Therapy For Stones Research Articles

Outcome of a-Blockers, with and without Corticosteroid Combination, in Medical Expulsive Therapy for Lower Ureteric Stones

Background: Urinary calculi have serious implications in urology. Lower ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. Because the patient’s symptoms and stone size do not predict loss of renal function and because there is no clear time threshold for irreversible damage, treatment should be strongly considered in any patient with ureteral stones. In this study we are comparing the results of medical expulsive therapy using alpha blockers with vs, without combination of corticosteroids as adding steroids increases the efficacy by decreasing stone expulsion time. Keywords: Ureteric calculi, stone clearance, stone expulsion time, medical expulsive therapy

Is medical dissolution treatment for uric acid stones more cost-effective than surgical treatment? A novel, solo practice, retrospective cost-analysis of medical vs. surgical therapy.

Effective medical dissolution therapy (MDT) for uric acid stones is more cost-effective than surgical treatment; however, treatment failure may be associated with increased cost. We aimed to study the cost-effectiveness of MDT for uric acid stones vs. surgical management. We performed a retrospective study within our institution of all patients receiving MDT for uric acid stones from 2008-2019. All patients had a known history of uric acid stones, urine pH ≤5.5, and <500 Hounsfield units on preoperative computed tomography (CT). The cost of treatment in the dissolution group was compared to the cost of primary surgical treatment in a theoretical matched cohort. Cost was estimated using local Medicare reimbursement scales. Statistical analysis was performed with SPSS Statistics. A total of 28 patients were identified, of which 18 were included in the study. Complete and partial dissolution occurred in six (33%) and four (22%) patients, respectively. Five (28%) patients developed symptoms and underwent ureteral stent placement. Ureteroscopy and percutaneous nephrolithotomy (PCNL) were each performed in three (17%) patients in whom dissolution treatment was not effective on followup CT. Following dissolution trial, six (33%) patients had residual stone burden requiring surgical intervention. The average cost of treatment, including surgeries, was $14 604 in the dissolution group vs. $17 680 in the surgical cohort. The average cost to achieve stone-free status in patients with complete, partial, or no response to dissolution were $1675, $10 124, and $21 584, respectively, while primary surgical treatment for the same patients would cost $15 037, $10 901, and $20 511, respectively. Successful MDT is highly cost-effective. Incomplete response to dissolution can stem from several reasons and contributes to higher costs and likely decreased quality of life.

Semirigid Ureteroscopy Therapy against Childhood Kidney Stones.

Objective The purpose of the current study was to assess the effectiveness of semirigid ureterorenoscopy (URS) as first-line therapy for early childhood patients with <20 mm stones in the pelvic, middle, or upper calices. Methods In all, 61 pediatric kidney stone patients who had flexible ureteroscopy (fURS) between January 1, 2010, and December 31, 2019, were included in this study. Before fURS, semirigid URS employed the UreTron or holmium: YAG (Ho : YAG) laser was conducted. When semirigid URS was unsuccessful, fURS was used for retrograde intrarenal surgery (RIRS). All participants were monitored clinically for a minimum of three months after each procedure. Results The patient's mean age was 4.52 ± 1.53 years, and 52 (83.61%) participants underwent semirigid URS successfully. Mean procedural duration of semirigid URS was 36.49 ± 7.72 min. The stone-free rate after semirigid URS was 92.16% (47/51). During the postprocedural medical observation, there were no serious adverse effects. Conclusions Based on the present study's findings, semirigid URS is a low-risk, effective therapy for kidney stones in selected pediatric patients.

Comparative Study of Efficacy and Safety of Tamsulosin plus Tadalafil Combination Therapy versus Tamsulosin Monotherapy as Medical Expulsive Therapy of Ureteric Stone

