Lower Ureteral Stones Research Articles

Двухэнергетическая компьютерная томография в диагностике мочекаменной болезни

To assess the diagnostic performance of dual-energy computed tomography (DECT) in the evaluation of the composition of urinary stones "in vivo". A total of 91 patients aged from 20 to 70 years old (mean 42.7) with urinary stone disease were examined at Sechenov University, including 68 men (75%) and 23 women (25%). Prior to surgery, all patients underwent DECT (Canon, Japan) in order to predict the chemical composition of urinary stones in vivo. Extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) was performed in 53 (58.2%), 18 (19.7%) and 20 (22.1%) patients, respectively. Postoperatively, all stones or stone fragments (n=91; 100%) were examined using a comprehensive physical and chemical analysis (X-ray phase analysis, electron microscopy, infrared spectroscopy). In 6 patients (6.6%) staghorn stones were diagnosed, while in 15 (16.5%), 17 (18.7%), 22 (24.2%) and 31 (34.1%) stones were located in ureteropelvic junction, pelvis and ureter, respectively, including 24 patients with lower ureteric stones (26.4%). Prediction of the stone composition in vivo was carried out on the basis of the one indicator, the dual energy ratio (DER). The threshold values of DER for different types of stones were taken from the literature. All stones were divided into 4 groups according to the DECT results: vevellite stones (n=40, 43.9%), Ca-containing stones without vevellite (n=34, 37.3%), uric acid stones (n=10, 10.9%) and struvite stones (n=7, 7.9%). Thus, when comparing the results of DECT and physical and chemical analysis, in the first group four stones were incorrectly assigned by DECT to the group of Ca-containing stones without vevellite and three stones were incorrectly assigned to the group of struvite stones; in the second group four stones were incorrectly assigned to the group of vevellite stones; in the third group one stone was incorrectly assigned to the group of struvite stones; in the fourth group one stone was incorrectly assigned to the group of vevellite stones and one stone in the group of uric acid stones. In order to increase the diagnostic efficiency of DECT, we performed a comprehensive analysis of five specific DECT indicators (stone density at 135 kV, Z eff of the stone, DER, DEI, DED) using discriminant analysis. Thus, the sensitivity, specificity and overall accuracy of DECT with the use of just one indicator (DER) were 83.3%, 89.8%, 86.8% for vevellite, 88.2%, 92.9%, 91.2% for Ca-containing stones without vevellite, 90%, 98.8%, 97.8% for uric acid stones and 60%, 95.3%, 93.4% for struvite stones, respectively. When using discriminant analysis with five specific DECT indicators, higher values of sensitivity, specificity and overall accuracy were seen: 95.2%, 89.8%, 92.3% for a vevellite, 85,3%, 96,4%, 92,3% for Ca-containing stones without a vevellite and 100%, 100% and 100% for both uric acid and struvite stones, respectively. Dual-energy computed tomography is a highly informative method which allows to perform preoperatively the reliable assessment of the chemical composition. DECT in patients with urinary stone disease allows to optimize the treatment strategy and carry out preventive measures on individual basis, taking into account the stone type.

Can magnitip double-J stent serve as a substitute for a standard double-J stent?

To evaluate the morbidity of the magnitip double-J stent (DJ), compare its morbidity to the standard stent, and evaluate the possibility of retrieving the magnetic tip of the DJ stent without cystoscopy. A total of 50 patients having a lower ureteric stone, who underwent uretroscopic stone retrieval and required the use of a DJ, were randomly assigned to 2 groups, each containing 25 patients. Patients in group A were subjected to exploration with a uretroscope and a magnitip DJ while those in group B received a uretroscope and a standard DJ. The morbidity of both types of DJs was assessed by the Arabic version of the ureteral stent symptom questionnaire (USSQ). There was a high level of statistically significant differences between the two groups with regards to the total score of the USSQ, which were higher in group A as compared to group B (126.96±14.76 vs. 98.24±12.9) (p=0.001). Further, the cost of the total procedure was significantly higher in group B (9600±1456.59 vs. 8444±783.73) (p=0.001). No statistically significant difference was found between both groups regarding the application, retrieval accuracy, and discomfort caused by DJ removal. The morbidity caused by the magnetic DJ was found to be higher. However, the removal of the magnetic DJ was less costly than the standard DJ.

