Site Of Stones Research Articles

Medial deviation of the ureter is a new sign that could predict stone impaction: a pilot study

ObjectiveTo assess the value medial deviation of the ureter at site of ureteric stone as a sign of ureteric stone impaction.Patients and methodsAll cases with medial deviation of the ureter at site of ureteric stones in our department over 4 years were enrolled in this pilot study. All cases were diagnosed with KUB and non-contrast CT (NCCT). Radiological and ureteroscopic findings were recorded.ResultsA total of 32 patients with a single impacted stone in the proximal and middle third of the ureter were included in the study. Medial deviation of the ureter at the site of the stone was detected in the upper third of the ureter in 24 (75%) cases and in the middle third in 8 (25%) cases. There were mucosal polyps and mucosal erythema (inflammatory changes) seen by ureteroscopy in all cases (100%). Ureteroscopy was successfully completed with stone fragmentation in 23 (71.8%) patients: 8 of them needed ureteric catheter and 15 required JJ stent insertion. Failure of ureteroscopy with insertion of JJ stent was done in 5 (15.6%) patients. Removal of the stent and ureteroscopy was done after 4 weeks.ConclusionWe conclude from this study that medial deviation of the ureter is a new reliable radiological sign of ureteric stone impaction.

Detection of Renal Stones by Ultrasonography

Background: Kidney stones also known as renal stones are hard deposits made of minerals that develop in the urinary system or kidneys. Numerous symptoms, including excruciating pain in the lower back, abdomen, or groin, nausea, and vomiting, can be brought on by renal stone. Objective: To evaluate the accuracy of ultrasonography for the presence, location, and site of stones in patients with acute renal colic Methods: This research was conducted in the radiology department of the Jalal Pur Diagnostic Centre. Data were acquired from October 2022 to March 2023.100 patients were included in the study. Patient-informed permission was acquired following the ethical standards outlined by the research committee. Results. The study shows that 74% of patients have unilateral renal stones while 26% have bilateral renal stones. About 43 people had urolithiasis on the left side. The majority of stones were present in the lower pole of the kidney. Conclusion: Ultrasonography can be utilized as a primary evaluation technique in patients presenting with acute renal colic. Males are most commonly affected by renal stones than females and patients between the ages of 31 and 45 are the most usually affected.

Concerns about stone free rate and procedure events of percutaneous nephrolithotripsy (PCNL) for 2–4 cm kidney stones by standard-PCNL vs mini-PCNL- comparative randomised study

BackgroundTo compare the efficacy and safety of standard percutaneous nephrolithotomy (PCNL) with mini- PCNL for kidney stones 2–4 cm.MethodsEighty patients were enrolled in a comparative study, they were randomly divided into mini-PCNL group (n = 40) and standard-PCNL (n = 40). Demographic characteristics, perioperative events, complications, stone free rate (SFR) were reported.ResultsBoth groups showed no significant difference in clinical data about age, stone location, back pressure changes, and body mass index. The mean operative time was (95 ± 17.9 min) in mini-PCNL, and (72.1 ± 14.9 min). Stone free rate were 80% and 85% in mini-PCNL and standard-PCNL respectively. Intra-operative complications, post-operative need for analgesia, hospital stay were significantly higher in standard-PCNL compared to mini-PCNL (85% vs. 80%). The study followed CONSORT 2010 guidelines for reporting parallel group randomization.ConclusionMini-PCNL is an effective and safe treatment of kidney stones 2–4 cm, it has the advantage over standard-PCNL being has less intra-operative events, less post-operative analgesia, shorter hospital stay, while operative time and stone free rate are comparable when considering multiplicity, hardness, and site of stones.

Ureteral wall thickness and distal ureteral density in patients with residual fragments after Ho:YAG laser semi-rigid ureterolithotripsy.

