Lower Ureteral Stones Research Articles

Efficacy of Tamsulosin alone versus Tamsulosin Phloroglucinol combination therapy for medical expulsion of lower Ureteral calculi.

Objective:To see whether phloroglucinol-added tamsulosin therapy exhibits better efficacy than tamsulosin alone in medical expulsion of lower ureteral stone (LUS).Methods:Sixty four consecutive adult patients presented in a urological setting at Sialkot, Pakistan between January 2015 and December 2016 with solitary, unilateral 3-8mm sized lower ureteral stone (reported by noncontrast computed tomography of the kidney-ureter-bladder) were documented. Group either study or control was allotted, randomly. Same 0.4 mg tamsulosin, once daily was given to all the participants. However, additional 40 mg phloroglucinol, thrice daily was advised for study group (n = 32). The therapy terminated on confirmation of stone expulsion otherwise continued for 6 weeks. Patients were asked to use 50 mg diclophenac Na on colic episode.Results:Demographic characteristics revealed 81.2% (n = 52) male patients while age statistics as M = 42.3, SD = 5.93 (range 32-60) years. The study group showed higher stone expulsion rate (100%) and time to expulsion (M = 10.34 days) than control. The values were statistically significant (p = .02 and p = .0001; χ2 test in SPSS). Similarly, combination therapy had advantage on mono therapy for reporting statistically lesser numbers of colic episode (p = .03) and consumption of analgesic (p = .02). A marked difference in rate of adverse effects i.e. 68.8 vs. 90.6% was observed in study and control groups.Conclusion:Phloroglucinol-added therapy is a better choice for expulsion of LUS than tamsulosin alone with reference to stone expulsion rate and medication time.

Extracorporeal Shock Wave Lithotripsy success rate for upper and lower ureteric stones in Azadi-teaching (Dohuk) hospital in Kurdistan Region-Iraq

Extracorporeal Shock Wave Lithotripsy success rate for upper and lower ureteric stones in Azadi-teaching (Dohuk) hospital in Kurdistan Region-Iraq

Comparing tamsulosin, silodosin versus silodosin plus tadalafil as medical expulsive therapy for lower ureteric stones: A randomised trial

ObjectiveTo compare the efficacy of tamsulosin, silodosin, and silodosin plus tadalafil as medical expulsive therapy (MET) for distal ureteric calculi. MethodsIn all, 120 patients who met the inclusion criteria were randomised into one of three treatment arms: tamsulosin (Group A), silodosin (Group B), and silodosin plus tadalafil (Group C). The drugs were given for a maximum of 4 weeks. The primary endpoint was the stone expulsion rate and secondary endpoints were stone expulsion time, number of pain episodes, and side-effects associated with MET. The follow-up period was for 4 weeks, after which ureteroscopic lithotripsy was done to remove any stones that were not expelled. ResultsThere was a statistically significantly higher stone expulsion rate in Group C (90%) as compared to groups A (57.5%) and B (77.5%) with a shorter mean time to stone expulsion. Also, there were statistically fewer pain episodes in Group C as compared to groups A and B. There were no serious side-effects. ConclusionThe present study concludes that the combination of silodosin and tadalafil increases the ureteric stone expulsion rate and decreases the expulsion time significantly. This combination provided significantly better control of pain without any serious side-effects.

THE USE OF ALPHA BLOCKERS IN TREATMENTOF LOWER URETERIC STONE

Depending on the fact that alpha adrenergic receptors are present in the ureter, the alpha blocker (terazosin) has been added to the conventional treatment of ureteric colic due to lower ureteric stone in hundred patients, to asses its advantage in hasting the passage of lower ureteric stone. The patients were selected on the bases of having a stone of one cm or less in the lower ureter discovered by sonography. The patients followed after ten days by sonography if the stone not pass before that.Eight patients developed intolerable side effects (dizziness and postural hypotension) so that terazosin was stopped and twenty patients not come back for follow up. Those patients were excluded from the study. Sixty-six patients, from the remaining 72 patients, (91.6%) pass the stone within ten days. Fifteen (22.7%) of them pass the stone after three days, nineteen (28.8%) of them did so after five days and eighteen (27.3%) patients after one week, in fourteen(21.2%) patients the stone disappear in the sonography taken after ten days. Six patients (8.3%) need urological interventions as the stone failed to pass even after two course of therapy. In conclusion, the use of alpha blocker (terazosin) seemed beneficial in hasting the passage of lower ureteral stone.

