Passage Of Ureteral Stones Research Articles

Applying urinary ultrasound to predict the risk of spontaneous ureteral stone passage: a retrospective cohort study

BackgroundTo assess the value of urological ultrasound in predicting the risk of spontaneous passage of ureteral stones.MethodsClinical and ultrasound data were collected consecutively from patients receiving conservative treatment for ureteral stones, and the outcome of spontaneous passage was followed up for 1 month. Ultrasound variables independently associated with the risk of spontaneous stone passage were screened. A logistic regression prediction model was constructed based on the independent risk factors, and the discriminative efficacy and clinical utility of the prediction model in inferring the risk of spontaneous passing were assessed by the receiver operating characteristic (ROC) curve, calibration curve and clinical decision curve.ResultsA total of 163 patients undergoing conservative treatment for ureteral stones were included in the study, with a mean age of 45.95 ± 13.01 years. Among them, 47 cases (28.83%) experienced failure of spontaneous stone passage. Multivariable analysis revealed that stone length (OR: 2.622, P = 0.027), distal stone location (OR: 0.219, P = 0.003), and ureteral jetting frequency (OR: 6.541, P < 0.001) were independent risk factors for spontaneous stone passage. A prediction model incorporating stone length, stone location, and affected ureteral jetting frequency was developed to assess the risk of spontaneous stone passage. The area under the ROC curve was 0.814 (95% CI: 0.747–0.882), indicating good discriminatory power. The prediction model also demonstrated favorable net clinical benefit.ConclusionA prediction model based on ultrasound-derived stone length, location, and ureteral jetting frequency can accurately evaluate the risk of spontaneous stone passage in patients with ureteral stones, providing a basis for optimizing the clinical decision-making on ureteral stones, and has reliable clinical application value.

Radiological and Hematological Parameters Predicting Success of Medical Expulsive Therapy in Patients With Ureteral Calculus.

Background Urolithiasis, characterized by the formation of stones in the urinary tract, is a common condition with significant morbidity. Medical expulsive therapy (MET) has emerged as a non-invasive treatment modality for facilitating the spontaneous passage of ureteral stones. However, MET success varies widely among individuals, and identifying predictive factors for treatment outcomes is crucial for optimizing patient care. Objective This study aimed to evaluate the predictive role of radiological and hematological parameters in the success of MET for ureteral stones. Methods A prospective observational cohort study was conducted at the Department of Urology, tertiary care center, Patna, involving consecutive patients who underwent MET for ureteral stones. Radiological parameters (stone size, location, and hydronephrosis) and hematological markers (C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR)) were assessed as predictors of treatment success. Univariate and multivariate logistic regression analyses were performed to identify significant predictors of MET success. Results Among the 156 patients included in the study (mean age: 42 years; range: 18-50 years), radiological parameters, such as smaller stone size (<10 mm) and absence of hydronephrosis, were significantly associated with higher rates of MET success (p<0.05). Lower CRP levels (p<0.001) and NLR (p<0.05) were also predictive of treatment success. Logistic regression analysis confirmed the independent predictive value of these parameters after adjusting for potential confounders. Conclusion Radiological and hematological parameters are valuable predictors of the success of MET for ureteral stones. Incorporating these predictive factors into clinical decision-making can optimize treatment outcomes and minimize unnecessary interventions in patients with a higher likelihood of spontaneous stone passage.

CT-Based Predictors of Spontaneous Ureteral Stone Passage.