Recent data suggest that greater ureteral density distal to ureteral stones or increased ureteral wall thickness (UWT) can predict impacted stones. The aim of our study was to evaluate if patients with residual fragments present with greater ureteral density and larger UWT when compared to stone-free patients. From January onward, a consecutive series of patients undergoing semi rigid Ho:YAG laser ureterolithotripsy (ULT) for ureteral stones were enrolled. A non-contrast enhanced computed tomography (CT) scan was performed before the procedure to evaluate distal ureteral density (DUD) and wall ureteral thickness (UWT) at the site of ureteral stones. Patients with residual fragments were compared to stone-free patients using a matched-pair analysis (1:1 scenario). Cases were matched sequentially using the following criteria: age, gender, body mass index (BMI), stone length, hydronephrosis, location of stones, and mean Hounsfield unit (HU) of the stone. Overall, 160 patients were enrolled, mean age was 57.9 ± 14years, mean BMI was 25.8 ± 4kg/m2, mean length of the stone was 10.6 ± 4.9mm, and mean UWT was 1.4 ± 1.6mm. A total of 150/160 (94%) patients presented hydronephrosis; mean HU stone was 868 ± 327; mean DUD was 54 ± 17.8 HU. Ureteral distal density (51.7 vs 56.6; p = 0.535) and ureteral distal thickness (1.39 vs 1.54; p = 0.078) were similar in both groups of patients. In our study, the evaluation of distal ureteral density does not predict stone-free rate. Further studies should evaluate the role for preoperative computer tomography in predicting surgery outcome.

Urolithiasis: a descriptive study in a single urological unit at a tertiary care hospital

Introduction: Urolithiasis is the most prevalent surgical disorder of urinary tract in Asia. The prevalence of urolithiasis varies with demographic factors. There are many treatment options feasible. The specific treatment approach depends on composition, location, size of the stones and preferences of the patients and hospital capability. Objective: The aim of the study was to assess the demographic details, clinical presentation, and management of patients with urolithiasis in a single urological unit at a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in a total of 247 diagnosed urolithiasis patients in a single urological unit at a tertiary care hospital from August 2021 to July 2022. Data were collected from patients' records; demographic details, clinical presentation and management of urolithiasis were retrieved. Collected data were analyzed with SPSS 26.0. Results: Among the 247 patients, the majority were males (n=159, 64.4%). Patients ranged from the age of 13-83 years, with a mean age of 48.8 (SD: 15.2) years. The most common presenting symptom was pain (n=150, 60.7%). In 45.3% (n=112) comorbidities such as diabetic mellitus (n=64), hypertension (n=77), hyperlipidemia (n=29), chronic kidney disease (n=15) and ischemic heart disease (n=12) were seen. The majority had single stones (n=171, 69.2%). The commonest site of stones was on the left urinary tract (n=101, 40.9%) followed by right (n=95, 38.5%), and bilateral (11.3%), Bladder (8.5%) and urethra (0.8%) were the other sites. The ureteric stones (n=125, 50.6%), and a mean size of 14.8mm (SD: 11.7) were more common than renal stones (n=74, 30.0%), and a mean size of 19.9mm (SD 11.8). The majority (n=186, 75.3%) were treated surgically. Conclusion: Urolithiasis was more commonly seen in males. The commonest presentation was pain, and the site was ureter. Nearly half of the patients had at least one non-communicable comorbidity, and the majority were treated surgically.

Late Woodland feasting and social networks in the lower Missouri River region

Feasting and its function among small scale societies have received little attention among many descriptive and theoretical studies of this activity. Evidence of feasting focused on large roasting pits by Late Woodland (AD 500–1000) hunter-gatherer-gardeners in the lower Missouri River region on the eastern edge of the Great Plains is presented. Two features at the Quixote site and lipid analyses of stones from them attest single events focused on roasting deer and fish, and perhaps ritual use of red cedar and ceramic pipes. Such features at other Late Woodland sites in the LMRR, specifically the Valley Falls locality of the Delaware River valley in northeastern Kansas, are reinterpreted. Burned stone features at Middle Woodland sites differ and suggest pit roasting was a practice of dispersed Late Woodland groups. Feasting for solidarity forged a social network based on reciprocity, not competition, to mitigate food insecurity among diffuse, low level food producers.

