Higher Expulsion Rate Research Articles

The Success of Mifepristone and Misoprostol in the Management of Early Pregnancy Loss at a Community Hospital: A Prospective Study

ObjectivesThis prospective single-arm study was conducted to understand the expulsion rate of the gestational sac in the management of early pregnancy loss (EPL). MethodsWe recruited 441 participants; 188 met the eligibility criteria. Participants were 18 years of age and older who experienced a confirmed EPL (<12 weeks gestational age) defined by an intrauterine pregnancy with a non-viable embryonic or anembryonic gestational sac with no fetal heart activity. Participants were given 200 mg of mifepristone pre-treatment orally followed by 2 doses of misoprostol 800 μg vaginally after 24 and 48 hours. Participants were seen in follow-up on day 14 to confirm the absence of a gestational sac, classified as treatment success. For failed treatment (defined by retained gestational sac), we offered expectant management or a third dose of misoprostol and/or dilatation and curettage. We followed all participants for 30 days. We collected data on overtreatment for retained products of conception and hospital admissions for adverse events. ResultsOverall, 181 participants followed the protocol and 169 (93.3%) participants had a complete expulsion of the gestational sac by the second visit (day 14). Twelve (6.6%) failed the treatment and 1 had an adverse event of heavy vaginal bleeding requiring dilatation and curettage. Despite the expulsion of the gestational sac, 29 cases (17.1%) at subsequent follow-up were diagnosed as retained products of conception based on ultrasound assessment of thickened endometrium. ConclusionsPretreatment with mifepristone followed by 2 doses of misoprostol with a 14-day follow-up resulted in a high expulsion rate and is a safe management option for EPL.

The association of insertion methods on immediate postpartum intrauterine device expulsion rates: A retrospective cohort study

ObjectiveTo evaluate the method of immediate postpartum IUD (ppIUD) insertion (manual versus ring forceps) and expulsion rate within 6-week postpartum. Study designWe performed a retrospective cohort study of patients who had a singleton vaginal delivery and an immediate ppIUD inserted at Rush University from January 2014 to September 2023. The primary outcome was rate of expulsion within 6-week postpartum. We compared the rate of expulsion by method of insertion, either using a manual technique versus using ring forceps. We performed univariable analysis for the association between baseline maternal characteristics and the primary outcome and we performed multivariable logistic regression to determine the independent association of the method of insertion and the primary outcome. ResultsTwo hundred nineteen patients met eligibility with 117 immediate ppIUDs inserted manually and 102 inserted with ring forceps. Baseline maternal demographics were similar across study groups. After adjusting for factors selected a priori (estimated blood loss, body mass index, gestational age at delivery, nulliparity, type of IUD), use of ring forceps was more likely to result in expulsion compared to manual insertion (30.4% vs 16.2% respectively; adjusted OR 2.49, 95% confidence interval 1.28–4.90). ConclusionIn this retrospective analysis, insertion of immediate ppIUD with ring forceps was independently associated with an increased rate of expulsion within 6 weeks postpartum when compared to manual insertion. ImplicationsIn this setting, ring forceps was associated with high rates of immediate postpartum IUD expulsion compared to manual technique. Studies disagree, suggesting need for additional work.

Longitudinal impact of a residency-based postplacental levonorgestrel intrauterine device insertion program: Expulsion rates in years 1, 2, and 3

ObjectiveTo evaluate expulsion rates in the first 3 years of an academic postplacental levonorgestrel intrauterine device (LNG-IUD) insertion program. Study designRetrospective case series, January 2016 to December 2018. We measured LNG-IUD expulsion rates by 12 weeks postpartum. ResultsOf 235 LNG-IUD insertions, in years 1, 2, and 3, expulsion rates were 11/39 (28%), 9/94 (10%), and 15/102 (15%) (p = 0.03). After vaginal delivery, manual insertion was associated with a higher expulsion rate than ring-forceps (10/28 [36%] vs 17/105 [16%], p = 0.04). ConclusionsLNG-IUD expulsion rates decreased after program year 1, suggesting program maturity may be associated with a lower expulsion risk.