ESWL;

Objectives: Objectives of the study are to evaluate extracorporeal shock waveslithotripsy (ESWL) with and without double-J-ureteric stent in 2-3 cm renal stone. Study Design:Comparative study. Place and Duration of Study: This study was out conducted at LithotripsyCenter, Department of Urology & Renal Transplantation, KEMU/ Mayo Hospital, Lahore, fromJune 2015to May 2016.”Methodology: This study consisted of 60 patients admitted. Allpatients were divided into two equal groups. Thirty patients of kidney stones were included ingroup A, who were treated by ESWL without double-j-ureteric stent. Group B, who were treatedby ESWL with prior double-j-ureteric stent insertion. Detailed History was taken from all thepatients with special regard to the renal stone pain. Detailed Clinical examination of the patientwas done and recorded in proforma. Systemic review was also done to see any co-morbidity.All patients underwent for base line and specific investigations” like Urinalysis Pre-ESWL andat monthly intervals post ESWL, mid-stream urine examination for Gram’s staining; culture andsensitivity were performed in selected patients, renal ultrasonography, Plain X-Ray KUB andintravenous Urography. Inclusion criteria were that all patients from both sexes between theages of 15-45 years suffering from renal stones 2-3cm will be included in the study. In Exclusioncriteria; patients are unfit for general anesthesia, advance cardiac diseases, bleeding disorders,pregnant women, lower ureteral stones, malignancy and severe urinary infection. Results: 60patients, there were 40 males and 20 females, with male to female ratio of 2:1. Minimum of 15year to 45 years in both group. Mean age was 32+ 2.1years. 38(63.33%) of patients has 2.5-3 cm stone and 22(36.66%) patients has 2-2.5cm stone. Commonest location of stone was34(57%) cases were lying in calyces followed by pelvis stones which accounted for 26(43%)stones. The average number of retreatment sessions was 2 to 3 sessions, ranged 1 to 5sessions. The majority 39 (65%) patients needed one & two sessions. Three & four sessionswere used in 17 (28.33%) and in five session 04(06%) cases needed. Stone clearance observed5 to 45days in 2 to 2.5 cm stone. Means clearance were seen 35+4.6 days in without Double-J-Ureteric Stent while 29+3.8 days in with Double-J-Ureteric Stent. Conclusion: In conclusionour study revealed that The extra corporeal shock waves lithotripsy with double-j-ureteric stentis safe, effective and with less complication rate then without double-j-ureteric stent.

English

Objectives: Objectives of the study are to evaluate extracorporeal shock waveslithotripsy (ESWL) with and without double-J-ureteric stent in 2-3 cm renal stone. Study Design:Comparative study. Place and Duration of Study: This study was out conducted at LithotripsyCenter, Department of Urology & Renal Transplantation, KEMU/ Mayo Hospital, Lahore, fromJune 2015to May 2016.”Methodology: This study consisted of 60 patients admitted. Allpatients were divided into two equal groups. Thirty patients of kidney stones were included ingroup A, who were treated by ESWL without double-j-ureteric stent. Group B, who were treatedby ESWL with prior double-j-ureteric stent insertion. Detailed History was taken from all thepatients with special regard to the renal stone pain. Detailed Clinical examination of the patientwas done and recorded in proforma. Systemic review was also done to see any co-morbidity.All patients underwent for base line and specific investigations” like Urinalysis Pre-ESWL andat monthly intervals post ESWL, mid-stream urine examination for Gram’s staining; culture andsensitivity were performed in selected patients, renal ultrasonography, Plain X-Ray KUB andintravenous Urography. Inclusion criteria were that all patients from both sexes between theages of 15-45 years suffering from renal stones 2-3cm will be included in the study. In Exclusioncriteria; patients are unfit for general anesthesia, advance cardiac diseases, bleeding disorders,pregnant women, lower ureteral stones, malignancy and severe urinary infection. Results: 60patients, there were 40 males and 20 females, with male to female ratio of 2:1. Minimum of 15year to 45 years in both group. Mean age was 32+ 2.1years. 38(63.33%) of patients has 2.5-3 cm stone and 22(36.66%) patients has 2-2.5cm stone. Commonest location of stone was34(57%) cases were lying in calyces followed by pelvis stones which accounted for 26(43%)stones. The average number of retreatment sessions was 2 to 3 sessions, ranged 1 to 5sessions. The majority 39 (65%) patients needed one & two sessions. Three & four sessionswere used in 17 (28.33%) and in five session 04(06%) cases needed. Stone clearance observed5 to 45days in 2 to 2.5 cm stone. Means clearance were seen 35+4.6 days in without Double-J-Ureteric Stent while 29+3.8 days in with Double-J-Ureteric Stent. Conclusion: In conclusionour study revealed that The extra corporeal shock waves lithotripsy with double-j-ureteric stentis safe, effective and with less complication rate then without double-j-ureteric stent.