A Prospective Study on Evaluation of Efficacy of Combination Therapy of Tamsulosin and Deflazacort In Ureteric Stone Expulsion

The patients with ureteric stone are increasing day by day all over the world. A ureteric stone is a mineral mass in the ureter which may or may not originated in the kidney and travelled down to the ureter. The presence of stone in ureter causes inflammation and edema. There are mainly four types of ureteric stone such as Calcium stones, Uric acid stones, Struvite stone, Cystine stone. About 23-53% of spontaneous stone expulsion occurs where the size of stone is 5-10mm diameter. Tamsulosin is an alpha 1 adrenergic blocker which has a spasmolytic action and thus hasten stone expulsion. Deflazacort is a corticosteroid prodrug which acts on the glucocorticoid receptor to show an anti-inflammatory effect. Deflazacort decreases the edema and when prescribed along with alpha 1 adrenergic receptor blocker it facilitate the expulsion of calculi. This study was conducted in 20 patients diagnosed with ureteric calculi. The study was conducted by using suitable proforma for collecting various data’s like site of stones, presence of hydronephrosis, signs and symptoms. Health related quality of life of the patients with ureteric calculi under the treatment of Tamsulosin and Deflazacort combination were assessed by using Wisconsin Stone-QOL questionnaire. As counselling aid patients information leaflet was provided. The patients were asked to review after 10 days of taking the medication. At the end of the study all the parameters and scores were compared with baseline to the end of the study. In our study we analyzed that the data collected from 20 patients diagnosed with ureteric calculi accessed the improvement of quality of life of patients under the treatment of Tamsulosin and Deflazacort combination by using Wisconsin Stone-QOL questionnaire. The observed difference before and after the treatment with Tamsulosin and Deflazacort w

The Role of Endoscopic Ultrasound in Patients with Choledocholithiasis: A pilot study

Background and study aim. Endoscopicultrasound (EUS) is a diagnostic modality that continuesto expand its clinical applications. The aim of this studyis to evaluate the diagnostic role of EUS in commonbile duct stones. Patients and methods: This study wascarried on 29 patients with suspected CBD stones fromthem only 15 patients were diagnosed as Common BileDuct stone(s). Endoscopic retrograde cholangiopancreatography(ERCP) is considered as gold standard fordiagnosis of CBD stones and compare EUS findingswith that of ERCP. Results: The diagnostic performanceof EUS shows that the sensitivity, specificity, PPV, NPVand accuracy of 100%, 92.8%, 93.7%, 100% and 96.5%respectively. It can catch 15 true positive cases withonly one false positive case and 13 of 14 true negativecases. EUS is considered as a minimally invasivemethod with low incidence of complications, allowingexact determination of the site and size of stones. SoEUS aid in better planning for CBD stone removal.Conclusion: EUS is considered as a minimally invasivemethod with low incidence of complications, allowingexact determination of the site and size of stones withgood diagnostic performance.

A 13 year hospital based study on the Trend of Urinary Stone Disease in Uttarakhand, India.

BackgroundThe present retrospective study on urinary stone disease in the Uttarakhand state was necessitated as no study has been done yet.MethodsA 13 year retrospective study (from 2005 to 2018) was conducted on the urinary stones removed from the patients, admitted at Himalayan Institute of Medical Sciences, Dehradun. The incidence of the disease, site of stones in urinary tract upon diagnosis, composition of removed stones and occurrence of a possible co-relationship between the incidence of the urinary stone disease at different times, age, sex, religion of the patients was investigated.ResultsThe frequency of occurrence of urinary stones in males was found to be almost three times more as compared to their female counterparts. The above trend was consistent over the entire period of the study. Interestingly, in the Muslim and Sikh population of the area, females were found to be less prone to the problem as compared to their Hindu counterparts. However, in all religious groups, 21-40 years old subjects were found to be most susceptible to the problem and approximately 90% of the urinary stones were recovered from the kidneys and primarily composed of calcium oxalate.ConclusionThe co-relationship between the occurrence of urinary stones with age, sex of the patients, their religion & site of stones on diagnosis was found to be statistically significant.

