Management Of Ureteral Stones Research Articles

‘Out of Scope’ – Operative Challenges in Ureteric Stone Management for Patient With Abnormal Ureteric Anatomy Post Multiple Urinary Diversion Procedures for Posterior Urethral Valves

‘Out of Scope’ – Operative Challenges in Ureteric Stone Management for Patient With Abnormal Ureteric Anatomy Post Multiple Urinary Diversion Procedures for Posterior Urethral Valves

Follow-Up Survey for Conservatively Managed Ureteric Stones.

Introduction Currently, there are no agreed-upon investigations and follow-up guidelines for the conservative management of ureteric stones. This study used common themes identified in previous works to investigate whether there is a consensus amongst urology consultants in the United Kingdom. Methods This was a questionnaire-based survey study. An online questionnaire was disseminated nationally to urological consultants practicing in the United Kingdom to explore a range of common factors. The initial sample size was 81 UK-based urological consultants with an interest in endourology and stone surgery. Of the initial 81, 20 participants did not complete the survey and therefore the final sample size was 61. Descriptive analysis was used to analyze the data. Results Our survey found that the main factors influencing the follow-up of conservatively managed ureteric stones were stone size 98% (60), stone location 92% (56), and the degree of altered renal function 79% (48). Regardless of stone size, most participants chose to follow up at 2-4 weeks with asymptomatic patients requiring imaging with discrepancies about the modality. Regarding biochemical markers, most participants only repeated renal function tests if this was deranged on presentation. Calcium and uric acid levels were checked regularly. Diclofenac was the analgesia of choice 93% (55). Regarding the availability of acute ESWL services, over half (59%) were able to offer acute ESWL within the week. The majority offer services at least three or more lists per week. Conclusion Our results demonstrate that there is still no overarching consensus in the follow-up of conservatively managed ureteric stones.Several factors backed by high-level evidence are already consistent across the population of urology consultants and considered "best practice." However, before any all-encompassing national guidelines are formalized, further studies in the form of randomized control trials will be needed to yield high-level evidence.

Optimum combined MET according to tolerability with efficacy, Silodosin Tadalafil versus Silodosin Vardenafil for distal ureteric stone: a prospective, double blinded, randomized clinical trial.

To determine the optimum combination therapy of Silodosin-Tadalafil versus Silodosin-Vardenafil in terms of both tolerability and efficacy for the management of distal ureteric stones. This prospective, double blinded, randomized clinical trial included 140 patients with distal ureteric stones, randomized into two groups: Group I (n = 67) received Silodosin 8mg once daily combined with Tadalafil 5mg once daily, and Group II (n = 68) received Silodosin 8mg once daily combined with Vardenafil 10mg once daily. The primary outcome was the tolerability of the combination therapies, assessed through the incidence of adverse events. Secondary outcomes included stone expulsion rate, expulsion time, and the need for analgesics. Both combination therapies demonstrated similar efficacy, with no significant differences in stone expulsion rate (70.1% vs. 67.6%, P = 0.754), expulsion time (19 ± 3days for both groups, P = 0.793), and analgesic requirements (P > 0.05). However, the Silodosin-Tadalafil combination showed a significantly lower occurrence of adverse events, with notable differences in headache (23.9% vs. 57.4%, P < 0.001), dizziness (32.8% vs. 60.3%, P = 0.001), and gastrointestinal upset (9% vs. 66.2%, P < 0.001), and other adverse effects. The overall occurrence of any adverse event was significantly lower in the Silodosin-Tadalafil group (88.1% vs. 98.5%, P = 0.017). Both Silodosin-Tadalafil and Silodosin-Vardenafil therapies are effective in managing distal ureteric stones. However, the Silodosin-Tadalafil combination is associated with a significantly lower incidence of adverse events, making it a more tolerable option for patients.

Application of 11/13Fr suctioning ureteral access sheath and 8.55Fr single-use digital flexible ureteroscope in one-stage flexible ureteroscopic lithotripsy: an initial experience of 900 cases.

