Stone Length Research Articles

Correlations studies in ber (Zizyphus mauritianaLamk.)

The correlation coefficient (r) of 41 growth, fruiting and fruit quality characters of Ber was estimated using 24 cultivars. The correlation coefficient indicated that tree height was positively correlated with trunk girth, tree volume, cross trunk sectional area, number of shoots per tree, leaf length: breadth ratio and number of fruits per kg. The photosynthetic efficiency had positive but non-significant correlation with yield. Positive and significant correlation of fruit weight was found with fruit volume, stone length, stone breadth and stone weight. TSS showed negative and non-significant correlation with TSS: acid ratio and ascorbic acid content but it showed positive and non-significant correlation with acidity. The TSS: acid ratio gave positive and significant correlation with ascorbic acid content of fruit flesh.

Domestication Potential of Aromatic Pickle-mango (Appemidi) Types in the Central Western Ghats, India

Aromatic pickle-mango types, locally termed as ‘Appemidi’, are extensively collected for household use and for commerce from the wild habitats even today in the central Western Ghats, India. Because of the deep cultural attachment, people have recognized several pickle-mango types from the wild habitats. However, studies on treeto-tree variation in fruit and stone traits in natural populations are not done, which is a pre-requisite for cultivar development. Unripe fruits collected from 34 wild fruiting trees in two populations, 17 from Sirsi and 17 from Siddapur localities in Central Western Ghats, India were studied for variation in fruit traits and its association traits. Fruits from Sirsi locality were significantly larger than those from Siddapur (84.27 vs. 51.26g) due to their greater green flesh mass (79.91 vs. 43.17 g). Tree-to-tree variation was highly significant and continuous in fruit length (Sirsi = 49.45–102.51 mm; Siddapur = 28.23–59.19 mm), stone length (Sirsi=26.97–55.59 mm; Siddapur=20.43–51.47mm), fruit mass (Sirsi=19.78–84.27g; Siddapur=15.50–51.26 g) and flesh mass (Sirsi=18.01– 79.91g; Siddapur=13.93–43.17g), indicating the potential for selection. The strong relationships between fruit mass and green flesh mass in aromatic pickle-mango found in this study indicated that selection for green flesh mass can be based on fruit mass. Based on five important traits preferred by growers/fruit collectors/sellers and four quantitative traits from observations, development of an ‘ideal type’ and identification of potential superior trees was attempted. These results have important implications for the domestication of pickle-mango genetic resources.

Enlargement of umbilical incision in standard laparoscopic cholecystectomy is frequently necessary: An argument for the single incision approach?

Objective: Cosmetic result after cholecystectomy is up for debate. The aim of this study was to investigate the incidence and extent of enlargement of initial skin and fascia incision in standard laparoscopic cholecystectomy and to detect predictive factors for such an enlargement. Material and methods: The size of the umbilical incision was measured before and after standard laparoscopic gallbladder removal in 391 patients from August 2009 to October 2012. Predisposing factors for the need of enlargement of the umbilical incision were analysed. Results: Additional enlargement of the umbilical incision for gallbladder removal was required in 35.8% of the patients at skin level, and in 40.4% at fascia level. The median enlargement of the umbilical skin incision was 11 mm, from 25 mm to 36 mm. Gallbladder weight, total stone weight, maximum diameter of largest stone and shorter initial length of incision were independent predisposing factors for enlargement of the incision. Conclusions: In standard laparoscopic cholecystectomy the umbilical incision frequently requires secondary enlargement, especially if a large stone mass is involved. Therefore, the cosmetic result after laparoscopic cholecystectomy depends on more than only the technique used for access and the surgical technique for cholecystectomy should be chosen individually for each patient according to the stone mass.