Role of Medical Expulsive Therapy in Ureterolithiasis

Objective: Medical expulsive therapy (MET) for urolithiasis has gained increasing attention in the last few years. MET is an excellent treatment modality for ureteric stones in the appropriately selected patients. This study was carried out to study the role of MET in the treatment of upper/middle/lower ureteric and VUJ calculi to compare the safety and efficacy of tamsulosin and tamsulosin with Deflazacort as medical expulsive therapy for ureteric stones. Materials and methods: Between July 2013 to June 2014, 105 adult patients with ureteric stones sized 5mm to 10mm were randomized equally to treatment with tamsulosin or tamsulosin with deflazacort. Therapy was given for a maximum of 6 weeks. The stone expulsion rate, mean time to expulsion (days), site of stones passed, endoscopic treatment (URS) and adverse effects of the drugs were noted. Statistical analysis was done by using student’s t-test and chi-square test. Results: Total 105 patients were included in this study. Only Tamsulosin 0.4mg once daily was given to 53 patients in group A. Fifty two patients in group B were treated with Tamsulosin 0.4mg once daily plus Deflazacort 6mg twice daily.The stone expulsion rate was 84.9% (45/53) in group A and 96.1% (50/52) in group B. Mean expulsion time (days) was shorter in group B. It was 4.96 days in group B compared with group A (8.53 days) which was highly statistically significant. Conclusion: Medical expulsive therapy (MET) for ureteric stones using tamsulosin and tamsulosin with Deflazacort is safe and efficacious. Tamsulosin with Deflazacort is very effective in expelling stones present in all the levels of the ureter. Bangladesh Journal of Urology, Vol. 17, No. 2, July 2014 p.67-70

Medical expulsive therapy: a cost effective evidence-based definitive treatment for ureteric stones

Background: The lifetime risk of kidney stones is between 5% and 10% and rates of recurrence are as high as 50%. Majority of the ureteric stones (70%) are found in the lower third of the ureter. Available setup, type, size of the stone, and expertise of the surgeon are the major factors affecting the treatment modality. Medical expulsive therapy has shown promising results in previous studies. Aim of the study was to assess the efficacy of tamsulosin and deflazacort combination therapy for stone expulsion in relation with site and size of stones.Methods: A total of 97 patients with ureteric calculi of size 10 mm or less attending the urology out-patient department were included. Received medical expulsive therapy using tamsulosin (0.4 mg) and deflazacort (30 mg) for 7 days. Patients were evaluated for stone expulsion on 7th day by non-contrast computed tomography of kidney ureter bladder. Site, side and size of stones were noted.Results: Ureteric calculi was more prevalent in the age group of 21-30 years 38 (39.2%). Male preponderance was observed (76.28%) with male female ratio being 3.2:1. Lower site 64 (65.97%) ureteric calculi were most common. The majority had a stone size of 4-6 mm (42%). Stones were expelled on 7th day in 69 (71.13%) patients. Expulsion rates were highest for the stone size of 2-4 mm (94.4%) followed by 4-6 mm (88.1%). The highest expulsion rates were observed for Lower ureteric stones (84.4%).Conclusions: Medical expulsive therapy using tamsulosin and deflazacort is an effective treatment modality for the management of ureteric stones, especially those present in lower ureter and those ≤8 mm in size.

