Management Of Ureteral Calculi Research Articles

Laser Lithotripsy for the Management of Ureteric Calculus

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size <10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size < and ≥ 10 mm, stone density < and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

Safety and Efficacy of Ureteroscopic Laser Lithotripsy in the Management of Ureteric Calculi in Pregnancy-Experience of a Tertiary Care Center.

Ureteric colic in pregnancy is one of the common non-obstetric reasons for emergency department visits. Ureteric calculi present a significant threat to maternal and fetal health and definitive management often becomes necessary. Our aim is to assess the safety and efficacy of ureteroscopic laser lithotripsy in the management of ureteric stones in pregnancy. This is a prospective observational study of 3years carried at a tertiary referral center. It includes all pregnant patients who underwent ureteroscopic laser lithotripsy for ureteric stones. A total of 29 pregnant patients underwent ureteroscopic laser lithotripsy at our center in 3years. The mean age of patients was 33.5 ± 6.2years, and the mean gestation age at the time of ureteroscopy was 23.34 ± 5.9weeks. The average stone size was 8.3 ± 3.6mm and was predominantly found in upper ureter (62%). The mean operative time was 31 ± 8.9min, and the average laser energy spent was 4.3 ± 1.1kJ/case. There was no major Intraoperative complication, and the average hospital stay was 2.5 ± 1.5days. Complete stone clearance was achieved in 93.1% of cases. Ureteroscopic laser lithotripsy is safe and effective treatment of ureteric stones in terms of obstetric outcome and stone clearance in pregnancy.

Analysis of Stenting versus Non-Stenting in patients Undergoing Ureteroscopic Lithotripsy for Management of Ureteric Calculi

Background: Ureteroscopic lithotripsy (URL) for ureteric calculi is commonly followed by ureteric stenting in around 60% of patients. However, its use for ureteric stones is debatable due to the stent-related symptoms and extra risks of stent migration, stent encrustation, and vesicoureteral reflux. Aim: To compare stenting to no-stenting in terms of mean operative time and mean hospital stay in patients receiving ureteroscopic lithotripsy for the treatment of ureteric calculi. Methods: This RCT, conducted at the Armed forces institute of urology Rawalpindi, included 104 patients aged 18 to 65 years with newly diagnosed ureteric calculi of 10-20 mm in size. They were subsequently separated into two equal groups, group A patient underwent ureteric stenting, and group B patients without a ureteric stent after uncomplicated calculus clearance with URL. Operative time was recorded in minutes, and hospital stay was measured in hours. Data were analyzed by SPSS version 22. Results: The mean (SD) operative time was significantly longer in group A as compared to Group B, 48.02 ± 4.33 and 33.67 ± 2.27 min, respectively (p-value <0.0001), similarly mean duration of hospital stay for Group B patients was significantly shorter as compared to Group A patients (21.94 ± 2.29 versus 27.10 ± 4.16 hours) which were significant statistically (p < 0.0001). Conclusions: Non-stenting has reduced mean hospital stay duration and reduced mean operative time in comparison with stenting after URL; thus, unless desirably needed stenting in URL should be avoided. Keywords: Ureteroscopy (URL), DJ stenting, operative time. hospital stay. Keywords: Ureteroscopy (URL), DJ/JJ stenting, operative time. Hospital stay.

Analysis of Stenting versus Non-Stenting in patients Undergoing Ureteroscopic Lithotripsy for Management of Ureteric Calculi

