Medical Expulsive Therapy Research Articles

The Efficacy of Mirabegron as Medical Expulsive Therapy for Distal Ureteral Stones: A Systematic Review and Meta Analysis

The aim of this study was to determine how good mirabegron is as MET for adults with ureteral stones. The study adhered to the 2020 PRISMA guidelines for Systematic Reviews and Meta-Analyses throughout its duration. Four randomized controlled trial (RCT) studies were included in our analysis, encompassing a total of 369 participants. Our meta-analysis findings indicated that individuals who were administered mirabegron exhibited a statistically significant increase in SER [OR = 2.69, 95% CI 1.16-6.23, p = 0.02] and a reduction in the frequency of pain episodes [MD= -0.18, 95% CI -0.33-(-0.04), p = 0.01] in comparison to those receiving a placebo. However, there was no substantial impact of mirabegron on SET [MD= -3.47, 95% CI -8.65-1.72, p = 0.19] when contrasted with the placebo group. Mirabegron exhibited significantly increased SET levels and reduced pain episodes, although it did not have a significant impact on SER.

Tamsulosin vs. Tadalafil as medical expulsive therapy for distal ureteral stones: a systematic review and meta-analysis.

Medical expulsive therapy (MET) is recommended for distal ureteral stones from 5 to 10 mm. The best drug for MET is still uncertain. In this review, we aim to compare the effectiveness of tadalafil and tamsulosin for distal ureteral stones from 5 to 10 mm in terms of stone expulsion rate (SER), stone expulsion time (SET) and the side effect profile. A comprehensive literature search was conducted on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science, from inception until April 2023. Only randomized controlled trials were included in the analysis. Eleven publications with 1,330 patients were included. We observed that tadalafil has a higher SER (OR 0.55, CI 95% 0.38;0.80, p=0.02, I2=52%) and the same efficacy in SET (MD 1.07, CI 95% -0.25; 2.39, p=0.11, I2=84%). No differences were found when comparing side effects as headache, backache, dizziness, and orthostatic hypotension. Tadalafil has a higher stone expulsion rate than tamsulosin as a medical expulsive therapy for patients with distal stones from 5 to 10 mm without differences in side effects.

Development of a new scoring system predicting medical expulsive therapy success on 4-10mm distal ureteral stones: medical expulsive therapy stone score (METSS).

Ureteral stone passage by using medical expulsive therapy (MET) are affected by numerous radiological and clinical parameters. We aimed to construct a scoring system, which would be based on clinical and computed tomography (CT)-derived data, to predict the success of the MET approach. 186 patients presenting to urology clinic or emergency department with unilateral single 4-10mm distal ureteral stone and who had MET were included. All patients were divided into two groups as the MET-successful group and the MET-unsuccessful group. The success rate of MET was 67.2%. Stone size ≥ 6.5mm, stone density > 1078 HU, ureteral wall thickness (UWT) > 2.31mm, ureteral diameter (UD) > 9.24mm, presence of periureteral stranding (PUS) and presence of diabetes mellitus (DM) were stated as the independent risk factors. Based on the regression coefficients on multivariate logistic regression analysis, 1 point for stone size > 6.5mm, 2 points for stone density > 1078 HU, 2 points for UWT > 2.31mm, 3 points for UD > 9.24mm, 1 point for presence of PUS and 1 point for presence of DM were assigned to patients for each risk factor. Higher medical expulsive therapy stone score (METSS) indicated lower MET success. All patients were classified into three risk groups according to METSS: low risk (0-3 points; success percentage: 92.8%); intermediate risk (4-5 points; success percentage: 60.4%) and high risk (6-10 points; success percentage: 8.3%). The METSS seems to separate successfully the patients with a favorable or adverse constellation of factors.

Improved stone quality of life in patients with an obstructing ureteral stone on alpha-blocker medical expulsive therapy.

