Spontaneous Passage Research Articles

PD34-02 NATURAL HISTORY OF RESIDUAL FRAGMENTS AFTER AGGRESSIVE URETEROSCOPY AND FRAGMENT RETRIEVAL

You have accessJournal of UrologyStone Disease: Surgical Therapy V (PD34)1 Apr 2020PD34-02 NATURAL HISTORY OF RESIDUAL FRAGMENTS AFTER AGGRESSIVE URETEROSCOPY AND FRAGMENT RETRIEVAL Ryan L. Steinberg*, Brett A. Johnson, Igor Sorokin, Alaina Garbens, Vishnuvardhan Ganesan, Joseph Crivelli, Abdulhadi Akhtar, Jodi Antonelli, and Margaret Pearle Ryan L. Steinberg*Ryan L. Steinberg* More articles by this author , Brett A. JohnsonBrett A. Johnson More articles by this author , Igor SorokinIgor Sorokin More articles by this author , Alaina GarbensAlaina Garbens More articles by this author , Vishnuvardhan GanesanVishnuvardhan Ganesan More articles by this author , Joseph CrivelliJoseph Crivelli More articles by this author , Abdulhadi AkhtarAbdulhadi Akhtar More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , and Margaret PearleMargaret Pearle More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000905.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Follow-up of patients with residual fragments (RFs) after ureteroscopy (URS) for upper tract stones has shown that the occurrence of stone-related events is common. Short-term follow up of a cohort with RFs detected by CT after URS revealed that 41% of patients experienced a stone-related event (SE) at a mean follow-up of 16 months. We have continued to follow these patients with RFs to determine intermediate outcomes. METHODS: Between December 2015 and February 2017, 167 patients (209 renal units, RUs) underwent URS for renal and ureteral calculi and were imaged with CT at 6-8 weeks post-operatively. Patients were evaluated at subsequent office visits with imaging studies and/or contacted by phone to determine the occurrence of stone events attributable to their RFs. A stone event was defined as spontaneous stone passage, symptoms requiring emergency department (ED) visit, surgical intervention, or stone growth. Patients with RFs of any size were included for analysis. Stone-event free survival (SEFS) was determined by the Kaplan Meier analysis and risk factors for an event were identified by logistic regression. RESULTS: A total of 73 patients (87 RUs) had RFs after URS with a median follow-up of 29 months (IQR 22-34). The mean number of RFs per patient on post-operative CT was 2.1 ± 1.5 and mean largest fragment size was 3.7 ± 2.0 mm. SE occurred in 47% of RUs (41/87). Unplanned ED or clinic visits occurred in 13%, a secondary stone surgery was required in 17%, and 17% of patients experienced spontaneous stone passage. The median time to SE was 20 months (IQR 7-26). Neither size (p=0.11) nor location (p=0.816) of the residual fragment predicted a stone event. Bilateral procedures were associated with an increased risk of a stone event (OR 3.2, CI 1.4 – 7.8, p=0.01), while increasing age (OR 0.3, CI 0.1 – 0.8, p=0.01) and male gender (OR 0.9, CI 0.91– 0.98, p<0.01) were protective on multivariable analysis. By Kaplan-Meier analysis, SEFS was 74% at 24 months year and 58% at 30 months post-operatively (Figure). CONCLUSIONS: With longer follow up, nearly half of patients left with RFs after URS will experience a SE, rates comparable to those following SWL. Better patient selection for URS and new ways to enhance stone free rates after URS are essential to improve outcomes. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e711-e712 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan L. Steinberg* More articles by this author Brett A. Johnson More articles by this author Igor Sorokin More articles by this author Alaina Garbens More articles by this author Vishnuvardhan Ganesan More articles by this author Joseph Crivelli More articles by this author Abdulhadi Akhtar More articles by this author Jodi Antonelli More articles by this author Margaret Pearle More articles by this author Expand All Advertisement PDF downloadLoading ...

MP15-05 PERCUTANEOUS NEPHROSTOMY, URETERAL STENT OR PRIMARY URETEROSCOPY WITH STONE REMOVAL FOR THE TREATMENT OF HYDRONEPHROSIS SECONDARY TO URETERIC CALCULI: A PROSPECTIVE EVALUATION OF THE IMPACT ON COMPLICATIONS, STONE MANAGEMENT AND HEALTH-RELATED QUALITY OF LIFE