To assess CT-scan based parameters, particularly ureteral wall thickness (UWT), in predicting spontaneous ureteral stone passage. Cross-sectional, analytical study. Place and Duration of the Study: Section of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from June to November 2023. Patients with symptomatic, single, radio-opaque, unilateral ureteral stones having size ≤10 mm with normal kidney functions, diagnosed by non-contrast CT-scan KUB, and treated by conservative option for four weeks were enrolled. Clinical and radiological predictors for stone passage (SP), including stone size, area, laterality, location, density, degree of hydronephrosis, maximal UWT at the stone site, and ureteral diameter and density above and below the stone, were evaluated. Binary logistic regression analysis was employed to identify predictors of stone passage. Receiver operating characteristic (ROC) curve was used to find the optimal cut-off for UWT. Among 34 eligible patients, 22 (64.7%) passed their stones spontaneously. Patients who passed had smaller stone size and area and lesser UWT. Stone location, laterality, degree of hydronephrosis, stone density, ureteral wall diameter, and density above and below stones were not associated with SP. Multivariate analysis revealed maximum UWT as the independent predictor of SP, with a cut-off of 1.95 mm and an accuracy of 0.94. UWT was the single most convincing factor for the spontaneous passage of ureteral stone in this study. By applying UWT's optimal cut-off value, it might be an extremely significant tool when taking decisions in daily practice. Ureteral wall thickness, Medical expulsive therapy, Non-contrast computed tomography.

Neutrophil to lymphocyte ratio and serum procalcitonin level as a predictor of spontaneous ureteral stone passage: A prospective study.

Ureteric stone is responsible for around 20% of urinary tract stones and among them 70% of these are located in distal portion of the ureter. Stone causing ureter obstruction produce inflammatory changes in ureteric wall and prevent spontaneous passage of stone. The objective of the study is to compare the predictive role of procalcitonin and Neutrophil-to-lymphocyte ratio (NLR) for spontaneous passage of stone. Total 150 participants having ureteric stone of 4-8 mm, were included in prospective observational study. The patients were followed up for 4 weeks. Spontaneous Stone Passage (SSP) was confirmed with either the patient collecting the stone during urination or by Non-Contrast CT performed at 4 weeks. Blood samples of the patients were analysed and White blood cells, sedimentation, Neutrophile to Lymphocyte (NLR), procalcitonin level compared to analyse predictors of future SSP. The procalcitonin levels of the Spontaneous stone passing SSP (-ve) group (209.05 ± 78.45 pg/ml) were significantly higher than the not passing the SSP (+ve) group (130.76 ± 24.18) (p < 0.001). NLR is significantly higher in the SSP -ve (3.84 ± 0.41) than the SSP +ve (2.18 ± 0.38) group (p < 0.001). In single and multivariate analysis, significant activity was found for procalcitonin in SP +ve group. The findings of the study suggests that high level of procalcitonin, and high NLR have a negative effect on passage of stone. So early intervention can be planned to these patients to prevent complications.

Predictive Value of C-reactive Protein in the Spontaneous Passage of Lower Ureteric Stones: A Prospective Single-Centre Study.

Ureteric stones, characterised by their presence in the ureter, present a common yet often painful urological condition requiring timely intervention. As C-reactive protein (CRP) emerges as a potential biomarker, its correlation with the spontaneous stone passage(SSP) offers valuable insights into patient management and treatment strategies. The present study aimed to assess if CRP levels can predict SSP in symptomatic lower ureteric calculi of size 5 mm-10 mm. This prospective observational study, conducted at the Indira Gandhi Institute of Medical Sciences in Patna, India, from July 2022 to June 2023, focused on individuals aged 13 to 60 years presenting with ureteric colic and single distal ureteral stones (5 mm-10 mm). Patients underwent comprehensive initial assessment and monitoring, including diagnostic procedures such as a complete blood count, urinalysis, CRP levels, and renal function evaluations. Treatment consisted of hydration encouragement, tamsulosin (0.4 mg) daily administration, and diclofenac (50 mg) as needed. Follow-up assessments at one-month post-treatment involved clinical examination and imaging studies to evaluate treatment efficacy. This study analysed 157 patients with ureteric stones, finding that 76% experienced SSP. Lower CRP levels (≤6 mg/L), along with other laboratory parameters like low white blood cell counts, low neutrophil levels, absence of leukocyturia, absence of hematuria, and lower urine specific gravity, were associated with higher SSP rates. C-reactive protein levels ≤6 mg/L emerged as a strong predictor of SSP in multiple regression analysis. The findings underscore the potential utility of CRP as a predictive biomarker in guiding the management and treatment strategies for ureteric stones.

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.

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.

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.