A comparative study of efficacy and safety of tamsulosin with nifedipine versus tamsulosin alone as medical expulsive therapy for lower ureteric stones

Background: Lower ureteric stones (LUS) comprises of 70% of ureteric stones. Spontaneous passage depends on stone size and location in ureter. Impacted calculi initiate smooth muscles contractions causing ureteric spasms. α-1 blockers like tamsulosin and calcium channel blocker like nifedipine relaxes ureteric smooth muscle, facilitating spontaneous expulsion. Pain and discomfort associated with urolithiasis, hospitalization and surgical cost can be minimized by medical expulsive therapy. Many studies had compared efficacy of tamsulosin with nifedipine, only few have explored the combination. This study compared efficacy of nifedipine and tamsulosin versus tamsulosin alone.Methods: 64 patients with LUS (5-10 mm) were assigned into 2 groups. Group 1 received tamsulosin and nifedipine and group 2 only tamsulosin. Rate of expulsion, time to expulsion, analgesic frequency and pain VAS score were analyzed. Chi-square or Fisher’s exact test to analyze categorical data, Mann Whitney U test or unpaired t test for differences between groups and Wilcoxon matched-pairs signed rank test for within group. A p<0.05 was statistically significant.Results: Rate of expulsion was 87.5% in group 1 and 65.6% in group 2 (p<0.05). Mean expulsion time was 6.68±1.89 days for group 1 and 8.52±2.62 in group 2 (p<0.05). Analgesic requirement was similar. Adverse effects were headache, dizziness and postural hypotension.Conclusions: Combination therapy yielded better rate of expulsion and reduction in stone expulsion time than tamsulosin alone. Thus, combination therapy can be considered for effective treatment outcomes.

Risk factors for ureteroscopic lithotripsy: a case-control study and analysis of 385 cases of holmium laser ureterolithotripsy.

IntroductionUreteroscopic lithotripsy has become the first choice for the treatment of middle and lower ureteral stones, but it still has a certain rate of surgical failure. Here we aimed to determine the factors that may affect the success rate of holmium laser ureterolithotripsy (HLU) and provide the basis and guidance for its future use.AimTo evaluate the risk factors for HLU failure.Material and methodsThe clinical data of 385 patients undergoing holmium laser ureterolithotripsy from 2009 to 2012 were retrospectively reviewed to analyze the impact of gender, age, stone side, stone size, stone location, stone number, degree of hydronephrosis, stone impaction, previous extracorporeal shock lithotripsy (ESWL), and associated urinary tract infection (UTI) on the success or failure of surgery.ResultsSurgical success was achieved in 338 (87.8%) patients versus surgical failure in 47 (12.2%) patients. Univariate analysis revealed that the degree of hydronephrosis (p = 0.024), stone impaction (p = 0.003), stone location (p = 0.012), and previous ESWL (p = 0.037) were risk factors for surgical failure. Multivariate logistic regression revealed that stone impaction (odds ratio (OR) = 2.66; p = 0.018) and stone location (OR = 2.11; p = 0.013) were significantly associated with surgical failure. Since some cases of ureterostenosis developed postoperatively, we continued follow-up. The patients had the stent for a year and underwent regular follow-up checks until 5 years. No cases of ureterostenosis recurred.ConclusionsUreteroscopic lithotripsy is a safe procedure with few complications. Stone impaction and proximal location are the risk factors for its failure.

Association of spontaneous expulsion with C-reactive protein and other clinico-demographic factors in patients with lower ureteric stone.

The purpose of our study is to analyze the definitive relation of C-reactive protein (CRP) and other factors with the spontaneous stone passage in patients with distal ureteric calculus of 5-10mm and to calculate the risk of failure of expectant management in patients. 185 patients of ureteric colic, who were subjected to medical expulsive therapy (MET), were included prospectively from August 2016 to May 2018 and followed up for 4weeks. Patients were divided into two groups. Group A included successful spontaneous passage patients and group B included failure in the same. The parameters analyzed were age, gender, longitudinal and transverse diameter of stone, CRP, total leucocyte count, ureteric diameter and hydroureteronephrosis (HUN). We performed univariate and multivariate analysis. Receiver operating characteristics curve was used to determine the cutoff value for significantly associated variables. 122 (65.90%) and 63 (34.10%) patients were included in group A and B, respectively. In univariate analysis, CRP, longitudinal and transverse diameter of stone, HUN, proximal and distal ureteric diameters were statistically significant. However, in multivariate analysis, only negative CRP (p=0.002), smaller longitudinal diameter of stone (p<0.001) and absence of HUN (p=0.005) were significantly associated with successful expulsion. Cutoff for CRP was 0.41mg/dl and longitudinal diameter was 6.7mm. The success rate in the group of patients with no risk factor was 96.7% and with all three risk factors was 16.7%. Patients with a longitudinal diameter of stone >6.7mm, HUN, and CRP >0.41mg/dl should be considered for early intervention. The success rate of MET can be increased to 86% after exclusion of patients with all three risk factors.