You have accessJournal of UrologyStone Disease: Surgical Therapy III (MP15)1 Apr 2020MP15-05 PERCUTANEOUS NEPHROSTOMY, URETERAL STENT OR PRIMARY URETEROSCOPY WITH STONE REMOVAL FOR THE TREATMENT OF HYDRONEPHROSIS SECONDARY TO URETERIC CALCULI: A PROSPECTIVE EVALUATION OF THE IMPACT ON COMPLICATIONS, STONE MANAGEMENT AND HEALTH-RELATED QUALITY OF LIFE Ricardo Matos Rodrigues*, Bárbara Silva, Nuno Morais, José Pedro Pereira, Sara Anacleto, Pedro Passos, Torres João, Emanuel Dias, Estêvão Lima, and Paulo Mota Ricardo Matos Rodrigues*Ricardo Matos Rodrigues* More articles by this author , Bárbara SilvaBárbara Silva More articles by this author , Nuno MoraisNuno Morais More articles by this author , José Pedro PereiraJosé Pedro Pereira More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Pedro PassosPedro Passos More articles by this author , Torres JoãoTorres João More articles by this author , Emanuel DiasEmanuel Dias More articles by this author , Estêvão LimaEstêvão Lima More articles by this author , and Paulo MotaPaulo Mota More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000840.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral calculi can be associated with urinary drainage blockage requiring urgent treatment, usually with urinary diversion with percutaneous nephrostomy or retrograde ureteral stent, but primary ureteroscopy with stone removal can be an option. Currently no strong evidence exists to support the superiority of one method over the others. This study proposes to compare these three approaches regarding stone management efficacy, complication rate and its effect on patient's quality of life (QoL). METHODS: A prospective trial was carried out and 94 patients were selected with hydronephrosis secondary to ureteral stones requiring urgent urinary treatment. The patients were divided into three groups according to treatment technique: percutaneous nephrostomy (PCN), retrograde ureteral stent (RUS) or primary ureteroscopy with stone removal (pURS). The stone management efficacy, complications and QoL were evaluated (EQ VAS). RESULTS: A PCN group (n=21), a RUS group (n=53) and a pURS group (n=20) were set. Stone size was higher in RUS (median=9mm) than PCN (median=8mm) and pURS (median=7mm). All pURS successfully removed the stone and the spontaneous stone passage (SSP) after multivariable analysis was higher for PCN than RUS (OR=2,31). A decrease between pre- and post-intervention QoL was found with RUS (p<.001), but not found with PCN (p = .092) and an increase was found with pURS (p=.011). Patients in pURS group experienced less haematuria (p<.001), dysuria (p<.001), urgency (p<.001) (table 1.1), and less need of antibiotics use (p=.005), than RUS and PCN (table 1.2). CONCLUSIONS: pURS shows better chance of higher stone management efficacy than PCN and RUS, moreover PCN was associated with higher rate of spontaneous stone passage than RUS. The QoL improve for pURS patients and decrease for RUS patients. pURS was associated with less symptoms and complications than PCN and RUS, regarding RUS had the higher level of patients with symptoms and complication rate. The pURS appears to be a safe and optimal solution for treatment of patients with ureteral calculi with urinary drainage blockage requiring active treatment. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e205-e206 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricardo Matos Rodrigues* More articles by this author Bárbara Silva More articles by this author Nuno Morais More articles by this author José Pedro Pereira More articles by this author Sara Anacleto More articles by this author Pedro Passos More articles by this author Torres João More articles by this author Emanuel Dias More articles by this author Estêvão Lima More articles by this author Paulo Mota More articles by this author Expand All Advertisement PDF downloadLoading ...

MP43-02 PATIENTS ON MEDICAL EXPULSIVE THERAPY FOR OBSTRUCTING URETEROLITHIASIS - THE WISCONSIN STONE QUALITY OF LIFE (WISQOL) SURVEY