MP27-04 TAMSULOSIN AS AN EXPULSIVE THERAPY FOR STEINSTRASSE AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY: A RANDOMIZED CONTROLLED STUDY

You have accessJournal of UrologyStone Disease: Therapy III1 Apr 2014MP27-04 TAMSULOSIN AS AN EXPULSIVE THERAPY FOR STEINSTRASSE AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY: A RANDOMIZED CONTROLLED STUDY Essam ElDin Moursy, Wael Gamal, and Abdelmenem Abuzeid Essam ElDin MoursyEssam ElDin Moursy More articles by this author , Wael GamalWael Gamal More articles by this author , and Abdelmenem AbuzeidAbdelmenem Abuzeid More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.367AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Steinstrasse is a well-known complication following extracorporeal shockwave lithotripsy (ESWL). The objective of this study was to evaluate the efficacy of tamsulosin as a management of steinstrasse. METHODS 88 patients with unilateral steinstrasse were treated between January 2005 and December 2008. The patients were randomly allocated into two equal groups. There were no significant differences between groups for age, gender, stone location, stone length or stone fragment size (p > 0.05). Patients in group 1 (study group) received a single daily morning dose of tamsulosin (0.4 mg) for a maximum of 4 weeks, in addition to pain-relieving therapy. Patients in group 2 (control group) received only the pain relieving therapy. All patients were checked weekly with a plain X-ray of the urinary tract, urinary ultrasonography, urine analysis and serum creatinine. Pain episodes, day of spontaneous stone expulsion, total analgesic dosage and drug side effects were recorded. RESULTS Stone expulsion occurred in 32 of the 44 patients (72.7%) receiving tamsulosin and in 25 of the 44 patients (56.8%) in the control group. Patients receiving tamsulosin had a significantly higher stone expulsion rate (p = 0.017). There were no significant differences between groups for mean stone expulsion time or number of analgesics used. Twelve patients (27.3%) in the group receiving tamsulosin and 19 patients (43.3%) in the control group needed hospitalization; the group difference was statistically significant (p = 0.017). CONCLUSIONS When compared with no treatment, tamsulosin can significantly facilitate expulsion of retained ureteral stone fragments following ESWL. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e276 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Essam ElDin Moursy More articles by this author Wael Gamal More articles by this author Abdelmenem Abuzeid More articles by this author Expand All Advertisement Advertisement Loading ...

Dissolution Therapy versus Shock Wave Lithotripsy for Radiolucent Renal Stones in Children: A Prospective Study

We prospectively evaluated the efficacy of dissolution therapy and standard shock wave lithotripsy as a noninvasive modality for radiolucent renal stones in children. A total of 87 children with radiolucent renal calculi were included in study. Median age was 2.5 years (range 0.5 to 13). Computerized tomography was done to confirm a stone density of less than 500 HU. Median stone length was 12 mm (range 7 to 24). Patients were randomly divided into 2 groups. The medical group of 48 patients received potassium sodium hydrogen citrate at a dose of 1 mEq/kg per day for 1 to 3 months. The shock wave lithotripsy group of 39 patients were treated with a Lithotripter S (Dornier Medtech, Kennesaw, Georgia) while under general anesthesia. Complications in each group were recorded. Patients were considered stone free when imaging within 3 months showed no evidence of stones. The stone-free rate was 72.9% for dissolution therapy vs 82.1% after a single session of shock wave lithotripsy (p = 0.314). One patient per group experienced a pyelonephritis episode during followup (p = 0.698). Three of the 13 patients in whom medical regimens failed were noncompliant and 5 ingested the medication sporadically. Medical dissolution therapy is a well tolerated, effective treatment for radiolucent renal stones in children. It eliminates the need for shock wave lithotripsy in up to 73% of cases.

Effect of growth regulators on quality of ber (Zizyphus mauritianaLamk) cv. Umran.

There is huge potential to improve market acceptability of ber with application of growth regulators. Significant increase in fruit size traits i.e. fruit length, breadth, weight and volume was recorded with application of NAA 30 ppm. The palatability rating of fruits in terms of taste, colour and texture of fruit was recorded maximum with application of GA3 50 ppm. For the stone related traits, the maximum reduction in stone breadth and percentage was recorded with NAA 30 ppm. There was no significant variation in stone length and weight with growth regulators.

Effectiveness of Flexible Ureterorenoscopy and Laser Lithotripsy for Multiple Unilateral Intrarenal Stones Smaller Than 2 cm.