Effect of Silodosin in the Treatment of Distal Ureteral Stone

Background: Ureteral stones are a common type of urinary tract stones, accounting for 20% of all cases. The majority of these stones, approximately 70%, are located in the distal ureter. Recent studies have shown that α1- Adrenergic blockers can enhance the spontaneous passage of distal ureteral stones. Objectives: This study was done to compare the outcomes of treating distal ureteral stone with Silodosin, an α1- A adrenergic blocker, versus without Silodosin. Materials and Methods: A total of 70 patients aged between 18 and 50 years, diagnosed with distal ureteral stone, were enrolled in the study, which took place at the Department of Urology, Dhaka Medical College, from October 2017 to March 2019. The patients were divided into two groups: Group A and Group B. Group A consisted of 35 patients who were instructed to drink 3 litres of water daily, while Group B received the same instruction and also received Silodosin 8 mg/day. The treatment duration was four weeks, during which patients were monitored weekly through history, serum creatinine levels, X-ray KUB, and ultrasonogram of KUB. The number of stone expulsions, duration of spontaneous stone passage through the ureter, analgesic dosages, and adverse effects were recorded. Results: The higher expulsion rate in Group B (91.4%) compared to Group A (71.4%) (P=0.031). The mean expulsion duration was significantly shorter in Group B (8.94±3.58 days) compared to Group A (13.08±7.26 days) (P&lt;0.00298). Additionally, Group B required significantly lower analgesic dosages (115.71±75.51 mg) compared to Group A (255.71±108.31 mg) (P=0.00001). No adverse effects were observed in Group A, while two patients in Group B experienced adverse effects (retrograde ejaculation and postural hypotension). Conclusion: These results indicate that 8 mg/day of silodosin facilitates the expulsion of distal ureteral stone of about 5 to 10 mm in diameter in the largest dimension and significantly reduces the number of analgesic dosages.

MP16-01 MACHINE LEARNING MODEL TO PREDICT LIKELIHOOD OF SPONTANEOUS URETERAL STONE PASSAGE

You have accessJournal of UrologyCME1 Apr 2023MP16-01 MACHINE LEARNING MODEL TO PREDICT LIKELIHOOD OF SPONTANEOUS URETERAL STONE PASSAGE Katherine Fischer, Abhay Singh, Joey Logan, Benjamin Schurhamer, Brent Cao, Roby Daniel, Ryan McGregor, Iqra Nadeem, Curran Uppaluri, Alice Xiang, Ester Choi, Yuemeng Li, Yong Fan, Justin Ziemba, and Gregory Tasian Katherine FischerKatherine Fischer More articles by this author , Abhay SinghAbhay Singh More articles by this author , Joey LoganJoey Logan More articles by this author , Benjamin SchurhamerBenjamin Schurhamer More articles by this author , Brent CaoBrent Cao More articles by this author , Roby DanielRoby Daniel More articles by this author , Ryan McGregorRyan McGregor More articles by this author , Iqra NadeemIqra Nadeem More articles by this author , Curran UppaluriCurran Uppaluri More articles by this author , Alice XiangAlice Xiang More articles by this author , Ester ChoiEster Choi More articles by this author , Yuemeng LiYuemeng Li More articles by this author , Yong FanYong Fan More articles by this author , Justin ZiembaJustin Ziemba More articles by this author , and Gregory TasianGregory Tasian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Standard treatment options for patients with a ureteral stone are a trial of passage or surgical intervention. Prior studies have tried to identify factors that predict the likelihood of spontaneous passage, such as stone size and location, but this remains difficult. Successful prediction of spontaneous passage can help avoid the risks of unnecessary surgery or shorten the symptomatic period in patients that will ultimately require surgery. Our goal was to create a machine learning model incorporating patient clinical and imaging characteristics to accurately predict the likelihood of ureteral stone passage. METHODS: We performed a retrospective cohort study of pediatric and adult patients presenting with ureteral stones on CT scan. Chart review was performed to ascertain patient clinical and imaging characteristics and to determine the primary outcome of spontaneous stone passage. A random forest model was built using these characteristics to predict spontaneous ureteral stone passage. RESULTS: 103 pediatric (median age 14 years, 56% female) and 153 adult (median age 57 years, 35.9% female) patients with confirmed ureteral stones were identified. Spontaneous passage occurred in 54% of pediatric and 44.4% of adult patients. Separate models were created for pediatric and adult patients since different features were important for prediction in each cohort. The pediatric model had an accuracy of 70% (95% CI 67-74%) and the adult model 63% (95% CI 58-66%). Stone area was the most important feature in both models (Figure 2). CONCLUSIONS: We created a machine learning model that predicted ureteral stone passage based on clinical and imaging features with 63-70% accuracy. Our long-term aim is to create a deep learning model that incorporates clinical characteristics and automated segmentation of CT imaging to accurately predict stone passage without the need for human abstraction and input. Our hope is that this will allow for better individualized patient care through early identification of those who will have a successfully trial of passage versus those that require surgical intervention. Source of Funding: NIDDK P20 CHOP/ Penn Center for Machine Learning in Urology (P20DK127488)AUA Care Foundation and SPU Sushil Lacy Research Scholar Award (KMF) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e201 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Fischer More articles by this author Abhay Singh More articles by this author Joey Logan More articles by this author Benjamin Schurhamer More articles by this author Brent Cao More articles by this author Roby Daniel More articles by this author Ryan McGregor More articles by this author Iqra Nadeem More articles by this author Curran Uppaluri More articles by this author Alice Xiang More articles by this author Ester Choi More articles by this author Yuemeng Li More articles by this author Yong Fan More articles by this author Justin Ziemba More articles by this author Gregory Tasian More articles by this author Expand All Advertisement PDF downloadLoading ...