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (MP43)1 Apr 2020MP43-02 PATIENTS ON MEDICAL EXPULSIVE THERAPY FOR OBSTRUCTING URETEROLITHIASIS - THE WISCONSIN STONE QUALITY OF LIFE (WISQOL) SURVEY Tarik Phillips*, Alexander Chow, Alethea Paradis, Joel Vetter, and Ramakrishna Venkatesh Tarik Phillips*Tarik Phillips* More articles by this author , Alexander ChowAlexander Chow More articles by this author , Alethea ParadisAlethea Paradis More articles by this author , Joel VetterJoel Vetter More articles by this author , and Ramakrishna VenkateshRamakrishna Venkatesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000898.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Medical expulsive therapy (MET) utilizing alpha- blockers is commonly prescribed by urologists and emergency department (ED) physicians, however, its efficacy in ameliorating ureteral stone passage is controversial. Hence, as is currently unknown, it is desirable to know the overall quality of life (QOL) of patients on MET. We evaluated the QOL of patients utilizing a validated patient reported stone specific questionnaire, Wisconsin Stone Quality of Life (WISQOL) METHODS: This is an IRB approved prospective study of 100 patients on MET who presented to a tertiary care ED with a symptomatic obstructing ureteral stone. MET consisted of one month of Tamsulosin (.4 mg PO daily) and additional medications for analgesia and emetic control as needed per recommendation of the prescribing physician. The WISQOL survey was administered at baseline, 7, 14, 21 and 28 days following discharge from the ED or until stone expulsion. RESULTS: 100 patients were enrolled, of which 47 completed questionnaires for analysis. Average ureteral stone size was 5.1(STD 1.4) mm. 38% reported having a history of stones. 39 (83%) completed the survey at day 7, and 23 (48.9%), 20 (40.6%), 12(25.5%) at days 14, 21, 28 respectively. 13 (27.7%) reported spontaneous stone passage while on MET. Two (4.3%) patients returned to the ED for intractable pain and 5 (11.1%) required surgical intervention. Compared to baseline, there was no change in WISQOL domains including social impact, emotional impact, disease impact or overall score while on MET at 7 days. Those who remain on MET at 14 days reported a significantly negative impact on all QOL domains including social (p = 0.01), emotional (p < 0.01), disease (p = 0.04), vitality (p = 0.03), and overall score (p < 0.01). In completed subsequent surveys, negative QOL impact persisted up to 28 days [Figure 1]. Stone size, age, race, sex and a prior stone history were not associated with risk of negative effect on QOL. CONCLUSIONS: Patients remaining on MET at two weeks and beyond reported a negative impact on social, emotional and vitality QOL on the WISQOL survey. Identifying factors related to the poor QOL in patients on MET, may help in use of MET in select patients and counseling about the adverse effects of MET. Surgical intervention if stone fails to pass at two weeks may need to be considered. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e647-e647 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarik Phillips* More articles by this author Alexander Chow More articles by this author Alethea Paradis More articles by this author Joel Vetter More articles by this author Ramakrishna Venkatesh More articles by this author Expand All Advertisement PDF downloadLoading ...

PD34-03 COMPARISON OF STONE-RELATED EVENTS AFTER URETEROSCOPY IN PATIENTS WITH AND WITHOUT RESIDUAL FRAGMENTS

You have accessJournal of UrologyStone Disease: Surgical Therapy V (PD34)1 Apr 2020PD34-03 COMPARISON OF STONE-RELATED EVENTS AFTER URETEROSCOPY IN PATIENTS WITH AND WITHOUT RESIDUAL FRAGMENTS Ryan L. Steinberg*, Brett A. Johnson, Alaina Garbens, Igor Sorokin, Joseph Crivelli, Abdulhadi Akhtar, Vishnuvardhan Ganesan, Jodi Antonelli, and Margaret Pearle Ryan L. Steinberg*Ryan L. Steinberg* More articles by this author , Brett A. JohnsonBrett A. Johnson More articles by this author , Alaina GarbensAlaina Garbens More articles by this author , Igor SorokinIgor Sorokin More articles by this author , Joseph CrivelliJoseph Crivelli More articles by this author , Abdulhadi AkhtarAbdulhadi Akhtar More articles by this author , Vishnuvardhan GanesanVishnuvardhan Ganesan More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , and Margaret PearleMargaret Pearle More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000905.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We previously showed that nearly half the patients left with residual fragments (RFs) after URS experience a subsequent stone-related event (SE). We aimed to determine if a stone free state after URS is associated with a fewer SEs than those left with residual fragments. METHODS: After undergoing URS for renal and ureteral calculi between December 2015 and February 2017 167 patients (209 renal units, RUs) were prospectively enrolled. CT was obtained 6-8 weeks post-operatively. Patients were evaluated at subsequent office visits and/or contacted by phone to determine if a stone event attributable to the treated RU occurred. A stone event (SE) was defined as spontaneous stone passage, symptoms requiring emergency department (ED) visit, surgical intervention, or stone growth. Only patients with at least 12 months of follow-up were included for analysis. Kaplan Meier analysis, Chi-squared analysis, log rank test, and logistic regression were used to assess outcomes. RESULTS: Among the study group, 123 patients and 152 RUs met study criteria, including 57% (87 RUs) with residual fragments and 43% (65 RUs) who were rendered stone-free on post URS CT. Median overall follow-up was 29 months (IQR 22-34). The mean number of RFs per patient was 2.1 ± 1.5 and mean largest fragment size was 3.7 ± 2.0 mm. SE occurred in 47% (41/87) of RUs with RFs and 14% (9/65) of those that were stone free (p<0.001). Median time to SE was 33 months for those with RFs (CI 23-43) and 45 months in those who were stone free (CI 40-50). The stone event-free survival was 68% in those with RFs and 98% in those stone free at 24 months (p<0.001) (Figure 1). Multivariate regression demonstrated stone-free status as a predictor of a stone event (OR 4.98, p<0.001), although residual fragment size and number were not. CONCLUSIONS: Attaining a stone-free state after URS with basket extraction reduces the rate of SEs in patients undergoing ureteroscopy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e712-e712 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan L. Steinberg* More articles by this author Brett A. Johnson More articles by this author Alaina Garbens More articles by this author Igor Sorokin More articles by this author Joseph Crivelli More articles by this author Abdulhadi Akhtar More articles by this author Vishnuvardhan Ganesan More articles by this author Jodi Antonelli More articles by this author Margaret Pearle More articles by this author Expand All Advertisement PDF downloadLoading ...