The fate of intracoelomic acoustic transmitters in Atlantic salmon (Salmo salar) post-smolts and wider considerations for causal factors driving tag retention and mortality in fishes

Acoustic telemetry is a widely used method in assessing behavioural dynamics in fishes. Telemetry transmitters (tags) are often surgically implanted in the coelom of the animal with limited in situ testing and sometimes only assuming that they have minimal rates of post-release tag shedding and mortality. However, fish are capable of expelling tags and mortalities do occur following release, with the mechanism (s) underlying these effects not well-understood. The purpose of this research was to address causal factors underlying tag expulsion and tagging mortality in fishes. We conducted an empirical assessment of tag retention and post-surgical mortality rates in post-smolt Atlantic salmon (Salmo salar) fitted with dummy (non-transmitting) acoustic tags over a 92-day monitoring period. This was complimented with a meta-analysis of factors affecting tag retention and post-surgical mortality rates in the wider literature. Post-smolt salmon had high rates of tag expulsion (54.8%), impaired growth, and a foreign body response evident but exhibited low rates of mortality following tag implantation (≤ 5.1%). The meta-analysis showed that mortality was generally low across all studies (12.4%) and was largely unaffected by model cofactors. Tag retention rates were high among the studies investigated here (86.7%) and had a weak negative relationship with tag:body mass ratios. Our results suggest that while mortality is often low among tagging studies, including this one, caution must be exercised in assessing stationary tag location data as they may represent an expelled tag rather than a mortality event. Our results also indicate that tag dimensions are not nearly as important as the tag:body mass ratio.

Effect of Silodosin in the Treatment of Distal Ureteral Stone

Background: Ureteral stones are a common type of urinary tract stones, accounting for 20% of all cases. The majority of these stones, approximately 70%, are located in the distal ureter. Recent studies have shown that α1- Adrenergic blockers can enhance the spontaneous passage of distal ureteral stones. Objectives: This study was done to compare the outcomes of treating distal ureteral stone with Silodosin, an α1- A adrenergic blocker, versus without Silodosin. Materials and Methods: A total of 70 patients aged between 18 and 50 years, diagnosed with distal ureteral stone, were enrolled in the study, which took place at the Department of Urology, Dhaka Medical College, from October 2017 to March 2019. The patients were divided into two groups: Group A and Group B. Group A consisted of 35 patients who were instructed to drink 3 litres of water daily, while Group B received the same instruction and also received Silodosin 8 mg/day. The treatment duration was four weeks, during which patients were monitored weekly through history, serum creatinine levels, X-ray KUB, and ultrasonogram of KUB. The number of stone expulsions, duration of spontaneous stone passage through the ureter, analgesic dosages, and adverse effects were recorded. Results: The higher expulsion rate in Group B (91.4%) compared to Group A (71.4%) (P=0.031). The mean expulsion duration was significantly shorter in Group B (8.94±3.58 days) compared to Group A (13.08±7.26 days) (P&lt;0.00298). Additionally, Group B required significantly lower analgesic dosages (115.71±75.51 mg) compared to Group A (255.71±108.31 mg) (P=0.00001). No adverse effects were observed in Group A, while two patients in Group B experienced adverse effects (retrograde ejaculation and postural hypotension). Conclusion: These results indicate that 8 mg/day of silodosin facilitates the expulsion of distal ureteral stone of about 5 to 10 mm in diameter in the largest dimension and significantly reduces the number of analgesic dosages.