Role of tamsulosin in the management of lower ureteric stone at tertiary care hospital in Western Rajasthan, India

Background: Many minimally invasive interventional techniques as well as expectant treatments exist for the management of lower ureteric calculi.Methods: 100 patients [group A (50 patients) patients given capsule tamsulosin 0.4mg, 1 daily up to 4 weeks while group B (50 patients) patients given regularly practiced treatment without Tamsulosin] with distal ureteric stone included in the study. Study duration was 6 months and study performed at S.P. Medical College. Bikaner, Rajasthan, India.Results: Group A showed a statistically significant advantage in terms of the stone expulsion rate. 41 patients (82%) in group A and 30 patients (60%) in group B expelled stones. Overall patients in group A had mean expulsion time of 7.86 days, whereas in group B mean expulsion time was 18.64 days. In group A stone expulsion rate was higher as compared to group B. In group A only 12 (24%) patients experienced pain relapses whereas in group B 32 (64%) patients reported pain relapses. The diclofenac dosage required in group A was observed to be 1.62 tablets whereas in group B it was 2.6 tablets.Conclusions: It is concluded that tamsulosin should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.

MP90-18 SILODOSIN FOR MEDICAL EXPULSIVE THERAPY IN CHILDREN WITH DISTAL URETERAL STONE: A PROSPECTIVE RANDOMIZED, PLACEBO-CONTROLLED, SINGLE BLIND STUDY STUDY

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy1 Apr 2017MP90-18 SILODOSIN FOR MEDICAL EXPULSIVE THERAPY IN CHILDREN WITH DISTAL URETERAL STONE: A PROSPECTIVE RANDOMIZED, PLACEBO-CONTROLLED, SINGLE BLIND STUDY STUDY Ahmed fahmy, hazem Rhasad, Amr Kamal, and Moustafa Elsawy Ahmed fahmyAhmed fahmy More articles by this author , hazem Rhasadhazem Rhasad More articles by this author , Amr KamalAmr Kamal More articles by this author , and Moustafa ElsawyMoustafa Elsawy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2837AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Silodosin, a selective a1-blocker,has been proposed for medical expulsive therapy (MET) instead of tamsulosin in adulthood urolithiasis with promising outcomes but studies comparing these substances for MET in children are lacking. The aim of this study was to verify the safety and efficacy of silodosin (8 mg) compared with tamsulosin (0.4 mg) and placebo as a MET for distal ureteral stones in children. METHODS A prospective randomized placebo-controlled study including 90 children diagnosed with unilateral, single, radio-opaque distal ureteral stones < 10 mm in size was conducted. Age ranged between 5.8 and 18 years old. Patients were randomized into three groups; silodosin group (n = 30) received 8 mg silodosin daily, tamsulosin group (n = 30) received 0.4 mg tamsulosin daily and placebo group (n = 30) were not given any of the above medications. Patients were offered a closely monitored trial for spontaneous stone passage in the 4-week period prior to definitive therapy. The stone clearance rate, time to stone clearance, number of pain episodes, need for analgesia and potential side effects of medications were observed. RESULTS The stone clearance rates for silodosin, tamsulosin and placebo groups were 78.5, 66.6 and 53.3 %, respectively. The time to stone clearance was significantly shorter in silodosin and tamsulosin groups than in placebo group (p = 0.006 and 0.035, respectively). Patients taking silodosin and tamsulosin had fewer pain attacks and lesser analgesic requirement than placebo group patients. CONCLUSIONS The current study showed the use of a-blockers for MET of lower ureteric stones in children to be effective, however, the use of silodosin was associated with higher stone clearance rates and shorter time to stone clearance as compared to tamsulosin. Both of these medications demonstrated a good safety and tolerability profile for MET in children with uncomplicated ureteral stones. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1217 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ahmed fahmy More articles by this author hazem Rhasad More articles by this author Amr Kamal More articles by this author Moustafa Elsawy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy of Silodosin Dose in Medical Expulsive Therapy for Distal Ureteral Stones: A Retrospective Study.