Though controversial, alpha blockers are used widely for ureteral stone passage. However, its effects on the patient-reported Quality of life (QOL) is unknown. We compared the QoL of patients on alpha-blocker medical expulsive therapy (MET) to patients not on MET (noMET) utilizing the validated Wisconsin Stone Quality of Life (WISQOL). This prospective study included patients prescribed either MET or noMET after presentation with symptomatic, obstructing ureteral stones. The treatment arm was decided at the point of care by the initial treating physician and included analgesia and antiemetics. Tamsulosin (0.4mg daily) was prescribed for the MET group. The WISQOL survey was administered at baseline, 7-, 14-, 21- and 28-days following discharge from the ED or until stone expulsion. 197 patients were enrolled, of which 116 (59.2%) completed questionnaires for analysis, 91 in the MET group and 25 in noMET. Average ureteral stone size was 4.7mm (SD 1.8) and 3.1mm (SD 1.0) for MET and noMET, respectively. Of completed surveys, 105 (90%) were completed at day 7, 67 (57.6%) at day 14, 53 (45.7%) at day 21, and 40 (34.5%) at day 28. MET was associated with improved QoL scores across all WISQOL domains compared to noMET. Stone size, age, race, sex, comorbidity score and a prior stone history were not associated with reduced QoL. The use of MET was associated with improved QOL on all WISQOL metrics compared to noMET patients. Improved stone QOL may be an indication of alpha-blocker therapy in patients with ureteral stone colic.

Standardization of the management of pediatric urolithiasis in the emergency department

The incidence of urolithiasis in the pediatric population is rising and medical expulsive therapy (MET) using alpha-adrenergic antagonists has been found to be effective in aiding in the passage of ureteral stones in children. A prior review of patients presenting to our quaternary children's hospital with urolithiasis found only 54% were prescribed MET and these patients had increased rates of spontaneous stone passage. Thus, an ED urolithiasis management protocol was created to standardize evaluation and care of children with suspected urolithiasis. To compare management of children with urolithiasis presenting to the ED before and after urolithiasis management protocol implementation. This is a retrospective review of patients with urolithiasis who presented to our children's ED from 2011 to 2022. The primary outcome was rate of MET prescribing before and after pathway implementation in July 2017, thus the pre-implementation group comprises patients who presented to the ED from July 2011 to July 2017, and the post-protocol group includes those who presented from August 2017 to April 2022. Secondary outcomes included CT utilization in the ED, surgical intervention rate, proportion with spontaneous stone passage, and frequency of urology consultation. Two-sample t-test and Fisher's exact test were used to compare the outcomes of interest before and after protocol implementation. Of 337 patients who presented to the ED after protocol implementation, 120 met inclusion criteria. When comparing outcomes before and after implementation of the protocol, there was significantly decreased use of CT scans (79% vs 50%, p<0.0001) and increased prescribing of MET (54% vs 82%, p<0.0001). There was a significant decrease in opioids prescribed (44% vs 26.7%, p=0.0040), and an increased rate of spontaneous stone passage (34% vs 46%, p=0.0483). Lastly, there was a significant reduction in the rate of surgery for stone management after the implementation of protocol (35% vs 17%, p=0.0020) DISCUSSION: As the ED is the primary site of presentation for many children with urolithiasis, standardization of evaluation and management provides an opportunity to improve outcomes in this population. We found that implementation of an ED urolithiasis management protocol was associated with decreased use of CT scans, decreased opioid prescribing, increased spontaneous stone passage, and decreased rate of surgical management for children with ureteral stones. This study demonstrates the positive impact of standardizing care for children presenting to the ED with urolithiasis.

A Comparison Between Silodosin and Tamsulosin for Medical Expulsive Therapy of Distal Ureteric Calculus.

Medical expulsive therapy (MET) is an established treatment option for distal ureteric stones. Tamsulosin, a selective alpha-1 blocker, has been used for MET with good results, while silodosin, a more selective alpha-1a blocker, is more effective than tamsulosin for MET. Thus, this study aimed to compare the efficacy of silodosin with tamsulosin. This prospective randomized study was conducted at the Department of Urology, Government Chengalpattu Medical College Hospital, Tamil Nadu, India. Eighty patients who presented with ureteric colic and were radiologically diagnosed with distal ureteric calculus of size <10mm were included. Participants in the silodosin group received tablet silodosin 8mg OD until the passage of the stone, not more than two weeks, and analgesics as per demand. And participants in the tamsulosin group received tablet tamsulosin 0.4mg OD until the passage of the stone, not more than two weeks, and analgesics as per demand. A total of 80 patients were included in the study. Forty patients in the silodosin group and forty patients in the tamsulosin group were included. In the silodosin group, out of 40 patients, 38 expelled the calculus. In the tamsulosin group, out of 40 patients, 28 expelled the calculus. The silodosin group had a significantly higher rate of expulsion, with a p-value of 0.003. Stone expulsion time was shorter in the silodosin group when compared with the tamsulosin group (10.15 vs. 13.4 days). Analgesic usage during medical expulsive therapy was lower in the silodosin group (5.68 vs. 8.4). We observed significant differences in comparing the outcome, stone expulsion time, and analgesic requirement between the silodosin and tamsulosin groups. We observed no significant difference between the groups for age-wise and gender-wise comparisons. Furthermore, non-expulsion of calculus in four patients and pain in eight patients were the reasons for intervention in the tamsulosin group. The reason for intervention in the silodosin group was the non-expulsion of calculus in two patients. Using silodosin for MET of distal ureteric calculus, we found to have a better stone expulsion rate, early expulsion time, and reduced analgesic requirement.