To report our initial experience of one-stage flexible ureteroscopic lithotripsy(FURL) with 11/13Fr suctioning ureteral access sheath(UAS) and 8.55Fr single-use digital flexible ureteroscope(SDFU) in upper ureteral or renal calculi. We retrospectively collected the clinical data of 900 adult patients with upper ureteral or renal calculi treated by FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU from January 2022 to April 2024. Demographics, peri- and postoperative outcomes were assessed. In all, 40 of 940 cases(4.26%) failed to introduce UAS and required second-stage FURL because of ureterostenosis and were excluded. Mean stones size of the remaining 900 eligible cases was 1.68 ± 0.58cm in greatest diameter. There were 228 cases of upper ureteral stone, 456 cases of renal stone and 216 cases of concomitant ureteral and renal calculi. The mean operation time was 52.20 ± 20.21min and the postoperative hospital stay was 2.87 ± 1.37 days. The stone-free rate of 1 month postoperatively was 89.56% and only 2.44% of patients with residue underwent additional reoperation. The rate of postoperative fever, postoperative pain needing analgesic and slight ureteral mucosal injury were 5.11%, 8.22% and 7.78%, respectively. None of patient suffered from severe complications, such as sepsis or ureteral perforation. It's practical and suitable for the vast majority of adult patients to undergo FURL in single session with 11/13Fr suctioning UAS without preoperative stenting. FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU is feasible, reliable, safe, and efficient in the management of renal stone and upper ureteral stone.

The optimal management of large upper ureteral stones (> 1.5 cm) with infection in elderly patients: a comparative analysis of three minimally invasive surgical approaches.

The aim of this study was to investigate the efficacy and safety of three minimally invasive surgical approaches for treating large upper ureteral stones complicated by infection in elderly (> 60years) patients. Clinical data from 95 elderly patients with large upper ureteral stones and infection, treated at our hospital between January 2018 and April 2023, were retrospectively analyzed. The surgical approaches included FURL (flexible ureteroscopic lithotripsy) 33 cases, mPCNL (minimally percutaneous nephrolithotomy) 29 cases, and RLUL (retroperitoneal laparoscopic ureterolithotomy) 33 cases. Surgical time, intraoperative blood loss, postoperative hospital stay, reoperation rate, incidence of postoperative complications, and hospitalization costs were observed and compared among the three groups. No statistically significant difference was found in stone clearance rates among the three groups (P > 0.05). The FURL group exhibited advantages over the mPCNL and RLUL groups in surgical time, intraoperative blood loss, and postoperative hospital stay (P < 0.05). However, it also had the highest reoperation rate and hospitalization costs (P < 0.05). RLUL demonstrated superiority over the mPCNL and RLUL groups in terms of reoperation rate, incidence of complications, and hospitalization costs (P < 0.05). Notably, mPCNL exhibited the highest complication rate at 37.9% (P < 0.05). For elderly patients with large upper ureteral stones complicated by infection, FURL, mPCNL, and RLUL represent effective surgical approaches. Further attention is needed regarding the perioperative safety of mPCNL. RLUL, which offers higher safety, efficacy, and cost-effectiveness, can be considered a primary surgical option for these patients.

Propensity score matched comparison of transperitoneal laparoscopic ureterolithotomy and percutaneous nephrolithotomy for management of large impacted proximal ureteral stones with long-term follow-up.