The discussion of surgical skills of holmium laser lithotripsy for treating lower ureteral stones in day surgery

Objective To explore the efficiency of day surgery in holmium laser lithotripsy for lower ureteral stones, and investigate the feasibility and surgery skills. Methods From August 2014 to March 2018, 408 cases with lower ureteral stones were randomly divided into day surgery group and non-day surgery group, who received holmium laser lithotripsy in one stage, stone was fragmented by holmium laser with F7/7.5 wolf ureterosope, and removed by basket , then indwelling D-J tube was done. Results All patients were treated successfully in one session. Operation time(34.89±20.62) min, hospital stays(1.00±0.00)days, total cost (12530.88±2423.08)yuan in day surgery group were significantly lower than non-day surgery group.There was no infection, no bleeding, no other severe complication was noted. D-J tube was removed 1-4 weeks postoperativly, and the stone clearance rate was 100%. Conclusions The holmium laser lithoripsy is a safe way to treat lower ureteral stones in day surgery. It has certain advantages of effecient, short stay in hospital, quick recovery, less complication.It is worthy to popularize. Key words: Ureteral Calculi; Lasers, Solid-State; Holmium; Lithotripsy, Laser

Pelvic ultrasonographic findings in patients with acute right iliac fossa pain

BACKGROUND: Pain in the right iliac fossa (RIF) is considered the most common presentation of the patients in the emergency department (ED). OBJECTIVE: The objective of this study was to assess various etiologies of acute pain in the RIF using ultrasonography. MATERIALS AND METHODS: This was a cross-sectional study conducted in Khartoum North Teaching Hospital and Alrebat University Hospital from January 2016 to July 2016. A total of 100 patients presented to the ED with acute pain in the RIF. The patients were investigated with ultrasound (US) using 3.5- and 5-MHz transducers. The exclusion criteria included chronic illness, known cancer, and women in late pregnancy. RESULTS: A total of 100 cases who presented with pain in the RIF had been examined clinically and sonographically. A number of 26 cases (26%) showed no findings, whereas 19% were with appendicitis, ovarian cysts represented 17%, right lower ureteric stone represented 16%, and pelvic inflammatory disease represented 12%. Gender and age were the significant factors affecting the distribution of diseases that cause pain in the RIF (P = 0.04). CONCLUSION: In addition to appendicitis, there were a variety of abnormalities that cause pain in the RIF. Ovarian cysts and lower ureteric stone were the most etiologies of pain in the RIF following appendicitis. US of the pelvis is essential before proceeding with any surgery for acute pain in the RIF, especially in young women.

Hounsfield unit and its correlation with spontaneous expulsion of lower ureteric stone.

Background:Hounsfield unit (HU) is the measure of stone density, and is utilized in the predetermination of type of stone. The purpose of this study was to identify some factors in noncontrast computed tomography (NCCT) of kidney, ureter, and bladder (KUB) that are easily extractable and can be used to determine the outcome of expectant management.Methods:All patients 18–50 years of age who presented with flank pain and diagnosed as having lower ureteric calculi of size 5–10 mm by NCCT KUB were included in the study. HU of stone was calculated from the mean HU at three different regions of interest. We prescribed tamsulosin for 4 weeks as medical expulsive therapy. We divided the patients into two groups: group A included patients with successful expulsion of stone, and group B included patients who failed to pass stone. We compared age, gender, laterality, stone size in axial and coronal section of NCCT, HU of stone, blood urea, creatinine, and renal parenchymal thickness.Results:A total of 180 patients with lower ureteric calculus were included in the study. The mean age of patients was 34 years, with male:female ratio of 2.3:1. Of these 180 patients, 119 (66%) successfully expelled the stone and were included in group A, with the remaining 61 (34%) forming group B. In univariate analysis, longitudinal diameter of stone (p < 0.001), transverse diameter of stone (p < 0.001) and high HU (p < 0.001) were significantly associated with failure of expulsion. However, in multivariate analysis only longitudinal diameter of stone (p < 0.001) differed significantly among groups. Differences in HU (p = 0.179) and transverse diameter of stone (p = 0.108) did not reach significance level.Conclusions:Lower ureteric calculi are definitely amenable to conservative management. Longitudinal diameter of stone can be a useful parameter; however, HU and its derivatives cannot be used as a predictor of outcome.

