Management Of Lower Ureteral Stones Research Articles

Evaluation of the Role of Preoperative Pharmacological Ureteral Dilatation in Ureteroscopic Stone Surgery

Abstract Background Urinary stone disease is very common, with an estimated prevalence among the general population of 2% to 3% and an estimated lifetime risk of 1 in 8 for white males and 5% to 6% for white females, with men forming stones three times as often as women. Aim of the Work To compare the effectiveness of antispasmodics (hyoscine-N- butylbromide), α-blockers (tamsulosin), placebo as control (in the form of multivitamins), as preoperative medications for ureteral dilatation prior to semirigid ureteroscopic stone surgery. Patients and Methods This prospective randomized control clinical study conducted on 90 patients admitted from Urology department, Faculty of Medicine, Ain Shams University hospitals in a period of 6 months starting from March 2022 till September 2022; they were randomized into 3 groups 30 patients per group: Group (A) received Tamsulosin 0.4 mg once daily for 7 days, Group (B) received Hyoscine-N- butylbromide 10 mg three times per day for 7 days, Group (C) received Placebo. Results The operation time and the need of double J stent insertion significantly decrease with Tasmulosin or Hyoscine-N-butylbromide versus Placebo. Operative and postoperative complications significantly decrease while using Tamsulosin or Hyoscine- N-butylbromide versus Placebo. Conclusion The administration of adjunctive alpha-blockers and/or antispasmodics prior to ureteroscopic management of lower ureteric stones seems to be associated with better advancing of the ureteroscope to access the stone, shorter procedure time, higher stone-free rate, lower incidence of intra- and postoperative complications and lesser need for postoperative analgesia.

Comparison of Synergistic Action of Alpha Blockers and Tadalafil in the Management of Lower Ureteric Stones as Medical Expulsive Therapy: A Prospective Cohort Study

Introduction: Medical Expulsive Therapy (MET) involves the utilisation of different drugs that act on the ureter through various mechanisms. Alpha-1 adrenoceptor and Phosphodiesterase (PDE) regulate ureteric motility thus combination of these drugs can increase the ureteric stone expulsion rate by complementing each other’s actions. Aim: To assess the synergistic role of alpha-blocker and Tadalafil therapy in facilitating the spontaneous expulsion of distal ureteral stones. Materials and Methods: A prospective cohort study was conducted in the Department of Urology at a Tertiary Care Centre (NSCB Medical College) from April 2020 to January 2022. A total of 281 patients diagnosed with lower ureteric stones (5-10 mm) were divided into five study groups: Group A was treated with tamsulosin, group B with silodosin, group C with tadalafil alone, group D with tamsulosin and tadalafil, and group E treated with a combination of silodosin and tadalafil. Corticosteroid (deflazacort 6 mg) was also included in every group. All patients were reassessed after three weeks of treatment for stone expulsion rate, expulsion time, the number of hospital visits for pain, and adverse effects of drugs. The statistical data was analysed using Statistical Package for Social Sciences (SPSS) software (version 21.0, IBM Corp, USA). The Chi-square test and Analysis of Variance (ANOVA) test were used to determine the effect on stone expulsion rate and expulsion time. The confidence interval was 95%, and the significance level of the p-value was set <0.05. Results: The stone expulsion rates in group A, B, C, D, and E were 70.91%, 79.63%, 52.63%, 84.21%, and 86.20%, respectively, which was significant (p=0.00194). The mean time taken for stone expulsion in group A, B, C, D, and E were 8.95±1.73, 8.43±1.57, 9.86±1.90, 7.96±2.03, and 7.75±1.84 days (p=0.0001). Minor side effects were not significant, except for retrograde ejaculation in group B and E, and 22.8% of patients needed hospitalisation in group C (tadalafil alone). Conclusion: Combination therapy is safe, efficacious, and welltolerated as MET for distal ureteric calculi in the 5-10 mm range, thereby avoiding surgical procedures and providing faster relief for the patients.