Purpose. To evaluate the safety and efficacy of RIRS for the treatment of multiple unilateral intrarenal stones smaller than 20 mm. Methods. Between March 2007 and April 2013, patients with multiple intrarenal stones smaller than 20 mm were treated with RIRS and evaluated retrospectively. Each patient was evaluated for stone number, stone burden (cumulative stone length), operative time, SFRs, and complications. Results. 173 intrarenal stones in 48 patients were included. Mean age, mean number of stones per patient, mean stone burden, and mean operative time were 40.2 ± 10.9 years (23–63), 3.6 ± 3.0 (2–18), 22.2 ± 8.4 mm (12–45), and 60.3 ± 22.0 minutes (30–130), respectively. The overall SFR was 91.7%. SFRs for patients with a stone burden less and greater than 20 mm were 100% (23/23) and 84% (21/25), respectively (χ 2 = 26.022, P < 0.001). Complications occurred in six (12.5%–6/48) patients, including urinary tract infection or high-grade fever >38.5°C in three cases, prolonged hematuria in two cases, and ureteral perforation in one case, all of whom were treated conservatively. No major complications occurred. Conclusions. RIRS is an effective treatment option in patients with multiple unilateral intrarenal stones especially when the total stone burden is less than 20 mm.

A meta-analysis to compare LC +LCBDE with ERCP+LC for patients with concomitant gallstones and common bile duct stones

Objective To compare the safety and efficiency of laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE) with endoscopic retrograde cholangiopancreatography (ERCP) /endoscopic sphincterotomy (EST) +LC for patients with concomitant gallstones and common bile duct stones.Methods The Pubmed,EMBASE and CNKI were searched for randomized controlled trials published from 1990 to March,2012.Revman 5.1 was used to perform the meta-analysis.The main outcomes were stone clearance rate,treatment morbidity,operative time and length of hospital stay.Results 9 studies with 1021 patients were included into the final analysis.Meta-analysis demonstrated that LC+LCBDE was similar to ERCP/EST+LC in the stone clearance rate (OR 1.55,95％CI 0.95～2.52,P=0.08),treatment morbidity (OR 1.12,95％CI 0.75～1.67,P=0.58),operative time (WMD-54.44,95％CI-107.7～-1.17,P=0.05) and length of hospital stay (WMD-0.22,95％CI-2.6～2.16,P=0.86).The P value of the stone clearance rate was approaching 0.05 with increased number of studies in the analysis.There was no significant difference in the operative time,probably because of small sample size.Conclusions LC-LCBDE was equivalent to ERCP/EST+ LC in stone clearance rate,treatment morbidity,operative time and length of hospital stay.There is a possibility that LC+LCBDE can be superior to ERCP/EST+LC in the stone clearance rate and the operative time with increase in sample size. Key words: Cholelithiasis; Cholecystectomy, laparoscopic; Cholangiopancreatography; Endoscopic retrograde; Meta analysis

4:10 PM Abstract No. 108 - A new percutaneous pneumatic lithotripsy technique for common bile duct gallstones removal

Purpose To develop a new technique for percutaneous removal of common bile duct (CBD) gallstones by using a pneumatic lithotripter with a XCOIL encapsulator (XE) and retractor (XR) system. Materials and Methods For in-vitro confirmation, a 6.0mm glass tube was shaped to simulate the cystic duct and CBD of pigs. Human gallstone was placed into the tube. An 11Fr custom balloon introducer sheath (BIS) was positioned close to the gallstone, and then inflated to occlude the proximal tube. An XE and XR system was advanced through the BIS into the tube, to catch the gallstone by pulling XR back into the XE. The stone was restricted within the XE by closing the distal XE end via a string. A 1.0mm lithotripter probe was manually-curved according to the glass tube shape and then advanced into the XE through the BIS, where the gallstone was shocked. Fragments were then extracted from the tube with the XE. Lithotripsy procedures were repeated for 6 times. The shock numbers, the skin-to-skin lithotripsy time and fragment sizes were recorded. For in-vivo validation, via a transcystic approach, human gallstones were positioned into CBDs of three pigs through a 16Fr introducer. Under fluoroscopy, an 11Fr BIS was placed into CBD to break and remove the gallstones with the same procedures as developed from the in-vitro experiment. Pre- and post-cholangiographies were obtained to confirm the successes of the gallstone placement, breaking, and removal. After the experiment, the pigs were euthanized and CBDs were harvested for histology. Results Of the in-vitro experiment, average 9.5±4.2 shocks were required to break gallstones. The average skin-to-skin lithotripsy time was 6'10. All stones were successfully broken, with the average maximal length of the gallstone fragments at 2.1±0.3mm compared to the pre-lithotripsy stone length at 5.3±0.2 mm (p Conclusion The new XCOIL-assisted percutaneous pneumatic lithotripsy is feasible and safe for CBD gallstones breaking and removal, which establishes groundwork for its further clinical application.

