Management Of Ureteral Stones Research Articles

Emergency versus elective ureteroscopy for the management of ureteral stones.

To assess the safety and efficacy of emergency ureteroscopy (URS) compared with elective URS. We conducted a retrospective analysis of patients who underwent URS for isolated ureteral stones in a single center from October 2001 to February 2014. Our patient cohort was divided into two groups: an emergency URS group (Group A), which consisted of patients who underwent URS within the first 24 h of admission, and an elective or planned URS group (Group B). The URS success rate was defined as being the incidence of successful stone fragmentation and whether there was resolution of renal obstruction. A total of 2957 patients' medical records were available for analysis. Of these, 704 (21%) comprised of emergency cases and the remaining 2253 (79%) were elective cases. Patients in Group A were younger, had a smaller BMIs, and had smaller stone sizes (p < 0.001). The URS success rate was found to be 97% in Group A and 96% in Group B (p = 0.35). Intraoperative or postoperative complication rates were not found to vary significantly between the groups (8% vs 7%, respectively, p = 0.50). The incidence of ureteral stenting was nearly twice as high if URS was performed during night hours (85% vs 45%, p < 0.001). However, ureteral stenting was more prevalent in Group B compared to Group A patients (57% vs 25%, p < 0.001), possibly as a result of the number of pre-stented patients (73%). Emergency URS is an effective and safe option for patients with renal colic. Younger patients without pre-existing obesity and with stone sizes up to 8 mm located in the distal ureter might be a better match for emergency URS.

A comparative study of supine-transgluteal extracorporeal shockwave lithotripsy and ureteroscopy for the management of distal ureteric stones

A comparative study of supine-transgluteal extracorporeal shockwave lithotripsy and ureteroscopy for the management of distal ureteric stones

Comparison of the Intracorporeal Ultrasonic Lithotripsy and Intracorporeal Pneumatic Lithotripsy in Terms of Stone Removal and Postoperative Complications

Background: Urolithiasis is the most common and painful urological disease. Intracorporeal lithotripsy has high success rate in management of ureteric stone. Objective: To do comparison of the intracorporeal ultrasonic lithotripsy and intracorporeal pneumatic lithotripsy in terms of rate of stone removal and post-operative complications. Study Design: Randomized Control Trial. Settings: Department of Urology, Lahore General Hospital, Lahore Pakistan. Duration: Six months from September 01, 2015 to February 29, 2016. Methodology: Total sixty patients were selected fulfilling the inclusion criteria into 2 groups. In group A, 30 patients were selected for intracorporeal ultrasonic lithotripsy and in group B, 30 patients were selected for intracorporeal pneumatic lithotripsy. In both groups all patients were compared in terms of rate of stone removal and postoperative complications then results were analyzed by SPSS 21. Results: Mean stone size in group A (Ultrasonic lithotripsy) was 1.13 ± 0.17 cm and in group B (Pneumatic lithotripsy) was 1.14 ± 0.18 cm. At first week after procedure, in group A 25(83.33%) and in group B 21(70%) of the cases had stone clearance, at 2nd week after procedure a total of 26(86.66%) in group A and 24(80%) cases in group B had stone clearance. At 3rd week after procedure there were 28(93.33%) cases in group A and 27(90%) cases in group B had stone clearance. The stone clearance in both groups at each follow up was statistically insignificant, p-value &gt; 0.05. At 1st week, in group A 3(10%) cases and in group B 6(20%) cases had pain, at 2nd week after procedure there were 1(3.33%) cases in group A and 3(10%) in group B who reported pain and at 3rd week after procedure there were 1(3.3%) case in each group had pain. The pain at each follow up was statistically same in both groups, p-value &gt; 0.05. According to complications, in group A and group B, 2(6.66%) and 3(10%) cases had fever, 3(10%) and 4(13.33%) had infection respectively. Only one case (3.3%) had retention of urine. All complications were statistically same in both groups, p-value &gt; 0.05. Conclusion: Through the findings of this study we conclude that both intracorporeal pneumatic lithotripsy and intracorporeal ultrasonic lithotripsy are equally effective and had fewer complications. However, the ultrasonic procedure had higher rate of stone removal at each follow up (but difference was insignificant with similar morbidity compared to pneumatic devices.