Background: Ureteroscopic lithotripsy (URL) for ureteric calculi is commonly followed by ureteric stenting in around 60% of patients. However, its use for ureteric stones is debatable due to the stent-related symptoms and extra risks of stent migration, stent encrustation, and vesicoureteral reflux. Aim: To compare stenting to no-stenting in terms of mean operative time and mean hospital stay in patients receiving ureteroscopic lithotripsy for the treatment of ureteric calculi. Methods: This RCT, conducted at the Armed forces institute of urology Rawalpindi, included 104 patients aged 18 to 65 years with newly diagnosed ureteric calculi of 10-20 mm in size. They were subsequently separated into two equal groups, group A patient underwent ureteric stenting, and group B patients without a ureteric stent after uncomplicated calculus clearance with URL. Operative time was recorded in minutes, and hospital stay was measured in hours. Data were analyzed by SPSS version 22. Results: The mean (SD) operative time was significantly longer in group A as compared to Group B, 48.02 ± 4.33 and 33.67 ± 2.27 min, respectively (p-value <0.0001), similarly mean duration of hospital stay for Group B patients was significantly shorter as compared to Group A patients (21.94 ± 2.29 versus 27.10 ± 4.16 hours) which were significant statistically (p < 0.0001). Practical implication: Every URS procedure does not need stenting. Patients with uncomplicated URS should not under DJ stenting. URS without stenting reduces hospital stay and operative time. Conclusions: Non-stenting has reduced mean hospital stay duration and reduced mean operative time in comparison with stenting after URL; thus, unless desirably needed stenting in URL should be avoided. Keywords: Ureteroscopy (URL), DJ stenting, operative time. hospital stay. Keywords: Ureteroscopy (URL), DJ/JJ stenting, operative time.Hospitalstay.

The effect of an herbal agent “Tutukon®” on the spontaneous passage rates of ureteric stones

Objective:: The objective of this study is to assess the efficacy of an herbal agent (Tutukon®) on the spontaneous passage rates of ureteral calculi 5-10 mm. Materials and Methods: 96 patients having a single radio-opaque ureteral stone 5-10 mm were randomized into two groups. Group 1 (n = 51) received Tutukon®, 45 mg/day (three times) in addition to conservative approach and Group 2 patients (n = 45) were followed with classical conservative approach during 4 weeks follow-up. The stone passage rates, stone expulsion time, change in weekly colic episodes and hospital readmission rates for colicky pain were compared. Results: Stone expulsion rates showed statistically significant difference between the two group (66.7 % vs 46.7 %, p = 0.048). Additionally mean time period required for the spontaneous passage of the calculi was meaningfully short in those cases receiving Tutukon® when compared with Group 2 patients undergoing conservative measures only (5.79 ± 2.39 vs 8.82 ± 3.48 days, respectively) (p = 0.001). Similarly, the mean renal colic episodes during follow-up period were significantly diminished in Group 1 patients (66.6 vs 36%, p = 0.001, respectively). Lastly, colic pain attacks were noted to be less in Group 1 and another advantage of“Tutukon®” was the relocation of the stones to a more distal part of ureter (35.2 vs 4 %). Conclusion: Use of Tutukon® in the medical management of ureteral calculi can accelarate the spontaneous passage rates and also relocate them into the lower portion of the ureter. Keywords: herbal agents, medical therapy, spontaneous passage, ureteral stones

Symptomatic Hydronephrosis and Ureteral Calculi in Pregnancy: A Narrative Review with a Proposed Management Protocol.

Introduction: Approximately 3% of pregnancies are complicated by symptomatic hydronephrosis and up to 0.8% with urolithiasis. Pain, coupled with the possibility of superimposed infection, increases the risks of premature labor and delivery, fetal loss, and caesarian sections. Surgical intervention as well as standard ionizing radiation imaging modalities are typically avoided making this a difficult, high-risk patient cohort to manage. In this study we propose a standardized contemporaneous approach to investigations and management in the pregnant population with acute upper tract pathology analysis. Methods: A literature search of PubMed, Cochrane, and EMBASE databases was performed to identify original, peer-reviewed articles from 2010 onward on the management of ureteral calculi and symptomatic hydronephrosis occurring during pregnancy. Search yielded 5636 articles and after exclusions, 24 full-text articles met inclusion criteria for analysis. Evidence Synthesis: Ultrasound remains the cornerstone of initial investigation with MRI in reserve if the diagnosis remains uncertain. Low-dose CT imaging can be used in limited cases. Conservative approaches for symptomatic hydronephrosis as well ureteral calculi is the preferred initial management option in the well patient. If intervention is required, ureteral stent and nephrostomy can be used with informed consent on the risks and benefits of each. Primary ureteroscopy with definitive stone management in centers with the appropriate expertise can safely deliver excellent stone-free rates and symptomatic improvement. Conclusions: Individualized investigation and management plans following a structured approach in pregnant women with symptomatic hydronephrosis or calculi are discussed. At all stages, the patient, obstetrician, anesthetist, and surgeon should be involved in a shared decision-making approach.

