Intramural Stones Research Articles

Evaluation of the efficacy of sexual intercourse on distal ureteral stones in women: a prospective, randomized, controlled study.

To evaluate the efficacy of sexual intercourse in the expulsion of distal ureteric stones in women. A total of seventy woman patients with distal ureteral or intramural stone were randomly divided into two groups. Group 1 included 35 patients who were advised to do sexual intercourse 3-4times/week with the administration of symptomatic treatment, and group 2 (control group) included 35 patients receiving symptomatic treatment only and were instructed not to do sexual intercourse or masturbation during the study. After 4 weeks follow up; the expulsion rate, need for analgesic and ureterorenoscopic lithotripsy were compared for each group. The mean ages of the patients in groups 1 and 2 were 36.4 ± 10.8, 37.1 ± 12.4, respectively. The mean stone size was 7.01 ± 1.6 in group 1, 6.67 ± 1.4mm in group 2 (p: 0.3). Stone expulsion rate, in the first 2weeks for group 1 was 80% (28/35), while 51.4% (18/35) in group 2 (p < 0.001). In the 4th week, the expulsion rate for group 1 was 85.7%, but 60% in group 2 (p < 0.001). The mean expulsion time was shorter in group 1 (12 ± 4.2days) than group 2 (16.1 ± 6.4days) (p < 0.01). The analgesic needs in groups 1 and 2 were found to be 1.9 ± 0.7, 2.6 ± 0.8 times/a day respectively, and were significantly lower in group 1 (p < 0.001). At least three or four sexual intercourses per week seem to increase the spontaneous passage for distal or intramural ureteral stones in women. Furthermore, sexual intercourse reduces the need for analgesics.

Does laparoscopy has a place in managing urinary stones in the era of mini- and micro-PCNL

Introduction: Surgical management of urinary stones has witnessed major development in the last few decades. After the successful introduction of Shock wave lithotripsy (SWL), the urologist's armamentarium for treating stones became versatile by adoption of rapidly evolving technologies that increasingly replaced the traditional open surgery.There are special situations when SWL and endourology is not the optimal choice and open surgery was the only option at a time, here comes the role of laparoscopy to replace the open surgery for dealing with these cases where endourology has major limitations. Hereby we will highlight the current international trend in laparoscopic surgery for urolithiasis and demonstrate our limited experience in laparoscopic stone surgery in ten patients in Aden, Yemen. Patient and Method: From March 2011 to September 2017. Ten consecutive patients' ages 4-60 years (mean 38 years) with renal and ureteral stones underwent laparoscopic removal of their stones. The indications for laparoscopy were; unavailability of pediatric PNL setup in two children, failed of SWL in one, renal stones with concomitant PUJO in one, and large impacted ureter stones in the rest of patients. Result: Stone largest diameter ranged from 25 to 45 mm (mean 28 mm), operative time ranged from one to 4 hours (mean 2.3 hours) and hospital stay ranged from four to seven days (mean 5 days). The procedure completed successfully an all, but one patient in whom conversion to open ureterolithotomy performed, because of difficulty to access the large impacted intramural stone, no major intra or post-operative complications, no blood transfusion needed. One patient develop prolonged urine leakage for 10 days managed conservatively. Follow up after three, six and 12 months with plain abdominal x-ray (KUB) ultrasonography (US) and Urography (IVU) when indicated showed no residual stones and no newly developed hydronephrosis. Conclusion: Laparoscopic surgery is safe and effective in management of large renal and ureter stones in patients who are not suitable candidate for endourology.

Evaluation of the efficacy of sexual intercourse in expulsion of distal ureteric stones.

To evaluate the efficacy of sexual intercourse in expulsion of distal ureteric stones. The study included 56 patients with distal ureteric or intramural stone. The stones size ranged from 5 to 10mm and were detected by US, plain X-ray film, and non-enhanced CT. The patients were divided randomly into group A included 28 patients who were advised to do sexual intercourse 3-4 times/week with administration of symptomatic treatment, and group B included 28 patients receiving symptomatic treatment only (control group) and were instructed not to do sexual intercourse or masturbation during the study. Follow-up (4weeks) was done by plain X-ray, US, and urine analysis every week and by asking the patients about stone passage, time of expulsion, number of colicky attacks, and analgesic injections. Group A patients mean age was 36.5±10.7years and group B 37.3±12.5years. Stone expulsion rate, in the first 2weeks for group A, was 82% (23/28), while in group B 53% (16/28), (P=0.006). At the fourth week, expulsion rate for group A reached to 89%, but in group B 71.4%. The mean expulsion time was shorter in group A (11.9±4.4days) than group B (16.2±6.7days). The number of colicky attacks and analgesics for group A was less than group B. Practicing sexual intercourse for 3-4 times/week for married male patients with distal ureteric stone (5-10mm) increases the expulsion rate and decreases the frequency of renal colic and the needs for analgesic.

Adenomyomatosis of the gallbladder with subserosal fatty proliferation: CT findings in two cases

Adenomyomatosis of the gallbladder is frequently seen in ordinary operative specimens. Subserosal fat may proliferate in the presence of adenomyomatosis, but the amount of subserosal fat may be quite variable. Typical and atypical computed tomographic (CT) findings in two cases of adenomyomatosis with subserosal fatty proliferation of the gallbladder are presented. The thick fatty layer surrounding the thickened gallbladder wall with intramural diverticula and stones, typical of CT findings, was seen in one case, and fat interspersed in the periphery of the thickened gallbladder wall without intramural stones, atypical of CT findings, was seen in a second case.

Frequency of abnormalities detected by abdominal ultrasound among Japanese adults

Abdominal ultrasound examination was given to 715 (566 male and 149 female) adult non-manual workers in Tokyo as part of their annually required medical check-up. Gross abnormalities were found in 44.5% of males and 34.2% of females. The most common finding was fatty liver (15.2%), seen four times as frequently in males as in females. There were 93 elevated lesions in the gall-bladder in 56 subjects (7.8%); some required follow-up examinations because malignancy could not be excluded. Small cystic lesions were frequently seen in the kidney (6.4%) and in the liver (4.8%). Gallstones were found in 3.4%. Mild splenomegaly occurred in 3.4%. Ten mass lesions, 8 hyperechoic and 2 hypo-echoic, were found in the liver, but subsequent imaging studies showed them to be benign haemangiomas. Other changes found included calcific lesions in the liver (2.1%) and in the spleen (0.4%), renal stones (2.0%), thickened wall of the gall-bladder (3.2%), intramural stones (0.8%) and debris/sludge (0.4%) in the gall-bladder, dilated pancreatic duct (0.7%) and common bile duct (0.3%), liver cirrhosis (0.4%), hydronephrosis (0.1%), enlarged pancreas (0.1%), small pancreas (0.1%), ovarian tumour (0.1%), uterine tumour (0.1%), abnormally shaped kidney (0.1%) and situs inversus (0.1%). It was concluded that abdominal ultrasound is an important examination for a mass screening or a physical check-up commonly practised as the 'human dock' for adults in Japan.

Laparoscopic finding of the gallbladder in a case of intramural gallstones

In this 42-year-old-man with suspected cholelithiasis the following finding of the serosal surface of the gallbladder was discovered by laparoscopic examination: Smooth serosal elevation, dark-greenish in color in a size of the small bean; No hypervascularity in the surrounding serosa. This finding was confirmed to be due to intramural gallstones. This is the first description of the laparoscopic finding of the intramural stones of the gallbladder, which may assist in establishing the clinical characteristics of the intramural gallstones.