In situ Management of Large Upper Ureteric Calculus by Mini-Percutaneous Nephrolithotomy in the Era of Retrograde Intrarenal Surgery.

PurposeThe aim of the study is to demonstrate the ease and success of in situ management of large upper ureteric stones with mini percutaneous nephrolithotomy (PCNL).MethodsThis was a prospective observational study conducted in the Department of Urology between January 2018 and June 2019. All patients underwent standard prone mini PCNL with 15Fr amplatz with 80 cases of fluoroscopic and 12 cases of ultrasound guided access. In three cases of tortuous ureters, wire was passed via retrograde catheter and retrieved via amplatz to straighten the ureter. Calculi fragmented with laser.ResultsA total of 77 patients were included in this study, 62 unilateral and 15 bilateral cases (92 renal units). The mean age was 45.4±13.7 years (range 17–71), male to female ratio was 61:16, the disease laterality (left: right) was 28:34. The mean stone size was 17.6±1.4 mm. Mean operative time was 22.4±1.5 min. 88% patients were discharged as day care. Complication rate was 6.5%, three patients had transient fever and two patients had distal migration of small fragments and they were extracted at the time of DJ stent removal by rigid ureteroscopy (100%).ConclusionWe conclude that it is easy and effective to deal with large upper ureteric calculus when it is in a fixed position. In situ management of large upper ureteric calculus by mini-PCNL can be done safely and effectively as it is a fast procedure, prevents unnecessary manoeuvres, less complication rates and has good stone clearance rates.

Systematic Review and Meta-Analysis Comparing Fluoroless Ureteroscopy and Conventional Ureteroscopy in the Management of Ureteral and Renal Stones.

Context: Stone recurrence is frequent in stone formers, and repeated diagnostic and therapeutic procedures in recurrent stone formers place patients and urologists at a significant risk of radiation-related effects. Objective: To assess the efficacy and safety of fluoroless ureteroscopy (fURS) compared with conventional ureteroscopy (cURS) in the management of ureteral and renal stones. Evidence Acquisition: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies providing data on the stone-free rate (SFR), secondary procedures, operative time (OT), and complication rate for fURS and cURS were included. An overall analysis and a subgroup analysis based on the stone target (ureteral stones, renal stones, or a combination thereof) were performed. Evidence Synthesis: A total of 23 studies were included, recruiting 4029 patients. Pooled data showed that in comparison with cURS, fURS exhibited a similar SFR (odds ratio [OR]: 0.99; 95% confidence interval [CI]: 0.92 to 1.06; p = 0.709), without significant differences in overall intraoperative complication rate (OR: 0.73; 95% CI: 0.33 to 1.63; p = 0.446), overall postoperative complication rate (OR: 0.98; 95% CI: 0.59 to 1.63; p = 0.949), major postoperative complication rate (Clavien ≥3; OR: 0.46; 95% CI: 0.14 to 1.53; p = 0.205), OT (standardized mean difference [SMD]: 0.07; 95% CI: -0.15 to 0.29; p = 0.537), hospital stay (SMD: -0.12; 95% CI: -0.26 to 0.02; p = 0.084), or secondary procedures (OR: 1.20; 95% CI: 0.58 to 2.49; p = 0.616). The subgroup analysis revealed no differences in outcomes according to the stone target. We also identified a rate of conversion to the conventional technique of 5% (95% CI: 3% to 7%). Conclusions: The available data suggest that for the treatment of ureteral and renal stones, fURS offers a similar SFR to that provided by the cURS without any increase in complication rate, OT, hospital stay, or secondary procedures. Critical review of the dogmatic routine use of fluoroscopy during ureteroscopy may be warranted.

