Medical Expulsive Treatment Research Articles

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.

Effect of alpha-adrenoceptor antagonists on sexual function. A systematic review and meta-analysis.

Alpha-adrenoreceptor antagonists or alpha-blockers are used in the treatment of hypertension, in the therapy of benign prostatic hyperplasia and in medical expulsive treatment of ureteral stones. These agents may affect the sexual function, with differences between drugs within the same class, depending on their selectivity for receptor subtypes. The aim of this review was to analyze the effects of alpha-blockers on sexual function. We conducted a systematic review and meta-analysis by searching PubMed, EMBASE and other databases for randomized controlled trials (RCTs) reporting sexual adverse effects in patients treated with alpha-blockers. Odds ratios for sexual dysfunction were calculated using random effects Mantel-Haenszel statistics. Out of 608 records retrieved, 75 eligible RCTs were included in the meta-analysis. Compared with placebo, alphablockers were associated with increased odds of ejaculatory disorders both in patients with lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia (BPH) (OR: 7.53, 95% CI: 3.77-15.02, Z = 5.73, p < 0.00001, I2 = 55%) and in patients with ureteral stones (OR: 2.88, 95% CI: 1.50-5.44, Z = 3.19, p < 0.001, I2 = 31%). Uroselective alpha-blockers showed higher odds of ejaculatory disorders. Conversely, nonselective alpha-blockers were not associated with higher odds of ejaculatory dysfunction. Silodosin was associated with increased odds of ejaculatory dysfunction compared with tamsulosin (OR: 3.52, 95% CI: 2.18-5.68, 15 series, 1512 participants, Z = 5.15, p < 0.00001, I2 = 0%). Naftopidil and alfuzosin showed lower odds of ejaculatory dysfunction compared to uroselective alpha-blockers.No statistically significant differences in the odds of erectile dysfunction were observed when alpha-blockers were compared to placebo.

Assessment of Ureteric Stone Composition Along with Medical Expulsive Treatment of Distal Unilateral Ureterolithiasis in Emergency Department

Background: Ureterolithiasis is among the foremost painful and prevalent among urologic disorders which will substantially impact health-related quality of life. The objective of this study is to provide a brief description regarding ureteric stone composition and treatment of ureterolithiasis. Method: The method of this study was chosen to be cross sectional prospective. The study was carried out in department of urology of Sialkot Medical Complex and Amina Hospital Sialkot cant. Sample size for this study was taken as 200 patients. Well-structured data collection form was prepared, analyzed and then filled by interviewing the patients. Result: The highest occurring stone type was calcium oxalate dihydrate stone (39.5%) and calcium oxalate monohydrate stone (33%). Tamsulosin (96%) was highest recommended for calculus expulsion therapy along with citro soda (90%), diclofenac sodium (76%) and omeprazole (62.5%).

Fragility index of urological literature regarding medical expulsive treatment.

The role of medical expulsive treatment (MET) is controversial. Fragility index is an additional metric to assess randomized controlled trials (RCTs) outcome validity and indicates how many patients would be required to convert a trial from being statistically significant, to not significant. The larger is the FI, the better the trial's data. The aim of this study is to assess FI of RCTs regarding MET for ureteral stones. A systematic literature search was performed. RCTs, reporting stone expulsion as a dichotomous outcome, showing statistical significance were eligible. FI (the number of patients needed to change from a non-event to event group, to lose statistical significance) and Fragility quotient (FI divided by total sample size), were calculated while Pearson's correlation and Mann-Whitney U test were used as appropriate. Thirty-six RCTs were eligible, with median FI = 3.5 and fragility quotient = 0.042, median sample size = 81, median journal impact factor = 1.73 and median reported p value = 0.008. In 33.3% of the studies, number of patients lost during follow-up was larger than FI, while in 13.89% of the studies, FI was 0, indicating use of inappropriate statistical method. Pearson's correlation showed significant positive association between FI and sample size (r = 0.981), number of events (r = 0.982) and impact factor (r = 0.731), while no association was found with p value or publication year. In this analysis, a calculated FI of 3.5 indicates that findings from RCTs on MET for ureteral stones are fragile and should be interpreted in combination with clinical thinking and expertise.