THE ROLE OF ULTRASONOGRAPHY IN THE DETECTION OF UROLITHIASIS IN PATIENTS WITH ACUTE RENAL COLIC

This study was conducted to assess the diagnostic Ultrasonography compared to unenhanced helical CT scan in detecting urinary stones in patients with acute renal colic. This retrospective study comprised of 156 patients who undergo unenhanced urinary tract CT scan and ultrasonography for thought of urolithiasis. Both techniques were used to resolve the presence or absence, site, size, and number of urinary stones, as well as company of any other intra-abdominal pathology. For statistical analysis, the sensitivity, specificity, predictive values, and diagnostic accuracy of ultrasonography were deliberate considering unenhanced CT scan as a gold normal. Unpaired two-tailed student’s t-test was used for judgment between mean size of true positive, false positive, and false negative stones. There were 68 patients having 115 urinary stones. Ultrasound identified 54 stones, missed 43, and falsely diagnosed 18 stones. The mean size of true positive, false positive, and false negative stones were 4.8 ± 3.3 mm, 6 ± 1.8 mm and 4.18 ± 3 mm, respectively. There were 23 patients with other intra-abdominal pathologies, equally detected by both techniques. Ultrasound helped in identifying the cause of acute flank pain in 62% of cases. The overall sensitivity, specificity, positive and negative predictive values, and correctness of ultrasonography in the diagnosis of renal stone disease were 58%, 91%, 79%, 78%, and 78%, respectively. Our study suggests that, despite its limited value in detecting urinary stones, ultrasonography should be performed as an initial assessment in patients with acute flank pain. Unenhanced helical CT should be reserved for patients in whom ultrasonography is uncertain.
 Keywords: Ultrasonography, CT scan

The role of endoscopic ultrasound in patients with choledocholithiasis: A pilot study

Background and study aim. Endoscopicultrasound (EUS) is a diagnostic modality that continuesto expand its clinical applications. The aim of this studyis to evaluate the diagnostic role of EUS in commonbile duct stones. Patients and methods: This study wascarried on 29 patients with suspected CBD stones fromthem only 15 patients were diagnosed as Common BileDuct stone(s). Endoscopic retrograde cholangiopancreatography(ERCP) is considered as gold standard fordiagnosis of CBD stones and compare EUS findingswith that of ERCP. Results: The diagnostic performanceof EUS shows that the sensitivity, specificity, PPV, NPVand accuracy of 100%, 92.8%, 93.7%, 100% and 96.5%respectively. It can catch 15 true positive cases withonly one false positive case and 13 of 14 true negativecases. EUS is considered as a minimally invasivemethod with low incidence of complications, allowingexact determination of the site and size of stones. SoEUS aid in better planning for CBD stone removal.Conclusion: EUS is considered as a minimally invasivemethod with low incidence of complications, allowingexact determination of the site and size of stones withgood diagnostic performance.

Petrography and mineralogy of the white marble and black stone of Göktepe (Muğla, Turkey) used in antiquity: New data for provenance determination

The discovery near Göktepe (Muğla province, Western Turkey) of an ancient quarrying site of white marbles and black stones has recently been reported by some authors. Assigning the provenance of stone from ancient artifacts to Göktepe is currently possible mainly thanks to chemical, EPR and MGS data. Petrographic description, which many researchers use to characterize ancient marbles, is still incomplete. Several thin sections of both types of stone were thus examined in this study, and also used for cathodoluminescence analysis. As the rock is >99% calcite, trace minerals could only be detected in some samples by XRD analysis of insoluble residues after acetic acid attack. Data on strontium and manganese contents and carbon and oxygen isotopes were also recorded, for better understanding of some petrographic features.A new method of grain size characterization was tentatively introduced to improve the description of grain size variability in the white marble. Microstructure and grain size measurements on thin sections of this marble identify two petrographic varieties: the first is extremely fine with signs of dynamic recrystallization, and the second exhibits texture and MGS similar to those of Carrara marble.Statuary samples of white marble from Villa Adriana (Tivoli, Rome), preliminarily assigned in a previous study partly to Carrara and partly to Göktepe quarry, are reconsidered here.A certain degree of variability was found in the structures and textures in the thin sections of the Göktepe black stone. It may have undergone transformations at an advanced stage of diagenesis. One important source of this variability seems to be a fluid alteration event, revealed by both isotopic and chemical data and trace mineral assemblages.

