Stone Passage Research Articles

PREDICTIVE FACTORS AFFECTING THE SUCCESS OF MEDICAL EXPULSIVE THERAPY IN PATIENTS WITH DISTAL URETERAL STONE

OBJECTIVE: In this study, we aimed to investigate the factors affecting spontaneous stone passing in patients who received medical expulsive therapy due to distal ureteral stones. MATERIAL AND METHODS: From September 2022 to October 2023, a total of 148 patients with distal ureteral stones sized 4-10 mm were included. Patients received silodosin 4 mg as medical expulsive therapy and were followed up for a maximum of four weeks. The patient- and stone-related variables affecting spontaneous stone passage were evaluated. RESULTS: The mean age of the participants was 42.92±12.78 years. The stone expulsion rate was 64.2%. The rate of spontaneous stone passage was significantly higher in patients with lower stone size, stone burden, ureteral wall thickness, distance of the stone to the ureterovesical junction, neutrophil-lymphocyte ratio and hydronephrosis grade. (all, p<0.05). The distance of the stone to the ureterovesical junction, ureteral wall thickness, and neutrophil-to-lymphocyte ratio were independent predictors of spontaneous passage (p:0.036, p:0.001, p:0.001, respectively). CONCLUSIONS: The distance of stone to the ureterovesical junction, ureteral wall thickness, and neutrophil-to-lymphocyte ratio can be useful parameters to estimate spontaneous stone expulsion. These factors play important roles in decision-making for the management of distal ureteral stones.

Assessment of The Factors Related to The Spontaneous Passage of Common Bile Duct Stones.

Background: Common bile duct (CBD) stones may pass spontaneously without any intervention. Assessment of the predictors of spontaneous passage can contribute to avoiding unnecessary endoscopic retrograde cholangiopancreatography (ERCP) implementation. This study aimed to investigate the factors related to spontaneous passage of CBD stones. Methods: From January 2021 to August 2023, patients with naïve papilla who had undergone biliary ERCP and with CBD stones detected by MRCP before the procedure were analyzed retrospectively. Subjects were divided into two groups on the basis of the presence of stones during the ERCP procedure: the spontaneous passage group and the non-passage group. Groups were compared in terms of demographic, laboratory, and radiological data. Results: A total of 236 patients, including 26 in the spontaneous passage group and 210 in the non-passage group, were involved. Multivariate logistic regression analyses revealed that only stone size was significantly associated with spontaneous passage. From ROC curve analysis, stone size with a cut-off value of 4.3 mm predicted spontaneous passage with 58% sensitivity and 85% specificity. Conclusions: Stones with a size of less than 4.3 mm are more likely to pass spontaneously without endoscopic intervention. Paying attention to the stone diameter before ERCP procedures can contribute to avoiding unnecessary ERCP implementation.

Severity of Gallstone-, Sludge-, or Microlithiasis-Induced Pancreatitis-All of the Same?

Severity of microlithiasis- and sludge-induced pancreatitis in comparison to gallstone-induced pancreatitis has never been studied for a lack of definition. In this retrospective cohort study, 263 patients with acute biliary pancreatitis treated at a tertiary care center from 2005 to 2021 were stratified according to the recent consensus definition for microlithiasis and sludge. The gallstone-pancreatitis cohort was compared to microlithiasis, sludge, and suspected stone passage pancreatitis cohorts in terms of pancreatitis outcome, liver function, and endosonography/endoscopic retrograde cholangiopancreatography results using one-way analysis of variance and χ 2 test. Multinomial logistic regression analysis was performed to correct for bias. Microlithiasis- and sludge-induced pancreatitis, classified according to the revised Atlanta classification, did not present with a milder course than gallstone-induced pancreatitis ( P = 0.62). Microlithiasis and sludge showed an increase in bilirubin on the day of admission to hospital, which was not significantly different from gallstone-induced pancreatitis ( P = 0.36). The likelihood of detecting biliary disease on endosonography resulting in bile duct clearance was highest on the day of admission and day 1, respectively. Microlithiasis and sludge induce gallstone-equivalent impaired liver function tests and induce pancreatitis with similar severity compared with gallstone-induced acute biliary pancreatitis.