Preschool and Childcare Expulsion

The purpose of this review is to understand what has been learned over the past 20 years of research on preschool and childcare expulsions in the United States. Our literature search identified 16 research studies on this topic. An extensive review of the identified studies was conducted to critically examine the methods used to measure expulsion, the purposes of the reviewed studies, and interventions used to mitigate expulsion rates. Results from this review revealed that researchers have examined the rates of expulsion and factors that could influence expulsion, such as predictive and risk factors (e.g., demographics, disability status), teachers' roles, teacher–family relationships, and interventions. Notably, the reviewed studies highlighted high rates of expulsion among Black male students and students with disabilities. Many teachers reported high stress, limited access to resources, and challenging relationships with administrators and parents during the process of expulsion. Although a variety of methods (e.g., survey, interview, observation) were used to measure expulsion rates, surveys were the primary method of data collection. Interventions targeting teacher well-being, mental health consultation, and classroom-wide interventions (e.g., Pyramid Model) were found to be promising methods for reducing expulsions. Based on the results, gaps in the literature and implications for future research and practice are discussed.

Conventional manual technique of post placental IUD insertion versus intra-cesarean post placental introducer withdrawal IUD insertion technique: a new standardized technique for IUD insertion during cesarean section: a randomized controlled trial

BackgroundInserting IUDs during cesarean section reduces the need for more manipulation and discomfort. The current conventional manual technique for IUD insertion during cesarean section is not standardized with many modifications and high rates of expulsion, displacement, missed threads, and discontinuation. This study aims to find a standard technique for IUD insertion during cesarean section with the least possible problems, especially displacement and missed threads.MethodsA randomized controlled study was conducted at Kasr Al-Ainy Maternity Hospital, Cairo University, Egypt. The study was performed over 12 months, from September 2020 to September 2021. Two groups of patients were selected; each group included 420 patients with a desire for IUD insertion during cesarean section. Group (A) (Control group) was subjected to a post-placental intrauterine device (Copper T380) during cesarean section using a conventional manual method; Group (B) (Study group): the IUD (Copper T380) was placed at the top of the uterine fundus using a new technique (intra-cesarean post placental introducer withdrawal IUD insertion technique).ResultsThere was a significant statistical difference between the two groups regarding displacement of the IUDs at the end of puerperium, at 6 months, non-visibility of IUD threads, and continuation of use with p-value < 0.05. There was no significant statistical difference in the term of duration of surgery.ConclusionThe new technique of post-placental IUD insertion can be the standard technique of intra-cesarean section IUD insertion as it is associated with more favorable outcomes among the included women in the form of lower incidence of IUD displacement, non-visibility of IUD threads, and higher rates of continuation without increasing the duration of surgery as compared with the conventional manual technique.Trial registrationClinicalTrial.gov ID: NCT05788354, registration date: 28/03/2023 (retrospectively registered).

Incidence of Post-Placental IUD Expulsion in Women of Childbearing Age

Background:The United States Medical Eligibility Criteria for Contraceptive Use and the American College of Obstetricians and Gynecologists recommend insertion of an Intra Uterine Device (IUD) immediately after delivery, due to the low complication rate. Postplacental IUD insertion is the insertion of an IUD immediately after delivery of the placenta during vaginal delivery. This method serves to reduce the number of births. However, post-placental insertion is believed to have a high expulsion rate. which is around 2-27%Purpose : To analyze and summarize the results of one study with another regarding the incidence of postplacental IUD expulsion in women of childbearing ageMethod:The research method used is literature review by searching for articles related to the theme taken from several search engines namely Pubmed, and Google Scholar and Search is done using the keyword IUD expulsion, Postplacental, women of childbearing age.Results: the installation of post placental IUDs has the opportunity to experience an expulsion eventConclusion: From all the journals that have been reviewed It can be concluded that the installation of post placental IUD has the opportunity to experience an expulsion event.

Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates.

To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.

Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.

Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.

Sinister Schooling: Modern-Day Implications of Hampton Model Industrial Schools and American Indian Boarding Schools

Throughout American history, the government has taken various systemic measures to monitor, surveil and control its burgeoning minority populations. In the postbellum era, these aims were primarily focused on assimilation and cultural genocide modeled, beginning with the creation of schools like the Hampton Model Schools for Black students and American Indian boarding schools for Indigenous students. Though neither remain in operation, their spirit lives, particularly as we see Native and Black students being funneled into occupational tracks in high school, having disproportionately high rates of suspension and expulsion, and being subjected to a whitewashed curriculum that positions them as victims, criminals, or non-existent. This work seeks to explore the linkages between these historical institutions and the current status of Native and Black students in modern-day schools.