Canadian Urological Association guideline: Management of ureteral calculi - Abridged version.

Canadian Urological Association guideline: Management of ureteral calculi - Abridged version.

Canadian Urological Association guideline: Management of ureteral calculi - Full-text.

Canadian Urological Association guideline: Management of ureteral calculi - Full-text.

English

BACKGROUND This study was conducted to check whether computer tomography (CT) parameter Hounsfield Unit has any bearing on outcome of ureteroscopic pneumatic lithotripsy and as to whether it can predict success rate of ureteroscopic lithotripsy in the management of ureteric calculus. CT Hounsfield Unit tells us about hardness of stone, and it is primarily important in non-invasive management of ureteric and renal calculus such as extracorporeal shock wave lithotripsy (ESWL). METHODS We retrospectively reviewed records of 420 patients who underwent URSL from January 2016 to January 2020. A total of 186 patients of ureteric calculus did undergo CT in pre-operative evaluation for stone. Data of those patients was taken for study. Intra op clearance of calculus was decided by ureteroscopy finding on the table. All complications and difficulties of the procedure were documented. RESULTS We analysed the correlation between the outcome of the URSL and Hounsfield unit in finding the position of the stone and size of the stone. Out of 186 study participants, 111 (59.6 %) patients needed a single procedure for stone clearance whereas 75 (40.4 %) needed multiple procedures for clearance. Out of 186, 22 had HU < 500, 112 had HU 501 - 1000, 52 had HU > 1000. The majority of patients had HU between 501 - 1000HU. Complete clearance was seen in 63.6 % of < 500 HU patients, 62.5 % of 501 - 1000 HU patients and 55.7 % of > 1000 HU patients. This difference in clearance was statistically not significant. Similarly, the rate of complication when compared among the three groups doesn’t show a statistically significant difference (P value 0.293). The requirement of repeat procedure was maximum in > 1000 HU patients but the difference between the three groups was not statistically significant. Stone migration rate was found to be more in > 1000 HU stones (80.76 %) and this was statistically significant. CONCLUSIONS To conclude CT Hounsfield Unit’s utility in predicting the stone-free rate and complication rate doesn’t show significant bearing in patient undergoing URSL procedure. KEYWORDS CT, Hounsfield Unit, URSL, Stone Free Rate, Stone Density, Complication

Safety and efficacy of flexible and semi-rigid ureteroscopy with laser lithotripsy for the management of ureteral calculi in pregnancy

BackgroundSymptomatic ureteric stone during pregnancy can present a clinical challenge because of potential risks to both the mother and foetus. Ureteroscopy with laser and stone basket extraction represents an emerging strategy for definitive stone management in pregnancy, with minor complications. We aimed to evaluate the safety and efficacy of ureteroscopy with auxiliary procedures as a primary treatment for pregnant women with symptomatic ureteric stones who have failed conservative management.MethodsA prospective analysis was conducted in the Urology Department of Sulaymaniyah Teaching Hospital from June 2017 to November 2019 to evaluate pregnant patients who were treated with ureteroscopy and holmium laser lithotripsy for symptomatic ureteric stone.ResultsTwenty-six pregnant women aged between 18 and 34 years presented with renal colic (22 patients, 84.61%), severe hydronephrosis (3 patients, 11.53%), and progressive hydronephrosis (1 patient, 3.8%), suggesting ureteric stones. The diagnosis was established by abdominal ultrasonography. The mean stone size was 7.38 mm, ranging from 6–12 mm. The stones were located in the proximal ureter (n = 6, 23.1%), middle ureter (n = 0), and distal ureter (n = 20, 76.9%). Complete stone fragmentation was achieved in all patients. The overall procedure success rate was 87%, the stone-free rate was 23 out of 26 cases (88.46%), and no major obstetric or urologic complications were encountered.ConclusionsUreteric stone in pregnancy requires a high index of suspicion for a prompt and correct diagnosis. Ureteroscopy: flexible or semirigid endoscopy combined with holmium: YAG laser lithotripsy or with stone extraction are a preferred modality for the definitive treatment of symptomatic ureteric stone in pregnancy.