JU Open Plus: More AUA 2023 Annual Meeting Behind the Scenes

JU Open Plus: More AUA 2023 Annual Meeting Behind the Scenes

Efficacy of Silodosin versus Sildosin plus Tadalafil as medical expulsive therapy for lower ureteric stones: A prospective randomized placebo controlled study

Efficacy of Silodosin versus Sildosin plus Tadalafil as medical expulsive therapy for lower ureteric stones: A prospective randomized placebo controlled study

Alpha Blocker Medical Expulsive Therapy for Ureteral Stones—Usage of Health Care Resources

Abstract Objective: To study the effects of alpha blocker prescription for ureteral stones on health care resources. Methods: In this retrospective study, patients with a new ureteral stone diagnosis were selected from a commercial claims database between 2011 and 2016. We examined data from patients who were and were not prescribed an alpha blocker for ureteral stone diagnosis. Comparative analyses were performed between these groups at 30 and 90 days postdiagnosis. We evaluated the need for surgical intervention, repeat imaging, emergency department (ED) visits, adverse events, and total medical claims cost. Results: Of 70,599 patients with ureteral stones, alpha blockers were prescribed to 51.1% for a median duration of ten days. At 30 and 90 days after index diagnosis, alpha blocker treated patients were more likely to undergo surgical intervention (P &lt; .01, 1.06 HR), have additional imaging studies (P &lt; .01, 1.37 HR), and visit the emergency department (P &lt; .01, 1.19 HR). Total medical costs at 30 and 90 days were increased by 11.3% and 10.1%, respectively, for patients treated with an alpha blocker (P &lt; .01). Conclusions: Patients who were prescribed an alpha blocker for a diagnosis of ureteral stone had increased surgical interventions, subsequent ED visits, additional imaging studies, and overall total cost to the health care system compared with patients not on alpha blockers. In addition to uncertain and disputed efficacy, the negative impact on health care resources should also be considered in the decision for the use of alpha blockers for ureteral stones.

Medical Therapy to Facilitate Urinary Stone Passage

Background: Urinary stones are now a worldwide problem due to a rise in occurrence over the past few decades. All racial and cultural groups have experienced this. Complex metabolic and environmental risk factors are both involved in the pathogenetic pathways of stone production. This disease affects roughly 12% of the world's population. Its recurrence rate is about 70% in men and 47% in women. Urinary stones have significantly increased in prevalence over the past 20 years, becoming a global disease. Aim: This review covers literature on the medical therapy of urolithiasis to facilitate urinary stone passage and their mechanism of action in the light of the new data on the diagnosis and different types of urinary tract stones. Method: A preliminary search of related articles was obtained from three online databases PubMed, Sci.hub and Google scholar whichwere used to conduct a systematic evaluation of the literature. Inclusion and exclusion criteria screened the initial search results, and 67 papers were chosen to be appropriate for this literature review following careful reading, analysis, and evaluation. Results: Different methods of medical therapy (phosphodiesterase-5 inhibitors, alpha blockers, calcium blockers, non-steroidal anti-inflammatory drugs and different types of surgical procedures (extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy,ureteroscopy)were thoroughly reviewed but among all of them the expulsion rate to remove the urinary stone was found to be larger and faster in calcium channel blocker (CI 1.33-1.66) and alpha blockers(CI 1.152–7.45). Practical implications: Medical therapies facilitate the urinary-stone passagebut these therapies are not generally used. The choices for treating urinary stones are expanded by these techniques. Patients with big ureteral stones have had better results with medical expulsive therapy.Removing the urinary stones also decreases the chances of other diseases which happened as a result of urinary stone. There are many benefits of medical expulsive therapy which are diverse in nature andthis therapy minimizes the exposure to anesthesia and radiations. Conclusion: Different surgical procedures are used to remove the stones from the urinary passage. Despite of surgical procedures, medical expulsive therapy are more helpful. Alpha-blockers and calcium channel blockers are the main medical expulsive therapies for primary evacuation of urinary tract stones. Keywords: Urolithiasis, Urinary tract stones, Medical expulsive treatment.