1819 TRIPLE D SCORE IS A REPORTABLE PREDICTOR OF STONE FREE RATES FOLLOWING SHOCKWAVE LITHOTRIPSY

and past history of ureteral stone. The association with CT parameters of stone including diameter (D), length (H), volumetric stone burden (VSB; D H 5 / 6), estimated stone location (ESL; number of axial cut images between stone and UVJ), tissue rim sign (RS; 0-3), perinephric edema (0-3), hydronephrosis (0-3), and Hounsfield unit (HU) were also analyzed. Then a logistic regression model was developed using these variables to estimate the stone-free rate after URSL. RESULTS: The stone-free rate of URSL was 85.7% (203/237). Univariate analysis found that stone diameter, length, VSB, ESL, HU and RS significantly affect the stone-free rate (p 0.000, 0.000, 0.003, 0.000, 0.005, 0.000, respectively). Multivariate analysis indicated that stone diameter (HR 1.165, p 0.005), ESL (HR 1.074, p 0.001), and RS (HR 4.635, p 0.009) significantly affect the stone-free rate. Predictive model by logistic regression analysis for stone-free rate after URSL was defined as follows: stone free rate 1/[1 exp{6.146 0.153(D) 0.071(ESL) 1.534(RS)}] with AUC 0.825 from ROC curve. Internal validation showed that stone-free rate concordance was 0.774. CONCLUSIONS: Present study demonstrated that CT-measured parameters including stone diameter, ESL and RS are independent factors affecting URSL outcome. A CT-based predictive model using these factors helps to estimate stone-free rate after URSL in individual patients and facilitates treatment planning.

1692 ANALYSIS OF STONE'S COMPOSITION AND CT DENSITY

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (II)1 Apr 20131692 ANALYSIS OF STONE'S COMPOSITION AND CT DENSITY Takashi Kawahara, Hiroshi Miyamoto, Hiroki Ito, Hiroji Uemura, Yoshinobu Kubota, and Junichi Matsuzaki Takashi KawaharaTakashi Kawahara Rochester, Japan More articles by this author , Hiroshi MiyamotoHiroshi Miyamoto Rochester, Japan More articles by this author , Hiroki ItoHiroki Ito Yokohama, Japan More articles by this author , Hiroji UemuraHiroji Uemura Yokohama, Japan More articles by this author , Yoshinobu KubotaYoshinobu Kubota Yokohama, Japan More articles by this author , and Junichi MatsuzakiJunichi Matsuzaki Yokohama, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3054AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study investigated the correlation between the stones' computed tomography (CT) densities and the stone's chemical composition. METHODS A total of 505 patients were analyzed in this study. In these patients, 449 patients were matched to analyze this study from 2009 to 2011. The stones were viewed with helical NCCT (Aquilion 64; Toshiba, Tokyo, Japan) (120 kVp; 300 mA; 0.5-1.0 s; collimation 5 mm; pitch 1:1), and a standard renal stone viewing protocol that uses soft-tissue settings (width 350/length 50) was utilized. A region of interest was drawn using the center slice of the primary stone on axial reconstructions. The maximum and average attenuation coefficients were measured by placing a freehand region of interest along the inner contours of the renal stone margins. The stone maximum diameter of stone length and width on NCCT were determined using digital calipers (SYNAPSE-PACS Software Program System, Fujifilm, Tokyo, Japan). All NCCT scans were interpreted by a single urologist (H.I.). All stone fragments were acquired by ureteroscopic lithotripsy during the procedure and analyzed in chemical stone composition. RESULTS The initial assessment between stone size and stone's CT density showed that increasing the stone diameter affects the stone's CT density. The correlation was higher less than 5 mm and was gradually decreasing as the stone diameter increases more than 5mm. So, we determined the cut off point to assess between stone's CT density and stone's chemical composition using the stones which diameter were more than 5mm. Cut off point as of 5mm was standard cut off point reported by previous studies. A chemical analysis revealed calcium oxalate in 201 (44.8 %), mixed with calcium oxalate and calcium phosphate in 207 (46.1 %), calcium phosphate in 17 (3.8%), uric acid in 13 (2.9 %), struvite in 6 (1.3 %) and cysteine in 5 (1.1 %). The mean Hounsfield units (HUs) values of stone's CT density were 1074 HUs in calcium oxalate, 1059 Hus in mixed with calcium oxalate and calcium phosphate, 893 HUs in calcium phosphate, 660 HUs in uric acid, 813 HUs in struvite and 698 HUs in cystine. The HUs values in calcium oxalate were significantly higher than in uric acid and struvite in each procedure. And comparing between monohydrate and dehydrate calcium oxalate stones, monohydrate stones were significantly higher CT densities than dehydrate stones. CONCLUSIONS This study is the largest study to assess the stone CT density and stone composition ever published. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e696 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takashi Kawahara Rochester, Japan More articles by this author Hiroshi Miyamoto Rochester, Japan More articles by this author Hiroki Ito Yokohama, Japan More articles by this author Hiroji Uemura Yokohama, Japan More articles by this author Yoshinobu Kubota Yokohama, Japan More articles by this author Junichi Matsuzaki Yokohama, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1985 PREOPERATIVE TAMSULOSIN FACILITATES URETEROSCOPIC MANAGEMENT OF LOWER URETERIC CALCULI: A PROSPECTIVE RANDOMIZED STUDY