MP70-18 WHAT IS THE BEST CLINICAL APPROACH FOR 5-10MM URINARY STONES ON INFANTS? TREAT OR FOLLOW?

You have accessJournal of UrologyCME1 Apr 2023MP70-18 WHAT IS THE BEST CLINICAL APPROACH FOR 5-10MM URINARY STONES ON INFANTS? TREAT OR FOLLOW? Ezel Aydoğ, Mehmet Fatih Özkaya, Furkan Özsoy, Elif Ipek Aksoy, Tarkan Soygür, and Berk Burgu Ezel AydoğEzel Aydoğ More articles by this author , Mehmet Fatih ÖzkayaMehmet Fatih Özkaya More articles by this author , Furkan ÖzsoyFurkan Özsoy More articles by this author , Elif Ipek AksoyElif Ipek Aksoy More articles by this author , Tarkan SoygürTarkan Soygür More articles by this author , and Berk BurguBerk Burgu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are not many researches regarding the management modality for pediatric patients, especially infants. Because of the lack of prospective randomized researches, while ESWL has a more impactful role, the overall management for pediatric patients is almost the same with adults. METHODS: 136 patients that were consulted to our clinic between Jan-2018 to Apr-2022 with incidentally detected 5-10 mm renal stones were randomized into two groups for this prospective study. The treatment group, had undergone a metabolic evaluation and a low-dose CT if required apart from the Ultrasound scans. ESWL was the preferred first approach unless the stone location was lower pole or patient had a history of a prior failed ESWL. Afterwards, either URS or PCNL were preferred depending on the ureter calibration. The control group did not undergo any further diagnostic tesst or surgical approach, unless a G2 hydronephrosis or febrile UTI presented. Two sample t-test was used for statistical analysis. RESULTS: All patients were followed every 2 months during infancy period. 23% of patients (n=16) in the control group were eventually treated with ESWL because of obstruction during ureteral stone passage. 50% of patients (n=34) had spontaneous passage of stone without any complications. At the end of the infancy, there was no significant difference of change on kidney functions between two groups. CONCLUSIONS: 5-10 mm kidney stones on infants that doesn’t cause >G2 hydronephrosis or febrile UTIs can safely be followed without any intervention or extensive metabolic evaluation during the infancy period. Source of Funding: Ankara University © 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 Ezel Aydoğ More articles by this author Mehmet Fatih Özkaya More articles by this author Furkan Özsoy More articles by this author Elif Ipek Aksoy More articles by this author Tarkan Soygür More articles by this author Berk Burgu More articles by this author Expand All Advertisement PDF downloadLoading ...