Direct Comparison of Pneumatic and Ho:YAG Laser Lithotripsy in the Management of Lower Ureteric Stones

Introduction: Besides extracorporeal shockwave lithotripsy, semi-rigid ureteroscopy (URS) has become an equal therapy of choice for the treatment of most distal ureteric stones. Before the wide availability of laser lithotripsy as a tool for stone fragmentation, pneumatic lithotripsy was, and still is, widely used. In a country like Iraq, availability and affordability are the huge questions asked. Besides the capital investment for a laser machine, the pneumatic device is reusable, whereas the laser fibers are limited in their reusability. This makes pneumatic lithotripsy a more cost-effective option, at least in our setting. The question remains whether both options, compared in our setting with our limited resources, are equally effective and beneficial to our patients. Patients and Methods: Fifty patients were included in our prospective study who underwent URS for the treatment of a distal ureteric stone. Half each (n = 25) underwent pneumatic (group A) or laser lithotripsy (group B). Inclusion criteria were a single distal ureteric stone measuring 7–20 mm in largest diameter, no anatomical abnormality, age >18 years, and an unsuccessful attempt of medical expulsion therapy. Patients with signs of urinary infection and pregnant women were excluded. All patients were operated upon under spinal anesthesia. Data recorded included operation time, stone size, type of scope and lithotripter, complications, hospital stay, and stone-free rate. Results: Both groups did not show statistically significant differences in patient demography, stone size, operation time, complications, and stone-free rates (p > 0.05). Conclusion: Both pneumatic and Ho:YAG laser lithotripsy are equally effective and safe in treating distal ureteric stones in our setting. If the cost and availability of laser treatment is an issue, pneumatic lithotripsy is a viable and more cost-effective option.

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.

Outcome of α-blockers, with or without methylprednisolone combination, in medical expulsive therapy for lower ureteric stones: A prospective randomised study

ObjectivesTo compare the safety and efficacy of tamsulosin, alfuzosin, and their combinations with methylprednisolone, in the medical management of lower ureteric stones. Patients and methodsBetween September 2012 and June 2014, patients diagnosed with a single lower ureteric stone of ⩽10mm (longest dimension) were enrolled. Patients with urinary tract infection, severe hydronephrosis, pregnancy, hypertension, diabetes, ulcer disease, or renal insufficiency were excluded. According to the medication added to the analgesic anti-inflammatory, patients were stratified into four groups, with 53 patients in each. Group I patients received tamsulosin 0.4mg and those in Group II received tamsulosin 0.4mg and methylprednisolone 8mg. Group III patients received alfuzosin 10mg and those in Group IV received alfuzosin 10mg and methylprednisolone 8mg. Treatment was continued until stone expulsion or to a maximum of 2weeks. The patients’ demographics, stone criteria, and stone-free rates were calculated and analysed. ResultsThe mean (SD) maximum stone dimension was 7.8 (1.5), 8.1 (1.3), 7.9 (1.6) and 8.0 (1.4)mm in Groups I, II, III and IV, respectively. Groups II and IV had significantly higher stone-free rates than Groups I and III (P<0.05), whilst there were no statistically significant differences between Groups I and III or between Groups II and IV. There was no statistical difference among the four groups for the time to stone expulsion. Three patients in Group II and two patients in Group IV developed transient hyperglycaemia, which resolved after cessation of methylprednisolone. ConclusionsThe combination of alfuzosin or tamsulosin with methylprednisolone seems to be effective and safe for managing lower ureteric stones of <1cm.

MP41-09 A PROSPECTIVE RANDOMIZED STUDY TO EVALUATE THE OUTCOME OF ALPHA BLOCKERS AND THE COMBINATION WITH METHYLPREDNISOLONE IN MEDICAL EXPULSIVE THERAPY FOR LOW ER URETERAL STONES