INTRODUCTION AND OBJECTIVES: Tamsulosin is proved to promote spontaneous passage of distal ureteral and juxtavesical calculi. Our aim is to prospectively evaluate the role of neoadjuvant tamsulosin during ureteroscopic treatment of lower ureteric stone. METHODS: One hundred thirty-eight adult patients with lower ureteral calculi underwent ureteroscopic management. Stone length varied from 7 to 12 mm. Before treatment, the patients were randomly divided into 2 groups; the study group (n 70) received tamsulosin 0.4 mg once daily for 3-6 weeks and the control group (n 68) received standard analgesia only. Preoperative medications were blinded to the endourologists. The primary endpoint was the need for intraoperative ureteral dilatation. Postoperative complications were recorded for both groups. RESULTS: Of the 120 patients available for follow up, the need for intraoperative ureteral dilatation was 30% in the study group, compared with 86.7% in the control group (p 0.001). Of the control group, 5% had postoperative pyelonephritis episodes, in contrast to only 1.7% of the study group (p 0.619). CONCLUSIONS: Preopertive tamsulosin simplifies ureteroscopic management of lower ureteric calculi. To the best of our knowledge, this is the first study to show the value of neoadjuvant tamsulosin in ureteroscopic management of distal ureteric calculi.

Extracorporeal shockwave lithotripsy for renal stones in pediatric patients: A multivariate analysis model for estimating the stone‐free probability

To define factors affecting the stone-free rate of extracorporeal shockwave lithotripsy in the treatment of pediatric renal calculi, and to establish a regression model for pretreatment prediction of stone-free probability. From January 1999 through February 2012, 207 children with mean age 6.4 ± 3.8 years underwent shockwave lithotripsy with Dornier Lithotripter S for treatment of renal stones. The stone-free rate was evaluated 3 months after the last shockwave lithotripsy session with non-contrast computed tomography. Treatment success was defined as complete clearance of the stones with no residual fragments. Multivariate logistic regression analysis was used to identify independent risk factors and to predict the probability of being stone free. The mean length of the stone was 11.6 ± 4 mm. The stone-free rate was 71%. Independent factors that adversely affect stone-free rate were increasing stone length and calyceal site of the stone. Relative risks for not being free of stones were 1.123 for stone length, 2.673 for stones in the upper or middle calyx and 4.208 for lower calyx stones. Stone length and location are prognostic factors determining stone-free rate after shockwave lithotripsy for renal calculi in pediatric patients. Based on our analysis, shockwave lithotripsy should be recommended for renal pelvis stones up to 24 mm, upper or middle calyceal stones up to 15 mm and lower calyceal stones up to 11 mm.

