Lower Ureteral Calculi Research Articles

Pelvicalyceal system rupture due to obstruction by lower ureteric calculus

Abstract The most common cause of spontaneous non traumatic pelvicalyceal system rupture is distal obstruction by a ureteric calculus and should be included in the differential diagnosis of patients with acute flank pain and perinephric fluid on ultrasound and Contrast enhanced CT scan with delayed images should be done to confirm the diagnosis. We present a case of spontaneous non traumatic pelvicalyceal system rupture due to a tiny ureteric calculus managed with primary ureteroscopic lithotripsy.

Effect of adjunctive drug therapy on early expulsion of distal ureteral calculi after extracorporeal shock wave lithotripsy

Objective: To evaluate the efficacy of ketochromate tromethamine and phloroglucinol combination therapy in early expulsion of ureteral calculi after extracorporeal shockwave lithotripsy (ESWL) in patients with distal ureteral clculi. The clinical and follow-up data of 275 patients with lower ureteral calculi who underwent ESWL were collected retrospectively in Civil Aviation General Hospital from January 1st 2021 to June 30th 2021. According to whether adjunctive medication used before ESWL patients were divided into control group and medication group (with ketochromate tromethamine 30 mg and phloroglucinol 80 mg before ESWL). Primary endpoint is the clearance rate of ureteral calculi after ESWL, secondary endpoint are the other outcomes and drug allergy. There were 138 cases in control group [117 were males and mean age (42±13) years]. Meanwhile, there were 137 cases in medication group [118 were males and mean age (42±12) years]. The clearance rate of ureteral calculi at 24 h (67.88% vs 48.55%, P=0.001)、one week (76.64% vs 57.97%, P=0.001) and four weeks (89.05% vs 76.08%, P=0.005)after ESWL in medication group were significant higher than that in control group. There was a significant difference in the VAS score of pain scale after ESWL (1.77±0.80 vs 2.06±1.04, P=0.012) and re-ESWL rate (8.03% vs 17.39%,P=0.02) between two groups, but no difference with gross hematuria in 6 h after ESWL and drug allergy. Conclusions combination use of ketochromate tromethamine and phloroglucinol significantly improve early expulsion of ureteral calculi after ESWL in patients with distal ureteral calculi, with no side effect.

Can Silodosin Be Considered a Superior Substitute for Tamsulosin in Medical Expulsion Therapy for Patients with Lower Ureteral Calculi

Introduction: Urinary stones, also known as calculi, are a common urological problem affecting millions of people worldwide. Medical expulsion therapy (MET) is a commonly used treatment for lower ureteral calculi. Objectives: The main objective of the study is to find the role of silodosin as a superior substitute for tamsulosin in medical expulsion therapy for patients with lower ureteral calculi. Material and methods: The study design for this research article would be a randomized controlled trial comparing the efficacy and safety of silodosin and tamsulosin in medical expulsion therapy (MET) for patients with lower ureteral calculi. Patients with lower ureteral calculi who meet the inclusion criteria will be recruited for the study. Inclusion criteria may include age over 18 years, presence of lower ureteral calculus confirmed by imaging, and willingness to participate in the study. Exclusion criteria may include previous history of ureteral surgery, contraindication to alpha-blockers, and pregnancy. Results: A total of 100 participants were randomized to receive either silodosin (n=50) or tamsulosin (n=50) for medical expulsion therapy of lower ureteral calculi. The mean age of the participants was 45 years, and 60% were male. The stone expulsion rate at 4 weeks was 80% in the silodosin group and 75% in the tamsulosin group. There was no statistically significant difference between the two groups (p=0.54). Conclusion: In conclusion, the results of this study indicate that silodosin may not be a superior substitute for tamsulosin in medical expulsion therapy for patients with lower ureteral calculi. Both drugs demonstrated similar rates of stone expulsion and time to stone passage, as well as comparable safety profiles and patient satisfaction rates. Keywords: Silodosin, Tamsulosin, Lower Ureteral Calculi

USING TAMSULOSINE IN THE MANAGEMENT OF LOWER URETERIC CALCULI: OUR EXPERIENCE OF MEDICAL EXPUSIVE THERAPY OF URETERIC CALCULI IN A RANDOMIZED CONTROLLED TRIAL