Noninvasive Prediction of Renal Stone Surface Irregularities by Numerical Analysis of the Color Doppler Twinkling Artifact: An Ex Vivo Study.

The physical structures of renal stones are highly correlated with their breakability. Noninvasive estimation of stone roughness will be beneficial for management. The intensity of the twinkling artifact appearing at the site of renal stones on Doppler ultrasound imaging is also influenced by the stone's roughness level. This article proposes a quantitative method for roughness prediction of ex vivo renal stones based on a twinkling analysis of their color Doppler images. Twenty surgically removed renal stones were first spatially modeled by an optical method, and 12 standard roughness measures were extracted from them. Stones were then embedded in an agar-based phantom and Doppler imaged with a calibrated ultrasound system. The images were preprocessed, and 11 twinkling intensities were measured numerically. The twinkling data along with the roughness labels were then analyzed by multiple linear regressions, and finally, a linear roughness predictor was trained for renal stones. The core height measure of roughness had the best linear fit to the twinkling data among other roughness parameters. The results of the multiple linear regression analysis indicated a strong linear relationship between twinkling data and stones' roughness, with an R2 value of 83.29% and high statistical significance of F(11,868) = 393.36 and P < .001. It was possible to predict the core roughness of renal stones using the proposed method and the twinkling artifact data acquired from the color Doppler images ex vivo.

OC-009 Spyglass DS™ Cholangioscopy for Difficult Stones: Early Experience of Two UK Centres

Introduction Endoscopic clearance of bile duct stones is achievable in >90% with conventional ERCP (ASGE 2015). Additional techniques may be necessary for those patients with difficult stones, which may be due to stone location, size, or number. Cholangioscopy and intraductal lithotripsy may have a specific role in treating difficult stones. The Spyglass DS™ peroral cholangioscopy system was introduced in mid-2015, and here we report our early experience with this technique. Methods Spyglass DS cholangioscopy was available in the UK from May 2015. Cases referred to our 2 centres were assessed within a specialist HPB multidisciplinary meeting, and all cases deemed appropriate for Spyglass DS were prospectively followed. Patient demographics, indication for cholangioscopy, technical outcome and complications were recorded. Results Eight-four patients (54% female, median age 61 years (range 25–90)) underwent ERCP with plan for cholangioscopy. Indications were stones (83%), strictures (14%) and other (3%). The stones were extrahepatic (62%), intrahepatic (15%), cystic duct (15%), and intra + extrahepatic (8%). The total number of stones was 20 stones in 6%. The 70 patients with stones had undergone a median 2 ERCPs (range 1–7) prior to referral. At our centres duct clearance was achieved in 30% (n = 21/70) without need for cholangioscopy, using combinations of extraction balloon (100%), sphincteroplasty (69%) and mechanical lithotripsy (ML) (54%). Cholangioscopy was needed for 49 cases, in 46 patients. Cholangioscopy with electrohydraulic lithotripsy (EHL) led to complete stone clearance in 72% of patients (33/46), of whom 3 on second EHL. The remaining patients await a second EHL procedure. In the 18 patients with unsuccessful stone clearance to date, reasons included: stone size + density (n = 8 with stones >15 mm); intrahepatic stones (n = 9); inability to apply EHL (n = 1). Overall, stone clearance was achieved in 54/67 (81%) of patients undergoing ERCP +/- cholangioscopy with EHL. The mean (SD) duration of ERCP + cholangioscopy + EHL was 93 (±28) minutes; 90% had propofol sedation, and 10% conscious sedation. No complications were observed. Conclusion In patients who have failed multiple attempts at endoscopic stone clearance, referral to a centre with availability of Spyglass DS cholangioscopy and EHL results in definitive stone clearance in 81% of patients. This success includes further conventional ERCP. Stone clearance with cholangioscopy may be achieved irrespective of site or size of stones, but failure of complete fragmentation with EHL may contribute to need for repeat procedures, and occasional failure. Disclosure of Interest None Declared

The effect of ureteroscope size in the treatment of ureteral stone: 15-year experience of an endoscopist.