A machine learning model for predicting surgical intervention in renal colic due to ureteral stone(s) < 5 mm

A 75–89% expulsion rate is reported for ureteric stones ≤ 5 mm. We explored which parameters predict justified surgical intervention in cases of pain caused by < 5 mm ureteral stones. We retrospectively reviewed all patients with renal colic caused by ureteral stone < 5 mm admitted to our urology department between 2016 and 2021. Data on age, sex, body mass index, the presence of associated hydronephrosis/stranding on images, ureteral side, stone location, medical history, serum blood count, creatinine, C-reactive protein, and vital signs were obtained upon admission. XGboost (XG), a machine learning model has been implemented to predict the need for intervention. A total of 471 patients (median age 49, 83% males) were reviewed. 74% of the stones were located in the distal ureter. 160 (34%) patients who sustained persistent pain underwent surgical intervention. The operated patients had proximal stone location (56% vs. 10%, p < 0.001) larger stones (4 mm vs. 3 mm, p < 0.001), longer length of stay (3.5 vs. 3 days, p < 0.001) and more emergency-room (ER) visits prior to index admission (2 vs. 1, p = 0.007) compared to those who had no surgical intervention. The model accuracy was 0.8. Larger stone size and proximal location were the most important features in predicting the need for intervention. Altogether with pulse and ER visits, they contributed 73% of the final prediction for each patient. Although a high expulsion rate is expected for ureteral stones < 5 mm, some may be painful and drawn out in spontaneous passage. Decision-making for surgical intervention can be facilitated by the use of the present prediction model.

PD55-04 PREDICTING THE NEED FOR INTERVENTION IN RENAL COLIC DUE TO A URETERAL STONE &lt;5 MM: A MACHINE LEARNING MODEL

You have accessJournal of UrologyCME1 May 2022PD55-04 PREDICTING THE NEED FOR INTERVENTION IN RENAL COLIC DUE TO A URETERAL STONE <5 MM: A MACHINE LEARNING MODEL Rennen Haramaty, Nir Kleinmann, Miki Haifler, and Dorit E. Zilberman Rennen HaramatyRennen Haramaty More articles by this author , Nir KleinmannNir Kleinmann More articles by this author , Miki HaiflerMiki Haifler More articles by this author , and Dorit E. ZilbermanDorit E. Zilberman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002635.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal colic due to ureteral stone is among the most common reasons for acute admissions to a hospital urology department. A high expulsion rate is reported for ureteric stones ≤5 mm. We aim to fit a machine learning model (ML) for surgical intervention prediction in cases of intractable pain caused by <5 mm ureteral stones. METHODS: We retrospectively reviewed all patients with renal colic caused by ureteral stone <5 mm at our institute between 2016-2021. Data on age, sex, body mass index, the presence of associated hydronephrosis, fat stranding, stone side and location, medical history, serum white blood and neutrophil counts, creatinine, C-reactive protein, and vital signs were obtained upon admission. Continuous and categorical variables were compared with the Wilcoxon rank-sum test and Fisher exact test. Missing data were imputed with multiple imputations. We fit an extreme gradient boosting ML model (XGboost) to predict the need for intervention based on clinical parameters. Variable importance was assessed with Shapley values additive explanation. The performance of the XGboost was determined by the area under the ROC curve metric (AUC) and decision curve analysis. RESULTS: 471 patients (median age 49 [IQR 40.5 ,60], 83% males) were included. The median stone diameter was 3.5 mm (3-4.1) and 74% of the stones were in the distal ureter. 160 (34%) patients who experienced intractable pain underwent surgical intervention. The time to stone expulsion and the time to surgical intervention were not significantly different. The model’s AUC according to the training and test data AUC were 0.8 and 0.78, respectively (p=0.68, Figure 1). Stone location and size had the highest variable importance compared to other variables. CONCLUSIONS: The decision to surgically remove ureteral stones <5 mm is difficult and can be facilitated by the use of our accurate prediction ML model. Our prediction ML model was both accurate and generalizable. The most important variables for intervention prediction were stone size and location. The presented model may be implemented in the treatment protocols, helping the decision-making process. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e948 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rennen Haramaty More articles by this author Nir Kleinmann More articles by this author Miki Haifler More articles by this author Dorit E. Zilberman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Patient acceptability, continuation and complication rates with immediate postpartum levonorgestrel intrauterine device insertion at caesarean section andvaginal birth.

