The stone-free status for ESWL and URS at 3 months was 81.5% and 97.5%, respectively (p < 0.0001). In addition, 88% of patients who underwent ESWL versus 20% who underwent URS were discharged home the day of procedure. Minor complications occurred in 3.3% and 8.3% of the ESWL and URS groups, respectively (p = 0.127). No ureteral perforation or stricture occurred in the URS group. Postoperative flank pain and dysuria were more severe in the URS than ESWL group, although the differences were not statistically significant (p = 0.16). Patient satisfaction was high for both groups, including 94% for URS and 80% for ESWL (p = 0.002). URS is more effective than ESWL for the treatment of distal ureteral calculi. ESWL was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was significantly higher for URS according to the questionnaire used in this study.