Introduction: If surgical intervention is not indicated, current international guidelines and evidences recommend medical expulsive therapy (MET) involving the administration of drugs to improve spontaneous stone passage. Medical expulsive therapy has now become an established modality of treatment, and employs the use of various drugs that act on the ureter with different mechanisms. It is hypothesised that elevation of cyclic guanosine monophosphate in ureteral smooth muscle by phosphodiesterase type 5 (PDE5) inhibitors may result in ureteral relaxation and increased stone clearance. Aims/ objective: To investigate whether we can achieve better ureteric relaxation and reduction in intramural pressure in order to facilitate stone passage by tamsulosin plus tadalafil combination therapy. Materials and Method: Stone expulsion rate of tamsulosin + tadalafil when compared to tamsulosin was our primary endpoint. (Assessed by subjective response and confirmed by repeat plain X ray abdomen and if needed CT scan abdomen). The efficacy of the individual drugs was analysed and compared with the help of Pearson chi square test. p value &lt;0.05 were considered as statistically significant. Results: 33 patients (66%) receiving tamsulosin and 43 patients (86%) receiving combination therapy showed positive outcome (expulsion of stones). So, tamsulosin plus tadalafil combination therapy had significantly better efficacy. In tamsulosin group 30 patients among 33 (90.9%) expelled the stone in less than 5 days. In tamsulosin plus tadalafil group, 37 patients among 43 (86%) expelled in less than 5 days. But the difference was not statistically significant. Both drugs were well tolerated by the study patients. Conclusion: Tamsulosin plus tadalafil is more efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones compared to tamsulosin. Medical expulsive therapy also doesn’t carry post-operative morbidities as compared to surgical methods.

A randomized trial of adjuvant tamsulosin as a medical expulsive therapy for renal stones after shock wave lithotripsy.

Adjuvant medical expulsive therapy (MET) for shock wave lithotripsy (SWL) is controversial. With limited use of the computed tomography (CT), the stone free rate (SFR) become overestimated. Herein we evaluate tamsulosin post-SWL for renal stone using the CT to assess SFR. A randomized controlled trial (NCT05032287) was carried out for renal stone patients amenable for SWL. Patients were allocated after 1st session of SWL to receive tamsulosin 0.4 mg or placebo once daily from the 1st day of SWL and for 3-months or becoming stone free. The primary outcome was SFR, defined by presence of residual fragments (RF) ≤ 3 mm (3C-SFR). The 3C-SFR were 73.8% and 59.6% in tamsulosin and placebo groups, respectively (p=0.03). The median (IQR) pain scores were 3 (3, 5) and 5 (3, 6) in tamsulosin and placebo groups, respectively (p=0.04), However, the post-SWL complication and add-on analgesia needed showed no significance differences between groups. The median time for stone free were 30 days (95% CI: 27.29-32.71) in tamsulosin arm, and 36 days (95% CI: 31.01-40.99) in placebo arm, HR= 1.42 (95% CI: 1.02-1.98). Tamsulosin has more reversible adverse effect, compared to placebo (p=0.03). In our study, the use of tamsulosin as MET following SWL facilitates expulsion of retained residual fragments. Tamsulosin shortens time to reach stone free, decreases pain scores. However, tamsulosin does not affect the add-on IV analgesics and have more reversible adverse effect, compared to placebo.

Follow-up after urolithiasis management

HintergrundVon einer Harnsteinerkrankung sind häufig auch jüngere Menschen betroffen. Weil das Rezidivrisiko hoch ist, ist es wichtig, gefährdete Personen regelmäßig nachzukontrollieren.ZielEs wird das Ausmaß von Harnsteinleiden und dessen gesundheitlicher und wirtschaftlicher Einfluss in der Bevölkerung untersucht und eine Empfehlung zur allgemeinen und steinspezifischen Nachkontrolle gegeben.Material und MethodePublikationen sowie Leitlinienempfehlungen werden analysiert und diskutiert.ErgebnisseDas Rezidivrisiko nach einem Steinerstereignis kann je nach Risikoprofil hoch sein. Eine erste metabolische Abklärung ist rasch nach einer Steintherapie durchzuführen. Eine allgemeine Ernährungsanpassung sollte durch eine steinspezifische je nach Risikoprofil intensiviert werden. Eine Ernährungsberatung kann dabei hilfreich sein. Bildgebende Kontrollen nach Steintherapie erfüllen den Zweck der Kontrolle des Therapieerfolgs sowie der Früherkennung von Rezidiven. Da das Rezidivrisiko je nach Steinzusammensetzung stark variieren kann, sollte nicht nur die Art der Bildgebung, sondern auch deren Frequenz dementsprechend angepasst werden. Dasselbe gilt auch für die verschiedenen Steintherapien, welche die Häufigkeit und die Art der bildgebenden Nachkontrollen mitbestimmen. Genaue Richtlinien sowie Kosteneffizienzanalysen von Nachkontrollen nach Steintherapie fehlen leider.SchlussfolgerungDie akute Urolithiasis stellt ein einschneidendes Erlebnis für die Patienten dar. Dementsprechend ist deren Bereitschaft zur Metaphylaxe und Nachkontrolle kurz nach dem Ereignis groß. Da das Rezidivrisiko nach Steinerstereignis sehr hoch sein kann, ist eine gute Nachbetreuung nach Steintherapie mit regelmäßigen Nachkontrollen unerlässlich. Die Frequenz der Nachkontrollen sollte der Wahrscheinlichkeit für ein Steinrezidiv angepasst werden.