Oral 27 - The role of a stone clinic in the conservative management of ureteric calculi

Oral 27 - The role of a stone clinic in the conservative management of ureteric calculi

Semi-rigid Ureteroscopy for the Management of Ureteric Calculi: Our Experience and Complication Encountered.

Semi-rigid ureteroscopy lithotripsy have become standard of treatment for ureteral calculi. The aim of this study isto review outcome of Semi-rigidureteroscopy lithotripsy and to report the complications encountered. After approval from institutional committee of Public Health Concern Trust Nepal,we retrospectively reviewed the chart of all patients of ureteral stone who underwent ureteroscopy and pneumatic lithotripsy at Kathmandu Model Hospital between January 2013 and September 2017. Patient characteristics, stone size, success rate and complications were assessed. Intraoperative complications were graded using modified Satava classification system and the postoperative complications graded according to modified Clavien classification system. The success rate was based on stone free status after primary semi-rigid ureteroscopy lithotripsy, without the need of any other secondary procedures. Total 232 patients underwent semi-rigidureteroscopy lithotripsy. Mean age was 46 (16-76) years, with 128 males and 104 females. Size of the stone ranges from 5-18mm. The success rate of primary semi-rigidureteroscopy lithotripsy was in218 (93.9%) cases.Most intraoperative complications were modified Satava grade I (41.7%) andII(3.87%).Four(1.7%) patient had grade III complication, requiring conversion to open surgery. Ureteral avulsion was seen in 1(0.43%) patient, requiring ureteral reimplantation.The postoperative complication were modified Clavien grade I(10.7%), grade II(5.17%), grade III (4.6%) and grade IV(0.43%). Double J stents were inserted in all the patients postoperatively.The mean hospital stay was 2.2(1-14)days. Semi-rigid ureteroscopy lithotripsy for the management of ureteral stones is efficacious and have a lesser major complications.

The comparation of effects and security of double-J stent retention and ureteroscopy lithotripsy in the treatment of symptomatic ureteral calculi during pregnancy

ObjectiveTo describe the efficacy of double-J stent retention and ureteroscopy lithotripsy, we performed a study to evaluate the management of symptomatic ureteral calculi during pregnancy. Materials and MethodsFrom January 2005 and June 2015, 53 pregnant women with symptomatic ureteral calculi were admitted and treated in our hospital. According to the treatment techniques, there were divided into two groups: double-J stent retention group (30 cases) and ureteroscopy lithotripsy group (23 cases). We collected the characteristics and treatment outcome of the patients. ResultsDouble-J stent retention was performed on 30 patients. And the stents were successfully inserted in 25 patients (83.3%). 4 cases got complication in double-J group (16%). The mean operating time, medical cost and hospitalization time of double-J group were 20.6 min, 1632 yuan and 1.3 days. Ureteroscopy lithotripsy was performed on 23 patients. 20 patients were operated successfully (87.0%). 2 cases got complication in ureteroscopy group (10.0%). The mean operating time, medical cost and hospitalization time of ureteroscopy group were 41.5 min, 2792 yuan and 6.0 days. ConclusionIn summary, both double-J stent retention and ureteroscopy lithotripsy are effective and safe in the managation of ureteral calculi during pregnancy.