The Impact of Ureteral Wall Thickness on Spontaneous Passage and Development of Long-term Ureteral Stricture in Patients with Ureteral Stone

To evaluate the association of ureteral wall thickness (UWT) with spontaneous passage (SP) of ureteral stones and formation of ureteral stricture (US) in patients who underwent ureterorenoscopy for ureteral stones. Cohort study. Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Turkey, between January 2019 and June 2021. One hundred and sixty-nine patients with ureteral stones were restrospetively reviewed for maximum stone diameter, stone density, degree of hydronephrosis, parenchymal thickness, and UWT measurement from CT images. The patients were divided into two groups; patients who had (group 1) and had not (group 2) undergone SP of ureteral stones. These two groups were compared for stone characteristics and UWT. Ureterorenoscopy was performed on 52 patients who did not experience SP. Data related to the passage of guide wire and radio-opaque material, drainage method, ureteral wall injury and patients who developed US were recorded. Ureterorenoscopy group were divided into two groups of patients who did and did not develop stricture. These two groups were compared for stone characteristics and perioperative findings. Of the 169 patients, 106 (62,7%) patients spontaneously passed stones. Ureterorenoscopy was performed on 52 patients. US developed in 9 (17%) patients. Maximum stone diameter, density, and antero-posterior (AP) diameter of the renal pelvis and UWT were statistically different between both groups. The degree of hydronephrosis, ureteral wall injury, density, AP diameter of the stones, parenchyma thickness, length of hospital stay, and UWT were found to be significantly increased in the stricture group. UWT is a simple measurement that can be used to predict SP of ureteral stones. It can also predict the development of US after ureterorenoscopy in long-term. Ureteral calculi, Ureterorenoscopy, Ureteral wall thickness, Ureteral stricture.

Management of pediatric ureterolithiasis in the emergency room: A single institution review and new management pathway

Urolithiasis is an increasingly common condition seen in children with an annual incidence of 2-3% in children under 18, and up to 10% in adolescents. Treatment of stones varies including observation, IV hydration, pain management, medical expulsive therapy (MET), or surgery. Though well-studied and often used in adults, MET (alpha-adrenergic antagonists to facilitate passage of ureteral stones), is not routinely prescribed in pediatric patients. The goals of this study were to review a quaternary children's hospital's emergency room frequency of MET utilization for ureterolithiasis as well as evaluate the clinical outcomes of children who were prescribed MET compared to those treated with pain control alone. A retrospective review was performed of children 2 months to 18 years with ureterolithiasis who presented to a quaternary children's hospital ED from 2011 to 2017. The primary outcome was the frequency of MET prescribed. Secondary outcomes included the following comparisons in patients who received MET and analgesics with those who received analgesics alone: hospital admission rate, length of hospitalization, emergency room re-presentation rate, surgical intervention, spontaneous stone passage, urology consultation, how the urology consult affected MET utilization, referral to outpatient urology and nephrology clinics, and CT utilization in the ED. Comparisons were performed utilizing Fischer's exact and t-tests. 139 patients were included with a mean age of 14 years (SD 4.14), 42% male. There was no difference between age, gender, stone size, return to the ED, serum creatinine, or length of hospitalization (if admitted) between patients who were and were not placed on MET. The rate of stone passage was significantly higher for those placed on MET (45%) versus not (20%)(p=0.0022). Urology was consulted for 93% of the cases where children were prescribed MET, compared with only 52% of cases where MET was not prescribed (p = <0.0001). In our experience MET was significantly underutilized in patients where urology was not involved. This is similar to a study by Itano etal. which found urology consultation in the ED significantly increased use of tamsulosin for ureterolithiasis in adults. Children with ureterolithiasis placed on MET had a significantly higher rate of stone passage compared to children managed by pain control alone. Given the benefits of MET to increase the rate of spontaneous stone passage it may be considered first line therapy for treatment of children with ureterolithiasis.