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 < 0.001) and stone location ( p < 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

Effect of preoperative alpha-blockers on ureteroscopy outcomes: A meta-analysis of randomised trials.

This work aims to determine the efficacy and safety of preoperative alpha-blocker therapy on ureteroscopy (URS) outcomes. In this systematic review and meta-analysis of randomised trials of URS with or without preoperative alpha-blocker therapy, outcomes included the need for ureteral dilatation, stone access failure, procedure time, residual stone rate, hospital stay, and complications. Residual stone rates were reported with and without adjustments for spontaneous stone passage, medication noncompliance, or adverse events leading to patient withdrawal. Data were analysed using random-effects meta-analysis and meta-regression. Certainty of evidence was assessed using the GRADE criteria. Among 15 randomised trials with 1653 patients, URS was effective and safe with a stone-free rate of 81.2% and rare (2.3%) serious complications. The addition of preoperative alpha-blockers reduced the need for ureteral dilatation (risk ratio [RR] = 0.48; 95% CI = 0.30 to 0.75; p = 0.002), access failure rate (RR = 0.36; 95% CI = 0.23 to 0.57; p < 0.001), procedure time (mean difference [MD] = -6min; 95% CI = -8 to -3; p < 0.001), risk of residual stone in the primary (RR = 0.44; 95% CI = 0.33 to 0.66; p < 0.001) and adjusted (RR = 0.52; 95% CI = 0.40 to 0.68; p < 0.001) analyses, hospital stay (MD = -0.3days; 95% CI = -0.4 to -0.1; p < 0.001), and complication rate (RR = 0.46; 95% CI = 0.35 to 0.59; p < 0.001). Alpha-blockers increased ejaculatory dysfunction risk and were less effective for renal/proximal ureter stones. The certainty of evidence was high or moderate for all outcomes. The main limitation of the review was inconsistency in residual stone assessment methods. While URS is an effective and safe treatment for stone disease, preoperative alpha-blocker therapy is well tolerated and can further improve patient outcomes.

Role of the systemic immune-inflammation index in predicting spontaneous stone passage in patients with renal colic

ABSTRACT Objectives Renal colic (RC) is one of the most frequent reasons for presentation to the emergency department (ED) and creates a high economic and medical burden. Management strategies for RC range from waiting for spontaneous passage to surgical intervention. However, factors determining spontaneous stone passage (SSP) are still poorly understood. Therefore, in this study, we aimed to investigate the role of the systemic immune-inflammatory index (SII) in predicting SSP. Methods We retrospectively analyzed the data of 924 patients aged over 18 years, who were diagnosed with RC in our clinic between 1 January 2019, and 30 May 2022, and had ureteral stones of ≤ 10 mm. The patients were divided into two groups according to whether they had SSP. The clinical and laboratory characteristics of the patients in the ED were evaluated. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII (neutrophil count x platelet count/lymphocyte count) values of the patients were calculated. Stone size and location were also recorded. Results In the univariate analysis of SSP, a ureteral stone size of ≤ 5 mm (p < 0.001), distal ureteral location (p < 0.001), SII (p < 0.001), NLR (p < 0.001), and PLR (p = 0.036) were significantly correlated with SSP. ROC analysis showed that an SII level < 721.8 (Sensitivity %82.6, Specificity %74.7, p < 0.001) was an independent predictor of SSP. Conclusion Our findings showed that a low SII level was associated with SSP and could be used as a predictive marker of SSP as a more valuable parameter than NLR. SII and NLR, together with other indicators, are inflammatory markers that can be used in the clinical decision-making process for ureteral stone treatment.