We aimed to investigate the ureter stone treatment results performed by using different- caliber semirigid ureteroscopes (URS). Adult patients who were treated for ureteral stones by a single endoscopist between January 2000 and March 2015 were analyzed. The patients were divided into 3 groups in accordance with the caliber of the ureteroscope used: 10/10.5 F Storz (Karl Storz, Tuttlingen, Germany) (January 2002-January 2005) URS was used in group 1, 8.9/9.8 F Storz (February 2005-December 2011) URS was used in group 2, and 6/7.5 FWolf (Richard Wolf, Knittlingen, Germany) (January 2012-March 2015) URS was used in group 3. Patients' age and gender, size and site of stones, stone-free rates (SFR), intra- and perioperative complication rates, and durations of surgery were compared among the groups. Intraoperative complications were classified according to modified Satava, and perioperative complications were classified according to modified Clavien classification systems. A total of 2461 patients treated for ureteral stones were analyzed. There were 583 patients in group 1 (10/10.5 F Storz), 1302 patients in group 2 (8.9/9.8 F Storz), and 576 patients in group 3 (6/7.5 F Wolf). SFR were 83.7%, 87.4%, and 92.2% in groups 1, 2, and 3, respectively (p=0.01). Duration of surgery was 30.34±10.36 min in group 1, 31.61±10.10 min in group 2, and 42.40±7.35 min in group 3 (p=0.01). The overall complication rates classified according to modified Satava classification were 10.8%, 7.6%, and 6.9% (p=0.01) while grade 3 modified Satava complication rates were 1.9%, 1.5%and 0.5% in groups 1, 2, and 3, respectively (p=0.01). In this study, we found that more frequent use of a small- caliber URS resulted in a longer duration of surgery and an increased rate for JJ stent insertion, however it facilitated a safer and more successful ureteroscopy procedure.

MP33-08 PREDICTING FACTORS FOR COMPLICATIONS AND STONE CLEARANCE FOLLOWING PEDIATRIC MINI-PERCUTANEOUS NEPHROLITHOTOMY

INTRODUCTION AND OBJECTIVES: To detect predicting factors for complications and stone clearance following pediatricMiniperc METHODS: From January 2012 to December 2014, children ( 12 yrs) with renal calculi who underwent Miniperc were included (79 children). Nephroscopy was done using 9.5 Fr semirigid ureteroscope through 14 Fr renal access sheath with Holmium:YAG laser lithotripsy. Finally, a 10 Fr percutaneous nephrostomy (PCN) was inserted. Effects of different factors on complications and stone free rate (SFR) were compared using Chi square or Fischer exact tests. RESULTS: Mean age was 58.1 31.3 months (6-144) while stone size was 16.3 7.9 mm (5-49). 22 (27.8%) stones were 20 mm while 8(10.1%) stones were branching. Multiple stones were present in 25(31.6%) patients. Single puncture was used except in 4 patients (5.1%). Operative time was 64.7 28.5 min (25-180). Complications were bleeding (3.8%), blood transfusion (1.3%), renal pelvis perforation (2.5%), postoperative leakage from PCN tract (5.1%) and fever (17.7%). SFR after primary-Miniperc was 86.1%. Second-look Miniperc was required in 3.8% with SFR improvement to 89.9%. Auxiliary ESWL was performed for 6.3% with SFR improvement to 94.9%. If the 3 patients with clinically insignificant residual fragments (CIRF) were included, SFR would be 98.7%. SFR was significantly lower in children with 2 stones (p 1⁄4 0.011), with stone size 20mm (p 1⁄4 0.005), with grade 2-3 hydronephrosis (p 1⁄4 0.019), and when stones were in other sites than pelvis (p 1⁄4 0.042) (Table 1). Complication rate was not affected by sex, degree of hydronephrosis, side, number, size, shape or site of stones (Table 2). CONCLUSIONS: Miniperc has high SFR in children using 14 Fr sheath and 9.5 Fr ureteroscope with acceptable complications. Stone clearance is affected by the presence of 2 stones, size 20mm, and when stones were in other sites than pelvis. Source of Funding: none

전자기식 체외충격파쇄석술시 하부요관 결석 환자에 대해 적합한 충격강도와 C-arm 총 가동시간

The advantages and disadvantages of the various models of crushed ESWL (Extracorporeal Shock Wave Lithotripsy) and their various side effects due to pre-treatment have been reported. We look for the appropriate intensity of the shock wave in the electromagnetic ESWL treatment of patients with lower Inferior Ureter Stones and measure the total running time of C-arm saw. This study is based on the January-June 2014 launch of 65 patients of C university hospital located in Gyeongbuk, who conducted ESWL without pre-treatment. Patients are composed of 48 male and 17 female which were more common in men, while the most common age is 50s. The occurrence of lower urinary tract stones were left and they were more absent than 5mm in size in 39 of the most common. Optimal intensity is one of the suitable intensity of pain, and it is possible to switch the strength of impact to C if one appeals pain. In addition, the C-arm of the total operating time showed 241.73±30.37 seconds, which is the size of the lower urinary tract that showed a significant difference (p <0.05). Therefore, ESWL treatment without pre-enforce treatment, the standard for the impact frequency and impact strength depending on the site of ureteral stones is required. The standard for total operating time of C-arm generated for ureteral stones is needed in order to reduce radiation exposure, and the standard for the total operating time for the criteria is needed depending on the site in order to minimize the exposure.

Lithotripsy for salivary stones with prospective US assessment on our first 25 consecutive patients

ObjectivesTo evaluate the predictive value of sonographic fragmentation in the successful treatment of sialolithiasis.The main objective was to streamline the management by treating the patients with three sessions of ultrasonic lithotripsy, and to compare the success rate and complications with data from the literature. A second objective was to analyse the predictive value of data from the post procedure and follow-up sonography related to therapeutic success with regard to size, site and location of stones. Material and methodsProspective follow-up of 25 patients (mean age of 43 ± 17.2 years old 11–68; 13 women, 10 men) over a period of 31 months (October 2009–April 2012) with one or more salivary calculi (19 parotid, submandibular 6) treated with extracorporeal lithotripsy (electromagnetic MINILITH SL 1, Storz Medical, Switzerland). No anaesthesia or analgesia was used. Each session of lithotripsy lasted on average 30 min. Minor complications were collected on an anonymised sheet. ResultsComplete success (absence of clinical symptoms 3 months after the end of treatment (or the last session) and residual stones <2 mm) was observed in 36% of patients, partial success (persistence of symptoms least 3 months (lower intensity and lower frequency) or size of residual stones>2 mm) in 48% and failure (persistence of same or increased symptoms at 3 months or no change in size of the calculi) in 17% of patients.Sonographic fragmentation of the stone (p = 0.004), total energy delivered (p = 0.008) and the total number of shock waves (n = 0.045) are predictive factors of complete success. Size, salivary topography, ductal topography, mobilization of the stones, occurrence of minor side effects and total duration of treatment had no predictive value of complete success (p > 0.05). There was no significant difference between the first 5 and the last 20 patients (p = 0.367).In agreement with the literature data, the efficacy of treatment was greater for parotid than submandibular calculi. ConclusionExtracorporeal lithotripsy is an alternative to conventional surgery with no major complications. Sonographic fragmentation of calculi, total energy and total number of shock waves are predictive factors of successful treatment.