The Efficacy of Mirabegron in Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis.

Background This study aimed to assess the efficacy of mirabegron (50 mg daily) as a medical expulsive therapy for ureteral stones in adults. Materials and Methods We searched PubMed, Embase, Cochrane Library, and Web of Science from inception to July 2021 to collect the clinical trials. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies by using the Cochrane risk of bias tool. Review Manager 5.3 software was used for the meta-analysis. Results A total of four studies were included, involving 398 patients: 197 patients in mirabegron group and 201 patients in control group. The meta-analysis showed that the stone expulsion rate was higher in the mirabegron group than in the control group (OR: 2.12; 95% CI: 1.33 to 3.40; p=0.002). Subgroup analysis identified that the stone expulsion rate of patients with stone size <5/6 mm was significantly higher than that of patients with stone size ≥5/6 mm (OR: 0.31; 95% CI: 0.13 to 0.72; p=0.006). But no significant difference was identified between the mirabegron group and the control group for the stone expulsion interval (MD: −1.16, 95% CI: −3.56 to 1.24; p=0.35). In terms of pain episodes, the mirabegron group was significantly lower than that of the control group (MD: −0.34, 95% CI: −0.50 to 0.19; p < 0.0001). Conclusions The medical expulsive therapy with mirabegron had a significant effect in improving the stone expulsion rate for patients with ureteral stones, especially in those whose stone size <5/6 mm. Mirabegron had no effect on the stone expulsion interval but did decrease the pain episodes.

A0252 - Efficacy of mirabegron as medical expulsive therapy for distal ureteral stones: A prospective randomized, double blind, controlled study

A0252 - Efficacy of mirabegron as medical expulsive therapy for distal ureteral stones: A prospective randomized, double blind, controlled study

Efficacy of Mirabegron as Medical Expulsive Therapy for Distal Ureteral Stones: A Prospective, Randomized, Double-Blinded, Controlled Study

Background: Today, medical expulsive therapy (MET) is more effective and commonly used in distal ureteral stones when compared with conservative treatments. Many treatments, namely, alpha-adrenergic blockers and calcium channel blockers, prostaglandin synthesis inhibitors, glyceryl trinitrate, and steroids, have been, therefore, utilized to mitigate such complications and accelerate stone expulsion. Several animal and human studies revealed the presence of β3-receptors in the ureter and bladder, where stimulating these receptors could relax the distal ureteral segment. Objectives: The aim of the study was to evaluate the efficacy of use of mirabegron as MET for distal ureteral stones (intramural and extramural). Methods: This is a prospective randomized controlled study including 90 patients who had distal ureteral stones less than 10 mm and were evaluated between January and June 2020. The patients were classified into 3 groups: group (A) 30 patients: mirabegron 50 mg d−1 + diclofenac Na 100 mg tab (to be taken only during colic episodes), group (B) 30 patients: tamsulosin HCL 0.4 mg cap + diclofenac Na 100 mg tab (to be taken only during colic episodes), and group (C) 30 patients: diclofenac Na 100 mg tab only (to be taken only during colic episodes). Age, sex, stone size, laterality, and grade of ureterohydronephrosis were recorded. Patients were observed for 30 days, and ureteroscopy was completed for those with nonexpulsed stones. Follow-up parameters included number of renal colic episodes, duration of medical therapy, stone expulsion time, and stone expulsion rate (SER). Results: In the group (A), 2 (6.6%) patients were excluded due to nasal congestion, and 1 (3.3%) patient was excluded due to a 20-mm Hg systolic blood pressure increase. Four (13.3%) patients in group (B) were noncompliant on medical treatment. In addition, 2 (6.6%) patients in group (A), 1 (3.3%) patient in group (B), and 5 (16.6%) patients in group (C) who did not attend follow-up examinations were excluded from the study. The SER increased significantly in group (A) and (B) when compared with group (C). The mean time of stone expulsion was about 15, 25, and 12 days for groups A, B, and C, respectively, and there was a significant statistical difference (p value = 0.006) among the 3 groups. The mean number of renal colic episodes of group (A) of patients was 1.8 times, while that of group (B) was 2.6 times and that of group (C) was 2.16 times with no significant statistical difference after comparing the 3 groups (p value = 0.660). Conclusions: Treatment with mirabegron appears to be a safe and effective medical expulsion therapy for distal ureteric stones and is better than tamsulosin.