Stones: MET for distal ureteral calculi: not all stones are created equal.

Results of two large randomized controlled trials have challenged the use of medical expulsive therapy for the management of ureteral calculi. A new trial now shows that tamsulosin is effective in patients with distal calculi >5 mm in size, demonstrating that the effectiveness of MET depends on stone size and location.

Medical expulsive therapy for ureteric calculi – yes or no?

In recent years, there has been a potential paradigm shift in the conservative management of ureteric calculi away from the routine use of medical expulsive therapy (MET). A large body of evidence exists to hopefully answer this common clinical question. Multiple meta-analyses have been performed in the last decade to evaluate the existing evidence. Most, if not all have demonstrated benefit of administering MET for patients with ureteric calculi. In more recent years, the publication of several good quality, randomised controlled studies has cast doubt over the routine use of MET in these patients. These recent studies suggest that MET has no benefit in the conservative management of patients with ureteric calculi. In this article, we aim to provide a pragmatic commentary on the evidence to date and highlight the arguments both for and against the routine use of MET. We aim to highlight the steps that our unit has taken in translating good quality medical research into day-to-day clinical practice and also, to demonstrate our department’s current practice and the rationale behind it.

Medical expulsion therapy in the management of ureteric calculi: a comparative real-life experience

Background: One of the conservative management of ureteric caculi is by medical expulsive therapy by targeting common causes of obstruction such as edema, ureteral spasm and infection which will favour expulsion of calculi. The objective of this study was to assess comparative efficacy and safety of medical expulsive therapy of ureteric calculi.Methods: This was a randomized, prospective, open label, comparative study. Subjects satisfying inclusion and exclusion criteria were randomized into 4 groups tamsulosin, nifedipine, progesterone and control. Medical expulsion of calculi of 6mm to 15 mm size was carried out in 120 patients. Patients were followed up on OPD basis every third day. Calculi expulsion until day 28 as confirmed by abdominal ultrasonography was taken as the end point.Results: Expulsion rate in tamsulosin group was 90%, whereas nifedipine, progesterone group were 83.33% and 70% respectively which was significant compared to control group which was 36.6% (p < 0.005). Expulsion time was also reported to be significantly less in these groups as compared to control group. Therapy related adverse effects were minor and were seen in only 6 patients.Conclusions: Medical expulsive therapy of ureteric calculi of size 6 to 15mm with Tamsulosin, nifedipine and progesterone were safe and efficacious and could be implemented for initial management in selected patients.

Ureteroscopy for management of ureteric calculi: Five years experience in Erbil, Iraq

Background and objective: Retrograde ureteroscope has recently gained a broaden indication for use in from diagnostic to a variety of disorders that occur in the upper urinary tract. This study aimed to review our five years experience with ureteroscopic management for ureteral stones and to compare our rates of efficacy and safety of ureteroscopy with other centers. Methods: Review of 736 consecutive patients who underwent ureteroscopic procedures for the treatment of upper urinary tract problems between January 2010 and January 2015 was done in Erbil, Iraq. Out of those patients, 587 patients underwent a ureteroscopic procedure for the treatment of ureteric calculi. The studied variables were patients and stones characteristics, in addition to the mean operative time and mean hospital stay, the stone-free rate, and complication rates were also calculated. Results: The overall success rate (complete stone clearance) in 587 patients was 550 patients (93.7%). Mean operative time was 26.1 minutes and mean hospital stay was <24 hours. The overall complication rate was 12%. The intra-operative complication rate was 3.2%, the early postoperative complication rate was 8 %, and the late postoperative complication rate was 0.85%. Conclusion: Growing skill and experience of ureteroscopy will lead to a significant increase in the success rate and reduce complications.