Impacted proximal ureteral stones (IPUS) present challenging clinical scenarios due to their persistent nature and associated complications. While ureterorenoscopy (URS) lithotripsy is recommended as the primary treatment, controversies exist regarding the optimal management of such stones. In this retrospective analysis, we compared the operative outcomes and long-term results of transperitoneal laparoscopic ureterolithotomy (LU) and percutaneous nephrolithotomy (PCNL) for IPUS larger than 15mm. Propensity score matching (PSM) was employed to mitigate potential selection biases. Following PSM, 83 patients in each cohort exhibited comparable baseline characteristics. LU demonstrated a superior surgical success rate (100% vs. 96.4%, p = 0.244) and significantly lower perioperative hemoglobin decline (0.6 ± 0.4g/dL vs. 1.5 ± 0.7g/dL, p = 0.036) compared to PCNL. Additionally, LU exhibited a higher stone-free rate after 2 months (100% vs. 91.6%, p = 0.043), but a longer duration of catheterization (7.4 ± 1.2 days vs. 3.5 ± 2.2 days vs., p = 0.011). Conversely, PCNL was associated with a higher incidence of total complications (21.7% vs. 9.6%, p = 0.033) and stone recurrence during a mean period of 40-month follow-up (20.5% vs. 8.4%, p = 0.027). Transperitoneal LU and PCNL represent effective interventions for managing IPUS exceeding 15mm. Notably, LU emerges as a preferable option over PCNL, offering superior stone clearance rates, reduced perioperative complications, and lower recurrence rates.

Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy in the Management of upper Ureteric Stones Measuring from One to Two Centimeters: Randomized Prospective Study

Abstract Objective This prospective study aims to compare the clinical efficacy and safety of flexible ureteroscopy versus laparoscopic ureterolithotomy in the management of upper ureteric stones measuring from one to two centimeters. Methods his randomized-prospective study was conducted on 64 patients admitted from Urology unit, Ain Shams University in the period from October 2020 till September 2022; only 56 patients were analyzed statistically and 8 patients were excluded due to shortage in post- operative data and follow up. Patients were divided into two groups Group A consists of 31 patients and Group B consists of 25 patients with matched age, gender and body mass index (BMI). Results In our study, The VAS score at 6 hours post-operative and day 1 post-operative was found to be 5.32 and 2.71 in FURS group and was found to be 7.28 and 3.28 in RPLU group respectively showing significant difference with (p- value &amp;lt;0.001 and 0.016 respectively) between the two groups with more satisfaction in FURS group mostly due to the absence of trocars incisions. The complications were classified according to modified Clavien classification system. No major complications such as septic shock or death were reported in either treatment groups. As regards the recovery to work in postoperative and follow up periods in the present study, there was a significant difference between both groups with (P-value &amp;lt;0.001), as we found that it takes about 4.56 ± 0.82 days in RPLU group and 3.06 ± 1.91 days in FURS group to return daily routine activities. As regards the stone free rate in follow up periods in the present study, there was a significant difference between both groups with (P-value 0,02), as we found that it was 100% and 80,6% in RPLU and FURS group respectively. Our success rate in RPLU group was found to be 100% in comparison to Irfan Nazir Mir et al which was 93.4% (28/30) with two patients (2/30) converted to open ureterolithotomy, either due to technical snag or due to difficulty in localizing the ureter laparoscopically. Conclusion Both F-URS and RTLU were safe and effective surgical procedures for treatment of large proximal ureteral stones. However, RTLU had a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. Also as regards to postoperative pain, shorter hospital stay and faster return to daily activities, both have almost similar results.

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 Between Retrograde and Antegrade Ureteroscopic Laser Lithotripsy for the Management of Medium-Sized Proximal Ureteral Stones: A Randomized Prospective Study.