Comparative Study Between Holmium Laser versus Pneumatic Ureteroscopic Lithotripsy for Proximal Ureteric Stones Close to Pelvi-ureteric Junction (PUJ) -A Prospective Trial

Objective: To compare the outcomes of ureteroscopic lithotripsy with pneumatic lithotripter versus Holium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in the management of upper ureteric stones.&#x0D; Materials and methods: Patients who underwent ureteroscopic lithotripsy with pneumatic lithotripter or Ho:YAG laser for upper ureteric stones were reviewed. Patients with urinary tract infection, ,loss of follow-up, concurrent middle or lower third ureteral stones or acute renall failure were excluded. Patient age, stone size and burden (based on KUB or computerized tomography), stone upward migration, double J stent insertion rate, stone free rate and secondary intervention rate for residual stones were compared in both groups.&#x0D; Results: There were 70 patients with upper ureteric stones (35 in pneumatic group and 35 in laser group) meeting the study criteria. Patients’ age, gender, stone size and burden were similar in both groups. The Ho:YAG laser lithotripsy group had better stone free rate, less double J stent insertion rate and less upward migration and secondary intervention rate, sepsis as compared with pneumatic lithotripsy (94.2% vs. 60%; 85% vs. 100%; 5.7% vs 40%; 5.7% vs 34.2%; 2.8 vs 2.8 respectively, all p &lt; 0.05). In patients with stones sizes 8-10 mm, Ho:YAG laser lithotripsy had significantly lower upward migration rate, lower double J stent insertion rate, higher stone free rate and less secondary intervention rate.&#x0D; Conclusions: Ho:YAG laser lithotripsy is better and much effective than pneumatic lithotripsy in the management of upper ureteric stones in terms of, stone free rate and secondary intervention rate for stones of sizes about 8 to 10 mm.Although the access of upper ureter is difficult but our small calibre (4.5 fr) ureteoscope and gentle manuevre have made the procedures safe and successful.&#x0D; Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.188-192

Comparative study between Silodosin alone and Silodosin plus Tadalafil for the medical management of lower Ureteric Stone in South-Western part of the Bangladesh

Objective: To compare the treatment outcome of Silodosin alone and Silodosin plusTadalafil as a medical expulsive therapy (MET) of lower ureteric stone in south-westernpart of Bangladesh.&#x0D; Methodology: The study was conducted in a tertiary hospital in Khulna, over a periodof 12 months (January 2019 to December 2019). Out of 108 patients, 100 meet theinclusion criteria who were purposively assigned into 2 groups. 48 patients included inSilodosin alone group and 52 in Silodosin plus Tadalafil group.&#x0D; Result: There was a significant higher stone expulsion rate in Silodosin plus Tadalafilthan Silodosin alone which was 88.46% vs75% respectively (P value 0.02). The meanstone expulsion time of Silodosin alone was14.33 (±3.1) days and Silodosin plus Tadalafilwas 11.48(±2.3) days (P value 0.001). The episodes of pain in Silodosin alone were0.7(±0.06) and 0.6(±0.2) in Silodosin plus Tadalafil group that was statisticallysignificant.&#x0D; Conclusion: The present study concludes that Silodosin plus tadalafil combinationtherapy significantly increases ureteric stone expulsion rate and decreases the expulsiontime and pain episodes than treatment with silodosin alone.&#x0D; Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.67-71

Outcome of Lower Ureteric Stone Fragmentation by Laser in Comparison with Pneumatic Lithotripsy