Optimal duration of medical expulsive therapy for lower ureteral stones: a critical evaluation

To evaluate the optimal duration of Medical Expulsive Therapy (MET) application for distal ureteric stones on a time period based manner. 89 patients with 5–10 mm distal ureter stones received tamsulosin (0.4 mg) for MET and diclofenac sodium (75 mg) for analgesia. Patients were evaluated once a week for 4 weeks. Radiologic stone passage was evaluated by kidney ureter bladder (KUB) and ultasonography where non-contrast computed tomography (NCCT) was also performed if needed. While 23 cases (28.4%) were SF after first week, 23 were SF (28.4%) after 2 weeks, 9 cases (11.1%) after 3 and lastly 7 cases (8.6%) became SF after four weeks. Nineteen (23.5%) cases were not SF after 4 weeks. A positive relationship was found between the time period elapsed for stone passage and ureteral wall thickness (UWT) along with the degree of hydronephrosis. In addition, mean number of renal colics and emergency department (ED) visits were found to be higher in patients passing stones in the 4th week along with the ones who could not despite MET. SFR for distal ureteric stones sizing 5–10 mm was higher within the first 3 weeks under MET application. Thus, waiting for a longer period of time may result in increased analgesic and unnecessary MET treatment with increased risk of emergency department visits and additional costs as well. We believe that other options could be considered in such cases who are not SF at the end of the first 3 weeks.

Efficacy and safety comparison between silodosin and tamsulosin as medical expulsive therapy for distal ureteral stones

BACKGROUND Ureteral stones are a common urological condition causing significant discomfort and morbidity. Medical expulsive therapy (MET) is a noninvasive approach to facilitate the passage of stones. This study aimed to compare the efficacy and safety of silodosin and tamsulosin as MET in patients with distal ureteral stones (DUS).&#x0D; METHODS We searched CINAHL, Cochrane Library, PubMed, and ScienceDirect for randomized controlled trials (RCTs) on the administration of silodosin and tamsulosin for DUS. The primary outcomes analyzed were stone expulsion rates and expulsion times, measured as risk ratio (RR) and mean difference (MD), respectively. Statistical analyses were performed using Review Manager 5.4 and STATA 17.&#x0D; RESULTS 14 RCTs comprising 1,535 patients (770 received silodosin) met the inclusion criteria. The silodosin group had notably higher stone expulsion rates (RR 1.20, 95% confidence interval [CI] 1.13–1.27, p&lt;0.00001, I² = 37%), shorter expulsion times (MD −2.98, 95% CI −4.35–−1.62, p&lt;0.01, I² = 85%), and fewer colicky pain episodes (MD −0.35, 95% CI −0.59–−0.10, p&lt;0.01, I² = 83%) than the tamsulosin group. Retrograde ejaculation was the only adverse event that had a significant difference between both groups, statistically favoring tamsulosin (RR 1.61, 95% CI 1.12–2.33, p = 0.01, I² = 0%).&#x0D; CONCLUSIONS Silodosin should be preferred as the first-line MET agent for DUS owing to its better expulsion rate, shorter stone expulsion time, and fewer colicky pain episodes. However, tamsulosin may be used in selected cases where patients experience retrograde ejaculation after receiving silodosin.

Prediction of spontaneous distal ureteral stone passage using artificial intelligence.

Identifying factors predicting the spontaneous passage of distal ureteral stones and evaluating the effectiveness of artificial intelligence in prediction. The files of patients presenting with distal ureteral stones were retrospectively evaluated. Those who experienced spontaneous passage were assigned to Group P, while those who did not were assigned to Group N. Demographic and clinical data of both groups were compared. Then, logistic regression analysis was performed to determine the factors predicting spontaneous stone passage. Based on these factors, a logistic regression model was prepared, and artificial intelligence algorithms trained on the dataset were compared with this model to evaluate the effectiveness of artificial intelligence in predicting spontaneous stone passage. When comparing stone characteristics and NCCT findings, it was found that the stone size was significantly smaller in Group P (4.9 ± 1.7mm vs. 6.8 ± 1.4mm), while the ureteral diameter was significantly higher in Group P (3.3 ± 0.9mm vs. 3.1 ± 1.1mm) (p < 0.05). Parameters such as stone HU, stone radiopacity, renal pelvis AP diameter, and perirenal stranding were similar between the groups. In multivariate analysis, stone size and alpha-blocker usage were significant factors in predicting spontaneous stone passage. The ROC analysis for the logistic regression model constructed from the significant variables revealed an area under the curve (AUC) of 0.835, with sensitivity of 80.1% and specificity of 68.4%. AI algorithms predicted the spontaneous stone passage up to 92% sensitivity and up to 86% specifity. AI algorithms are high-powered alternatives that can be used in the prediction of spontaneous distal ureteral stone passage.