PD14-03 DEVELOPMENT OF PREDICTION MODELS OF SPONTANEOUS URETERAL STONE PASSAGE THROUGH MACHINE LEARNING: COMPARISON WITH CONVENTIONAL STATISTICAL ANALYSIS

INTRODUCTION AND OBJECTIVE:Indications for management of ureteral stones are unclear, and clinician determines whether to wait for spontaneous ureteral stone passage (SSP) or perform active treatme...

V05-08 MANAGEMENT OF MULTIPLE URETERAL STRICTURES IN A PARTIALLY DUPLICATED COLLECTING SYSTEM

You have accessJournal of UrologyUpper-Tract Reconstruction (V05)1 Apr 2020V05-08 MANAGEMENT OF MULTIPLE URETERAL STRICTURES IN A PARTIALLY DUPLICATED COLLECTING SYSTEM Aeen Asghar*, Ziho Lee, Michael Metro, and Daniel Eun Aeen Asghar*Aeen Asghar* More articles by this author , Ziho LeeZiho Lee More articles by this author , Michael MetroMichael Metro More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000874.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Duplication of the collecting system can be found in nearly 1% of the general population. It can present as partial or complete duplication with or without obstruction and reflux. Herein, we present a patient with idiopathic high-grade ureteral strictures in both ureters of her partially duplicated system. METHODS: We present a 36-year-old female who was initially diagnosed with sepsis secondary to a distal left ureteral stone requiring percutaneous nephrostomy tube placement. After resolution of infection and spontaneous passage of stone, she was found to have a partially duplicated collecting system with dense strictures in both lower and upper proximal ureters on antegrade and retrograde pyelograms. A MAG-3 renal scan revealed functioning moieties with no drainage from the lower moiety and delayed drainage from the upper pole. Given her young age and desire for definitive surgery, we proceeded with Robot-Assisted Laparoscopic (RAL) ureteral reconstruction. Intraoperatively, we encountered severe peri-ureteral inflammation with an obliterated long segment lower pole proximal ureter and a dense 2.8 cm upper pole ureteral stricture, we decided to perform a ureteropyelostomy and an augmented anastomotic buccal mucosal graft ureteroplasty. This was done by creating an ureteropyelostomy anastomosis between the lower moiety pelvis to the upper moiety proximal ureter, followed by reconstruction of the 2.8 cm stricture in the upper ureter to create a new common ureteral drainage pathway. A ureteral stent was placed with the proximal curl in the lower moiety pelvis. We also placed a Foley catheter in the bladder and a Jackson-Pratt (JP) drain. RESULTS: Our console time was 303 minutes with 100 mL of blood loss. The foley catheter was removed on post-operative day (POD) 1, along with the JP drain, given its low output. Patient was discharged on POD 1 and had no 30-day post-operative complications. Her stent was removed 6 weeks post-operatively and her MAG-3 renal scan results are pending. CONCLUSIONS: Duplicated collecting systems are a rare congenital anomaly, often asymptomatic in those with bifid ureters. Patients in this population suffering from ureteral strictures may benefit from minimal invasive ureteral reconstruction. Complex ureteral reconstruction even in multi-level dense ureteral strictures in both limbs of a bifid ureter can be feasible by experienced teams if advanced surgical options such as RAL ureteropyelostomy and buccal mucosal graft ureteroplasty are utilized. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e472-e472 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aeen Asghar* More articles by this author Ziho Lee More articles by this author Michael Metro More articles by this author Daniel Eun More articles by this author Expand All Advertisement PDF downloadLoading ...