MP70-17 IMPLEMENTATION OF AN ED NEPHROLITHIASIS PROTOCOL INCREASES USE OF MEDICAL EXPULSIVE THERAPY IN THE PEDIATRIC POPULATION

You have accessJournal of UrologyCME1 Apr 2023MP70-17 IMPLEMENTATION OF AN ED NEPHROLITHIASIS PROTOCOL INCREASES USE OF MEDICAL EXPULSIVE THERAPY IN THE PEDIATRIC POPULATION Daniel Salevitz, Chung-Yon Lin, Bernice Alcanzo, Abhijeet Namjoshi, Philip Lee, Cecilia Monteilh, and Gwen Grimsby Daniel SalevitzDaniel Salevitz More articles by this author , Chung-Yon LinChung-Yon Lin More articles by this author , Bernice AlcanzoBernice Alcanzo More articles by this author , Abhijeet NamjoshiAbhijeet Namjoshi More articles by this author , Philip LeePhilip Lee More articles by this author , Cecilia MonteilhCecilia Monteilh More articles by this author , and Gwen GrimsbyGwen Grimsby More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A review of children presenting to our emergency department (ED) from 2011 to 2017 found that ureteral stone passage was significantly higher for those prescribed medical expulsive therapy (MET), versus analgesics alone (45% vs 20%, p<0.0001). Urology consultation was also associated with increased MET use (p<0.0001). As a result, a new nephrolithiasis management protocol was implemented at our ED in August 2017 with the goal of increasing MET usage, decreasing use of CT scans, and increasing outpatient referrals to Urology and Nephrology. METHODS: This is a retrospective study of children aged 2 months to 18 years old who presented to a quaternary children’s hospital ED with an ICD-9 or ICD-10 diagnosis of urolithiasis from August 2017 to April 2022. Basic demographics, MET prescribing, use of CT for stone diagnosis, opioid prescription rate, and referral to Urology and Nephrology were compared before and after implementation of the ED nephrolithiasis protocol. Statistical analysis was performed using two sample t-test analysis and Fisher’s exact test. RESULTS: A total of 124 patients met inclusion criteria. Mean age was 14 years (SD 3.64), 47 (38%) male. Comparing pre and post-protocol implementation, there was no difference in mean age, gender, or stone size between groups (Table 1). Post-protocol, 99 patients (80%) were prescribed MET, which was significantly higher compared with 54% prior to the protocol (p<0.0001). Patients prescribed MET were older (mean 16 vs 15, p=0.014), and a higher proportion were discharged from the ED (71% vs 48%, p=0.033). Post protocol significantly less patients were prescribed opioids (27% vs 44%, p=0.0069). There was no difference in use of CT scans (79% vs 70%, p=0.1169), return to the ED (14% vs 14%, p=0.8681), outpatient urology (89% vs 89%, p=1.0) or nephrology referrals (23% vs 22%, p=1.0) pre and post protocol implementation, Table 1. CONCLUSIONS: After implementation of an ED nephrolithiasis protocol, use of MET for ureteral stones increased and prescription of opioids decreased. There was no difference in use of CT scans or outpatient referral to Urology and Nephrology pre versus post-protocol. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1010 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Salevitz More articles by this author Chung-Yon Lin More articles by this author Bernice Alcanzo More articles by this author Abhijeet Namjoshi More articles by this author Philip Lee More articles by this author Cecilia Monteilh More articles by this author Gwen Grimsby More articles by this author Expand All Advertisement PDF downloadLoading ...

Re: Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol 2023;39:21-6.

Re: Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis. Indian J Urol 2023;39:21-6.