Kidney Stone Size and Hounsfield Units Predict Successful Shockwave Lithotripsy in Children

To define the preoperative kidney and stones characteristics on noncontrast-enhanced computed tomography that affect the success of extracorporeal shockwave lithotripsy (SWL) for treatment of renal calculi in pediatric patients. From 2005 to 2011, 57 children (age<16 years) with documented preoperative noncontrast-enhanced computed tomography scans underwent SWL for treatment of renal stones and were included in the present study. Stone size, site, multiplicity, average skin-to-stone distance, stone attenuation value, and kidney morphology were determined from the preoperative noncontrast-enhanced computed tomography scans. Success was defined as radiographically stone-free status at the 3-month follow-up examination after a single lithotripsy session without the need for additional sessions or ancillary procedures. After a single session of SWL, 24 children (42.1%) were stone free on the 3-month follow-up imaging study without the need for additional SWL sessions. Treatment failed in 33 patients (57.9), with residual fragments in 30 children, of whom 29 required repeat SWL, and 3 with stones that were considered unchanged and were finally treated with percutaneous nephrolithotomy. Logistic regression analysis revealed that stone attenuation in Hounsfield units (HU) and stone length were the only significant predictors of success. When the HU were stratified into 2 groups of≤600 and >600 HU, the SWL success rate was 82.1% and 20%, respectively (P=.023). When length was stratified as≤12mm and >12mm, the stone-free rate was 58.6% and 25.1%, respectively (P= .016). Stone attenuation≤600 HU and stone length≤12mm were significant independent predictors of SWL success in children.

Stone Attenuation Value and Cross-Sectional Area on Computed Tomography Predict the Success of Shock Wave Lithotripsy

PurposeTo identify the parameters on noncontrast computed tomography (NCCT) that best predict the success of shock wave lithotripsy (SWL).Materials and MethodsWe reviewed the records of 75 patients who underwent SWL for urinary calculi measuring 5 to 20 mm. Using NCCT images, we estimated the largest stone cross-sectional area and contoured the inner edge of the stone. Clinical outcome was classified as successful (stone-free or <4 mm in diameter) or failed (stone fragments, ≥4 mm). The impact of preoperative parameters was evaluated by univariate and multivariate analysis.ResultsThe overall success rate was 73.3%. Average stone attenuation value, stone length, and stone cross-sectional area in the success and failure groups were 627.4±166.5 HU (Hounsfield unit) vs. 788.1±233.9 HU (p=0.002), 11.7±3.8 mm vs. 14.2±3.6 mm (p=0.015), and 0.31±0.17 cm2 vs. 0.57±0.41 cm2 (p<0.001), respectively. In the multivariate analysis, stone attenuation value was the only independent predictor of SWL success (p=0.023), although stone cross-sectional area had a tendency to be associated with SWL success (p=0.053). Patients were then classified into four groups by using cutoff values of 780 HU for stone attenuation value and 0.4 cm2 for cross-sectional area. By use of these cutoff values, the group with a low stone attenuation value and a low cross-sectional area was more than 11.6 times as likely to have a successful result on SWL as were all other groups (odds ratio, 11.6; 95% confidence interval, 3.9 to 54.7; p<0.001).ConclusionsStone attenuation value and stone cross-sectional area are good predictors of extracorporeal SWL outcome.

Development of a nomogram for predicting the stone‐free rate after transurethral ureterolithotripsy using semi‐rigid ureteroscope

To develop and to internally validate a novel nomogram for predicting the stone-free rate after transurethral ureterolithotripsy. A total of 412 patients with 534 ureteral stones were treated with transurethral ureterolithotripsy using semi-rigid ureteroscopes. Treatment efficacy was evaluated 3 months after the procedure. Multivariate stepwise logistic regression analysis was used to identify independent predictors of being stone-free in the model-building set. A total of 427 stones (80% of 534) were randomly allocated for identification and statistical analysis to build the model, and the remaining 107 (20%) were used for cross-validation. A nomogram for the stone-free rate was developed based on the final logistic regression model. Stone length, number of stones, stone location and the presence of pyuria were independent factors related to the stone-free rate after transurethral ureterolithotripsy treatment, and these were used to develop a nomogram. In this nomogram, the area under the receiver operating characteristic curve was 0.7432 for the nomogram, 0.5641 for stone size, 0.5908 for the number of stones, 0.6594 for stone location and 0.6076 for pyuria. Validation using 20% of the data also achieved a reasonable predictive accuracy (area under the receiver operating characteristic curve = 0.682). The first nomogram for predicting the stone-free rate after transurethral ureterolithotripsy was developed. It has a reasonable predictive accuracy, and in combination with extracorporeal shock wave lithotripsy nomograms, it might be useful for deciding treatment methods.