MP22-02 THE EFFECT OF SMALLER RESIDUAL STONES AFTER MINIMAL INVASIVE ENDOUROLOGY PROCEDURES FOR RENAL STONES

INTRODUCTION AND OBJECTIVE: The new era in urology with the advent of minimally invasive surgical techniques has helped in reduction of morbidity associated with surgical treatment of renal stones. Nevertheless, there is lack of agreement as to what has to be done to residual stones, as it has been known that these fragments might have the potential to cause complications after these elective procedures.The objective of our study was to evaluate the natural course followed by residual stones after percutaneous nephrolithotomy (PCNL) or flexible ureterorenoscopy (F-URS) procedures for treatment of kidney calculi. METHODS: Total of 373 patients were submitted to prospective follow-up after elective endoscopic procedures such as PCNL and URS for treatment of kidney stones. The presence and features of residual fragments was followed on radiologic scans and the frequency of revisiting hospital for complications or the necessity of additional procedures were sorted out. RESULTS: The overall stone-free rate was 76.3% in F-URS and 67.7% in PCNL. The natural history of 257 patients having residual stone fragments was followed. There was spontaneous passage of these fragments in 13.4% (34) of cases. While 18.2% (47 patients) developed pain or colicky symptoms, 10.5% (26 patients) had complications such as readmission for pain, fever and Urinary tract infection. Total of the 257 patients followed, 16.7% (43 subjects) needed a next surgical procedure. The residual stones larger than 4mm had more complications (p<0.003), more recurrence of pain symptoms (p=0.04) and need for additional surgeries (p<0.002) as compared to the stones of smaller than 4mm in size. Number of the residual fragments even less than 4 mm were more prone to the complications. Size and number of the residual fragments and the multi-calicial distribution were strong predictors of the development of new symptoms and the need of surgical re-intervention. (p=0.04). CONCLUSIONS: Residual stones are frequently seen in endourological procedures for renal stones treatment and might cause morbidity and complications.Number of stone fragements and poles involved have role in these complications. More multicenter prospective studies are needed in this regard. Source of Funding: None

No stone unturned: The epidemiology and outcomes of paediatric urolithiasis in Manchester, United Kingdom

The epidemiology and risk factors for paediatric urolithiasis (UL) in developed countries are evolving, with increasing rates of metabolic stone-formers. In the United Kingdom (UK), only a single London cohort has been studied in the past three decades. Regional disease patterns across the UK remain unknown. UL has been associated with an increased risk of chronic kidney disease in adults, but long-term paediatric outcomes remain poorly understood. We assessed the epidemiology of paediatric UL by defining the demographics, incidence, aetiology, recurrence rates and outcomes at tertiary nephro-urology centres in Greater Manchester. Health records of 177 consecutive paediatric urology referrals (0-18 years) for UL between 2002 and 2015 were retrospectively included for observational analysis. Metabolic screening was performed in 105 children. The incidence of paediatric urology referrals for UL was 1.77/100,000 person-years, increasing annually by 13.6%. Mean patient age was 8.2 years and the male:female ratio was 1.3:1. The upper urinary tract was involved in more than 90% of cases and 45% of children presented with multiple calculi. Metabolic abnormalities were identified in 52% of children screened: hypercalciuria (64%), hyperoxaluria (18%) and cystinuria (11%) were the most common. Significant family history was predictive of metabolic abnormalities (OR 4.9:1, 95% CI 1.4-17.0). 30% of children had infective stones, which were more common in children less than 6 years. Ultrasound was found to be 90% sensitive for UL detection. Dimercaptosuccinic acid (DMSA) imaging identified renal scarring in 33 of the 55 children tested (60%). Recurrence was observed in 18% of children over mean 6.4 year follow-up and was more common in metabolic stone-formers. Spontaneous passage was observed in 83% of stones ≤ 5mm, 69% between 5 and 10mm and only one calculi > 10mm. The incidence of paediatric urology referrals for UL is rising in North West England. Metabolic abnormalities were detected in half of the children tested, justifying comprehensive screening. Recurrence is common following paediatric UL, reinforcing the need for stone prevention strategies. The majority of calculi less than 10mm were found to pass spontaneously with supportive measures, which favours an initial observation period over surgical intervention for small calculi. UL was associated with renal scarring in the analysed population and therefore, children with UL require long-term assessment of blood pressure and proteinuria.

AB188. Endoscopic removal of accidently swallowed tooth brush by healthy male—a case report

: Swallowing of foreign body (FB) is a common presentation to emergency department. Most ingested FB pass spontaneously without intervention, however about 20% of FB swallowing cases require endoscopic or surgical removal. Toothbrush swallowing is rare and no spontaneous passage has been reported due its shape, but swallowed for tooth brushes found in esophagus or stomach, prompt removal either endoscopically or surgically is recommended to avoid complications. We report a case of a young healthy male who accidently swallowed a tooth brush, which was successfully removed in the theatre endoscopically under general anaesthetic using polypectomy snare. This is a case report of a 35-year-old healthy male who presented to emergency department claiming he had swallowed a tooth brush accidently. He had no other symptoms and he was able to swallow water. His examination was unremarkable with normal chest X-ray. Initially, he was also assessed by ENT team and no FB was seen in oropharynx and he was referred to general surgeons for endoscopy and FB removal. The patient underwent gastroscopy in theatre under general anaesthesia and toothbrush was noted in oesophagus with the head of the brush stuck at oesophago-gastric junction and the handle of toothbrush in stomach. the toothbrush was removed using polypectomy snare without any complications. Patient was discharged the next day. Despite having a difficult shape for a foreign body, this is possible to remove this type of FB through gastroscopy if done so in a timely matter, avoiding potential future complications.

Medical Expulsive Therapy (Alpha Blockers) for Urologic Stone Disease.