Does silodosin offer better results than tamsulosin as medical expulsive treatment after shock wave lithotripsy for single distal ureteric stones?

IntroductionDifferent antagonists of αadrenergic receptors (α-blockers) have been used as medical expulsive treatment (MET) after extracorporeal shock wave lithotripsy (ESWL).AimTo retrospectively evaluate the expulsion rate of fragments after extracorporeal shock wave lithotripsy performed for single ureteral stones followed by different medical expulsive treatments.Material and methodsWe retrospectively analyzed stone expulsion rates of 190 patients treated by shock wave lithotripsy (SWL) for single, 5 to 10 mm, symptomatic and uncomplicated distal ureteric stones, treated with tamsulosin 0.4 mg, silodosin 8 mg or silodosin 4 mg as MET. Beside the stone-free rate after 4 weeks of treatment, we also investigated the pain intensity using the visual analogue scale (VAS), adverse events induced by the medication, safety of drug administration and the reasons for possible early treatment discontinuation.ResultsSilodosin 8 mg and tamsulosin 0.4 mg have similar results in terms of stone-free rate. For silodosin 4 mg the stone-free rate was significantly lower than for the previous two drugs. In patients treated with silodosin 4 mg the VAS was significantly higher than in patients treated with silodosin 8 mg or tamsulosin 0.4 mg, for all the follow-up visits.ConclusionsAlpha-blocker treatment after ESWL with silodosin 8 mg offers a similar stone-free rate compared with tamsulosin 0.4 mg, being well tolerated. A lower dose of silodosin (4 mg) has significantly poor results, irrespective of ureteric stone size, with more frequent renal colic and severe pain.

The evaluation of the effectiveness of Gilaburu (Viburnum opulus L.) extract in the medical expulsive treatment of distal ureteral stones.

Medical expulsive therapy is an important non-invasive treatment modality that facilitates the passage of ureteral stones. The aim of the present study was to evaluate the efficacy of Gilaburu (Viburnum opulus) extract in the treatment of distal ureteral stones <10 mm. Data of 103 patients were retrospectively analyzed. Patients were divided into two groups: those given V. opulus 1000 mg peroral 3×2 and diclofenac 50 mg peroral on-demand (n=53) and those given only diclofenac sodium 50 mg peroral on-demand (n=50). Comparisons of stone expulsion rates and the elapsed time until the expulsion between the groups were determined as primary outcome measures. The comparison of the need for additional treatment [ureteroscopy (URS) or extracorporeal shock wave lithotripsy (ESWL)], the need for emergency admission, analgesic requirement, and the complication rates in additional treatment were determined as secondary outcome measures. The mean age of the patients was 45.8±14.5 years. The rate of stone expulsion was significantly higher (82% vs. 66%, p=0.026), and elapsed time to stone expulsion was significantly shorter (9±1.8 vs. 14±2.3 day, p=0.018) in the V. opulus group. The need for additional treatment (URS and ESWL) and analgesic requirement was less in the V. opulus group (9.4% vs. 20%, p=0.038 and 24.5% vs. 44%, p=0.042, respectively). V. opulus is an herbal treatment alternative that facilitates the passage of ureteral stones <10 mm. Prospective, randomized studies are needed to support these results.

Mirabegron: A Novel and Promising Medical Expulsive Treatment for Ureteral Stones?

Medical expulsive therapy (MET) is used especially in distal ureteral stones to reduce colics and decrease the number of endourological surgical interventions. A broad spectrum of agents can be used for the relaxation and the dilatation of the ureter, reducing the intraureteric pressure. Alfa-blockers, calcium channel blockers, phosphodiesterase (PDE) inhibitors, and spasmolytics have been shown as effective in clinical trials on urolithiasis. It is a fact that the urothelium itself, the interstitial cells and the ureteric smooth muscle, have B-beta-2 and beta-3 adrenoreceptors. Stimulation of these receptors results in relaxation of the ureter. A recent beta-3 agonist, mirabegron, is commonly used for overactive bladder nowadays. The mechanism of action is adrenergic agonism that affects with the storage phase of the bladder, without interfering the voiding phase, which is regulated by parasympathetic pathways, commonly muscarinic. Agonism of the beta-3 receptors in the ureter has been shown to decrease the intraluminal pressure. By this mechanism, mirabegron can be thought as an alternative MET agent. Acting through different pathways, and having low adverse effect profile, can be thought as the most striking advantages of mirabegron as a MET. In vitro and in vivo trials should be conducted to support this hypothesis.