Two novel deep-learning models to predict spontaneous ureteral calculi passage: Model development and validation

Abstract Objective The aim of this study was to develop and evaluate two deep-learning (DL) models for predicting spontaneous ureteral stone passage (SSP). Materials and methods A total of 1217 patients with thin-layer computed tomography–confirmed ureteral stones in our hospital from January 2019 to December 2022 were retrospectively examined. These patients were grouped into 3 data sets: the training set (n = 1000), the validation set (n = 100), and the test set (n = 117). Two DL models based on residual neural network (ResNet)—2-dimensional (2D) ResNet29 and 3-dimensional (3D) ResNet29—were separately developed, trained, and assessed. The predictive ability of a conventional approach using a stone diameter of &lt;5 mm on computed tomography was investigated, and the results were compared with those of the two DL models. Results Of the 1217 patients, SSP was reported in 446 (36.6%). The total accuracy, sensitivity, and specificity were 76.9%, 56.1%, and 90.8% for the stone diameter approach; 87.1%, 84.2%, and 92.7% for the 2D ResNet29 model; and 90.6%, 88.2%, and 95.1% for the 3D ResNet29 model, respectively. Both the 2D and 3D ResNet29 models showed significantly higher accuracy than the stone diameter approach. Receiver operating characteristic curve analysis showed that both DL models had a significantly higher area under the curve than the stone diameter–based classification. Conclusions The DL models, particularly the 3D model, are novel and effective methods for predicting SSP rates. Using such models may help determine whether a patient should receive surgical intervention or expect a long interval before stone passage.

Application of novel burst wave lithotripsy and ultrasonic propulsion technology for the treatment of ureteral calculi in a bottlenose dolphin (Tursiops truncatus) and renal calculi in a harbor seal (Phoca vitulina)

Marine mammals may develop kidney stones, which can be challenging to treat. We describe burst wave lithotripsy (BWL) and ultrasonic propulsion to treat ureteral calculi in a 48-year-old female bottlenose dolphin (Tursiops truncatus) and to reduce renal stone burden in a 23-year-old male harbor seal (Phoca vitulina). BWL and ultrasonic propulsion were delivered transcutaneously in sinusoidal ultrasound bursts to fragment and reposition stones. Targeting and monitoring were performed with real-time imaging integrated within the BWL system. Four dolphin stones were obtained and fragmented ex vivo. The dolphin case received a 10-min and a 20-min BWL treatment conducted approximately 24 h apart to treat two 8–10 mm partially obstructing right mid-ureteral stones, using oral sedation alone. For the harbor seal, while under general anesthesia, retrograde ureteroscopy attempts were unsuccessful because of ureteral tortuosity, and a 30-min BWL treatment was targeted on one 10-mm right kidney stone cluster. All 4 stones fragmented completely to < 2-mm fragments in < 20 min ex vivo. In the dolphin case, the ureteral stones appeared to fragment, spread apart, and move with ultrasonic propulsion. On post-treatment day 1, the ureteral calculi fragments shifted caudally reaching the ureteral orifice on day 9. On day 10, the calculi fragments passed, and the hydroureter resolved. In the harbor seal, the stone cluster was observed to fragment and was not visible on the post-operative computed tomography scan. The seal had gross hematuria and a day of behavior indicating stone passage but overall, an uneventful recovery. BWL and ultrasonic propulsion successfully relieved ureteral stone obstruction in a geriatric dolphin and reduced renal stone burden in a geriatric harbor seal.

Prevalence and predictors of stone passage after double J stenting for symptomatic ureteral stones: a cross-sectional, real-life study.