Urinary tract stones are common and usually painful. Lifetime prevalence is approximately 10%.1 Direct healthcare costs are estimated to be over $10 billion dollars annually.2 First-line treatment is typically analgesia with non-steroid anti-inflammatory drugs until the stone passes. If the stone does not pass spontaneously, urological intervention may be necessary.

Current aspects in pediatric urolithiasis treatment

Compared with adults, urolithiasis is quite rare in children (1-2% of all urinary stones occur during childhood). In principle, all therapy modalities for adults can also be used in children. However, due to some anatomic and functional peculiarities in children, the differential indication for the various treatment modalities differ. As arule, asymptomatic renal stones are not treated but observed. More urinary stones pass spontaneously in children compared with adults. If spontaneous passage is not possible or does not occur, noninvasive and minimally invasive techniques are indicated. Extracorporeal shock wave lithotripsy is the therapy of choice in most instances. Today, endoscopic techniques, however, can be safely used even in very small infants. For larger renal stones and those consisting of cysteine or whewellite, percutaneous nephrolithotomy (PCNL) is the therapy of choice, and for distal ureteral stones ureteroscopy is the method of choice. Laparoscopic and open surgery are reserved for very rare cases, especially with concomitant pathologies. Bladder calculi are treated by transurethral or suprapubic lithotripsy.

A treatment strategy to help select patients who may not need secondary intervention to remove symptomatic ureteral stones after previous stenting.

This study aimed at evaluating whether removal of the ureteral stent the day before scheduled secondary intervention facilitates spontaneous ureteral stone passage and thus can spare the pre-stented patient this surgery. Retrospective analysis of a single-centre consecutive series of 216 patients after previous stenting due to a symptomatic ureteral stone from 01/2013 to 01/2018. Indwelling stents were removed under local anaesthesia. Patients were told to filter their urine overnight. Multivariate analysis was performed to assess predictive factors for spontaneous stone passage. 34% (74/216) of patients had spontaneous stone passage while the stent was indwelling. Of the remaining 142 patients, 41% (58/142) had spontaneous stone passage within 24h after stent removal. Only 84/216 (39%) patients needed secondary intervention. Multivariate logistic regression analysis of all 216 patients showed a significant association between spontaneous stone passage and smaller stone size (p < 0.001), distal stone location (p = 0.046) and stent dwell time (p = 0.02). Predictive factors for spontaneous stone passage after stent removal were smaller size (p < 0.001), distal location (p = 0.001), and stone movement while the stent was indwelling (p = 0.016). A treatment strategy was established that helps select patients suitable for conservative management. The majority (61%) of ureteral stones passed spontaneously after pre-stenting; 34% while the stent was indwelling, 27% within 24h after stent removal. Besides distal stone location, stone size (< 6mm) and stone movement (≥ 5cm) while the stent is indwelling indicate patients who are likely to pass their ureteral stone spontaneously after stent removal. The treatment strategy (decision tree) presented here helps identify those patients. https://doi.org/10.1186/ISRCTN12112914 .

Akut ve Elektif Üreteroskopinin Semptomatik Üreter Taşlarında Etkinlik ve Finansal Yönlerinin Değerlendirilmesi

Objective: In this study, we aimed to compare the efficacy, complications, and financial aspects of urgent ureteroscopy (URS) with elective URS in patients who applied with the acute flank pain caused by ureteral calculi. Material and Methods: The records of 70 adult patients, who applied to the emergency and urology department at Gata Haydarpasa Research and Training Hospital between June 2012 and May 2014 evaluated prospectively. Patients were divided into two group including the patients with colic pain that had started within 12 hours before admission who also agreed to be operated urgently (Group 1: acute URS) and the patients who requested the necessary intervention only if spontaneous passage cannot be provided (Group 2: elective URS). Kidney, ureter, bladder radiography (KUB), and urinary ultrasonography (USG) were applied to all patients. A total of 16 urgent and 19 elective URSs were performed. Results: The average treatment cost of the urgent URS patients was found to be 855.00 TL (143.78 ?) per payment, and the average treatment cost of the elective URS patients was found to be 979.00 TL (164.63 ?) (p<0.001) per patient. These results were statistically significant. Conclusion: Urgent URS is a treatment modality that requires minimal additional treatment. Besides, the patients can turn back to their social activities earlier, and it also reduces the psychological side-effects of urolithiasis. Although the superiority of one method over another cannot be concluded with this study, the application of urgent URS costs less compared to elective URS.

Failure of ureteral access sheath insertion in virgin ureters: A retrospective tertiary care center study.