Efficacy of mirabegron in medical expulsive therapy.

To show the efficacy of mirabegron for medical expulsive treatment, in patients had intramural located distal ureteral stone. A 80 patients had intramural ureteral stone were assessed retrospectively between April 2017 and January 2018. Mirabegron 50mg/day + diclofenac 100mg/day (group 1, n = 40), and only diclofenac 100mg/day (group 2, n = 40) were administered to patients, consecutively. Age, gender, stone size, laterality, and severity of hydronephrosis were recorded. Spontaneous stone expulsion rates (SER), stone expulsion time, and the number of daily colic episodes were evaluated. In the group 1, one (2.5%) patient was excluded due to nasopharyngitis, and one (2.5%) patient was excluded due to 5mmHg systolic blood pressure increase. In addition, four (10%) patients in group 1, and six (15%) patients in group 2, who did not attend follow-up examinations, were excluded from the study. There was not any statistically significant difference between the two groups in terms of age, gender, stone location, severity of hydronephrosis, stone size (p = 0.736, p = 0.310, p = 0.467, p = 0.801, p = 0.761, consecutively). Spontaneous expulsion ratios were calculated as 73.52% in group 1, and 47.05% in group 2 (p = 0.026). However, there was not any statistically significant difference in terms of stone expulsion time (p = 0.979). SER for patients had ≤ 6mm stones was higher in group 1 (87.5 vs 52.49%, p = 0.031). In addition, group 2 patients had more pain episodes (1.02 ± 0.52 vs. 1.29 ± 0.57, p = 0.049). In the current study, mirabegron has been shown to be an efficient, safe and a new treatment modality, with lower side effect profile for the intramural located distal ureteral stones.

Predictor Role of Pretreatment Resistive and Pulsatile Indexes in the Success of Medical Expulsive Therapy of Ureteral Stones

To investigate the role of renal resistive index (RI) and pulsatile index levels measured with renal Doppler ultrasonography in predicting the success of medical expulsive treatment in patients with ureteral stones. Patients admitted to our clinic between January and December 2017 with a ureteral stone of less than 1 cm in diameter were evaluated in terms of their RI and pulsatile index values obtained using Doppler ultrasonography, and the localization and diameter of their stone and grade of hydronephrosis using computed tomography at the time of admission. After 4 weeks of medical expulsive treatment with tamsulosin, spontaneous stone passage was assessed to investigate the relationship between the data obtained before treatment and the success of medical expulsive treatment. Forty-eight of 71 patients passed the stone spontaneously after treatment (67.6%). Among the related variables, the largest diameter of stone and ipsilateral RI levels were independently associated with the success of medical expulsive treatment (P <.001). In the receiver operating characteristic curve analysis, a RI value of less than 0.72 was associated with spontaneous stone expulsion with a sensitivity of 89.6%, a specificity of 69.6%, and a positive predictive value of 97%. It is possible to predict the success of medical expulsive treatment using RI levels. We anticipate that in patients who are not likely to pass the stones spontaneously with medical treatment, surgery should not be postponed to avoid irreversible kidney damage.

The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis.

ABSTRACTIntroduction:Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion.Objective:This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis.Evidence Acquisition:An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus.Evidence Synthesis:Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3).Conclusion:Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain.Patient Summary:This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.

963 Impacted ureteral stones: Radiological and perioperative findings and the efficiency of preoperative medical expulsive treatment

963 Impacted ureteral stones: Radiological and perioperative findings and the efficiency of preoperative medical expulsive treatment

Medical expulsive treatment in pediatric urolithiasis.