Background: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes.&#x0D; Aims: To see the outcome of lower ureteric stone fragmentation by laser in comparison with pneumatic lithotripsy.&#x0D; Methods: The prospective clinical study was conducted during the period from July 2012 to June 2014 in Dhaka Medical College Hospital. From the patient admitted in Dhaka medical college hospital a total of 60 patient were selected using purposive sampling methods. Selected patients were numbered chronologically and odd number group as group A (laser lithotripsy) and even number group B (pneumatic lithtripsy). Cystoscopy followed by ureterescopy with the help of guide wire was done and stone fragmentation done by either laser lithotripsy (done in general operation theatre in Dhaka Medical College Hospital) or pneumatic lithotripsy (done in Urology operation theatre in Dhaka Medical College Hospital). Collected data were processed and analyzed using computer software SPSS (statistical package for social science), version-18. Un-pair t-test, chisquare test and Fishers Exact probability test were used to analyze the data. The findings of the study showed age and sex are almost identically distributed in both groups.&#x0D; Results: The mean age of group A and group- B were 35.63±11.66 and 38.90±11.21 years respectively. A male predominance was observed in both groups with 70% male in group- A and 53.3% in group-B. Stone size was also observed identically in both groups. 43% of stone are larger than 10mm in group- A and 47% stone are larger than 10mm. None of other baseline variable found very between groups. Immediate stone clearance was much higher in group-A (96.7%) then that in group- B (80%). Although both the groups demonstrated 100% clearance after 1 month. Immediate complications were higher in group B then those of group- A. Ureteral perforation in group B was found 6.7% as opposed to none in group-A. Fever in group A (6.7%) was observed to be more than 3 times higher than in group- B (23.3%). Comparison of complications after 1 and 3 months shows some differences (higher in group-B) but that is not significant. Ureteral stricture developed in 3 patients in group- B compared to nil in group- A. More than 90% of patients of group-A were released from the hospital within 3 days after operation, in contrast about 40% in group-B left the hospital within 3 days.&#x0D; Conclusion: So, laser lithotripsy is better option for the management of lower ureteric stone by using semi rigid ureteroscope, in term of stone migration, rate of stone fragmentation and clearance, operation time, hospital stay and complication.&#x0D; Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.169-175

Comparative Study Between Holmium: Yag Laser and Pneumatic Lithotripsy in the Management of Upper Ureteric Stone

Background:Among various intracorporeal lithotripters, Pneumatic lithotriptorhas become the widely used tool for the treatment of ureteric stones. Recently the Holmium:YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of ureteric stones.&#x0D; Objective: To compare the treatment of upper ureteric stone between laser and pneumatic lithotripsy.&#x0D; Materials and methods: One hundred patients with upper ureteric stone who underwent ureteroscopic lithotripsy in the Department of Urology, CMH, Dhakafrom October 2012 to September 2015 were enrolled in this study. Patients were divided into two groups. Group A (LL) were treated with holmium: YAG laser and Group B (PL) were treated with pneumatic lithotripsy. Two procedures were compared in term of stone fragmentation, stone clearance rate, duration of lithotripsy, complications and duration of post operativehospital stay. Patients were monitored as outpatients after one month and after three months with a kidney ureter and bladder radiograph and ultrasonograph. Patients with migrated fragments or incomplete clearance underwent an auxiliary procedure such as Extra Corporeal shock wave lithotripsy (ESWL).&#x0D; Results: Mean stone size was 1.36 ± 0.36 cm in group A (LL) and 1.37± 0.36 cm in group B (PL). The immediate stone clearance rate was significantly higher inGroup A (94.0%) than Group B (76.0%). Fragments proximal migration were 6.0% in LL group and 24.0% in PL group. Use of stone retrieval equipments (baskets, forceps) was 16.0% and 64.0% in LL and PL group respectively (p&lt;0.05) and stone fragments clearance requiring auxiliary procedures were 6% and 24% (p&lt;0.05) in LL and PL group respectively. The mean lithotripsy time 40.46 ± 19.25 min and 36.86 ± 14.83 min and mean period of post operative hospital stay was 2.32 ± 1.22 days and 2.44 ± 1.18 days in the LL and PL group respectively. Periprocedural complications like hemorrhage, mucosal disruption/ perforation were almost same in both groups.&#x0D; Conclusion: In this study stone clearance and fragmentation of stone in Holmium:YAG assisted ureteroscopy was significantly higher than pneumatic lithotripsy group. The need for auxiliary procedure like ESWL for proximally migrated fragments was significantly less inHolmium:YAG assisted ureterocopy compared with pneumatic lithotripsy.&#x0D; Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.160-165