Can Silodosin Be Considered a Superior Substitute for Tamsulosin in Medical Expulsion Therapy for Patients with Lower Ureteral Calculi

Introduction: Urinary stones, also known as calculi, are a common urological problem affecting millions of people worldwide. Medical expulsion therapy (MET) is a commonly used treatment for lower ureteral calculi. Objectives: The main objective of the study is to find the role of silodosin as a superior substitute for tamsulosin in medical expulsion therapy for patients with lower ureteral calculi. Material and methods: The study design for this research article would be a randomized controlled trial comparing the efficacy and safety of silodosin and tamsulosin in medical expulsion therapy (MET) for patients with lower ureteral calculi. Patients with lower ureteral calculi who meet the inclusion criteria will be recruited for the study. Inclusion criteria may include age over 18 years, presence of lower ureteral calculus confirmed by imaging, and willingness to participate in the study. Exclusion criteria may include previous history of ureteral surgery, contraindication to alpha-blockers, and pregnancy. Results: A total of 100 participants were randomized to receive either silodosin (n=50) or tamsulosin (n=50) for medical expulsion therapy of lower ureteral calculi. The mean age of the participants was 45 years, and 60% were male. The stone expulsion rate at 4 weeks was 80% in the silodosin group and 75% in the tamsulosin group. There was no statistically significant difference between the two groups (p=0.54). Conclusion: In conclusion, the results of this study indicate that silodosin may not be a superior substitute for tamsulosin in medical expulsion therapy for patients with lower ureteral calculi. Both drugs demonstrated similar rates of stone expulsion and time to stone passage, as well as comparable safety profiles and patient satisfaction rates. Keywords: Silodosin, Tamsulosin, Lower Ureteral Calculi

Distal üreter taşı olan hastalarda taş düşürmede medikal ekspulsif tedavi olarak tamsulosinin silodosine karşı etkinliği: Geriye dönük tek merkezli bir çalışma

Objective: This study aimed to compare the efficacy of tamsulosin and silodosin as medical expulsive therapy in patients with symptomatic uncomplicated distal ureteric stones. Material and Methods: The data of adult patients who had distal ureteric stones in size between 4 and 10 mm and were treated with medical expulsive therapy between June 2019 and January 2022 were retrospectively documented. Patients were divided into two groups. Patients in Group 1 received silodosin 4 mg, and Group 2 received tamsulosin 0.4 mg. Therapy was given for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, stone burden, and stone size were recorded. The efficacy of tamsulosin and silodosin as adjunctive medical therapy was determined. Results: A total of 152 patients were included in the study. Demographic profiles were comparable between the 2 groups. 116 (76.3%) patients were stone-free at the end of the follow-up. The stone expulsion rate was calculated in 47 patients (73.4%) in Group 1, and 69 patients (78.4%) in Group 2 (P = 0.477). The distance of the stone to the ureterovesical junction was significantly associated with successful stone expulsion in multivariate analysis (P=0.032). Conclusion: There was no significant superiority between tamsulosin and silodosin as medical expulsive therapy for distal ureteral stones. The distance of the stone to the ureterovesical junction was the only independent predictor of stone expulsion in multivariate analysis. Keywords: Medical expulsive therapy,

Comparative study between Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for lower ureteral stones.

To compare the efficacy of Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for treatment of distal ureteral calculi. Over a period of 6 months (January 2022 to June 2022) this prospective randomized study was conducted on 170 patients with distal ureteric stone ≤ 10 mm. Patients were randomly divided into three groups. Patients in group A received Tamsulosin 0.4mg, in group B received Silodosin, and in group C receive Tadalafil 5 mg. Therapy was given for a maximum of 4 weeks. The rate and time of stone expulsion, the analgesic use, attacks of colic and hospital visits for pain, and adverse effects of drugs were recorded. Among 170 patients who were enrolled in study, 20 were lost to follow-up (7, 8, 5 in group A, B, And C respective-ly). There was a significant higher stone passage rate in group C than group A and B (90% vs. 70% and 76% respectively; p-value = 0.043) and shorter expulsion time in group C (8.7 ± 3.3 days) vs. group A (12.5 ± 5.2 days) and group B (11.3 ± 4.2 days) with (p-value = 0.001)(highly statistically significant with p-value < 0.001) and increased amount of analgesics required in group A (225 ± 115.7 mg) and group B (163 ± 77.5 mg) when compared with group C (120 ± 55.3 mg). Tadalafil is more effective than Tamsulosin and Silodosin in treatment of patients with distal ureteric stones ≤ 10 mm as regard stone expulsion rate, expulsion time with decreased number of colicky episodes and side effects.