The frequency of stone disease in childhood ranges between 0.1-5 percent. Stone disease occurs as a result of enviromental, metabolic, anatomical, infectious and nutritional factors. Percutaneous nephrolitotomy, uretherorenoscopy, laparoscopic surgery, open surgery and extracorporeal shock wave lithothripsy are treatment alternatives for stone disease during childhood. However, these methods are not completely innocent. Some complications may occur after these procedures. These procedures are generally not cost- effective. Even invasive procedures have high success rates, so medical expulsive treatment modalities have become an alternative for a group of patients. Nonsteroidal anti- inflammatory drugs, antimuscarinic drugs, phospodiesterase type 5 inhibitors, steroids, calcium channel blockers and alpha blockers are treatment alterneatives used for this modality in the literature. The drug is chosen according to the location, size, and composition of the stone, recent technology, cost, surgeon's experience and surgeon's and the parents' preferences. In this review article the following topics will be discussed such as "Why medical expulsive treatment is needed during childhood? Which drug should be chosen for which stone type? How long should a treatment of urolithiasis last?

Usefulness of hounsfield unit and density in the assessment and treatment of urinary stones.

Computed tomography (CT) is widely used to examine stones in the urinary system. In addition to the size and location of the stone and the overall health of the kidney, CT can also assess the density of the stone in Hounsfield units (HU). The HU, or Hounsfield density, measured by CT, is related to the density of the tissue or stone. A number of studies have assessed the use of HU in urology. HUs have been used to predict the type and opacity of stones during diagnosis, and the efficacy has been assessed using methods including extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopic ureterolithotripsy (URSL), and medical expulsive treatment (MET). Previous studies have focused on the success rate of HU for predicting the type of stone and of ESWL treatment. Understanding the composition of the stone plays a key role in determining the most appropriate treatment modality. The most recent reports have suggested that the HU value and its variants facilitate prediction of stone composition. However, the inclusion of data regarding urine, such as pH and presence of crystals, increases the predictive accuracy. HUs, which now form part of the clinical guidelines, allow us to predict the success of ESWL; therefore, they should be taken into account when ESWL is considered as a treatment option. However, there are currently insufficient data available regarding the value of HU for assessing the efficacy of PCNL, URSL, and MET. Studies performed to date suggest that these values would make a significant contribution to the diagnosis and treatment of urinary system stones. However, more data are required to assess this further.

Efficacy of Medical Expulsive Treatment With Doxazosin in Pediatric Patients

To evaluate the possible efficacy of an α1 blocker (doxazosin) therapy on the management and disease course in pediatric patients with distal ureteral stones. A total of 45 patients (24 boys and 21 girls) with a single lower ureteral stone were included in the study program. Their age range was 3-15 years (mean 6.65 ± 3.78). The children were randomized into 2 main groups: group 1 (n= 21), who received only ibuprofen 20 mg/kg/d divided into 2 equal doses for pain control during follow-up; and group 2 (n= 24), who received, in addition to ibuprofen, 0.03 mg/kg/d doxazosin once daily, before bed. The stone expulsion rate was 28.5% (6 of 21) in group 1 and 70.8% (17 of 24) in group 2 (P=.001). The number of daily colic attacks and stone expulsion time clearly demonstrated the advantage of doxazosin, with a statistically significant diminished number of pain attacks (P=.04) and shorter stone expulsion period (P= .001). Stones<5mm were expulsed at greater rates than stones 5-10mm in group 2 (P= .046). Also children aged<6 years passed the stones with significantly greater rates than children aged≥7 years (P= .008). The use of α-adrenergic blocker agents could have certain advantages in attempts to render children stone free within a shorter period, which would inevitably diminish the number of colic attacks and the need for analgesic usage.

Spontaneous Renal Pelvis Rupture: Unexpected Complication of Urolithiasis Expected to Passage with Observation Therapy

Seventy percent of ureteral stones are located at distal ureter. Effective and safe passage of distal ureter stones is mediated by observation or medical expulsive treatment. Most of stones located at distal ureter pass spontaneously under observation; however, some are complicated with urinary tract infection, hydronephrosis, and renal function disturbances. Spontaneous perforation of the upper ureter is a rare condition that poses diagnostic and therapeutic problems. This case is reported, because the patient developed an unexpected spontaneous renal pelvis rupture (SRPR), while she was under observation and expected to pass her right ureteral stone spontaneously through hydration and analgesic treatment.