Holmium: YAG Laser in the Management of Impacted Ureteral Stones HYLe Study

Background: Holmium: yttrium-aluminium-garnet (YAG) laser is considered cost-effective and efficient choice in ureteroscopic lithotripsy on all types of stones. We aim to evaluate the efficacy of Holmium: YAG laser in impacted ureteral stones. Methods: We conducted a prospective case series at the Sindh Institute of Urology and Transplantation (SIUT) Pakistan from 1st October 2016 till 30th September 2017. All adult patients between 18 to 60 years of age with single &lt;20mm ureteral stone impacted for more than one month. The primary outcomes include stone-free and recurrence of ureteric stone during two-year follow-up. Analyses performed using SPSS version 21.0. Results: A total of 117 patients recruited, of which most were males (61,52.14%). The average duration of disease was 7.82±1.79 months, with a stone size of 12.49±3.8 mm. Most of the stones were located in the middle of the ureter (56,47.86%). Holmium: YAG laser for treatment was effective in 99 (84.62%) cases, and efficacy above 80% in all age groups, but the insignificant difference was observed between both gender, location, duration of disease, size of the stone, use of a guidewire and the different catheter. All of the patients were found to be stone-fragment free at six weeks. The ureteral injury was observed (4,3.41%) and recurrence rate in the same ureter was found in a total of 5 (4.27%) patients. Conclusions: Holmium: YAG laser lithotripsy may be considered a safe and effective first-line therapy for impacted ureteral stones, avoiding futile repetition and complication of extracorporeal shock wave lithotripsy (ESWL). Keyword: ureteroscopic lithotripsy, stone-fragment, YAG laser lithotripsy.

SpyGlass cholangioscopy – first experiences

SpyGlass cholangioscopy is a recently developed endoscopic technique to the direct visualization of the biliary tract. The SpyGlass cholangioscop is a 10,8 Fr diameter endoscop which can be guided to the biliary tract through the work channel of the doudenoscope and has its own work channel for the different endoscopic accessories. The main indications of the examination are the diagnosis of the uncertain dignity biliary stenosis and the therapy of the biliary stones which failed conventional therapy. Our aim was to assess the utility and efficacy of the SpyGlass system. In Jahn Ferenc South Pest Hospital Gastroenterology Department, we used the SpyGlass™ DS I system between 2018 and 2020 and from 2021 the SpyGlass™ DS II. 14 diagnostic and 15 therapeutic Spyglass procedures have been performed. Inclusion criterion of diagnostic procedures was indeterminate bile duct stenosis where the final diagnosis could not be confirmed by endoscopic retrograde cholangiopancreatography or endoscopic ultrasound-guided biopsy. Inclusion criteria of the therapeutic examinations were difficult bile duct stones which failed conventional therapy. Concerning the correspondence of the macroscopic image and the final diagnosis, the accuracy of the cholangioscope was 85%. The accuracy of the histological diagnosis in the case of cholangioscopy-guided biopsies was 62.5%. The sensitivity of the macroscopic diagnosis was 100%, specificity was 71%, while the sensitivity of histologic samples was 60% and the specificity was 100%. Complete clearence was performed four times in the case of therapeutic procedures, which refers to 57.14% success rate. The use of SpyGlass enhances the precise evaluation of indeterminate bile duct lesions and tissue acquisition is easier to perform. However, to reach the international standards of diagnostic sensitivity and specificity, further improvement and examinations are necessary. Spyglass-guided electrohydraulic lithotripsy is an alternative for difficult stones which failed conventional therapy. Orv Hetil. 2022; 163(4): 150-156.