You have accessJournal of UrologyStone Disease: Medical Therapy1 Apr 2015MP41-09 A PROSPECTIVE RANDOMIZED STUDY TO EVALUATE THE OUTCOME OF ALPHA BLOCKERS AND THE COMBINATION WITH METHYLPREDNISOLONE IN MEDICAL EXPULSIVE THERAPY FOR LOW ER URETERAL STONES Waleed Shabana, Mohamed Teleb, Tamer Dawod, and Mahmoud Eladl Waleed ShabanaWaleed Shabana More articles by this author , Mohamed TelebMohamed Teleb More articles by this author , Tamer DawodTamer Dawod More articles by this author , and Mahmoud EladlMahmoud Eladl More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1637AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare the safety and efficacy of tamsulosin, alfuzocin and their combinations with methylprednisolone in medical management of lower ureteral stones. METHODS Between September 2012 and June 2014 patients diagnosed with single lower ureteral stone ≤ 10 mm in longest dimension were enrolled in this study. Patients with urinary tract infection, severe hydronephrosis, pregnancy, hypertension, diabetes, ulcer disease, or renal insufficiency were excluded from the study. According to the medication added to the analgesic anti-inflammatory, patients were stratified into 4 groups, 53 patients each. Group I received tamsulosin 0.4 mg daily. In group II methylprednisolone 8 mg daily is added to tamsulosin. Group III received alfuzocin 10 mg once daily. In group IV patients received alfuzocin and methylprednisolone. The treatment was continued until stone expulsion or to a maximum of 2 weeks. Patients' demographics, stone criteria stone free rate were calculated and analyzed. Kaplan Meier analysis of time to achieve stone expulsion was done and analyzed using Log Rank test with P < 0.05 considered significant. RESULTS The mean stone maximal dimension was 7.8 ± 1.5, 8.1 ± 1.3, 7.9 ± 1.6 and 8.0 ± 1.4 in groups I, II, III and IV respectively. Group II and IV had significantly higher stone free rates in comparison to group I and III (p < 0.05), whilst there were no statistically significant differences between group I and III as well as between group II and IV. Kaplan Meier analysis of time to stone expulsion revealed no statistical difference among the 4 groups with p < 0.05. Three (5.7%) patients of group II and two (3.8%) patients of group IV developed transient hyperglycemia which resolved after stoppage of methylprednisolone. CONCLUSIONS The combination of alfuzosin or tamsulosin with methylprednisolone is effective and safe for management of lower ureteral stones less than 1 cm. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e503 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Waleed Shabana More articles by this author Mohamed Teleb More articles by this author Tamer Dawod More articles by this author Mahmoud Eladl More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL.

Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75–0.88; P < 0.00001). The subgroup analysis indicated no statistically significant difference between the drugs with regard to minor or major adverse effects (fixed-effect model; RR = 1.19, 95% CI = 0.91–1.54, P = 0.20; and RR = 1.63, 95% CI = 0.22–11.82, P = 0.63, respectively). This meta-analysis demonstrated that tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS.

Tamsulosin and Spontaneous Passage of Ureteral Stones in Children: A Multi-Institutional Cohort Study

Tamsulosin is associated with increased passage of ureteral stones in adults but its effectiveness in children is uncertain. We determined the association between tamsulosin and the spontaneous passage of ureteral stones in children. We performed a multi-institutional retrospective cohort study of patients 18 years or younger who presented between 2007 and 2012 with ureteral stones up to 10 mm and who were treated with tamsulosin or oral analgesics alone. The outcome was spontaneous stone passage, defined as radiographic clearance and/or patient report of passage. Subjects prescribed tamsulosin were matched with subjects prescribed analgesics alone, using nearest neighbor propensity score matching to adjust for treatment selection. Conditional logistic regression models were used to estimate the association between tamsulosin and spontaneous passage of ureteral stones, adjusting for stone size and location. Of 449 children with ureteral stones 334 were eligible for inclusion, and complete data were available for 274 patients from 4 institutions (99 receiving tamsulosin, 175 receiving analgesics alone). Following case matching, there were no differences in age, gender, weight, height, stone size or stone location between the 99 subjects prescribed tamsulosin and the 99 propensity score matched subjects prescribed analgesics alone. In the tamsulosin cohort 55% of ureteral stones passed, compared to 44% in the analgesics alone cohort (p=0.03). In multivariate analysis adjusting for stone size and location tamsulosin was associated with spontaneous passage of ureteral stones (OR 3.31, 95% CI 1.49-7.34). The odds of spontaneous passage of ureteral stones were greater in children prescribed tamsulosin vs analgesics alone.