Single‐session ureteroscopy with holmium laser lithotripsy for multiple stones

Multiple stones are found in 20-25% of patients with urolithiasis. The stone multiplicity is a powerful adverse factor influencing the treatment outcome after shockwave lithotripsy, although guidelines for the treatment of multiple stones have not been well established yet. Herein we report our most recent experience of a single-session ureteroscopy for multiple stones. Between September 2008 and December 2011, 51 patients with multiple stones (total 146 stones) in different locations (37unilateral, 14 bilateral) underwent a total of 65 ureteroscopic procedures. Operative time, stone-free rates and complications were evaluated. Stone-free status was defined as no fragments in the ureter and the absence of >2 mm fragments in the kidney. The mean stone number per patient was 2.9 ± 1.7 and the mean stone burden (cumulative stone length) was 21.5 ± 11.6 mm. The mean number of procedures was 1.3 ± 0.6. Overall, the stone-free rate after a single session was 80% (41/51). In patients with stone burden <20 mm and ≥20 mm, stone-free rates after a single session were 92% (23/25) and 69% (18/26), respectively. Multivariate analysis showed that the stone burden and the presence of impacted stones were the factors significantly influencing the treatment outcome. Stone location did not have a strong influence on the outcome. No major intraoperative complications were identified. Our findings suggest that ureteroscopy is an efficient treatment for multiple stones. For patients with stone burden <20 mm, either unilaterally or bilaterally, a single session of ureteroscopy is a favorable treatment option with a high stone-free rate.

1840 THE EFFECT OF COMBINED FUROSEMIDE AND INTRAVENOUS HYDRATION TO ESWL SUCCESS ON RENAL STONES

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal III1 Apr 20121840 THE EFFECT OF COMBINED FUROSEMIDE AND INTRAVENOUS HYDRATION TO ESWL SUCCESS ON RENAL STONES Salim Küçükpolat, Akin Soner Amasyali, Ugur Yücetas, Erkan Erkan, Gökhan Toktas, and Erdinc Unlüer Salim KüçükpolatSalim Küçükpolat Istanbul, Turkey More articles by this author , Akin Soner AmasyaliAkin Soner Amasyali Istanbul, Turkey More articles by this author , Ugur YücetasUgur Yücetas Istanbul, Turkey More articles by this author , Erkan ErkanErkan Erkan Istanbul, Turkey More articles by this author , Gökhan ToktasGökhan Toktas Istanbul, Turkey More articles by this author , and Erdinc UnlüerErdinc Unlüer Kars, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1928AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to investigate the efficacy of diüresis during extracorporeal shockwave lithotripsy (ESWL) treatment of renal calculi. METHODS From June 2009 - June 2010, 200 patients presenting with renal calculus were treated by ESWL (Siemens Modularis Vario Lithostar®) in Istanbul Teaching and Research Hospital enrolled the study. Shock waves were given at a rate of 90 shocks/minute with max. energy 5,5 KV. Patients were randomised into 2 groups. The first group was treated by standard ESWL and included 100 patients. The second group was treated with preoperative intravenous (IV) 20 mg furosemide administered 30 minutes before ESWL and hydration (1000 cc %0,9 NaCl) during procedure. Patients with ureteropelvic junction obstruction, congenital renal anomaly, who have hydronephrosis more than grade 1 and age under 18 were excluded. Failure of disintegration was defined as no fragmentation of the stone after three sessions or residual fragments larger than 4 mm after last session. Three months after last ESWL session outcomes were compared. RESULTS Maximum stone length was between 6 – 20 mm. There were no statistical difference in terms of age, maximum stone length, maximum hounsfield unit (HU), mean HU, skin-to-stone distance, urine density and pH between study and control group (Table 1). Clearance rates were 69% and 71% for control and study group, respectively (p=0,758) (Figure 1). Complications rates were similar and wasn't statistically significant (9% vs 6%, p=0,421). Also no significant difference was observed according to mean number of ESWL sessions, shocks per stone and mean admitted energy. CONCLUSIONS Although concomittan diuretic and IV hydration during ESWL is safe, inexpensive and feasible, present study did not find any difference for stone clearance. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e744 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Salim Küçükpolat Istanbul, Turkey More articles by this author Akin Soner Amasyali Istanbul, Turkey More articles by this author Ugur Yücetas Istanbul, Turkey More articles by this author Erkan Erkan Istanbul, Turkey More articles by this author Gökhan Toktas Istanbul, Turkey More articles by this author Erdinc Unlüer Kars, Turkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10–20 mm