We aimed to investigate the efficacy of silodosin 4 mg/day and 8 mg/day for medical expulsive therapy(MET) of lower ureteral stones. We retrospectively analyzed the medical records of 161 patients admitted to urologyclinics of Ahi Evran University Medical Faculty and Ankara Training and Research Hospital with distal ureteralstones and treated with MET with different doses of silodosin between January 2013 and August 2015. 81 patientswere treated with silodosin 4mg/day in group-1 and 80 patients with silodosin 8mg/day in group-2. Age, gender,complaints on admission, stone size, the distance between the stone and ureterovesical junction, stone passage rate,duration of stone passage after starting MET, and adverse effects were noted from the charts of the patients, andthe groups were compared. There were 81 patients in group-1, and 80 patients in group-2. Two groups were similar for age (P =.38)and gender (P =.92). Spontaneous stone passage was seen in 41 (50.9%) patients in group-1, and in 59 (73.8%)patients in group 2. The groups were different for spontaneous stone passage rate (P =.002). In group-1, 10 (25%)patients that could not pass their stones spontaneously and were treated with extracorporeal shockwave lithotripsy(SWL), and 30 (75%) of them were treated with ureterolithotripsy. Eight (38%) patients that could not undergoureterolithotripsy and/or anesthesia and were not able to pass their stones were treated with SWL, and 13 (62%)patients were treated with ureterolithotripsy in group-2. All of the patients were stone free at the end of the treatment. A dose of 8 mg/day should be preferred if silodosin is to be preferred for MET in lower ureteral stones.

Determine the Effectiveness of Low Dose Tamsulosin as a Medical Expulsive Therapy in Patients with Lower Ureteric Stones

Introduction: The human ureter contains a high number of α-adrenergic receptors, especially α1d -receptors at the lower part of the ureter. Tamsulosin is a combined α1a- and α1d- selective adrenergic antagonist that is an alternative to other medications, such as calcium channel blockers, corticosteroids, and analgesic and anti-inflammatory drugs, for the treatment of distal ureteric stones. Objective: To determine the effectiveness of low dose tamsulosin as a medical expulsive therapy in patients with lower ureteric stones. Setting: Department of Urology, Liaquat University of Medical and Health Sciences Jamshoro. Study design: Randomized controlled trial.Duration of study: 6 months Subjects and methods: All patients with either gender, age range 30-60 years and stone size 4-10 mm in the lower 1/3rd of the ureter determined on ultrasound were enrolled. Group A patients was offered low dose tamsulosin (0.2 mg) one tablet daily in the morning for a maximum of 4 weeks and group B served as control. The final outcome was measured at the end of 4th week of treatment. Patients were instructed to note the time and the date of expulsion of stone. Absence of echoic shadows on lower 1/3rd of ureteric line on ultrasound was taken as effectiveness (expulsion of stone). Results: In control group mean age was 45.52 ± 6.70 years whereas in low dose Tamsulin mean age was 46.72 ± 6.73 years. Frequency of male was higher in both control and low dose Tamsulin group, i.e. 39 (78%) and 21 (42%) respectively. In control group effectiveness was found 3 (6%) patients whereas in low dose Tamsulin group effectiveness was found in 47 (94%). Conclusion: In our study the effectiveness of low dose tamsulosin as a medical expulsive therapy in patients with lower ureteric stones was higher as compared to control.

Acute kidney injury in Ureteric Stones:Single centre short term analysis.