Background: Lower ureteric calculi can be treated by different modalities. There are many minimally invasive interventional (e.g.,ESWL, ureterorenoscopy, the holmium: YAG laser and basket devices) as well as expectant (watchful waiting) treatments are in practice for the management of distal ureteric calculi. selected method depend on the type of equipment available, location, type and size of stone, needs of the patient and skills of the surgeon. Most of the work on the potency of tamsulosin in lower ureteric calculi expulsion has been done in the developed countries.
 Methods: Our randomized controlled trial in Avicenna Hospital Lahore included 100 patients over 18 years of age with stone Size ≤8mm in distal one third of ureter. Patients were randomly assigned into two groups (A & B). Group A Patients were given Capsule Tamsulosin 0.4 mg, once daily up to four weeks while group B patients were given placebo, one Capsule daily up to four weeks. The final result was the expulsion rate.
 Informed consent was obtained from all the patients. Stone Expulsion time, analgesia requirement, need for
 hospitalization and drug adverse effects were secondary endpoints.
 Results: A total of 49 patients in group A and 48 patients in group B came for follow up, therefore 97 out of 100 patients were evaluated. Mean age of the patients was 36.34 years (range 18–57 years). Mean stone size was 5.78 mm (range 4–8 mm) in largest dimension. A stone expulsion rate of 85.71% (42 patients) was noted in group A and 54.20% (26 patients) in group B. Group A showed a statistically significant advantage in terms of stone expulsion rate (p=0.032). Considering expulsion time in days group A demonstrated statistically significant advantage (p=0.015). Regarding age, sex, stone size and stone lateralization (right/left), there was no remarkable difference between the group A and B. No drug adverse effects were seen in both the groups.
 Conclusion: Tamsulosine can be used as medical expulsion therapy in lower ureteric calculi of size less than or equal to 8mm.

Assessment of the efficacy of reduced-radiation noncontrast computed tomography scan compared with the standard noncontrast computed tomography scan for detecting urolithiasis: A prospective single-center study.

Noncontrast computed tomography (CT) scan of the kidneys, ureter and bladder is the standard investigative modality for diagnosing and following up patients with urolithiasis. With each scan, a patient receives radiation of 18-34 mGy. Dose considerations become pertinent because of a 10% lifetime incidence rate and higher than 50% risk of recurrence, necessitating repeated imaging in the lifetime of a stone former. Hence, this study aimed to assess the sensitivity of "reduced-radiation" CT imaging by altering scan settings to lower than the "standard" norms. Altogether, 222 patients (255 "kidney-ureter" stone-bearing units or "renal units") with urolithiasis and patients undergoing CT for other reasons with incidental findings of renal/ureteric calculi between 2017 and 2019 were included. All patients were subjected to 3 sequential scans at tube current settings of 250 mA (CT-N/Standard), 100 mA (CT-100), and 50 mA (CT-50) at a constant voltage of 120 kV. Their clinicodemographic and radiological findings were recorded and assessed for significance. Of the 255 renal units, 117 were between 30 and 44 years of age, 75% were men. Of the 255 patients, 178 (70.1%) reported a first stone episode and 77 had recurrence. Lower ureteric calculi were predominant (40.4%). All calculi were identified on CT-N; CT-100 failed to detect calculi in 1 patient, and CT-50 failed in 3 patients, where all calculi were <3 mm in size. Meanwhile, none were undetected among patients with obesity. The sensitivity was 99.61% for the CT-100 and 98.82% for the CT-50, which indicated a 2.5 and 5 times lower radiation and dose/length, respectively, than CT-N. The reduced-radiation CT scan is safe, sensitive, and accurate for the diagnosis and follow-up of patients with urolithiasis with significantly lower radiation exposures. Our study lays the foundation to accept low-dose CT in general and CT-50 in particular, as the new "standard of care," and attempt further dose reduction without loss of diagnostic efficacy.

Application of ureteral access sheath in the operation of middle and lower ureteral calculi in patients with massive benign prostatic hyperplasia

Objective: To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. Methods: From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm3 (range: 85 to 186 cm3). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. Results: The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. Conclusions: In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.