Factors Affecting the Outcome of Medical Treatment in Cats with Obstructive Ureteral Stones Treated with Tamsulosin: 70 Cases (2018-2022).

Simple SummaryOther than surgical approaches the treatment options for feline ureterolithiasis are limited compared to those of human medicine. After various studies on ureteral muscle relaxation drugs, tamsulosin has been used as a treatment for distal ureteral stones in human medicine. However, the available clinical veterinary data on the efficacy of drugs that relax the ureter are limited. Thus, this study aimed to investigate the factors affecting the outcome of tamsulosin treatment for feline ureterolithiasis. With tamsulosin treatment, the ureteric stone passage was confirmed in 22 out of 70 cats, with a success rate of 31.43%. Negative factors with statistical significance for stone passage in this study were high baseline creatinine levels, female sex, proximal location of stones, and large diameter stones. The results of this study suggest that tamsulosin can be considered for the treatment of ureterolithiasis in cats with small distal ureteral stones. In addition, this study serves as an important reference for determining whether medical treatment of feline ureteral obstruction using tamsulosin can be attempted.The incidence of diseases associated with feline ureteral obstruction is increasing; however, non-surgical treatment options are limited. This study evaluated the outcome of medical treatment in cats with obstructive ureteral stones treated with tamsulosin and identified potential factors predicting spontaneous stone passage. We retrospectively reviewed 70 client-owned cats treated at the Western Referral Animal Medical Center, Seoul, Korea, from 2018 to 2022. All the cats had obstructive ureterolithiasis and were treated using tamsulosin. The baseline characteristics of the cats, stone diameter and location, and stone passage outcomes were analyzed. Stone passage occurred in 22 cats; the remaining 48 cats showed no change in stone locations. Sex, creatinine, and diameter and location of stones were potential risk factors associated with successful stone passage, but age, weight, and side of the stone were not. No serious adverse events related to tamsulosin treatment were observed. This is the first study to identify the risk factors predictive of the spontaneous stone passage of cats with obstructive ureterolithiasis after tamsulosin treatment. Tamsulosin could be an alternative treatment for ureteral obstruction in male cats with smaller distal ureteral stones and low baseline serum creatinine levels. These findings could help develop guidelines for treating feline ureterolithiasis.

The use of tamsulosin in the treatment of 10–15 mm lower ureteral stones in adults: a double-blinded randomized controlled trial

BackgroundThe discovery of alpha-adrenergic receptors in the ureteral smooth muscle cells led to a thorough investigation of the therapeutic potential of alpha-blockers for ureteral calculi. Tamsulosin is a selective blocker of alpha-1A and alpha-1B adrenoceptors. It significantly improved the expulsion of distal ureteral stones measuring 3–10 mm in most randomized trials. To the best of our knowledge, tamsulosin was not tested before in the management of ureteral stones 10–15 mm. Hence, the present study aimed at estimation of the efficacy of tamsulosin in the expulsion of lower ureteral stones 10–15 mm in length compared to placebo in adult patients (primary goal) and the need for ureteral dilatation at scheduled ureteroscopy.MethodsBetween November 2017 and November 2019, 80 patients with distal ureteral stones 10–15 mm were divided into two equal groups. One group received tamsulosin 0.4 mg/day and the other received a placebo. Patients were followed-up for 8 weeks.ResultsSix patients of the tamsulosin group (15%) passed their stones spontaneously compared to none of the placebo group (p = 0.026). Two of the 6 patients who passed the ureteral stones developed urinary retention and required endoscopic treatment of urethral stones. So, the adjusted spontaneous ureteral stone passage ratios for the tamsulosin and the control groups were 10 and 0%, respectively (p = 0.12). Overall, 37.5% reported adverse effects in the tamsulosin group, and 30% in the placebo group (p = 0.7). The most common adverse effect reported in both groups was dizziness, which occurred more frequently with tamsulosin (25%) than placebo (22.5%) (p = 0.9). We noticed increased ejaculatory dysfunction among men in the tamsulosin group versus placebo group [17.9% vs. 3.5% (p = 0.1)]. Among patients who needed ureteroscopy, ureteral dilatation was always needed in the control group versus 85.3% of the tamsulosin group (p = 0.015). Although 23.5% of the treatment group didn’t need stents after ureteroscopy compared to only 12.5% of the control group, this difference was not statistically significant (p = 0.2).ConclusionsAlthough tamsulosin significantly increased spontaneous passage of 10–15 mm lower ureteral stones in adults, it did not decrease the need for operative intervention. Preoperative tamsulosin significantly facilitated ureteral dilations during ureteroscopic management.