Study of the outcome on ureteroscopic lithotripsy in patients with upper ureteric calculi: a descriptive study

Background: Ureteric calculi are one of the most common cause of abdominal pain in the emergency room. There are several options for the management of ureteric stones. Ureterorenoscopy and lithotripsy is the commonly used modality because it is less morbid and invasive, but the drawback is proximal stone migration which leads to persisting symptoms and increased costs. The aim of this study is to use an anti-retropulsion device to reduce the rate of proximal stone migration.Methods: This description study was conducted in Sree Gokulam Medical college from December 2014 to December 2015, on 75 consecutive patients who had ureteric stones, of ages 20-60 who were willing to give consent. All patients underwent ureteroscopy and lithotripsy and in those patients from who anti-retropulsion device could not be manipulated proximal to the stone lithotripsy alone was done. Both groups were compared for procedure time, post-operative symptoms and stone free rates.Results: The average time taken for the procedure with anti-retropulsion device was 45 minutes whereas in the other group was 72 minutes. 48 (96%) of patients using the device were symptom free and 48 (96%) patients had no symptoms after the procedure.Conclusions: The use of a anti retropulsion device can significantly reduce proximal stone migration, so thereby reducing further procedures and costs.

Effectiveness of ultrasound-guided shockwave lithotripsy and predictors of its success rate in pediatric population: A report from a national reference center

Shockwave lithotripsy (SWL) remains a well-established treatment modality for many of the pediatric renal and ureteral stones. Repeated SWL sessions carry limitations due to the use of general anesthesia and X-ray radiation. The objective of our study was to evaluate stone-free rate (SFR) of 1-session of SWL for the management of pediatric renal and ureteral stones less than 2cm performed exclusively under ultrasound guidance and identify factors influencing its success. The study utilized a retrospective cohort design including 124 consecutive pediatric patients with 133 renal and ureteral stones less than 2cm whom SWL was performed in the period of January 2008 to December 2019. SWL procedures were performed by one expert surgeon in a single, national reference center, exclusively under ultrasound guidance using Modulith® SLK lithotripter. Follow-up was performed in post-SWL 2nd, 4th, 12th weeks and 6 months. The mean age of the children was 10 years (SD=6.0) and the mean stone size was 10.4mm (SD=3.6mm). Sedation type of anesthesia was used in 80 patients (64.5%). No major complication was developed, and no ureteral stenting was required in any of the patient following SWL. The SFR following 1-session of SWL was 88.0% at 12-week. Younger age (P=0.002), sedation type of anesthesia (P=0.001) and presence of radiolucent stones (P=0.033) significantly improved post-SWL early stone clearance on univariate analysis, the latter being the only significant factor according to final model (P=0.031). Ultrasound-guided SWL represents a safe and effective method for the management of both renal and ureteral stones in children. The SFR following 1-session of SWL at 12-weeks was achieved in 88.0%, the overall success rate after all SWL sessions reaching 91.7%. A higher success rate was observed in children harboring radiolucent stones.

Predictive factors of renal and ureteric stone disintegration by the extracorporeal shock wave lithotripsy

Objective The objective of this work was to evaluate possible predictive variables for the outcome of shock wave lithotripsy of renal and ureteric stones. Background Nephrolithiasis is a common disease affecting the population with a peak incidence at around the third to fourth decade of life. The prevalence of stone disease is increasing with increasing annual expenditure. Extracorporeal shock wave lithotripsy (ESWL) is the preferred treatment for renal and several ureteral calculi owing to its noninvasive characteristic and its favorable clinical outcome. Patients and methods This study was carried out on 100 patients who are supposed to be treated with ESWL and diagnosed with renal or ureteric stone. All cases were evaluated before, during, and after the procedure as follows: full medical history, clinical examination, laboratory investigations, and radiological investigations. Results A total of 91 of the studied patients were males. Age of the studied patients ranged from 24 to 58 years, with a mean of 38.72 years. There is a significant relation between need for second session and presence of tenderness, hypertension and stone site, international normalized ratio, operation duration, complaint duration, stone size, and Hounsfield unit. Presence of renal stone significantly protects from that risk. There are significant relations between postoperative complications and smoking, BMI, urine analysis, hypertension, and past history of stone. There are significant relations between postoperative complications and need for second session, serum creatinine, operation duration, and stone size. Conclusion ESWL is an effective and reasonable initial therapy in the management of ureteral stones 2 cm or less at all levels of the ureter.