Objective:To analyze acute kidney injury (AKI) frequency, risk factors and outcome in ureteric stone patients.Methods:This is an observational retrospective study performed in a single tertiary care centre in Abu Dhabi from October 2014 till August 2015. Convenient sampling was done on 152 consecutive patients who underwent decompression surgery (Ureterorenoscopy LASER Lithotripsy and DJ Stenting) for ureteric stones. Serum Creatinine was used to calculate creatinine clearance by cock croft Gault formula in all patients before and after procedure. Analysis was done on SPSS version 17.Results:Out of 152 patients who under went decompression surgical procedure for ureteric stones AKI was seen in 49(32.2%). Patients with AKI were found to be more higher age, increasedweight, bilateral stones, lower ureteric stones and with co morbidities in comparison to those who were without acute kidney injury. Patients developing AKI, 89.7% recovered either partially(20.4 %) or completely (69.3%).Conclusion:AKI is seen more in ureteric stone patients with older age, increased weight, bilateral stones, lower ureteric stones and with co morbidities. Recovery is good when obstruction is relieved.

Preliminary study of the efficacy of the combination of tamsulosin and trospium as a medical expulsive therapy for distal ureteric stones

ObjectivesTo evaluate and compare the efficacy of tamsulosin (0.4mg, once/day) and combinations of it with trospium (20mg, twice/day) in the treatment of single small lower ureteral stones. Patients and methodsA total of 126 patients presenting to urology outpatient clinics from July 2012 to May 2015, with a single 5–10mm sized lower ureteral stone were randomly classified into two treatment groups. Patients in group A (n=62) received an oral dose of 0.4mg tamsulosin once daily and 20mg trospium chloride twice daily. Patients in group B (n=64) received 0.4mg tamsulosin once daily and placebo twice daily. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated. ResultsThere were no significant differences in baseline characteristic of the patients in both groups. Stone expulsion was observed in 47 patients (75.8%), and 58 (90.62%) in groups A and B respectively. The average time to expulsion was 11.65±5.32days in group A and 17.35±6.21days in group B. The spontaneous stone passage rate through the ureter was significantly higher and the stone expulsion time was faster in groups A than in group B (p<0.05). The adverse effects observed in both groups were comparable and were mild. ConclusionsThe combination of 0.4mg tamsulosin and 40mg trospium as MET for single lower ureteral stones <10mm is safe and more effective than 0.4mg tamsulosin as a mono-therapy.

Ureteroscopy for Management of Ureteric Stones in Children - A Single Centre Experience.

To determine the outcomes of pediatric patients who underwent ureteroscopic removal of ureteric stones in terms of stone free rates and complications. Descriptive case series. Urology Department at Shifa International Hospital, Islamabad, from January 2012 to December 2014. A retrospective analysis of 37 patients, who underwent ureteroscopy for the treatment of ureteral calculi at the study centre, was conducted. Data regarding mean stone size, stone location, stone clearance and complications was recorded on specified proforma. Data was analysed on SPSS version 16. Thirty-seven children with mean age of 8.36 ±5.17 years were included. Twenty-five (67.6%) patients were male, whereas 12 (32.4%) patients were female. Mean stone size was 10.01 ±6.24 mm. Location-wise 25 (67.56%) patients had upper ureteric stones, 5 (13.5%) patients had mid ureteric stones and 7(18.9%) patients had distal ureteric stones. Twentytwo (59.5%) children underwent one procedure, while 15 (40.5%) children underwent relook ureteroscopies. Second relook ureteroscopy was done in 13/25 (52%) patients, 1/5 (20%) patient and 1/7 (14.28%) patient in upper, mid and lower ureteric stones, respectively. Overall stone clearance rate was 35/37 (94.59%) after first procedure. Mean operative time was 52.54 ±12.39 minutes. Urosepsis was seen in 2 patients. No major complications were seen. After the second URS procedure, stone free rate was 100%. Ureteroscopy is a safe and effective procedure in children in terms of stone free rate and complications.