This study aimed to present the outcomes of retrograde and antegrade ureteroscopic laser lithotripsy in the treatment of proximal ureteral stones ranging in size from 10 to 20 millimeters in diameter. From March 2023 to December 2023, 70 patients were included in this prospective randomized double-arm interventional study. Patients were divided into two groups: Group 1 (35 patients) had semi-rigid retrograde ureteroscopic laser lithotripsy, and Group 2 (35 patients) had semi-rigid antegrade ureteroscopic laser lithotripsy. In terms of length of hospitalization, there was a statistically significant distinction between the groups that were evaluated (p = 0.001). Group (1) showed a statistically significant distinction in Hb and HCT levels before and after the procedure (p < 0.05), whereas Group (2) showed a similar difference in Hb, creatinine, and HCT levels before and after the operation (p < 0.05). The antegrade group had much more hemorrhage than the retrograde group. Reduced hemoglobin (p = 0.008) and hemoglobin saturation (p = 0.029) were most noticeable in the antegrade group. Regarding stone-free rates (SFRs), no statistically significant difference was noted between the groups (p = 0.643). Both retrograde and antegrade ureteroscopic laser lithotripsy are dependable and successful for the treatment of proximal ureteral stones. For medium-sized proximal ureteral stones (10-20 mm), retrograde ureteroscopic laser lithotripsy may be the first option due to its shorter hospital stays, decreased bleeding rates, blood transfusion needs, and temporary rise in serum creatinine.

CT-Based AI model for predicting therapeutic outcomes in ureteral stones after single extracorporeal shock wave lithotripsy through a cohort study.

Exploring the efficacy of an artificial intelligence (AI) model derived from the analysis of CT images to precisely forecast the therapeutic outcomes of singular-session extracorporeal shock wave lithotripsy (ESWL) in the management of ureteral stones. A total of 317 patients diagnosed clinically with ureteral stones were included in this investigation. Unenhanced CT was administered to the participants within the initial fortnight preceding the inaugural ESWL. The internal cohort consisted of 250 individuals from a local healthcare facility, whereas the external cohort comprised 67 participants from another local medical institution. The proposed framework comprises three main components: an automated semantic segmentation model developed using 3D U-Net, a feature extractor that integrates radiomics and autoencoder techniques, and an ESWL efficacy prediction model trained with various machine learning algorithms. All participants underwent thorough postoperative follow-up examinations four weeks hence. The efficacy of ESWL was defined by the absence of stones or residual fragments measuring ≤2mm in KUB X-ray assessments. Model stability and generalizability were judiciously validated through a fivefold cross-validation approach and a multi-center external test strategy. Moreover, Shapley Additive Explanations (SHAP) values for individual features were computed to elucidate the nuanced contributions of each feature to the model's decision-making process. The semantic segmentation model we constructed exhibited an average Dice coefficient of 0.88 ± 0.08 on the external testing set. ESWL classifiers built using Support Vector Machine (SVM), Random Forest (RF), XGBoost (XB), and CatBoost (CB) achieved AUROC values of 0.78, 0.84, 0.85, and 0.90, respectively, on the internal validation set. For the external testing set, SVM, RF, XB, and CB predicted ESWL with AUROC values of 0.68, 0.79, 0.80, and 0.83, respectively, with the last one being the optimal algorithm. The radiomics features and auto-encoder features made significant contributions to the decision-making process of the classification model. This investigation unmistakably underscores the remarkable predictive prowess exhibited by a scrupulously crafted AI model using CT images to precisely anticipate the therapeutic results of a singular session of extracorporeal shock wave lithotripsy for ureteral stones.

The reverse Trendelenburg position in proximal ureteral stone management: A systematic review and meta-analysis

IntroductionUreteroscopy lithotripsy (URSL) presents a therapeutic option for patients with proximal ureteral calculi warranting active removal. This systematic review and meta-analysis aimed to assess the efficacy of the reverse Trendelenburg (RT) position during this procedure. MaterialsA comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases to identify randomized controlled trials and observational studies comparing RT versus standard positioning (STD) in patients undergoing URSL for proximal ureteral stones. Heterogeneity was measured with the Cochran's Q test, I2 statistics, and prediction intervals (PI). A DerSimonian and Laird random-effects model was utilized for all outcomes. ResultsFour studies encompassing 505 patients undergoing URSL were analyzed. Among the studied participants, 293 (58%) underwent RT positioning. Overall, RT was associated with a lower average incidence of stone retropulsion (RR 0.42; 95% CI 0.27–0.65; I2=48%; PI 0.08–2.10) and a higher mean stone-free rate (RR 1.33; 95% CI 1.18–1.49; I2=0%). However, no significant difference between groups was found in the mean rate of overall complications (RR 0.76; 95% CI 0.40–1.43; I2=51%; PI 0.00–520.22) and operative time (MD –0.65; 95% CI –9.58–8.27; I2=94%; PI –111.95–110.65). In those with proximal ureteral stones undergoing RT positioning at only the 20° angle, there was a reduction in stone retropulsion without any measured heterogeneity (RR 0.35; 95% CI 0.23–0.52; I2=0%). ConclusionThese findings suggest that RT positioning is effective in improving outcomes for patients with proximal ureteral stones undergoing URSL, and its use should be considered during the procedure.