Inadvertent Stone Migration During Pneumatic Lithotripsy: Still a Conundrum in the 21st Century.

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, and the hunt for such a device is still ongoing in the 21st century. The quest for an ideal instrument is driven by the need to reduce cost, minimize ancillary procedure rates, reduce the device's operative time, and improve the stone-free rate. The purpose of the present review is to provide an update on the use of preventive measures that are used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management.

Eswl for Upper Ureteric Stone With and Without JJ Stent-A Comparative Study

Objective: To find out the outcome of stenting before ESWL in the management of upper ureteric stone.&#x0D; Methods and materials: This prospective comparative study was conducted in the department of urology, Sylhet Osmani Medical College Hospital from January 2011 to June 2012. Sixty two patients with upper ureteric stone, aged between 18 to 60 years irrespective of sex, unilateral radio opaque upper ureteric stone of greatest diameter 2cm, patients with normal renal function and negative urine culture and were agreed to participate in the study were selected. Selected 62 patients with upper ureteric stones were divided randomly into group-A and group-B each consisting 31 patients. The patients of group-A were treated with ESWL with a JJ stent and that of group-B without JJ stent. In the patients selected for JJ placement, a 5 fr JJ stent was placed under regional anaesthesia before ESWL. Siemens Lithotripsy ESWL machine was used to impart shock waves and 3500 shockwaves was given in a session. Both the groups were compared for stone clearance, ureteric colic, steinstrasse, fever, lower urinary tract symptoms (LUTS), number of ESWL sessions. Data were processed and analyzed using software SPSS.&#x0D; Results: The number ESWL session in stented group [single session 10 (32.3%) and multiple sessions 21 (67.7%)] and in non-stented group [single session 9 (29.0%) and multiple sessions 22 (71.0%)] was similar in both groups (p&gt;0.05) Stones were cleared in 23 (74.2%) patients in stented group and 25 (80.6%) patients in non-stented group. Difference was not statistically significant (p&gt;0.05). Ureteric colic was significantly fewer in stented group than that of non-stented group [4 (12.9%) vs 11 (35.5%); p&lt;0.05] but surapubic pain was significantly more in stented group than that of non-stented group [13 (41.9%) vs 5 (16.1%); p&lt;0.05]; while steinstrasse [3 (9.7%) vs 5 (16.1%); p&gt;0.05] and fever [5 (16.1%) vs 2 (6.5%); p&gt;0.05] did not differ statistically significant between groups. Lower urinary tract symptoms such as urinary frequency [15 (48.4%) vs 3 (9.7%); p&lt;0.01]; urgency [17 (54.8%) vs 5 (16.1%); p&lt;0.01] and dysuria [19 (61.3%) vs 6 (19.4%); p&lt;0.01] were significantly more in stented group than that of non-stented group; but gross haematuria [21 (67.7%) vs 15 (48.4%); p&gt;0.05] were more in stented group.&#x0D; Conclusion: ESWL is an effective and reasonable initial therapy in the management of upper ureteric stones measuring &lt;2 cm. Pre-ESWL ureteric stenting provides no additional benefit over non-stented ESWL in their management. Moreover, stents are associated with signiûcant patient discomfort and morbidity.&#x0D; Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.17-22

Уретероскопия в лечении камней мочеточника: необходимость в лазерной литотрипсии и дополнительном оборудовании