Tamsulosin therapy improved the outcome of ureterorenoscopy for lower ureteral stones: A prospective, randomised, controlled, clinical trial

IntroductionTamsulosin is an α-1A-specific blocker inducing selective relaxation of ureteral smooth muscle and inhibition of ureteral spasms leading to ureteral dilatation that can facilitates retrograde ureterorenoscopy (URS). ObjectiveTo assess the efficacy of tamsulosin in improving the outcome of URS management of lower ureteral stones. Patients and methodsThis prospective, randomised, controlled, clinical trial was carried out between June 2011 and December 2014. It included 98 patients with lower ureteral stones scheduled for treatment with URS. Before URS, patients were randomly divided into 2 groups; study group including 51 patients, in which pre-URS daily oral dose of tamsulosin 0.4mg tab, for 1 week, was given and control group including 47 patients who received no additional therapy rather than standard analgesic on demand. The URS outcomes were evaluated and compared between both groups. ResultsThe demographic and stone characteristics were comparable between both groups. The mean URS time was significantly shorter in study group than in control group (52.0±14.9min vs. 71.0±17.3min; p=0.039). Of the 98 patients, 89 (90.81%) had a successful URS procedures. The success rate was 94.1% (98/51) in study group compared 89.2% (58/65) in the control group, with statistically significant difference (p=0.045). The major complications occurred in 4.25% of patients in control group but in only 1.96% of those received tamsulosin (p=0.034). ConclusionPost-tamsulosin ureteroscopy was easier and safer; leading to significantly increased stone-free rates and fewer complications.

Feasibility and outcome of emergency ureteroscopic removal of lower ureteral stone under intravenous sedation: A prospective study

ObjectiveTo compare the efficacy of emergency ureteroscopy (URS) with that of elective URS in the treatment of distal ureteral calculi. Patients and methodsThis prospective study included 132 patients diagnosed with a distal unilateral ureteral stone ≤5mm and treated with either emergency or elective URS between August 2013 and July 2014. The indication for emergency URS was intractable renal pain not responding to narcotic analgesia. Children, pregnant women and patients with bilateral disease were excluded. The patients were categorized into two groups: Group I included 42 patients who underwent emergency URS under intravenous sedation, while Group II included 90 patients who underwent elective URS. The patients’ demographic data, the stone criteria, perioperative complications, procedure outcome and degree of patient satisfaction were recorded and statistically analyzed. ResultsThe mean stone size was 4.2±0.5mm in Group I and 4.1±0.6mm in Group II. The success rate was 90.5% and 97.8% in Groups I and II, respectively with a statistically insignificant difference. Complete stone retrieval without fragmentation was achieved in 83.3% in Group I and in 82.2% in Group II. The stone migrated proximally in 4 patients in Group I and in only 2 patients of Group II; these patients received ureteral stents. Mucosal injury was observed in 3 and 4 patients of Groups I and II, respectively. Thirty-seven patients of Group I (88%) reported that they were satisfied with the procedure and its outcome compared to 78 patients of Group II (87%). ConclusionEmergency URS under intravenous sedation is feasible, safe and equally effective when compared to elective URS for small lower ureteral stones.

Subcapsular renal hematoma after ureteroscopic pneumatic lithotripsy for lower ureter stone

Subcapsular renal hematoma after ureteroscopic pneumatic lithotripsy for lower ureter stone

In situ Piezoelectric ESWL for ureteric calculi

Objective: To assess in situ Piezoelectric ESWL for ureteric calculi, avoiding false positive results arising from the spontaneous passage of small stones and also to evaluate the efficiency of the EDAP LT02 Lithotriptor for insitu ESWL treatment of ureteric calculi. Study Design: A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor. Place &amp; Duration of Study: patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, coming to Urology department of Pakistan Institute of Medical Sciences (PIMS), Islamabad, as out door patients. Patients and methods: A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, Seventy two patients, 60 males and 12 females, with mean age of 39.6 years, presenting with solitary ureteric calculus were treated using EDAP LT 02 Piezoelectric Lithotriptor, lo calization with fluoroscopy. No regional or general anesthesia given. Results: After 3 months follow-up, of the 72 ureteric calculi cases, 60(83.3%) were successfully fragmented and ureter was stone free in 54 patients (75.1%) after insitu ESWL alone. The mean duration of stone clearance was 50 days (SD +11.58). Sixteen patients required one session only, 28 patients required 2 sessions and twelve patients required three and more than three sessions. Stone location was 28 upper ureteric, 18 middle and 26 in lower ureter. Stone size varied from 7mm.to 17mm. in longest diameter. The average number of session, 1.5 for upper ureteric stone, 1.8 for mid and lower ureteric stones. Stone clearance for upper ureteric calculus was 85.7%, for mid ureteric 66.7% &amp; for lower ureteric 69%, the overall stone clearance was 75%. Conclusion: In situ piezoelectric ESWL is safe, simple and effective technique for treating ureteric calculi. The site and size of the stone affects the success rate.