E82 Efficacy of tamsulosin in the management of lower ureteral stones: A randomized double-blind placebo-controlled study of 100 patients

E82 Efficacy of tamsulosin in the management of lower ureteral stones: A randomized double-blind placebo-controlled study of 100 patients

Management of lower ureteric stones: a prospective study.

ObjectiveTo discuss the current concepts in lower ureteric stone management.Material and methodsBetween October 2008 and November 2010, 190 patients of both sexes and of different age groups with lower ureteric stones, underwent in situ extracorporeal shock wave lithotripsy (ESWL) (48 cases), ureterorenoscopy (URS) (120 cases) and open stone surgery (OSS) (22 cases).The patients’ clinical and radiological findings, as well as stone characteristics, were reviewed and correlated with the stone–free status.ResultsIn the ESWL group, the operative time was 43.13 +22.5 min; the average number of sessions/patients was 1.5 sessions; the average number of SW/patients was 4500 SW/patients; the average energy was 16.5 kV; the average stone burden was 7.8/mm; the overall stone–free rate was 75% (36/48); and the average radiation exposure time was 3.5 min.In the URS group, the operative time was 49.21 +16.09 min; the average stone burden was 10.81mm; the overall stone–free rate was 97.5% (117/120); the average hospital stay was 3.99 days; and the average radiation exposure time was 0.75 min.In the OSS group, the operative time was 112.38 +37.1 min; the overall stone–free rate was 100% (22/22); and the average hospital stay was 9.74 days.ConclusionIn the management of patients with lower ureteral stones, URS, SWL and OSS were considered acceptable treatment options.This recommendation was based on the stone–free results, morbidity and retreatment rates for each therapy.

Prospective randomized trial comparing the efficacy of tamsulosin and tamsulosin combined with nifedepine for the management of lower ureteral stones

Prospective randomized trial comparing the efficacy of tamsulosin and tamsulosin combined with nifedepine for the management of lower ureteral stones

Semen quality after extracorporeal shockwave lithotripsy for the management of lower ureteric stones: a review of the literature

Extracorporeal Shockwave Lithotripsy has long been an important tool in the urologists' armamentarium for the treatment of distal ureteric stones. Several studies have been conducted on the morbidity and adverse effects of ESWL on human tissues but the effect of lithotripsy on semen and testes remains inconclusive. Impact on semen analysis and testes is important because the seminal vesicles and testes are exposed to the shock waves due to their anatomical proximity to the distal ureter. This article has reviewed all the published literature in English language on semen analysis after lithotripsy.

Effectiveness of doxazosin in the management of lower ureteral stones in male and female patients

To evaluate the effectiveness of doxazosin on the rate of spontaneous passage of distal ureteral stones in female patients. A total of 80 patients with stones sized 10 mm or smaller, located in the distal part of the ureter, were included. They were divided into two groups, according to the gender. Patients were followed-up until passage of the stone or for a maximum of 3 weeks. The number of pain episodes, stone expulsion rate and time, and possible side effects of medications were recorded and compared in both groups. All patients completed the study. No statistically significant difference was observed regarding patient age, stone size, and stone location between the groups (P > 0.05). Stone expulsion occurred in 29 patients (72.5%) in group 1 and in 28 patients (70%) in group 2 (P = 0.35). Mean time to expulsion was 6.5 days (range 3-15 days) in the male arm and 7.5 days (range 4-17 days) in the female arm (P = 0.97). There were no differences between the groups in the number of colic episodes and analgesic use. Medical treatment of distal ureteral stones with doxazosin has similar stone passage rate, expulsion time, and safety in women compared with men.

Efficacy of Tamsulosin in the Management of Lower Ureteral Stones: A Randomized Double-blind Placebo-controlled Study of 100 Patients