Efficacy of Naftopidil as a Medical Expulsive Therapy in Japanese Men With Ureteral Stones: A Prospective Randomized Controlled Study.

BackgroundNaftopidil combined with an antispasmodic agent and a supplement that facilitates stone expulsion has reportedly produced an increased rate of ureteral stone expulsion. A randomized controlled study was conducted to determine the efficacy of naftopidil as a medical expulsive therapy for male patients with ureteral stones.MethodsMale patients (n = 500) with stones from the upper to the lower ureter were randomized to one of four groups and followed for 1 month to assess spontaneous passage of stones. The control group received only analgesics. The other three groups received daily doses of 240 mg flopropione, an antispasmodic agent and 1,350 mg extract of Quercus salicina Blume/Quercus stenophylla Makino (QS), a supplement that facilitates stone expulsion; 50 mg naftopidil; or 50 mg naftopidil in combination with 240 mg flopropione and 1,350 mg QS. Stone expulsion and characteristics were evaluated by urinalysis; kidney, ureter and bladder X-ray; ultrasound; and computed tomography.ResultsThe probability of expulsion of ureteral stones < 6 mm increased 1.570-fold (95% confidence interval (CI): 1.039 - 2.374, P < 0.05) with naftopidil compared to control; the probability of expulsion of a lower ureteral stone < 6 mm increased 1.778-fold (95% CI: 1.066 - 2.965, P < 0.05) with naftopidil compared to control. None of the stones > 6 mm spontaneously passed.ConclusionsFor relatively small ureteral stones < 6 mm, analgesic treatment combined with naftopidil would be the first choice. However, for relatively large ureteral stones > 6 mm, it appears that analgesia is sufficient for initial treatment of ureteral stone.

Sildenafil is Safe and Effective for the Treatment of Lower Ureteric Stone with no Major Side Effect

INTRODUCTION: Urolithiasis is one of the most common diseases of the urinary tract. Prevalence of urinary stones in a life time is approximately 1% to 15%.Peak age of incidence is 30 years. Male are more commonly affected than female about 2 to 3 times. At the time of presentation 20 % of the calculi are found in the ureter, among which 70% are located in the distal third of the ureter.&#x0D; OBJECTIVE: To study the effect of sildenafil citrate on passage of stone from distal ureter.&#x0D; METHODOLOGY: This is the Quasi experimental study performed in College Of Medical Sciences, Chitwan, Nepal, from February 2017 to February 2018 for a period of one year. First 100 patients of urolithiasis were selected and divided into two groups with the help of lotiery method Group A and Group B. In group A we had patient on placebo and in group B we had patient receiving sildenafil 50 mg once daily and for the period of two weeks.&#x0D; RESULTS: The mean ± standard deviation of stone size was 7.01±1.70mm for treatment group and 6.85±1.56mm for placebo group (p&gt; 0.64) .The stone expulsion rate was 74.5% for treatment group and 41.7% for placebo group (P&lt;0.001). Mean ± standard deviation of expulsion time was 7.6 ±3.49 days for treatment group and 10.25±3.12 days for placebo group (P&lt;0.008). Mean ± standard deviation of VAS was 3.49±1.300for treatment group and 6.77±1.308 for placebo group (P&lt;0.0001).&#x0D; CONCLUSION: Medical Expulsive Therapy (MET) for lower ureterolithiasis with sildenafil during conservative treatment period is safe and effective as demonstrated by the absence of serious side effects and increased stone expulsion rate with early time.