Medical Expulsive Therapy: Worthwhile or Wishful Thinking

We set out to provide an overview of the most recent evidence for medical expulsive therapy (MET). Conflicting level 1 evidence for and against the use of MET has been published. The largest double-blind randomized control trial (1110 patients) comparing placebo, tamsulosin, and nifedipine found no benefit for MET in preventing the need for secondary intervention. A recent meta-analysis of 55 randomized trials using alpha-blockers suggests that no benefit is seen with smaller ureteric calculi, but patients with larger ureteric calculi experience shorter times to stone passage, fewer episodes of pain, require less surgical intervention, and fewer hospital admissions. All the major urological organizations (American Urological Association, European Association of Urology, Canadian Urological Association) suggest offering MET as part of conservative management for appropriate patients with ureteric calculi. MET is a reasonable option for conservative management of ureteric calculi that may avoid the need for surgical intervention. The greatest benefit is likely seen with alpha-blockers and calculi ≥5mm in the distal ureter. Expanding indications for the use of MET include facilitating stone fragment clearance after SWL. MET appears to be safe for use in pregnant and pediatric patients.

Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery

Introduction: The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm. Objectives: We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free. Materials and methods: 192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed. Results: Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm). Conclusion: Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute.

MP80-15 CAN FUNCTIONAL STUDIES BE OBVIATED IN MANAGEMENT OF URETERIC CALCULUS? A RANDOMIZED STUDY.

You have accessJournal of UrologyStone Disease: Evaluation II1 Apr 2015MP80-15 CAN FUNCTIONAL STUDIES BE OBVIATED IN MANAGEMENT OF URETERIC CALCULUS? A RANDOMIZED STUDY. Raman Tanwar, Nikhil Khattar, Rishi Nayyar, and Rajeev Sood Raman TanwarRaman Tanwar More articles by this author , Nikhil KhattarNikhil Khattar More articles by this author , Rishi NayyarRishi Nayyar More articles by this author , and Rajeev SoodRajeev Sood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Based on classic teaching, functional studies (Intravenous pyelography or contrast enhanced CT scan) are often considered a prerequisite before proceeding for surgery for urolithiasis. The routine use of imaging is time consuming and associated with real risks. There is no adequate clinical evidence as to whether detailed functional imaging as a routine has any role in management of calculi and at present no randomized controlled trial exists to evaluate the role and need of such investigations. A randomized study was performed to evaluate the role of functional studies in management of ureteric stones. METHODS 195 patients presenting to the outpatient department with a diagnosis of a demonstrable solitary unilateral ureteric calculus sized 0.5 to 1.5 cm with normal renal function tests and only mild to moderate hydronephrosis were included in the study. Patients with either increased creatinine, gross hydronephrosis with thinned out renal parenchyma, pyonephrosis or pregnancy were excluded. All included patients were randomized using a computer generated table into two groups. In the first group functional imaging was routinely done but in the other group no such study was performed. However, retrograde pyelogram was performed wherever required to delineate the anatomy. All patients were managed initially with medical expulsive therapy for a period of at least two weeks before they were subjected to ureterorenoscopy (URS). All patients were followed up with imaging after 3 months of successful management. The rates of spontaneous expulsion, difficulty or surprises during surgery and incidence of complications were noted. Results and complications in each of these groups were analysed using appropriate statistics. RESULTS 97 patients were randomized to the functional studies arm and 98 patients managed without any functional studies. The mean age, sex ratio, body mass index, size of calculus and location of calculus were comparable. Rate of spontaneous expulsion with medical expulsive therapy was 88.71%. Only 11 cases in each group required URS and 1 patient in each group had perforation. A weakly positive but clinically insignificant correlation was seen between size of calculus and need for URS. No significant difference was found in the spontaneous stone expulsion rates, difficulty and incidence of complications during URS and stone free rates between the two groups. CONCLUSIONS Functional studies may be obviated in management of solitary ureteric calculi amenable to endoscopic treatment in the presence of normal kidney function and absence of gross hydronephrosis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1025 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raman Tanwar More articles by this author Nikhil Khattar More articles by this author Rishi Nayyar More articles by this author Rajeev Sood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...