Immediate postpartum long-acting reversible contraception (LARC) has been shown to reduce unintended pregnancy but uptake of this type of contraception in Australia is low compared to European counterparts. To assess self-reported continuation rates, complications and satisfaction in patients having immediate postpartum hormonal intrauterine device (IUD) inserted at caesarean section (CS) or after vaginal birth (VB). Retrospective cohort study of all patients with immediate postpartum hormonal IUD insertion over three years at a tertiary maternity service. Primary outcomes were patient satisfaction, continuation and expulsion rates. Secondary outcomes were reason for discontinuation, patient-reported complications, attendance for postpartum check with a general practitioner (GP) and rate of unplanned pregnancy. Simple descriptive statistics were used to analyse the data. One hundred and ninety-three women had a hormonal IUD inserted and 143 consented to involvement (CS n= 79; VB n= 64). Six and 12months continuation rates for CS were 60.8% and 54.4%, and VB were 46.9% and 39.1%. The most common reasons for removal were: pain (34.5%), heavy or irregular bleeding (25.9%) and partial expulsion (24.1%). Expulsion was more likely after VB (34.1%) than CS (10.1%), (odds ratio 2.72; 95% CI 1.07-6.90; P= 0.036). There were 60.8% of women post-CS and 56.3% of women post-VB who were satisfied with their decision to have immediate postpartum insertion and most women attended routine postpartum follow-up with their GP (89.5%). Immediate postpartum hormonal IUD insertion in this cohort is associated with higher rates of expulsion and lower satisfaction rates compared to those documented in the literature for delayed postpartum insertion cohorts.

Effectiveness, safety and overall satisfaction of early postpartum placement of hormonal IUD compared with standard procedure: An open-label, randomized, multicenter study.

In this open-label, randomized controlled, non-inferiority, multicenter study we aimed to study the risk of termination of pregnancy within 1year postpartum, the safety profile and patient acceptability after early postpartum insertion of a hormonal intrauterine device (LNG-IUS, Mirena®) compared with standard placement 6-8weeks postpartum. April 2018 to January 2020 women with uncomplicated vaginal delivery at four urban birth centers in Sweden, were randomized to either early placement within 48h after delivery (early group) or standard placement 6-8weeks postpartum (standard group) of a hormonal intrauterine device. The main outcome measure was the proportion of terminations of pregnancies in each group during the first year after placement of the intrauterine device. Registration EudraCT database no. 2017-001945-29. The study was prematurely stopped according to the protocol due to an expulsion rate >20% in the early group. No pregnancies occurred. Fifty-two women were randomized to early and 49 women to standard insertion. In the early group, 23/52 (44.2%) of the intrauterine devices were expelled. After expulsion, 10 women chose to have another hormonal intrauterine device placed but still significantly fewer women (39/52, 75%, p=0.22) in the early group used the hormonal intrauterine device method at study completion. No expulsions occurred in the standard group, but 5/49 (10.2%) requested removal and 41/49 (83.7%, p=0.22) had used the hormonal intrauterine device method continuously for 1year. Early hormonal intrauterine device insertion after vaginal delivery is associated with high expulsion rates. Despite this, a high continuation rate of the hormonal intrauterine device method is seen among women once choosing the method. In the light of high continuation rates, the advantages of early insertion could balance the risk of expulsion for well-informed women.

Effect of modified levonorgestrel-releasing intrauterine system in human adenomyosis with heavy menstrual bleeding.