Objective:The objective of the study was to identify the failure rate of insertion of ureteral access sheath (UAS) during primary flexible ureteroscopy (FURS).Materials and Methods:This was a single-surgeon, single-tertiary care center retrospective study. All patients who underwent primary FURS for proximal ureteric or renal stones from November 2014 to May 2018 were included in the study. Patients with a stone burden of more than 20 mm were excluded from the study. A 10/12-Fr coaxial UAS (Bi-Flex, Rocamed) was used. Data collection included age, sex, body mass index (BMI), stone burden and location, previous spontaneous passage of stones, type of anesthesia, and preexisting congenital anomalies. The Chi-square test and t-test were used for the statistical analyses.Results:One hundred and twelve patients were included in the study. All patients underwent primary FURS. The failure rate of primary UAS insertion was 10.7% (n = 12). No statistically significant difference was found in age, BMI, type of anesthesia, previous history of spontaneous stone passage, and stone burden between the success and failure groups (P > 0.05).Conclusions:We believe that our study opens the door for a multicentric prospective trial. Identifying factors leading to a failed primary FURS and UAS insertion is crucial to properly counsel patients preoperatively about the number of procedures that they might need and to prevent the financial loss associated with failed UAS insertion.

Management of Impacted Urethral Calculi: An Uncommon Cause of Acute Urine Retention in North-western Nigeria

Urethral stones though rare manifestation of urolithiasis may be primary but mostly are secondary arising from either the urinary bladder or the upper tract. When impacted in the urethra may result in acute urinary retention and difficulty in urethral catheterization. Various treatment modalities are available ranging from initial suprapubic cystostomy and subsequent open surgical or endoscopic procedures as well as treatment of associated urethral pathology. We report our experience in the management of patients with acute urine retention due to impacted urethral calculi in a tertiary hospital. This was a retrospective review of forty patients with impacted urethral stones managed at the Urology Unit, Department of Surgery Usmanu Danfodiyo University Teaching Hospital Sokoto from January 2005 to December 2015. Data were collected from patients’ case notes and entered in to a proforma and analysed using SPSS 20.0 version for Windows. Forty patients comprising of one female (2.5%) and 39 males (97.5%), mean age was 25±17.4 years with a range of 1-63yrs. In twenty patients (50%), attempt at urethral catheterization was not successful. Location of the impacted calculi were meatal 7 (17.5%), distal penile 4 (10%), mid penile 8 (20%), proximal penile 1 (2.5%), bulbar 4 (10%), peno-bulbar junction 3 (7.5%), posterior urethra 11 (27.5%), and bladder neck 2 (5%). Spontaneous extrusion of the calculi occurred in 4 (10%), while expulsion occurred in 2 (5%) after intra-urethral instillation of 2% lidocaine jelly. Other treatment modalities in the remaining patients included; meatotomy 11 (27.5%), open urethrolithotomy 6 (15%), urethroscopy and pneumatic lithotripsy 6 (15%), urethroscopy and stone retrieval 1 (2.5%), urethrolithotomy and urethroplasty 2 (5%), and cystolithotomy 8 (20%). Impacted urethral stone may be a cause of acute urinary retention and failed urethral catheterisation. The stone can pass spontaneously with or without manipulation or can be removed by endoscopic or open technique when spontaneous passage is not successful.

Giant ureterocele management in an adult male: A rare case report

Ureterocele is dilatation of lower ureter at its entry into the urinary bladder. It is classified into the single or duplex system and acquired or congenital. Acquired type is rare and seen in adults. We report the case of a 23-year-old male presented with voiding lower urinary tract symptoms and intermittent flank pain. He had a history of frequent spontaneous stone passage with right colicky pain 2 years back. On ultrasonogram and magnetic resonance urogram, diagnosis was made as right renal hydronephrosis with hydroureter due to right side giant intravesical ureterocele. The patient was managed by endoscopic transurethral incision and excision of ureterocele. It is the first case ever reported in the literature, where in giant ureterocele was completely removed by total endoscopic approach.

Medical Expulsive Therapy (MET) for Large Distal Ureteral Stones: A Prospective Study Comparing Three Drugs

Introduction: One of the most common disorders of the urinary tract is Urolithiasis. Twenty percent of lithiasis are located in the ureter of which 68% are seen in the distal ureter. The concept of medical expulsive therapy (MET) has been developed with enough knowledge of the ureter physiology in order to make easier the spontaneous expulsion of the stone. The aim of this study was to evaluate the efficacy and safety of three different drugs for the treatment of pelvic ureteral stones. Materiel and Methods: Between October 2017 and November 2018, 90 adult patients presenting with low or non-obstructive pelvic ureteral stones sized 8 to 10 mm were included. They were prospectively randomized, using computer-based randomization charts, into three equal groups: treatment with ketoprofen 100 mg once daily (Group I), silodosin 8 mg once daily (Group II) and tadalafil 5 mg once daily (Group III). The aim was to compare spontaneous expulsion of stone between those drugs Results: The mean expulsion time from the start of MET was 11.5 ± 3.27 days for ketoprofen group, 10.71 ± 3.98 days for silodosin group and 10.57 ± 3.40 days for tadalafil group. But these differences were also not significant (P = 0.79). The use of analgesics (grade II) was higher in groups II and III compared to group I, but without significant difference (23.33% in group I, 33.33% in group II and 40% in group III, p = 0.38). Discussion: The overall chance of spontaneous passage is low when the stone diameter is sized more than 7 mm. A wide range of spontaneous passage rates have been reported in the literature, varying from 71% to 98% for distal ureteral stones less than 5 mm and 25% - 53% for stone sized 5 to 10 mm with a mean expulsion time of more than 10 days. Conclusion: The three drugs have a low expulsion rate for 8, 9 and 10 mm pelvic ureteral stones with a higher adverse event rate for the NSAID group.