Exploring the economic landscape of ureteric stones: impact of age and gender on direct healthcare costs.

To assess whether age or gender affects ureteric stone management costs, in patients presenting to the Emergency Department (ED) with CT proven ureteric stones. A retrospective examination was conducted on patients admitted to the ED who were diagnosed with a ureteric stone through CT scans. Data encompassing clinical, laboratory, and imaging parameters were gathered, alongside information on admissions, ED readmissions, surgical procedures, and the overall treatment cost. Comparative analyses were performed on various cost rates in relation to different stone parameters, patient clinical presentations, laboratory results, and personal histories of urolithiasis. From January 2018 to January 2020, 805 patients underwent abdominal CT scans at a single institution's ED and were diagnosed with ureteric stones. Among them, 773 patients met the inclusion criteria, with 78% (609) being males and 22% (169) females. The mean ages for males and females were 49.4 (SD 14.4) and 51.6 (SD 15.7), respectively (p = 0.08). Treatment costs exhibited a direct relationship with age, amounting to 4,025, 5,116, 6,058, and 9,225 US dollars (USD) in the 18-30, 31-50, 51-70, and over 70 age groups, respectively. Female gender was associated with higher treatment costs, averaging 6,831 USD, compared to 5,450 USD in males (p = 0.03). However, there were no significant differences between genders in terms of the type of surgical procedure (p = 0.4) or hospital stay duration (p = 0.1). Age and gender exerted a significant impact on treatment costs, revealing that advanced age and female gender were both correlated with higher direct treatment costs in the care of ureteric stones.

A retrospective study on the management of ureteric stones following presentation to the emergency department in the University Hospitals Sussex Trust East from November 2020 to November 2021

Objective: To ascertain which patient demographic, clinical and stone-specific factors were significant when predicting intervention for ureteric stones and determine the proportion of patients with smaller, more distally located stones requiring intervention to establish whether follow-up imaging was indicated to confirm stone passage. Subjects/patients and methods: This is a retrospective review of 227 patients presenting with ureteric stones on non-contrast computerised tomography (NCCT) between November 2020 and November 2021. Eleven different clinical, demographic and imaging-related factors were recorded, and multivariate logistical regression was used to determine which factors were significant when predicting intervention. Results: A total of 53 patients (23.3%) underwent some form of intervention with only stone size ( p &lt; 0.001) and stone location ( p &lt; 0.001) significant in predicting treatment. Only 4.17% of patients with a ⩽ 4 mm distally located stone required intervention. These patients either had raised inflammatory markers or significant pain. Conclusion: Given that 95.83% of patients with ⩽ 4 mm distal ureteric calculi passed their stone spontaneously, a patient-initiated follow-up (PIFU) could be implemented to replace a follow-up NCCT. Based on this dataset, the application of PIFU could have prevented additional radiation exposure of 1.5–3 mSv/patient and excess financial cost of approximately £7000 to services. Level of Evidence: Level 3

Safety and efficacy of ureteroscopy for the treatment of large impacted proximal ureteralstones