Tamsulosin as medical expulsive therapy for lower ureterolithiasis: A meta-analysis

ObjectiveTo review the evidence for tamsulosin as medical expulsive therapy in enhancing the effectiveness of distal ureteral stone clearance rate. MethodsWe searched Pubmed/Medline, Embase, CBM and the Cochrane Library up to October 2011. All randomized controlled trials in which tamsulosin was evaluated with distal ureterolithiasis were eligible for the analysis. Outcome measure assessed was stone clearance rate. Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5.1. ResultsThirteen studies involving 1067 participants met the inclusion criteria. Study duration ranged from 7 to 42 d. The pooled analysis showed an improvement of 41% in stone clearance rate of tamsulosin as medical expulsive therapy for distal ureteral calculi (RR=1.41, 95%CI=1.18 to 1.70). According to stone size (6 mm<size<10 mm, 5 mm<size<6 mm, size <5 mm), the pooling effects of tamsulosin were analyzed, with a higher stone expulsion rate obtained than control (RR=1.52, 1.75, 1.05, 95%CI=1.30 to 1.77, 1.25 to 2.45, 0.95 to 1.16, respectively). Adverse effects of tamsulosin, mainly retrograde ejaculation, dizziness and hypotension, were reported in 7 included trials. ConclusionTreatment with tamsulosin appears to be a safe and effective medical expulsion therapy for distal ureterolithiasis. To make a definite clinical recommendation to use tamsulosin as medical expulsive treatment for distal ureteral calculi, high quality multicentric, randomized, double blinded, controlled trials are necessary to prove its efficacy.

Editorial Comment

The main objective of the treatment of ureteral stones is to achieve the immediate relief of the symptoms, decompression of the urinary tract, and stone disintegration/expulsion, with an acceptable rate of complications. Shock wave lithotripsy (SWL), retrograde lithotripsy, and medical expulsive treatment are each valuable options. At present, no high-quality, randomized study has been published showing the superiority of 1 treatment over the other 2. Given the particular clinical setting, it is unlikely such a study will ever be performed. In contrast, retrospective and prospective series have undoubtedly shown that each approach is safe. 1 Parsons J.K. Hergan L.A. Sakamoto K. et al. Efficacy of alfa-blockers for the treatment of ureteral stones. J Urol. 2007; 177: 983-987 Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar , 2 Seitz C. Tanovic E. Kikic Z. et al. Impact of stone size, location, composition, impactation, and hydronephrosis on the efficacy of holmium:YAG laser ureterolithotripsy. Eur Urol. 2007; 52: 1751-1757 Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar , 3 Salem H.K. A prospective randomized study comparing shock wave lithotripsy and semirigid ureteroscopy for the management of proximal ureteral calculi. Urology. 2009; 74: 1216-1221 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar The authors describe a large retrospective experience of immediate versus delayed ureteroscopic treatment of ureteral stones. The latter group was treated first with appropriate medical treatment that failed to be effective. The results of the ureteroscopic procedures were similar. The main difference is practical and obvious. The delayed group surely experienced more pain, a later return to daily activities, and required more medical treatment. Nevertheless, it should be underlined that the report was not a comparison between immediate ureteroscopic treatment and medical expulsive therapy, because the patients who experienced successful medical treatment were not included in the analysis. Therefore, according to the authors, the main conclusion that can be drawn is that ureteroscopic lithotripsy is a safe option, even when performed immediately after the first colic attack, with results comparable to those for treatment delayed until expectant therapy has failed. In conclusion, when ureteral stones are complicated by hydronephrosis and/or fever or when the colic cannot be controlled by drugs, emergency ureteroscopic treatment can (and I believe should) be adopted. In most settings, emergency treatment means within 24 hours, a reasonable compromise, allowing time for a correct evaluation of the general condition of the patient. Patients with only 1 colic attack controlled by drugs and without hydronephrosis do not require hospitalization; thus, emergency ureteroscopic treatment could result in unnecessary overtreatment. One might finally debate in these cases the usefulness of emergency SWL (if available). Theoretically, SWL could improve the chance of spontaneous resolution, even if the fragmentation is partial. However, SWL of ureteral stones is not always easy, and, after colic, the visualization of the stone is even more difficult owing to intestinal meteorism, such that it would probably end as a fruitless attempt, with considerable cost. Emergency Ureteroscopic Removal of Ureteral Calculi After First Colic Attack: Is There Any Advantage?UrologyVol. 78Issue 3PreviewTo comparatively evaluate the efficacy of ureteroscopic stone treatment immediately after the first colic attack and in an electively planned manner. Full-Text PDF ReplyUrologyVol. 78Issue 3PreviewObstructing ureteral calculi have been the most common cause of severe colic pain evaluated and treated in an emergent manner. Regarding the management alternatives, because of its noninvasive and practical nature, shock wave lithotripsy is currently the preferred therapeutic option and can be performed after the onset of renal colic to relieve stones and related problems.1-5 However, although the success rates are high in the management of proximal ureteral calculi, these rates tend to decrease in distal stones and for those treated in an emergency setting. Full-Text PDF