Identification and local delivery of vasodilators for the reduction of ureteral contractions.

Kidney stones and ureteral stents can cause ureteral colic and pain. By decreasing contractions in the ureter, clinically prescribed oral vasodilators may improve spontaneous stone passage rates and reduce the pain caused by ureteral stenting. We hypothesized that ureteral relaxation can be improved via the local administration of vasodilators and other smooth muscle relaxants. Here, by examining 18 candidate small molecules in an automated screening assay to determine the extent of ureteral relaxation, we show that the calcium channel blocker nifedipine and the Rho-kinase inhibitor ROCKi significantly relax human ureteral smooth muscle cells. We also show, by using ex vivo porcine ureter segments and sedated pigs that, with respect to the administration of a placebo, the local delivery of a clinically deployable formulation of the two drugs reduced ureteral contraction amplitude and frequency by 90% and 50%, respectively. Finally, we show that standard oral vasodilator therapy reduced contraction amplitude by only 50% and had a minimal effect on contraction frequency. Locally delivered ureteral relaxants therefore may improve ureter-related conditions.

Safety and efficacy of Tamsulosin as medical expulsive therapy in pregnancy.

Use of medical expulsive therapy (MET) is common practice in urology for the treatment of symptomatic urolithiasis, despite this its efficacy is debated. Its use in pregnancy is controversial. Our objective was to evaluate the safety and efficacy of Tamsulosin as a MET in pregnant women. We retrospectively identified pregnant patients who presented with renal colic at the CHU de Québec from 2000 to 2015. We compared patients who received Tamsulosin as MET to a control group without MET. We evaluated efficacy as passage rate of lithiasis and necessity of intervention. We evaluated safety of the treatment according to fetal outcomes (birth weight, APGAR, gestational age). We evaluated 207 pregnant patients presenting renal colic, 69 patients in the MET group were compared to 138 patients in the control group. Of these, 48 (70%) in the Tamsulosin therapy group and 76 (56%) in the control group had proven urolithiasis. No significant difference was found for mean gestational age at birth, birth weight and APGAR. No sudden infant death syndrome was encountered in Tamsulosin group. There was no significant difference for length of hospital stay and need for surgical intervention. The spontaneous passage rate was 58% (25/48) in the MET group compared to 43% (29/76), but this difference was not statistically significant (p = 0.18). Short-term utilisation of Tamsulosin as MET in second and third trimester of pregnancy is not associated with adverse maternal or infant outcomes. Moreover, there was no significant adjunct for the rate of stone passage.

Inflammatory serum markers predicting spontaneous ureteral stone passage.

Ureteral stones pose a high economic and medical burden among Emergency Department (ED) admissions. Management strategies vary from expectant therapy to surgical interventions. However, predictors of spontaneous ureteral stone passage are still not well understood. We aim to explore the role of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in the spontaneous ureteral stone passage (SSP). Chart review was done for 619 patients who presented to our institution's ED with non-febrile renal colic and received a radiological diagnosis of ureteral stone of less than 10mm. Demographic, clinical, laboratory, and radiological data were collected. The Linear-by-Linear Association test was used to look at the trend among the NLR and PLR quartiles and other demographic variables. Univariate analysis was run for the collected variables. Then, a hierarchal backward multivariate logistic regression was run for each of NLR and PLR variables. To validate the results, bootstrapping was undertaken for each model. NLR between 2.87 and 4.87 had odds ratio (OR) 2.96 (95% CI 1.80-5.49) and an NLR > 4.87 had 3.63 (2.04-6.69) the odds of retained ureteral stone. A PLR between 10.42 and 15.25 and a PLR > 15.25 had 3.28 (1.79-6.19) and 3.84 (2.28-7.12) the odds of failed SSP, respectively. Other significant variables in the two models are diabetes, urine leukocyte esterase > 10 white blood cell/μl, moderate-to-severe hydronephrosis, and stone size. NLR and PLR are inversely associated with SSP of ureteral stones. In adjunct with other indicators, NLR and PLR are inflammatory markers that could be used in the clinical decision of ureteral stone management.