Introduction and objective: Management of large impacted proximal ureteral stones is often challenging due to the presence of mucosal edema, inflammation and angulations of the ureter. Improvements in ureteroscopic technology increased the efficacy and safety of ureteroscopy (URS) as a first-line treatment in large impacted stones in the proximal ureter. The objective of this retrospective study is to evaluate the efficacy and safety of URS for the management of impacted proximal ureteral stones ≥ 10 mm. Material and methods: The medical records of 700 patients with ureteral stones, who underwent ureteroscopy and intracorporeal lithotripsy between January 2016 and Аpril 2024 were retrospectively reviewed. 179 patients had impacted stones ≥ 10 mm located in the proximal ureter – 125 (70%) were stones sized 10÷15 mm and 54 (30%) – stones ≥ 15 mm. URS was performed with 8.6 or 6.4Fr semirigid ureteroscope and Holmium laser. Flexible URS was performed in cases with tortuous ureter or stone retropulsion. Data on patients‘ preoperative characterstics, stone-free rates, operating times, intra- and postoperative complications were analyzed. Results: Patients’mean age was 54.1±12.3 years and mean stone size – 14.7±.4.8 mm. 30 % of the patients had previous unsuccessful shock- wave lithotripsy of the stone. Mean operative time was 45.1±15.7 min min and overall success rate – 85.3%. 66.2% of patients were treated with semirigid URS and 33.8% – with flexible URS. On subgroup analysis patients with stones 10÷15 mm and patients with stones ≥ 15 mm had similar preoperative characteristics. Success rate after a single procedure was higher and operating times significantly shorter in the subgroup of stones sized 10÷15 mm (87.1% vs 71.3%, p=0.159 and 41.3±12.9 vs 53.3±21.3 min, p=0.040,respectively). There were no statistically significant differences between the two subgroups in intraoperative stent JJ placement (34.1% vs 50.0%, p=0.400), stone retropulsion (21.3% vs 23.1%, p=0.847) and overall postoperative complications rate (9.3% vs 0%, p=0.161). Conclusion: The results of this study suggest that URS is a safe and effective treatment for management of patients with large impacted proximal ureteral stones. Larger stone size was a predictor of lower success rate after a single procedure.

Comparison of efficacy and safety of open and laparoscopic proximal ureterolithotomy for ureteral stone management: A systematic review and meta-analysis.

Despite advances in non-invasive and minimally invasive techniques, some proximal ureteral stones with impaction require open or laparoscopic surgery. No systematic reviews or meta-analyses have compared the efficacy and safety of open proximal ureterolithotomy and laparoscopic approaches. The aim of this study was to compare the efficacy and safety between open and laparoscopic proximal ureterolithotomy for ureteral stone management. Following the PRISMA guidelines, systematic searches were conducted in five databases (PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest) to identify articles comparing those two surgical approaches. Operative time, blood loss, pain score, hospital stay, recovery time, and complications were collected and compared. Heterogeneity-based meta-analysis with random-effects or fixed-effects models were conducted. Two randomized controlled trials and four observational cohort studies with 386 participants met the criteria. Open surgery had significantly less time than laparoscopic ureterolithotomy (mean difference (MD): 26.63 minutes, 95%CI: 14.32, 38.94; p<0.0001). Intraoperative blood loss (MD: -1.27 ml; 95%CI: -6.64, 4.09; p=0.64) and overall complications (OR: 0.68; 95%CI: 0.41, 1.15; p=0.16) were not significantly different between two approaches. Laparoscopic ureterolithotomy reduced visual analogue scale (VAS) pain scores (MD: -2.53; 95%CI: -3.47, -2.03; p<0.00001), hospital stays (MD: -2.40 days; 95%CI: -3.42 to -1.38 days; p=0.03), and recovery time (MD: -9.67 days; 95%CI: -10.81 to -8.53 days; p<0.00001). In conclusion, open proximal ureterolithotomy had less time, but laparoscopic surgery reduced postoperative pain, hospital stay, and recovery time. Both methods had comparable intraoperative bleeding and complications.

Comparing Ureteral Catheterization's Impact on Flank Pain Post Ureteroscopic Stone Management

Background: Urolithiasis, or kidney stone disease, is a prevalent condition that poses significant challenges in urological practice. The management of ureteral stones, particularly through ureteroscopy, is a common intervention. The use of short-term ureteral catheterization as a postoperative pain management strategy following ureteroscopic stone removal has been a subject of debate, with limited evidence on its efficacy and necessity. Objective: This study aimed to evaluate the effectiveness of short-term ureteral catheterization in reducing postoperative flank pain compared to non-catheterization in patients undergoing uncomplicated ureterolithotripsy for the management of distal ureteral stones. Methods: A prospective, randomized, controlled trial was conducted at Liaquat National Hospital, Karachi, from January to July 2013, involving 60 patients aged 15-70 years with distal ureteral stones less than 1.0 cm. Patients were randomized into two groups: Group A received short-term ureteral catheterization, and Group B did not. The primary outcome measured was the reduction in mean pain score by at least 4 points from the baseline at every 6-hour interval for the first 24 hours post-procedure. Statistical analysis was performed using SPSS version 25, applying chi-square tests, independent sample t-tests, and Mann-Whitney tests, with a p-value of less than 0.05 considered significant. Results: Both groups demonstrated a significant reduction in pain scores at 12, 18, and 24 hours post-operation. However, there was no significant difference in pain reduction between the catheterized (Group A) and non-catheterized (Group B) groups, with p-values of 0.55 for efficacy in pain reduction. The mean age, stone size, and postoperative hospital stay did not significantly differ between the groups, indicating that short-term ureteral catheterization did not offer additional benefits in managing postoperative pain or recovery. Conclusion: Short-term ureteral catheterization following uncomplicated ureterolithotripsy does not significantly improve pain management compared to non-catheterization. This suggests that routine catheterization may be unnecessary, potentially leading to a paradigm shift in postoperative care for patients undergoing ureteroscopic stone removal. Future studies with larger sample sizes and long-term follow-up are needed to further validate these findings.

A Comparison of Ureterorenoscopy and Extra-Corporeal Shock Wave Lithotripsy for the Treatment Of Upper Ureteric Stone Measuring Less than 1cm.

Objective: To compare the efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS) in the management of upper ureteric stone measuring &lt;1cm. Methodology: Randomized clinical trial (RCT) was conducted by targeting the patient admitted in urology ward, Jinnah Hospital Lahorethrough a period of one year. A sample size of 132 patients fulfilling inclusion criteria were selected by employing Non-probability consecutive sampling technique was employed to select 132 (sample size) patients fulfilling inclusion criteria. Patients were randomly allocated into two groups (66 in each group A&amp;B) using lottery method. In group-A, stones were treated using ESWL, while in group-B, URS was performed, and stones were broken with pneumatic energy. Data were analyzed using SPSS version 27, and a Chi-square test was conducted to compare the proportions of qualitative variables, while an independent sample t-test was applied to assess mean differences between two groups of quantitative variables. Asignificance level of ≤0.05 was adopted for determining statistical significance. Results: The sociodemographic profile of the two groups was comparable. It was seen that stone free rate nextto first session was higher in URS (81.8%) as compared to ESWL (63.6%) which later increased to 87.7% after completion of three session. The complaint of pain in ESWL was more as compared to URS (22.7% vs 12.1% p= 0.05)while the differences betweenthe rate of complications like fever, UTI, mucosal abrasion, hematuria or perforation were not statistically significant in both group. (p&gt; 0.05) Conclusion: ESWL outperforms URS for the treatment of upper ureteric stones measuring &lt;1cm in terms of efficacy and safety.Although not statistically significant, ourfindings suggest that URS achieves stone-free rates earlier than ESWL. However, according to our findings, ESWL is recommended as the treatment of choice for the majority of patients due to better compliance. Keywords: Extra-corporeal Shock Wave Lithotripsy, Nephrolithiasis, Ureterorenoscopy

Evaluation of safety and efficacy of different endoscopic modalities in management of large proximal ureteric stone: A prospective randomized study

Evaluation of safety and efficacy of different endoscopic modalities in management of large proximal ureteric stone: A prospective randomized study

Comparison of Outcomes of Extracorporeal Shockwave Lithotripsy with Ureteroscopic Lasertripsy for Management of Proximal Ureteral Stones.