Over the past several decades, there has been a significant increase in the prevalence of nephrolithiasis in the general population. Ureteroscopy has become the treatment of choice for a growing number of urologic conditions; ureteroscopy is still relatively new procedure and continue to undergo significant advancement. The recent technical development of small caliber semi rigid and flexible deflectable ureteroscopes and the development of diminutive intra-corporeal lithotripsy probes have made the retrograde access to urinary calculi throughout the entire ureter a more feasible and low-risk technique. The study aims to identify the need for use of laser lithotripsy and/or other ureteroscopic ancillary equipment (ureteric stent, ureteric catheter, forceps and dormia basket) in patient undergoing ureteroscopy for ureteric stone management. A prospective observational study from 2013 to 2015. The study conducted in urosurgical theater in Al-Jumhoori Teaching Hospital. 200 patient with ureteric stone in the study treated by ureteroscopy. The mean age of the patient is 36 years. Ureteroscopy had done in the right side in 98 patients, left side in 83 patients, and bilateral ureteroscopy in 19 patients. Ureteric stones found in upper ureter in 86 patients, middle ureteric stone seen in 40 patients, and lower ureteric stone founded in 108 patients, whereas 16 patients had stones at more than one location. Ureteric catheter used in 33 patients, and had been removed after 48-72 hours, while Double J stent had been used in 175 patients and had been removed after 2 to 8 weeks.

Medical expulsive therapy: a cost effective evidence-based definitive treatment for ureteric stones

Background: The lifetime risk of kidney stones is between 5% and 10% and rates of recurrence are as high as 50%. Majority of the ureteric stones (70%) are found in the lower third of the ureter. Available setup, type, size of the stone, and expertise of the surgeon are the major factors affecting the treatment modality. Medical expulsive therapy has shown promising results in previous studies. Aim of the study was to assess the efficacy of tamsulosin and deflazacort combination therapy for stone expulsion in relation with site and size of stones.Methods: A total of 97 patients with ureteric calculi of size 10 mm or less attending the urology out-patient department were included. Received medical expulsive therapy using tamsulosin (0.4 mg) and deflazacort (30 mg) for 7 days. Patients were evaluated for stone expulsion on 7th day by non-contrast computed tomography of kidney ureter bladder. Site, side and size of stones were noted.Results: Ureteric calculi was more prevalent in the age group of 21-30 years 38 (39.2%). Male preponderance was observed (76.28%) with male female ratio being 3.2:1. Lower site 64 (65.97%) ureteric calculi were most common. The majority had a stone size of 4-6 mm (42%). Stones were expelled on 7th day in 69 (71.13%) patients. Expulsion rates were highest for the stone size of 2-4 mm (94.4%) followed by 4-6 mm (88.1%). The highest expulsion rates were observed for Lower ureteric stones (84.4%).Conclusions: Medical expulsive therapy using tamsulosin and deflazacort is an effective treatment modality for the management of ureteric stones, especially those present in lower ureter and those ≤8 mm in size.

Outcome of Semi-rigid Ureteroscopy with LASER Lithotripsy for Management of Upper Ureteric Calculi

Background: Proximal ureteral calculi are common with multi-modalities of treatment, with continuous invention of new modalities. Aim of the work: To present the early experience with LASER lithotripsy using semi-rigid ureteroscopy for treatment of upper ureteral calculi, regarding safety and efficacy. Patients and Methods:Eighty patients with upper ureteral stones managed by LASER lithotripsy using semi-rigid ureteroscopy were included [30 prospective and 50 retrospective]. Patient evaluation included medical history, clinical examination with preoperative laboratory and radiological investigations. The outcome measure was stone free rate, Intra operative and Postoperative complications, operative time, hospitalization time, and post-operative analgesia. Results: During the period from January 2018 through February 2020 in 30 prospective cases but retrospectively in 50 cases done in the last two years, 68.8% of patients were males and 31.2% of them were females, mean of age was 43.70 with range from 20 to 66 years, and mean of BMI was 19.75 with range from 18 to 23 with laterality of 60% of patients was right but of 40% was left and stone opacity of 96.25% of patients was radio opaque, while, 3.75% was radio lucent stones the mean operative time was 50.78 minutes and mean duration of hospital stay was 1.3 days. In addition, 66.2% of patient needed JJ, 32.5% required ureteric catheter and 15% failed ESWL. The mean ureteral stone diameter was 10.81. The clearance rate 97.5%; two cases had migrated stone. Conclusion: Semirigid ureteroscope with LASER lithotripsy is an effective and safe procedure for management of large proximal ureteral stones with a lesser rate of stone migration needs use of flexible ureterorenoscopy.

The COVID Stones Collaborative: How has the Management of Ureteric Stones Changed During and After the COVID-19 Pandemic? Rationale and Study Protocol

Background and objectives The coronavirus disease 2019 (COVID-19) pandemic is having a significant impact on healthcare delivery. As a result, management of patients with ureteric stones has likely been affected. We report our study protocol for the investigation of ureteric stone management during and after the COVID-19 pandemic. Material and methods The COVID Stones study is a multicenter national cohort study of the management and outcomes of patients with ureteric stones before, during, and after the COVID-19 pandemic in the United Kingdom. The study will consist of three data collection periods, pre-pandemic (“pre-COVID”), pandemic (“COVID”), and post-pandemic (“post-COVID”). This will allow quantification of what “normal” was, how this has changed, and to capture any persisting changes in management. The primary outcome evaluating the success rate of the initial treatment decision will be assessed following a 6-month follow-up from the time of first presentation and will be performed for each recruited patient from each of the three data collection periods. This will allow comparison between both management and outcomes before, during, and after the pandemic. Conclusions We anticipate that this study will lead to an increased understanding of the impact of the outcomes of emergency management of ureteric stones following changes in clinical practice due to the COVID-19 pandemic health provision restrictions.

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.

Optimal management of large proximal ureteral stones (>10mm): A systematic review and meta-analysis of 12 randomized controlled trials.

To develop an evidence base to guide clinicians treating adults with large proximal ureteral stones (LPUS) greater than 10mm. A systematic search of PubMed, EMBASE, and Cochrane Library was conducted to identify randomized controlled trials (RCT) concerning different LPUS management techniques including laparoscopic ureterolithotomy (LU), percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URL) up until March 2020. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement when searching and determining inclusion. All included articles were quality assessed and the data analyses were conducted with Review Manager (5.3). 12 RCTs involving 1416 patients met our eligibility criteria and were analyzed. Of these participants, 44.6% (n=632) underwent URL, 25.5% (n=361) PCNL, and 29.9% (n=423) LU. Pooled analysis revealed that URL had a significantly lower stone-free rate (SFR) compared to PCNL and LU (both with p<0.05). URL had a significantly higher ureteral injury rate compared to LU (Relative risk (RR)=5.27, 95% confidence interval (CI) 1.52 to 18.22, p=0.009) and PCNL (RR=4.11, 95% CI 1.03 to 16.34, p=0.04). However, no significant differences were found between PCNL and LU in terms of SFR or overall complications, both with p>0.05. URL initially costs less than PCNL (Weighted mean difference (WMD) -597.35US$, 95% CI -823.10 to -371.60, p<0.00001), but being less effective creates greater demand for repeat or ancillary treatments compared to LU (RR 15.65, 95% CI 2.11-116.12, p=0.007) and PCNL (RR 8.86; 95% CI 3.19-24.60; p<0.00001). Both PCNL and LU appear more effective and safer than URL for LPUS; although, LU has higher risk of urine leakage and is more likely incur trauma which requires additional support. However, caution must be taken because this recommendation is based upon a very limited number of clinical studies, and even fewer comparing flexible ureteroscopic technologies. Further prospective real-world studies or RCTs comparing flexible URL, LU and PCNL are required, as well as an in depth analysis of the hidden costs involved in unsuccessful URL treatments.