AimThe levonorgestrel‐releasing intrauterine (LNG‐IUS) system is an effective primary treatment for adenomyosis; however, it has high expulsion rates. We aimed to modify the system—allowing affixion to the myometrium—and evaluate the expulsion rate, effectiveness, and side effects in patients with adenomyosis and heavy menstrual bleeding.MethodsThis study included patients with adenomyosis and heavy menstrual bleeding who underwent implantation of: a modified LNG‐IUS (experimental group, n = 47); and the original system after gonadotropin‐releasing hormone agonist treatment (control group, n = 47), between January 2014 and April 2016.ResultsIn the experimental group, two device expulsions occurred 12–18 months postimplantation. In the remaining 45 patients, the system was safely removed after the 60‐month validity period, and no extrauterine device movement or infection occurred. In the control group, downward displacement and expulsion of the device occurred in eight (17%) patients within 60 months. The 5‐year total expulsion rates were 4.3% and 17.0% in the experimental and control groups, respectively (p = 0.045). There were significant changes in the pretreatment severity of dysmenorrhea, menstrual volume, uterine volume (cm3), and hemoglobin level in each group compared with after 1 year (p < 0.01 in all groups). The severity of dysmenorrhea, menstrual volume, uterine volume, and hemoglobin level after 1 year were similar between the two groups (p > 0.05 in all groups).ConclusionsUse of the modified LNG‐IUS is a safe, cost‐effective, and simple method for reducing the downward movement and expulsion rate in patients with adenomyosis and heavy menstrual bleeding.

THE DIFFERENCESS OF DISCONTINUITAS IUD IN POST PLACENTAL AND INTRA-CESAREAN IN MADIUN

AbstractBackground: Intra Uterine Device (IUD) which is placed after delivery of the placenta is an attempt to reduce the rate of population growth. However, the achievement is still very low, especially in the post-placental IUD insertion. It is this high expulsion rate that continues to be a concern for service providers, so this method is acceptable. The purpose of this study is to compare the sustainability of IUD acceptors in post-placental and intra-cesareann placement. Methods: The design of this study was cross sectional with an observational analytic method. Location of this research in the family planning clinic of Dr. Soedono Madiun Hospital, Banjarejo Health Center, Tawangrejo Health Center, and PMB Ny. “P” Madiun City in 2019.The sample used consecutive sampling as many as 114 acceptors. The independent variable was the time of IUD insertion. The dependent variable is the discontinuity of the IUD acceptor. The instrument used was the 2019 IUD acceptor medical record. The Fisher Exact Test on SPSS was used to perform data analysis. Results: From 114 acceptors, there was no difference in the discontinuity of IUD acceptors in post-placental and intra-cesarean placement (p=0.1). The incidence of expulsion was found in post-placental insertion (p=0.02). In intra-cesarean IUD acceptors more confirmed using ultrasound examination (p = 0.03). There was no perforation in both. Conclusion: There is no difference in IUD acceptor discontinuity in post-placental and intra-cesarean placement.

Efficacy of Phloroglucinol Tamsulosin Combination Therapy for Medical Expulsion of Lower Ureteral Calculi and Influence on Patients’ Cys-C Level

Objective: Phloroglucinol is a myotropic, non-atropine and non-papaverine smooth muscle antispasmodic which directly acts on the smooth muscles of the gastrointestinal tract and the urogenital tract with no anticholinergic effect, no symptoms like xerostomia, visual impairment, dysuria, hypotension, increased heart rate, and arrhythmia etc. To investigate the efficacy of phloroglucinol tamsulosin combination therapy for medical expulsion of lower ureteral calculi and influence on patients’ Cys-C level. Methods: Equally randomized 136 patients with lower ureteral calculi in our hospital into mono therapy group (phloroglucinol alone) and combination therapy group (additional tamsulosin was advised). The expulsion rate, expulsion time, stone diameter and levels of IL-10, CRP, NGAL, Cys-C, KIM-1 were compared between two groups, also with the effectiveness and the rate of adverse reactions. Results: The combination therapy group showed higher expulsion rate (P 0.05). Conclusions: Phloroglucinol tamsulosin combination therapy had clear advantages on medical expulsion of lower ureteral calculi in respect of higher expulsion rate and elevated IL-10, CRP, NGAL, Cys-C and KIM-1 levels with larger stone diameter in a shorter time.