What's known on the subject? and What does the study add? Shock wave lithotripsy and flexible ureterorenoscopy are acceptable treatment options for lower pole stones smaller than 10 mm, while percutaneous nephrolithotomy is the favoured treatment for stones larger than 20 mm. For treatment of lower pole stones of 10-20 mm, flexible ureterorenoscopy has a significantly higher stone-free rate and lower retreatment rate than shock wave lithotripsy. To compare the outcomes of flexible ureterorenoscopy (F-URS) and extracorporeal shock wave lithotripsy (ESWL) for treatment of lower pole stones of 10-20 mm. The database of patients with a single lower pole stone of 10-20 mm was examined to obtain two matched groups who were treated with F-URS or ESWL. Matching criteria were stone length, side and patient gender. Stone-free rates were evaluated 3 months after the last treatment session by non-contrast computed tomography. Both groups were compared for retreatment rate, complications and stone-free rate. The matched groups included 37 patients who underwent F-URS and 62 patients who underwent ESWL. Retreatment rate was significantly higher for ESWL (60% vs 8%, P < 0.001). Complications were more after F-URS (13.5% vs 4.8%), but the difference was not significant (P= 0.146). All complications were grade II or IIIa on modified Clavien classification. The stone-free rate was significantly better after F-URS (86.5% vs 67.7%, P= 0.038). One failure of F-URS (2.7%) and five failures (8%) of ESWL were treated with percutaneous nephrolithotomy. Significant residual fragments in three patients (8%) after F-URS were treated with ESWL, while significant residual fragments after ESWL in five patients (8%) were treated with F-URS. Residual fragments (<4 mm) were followed every 3 months in one patient (2.7%) after F-URS and in 10 patients (16%) after ESWL. For treatment of lower pole stones of 10-20 mm, F-URS provided significantly higher stone-free rate and lower retreatment rate compared with ESWL. The incidence of complications after F-URS was not significantly more than after ESWL.

Contribution of lateral processes to stone pavement formation in deserts inferred from clast orientation patterns

Stone pavements are widespread landforms of arid environments. They typically develop by accretionary rise above a thickening aeolian mantle which usually contains a surficial vesicular unit. Hence, stone pavements are regarded as stable landforms and, thus, are often used as surface-age indicators. We studied orientation patterns of pavement clasts and depict their geometrical properties. We introduce a new statistical approach for quantitative description of circular data. From four study regions in a wide variety of environmental settings we show that preferred, non-random orientation of clast length axes is a recurrent feature of modern stone pavements. Orientation is primarily determined by no other relief parameter than slope aspect. In 40 out of 52 measured plots an angle of 72 ± 9° separates two angle maxima. The same patterns are present in stone lines buried under a cover of aeolian dust. We interpret these features as fossil stone pavements, accordingly. Furthermore, on artificially cleared plots disturbed stone pavements begin to recover within few months by a process which creates essentially the same orientation pattern. We suggest that lateral surficial processes such as unconcentrated overland flow and creep contribute to the formation and maintenance of stone pavements as well as to this preferred clast orientation. They arrange clasts symmetrical to slope aspect with an angle determined by the axes ratio of the transported object. This results in the frequent bimodal pattern of stone length axes. This special type of transport requires previous accumulation of aeolian material forming a fine grained, even vesicular layer. Thus, there is close relationship between stone pavement and vesicular layer. We conclude that lateral processes take part in stone pavement formation. The commonly accepted model of dust accretion, which is not rendered obsolete by our findings, has to be complemented by this lateral component. This has implications for the stability of stone pavement-covered surfaces and for their applicability as age indicators. Quickly resealing disturbances as well as fossilised stone pavements imply this prominent desert surface feature may become fragile and transient.