To evaluate the rate of and predictors of stone passage (SP) after urgent retrograde stenting for symptomatic ureteral stones. We retrospectively analysed data from 249 consecutive patients presenting to the emergency department for symptomatic ureteral stones and treated with retrograde stenting. Demographic, clinical and laboratory characteristics were collected. Stones parameters were collected before stenting and SP was evaluated at 1month with computerized tomography. Descriptive statistics and logistic regression models tested the association between predictors and SP. Overall, median (IQR) age and stone diameter were 56 (45-68) years and 7.1 (4.4-9.8) mm, respectively. Stones were located in the proximal, mid and distal ureter in 102 (41.0%), 48 (19.3%) and 99 (39.8%) cases. SP was observed in 65 (26.2%) individuals. Stone diameter (3.2 vs. 7.7mm, p < 0.001) and stone density (416 vs. 741, p < 0.001) were lower and a higher rate of distal stones (76.9% vs. 26.7%, p < 0.001) was found in the SP group compared to that with persistent stones. Multivariable logistic regression analysis showed that distal ureteral stone location (OR 7.9, p < 0.01) and lower HU (OR 0.9, p < 0.01) were associated with SP, after accounting for stone volume. Patients with a distal stone of 500 HU had a 75% probability of SP. Stone passage occurred in 26% of patients with indwelling stent due to symptomatic ureteral stones. Lower stone density and distal stone location were independent predictors of stone passage. Patients with these criteria should be managed with follow-up imaging and stent removal instead of ureteroscopy.

Prevalence, Incidence, and Determinants of Kidney Stones in a Nationally Representative Sample of US Adults

Purpose: To determine the prevalence, incidence, and determinants of kidney stones among adults in the United States. Materials and Methods: This cross-sectional observational study evaluated the lifetime prevalence of kidney stones and the 12-month incidence of kidney stone passage from the 2017 to 2020 National Health and Nutrition Examination Survey. Survey statistical methods were used to estimate kidney stone prevalence and incidence and the association of patient characteristics with these outcomes using logistic regression. Results: The analysis included 9208 participants with prevalence data and 9193 with incidence data. The mean age of the sample was 51 ± 17 years, 49% were male, and the mean body mass index was 30 ± 8 kg/m2. The prevalence of kidney stones was 9.9% (95% confidence interval (CI): 8.7%-11.3%), and the incidence of stone passage was 1.8% (95% CI: 1.4%-2.4%). The most important covariates predicting kidney stone prevalence were a history of gallstones (OR = 2.89: 95% CI: 2.16-3.89, P &lt; .001), hypertension (OR = 1.73: 95% CI: 1.06-2.83, P = .03), and chronic kidney disease (OR = 1.99: 95% CI: 1.01-3.90, P = .046). The same variables were most important in predicting the incidence of kidney stone passage: history of gallstones (OR = 2.66: 95% CI: 1.47-4.81, P = .002), chronic kidney disease (OR = 3.34: 95% CI: 1.01-11.01, P = .048), and hypertension (OR = 2.24: 95% CI: 1.17-4.27, P = .02). Conclusions: The self-reported prevalence and incidence of kidney stones in the US adult population between 2017 and 2020 were 9.9% and 1.8%, respectively. History of gallstones, hypertension, and chronic kidney disease were important predictors of both outcomes. Individuals with these risk factors may require more frequent monitoring or targeted preventative lifestyle interventions.

An integrated microfluidic system for automatic detection of cholangiocarcinoma cells from bile.