To study the impact of tamsulosin on the rate of spontaneous passage of distal ureteral stones. A total of 100 patients with stones sized 10 mm or smaller, located in the distal part of the ureter were included. Patients were randomly assigned to 2 equal groups. Group 1 received 0.4 mg tamsulosin once daily and group 2 received placebo. The investigators and the patients were masked to the type of treatment. Patients were followed-up until passage of the stone, or for a maximum of 4 weeks. The number of pain episodes, need for analgesia, stone expulsion rate and time, and possible side effects of medications were observed in both groups. Apart from 4 patients in the placebo group who were lost to follow-up, all patients complied with the prescribed medications and continued the study. Stone expulsion occurred in 41 of 50 patients (82%) in group 1 and in 28 of 46 patients (61%) in group 2 (P = .02). The chance of stone expulsion was 3 times higher in the tamsulosin group (relative risk [RR] = 2.93; 95% CI, 1.152-7.45). In group 1, patients with stones sized < or = 5 mm showed a significantly higher expulsion rate compared to those with larger stones (> 5 mm). Age, gender, and stone laterality had no significant impact on the expulsion rate. The expulsion time was significantly shorter in the tamsulosin group (6.4 +/- 2.77 days vs 9.87 +/- 5.4 days for groups 1 and 2, respectively). Moreover, the frequency of pain episodes, the need for diclofenac, and its total dosage were significantly lower in the tamsulosin group. Side effects observed in both groups were comparable and mild, and no patient withdrew because of them. Tamsulosin is a safe and effective drug that enhances spontaneous passage of distal ureteral stones sized 10 mm or smaller.

Reply

We appreciate the comments of the respected reviewer. Various studies have been conducted for evaluating the role of α-blockers in assisting passage of lower ureteric stones, fragments resulting from SWL for renal and lower ureteral calculi, and fragments of steinstrasse. Tamsulosin has been the most commonly used medication; however, most studies have limitations in design, including sample size, heterogenecity of inclusion criteria, and lack of blinding and placebo-control, thereby lowering the strength of authenticity. Moreover, meta-analyses generated from such studies are similarly marred. Publication bias (file-drawer effect) and Simpson-effect are other limitations of meta-analysis. All factors combined lead to discrepancies between results of such meta-analysis and subsequent high quality large randomized controlled trials. 1 Agarwal M.S. Gupta M. Gupta A. et al. Prospective randomized trial comparing efficacy of alfuzosin and tamsulosin in management of lower ureteral stones. Urology. 2009; 73: 706-709 Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar Therefore, meta-analyses which are not based on “best evidence” should be interpreted with caution. Is There an Adjunctive Role of Tamsulosin to Extracorporeal Shockwave Lithotripsy for Upper Ureteric Stones: Results of an Open Label Randomized Nonplacebo Controlled StudyUrologyVol. 74Issue 5PreviewTo investigate the role of tamsulosin as an adjunct to management of upper ureteric stones (UUS) with extracorporeal shock wave lithotripsy (SWL). Full-Text PDF Editorial CommentUrologyVol. 74Issue 5PreviewThere have been several publications that have looked at the efficacy of expulsive therapy for ureteric and indeed renal stones after SWL. The rationale of using α-1-adrenergic antagonists in medical expulsion therapy (MET) for the treatment of distal ureteral stones arose from the concept that they can induce selective relaxation of the ureteral smooth muscle. This inhibits ureteral spasms and results in dilatation of the ureteral lumen, increasing the fluid volume transported, and thereby helping expulsion of the stone. Full-Text PDF

Prospective Randomized Trial Comparing Efficacy of Alfuzosin and Tamsulosin in Management of Lower Ureteral Stones

To study the efficacy of alfuzosin compared with tamsulosin in the management of lower ureteral stones. A total of 102 patients with stones <1 cm size and located in the lower ureter were enrolled in the present study and randomized into 3 equal groups. Group 1 patients (n = 34) received 0.4 mg tamsulosin daily, group 2 patients (n = 34) received 10 mg alfuzosin daily, and group 3 patients (n = 34) received placebo (control group). The patients were given 75 mg diclofenac injection intramuscularly on demand and were followed up for 4 weeks. The average stone size for groups 1, 2, and 3 was comparable (6.17, 6.70, and 6.35 mm, respectively). Stone expulsion was observed in 28 of 34 patients (82.3%) in group 1, 24 of 34 patients (70.5%) in group 2, and 12 of 34 patients (35.2%) in group 3. The average expulsion time for groups 1, 2, and 3 was 12.3, 14.5, and 24.5 days, respectively. The results of both study groups (groups 1 and 2) were superior to those in the placebo group (P = .003 and P = .001, respectively), but the study failed to show any statistically significant differences between tamsulosin and alfuzosin (P = .25). Alfuzosin was associated with fewer side effects than tamsulosin, especially in terms of retrograde ejaculation. Medical treatment of lower ureteral calculi with tamsulosin and alfuzosin resulted in a significantly increased stone expulsion rate, decreased expulsion time, and a reduced need for analgesic therapy.