Role of Aminophylline Intravesical Instillation on Enhancing Ureteral Dilatation prior to Ureteroscopy

Abstract Background Semi-rigid uretroscopy (URS) is a common intervention approach for lower ureteric stones. Ureteral dilatation is frequently needed before URS to enable ureter accessing. Aminophylline is known by its muscle relaxant effect and has been suggested to be effective in ureteral dilation. Objectives To evaluate the effect of intravesical administration of aminophylline on ureteroscopy and to measure intraureteral pressure Methods This prospective randomized controlled study included 50 before and after aminophylline injection. patients with lower ureteral calculi. In group A, the ureter was dilated by intravesical aminophylline whereas in group B balloon dilator was used. Intraureteral pressure was measured using pressure transducer connected to invasive pressure monitor. Results No statistically significant difference was noticed between both groups in operative time, intra operative complication, need for ureteral stenting or stone free rate. However, post-operative pain and haematuria were statistically significantly higher among balloon group compared to aminophylline group. In group A, there was statistically significant decrease in intraureteral pressure after injection of aminophylline (7.80 ± 1.71) compared to before injection (12.2 ± 1.85) with p-value &amp;lt; 0.001. Conclusion Aminophylline is effective in ureteral dilatation when intravesically injected with less frequent post-operative pain and hematuria.

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.

Study of efficacy and safety of surgical treatment of mid and lower ureteric calculi with rigid ureteroscope and pneumatic lithotriptor in adult patient

Study of efficacy and safety of surgical treatment of mid and lower ureteric calculi with rigid ureteroscope and pneumatic lithotriptor in adult patient

Laparoscopic Surgery in Pediatric Upper Tract Urolithiasis: An Alternate Modality.

Introduction:Incidence of pediatric urolithiasis has increased over the last few decades. Procedures such as extracorporeal short wave lithotripsy, percutaneous nephrolithotripsy, and ureterorenoscopic lithotripsy are not widely available for pediatric age group in many developing countries. It is desirable that advantages of minimally invasive surgery be offered to selected cases with urolithiasis.Materials and Methods:All patients with pediatric upper tract urolithiasis managed laparoscopically from January 2015 to April 2020 were retrospectively reviewed.Results:A total of 38 patients were included. The mean age of the patients was 8 ± 2.85 years. Thirty-four patients (renal and upper ureteric) were managed through retroperitoneal approach, while those with lower ureteric calculi (n = 4) were approached transperitoneally. A total of eight patients required conversion to open technique. The stone clearance rate was 79% by laparoscopic approach alone. There were no procedure-related complications.Conclusion:Our study suggests that laparoscopic management for pediatric upper tract urolithiasis is a radiation-free, single-time curative treatment and is feasible in centers where facilities for other endoscopic procedures are unavailable.

Study of clinical indication, difficulties and complications of DJ stenting in urological procedure at a tertiary hospital

Background: Urolithiasis is one of the major causes of morbidity in our society as our country is located near to equatorial distribution of stone disease Indwelling ureteral stents provide free drainage from the kidney to the bladder, reduce or eliminate urinary leakage and provide ureteral stenting. The present study was designed to observe indications, difficulties and complications of indwelling double J ureteral stenting. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients undergoing DJ stenting URS/ESWL (stone size &gt; 2cm), willing to participate in study. The data collected was entered into Microsoft excel and analyzed. Statistical analysis was done using descriptive statistics. Results: In the present study, we assessed prospectively the effectiveness of DJ stent insertion for treatment of ureteral stones in 100.patients. Gender distribution in the current study was 65% male and 35 % female. 65 % patients were between the age 10 to 40 years; 20 patients have lower ureteric calculi, 37 patient having mid ureteric calculi and 8 patients having upper ureteric calculi. In current study out of 100 patients 32 patients have stone between the range of 6-10 mm, 42 patients have stone size range between 11-16 mm and only 26 patient have stone size more than 16 mm. 32 patients having mid ureteric calculi in which 30 patients DJ stent procedure successfully completed, remaining 2 patients had ureteric stricture treated with URSL. 27 patients having lower ureteric calculi in which 25 patients DJ stent procedure successfully completed, remaining 2 patient had ureteric stricture treated with ESWL followed by cystoscopy removal. 8 patients having bilateral ureteric calculi in which 6 patients DJ stent procedure successfully completed, remaining 2 patient have impacted stone treated with URSL with PCNL. 100% success rate in DJ stent insertion in patients with stone size 11-16mm followed by in 93% with stone size 6-10mm and in 76% with stone size &gt;16mm. Conclusion: Most of the ureteral DJ stent related complications can be managed by surgical procedures hence they should be removed as soon as their purpose solves. The proper follow up from patients can help to early identification of post insertion complications of DJ stent and timely management of them.