Outcome of ureteric stone treatment with tamsulocin

Background and Objectives: Though medical expulsive therapy for ureteric stones is increasingly used these days, some recent randomized controlled trials have questioned its benefit. This study evaluates the result of treatment of ureteric stones with tamsulosin.&#x0D; Materials and Methods: This prospective study involved ultrasonographically confirmed cases of uncomplicated unilateral ureteric stones. All patients received tamsulocin 0.4 mg daily for 2 to 6 weeks. The primary end point was stone expulsion. The secondary endpoints were the use of analgesics and adverse events. &#x0D; Results: One hundred and sixty two patients completed the study. Ninety seven patients were male and male to female ratio was 3:2. The mean age was 34.9 ± 9.8 (range: 18-71) years. The mean stone size was 6.17 ± 1.68 (range: 3.3-11.2) mm. By the end of 2, 4 and 6 weeks, cumulative stone expulsion rate was 110 (69.1%), 121 (74.7%) and 126 (77.8%) respectively. For the 49 stones of size £ 5 mm, the expulsion rate was 47 (95.9%) by the end of 6 weeks. The expulsion rates for stones of size &gt; 5 - 7 mm, &gt; 7 – 9 mm and ³ 9 mm were 59 (85.5%), 17 (53.1%) and 3 (25%) respectively by the end of 6 weeks. Lower ureteric stones had the highest expulsion rate of 106 (87.6%) by the end of 6 weeks, and the rate was lowest for upper ureteric stones (34.6%). Ten (6.1%) patients required additional analgesics during the course of treatment. Eleven (6.8%) patients complained of mild light-headedness and dizziness which subsided in a few days.&#x0D; Conclusion: Tamsulocin appears to facilitate expulsion of ureteric stones especially the distal ones. The benefit of tamsulocin seems to be maximum for the stones of size up to 9 mm. Further large scale randomized controlled trial should better define the real benefit and more rationale use of tamsulocin in routine clinical practice.

Outcome, Efficacy and Safety of Ureteroscopic Pneumatic Lithotripsy In Management of Lower and Mid Ureteric Calculi

OBJECTIVE: To determine the efficacy and safety of pneumatic lithotripsy in the treatment of mid and lower ureteric calculi.DESIGN: prospective study.DURATION: From 2014 to 2015SETTING: Department of Urology, AL-Diwaniya teaching Hospital.PATIENTS &amp; METHODS:Over a period of one year,one hundred (100) patients of ureteric stones were treated with pneumatic lithoclast. Twenty five (25) Stones were located in mid ureter, Seventy five (75) stones were located in lower ureter . Success rate was defined as symptom free, no residual stones larger than 2mm. General anesthesia was given to all patients.RESULTS:Over all success rate was 90%. Success rate in middle and lower ureteric stones were 82%, 92% respectively. Completely fragmented stones cleared spontaneously within two weeks in 95% of cases and all patients were free of stones one month after the procedure. In six (6) patients stone was migrated, later on submitted for ESWL and successful. Complications were encountered in 11% of cases and were managed conservatively.Hospital stay was 24 to 48 hours.CONCLUSION:Pneumatic lithotripsy is reliable, highly effective rapid, safe and cost effective treatment modality for ureteric stones with negligible incidence of complications.

Vardenafil versus Tamsulosin as a Medical Expulsive Therapy for Distal Ureteral Stones

Background:urolithiasis is one of the most common diseases of the urinary tract. The lifetime prevalence of urinary stones is around 1% to 15% and the peak age of incidence is at 30 years. Men are affected 2 to 3 times more often than women. Ureteral stones account for 20% of the calculi in urolithiasis and about 70% of ureteral stones are present in the distal third of the ureter at the time of presentation. Aim of the work: this study aimed to compare the efficacy and safety of vardenafil (5mg twice daily) vs tamsulosin (0.4mg once daily) as a medical expulsive therapy in the management of distal ureteric stones (DUS) in terms of stone expulsion rate, stone expulsion time, number of pain episodes, analgesic use and side effects related to medical therapy. Patients and Methods: this was a prospective randomized comparative study conducted on 50 patients admitted through the outpatient Urology Clinic in Ain shams University Hospitals and Nasser Institute Hospital between February 2018 and August 2018. The patients were randomized using a closed envelope method. The patients were categorized into 2 main groups 25 patients each. Results: this study showed non significant stone expulsion rates and faster expulsion times in favor of vardenafil when compared to tamsulosin. Conclusion: both of the medications demonstrated a good safety and tolerability profile for medical expulsive therapy in patients with lower ureteric stones.