Knowledge, attitudes, and practices: a quantitative assessment of hospital physicians and medical interns treating snakebite envenomation in Rwanda

Snakebite envenomation (SBE) is a serious and potentially life-threatening condition that most often targets rural, subsistence-based farmers in sub-Saharan Africa. Rwanda is home to 13 venomous and medically important snake species. Those bitten are known to seek care from traditional healers and/or formal health facilities. No information is available on patient management at government health facilities. This quantitative evaluation aimed to characterize knowledge, attitudes and practices related to snakebite management in Rwanda. Target respondents included physicians working at hospitals with the highest SBE caseload and medical interns. Respondents were asked to complete questionnaires on paper or online through Qualtrics. Overall, 105 physicians and 171 interns agreed to participate. Our findings suggest that overall knowledge scores were low for both groups (mean 49.4%, minimum-maximum 31.3-70.8%). Respondents were keen to receive SBE training but often lacked essential supplies needed to adhere to recommended guidelines for SBE management. One-third of respondents (34.8%) believed that traditional healers could manage SBE successfully and two-thirds (66.3%) felt that black stone therapy was an appropriate first aid practice. These findings indicate a clear need for improved curricula related to SBE, enhanced supply chain management and practical mechanisms for supporting clinicians.

Nanoparticle-mediated delivery system alleviates the formation of infection stones by activating TRPV5.

Infection stones constitute a small but intractable group of diseases of urinary system. In this study, we explored the potential therapeutic effect of a small activation RNA, ds-320, encapsulated in chitosan (320-chitosan). Western blot analysis verified the downregulation of TRPV5 in patients and rat model of infection stones, as well as the stimulation of ds-320 on TRPV5 expression. MTT assay showed that chitosan-mediated delivery was less cytotoxic to ds-320 compared with liposome delivery. Further a modified invasion assay revealed an inhibitory effect of 320-chitosan on bacterial invasion into normal rat kidney epithelial NRK-52E cells. The establishment of infection stone model was performed by intravesical injection of 1×108 CFU of Proteus mirabilis. In animal experiments, no visible stones were obtained. The number of live bacteria and white blood cells in urine showed no difference among all infected rats at the time of sacrifice. However, we observed a decline in urine calcium and pH, suggesting the effect of acidification. Overall, our study provides evidence for the protective effect of 320-chitosan, for its ability to down-regulate urinary calcium, acidify urine, and inhibit bacteria from invading renal epithelial cells. Thus, it can be served as an important complementary therapy for infection stones.

Effect of Tamsulosin and URSL on Renal Function and Stone Free Rate in Unilateral Solitary Ureteric Stone: A Prospective Interventional Study

Introduction: Stones are common cause of obstructive uropathy which may lead to decrease in renal function. Though endourological procedure like Ureteroscopic Lithotripsy (URSL) is commonly done yet Medical Expulsive Therapy (MET) is often offered as a first line therapy for mid and distal ureteric stones of size less than one cm. Aim: To compare the effect of Tamsulosin and URSL on renal function and stone free rate for solitary mid and distal ureteric stone. Materials and Methods: This prospective interventional study was done in IPGME&amp;R and SSKM Hospital, Kolkata, West Bengal, India, from May 2020 to October 2020, on the total study population of 50 patients with 26 patients in MET and 24 patients in URSL group. Parameters measured and compared were changes in Glomerular Filtration Rate (GFR) and stone free rate after six weeks of intervention. Numerical variables and categorical variables were compared between two groups using independent t-test and chi square test respectively. Results: The mean age of patients in MET (n=26) and URSL group (n=24) was 37.12 years and 33.63 years respectively. GFR was significantly increased after completion of treatment in individual groups (p-value=0.01) and in final study population but change in GFR was not significant when compared between the groups (p-value=0.372). Difference in stone clearance rate between two groups was also insignificant (p-value=0.902) whereas within the groups was significant (p-value&lt;0.05). Conclusion: Tamsulosin for six weeks does not result in significant functional loss in the affected kidney and proved as effective as URSL for mid and distal solitary ureteric stone upto one cm in size with similar stone free rate.