Study of the efficacy of alpha1-adrenergic antagonist in the medical management of lower ureteric calculi

Study of the efficacy of alpha1-adrenergic antagonist in the medical management of lower ureteric calculi

Effect of Tamsulosin on Treatment of Lower Ureteric Calculi

Introduction: Medical expulsive therapy (MET) is one of the treatment modality for ureteric calculi. Recent studies have reported excellent results with MET for lower ureteral calculi. The aim of study to evaluate the effect of tamsulosin on treatment of lower ureteric calculi. Materials and Methods: A prospective study was conducted at outpatient department of Urology, Prime Medical College Hospital, Rangpur, Bangladesh during February 2018 to February 2019. A total of 100 patients with lower ureteric calculi included in this study. Cases were selected by inclusion and exclusion criteria and randomly allocated in two groups. Tamsulosin group (50 patients) were given capsule tamsulosin 0.4 mg, at bed time while observation group (50 patients) were given standard therapy without tamsulosin. The patients were prescribed diclofenac (50 mg) on demand for pain relief and were followed-up by X ray and ultrasonography of kidney, ureter and urinary bladder region for 28 days. The stone expulsion rate, expulsion time, and analgesic requirements were also recorded. Data were analyzed and compared by statistical tests. Results: Tamsulosin group showed a statistically significant advantage in terms of the stone expulsion rate. A stone expulsion rate of 78% (39 out of 50 patients) in tamsulosin group and 54% (27 out of 50 patients) was observed for observation group (p=0.011). In tamsulosin group, mean expulsion time was 7.26 ±3.35 days whereas in observation group mean expulsion time of 8.93 ±3.56 days (p=0.017). Tamsulosin group stone expulsion time was lower as compared to observation group. Overall the number of doses of analgesic (diclofenac) required in tamsulosin group, it was 3.78 ± 2.82 whereas in observation group was observed to be 5.93± 1.76. The variation between number of doses of analgesic required by patients in both groups was found to statistically significant (p=0.001). Conclusions: The effectiveness of tamsulosin as a medical expulsive therapy in patients with lower ureteric calculi was higher as compared to observation group. Tamsulosin has been found to increase stone expulsion rates, reduces mean days to stone expulsion and decreases number of doses of analgesic requirement. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.155-159

Extracorporeal shock wave lithotripsy in Indian children: Predictors of outcome and validation of pre-treatment nomograms

Although multiple variables have been shown to affect outcomes in pediatric lithotripsy (ESWL), there is no consensus on the same. Nomograms combine multiple variables and provide an objective prediction of outcomes. Two nomograms have been previously described and validated in two studies from the same geographical area. External validation in multiple settings is needed, as a nomogram's performance may vary with time, geographical area and clinical scenario. This study aimed to identify variables influencing pediatric ESWL outcomes, validate published nomograms and describe the clinical and metabolic profile of Indian children treated with ESWL. This retrospective cohort study included all children who underwent ESWL from 2002 to 2019at a single centre. ESWL was performed under general anaesthesia. Mid and lower ureteric calculi were treated in prone and the rest in supine position. 1500-2000 shocks were delivered at a voltage of 12-16kV. Data pertaining to patient characteristics, metabolic evaluation, imaging, ESWL details and post-procedure outcomes were obtained from the hospital information system and these variables, along with Onal and Doğan scores, were correlated with stone clearance. Cut-offs for Onal and Doğan scores were determined using receiver operator characteristic (ROC) curve analysis and compared with area under the curve (AUC). Complications, ancillary procedures and metabolic abnormalities were recorded. A total of 66 children (76 renal units) were included. Mean age was 5.5 years (Range 6 months-14 years) and median stone size, 12mm (IQR 9, 15.25). Average treatment sessions were 1.8±0.99. Median shocks in the stone-free group and those who failed treatment were 1750 (IQR 1500, 3000) and 3250 (IQR 1750, 4750) respectively. The remaining variables are depicted in Table 1. The stone free rate was 63.2%. Fragments <4mm were seen in 19 (25%). Efficacy Quotient was 40. The AUC for Doğan nomogram (cut-off <199.5) was 0.761 while that for Onal nomogram (cut-off <2.5) was 0.762 and 0.771 after one and three shocks respectively. On multivariate analysis, age, multiple calculi, Onal and Doğan scores were predictive of clearance. Doğan score had higher specificity. Complications were seen in 16 (21%) and ancillary procedures needed in 7 (9.2%). Metabolic abnormalities were seen in 84.8%, the commonest being hyperoxaluria. Mixed stones were most frequent. Lithotripsy in children is safe and effective. Older age, presence of multiple calculi, higher Onal and Doğan scores are predictive of treatment failure.