Application of new modified paracalculous uteteral catheter in ureteroscopic holmium laser lithotripsy

Objective To explore the clinical application value of new modified paracalculous ureteral catheter in ureteroscopic holmium laser lithotripsy for the treatment of large middle and lower ureteral stone. Methods From January 2014 to January 2017, 86 patients with unilateral middle and lower ureteral large stone were treated in Jingzhou Central Hospital. By adopted to random digital table, 86 patients were randomly separated into two groups, all of whom were treated with ureteroscopic holmium laser lithotripsy. Forty-three cases were underwent new modified laser lithotripsy with ureteral catheter inserted beneath the stone. Normal saline was injected continuously through the catheter during lithotripsy procedure (modified lithotripsy group). Forty-three cases were underwent direct ureteroscopic holmium laser lithotripsy (direct lithotripsy group). The outcome data were compared between the two groups, such as the operation time, stone clearance rate, ureteral perforation, transit to open surgery, postoperative urinary sepsis, perirenal hematoma, ureterostenosis and other complications. Measurement data were expressed as (±s), and t test was used for comparison between groups. Results All the patients in the modified lithotripsy group were completed successfully without ureteral perforation, rupture, loss of lithotripsy channel, transit to open surgery, perirenal hematoma, and urinary sepsis and so on. In the direct lithotripsy group, there were 5 cases of ureteral perforation, 4 cases of lithotripsy channel loss, 6 cases of transit to open surgery, 2 cases of perirenal hematoma, 1 case of urinary sepsis. The operation time of the two groups was (39.5±7.2) min and (47.2±11.6) min, respectively, t=-4.975, P=0.001. Stone clearance rate was 100%, 91.1%. The patients in both groups received an average of 1 year out-patient follow-up. There were 3 cases of mild ureterostenosis in the modified lithotripsy group, which were not re-operated. In the direct lithotripsy group, there were 5 cases of mild ureterostenosis, and 2 cases of severe ureterostenosis, which were re-operated. Conclusion It is safe and effective to use the new modified paracalculous uteteral catheter in the ureteroscopic holmium laser lithotripsy of large middle and lower ureteral stone, which can shorten the total operation time and reduce the occurrence of complications. It has a higher clinical value. Key words: Ureteral calculi; Ureteroscopes; Urinary catheterization

Study of the Effect of Tamsulosin HCl (an Alpha-1 Receptor Antagonist) as a Medical Expelling Agent on Subsequent Ureteroscopic Procedure for Treatment of Lower Ureteric Stones

AbstractBackground: Tamsulosin is an a-1A-specific blocker which induces selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen and facilitates stone expulsion.Aim of the Study: In this prospective randomized study we aimed to assess the efficacy of use of alpha blocker (tamsulosin Hcl 0.4mg) on the outecome of ureteroscopic lithotripsy for distal ureteric stone.Patients and Methods: In a prospective study by a rand-omized controlled clinical trial, which was performed from September 2016 to March 2017, about 50 patients underwent ureteroscopic lithotripsy with the pneumatic wolf lithotripsy. The patients were randomly divided into 2 groups: The study group including 25 patients, received tamsulosin with our traditional treatment (hydration and analgesic when required), and the control group with 25 patients who received placebo with traditional treatment. Patients prospectively will be evaluated for stone clearing rate by imaging at morning of URSL and at the end of 2nd week including: (KUB and pelvi abdominal ultrasound)and they will be evaluated for number of colic episodes, analgesic consumption and post-operative complications (haematuria and UTI).Results: The results showed that tamsulosin treatment group had short time of the procedure, easy extraction of the stone fragments, had low expulsion time, low urinary tract symptoms, least analgesic needs and low adverse effects.Conclusions: Administration of a-1A-specific antagon istmade the procedure of short time, easy extraction of the stone fragments reduced analgesic dosage and colic episodes, rate of adverse effects after ureteroscopic lithotripsy of lower ureteral stones and decreased gravel expulsion time after URSL.