Pediatric Nephrolithiasis

The prevalence of pediatric nephrolithiasis has increased dramatically in the past two decades for reasons that have yet to be fully elucidated. Workup of pediatric kidney stones should include metabolic assessment to identify and address any risk factors predisposing patients to recurrent stone formation, and treatment should aim to facilitate stone clearance while minimizing complications, radiation and anesthetic exposure, and other risks. Treatment methods include observation and supportive therapy, medical expulsive therapy, and surgical intervention, with choice of treatment method determined by clinicians' assessments of stone size, location, anatomic factors, comorbidities, other risk factors, and preferences and goals of patients and their families. Much of the current research into nephrolithiasis is restricted to adult populations, and more data are needed to better understand many aspects of the epidemiology and treatment of pediatric kidney stones.

Medical Expulsive Therapy for Pediatric Ureteral Stones: A Meta-Analysis of Randomized Clinical Trials

To evaluate the efficacy and safety of medical expulsive therapy (MET) for ureteral stones in pediatric patients, Cochrane, PubMed, Web of Science, Scopus, and the reference list of retrieved studies were searched up to September 2022 to identify RCTs on the efficacy of MET. The protocol was prospectively registered at PROSPERO (CRD42022339093). Articles were reviewed, data were extracted by two reviewers, and the differences were resolved by the third reviewer. The risk of bias was assessed using the RoB2. The outcomes, including the stone expulsion rate (SER), stone expulsion time (SET), episode of pain, analgesic consumption, and adverse effects, were evaluated. Six RCTs enrolling 415 patients were included in the meta-analysis. The duration of MET ranged from 19 to 28 days. The investigated medications included tamsulosin, silodosin, and doxazosin. The stone-free rate after 4 weeks in the MET group was 1.42 times that of the control group (RR: 1.42; 95% CI: 1.26-1.61, p < 0.001). The stone expulsion time also decreased by an average of 5.18 days (95% CI: -8.46/-1.89, p = 0.002). Adverse effects were more commonly observed in the MET group (RR: 2.18; 95% CI: 1.28-3.69, p = 0.004). The subgroup analysis evaluating the influence of the type of medication, the stone size, and the age of patients failed to reveal any impact of the aforementioned factors on the stone expulsion rate or stone expulsion time. Alpha-blockers as medical expulsive therapy among pediatric patients are efficient and safe. They increase the stone expulsion rate and decrease the stone expulsion time; however, this included a higher rate of adverse effects, which include headache, dizziness, or nasal congestion.

Decision regret analysis of patients opting for early ureteroscopy versus trial of medical expulsive therapy after shared decision making for management of ureteric calculi ≤ 10mm: Interim results from the DRAUMET study

Decision regret analysis of patients opting for early ureteroscopy versus trial of medical expulsive therapy after shared decision making for management of ureteric calculi ≤ 10mm: Interim results from the DRAUMET study

A 4 mm vesicoureteric junction stone causing rupture of pelvicoureteric junction - case report.

We discuss the case of a 67-year-old man who presented with a right-sided abdominal pain and on subsequent radiological imaging(s) in the form of an enhanced computed tomography scan of the abdomen and pelvis followed by a delayed excretory phase (computed tomography urogram), found to have a distal 4 mm vesicoureteric junction stone which had caused a pelvicoureteric junction rupture which was evident on extravasation of contrast. This warranted an urgent surgical intervention in the form of ureteric stent insertion. This case clearly depicts that with even a small stone associated with severe flank pain, rupture or pelvicoureteric junction/calyces should be suspected and we should never overlook symptoms and push for medical expulsive therapy in patients who do not appear to be septic or obstructed. This work has been reported in line with the Surgical CAse REport (SCARE) criteria.

Paediatric Ureteroscopy (P-URS) reporting checklist: a new tool to aid studies report the essential items on paediatric ureteroscopy for stone disease

The burden of urolithiasis in children is increasing and this is mirrored by the number of surgical interventions in the form of ureteroscopy (URS). There exist many challenges in performing this surgery for this special patient group as well as a lack of consensus on technique. There is also large variation in how results are described and reported. There exists therefore, a need to improve and standardise the core outcomes, which are reported. To this end, we developed a new checklist to aid studies report the essential items on paediatric URS for stone disease. The Paediatric Ureteroscopy (P-URS) reporting checklist comprises four main sections (study details, pre-operative, operative and post-operative) and a total of 20 items. The tool covers a range of important elements, such as pre-stenting, complications, follow-up, stone-free rate, concomitant medical expulsive therapy and imaging, which are often lacking in studies. The checklist provides a summary of essential items that authors can use as a reference to improve general standards of reporting paediatric URS studies and increase the body of knowledge shared accordingly.