English

English

Evaluation of the Management of Urolithiasis with Clinical Study

Background: Urolithiasis encompasses both renal and ureteric stones. It is estimated that up to 5% of the world population is affected by this disease and the lifetime risk of getting urinary stone is 8-15%. The aim of this study is to look for epidemiological patterns in the disease distribution, understand the causative factors of the disease and assess the existing surgical modalities of treatment of this disease. Subjects and Methods: In the present study 68 cases of Urolithiasis fulfilling the study parameters were admitted and subsequently operated in Medical College and Research Hospital. Results: 65% of the patients were between age group 18-40. The most common site of urinary calculus was lower 1/3ureter followed by lower pole kidney. Diet, fluid intake, diabetes and obesity were significant predisposing factors for urolithiasis. PCNL was the treatment of choice for renal calculus while ECSWL was treatment of choice in upper ureteric calculi and ureteroscopy for lower ureteric calculi. Conclusion: For renal calculi, PCNL is the best treatment modality as of now, but it is associated with greater post-operative morbidity. For stone less than 1cm size, ECSWL is a good alternative to PCNL, but has poor clearance rate and thus greater need for auxiliary procedure. For ureteric calculi, both ECSWL and ureteroscopy have given good results but ECSWL is better tolerated by the patients.

Experience and outcome of simultaneous bilateral endoscopic surgery (SBES) for patients with bilateral upper tract urolithiasis

Introduction: 15% of Urolithiasis patients presents with bilateral renal stones. Management of patients with renal stones along with ureteric stones commonly requires staged approach. Simultaneous bilateral endoscopic surgery (SBES) has emerged as more efficient treatment option which allows management of renal and ureteric stone in a simultaneous manner. We report our experience with SBES for patients with bilateral Urolithiasis. Patients and Methods: From May 2018 to February 2020, 12 patients who would otherwise have been treated in staged or in consecutive manner were planned for Simultaneous Bilateral Endoscopic surgery. Procedures were performed in the FOSML position to achieve both antegrade and retrograde access. Management of renal stones by supine approach and retrograde uretroscopic lithotripsy for ureteric stones under general anesthesia. Results: A total of 12 patients underwent simultaneous bilateral endoscopic surgery. Among these 12 patients, 2 patients had contra lateral upper ureteric calculus, 4 had mid ureteric calculus and remaining 6 had lower ureteric calculus. 11 patients were discharged on second postoperative day and remaining 1 patient was discharged on 3rd postoperative day due to procedure related complication. Conclusion: Simultaneous bilateral endoscopic surgery can be performed in FOSML position and is safe and effective procedure with shorter operative time and anesthesia. Procedure is beneficial for patient, healthcare system and surgeon.

External physical vibration lithecbole in treatment of ureteral calculi with renal colic used different positions: a prospective multicenter randomized controlled clinical study