Factores predictivos para la expulsión de la litiasis ureteral

Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment. Objectives To evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone. Material and methods A retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance. Results 34,2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR= 1,823, p=0,013), size (<5 mm, OR=3,37, p<0,02), and medication (combination of alpha blockers and NSAIDs, OR= 8,70, p<0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0,006) and medication (p<0,001) as independent predictive factors. The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8,21 (95% CI 3.37–20,01) the possibilities of spontaneous expulsion. Conclusions Size of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones.

1445 C-REACTIVE PROTIEN: A NOVEL MARKER FOR EXPULSION RATE OF LOWER URETERIC CALCULI?

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal I1 Apr 20101445 C-REACTIVE PROTIEN: A NOVEL MARKER FOR EXPULSION RATE OF LOWER URETERIC CALCULI? Altaf Khan and Manjunath Shetty Altaf KhanAltaf Khan More articles by this author and Manjunath ShettyManjunath Shetty More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1159AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Plasma C - reactive protien (CRP) is an acute phase protien which becomes elevated in inflammatory disorders. It is also increased in ureteric obstruction with pyelonephritis. Presence of edema and infection decreases the chances of expulsion of ureteric calculi. We used CRP as a marker to detect the expulsion rate of lower ureteric calculi following medical expulsive treatment. METHODS From January 2009 to June 2009, 100 consecutive patients with lower ureteric calculi, size ranging from 5-7mm with mild symptoms were included in the study. All patients were investigated in form of X-ray KUB, USG KUB and CRP. Patients were subjected for medical treatment with alpha blockers (tamsulosin 0.4mg in patients >40yrs and alfuzosin 10mg in <40 yrs age group), diuretics and analgesics whenever required. Of 100 patients 46 patients had CRP <20 mg/L, 26 patients between 20-40 and 28 patients had CRP >40mg/L. Average stone size was comparable for all the groups. RESULTS Patients were followed up after 3 weeks of medical treatment. Patients were assessed for symptom relief, investigated with X-ray KUB and USG KUB. Of the 46 patients with CRP <20 mg/L, 40(86.9%) had passed the stone. Of 26 patients with CRP between 20-40, 12(46.15%) had passed the stone. But of 28 patients with CRP >40 only 3(10.71%) had passed the stone. Patients with non expulsion of stone were subjected for Ureterorenoscopy and intracorporeal lithotripsy. CONCLUSIONS CRP is a novel sensitive marker in deciding the stone expulsion rate in patients with small sized (5-7mm) lower ureteric calculi. Patients with CRP >40mg/L should directly be subjected for intervention instead of medical therapy. Mangalore, India© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e557 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Altaf Khan More articles by this author Manjunath Shetty More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prognostic factors of spontaneous expulsion in ureteral lithiasis

Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment. ObjectivesTo evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone. Material and methodsA retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance. Results34.2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR=1.823, p=0.013), size (<5mm, OR=3.37, p<0.02), and medication (combination of alpha blockers and NSAIDs, OR=8.70, p<0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0.006) and medication (p<0.001) as independent predictive factors. The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8.21 (95% CI 3.37–20.01) the possibilities of spontaneous expulsion. ConclusionsSize of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones.