Spontaneous Passage Research Articles

LO24: What patients need early surgical intervention for acute ureteric colic?

Introduction: Ureteral colic is a common painful disorder. Early surgical intervention is an attractive management option but existing evidence does not clarify which patients benefit. Based on lack of evidence, current national specialty guidelines provide conflicting recommendations regarding who is a candidate for early intervention. We compared treatment failure rates in patients receiving early intervention to those in patients offered spontaneous passage to identify subgroups that benefit from early intervention. Methods: We used administrative data and structured chart review to study consecutive patients attending one of nine hospitals in two provinces with an index emergency department (ED) visit and a confirmed 2.0-9.9 mm ureteral stone. We described patient, stone and treatment variables, and used multivariable regression to identify factors associated with treatment failure, defined as the need for rescue intervention or hospitalization within 60 days. Our secondary outcome was ED revisit rate. Results: Overall, 1168 (37.9%) of 3081 eligible patients underwent early intervention. Patients with small stones <5mm experienced more treatment failures (31.5% v. 9.9%) and more ED revisits (38.5% v. 19.7%) with early intervention than with spontaneous passage. Patients with large stones ≥7.0mm experienced fewer treatment failures (34.7% v. 58.6%) and similar ED revisit rates with early intervention. Patients with intermediate-sized 5.0-6.9mm stones had fewer treatment failures with intervention (37.4% v. 55.5%), but only if stones were in the proximal or middle ureter. Conclusion: This study clarifies stone characteristics that identify patients likely to benefit from early intervention. We recommend low-risk patients with uncomplicated stones <5mm generally undergo initial trial of spontaneous passage, while high-risk patients with proximal or middle stones >5mm, or any stone >7mm, be offered early intervention.

MP10: Does early intervention improve outcomes for patients with acute ureteral colic?

Introduction: The optimal initial management approach for ureteral colic is unclear. Guidelines recommend spontaneous passage for most patients, but early stone intervention may rapidly terminate acute episodes. We compared 60-day treatment failure rates in matched patients undergoing early intervention versus spontaneous passage. Methods: We used administrative data and structured chart review to study all emergency department (ED) patients at nine Canadian hospitals who had an index ureteral colic visit and a computed tomography (CT) confirmed 2.0-9.9 mm stone during 2014. Using Cox Proportional Hazards models, we assessed 60-day treatment failure, defined as hospitalization or rescue intervention, in patients undergoing early intervention compared to propensity-score matched controls undergoing trial of spontaneous passage. Results: From 3,081 eligible patients, mean age 51 years and 70% male, we matched 577 patients in each group (total 1154). Control and intervention cohorts were balanced on all parameters and propensity scores, which reflect the conditional probability a patient would undergo early intervention, were similarly distributed. In the time to event analysis, 21.8% in both groups experienced the composite primary outcome of treatment failure (difference = 0%; 95% CI, -4.8 to 4.8%). Early intervention patients required more ED revisits (36.1% v. 25.5%; difference 10.6%; 95% CI 5.3 to 15.9%) and more 60-day hospitalizations (20.1% v. 12.8%). The strongest predictors of adverse outcome were stone size, proximal or middle stone location, and ED length of stay. Conclusion: If applied broadly to patients with 2.0-9.9mm ureteral stones, an early interventional approach was associated with similar rates of treatment failure, but more hospitalizations and emergency revisits. Research clarifying subgroups most likely to benefit will facilitate better targeting of early intervention, potentially reducing patient morbidity and improving system utilization.

P069: Does specialist referral influence emergency department return rate for patients with renal colic? A retrospective cohort study

Introduction: Renal colic is a common presentation which exerts a significant burden on healthcare infrastructure. A significant proportion of patients managed with observation may return to the Emergency Department (ED) prior to spontaneous passage due to inadequate analgesia. It is unclear whether early urologist consultation would limit the burden of renal stones by reducing returns to the ED. We wished to determine whether urologist referral from the ED department is associated with fewer returns to the ED with renal colic. Methods: We conducted a retrospective chart review using RECORD methodology of consecutive patients diagnosed with CT-confirmed, ureteric or renal calculi in our ED over a two-year period. Disposition was categorized as either hospital admission, outpatient urologist referral, follow up with primary care, or no follow up. The primary outcome was the 30-day ED re-presentation for renal colic. Multivariate logistic regression was used to identify predictors for ED-return. Results: In total, 232 patients met our inclusion criteria. Urgent or outpatient urologist referral was not associated with a significantly lower ED return rate when compared to patients with no follow-up. Surprisingly, urologic intervention and stent placement were both independent predictors for ED return (OR: 2.03; 95% CI: (1.06-3.88); p:0.03) and (OR:2.08; 95% CI: (1.07-4.05). Conclusion: A significant proportion of patients who underwent urologist-led intervention returned to the ED with renal colic. Further study may help clarify the role of early urologist referral for renal calculi, as this may not reduce ED return rates when compared to conservative management.

Association of spontaneous expulsion with C-reactive protein and other clinico-demographic factors in patients with lower ureteric stone.

The purpose of our study is to analyze the definitive relation of C-reactive protein (CRP) and other factors with the spontaneous stone passage in patients with distal ureteric calculus of 5-10mm and to calculate the risk of failure of expectant management in patients. 185 patients of ureteric colic, who were subjected to medical expulsive therapy (MET), were included prospectively from August 2016 to May 2018 and followed up for 4weeks. Patients were divided into two groups. Group A included successful spontaneous passage patients and group B included failure in the same. The parameters analyzed were age, gender, longitudinal and transverse diameter of stone, CRP, total leucocyte count, ureteric diameter and hydroureteronephrosis (HUN). We performed univariate and multivariate analysis. Receiver operating characteristics curve was used to determine the cutoff value for significantly associated variables. 122 (65.90%) and 63 (34.10%) patients were included in group A and B, respectively. In univariate analysis, CRP, longitudinal and transverse diameter of stone, HUN, proximal and distal ureteric diameters were statistically significant. However, in multivariate analysis, only negative CRP (p=0.002), smaller longitudinal diameter of stone (p<0.001) and absence of HUN (p=0.005) were significantly associated with successful expulsion. Cutoff for CRP was 0.41mg/dl and longitudinal diameter was 6.7mm. The success rate in the group of patients with no risk factor was 96.7% and with all three risk factors was 16.7%. Patients with a longitudinal diameter of stone >6.7mm, HUN, and CRP >0.41mg/dl should be considered for early intervention. The success rate of MET can be increased to 86% after exclusion of patients with all three risk factors.

SUN-284 DICER1 Mutations in Adolescent Girls: Clinicopathological Findings and Genetic Correlation

Background: The DICER1 syndrome is a rare tumor predisposition disorder associated with multinodular goiter (MNG), differentiated thyroid cancer, ovarian Sertoli-Leydig cell tumor, pleuropulmonary blastoma and pituitary blastoma (1,2). The DICER1 gene encodes the endoribonuclease protein of the ribonuclease III family which acts post-transcriptionally to downregulate messenger RNAs. Both germline and somatic mutations have been reported (3). We describe 2 previously healthy unrelated females referred for evaluation of thyroid nodules. Cases:Case 1: A 16yo female presented with spontaneous passage of polyps at her menstrual period. Histologic analysis revealed embryonal rhabdomyosarcoma. Her primary malignancy, confined to the cervix, was treated with surgical resection followed by chemotherapy. Staging evaluation revealed a left thyroid nodule. FNA of the nodule showed follicular patterned lesion with cytologic atypia; molecular testing was positive for DICER1 somatic mutation (c.5429A;p.D1810V). Peripheral blood genetic testing was positive for a heterozygous DICER1 germline mutation (1510-1G>A). She underwent left lobectomy; histology showed encapsulated papillary carcinoma. Case 2: A 13yo female developed a sudden non-tender neck mass. Ultrasound-guided FNA of the solid lesion in the left thyroid lobe revealed atypia of undetermined significance. Molecular studies identified a DICER1 gene mutation (c.5126A>G; p.D1709G). A peripheral blood sample showed heterozygous DICER1 mutation (c.1870C>T;pArg624*). Three 1st degree family members were also positive for the germline mutation. She underwent total thyroidectomy; pathology revealed MNG with a predominant hyperplastic nodule. Conclusion: Two adolescents with thyroid lesions were positive for DICER1 mutations (4). The prevalence of DICER1 mutations, natural history, and extent of phenotypic heterogeneity are unknown. Two mutations, one germline and one somatic, were identified in our patients. Enhanced molecular testing (ThyroSeqv3) is now available to identify mutations. Testing thyroid nodules for DICER1 mutations (5-7), followed by screening for germline mutations in positive cases is essential to identify patients at risk of other manifestations and to ensure surveillance. Scrutiny of cases will help elucidate the natural history of DICER1 syndrome and establish guidelines regarding the extent and frequency of screening.

Dusting versus fragmentation for renal stones during flexible ureteroscopy

ABSTRACTObjectives: To compare stone dusting and spontaneous passage vs fragmentation and active fragment retrieval during flexible ureteroscopy (fURS) for renal calculi.Patients and methods: The study included patients who underwent fURS and holmium laser lithotripsy for renal calculi from January 2015 to March 2017. Dusting was done using low energy and high frequency (0.3–0.5 J and 15–20 Hz, respectively), and fragmentation was done with higher energy and lower frequency (1–1.2 J and 6–10 Hz, respectively) and then stone fragments were extracted using a basket. The stone-free rate (SFR) was evaluated after 2 months with non-contrast computed tomography. Operative time, complication rate, SFR, and the need for secondary procedures were compared.Results: The study included 107 consecutive patients, with a mean (SD) age of 49 (13) years. Dusting was performed in 51 patients and fragmentation in 56. The patients’ demographics, laboratory tests, preoperative stents, stone and renal characteristics were comparable for both groups. Operative time was significantly shorter for dusting than fragmentation (76 vs 91 min, P = 0.009). Complication rates were comparable between the groups (7.8% for dusting and 8.9% for fragmentation, P = 0.840). The mean hospital stay was comparable for both groups (P = 0.686). The SFR was significantly better in fragmentation group (78.6%) compared with the dusting group (58.6%, P = 0.035). The need for a secondary procedure was 33.3% in the dusting group and 23.3% in fragmentation group (P = 0.244).Conclusions: During fURS for renal stones, the dusting technique had a significantly shorter operation time, whilst the fragmentation technique led to a significantly better SFR. Both techniques have comparable safety, hospital stay, and requirement for secondary procedures.Abbreviations: fURS: flexible ureteroscopy/ureteroscope; ICU: intensive care unit; KUB: plain abdominal radiograph of the kidney, ureter and bladder; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; UAS: ureteric access sheath

Re: Prediction of Spontaneous Ureteral Stone Passage: Automated 3D-Measurements Perform Equal to Radiologists, and Linear Measurements Equal to Volumetric.

Re: Prediction of Spontaneous Ureteral Stone Passage: Automated 3D-Measurements Perform Equal to Radiologists, and Linear Measurements Equal to Volumetric.

Anterograde irrigation - assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy

ABSTRACTIn complicated urinary tract infection with ureteral calculi, urinary diversion is inevitable. So, stenting or percutaneous drainage can be an option. In hemodynamically unstable patients, percutaneous drainage is superior to ureteral stenting (1). Once acute infection is controlled, definite treatment of the stone is necessary. According to a guideline, semirigid ureteroscopy is recommended for lower and mid - ureter stone and flexible ureteroscopy for upper ureter stone (2). Semi - rigid ureteroscopy can migrate stone to kidney, especially in upper ureter stone, lowering stone free rate (3). Not only flexible ureteroscopy creates additional costs but also is barely available in developing countries (4, 5). So, the authors would like to introduce anterograde irrigation - assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy.Retrograde irrigation was connected and flowed minimally enough to secure visual field. Once stone is noted, another saline irrigation, which is placed above 40 cm over the patient is connected to nephrostomy. Retrograde irrigation is disconnected from ureteroscope and the previous connected channel on ureteroscope is opened. Actual pressure detected by barometer from the opened channel of ureteroscope is usually about 30 cmH2 O while anterograde irrigation is administered in maximal flow, which means fully opened anterograde irrigation is not hazardous to kidney. There was no complication in 17 patients submitted to this method.Video shows advantages of our practice: clear visual field; reduced risk of stone migration into kidney; induced spontaneous passage of fragments without using instrumentation; and decreased operation time. In short, most of surgeons, even unexperienced, can perform an excellent procedure with less time consuming using our method.

Parental home removal of urethral catheters after urological surgery—a prospective benchmarking study

Many urological operations require placement of a urethral Foley catheter. The catheter often needs to remain in situ for a period of time after discharge; and patients subsequently require either a further hospital admission or community nurse review for catheter removal. Parents can easily remove the catheter at home by cutting the balloon port. This disrupts the valve and hence deflates the retaining balloon, thereby facilitating spontaneous passage of the catheter. The authors introduced this practice to their institution. The aim was to assess safety and success of parental home catheter removal. A prospective data study was performed in a large pediatric urology center over a 12-month time period. Patients <16 years after single-stage hypospadias repair or other penile surgery were included on a voluntary basis. Parents of eligible patients were instructed verbally and with an information leaflet, including date for removal. Telephone follow-up after removal was undertaken to assess the outcome. Thirty-eight patients were included over a 12-month time period. Patient age ranged from 9 months to 12 years (median age 2.5 years). The majority (82%) of patients had required a catheter after hypospadias repair. Home catheter removal was successful in 92% cases. Three children required professional support for catheter removal. Median time until catheter passage was 3h (range 0-24h). Considering that cost for day case admission for catheter removal averages at 130£ per patient, home catheter removal saved the NHS 4550£ in the time period. This is the first study to report the safety and feasibility of parental home catheter removal by cutting the balloon port valve in the pediatric population. It offers a number of distinct advantages compared with traditional methods for removal. These include, namely, (i) positive patient experience: catheter removal in a familiar environment by a relative minimizes stressful experiences for the family; (ii) minimal trauma to healing tissues through spontaneous catheter passage; and (iii) health care-related cost savings. This was an initial benchmarking study, so patient numbers were relatively small. Nevertheless, it shows that the method is safeand received positive parental feedback. Parental home removal of a urethral catheter is a feasible and safe alternative to catheter removal by a health-care professional. It minimizes parental anxiety and inconvenience related to the catheter removal appointment and allows for significant cost savings.

Parameters Suggesting Spontaneous Passage of Stones from Common Bile Duct: A Retrospective Study.

Background Common bile duct (CBD) stones are common. However, they are known to pass spontaneously, which obviates the need for ERCP. Aim The aim of this study is to identify specific predictors for spontaneous passage of CBD stones. Methods Data was retrospectively collected for all patients who were hospitalized with clinical, laboratory, or ultrasonographic evidence of choledocholithiasis and who underwent magnetic resonance cholangiopancreatography (MRCP) in Hadassah Medical Center between 2005 and 2011. The patients were classified into 4 groups: group A (positive MRCP and positive ERCP), group B (positive MRCP but negative ERCP), group C (positive MRCP but did not undergo ERCP), and group D (negative MRCP that did not undergo ERCP) for choledocholithiasis. All positive MRCP-groups (A+B+C) were further grouped together into group E. We compared groups A versus B and groups E versus D. Results Comparing groups A versus B, only gamma-glutamyl transferase predicted spontaneous passage of stones from CBD, as the level was significantly higher in group A (677±12.1) versus group B (362.4±216.2) (P=0.023). Patients with small stone diameter (P=0.001), distal stones (P=0.05), and absence of intrahepatic dilatation (P=0.047) tend to pass their stones spontaneously. Comparing groups D versus E, it was found that male gender (P=0.03), older age (P<0.001), high levels of GGT (P=0.022), high levels of alkaline phosphatase (P=0.011), high levels of total bilirubin (P=0.007), and lower levels of amylase (P<0.001) are predictors for positive MRCP studies for CBD stones. Conclusion Identification of specific predictors is important to avoid unnecessary invasive endoscopic intervention.

144 - Percutaneous nephrostomy vs ureteral stent for hydronephrosis secondary to ureteric calculi: Impact on spontaneous stone passage and health-related quality of life – a prospective study

INTRODUCTION AND OBJECTIVES:Ureteral calculi can be associated with urinary drainage blockage, requiring urinary diversion with percutaneous nephrostomy (PCN) or retrograde ureteral stent (RUS). Cu...

140 - Factors predicting the failure of spontaneous passage by patients of small ureteric stones ≤3 mm

140 - Factors predicting the failure of spontaneous passage by patients of small ureteric stones ≤3 mm

The Fate of Residual Fragments After Retrograde Intrarenal Surgery in Long-Term Follow-up.

We aimed to describe the natural history of stone fragments ? 7 mm that remained after retrograde intrarenalsurgery (RIRS) in long-term follow-up. We retrospectively reviewed 142 medical records of patients who had residual fragments (RFs) ? 7 mm after RIRS. Patients were divided into 2 groups according to the size of RFs as ? 4 mm (group 1) and 5 - 7 mm (group 2). Patients' demographic data, stone characteristics, perioperative data and complications were recorded. Re-growth of RFs, spontaneous passage, renal colic, infection and re-operation rates were our main variables. A total of 142 patients (86 in group 1 / 56 in group 2) were followed for mean 54.45 ± 14.24 and 56.22 ± 10.28 months. Mean size of RFs was 2.85 ± 1.22 mm in group 1 and 6.81 ? 2.21 mm in group 2. Mean number of RFs were 1.1 ± 0.2 in group 1 and 2.4 ± 1.6 in group 2 (P = .035). Spontaneous passage rate of RFs were 30.23% and 17.85% in group 1 and 2, respectively (P = .032). No difference was observed in the re-growth rate of RFs between the two groups (P = .094). Although no difference was observed in re-growth of RFs between the groups, patients in group 2 were more likely to experience stone-related events such as renal colic and re-intervention rate (P = .034, P = .029; respectively). Our results demonstrate that RFs > 4 mm take higher risk in terms of stone-related events and shouldbe followed up more closely.

Stone composition independently predicts stone size in 18,029 spontaneously passed stones.

To evaluate whether the size of spontaneously passed stones (SPS) may be associated with clinical parameters. A search for SPS was conducted in our electronic stone database, comprising data on stones analyzed over the last 33years at our institution. Adults with upper urinary tract stones were included. Cases with stenotic urinary tract disease or past history of anastomotic urinary tract surgery were excluded. Stone size expressed as maximal stone diameter (MSD) and stone volume (SV) was compared between groups by one-way ANOVA. Logistic regression analyses were performed to identify predictors of MSD ≥ 6mm. Overall mean MSD and SV for 18,029 SPS was 4.1mm and 11.5mm3, respectively, and significantly differed between stone composition groups (p < 0.001). The lowest mean MSD and SV were found for calcium oxalate monohydrate (3.6mm and 9.0mm3, respectively) and the highest mean MSD and SV were found for struvite (7.9mm and 61.0mm3, respectively). Stone composition and increasing age were found to be independent predictors of MSD ≥ 6mm (both p < 0.001). Sex differentiation did not contribute as a predictor of MSD ≥ 6mm. Stone composition and-to a lesser extent-age serve as independent predictors of size of spontaneously passed stones. Of particular importance, large spontaneously passed stones of ≥ 6mm may be frequently found in cystine, brushite or struvite stone formers, whereas a minority of all calcium oxalate stones exceed that cutoff. Future studies shall evaluate these parameters as possible predictors of spontaneous stone passage.

Use of head scarves pin and their consequences in young Muslim girls in Kashmir

Background: Foreign body ingestion is not so common in day today life but the recent change in increase in use of veil by Muslim girls has shown an upward trend in the accidental ingestion of these things. Foreign bodies with smooth edge are usually harmless with spontaneous passage while with sharp edge may have serious consequences in the form of bowel perforation of obstruction. The aim of our study was to evaluate and educate the young Muslim girls about the use and complication of hair pins.Methods: In this study 130 patients were admitted with the history of ingestion of foreign bodies in the department of Surgery, Government Medical College Srinagar over a period of two year from May 2016 to April 2018. All patients were evaluated including base line investigation, series of abdominal radiographs and frequent abdominal examinations. Results: Majority of patients were females in the age group of 11-20 with 71 (54.61%) of patients. Head scarf pins were the commonest foreign body in 78 (60%) of female patients. Maximum number of patients was managed conservatively.Conclusion: The rising trend in the ingestion of metallic foreign bodies especially hair pins need to be used with precautions to prevent serious health hazards like bowel perforation.

MIMIC: A pilot study for a randomised controlled trial of a risk calculator predicting stone clearance in acute ureteric colic

Aim: The BURST MIMIC study showed that 25% of patients discharged with conservative management of a ureteric stone were re admitted for surgery. We aim to determine the feasibility of a randomised controlled trial for the use of a risk calculator predicting stone passage in acute ureteric colic patients with a view to a full trial to determine if use of the calculator improves outcomes and patient satisfaction. Population inclusion: Patients (age>18) with a new hospital presentation of acute ureteric colic due to radiologically confirmed urolithiasis. Patient suitable and willing to undergo conservative management of ureteric stone. Exclusion: Uncontrolled Pain Stone>10 mm Pyrexia/sepsis Adverse radiological findings Bilateral ureteric stones Single functioning kidney Intervention: A risk calculator developed from the 4181 patient MIMIC study cohort (online ± smart device), predicting stone passage and complication rate. The calculator will be used to inform the clinicians decision regarding intervention or conservative management and to aid in the counselling of patients. We propose a cluster randomised controlled trial to prevent learning bias. Comparator: Standard of care (no calculator) Feasibility Outcomes Estimate on time to stone and tube free Ease calculator use Lost to followup rate Determine predicted value of spontaneous stone passage at which point clinicians would recommend and/or patients would chose immediate intervention. Full Study Outcomes: Primary: Time to confirmation of stone clearance (stone free either clinical or imaging based) and free of all stents and nephrostomies. Secondary: The 90day rate of hospital readmission for intervention after conservative management for ureteric colic. The 90day rate of stone related complications QoL and patient satisfaction as measured by validated PROMS questionnaires.

Ingested foreign bodies in children: Do they really pass spontaneously from the gastrointestinal tract? A single-centre experience with 1000 cases.

Foreign body (FB) ingestion is frequently encountered in all departments that treat children. FB may bring about significant anxiety for parents and physicians. The present study aims to determine the appropriate approach for FB ingestion in children. The records of 1000 children with a history of FB ingestion between the years 2005 and 2017 were reviewed retrospectively in this study. Of 1000 children, 53.8% were male. The most common types of FBs were coins (35%). X-ray was negative in 49% of the patients, and 86% of these patients received no intervention. Of the 504 (51%) X-ray-positive patients, the oesophagus (68%) was the most common location. Life-threatening complications were tracheo-oesophageal fistula (1), Meckel's diverticulum perforation (1), and perforation due to rigid endoscopy (1). We demonstrated that coins, which are the most commonly ingested FBs, have various types and sizes according to their countries of origin, and this affects spontaneous passage. We found that only 48% (quite low compared to the literature) of the coins passed spontaneously. In asymptomatic patients with a gastric button battery, we suggest a "watchful waiting" approach. The patients should be observed and managed at home. In our study, we found that 85% of the button batteries that reached the stomach passed spontaneously.

Efficacy of Naftopidil as a Medical Expulsive Therapy in Japanese Men With Ureteral Stones: A Prospective Randomized Controlled Study.

BackgroundNaftopidil combined with an antispasmodic agent and a supplement that facilitates stone expulsion has reportedly produced an increased rate of ureteral stone expulsion. A randomized controlled study was conducted to determine the efficacy of naftopidil as a medical expulsive therapy for male patients with ureteral stones.MethodsMale patients (n = 500) with stones from the upper to the lower ureter were randomized to one of four groups and followed for 1 month to assess spontaneous passage of stones. The control group received only analgesics. The other three groups received daily doses of 240 mg flopropione, an antispasmodic agent and 1,350 mg extract of Quercus salicina Blume/Quercus stenophylla Makino (QS), a supplement that facilitates stone expulsion; 50 mg naftopidil; or 50 mg naftopidil in combination with 240 mg flopropione and 1,350 mg QS. Stone expulsion and characteristics were evaluated by urinalysis; kidney, ureter and bladder X-ray; ultrasound; and computed tomography.ResultsThe probability of expulsion of ureteral stones < 6 mm increased 1.570-fold (95% confidence interval (CI): 1.039 - 2.374, P < 0.05) with naftopidil compared to control; the probability of expulsion of a lower ureteral stone < 6 mm increased 1.778-fold (95% CI: 1.066 - 2.965, P < 0.05) with naftopidil compared to control. None of the stones > 6 mm spontaneously passed.ConclusionsFor relatively small ureteral stones < 6 mm, analgesic treatment combined with naftopidil would be the first choice. However, for relatively large ureteral stones > 6 mm, it appears that analgesia is sufficient for initial treatment of ureteral stone.

Assessing spontaneous passage of prophylactic pancreatic duct stents by X-ray: is a radiology report adequate?

Background:Pancreatic duct stents are frequently placed for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Because of concern for possible secondary ductal changes from a retained stent, these stents need to be monitored and removed if retained. Usually an abdominal X-ray is performed to assess retained stent, and if present, an esophagogastroduodenoscopy is performed to remove the stent. Limited data is published on false-negative radiology reports for spontaneous passage of stents.Methods:Using an Institutional Review Board–approved stent log, a retrospective chart review of all pancreatic duct stents placed at our institution from 2008 to 2014 was performed.Results:A total of 856 pancreatic duct stents were placed during the study period. Of these, 435 (50.8%) were prophylactic stents and 421 (49.2%) were therapeutic. Complete follow-up data were available in 426 (97.9%) patients with prophylactic stents. Six patients (1.4%) were lost to follow up and three (0.7%) expired prior to removal. In all, 283 (66%) had follow-up imaging, with 167 (39.2%) having the official radiology read with no retained pancreatic duct stent in place. Eight of these cases were “false-negative” radiology interpretation (4.8% of cases read as “no stent,” NNH = 20). The stent was found either by review of image by an endoscopist or incidental stent discovery during a follow-up procedure.Conclusion:Radiologist interpretation of abdominal X-rays to assess spontaneous passage of prophylactic pancreatic ducts stents resulted in a false-negative interpretation in approximately 5% of cases. Independent review of the images by the endoscopist may be beneficial given unfamiliarity of these stents by radiologists.

Evaluation of Outcome of Ureteroscopic Pneumatic Lithotripsy in Single Lower Ureteric Calculus and Its Association with CT Parameters

Objective: To evaluate the outcome of ureteroscopic pneumatic lithotripsy in single lower ureteric calculus and correlate its success with different CT parameters like HU, size of calculus and hydrnephrosis, if present. Patients and Methods: This study was conducted from October 2017 to March 2019 in Department of General Surgery, Maulana Azad Medical College, New Delhi. 30 patients (out of which 6 were excluded due to spontaneous passage of calculus), with single lower ureteric calculus were chosen and the outcome of URSL was compared with respect to CT parameters of Size, HU and Hydronephrosis and intra-operative clearance of calculus. Results: Success rate of URSL in single lower ureteric calculus was found to be 75%. Lower HU (774.12 ± 212.85) was associated with higher success rate. Similarly smaller size of calculus (9 ± 2.1) mm was associated with success group. Patients with gross hydronephrosis had a poor outcome of URSL. Lower urinary tract infection (8.33%) was the most common complication. Conclusion: Patients with small size calculus, low HU and absence of hydronephrosis have a better outcome of URSL.