Objective To evaluate the efficacy and safety of different positions external physical vibration lithecbole (EPVL) therapy for ureteral calculi related renal colic. Methods This study was a prospective multicenter randomized controlled trial. The inclusion criteria was that patients volunteered to participate in the trial and signed informed consent, patients’age ranged from 18-65 years old, ureteral calculi related with renal colic, stone diameter was less than 7 mm, patients were not treated with analgesia, antispasmodic drugs. The exclusion criteria was that combination of severe urinary tract infection, severe hydronephrosis, urinary malformation, severe hypertension, history of cerebrovascular disease, vital organ dysfunction, obesity (BMI>35 kg/m2), history of ureteral calculi exceeded 2 months, abnormal blood coagulation. Patients were randomized into observation group and control group using random number table method. The observation group and the control group were placed on the physical vibration stone arranging machine with low foot high and high foot low respectively. The inclination angle was 24°. The secondary vibrator vibrated for 6 minutes, then the patient took the prone and opened the main, the secondary vibrator. The treatment is completed after 6 minutes of vibration. The analgesic effect, stone removal, follow-up effects and adverse reactions in the two groups was compared. We defined the pain relief rate as(VAS score before treatment-VAS score after treatment)/VAS score before treatment×100%. Results A total of 100 patients were included in the study, 50 in the observation group and 50 in the control group. There were no statistical difference in the age of the two groups [(41.8±11.7)years and (46.6±13.9 years)], gender distribution [37(male)/13(female) and 42(male)/ 8(female)], location of stones (in the observation group, 19 cases in upper ureter, 7 cases in the middle ureter and 24 cases in the lower ureter; in the control group, 12 cases in the upper ureter, 3 cases in the middle ureter, and 35 in the lower ureter), left and right distribution of stones [21(right)/ 29 (left) and 22 (right)/ 28(left)], long diameter of stones [(5.2±0.9)mm and(5.1±1.1)mm], VAS scores before treatment (7.5±1.4 and 7.6±1.5), and readmission rate [22%(11/50)With 18%(9/50)], 1 week stone removal rate [70%(35/50) and 64%(32/50)]. The incidence of adverse reactions was 8%(4/50) in the observation group including 3 cases of nausea, 1 case of vomiting. The incidence of adverse reactions was 4% in the control group (2/50), which 2 cases showed nausea. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in observation group was 35 cases, 9 cases, and 6 cases respectively. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in the control group was 35 cases, 10 cases and 5 cases respectively. There was no significant difference between the two groups (P>0.05). The VAS score after treatment of the observation group was lower than that of the control group (2.4±1.3 and 3.7±1.5, P<0.01). The total effective rate of the observation group was higher than that of the control group [94%(47/50) and 76%(38/50), P<0.01]. 46 patients underwent urinary ultrasonography to check the degree of hydronephrosis. The reduction rate of hydronephrosis was higher in the observation group than in the control group [54.5%(18/33) and 30.8%(4/13)], but there was no significant difference between the two groups (P=0.146). In the upper ureteral calculi, the VAS score of the observation group was lower than that of the control group (2.4±0.3 and 3.9±0.4, P<0.01). There was no significant difference in the total effective rate between the two groups. In the lower ureteral calculi, the observation group had low VAS score after treatment. In the control group (2.4±0.2 and 3.5±0.2, P<0.01), there was no significant difference in the total effective rate between the two groups; the middle segment stones were less included (10 in total) and were not discussed. Conclusions The external physical vibration lithecbole adopts high and low position has better effect than head low foot high position in treatment of ureteral calculi with renal colic, and security is acceptable. Key words: Ureteral calculus; Renal colic; Posture; Randomized control research; Multiple center

A Case of Congenital Portal Vein Aneurysm-Few and Far between

Portal vein aneurysm is an unusual vascular dilatation of the portal vein, which was first described by Barzilai and Kleckner in 1956, and since then, less than 200 cases have been reported. So, we would like to present our case, a 27-year-old male who presented with left lumbar pain diagnosed with left lower ureteric calculus and had an incidental finding of portal vein aneurysm. It required no treatment, and he was followed up with serial abdominal ultrasound every 6 months, and the patient is doing well without any complications. Hence, conservative management is the best option in the majority of patients. Surgical indication is currently reserved in 10% of cases, which are complicated by rupture, increase in size on surveillance scan, or are otherwise symptomatic; however, post-operative mortality remains extremely elevated.

Outcome of Uretero Renoscopic Lithotripsy (URSL) with Holmium LASER Vs Pneumatic Lithotripter for Lower Ureteric Stones, Experience from University Hospital of Nepal

Background There are various methods of endoluminal ureteral stone fragmentation. Among various modalities Laser lithotripsy and Pneumatic lithotripsy are commonly used and have shown comparable outcomes. Objective To compare the efficacy and outcome of laser and pneumatic lithotripsy in a patient with lower ureteric calculi. The comparison will be done in stone free rate, migration of stone and complication of the procedure. Method This is a prospective comparative study in a cohort of patients at University Hospital with Lower Ureteric stone. Ninety patients were randomized in to two groups (Laser Lithotripsy Vs Pneumatic Lithotripsy) during the study period. The purpose of this study was to measure the immediate stone free rate, intra-operative complications, mean operative time, post-operative complication and if any stone retention after six weeks follow up. Result Both the groups were similar in Age and Gender. Immediate stone free rate was slightly higher in Laser lithotripsy group (97.77%) in comparison to Pneumatic lithotripter group (84.44%) with p=0.507 which is not statistically significant. There was statistical difference in terms of stone migration rate, mean operation time in favor of Laser Lithotripsy group (p<0.01, in both parameters). There were no immediate complications in both the group however there were three cases of short segment ureteric strictures (6.66%) in case of Pneumatic lithotripsy on six weeks follow up which was managed conservatively. Conclusion Both LASER lithotripter and Pneumatic lithotripter are equally efficacious modality of endoluminal URSL in lower ureteric stone with similar Stone Free Rate. Laser lithotripsy showed lower frequency of stone migration and had shorter procedure time.