The Effective Medical Expulsion Therapy for Distal Ureteric Stones

The lifetime risk of developing genitourinary stone is 5-12%. &nbsp;Males are more prone to calculus formation as compared to females. The data for the Indian population suggests that 12% of the people develop urinary calculi and half of them end up with the loss of kidney functions. Symptomatic urolithiasis represents a common condition observed by surgeons and urologists in an emergency setting. The lower third/distal ureter is the most common site for the ureteric calculus. We did this study

Comparative Evaluation of Efficacy of Modified Ashmaghnasveda (Stone Therapy) and Choornapindasveda in Management of Katigraha (Lumbar spondylosis)

Background: Katigraha is one of the most common illnesses affecting the Kati area, in which Vata gets are unbalanced in their own sthana (seat), resulting in Graha (stiffness) and Ruja (pain). Lumbar Spondylosis is a disease that causes back discomfort caused by spine movement and is accompanied by rigidity. Ashmaghnasveda is a key svedana treatment that helps with vataja, particularly Sama vataja and vatakaphaja illnesses. In this project, a structurally modified form of Ashmaghnasveda will be employed to produce ekangasveda. The goal of this study was to assess the efficacy of modified Ashmaghnasveda (stone therapy) and churnapindasveda in the treatment of Katigraha (lumbar spondylosis).&#x0D; Methodology: A total of 64 patients will be enrolled, and they will be evenly divided into two groups. Modified Ashmaghnasveda will be performed for 14 days in GroupA(Interventional). Churnapindasveda will be performed for 14 days in GroupB (comparator group). Expected Results: The objective parameters will be monitored and documented as they change. Conclusion: Based on the information gathered, conclusions will be reached.

Multiphysics Analysis of Ultrasonic Shock Wave Lithotripsy and Side Effects on Surrounding Tissues.

Background: Today, the most common method for kidney stone therapy is extracorporeal shock wave lithotripsy. Current research is a numerical simulation of kidney stone fragmentation via ultrasonic shock waves. Most numerical studies in lithotripsy have been carried out using the elasticity or energy method and neglected the dissipation phenomenon. In the current study, it is solved by not only the linear acoustics equation, but also the Westervelt acoustics equation which nonlinearity and dissipation are involved.Objective: This study is to compare two methods for simulation of shock wave lithotripsy, clarifying the effect of shock wave profiles and stones’ material, and investigating side effects on surrounding tissuesMaterial and Methods: Computational study is done using COMSOL Multiphysics, commercial software based on the finite element method. Nonlinear governing equations of acoustics, elasticity and bioheat-transfer are coupled and solved.Results: A decrease in the rise time of shock wave leads to increase the produced acoustic pressure and enlarge focus region. The shock wave damages kidney tissues in both linear and nonlinear simulation but the damage due to high temperature is very negligible compared to the High Intensity Focused Ultrasound (HIFU).Conclusion: Disaffiliation of wave nonlinearity causes a high incompatibility with reality. Stone’s material is an important factor, affecting the fragmentation

Comparison of the Efficacy of Male Sexual Activity Versus Alpha-Blockers in the Expulsion of Distal Ureteric Stones: A Systematic Review and Meta-Analysis.