An Extremely Rare Complication of Ureteral Pigtail Stent Placement: A Case Report

Double-J (DJ) stents are the main tools used in urological practice for prevention and treatment of obstruction. Stenting is also mandatory after complicated ureteroscopy or TUL (Transureteral Lithotripsy). Known complications are upper migration of DJ stents into the kidney and lower migration to the bladder. In a man with an impacted right lower ureteral stone, a DJ stent was placed because the ureteroscope was not passed from an intramural ureter. We reported a very rare complication of DJ ureteral stent placement with intravascular migration to the pulmonary arteries, which was removed percutaneously through the right femoral vein under fluoroscopic guidance.

Ureteroscopic Lithotripsy; Retrospective Review of Mid and Lower Ureteric Stones- its Results and Complications

Purpose: To observe efficacy and complications of ureteroscopic lithotripsy in the treatment of mid and lower ureteric stones. The placement of DJ Stent was also compared for their beneficial role or otherwise. Materials and Methods: The medical records of 268 patients who underwent ureteroscopic lithotripsy (URSL) by a single surgeon from January 2010 December 2013 were reviewed retrospectively. All adult patients of mid and lower ureteric stones (10-22mm) were included in this study. Group I (n=98) patients had no DJ stent while Group II (n=96) patients had DJ stent due to prolong procedure. Group III (n=74) patients had DJ stent placed due to complications during the procedure or due to large volume of fragments that are left without retrieval after fragmentation. 28 patients required extracorporeal shockwave lithotripsy as during the procedure these patients had proximal stone migration. Results: The results were analyzed on aspects of stone clearance, hospital stay, complications and patient compliance. 80 patients in Group I, 82 patients in Group II and 42 patients in Group III completed the procedure in single session. The stone clearance at one week for mid ureteric stones in Group I (89.78%), Group II (91.67%), and Group III (91.89%) and in lower ureteric stones clearance was in Group I (97.96%), Group II (96.88%) and in Group III (95.95%). At one month 100% stone clearance was seen in all the three groups. The stented group had more complications than the non stented group. Conclusion: Ureteroscopic lithotripsy has gained wide acceptance worldwide and is an established technique for lower and mid ureteric calculi when patient demands single session removal of stone and alleviation of symptoms. Routine placement of DJ stent should be discouraged which has more complications as compared to non-stented patients.

What is the impact of extracorporeal shock wave lithotripsy on semen parameters? A systematic review and meta-analysis.

Extracorporeal shock wave lithotripsy (ESWL) is an important tool for the management of urolithiasis. The effects of shockwaves on tissues are established. The aim of this meta-analysis is to evaluate the microscopic semen characteristics of young men before and after ESWL treatment for lower ureteral calculi. Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included six trials that investigated the effects of ESWL on semen parameters, including sperm concentration, motility, and hematospermia. Meta-analyses were performed using fixed and random-effects models with tests for publication bias and heterogeneity. Significant worsening was detected in sperm concentration and motility after ESWL between case and control groups (mean difference -17.23, 95% confidence interval -22.53 to -11.93, p&lt;0.00001, mean difference -10.82, 95% confidence interval -18.56 to -3.07, p = 0.006). Rate of microscopic and macroscopic hematospermia was significantly higher after ESWL between case and control groups [risk ratio (RR) 40.00, 95% confidence interval 10.11-158.30, p&lt;0.00001, RR 14.33, 95% confidence interval 2.82-72.90, p = 0.001]. All parameters recovered after 3 months. This study showed sperm concentration, motility, and rate of hematospermia (microscopic and macroscopic) were affected by ESWL that was used for the treatment of lower ureteral stone. Long-term studies with a focus on male fertility (i.e., pregnancy rates) after ESWL are warranted.