Intrauterine device use is safe among nulligravidas and adolescent girls.

The use of intrauterine devices (IUDs), including the copper-bearing device and the levonorgestrel intrauterine system (LNG-IUS), is safe among nulligravidas and adolescent girls. However, several misconceptions limit their use in clinical practice; health-care providers are hesitant to prescribe IUDs, and several myths associated with their usage in nulligravidas and adolescents exist among both providers and women themselves. The high rates of unplanned pregnancies (which in many settings constitute a public health issue, primarily among adolescent females) can be attributed at least partially to lack of awareness and limited use of highly effective contraceptives such as IUDs. In this review, we discuss the role of non-hormonal and hormonal IUDs as effective contraceptives in nulligravidas and adolescent girls. We present a literature review of data that highlight contraceptive efficacy, side effects (including reasons for discontinuation), and continuation rates with the method. We searched the PubMed/MEDLINE, Cochrane Library, Embase, and Scopus databases for all articles published in English between January 1990 through September 2020. A large body of evidence confirmed the effectiveness of IUD/IUS, independent of age and parity. Studies showed a high expulsion rate among adolescents but not among nulligravidas. Additionally, bleeding patterns among adolescents and nulligravidas were similar to those observed among adults and parous women. The high early removal rates observed in adolescents were attributable to bleeding and/or pain, which indicate that compared with adults, adolescents are less likely to accept IUD-induced side effects. IUD placement is an excellent strategy to avoid the high rates of unplanned pregnancies in adolescents and nulligravidas. IUDs are more effective than short-acting reversible contraceptives with failure rates that are equivalent to those observed with permanent contraception. However, few long-term studies have investigated this category of women to definitively establish the role of IUD/IUS as effective means of contraception.

The safety and efficacy of doxazosin in medical expulsion therapy for distal ureteric calculi: A meta-analysis.

Alpha-adrenergic receptor blockers can be effectively used in the context of medical expulsion therapy (MET) to treat ureteric stones. This study was designed to evaluate the safety and efficacy of doxazosin in MET relative to placebo or tamsulosin. We systematically searched the PubMed, the Cochrane Library, EMBASE, Chinese Academic Database, and Web of Science databases to select randomized controlled trials (RCT) that compared the use of doxazosin with placebo or tamsulosin to treat ureteric stones. All patients we included were limited to those diagnosed with visible stones in the distal ureter. The diameter of ureteric stones does not exceed 10 mm. Eight trials comparing doxazosin with placebo or tamsulosin containing 667 patients were assessed in the final analysis. The meta-analysis showed that doxazosin effectively treated ureteric stones and was better than placebo in terms of efficacy. Relative to the placebo group, the expulsion rate of stones from the distal ureter (OR = 3.00, 95% CI [2.15, 4.19], I2 = 0%, P < 0.00001) was significantly increased, and the expulsion time (days) was shortened (mean difference) (MD) = -4.03, 95% CI [-4.53, -3.53], P < 0.00001). The doxazosin group experienced fewer pain episodes (MD = -0.78, CI = [-0.94, -0.23], I2 = 0%, P < 0.00001) than the placebo group. A subgroup analysis showed that the doxazosin group had a higher expulsion rate (of 5-10 mm stones) compared with the placebo group. Although doxazosin resulted in significantly more adverse effects compared with the placebo, the patient's symptoms were mild and no further medical interventions were required. Moreover, the expulsion time (days) was shorter for patients receiving doxazosin (MD = -0.61, 95% CI [-0.97, -0.24], I2 = 39%, P = 0.001) than those receiving tamsulosin. Compared with the placebo group, patients receiving doxazosin had a greater expulsion rate, a reduced expulsion time, and fewer pain episodes. The expulsion time of doxazosin was shorter than that of tamsulosin.