A Prediction Model Using Machine Learning Algorithm for Assessing Stone-Free Status after Single Session Shock Wave Lithotripsy to Treat Ureteral Stones

The aim of this study was to develop and validate a decision support model using a machine learning algorithm to predict treatment success after single session shock wave lithotripsy in ureteral stone cases. Of the 1,803 patients treated with shock wave lithotripsy we selected those with ureteral stones who had preoperative computerized tomography available. Treatment success after single session shock wave lithotripsy was defined as freedom from stones or residual stone fragments less than 2 mm long on computerized tomography or plain x-ray of the kidneys, ureters and bladder 2 weeks later. Decision tree analysis was done using a machine learning algorithm to identify relevant parameters. A decision support model was developed to calculate the probability of treatment success. A total of 791 patients were enrolled in study. Mean ± SD stone length was 5.9 ± 2.3 mm and mean stone volume was 89.3 ± 140.0 mm3. The overall treatment success rate after SWL was 64.4% (509 cases). The rate for upper, middle and lower ureter stones was 59.8%, 65.5% and 69.6%, respectively. On decision tree analysis the top 3 performance criteria factors were volume, length and HU. Decision models were constructed with all possible combinations of factors. The model with 15 factors had greater than 92% accuracy and an average ROC AUC of 0.951. We applied a machine learning algorithm, a subfield of artificial intelligence, to predict the outcome after single session shock wave lithotripsy for ureteral stones. A 92.29% accurate decision model was developed with 15 factors and an average ROC AUC of 0.951.

Efficacy and safety of PDE5-Is and \u03b1-1 blockers for treating lower ureteric stones or LUTS: a meta-analysis of RCTs

BackgroundLower ureteric stones and lower urinary tract symptoms are common in urology.Drug treatment is one of standard therapy,but the efficacy was controversial.Thus we aimed to investigate the efficacy and safety of monotherapy or combination therapy of adrenoceptor1 blockers and phosphodiesterase5 inhibitors for treatment.MethodsRandomized controlled trials up to November 2016 were retrieved from PubMed, the Cochrane Library, Web of Science and Embase. A total of 17 studies were included. We analyzed data through random or fixed effect models. The heterogeneity between studies was assessed by the I2 test statistic.ResultsAs for lower ureter stones, our analysis demonstrated tadalafil had a significantly lower incidence of abnormal ejaculation than adrenoceptor1 blockers (2.31 95%CI 0.22to0.84, P = 0.01),while combination therapy had a higher expulsion rate (2.49 95%CI 1.44to4.29, P = 0.001) and shorter expulsion time (− 1.98 95%CI -3.08to0.88, P = 0.0004) than tamsulosin. As for lower urinary tract symptoms, our analysis indicated adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on decreasing International Prostate Symptom Score (1.96 95%CI 0.03to3.89, P = 0.05) and Post-Void Residual (9.41 95%CI 1.40to14.41, P = 0.02) and phosphodiesterase5 inhibitors showed a greater effect than adrenoceptor1 blockers on improving Erectile Dysfunction (2.23 95%CI 1.24to3.22, P<0.0001).Combination therapy had a significantly better effect on International Prostate Symptom Score (1.47 95%CI 1.25to1.69, P<0.0001), Maximum flow rate (0.87 95%CI 0.71to1.04, P<0.0001), Post-Void Residual (10.74 95%CI 3.53to17.96,P = 0.004) and Quality of life (0.59 95%CI 0.22to0.97, P = 0.002) but was associated with higher incidences of adverse events (3.40 95%CI 1.82to6.36, P = 0.0001) than adrenoceptor1 blockers. Combination therapy had a significantly better effect on International Prostate Symptom Score (4.19 95%CI 3.34to5.04, P<0.0001), Maximum flow rate (1.86 95%CI 1.32to2.39, P<0.0001), Post-Void Residual (22.58 95%CI 9.13to36.04, P = 0.001) and Quality of life (0.68 95%CI 0.37to1.00, P<0.0001) without higher incidences of adverse events than PDE5-Is.ConclusionsIn conclusion, this meta-analysis suggested combination therapy had a best efficacy of therapy for lower ureteric stones or lower urinary tract symptoms correlated with benign prostatic hyperplasia than monotherapy. Adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on International Prostate Symptom Score and Post-Void Residual. Both monotherapy and combination therapy were safe.

Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study.