Globally, the prevalence of urolithiasis is increasing, with limited effective treatment options. Though debate exists within the literature, the use of medical expulsive therapy (MET) for distal ureteric stones in the form of alpha-blockers is commonplace. Alpha-blockers work via the inhibition of norepinephrine, resulting in a small degree of distal ureteric relaxation. Nitric oxide (NO), the main neurotransmitter involved in penile erection, causes smooth muscle relaxation of the distal ureter. It is hypothesised that these alternative pathways may achieve the same desire clinical effect.To our knowledge, this is the first meta-analysis comparing the efficacy of male sexual activity, in the form of intercourse or masturbation, to alpha-blockers in the expulsion of ureteric stones.We conducted a comprehensive search of electronic databases (PubMed, MEDLINE, EMBASE, SCOPUS, CENTRAL and Google Scholar), identifying studies comparing male sexual activity versus alpha-blockers, in male patients with distal ureteric stones. The Cochrane risk-of-bias tool was used to assess the included studies. For data analysis, a random effects model was used in the event of significant heterogeneity (>75%), with fixed-effects modelling in the event of low-moderate heterogeneity.A search of electronic databases found three randomised control trials (RCTs), enrolling a total of 262 patients. There was no statistically significant difference observed when patients engaged in sexual activity rather than alpha-blocker, when looking at stone expulsion rate at two weeks (P=0.36), expulsion rate at four weeks (P=0.57), or the mean stone expulsion time (P=0.21). Furthermore, there was no significant difference observed when looking at analgesic requirements (P=0.43), or the requirement for additional procedures (P=0.57).Our meta-analysis demonstrated that male sexual activity as an alternative therapy for distal ureteric stones had comparable outcomes to the use of alpha-blocker, proving a viable alternative therapy in those patients wishing to avoid pharmacological management.

Dexketoprofen vs. Tamsulosin vs. Silodosin vs. Tadalafil as Medical Expulsive Therapy for Distal Ureteral Stones in Men.

To assess the effectiveness of the use of dexketoprofen, tamsulosin, silodosin, and tadalafil in medical expulsive therapy for distal ureteral stones in male patients. Cohort study. Department of Urology, Gazi Hospital, Samsun, Turkey, from March 2020 to March 2021. Adult males satisfying the inclusion criteria were randomly assigned into dexketoprofen (Group 1), tamsulosin (Group 2), silodosin (Group 3), or tadalafil (Group 4) treatment arms. The primary endpoint consisted of the stone expulsion rate at the end of four weeks, while the secondary endpoints were the expulsion rate after two weeks and the occurrence of adverse events. Clinical findings were then compared among the study groups. Altogether 193 patients, 50 (25.9%) in group 1, 48 (24.9%) in group 2, 49 (25.4%) in group 3, and 46 (23.8%) in group 4, were enrolled in the study. No significant difference was determined in terms of age, body mass index, stone characteristics, expulsion time, pain episodes, or total analgesic consumption among the four groups. Expulsion rates in the fourth week were 48%, 79.2%, 81.6%, and 78.3% in groups 1, 2, 3, and 4, respectively. Stone expulsion rates were significantly greater in groups 2, 3, and 4 compared to group 1 (p <0.001), but no significant differences were determined between groups 2, 3, and 4. No severe adverse effects occurred throughout the study period. Tamsulosin, silodosin and tadalafil exhibited higher expulsion rates for distal ureteral stones in male patients, although none was significantly superior to the others. All three are safe, efficacious, and well-tolerated, with only very minor side-effects. Key Words: Dexketoprofen, Distal ureteral stones, Medical expulsive therapy, Silodosin, Tadalafil, Tamsulosin.

Post-ESWL and post-ERCP pancreatitis in patients with chronic pancreatitis: Do they share the same risks?

Endoscopic intervention combined with extracorporeal shock wave lithotripsy (ESWL) is recommended as the first line therapy for large pancreatic stones, yet both can cause adverse events. The aim of the study was to identify the risk factors for post-procedural pancreatitis. Consecutive patients with chronic pancreatitis and pancreatic stones treated with both ESWL and subsequent endoscopic retrograde cholangiopancreatography (ERCP) from October 2016 to December 2019 were prospectively enrolled. Multivariate logistic analyses were performed to detect risk factors for post-ESWL and post-ERCP pancreatitis (PEP). A total of 714 patients (507 males, 45.60±12.52years) were included in this study. A total of 80 patients (11.2%) developed post-ESWL pancreatitis,while 33 patients (4.6%) suffered from PEP. Steatorrhea (P=.018), multiple stones (P=.043), and stones located at the head combined with the body or tail of the pancreas (P=.015) were identified as independent protective factors for post-ESWL pancreatitis. The history of acute exacerbations (P=.013), post-ESWL pancreatitis (P<.001) and stricture dilation during ERCP (P=.002) were identified as risk factors for PEP. More attention should be paid to patients with post-ESWL pancreatitis, as well as a history of acute exacerbations and stricture dilation during ERCP to prevent PEP. (ClincialTrials.gov number, NCT04619511).