Evolving Role of Silodosin for the Treatment of Urological Disorders - A Narrative Review.

Use of α-androgenic receptor blockers remains a mainstay therapeutic approach for the treatment of urological diseases. Silodosin is recommended over other α-blockers for the treatment of lower urinary tract symptoms (LUTS) and benign prostate hyperplasia (BPH), due to its high α1A uroselectivity. Current research data suggest that silodosin is efficacious in the management of various urological diseases. Thus, we herein review the current evidence of silodosin related to its efficacy and tolerability and appraise the available literature that might ultimately aid in management of various urological conditions at routine clinical practice. Literature reveals that silodosin is beneficial in improving nocturia events related to LUTS/BPH. Silodosin exerts effect on relaxing muscles involved in detrusor obstruction, therefore prolonging the need for patients undergoing invasive surgery. Silodosin treatment, either as a monotherapy or combination, significantly improves International Prostate Symptom Score (IPSS) including both storage and voiding symptoms in patients with BPH/LUTS. Patients on other treatment therapies such as phosphodiesterase 5 inhibitors or other α-blockers are well managed with this drug. Steadily, silodosin has proved beneficial in the treatment of other urological disorders such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), overactive bladder/acute urinary retention (AUR), premature ejaculation (PE), and prostate cancer post brachytherapy-induced progression. In patients with distal ureteral stones, silodosin treatment is beneficial in decreasing stone expulsion time without affecting stone expulsion rate or analgesic need. Moreover, there were significant improvements in intravaginal ejaculation latency time, quality of life scores, and decrease in PE profile among patients with PE. Silodosin has also demonstrated promising results in increasing the likelihood of successful trial without catheter in patients with AUR and those taking antihypertensive drugs. Reports from Phase II studies have shown promising role of silodosin in the treatment of CP/CPPS as well as facilitating ureteral stone passage. From the robust data in this review, further silodosin treatment strategies in the management of different urological conditions need to be focused on.

The role of inflammatory serum markers and ureteral wall thickness on spontaneous passage of ureteral stone < 10 mm: A prospective cohort study

IntroductionUreteral stone is a worldwide disease and accounts for 20% of all urolithiasis. There is a widespread discussion on the preferred initial treatment method, whether medical or surgical, and each has its pros and cons. In this study, we aimed to assess the role of both ureteral wall thickness around the stone and inflammatory markers in guiding the decision-making process. MethodsIn this prospective study, 161 patients who presented with ureteric colic and were diagnosed with ureteral stone with NCCT were included. UWT around the stone was measured, and the NLR and PLR were calculated. The patients were given a single daily dose of tamsulosin 0.4 mg for 4 weeks with weekly follow-up to determine SSP or failure. ResultsOf the 161 patients with a mean age 40.12 ± 12.36 SD, 55.9% had a spontaneous stone passage. Receiver operating characteristics showed a cut off value of 2.45 mm UWT of non SSP patients with an 83% sensitivity and 86% specificity. Moreover, there was a significant correlation between higher NLR, PLR and increased UWT (Pearson correlation of 0.314 and 0.426 respectively). The combined higher NLR, PLR and increased UWT were associated with failure of SSP (p-value <0.001). ConclusionMany factors play a role in decision making for management of ureteral stones. Our study concludes that patients with high NLR, PLR, and UWT around the stone have lesser chance of SSP using MET. Their rise can be used as predictors to decide early intervention.