To compare the outcomes of extracorporeal shockwave lithotripsy with ureterorenoscopy and lasertripsy for managing upper ureteral stones of size 10mm to 15mm. Observational, cross-sectional study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), from December 2020 to December 2021. A total of 168 patients with the diagnosis of proximal ureteric stone of size 1-1.5 cm were enrolled for this study. Patients were divided into two groups by simple random method. Group 1 patients underwent ureteroscopic lithotripsy (URS) and lasertripsy while Group 2 patients were subjected to extracorporeal shockwave lithotripsy (ESWL). Patients' demography, operative time, duration of hospitalisation, complication rate and stone-free rates, were recorded for both groups. Frequency and percentages were calculated for categorical variables and mean and standard deviation were calculated for continuous variables. For comparison of continuous variables, one-way ANOVA was applied, and Chi-square test was applied to compare the categorical variables. The p-value ≤0.05 was taken as significant. The mean age was of 39.55 ± 14.06 years, with the majority falling within the age group of 26 to 40 years. There were more males (116, 69%) than females (52, 31%). Most of the patients did not have a history of diabetes or hypertension. Sixty-two patients had previous history of stones. The average duration of ureteric stone disease was 3.18 ± 3.14 months. The mean size of the ureteric stone was 10.82 ± 3.19mm. The procedure duration was significantly shorter for URS, as compared to ESWL (33.81 ± 15.42 minutes vs. 45.00 ± 0.00 minutes, p=<0.01. The overall stone clearance rate was significantly higher after URS (83.3%) as compared to ESWL (64.2%, p=0.05). URS was a superior treatment option as compared to ESWL. However, the selection of the most appropriate procedure should be based on a tailored approach considering the patient's preference and the size of the stones. Extracorporeal shockwave lithotripsy (ESWL), Ureteroscopic lithotripsy (URS), Modified clavien classification system (MCCS), Ureteric stone.

Ureteric Laser Tripsy with and without Stone Cone

Stones may block the ureter causing pain and discomfort. Ureteric laser lithotripsy, a notable breakthrough in urology, has transformed the treatment of urinary tract stones. Objectives: To compare the efficacy of ureteroscopic laser lithotripsy with and without stone cone. Methods: This retrospective analysis was done at LRH Peshawar's urology department from 1st December 2022 to 31th October 2023. Over the time, 50 patients had ureteroscopic holmium laser lithotripsy. Our research comprised adults over 18 with proximal ureteric stones (&gt;10mm) and hydro ureters on CT KUB. Patients were split into two groups. Group A included 27 patients and employed a 7mm stone cone (Boston Scientific Corp, Natick, MA). No stone cone was utilized in group B (23). Results: This prospective research included 50 adults with radiologically confirmed uretric stones in diverse ureteric sites. Male 35 (70%) and female 15 (30%) were 21–68 years old (mean 38.6 years). Stones size varied from 6 to 20 mm, averaging 12.6mm. Proximal stones were 8–20mm (mean 13.9). Mid-ureter stones were 7–18mm (mean 12.6). Lower ureter stones ranged from 6 to 16mm, with a mean of 11.9mm. Ten (20%) patients have normal pelvicalyceal systems. Patients with moderate hydronephrosis were 27 (55%). Conclusions: The use of a stone cone during ureteroscopic lithotripsy is a safe and effective technique for the management of ureteric stones.