Prospective Randomized Trial Comparing Efficacy of Alfuzosin and Tamsulosin in Management of Lower Ureteral Stones

Prospective Randomized Trial Comparing Efficacy of Alfuzosin and Tamsulosin in Management of Lower Ureteral Stones

THE COMPARISON AND EFFICACY OF 3 DIFFERENT α1-ADRENERGIC BLOCKERS FOR DISTAL URETERAL STONES

alpha1-Adrenergic blockers have recently been shown to increase the rate of spontaneous passage of distal ureteral stones. We compared efficacy of 3 different alpha1-adrenergic blockers for this purpose. A total of 114 patients between 18 and 65 years old who had lower ureteral stones were included in the study. Patients were randomly divided into 4 groups. Group 1 consisted of 28 patients and acted as the control group. Group 2 comprised 29 patients who received tamsulosin, group 3 was 28 patients receiving terazosin and group 4 was 29 patients receiving doxazosin. These agents were given for up to a month and hydration was also recommended simultaneously. Every week patients were controlled with x-rays of the kidneys, ureters, bladder and urinary ultrasonography. Meanwhile the number of pain episodes, analgesic dosage and the number of days for spontaneous passage of the calculi through the ureter were also recorded. There were no differences between the groups with respect to age, weight, height, sex and stone size. The calculi passed through the ureter spontaneously in 15 patients in group 1 (53.57%), in 23 patients in group 2 (79.31%), in 22 patients in group 3 (78.57%), and in 22 patients in group 4 (75.86%). In groups 2 to 4 the number of pain episodes, expulsion time and analgesic dosage were found to be lower compared with those in group 1. alpha1-Adrenergic blockers increase the frequency of spontaneous passage of the distal ureteral calculi. All 3 agents tested were equally efficacious.

Ureteroscopic management of lower ureteral stones: two years' experience.

A total of 140 ureteroscopies in 119 patients done between January 1992 and December 1994 at the Department of Urology, Hacettepe University Hospital, were reviewed. Factors such as previous ESWL therapy, previous surgery and use of in situ lithotripsy were noted. Success was defined as complete removal or disintegration and partial removal of the lower ureteral stones. All successes were confirmed by plain abdominal X-rays postoperatively. Of 140 stone manipulations attempted in 119 patients 106 (75.7%) were successful (in 80 by retrieval and in 26 by disintegration using electrohydraulic or laser). Perforation occurred in 4 of 13 cases where electrohydraulic lithotripsy was used for disintegration of stones. Extraction by ureteroscopic manipulation following extracorporeal shock wave lithotripsy (ESWL) was successful in all of the 12 cases of lower ureteral calculi. The success rate was found to be low for lower ureteral stones in patients with previous open surgery (2/9). A total of 43.2% of the patients were medically indicated to be hospitalized following the procedure with a mean hospitalization time of 5 days (ranging in between 1 to 7 days). Ureteroscopy is an effective method for management of lower ureteral stones. Use of the electrohydraulic lithotriptor may be associated with a high percentage of complications. Previous ESWL may be associated with a high rate of success. Results in patients with previous open surgery are not encouraging. Although all patients can be subjected to the procedure on an outpatient basis, a significant percentage need a short hospitalization.

Ureteral meatotomy with local-prototype urethrotome in the management of lower ureteral stones.

Surgical removal of stones impacted in the submucosa of the distal ureter is difficult. A local-prototype visual urethrotome was evaluated for the management of submucosal vesicoureteral stones and as an aid in the removal of a Dormia basket with an entrapped stone impacted in the submucosa of the vesical portion of the ureter. A total of 14 male and 11 female adult patients were included. Fifteen patients required ureteral meatotomy to release the stone. Transurethral ureteral meatotomy is a precise and safe procedure associated with minimal complications when carefully done. Our local-prototype instrument proved to be a simple, economical, and valuable tool.