BackgroundUrine solute supersaturation leads to the formation of urinary tract caliceal stones. Many parameters can be involved in the supersaturation of solutes in urine, such as pH. Uric acid has pKa ≤5.5, and it is solubilized at pH ≥5.5. The objective of the study was to evaluate the effects of potassium citrate and lemonade supplementation in pediatric patients with urolithiasis.Material/MethodsA total of 126 children who had lower ureteral stones calculi and fragments with severe colic pain participated in this cross-over study. Children drank lemonade (2 mEq/kg/day citrate) in 3 divided doses for 5 days. After a 15-day washout period, children drank 2 mEq/kg/day of potassium citrate in 3 divided doses for 5 days. On the sixth of the day of individual intervention, a 24-h urine sample was collected and evaluated for pH, urine volume, citrate level, uric acid level, magnesium, phosphorus, potassium, and sodium. Urinary parameters for 1-day urine collection measurements after each supplementation were compared with baseline using the Mann-Whitney test following Tukey post hoc test at 95% confidence level.ResultsPotassium citrate supplementation resulted in reduction of sodium concentration (p=0.0337; q=3.76) and increased pH of urine (p=0.0118; q=4.389). However, urine volume, citrate level, and uric acid level, as well as elemental magnesium, phosphorus, and potassium, remained unchanged after 5 days of supplementation with potassium citrate or lemonade.ConclusionsPotassium citrate supplementation is an effective therapy for preventing pediatric urolithiasis, with acceptable adverse effects.

STONE FREE RATES OF KIDNEY STONE WAS LOWER THAN THE ONE OF URETER STONE PATIENTS MANAGED BY ESWL AND THE ONE OF URETER STONE MANAGED BY URETEROLITHOTRIPSY

Objective: To evaluate the stone free rates of kidney and ureter stone patients managed by Extracorporeal Shockwave Lithotripsy (ESWL), and the ureter stone free rate managed by ureterolithotripsy. Material &amp; method: We reviewed the medical records of kidney and ureter stone patients managed by ESWL and ureter stone patients managed by ureterolithotripsy in Arifin Achmad Regional General Hospital Pekanbaru Riau Province, Indonesia, from January 2010 - December 2016. ESWL and ureterolithotripsy stone free rates were examined by the control of KUB röngents. Results: There were 891 kidney and ureter stone patients consisting of 325 (36.5%) were kidney stone patients and 566 (63.5%) were ureter stone patients. The pyelum stones were the most (78.2%) in kidney stones and the lower ureter stones were the most (57.2%) in ureter stones. There were more male patients than the female ones in which most of the patients were in the group age of 49-59 years. The amount of patients increased each year. The kidney stone free rate managed by ESWL was lower (71.7%) than ureter stone free rate (84.1%) by ESWL, while the stone free rate of ureter stone patients managed by ureterolithotripsy was 100%. Conclusion: The ESWL stone free rate of the kidney stone patients was lower than the one in ureter stone patients while the ureterolithotripsy stone free rate was 100%.

Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion.

ABSTRACTObjectiveTo present our experience in minimally invasive management of urinary tract stones in patients with urinary diversion.Materials and MethodsWe retrospectively reviewed 26 patients with urinary tract stones after cystectomy and urinary diversion. The types of urinary diversion were ileal conduit, colon conduit, ileal orthotopic neobladder in 19, 4, and 3 patients, respectively. At postoperative days 2, a plain KUB and urinary ultrasonography were performed in order to assess stone fragmentation or hydronephrosis. According to postoperative imaging, stone free rate (SFR) was defined as complete absence of fragments or residual stones less than 4mm.Results19 patients were treated with minimally invasive percutaneous lithotripsy (MPCNL) and 2 patients required second-look MPCNL. Anterograde flexible ureteroscopy was performed in 2 patients, while in 2 patients a combined anterograde and retrograde approach was required. Three reservoir stones were treated by transurethral neo-bladder lithotripsy. Postoperative significant complications occurred in 2 patients (7.7%). The highest percentage of stone composition was struvite, as a result of chronic urinary tract infection (UTI). SFR was 88.5% (23 of 26).ConclusionsOur experience showed that MPCNL is a safe and effective treatment modality with little morbidity for renal and upper ureteral stones in patients with urinary diversion. For middle and lower ureteral stones, an anterograde approach could be also considered as a first line treatment, but a combined anterograde and retrograde approach was required when the anterograde access alone cannot provide acceptable results.