Cholangiocarcinoma (CCA) is an aggressive cancer that originates from the epithelial cells lining the bile ducts. Due to its location deep within the body and nonspecific symptoms in the early stages, it is often diagnosed at the advanced stage, thus leading to worse prognosis. Circulating tumor cells within liquid biopsies (i.e. blood) have been considered as promising biomarkers for CCA diagnosis, though current methods for profiling them are not satisfactory in terms of sensitivity and specificity. Herein we developed a new cancer cell probing and immuno-tracking assay known as "CAPTURE", which was performed on an integrated microfluidic system (IMS) to automate CCA diagnosis from bile with a sample amount of only 1 mL. The assay utilized magnetic beads surface-coated with two affinity reagents, a nucleic acid aptamer (HN16) and a glycosaminoglycan (SCH 45-mix), for capturing cancer cells in bile; the "gold standard" anti-epithelial cell adhesion molecule was used as a comparison. In a single-blind test of 54 CCA-positive (+) and 102 CCA-negative (-) clinical samples, sensitivities and specificities of 96 and 80%, respectively, were documented with the CAPTURE assay on-bench. An IMS composed of a centrifugal module for sample pretreatment and a CAPTURE module for cell capture and staining was integrated with a new "vertical integration module" for detecting cancer cells from bile without human intervention. Furthermore, a novel micro-tier structure within the centrifugal module was designed to block passage of gallbladder stones with diameters >1 mm, thereby preventing their interference during the subsequent CAPTURE assay. Improved sensitivity and specificity (100 & 83%, respectively) by using three affinity reagents were achieved on the IMS when using 26 clinical bile samples, confirming its clinical bio-applicability for CCA diagnosis. This approach could be therefore used for early-stage CCA diagnostics, ideally enabling effective treatment, as well as reducing potential for relapse.

Unexpected cause of upper gastrointestinal bleeding: beyond the typical complications of gallstone disease.

An 88-year-old man presented with haematemesis with haemodynamic stability requiring transfusion of 5 units of blood. Physical examination was unremarkable. Upper endoscopy identified a fistulous opening in the proximal second part of the duodenum (D2) with an oozing bleed and blood clots. A computed tomography (CT)-angiogram revealed a 18mm cystic artery pseudoaneurysm next to a fistulous communication between the gallbladder and D2, allowing the passage of a large stone (Bouveret syndrome). The patient successfully underwent emergent arterial embolization guided by a clip endoscopically-placed near the duodenal fistulous orifice. There were no intercurrences or bleeding recurrence.

Long Segment Prolonged Right Ureteric Spasm Following Recent Passage of Stone Simulating Malignant Stricture in A Case of Hypoganglionosis

Long Segment Prolonged Right Ureteric Spasm Following Recent Passage of Stone Simulating Malignant Stricture in A Case of Hypoganglionosis

Ultrasound Diagnosis of Urolithiasis

Urolithiasis is a metabolic disease caused by various exogenous or endogenous factors, often has a hereditary nature and is determined by the presence of a stone in the urinary system. The causes and mechanism of stone formation remain open in urology. There is still no definitive theory for the development of urolithiasis. The main symptoms of urolithiasis are pain, hematuria, dysuria and stone passage. Urolithiasis (UCD) is one of the most common urological diseases and ranks second in the world after inflammatory nonspecific diseases of the kidneys and urinary tract.

Efficacy of sexual intercosurse in the spontaneous passage of distal or intramural ureteral stones: a randomsized controlled trial

Background: The role of sexual intercourse as an alternative treatment approach for ureteral stones (UTSs) is a recent area of investigation with only small sample-sized studies. This study aims to evaluate the role of sexual intercourse in the spontaneous passage of distal or intramural UTSs via a larger sample size. Materials and methods: The study population included cases that had either a distal ureteric or an intramural radiopaque stone. The patients were divided into two groups; group A was instructed to engage in sexual intercourse two to three times per week while also receiving symptomatic treatment for 4 weeks. Group B received symptomatic treatment alone and was instructed to abstain from sexual intercourse or masturbation for the same period. Results: A total of 160 male patients were enrolled in this study. The ages of the patients ranged from 21 to 58 years. The rate of stone expulsion after 2 weeks was 68.18% in group A and 53% in group B (P=0.053). The expulsion rate after 4 weeks was 80% in group A and 68.4% in group B (P=0.072). The mean expulsion time was 13.9±5.4 days for the experimental group and 15.2±6.7 days for the control group (P=0.179). The experimental group required fewer analgesic injections in comparison to the control group (P&lt;0.05). Conclusion: While the role of sexual intercourse in facilitating the passage of distal or intramural UTSs cannot be fully established, it may aid to some extent. However, it should not be relied upon as a standalone treatment modality.

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.