Symptomatic Ureteral Stones Research Articles

Cost-effectiveness of quality improvement intervention to reduce time between CT-detection and ureteroscopic laser fragmentation in acute symptomatic ureteric stones management

ObjectiveTo prospectively assess clinical and cost effectiveness of emergency ureteroscopic laser fragmentation of urinary stones causing symptoms or obstruction.Patients and methods100 consecutive patients with an average (median) age 55.6 (57.5) years and average (median) stone size of 8.2 mm (± 7 mm) between October 2018 and December 2021 who underwent emergency ureteroscopy and laser fragmentation formed the study cohort as part of a clinical service quality improvement. Primary outcome was single procedure stone-free rate and cost-effectiveness. The secondary outcomes were complications, re-admission and re-intervention. A decision analysis model was constructed to compare the cost-effectiveness of emergency ureteroscopy with laser fragmentation (EUL) and emergency temporary stenting followed by delayed ureteroscopy with laser fragmentation (DUL) using our results and success rates for modelling.ResultsSingle procedure stone-free rates (SFR) for EUL and DUL were 85%. The re-intervention rate, re-admission and complication rates of the study cohort (EUL) were 9%, 18%, and 4%, respectively, compared to 15%, 20%, and 5%, respectively for the control cohort (DUL). The decision analysis modelling demonstrated that the EUL treatment option was more cost-efficient, averting £2868 (€3260) per patient for the UK health sector. Total cost of delayed intervention was £7783 (€8847) for DUL in contrast to £4915 (€5580) for EUL.ConclusionsImplementation of quality improvement project based on a reduction in CT detection-to-laser fragmentation time interval in acute ureteric obstruction or symptoms caused by stones had similar clinical effectiveness compared to delayed ureteroscopic management, but more cost-effective.

Prevalence and predictors of stone passage after double J stenting for symptomatic ureteral stones: a cross-sectional, real-life study.

To evaluate the rate of and predictors of stone passage (SP) after urgent retrograde stenting for symptomatic ureteral stones. We retrospectively analysed data from 249 consecutive patients presenting to the emergency department for symptomatic ureteral stones and treated with retrograde stenting. Demographic, clinical and laboratory characteristics were collected. Stones parameters were collected before stenting and SP was evaluated at 1month with computerized tomography. Descriptive statistics and logistic regression models tested the association between predictors and SP. Overall, median (IQR) age and stone diameter were 56 (45-68) years and 7.1 (4.4-9.8) mm, respectively. Stones were located in the proximal, mid and distal ureter in 102 (41.0%), 48 (19.3%) and 99 (39.8%) cases. SP was observed in 65 (26.2%) individuals. Stone diameter (3.2 vs. 7.7mm, p < 0.001) and stone density (416 vs. 741, p < 0.001) were lower and a higher rate of distal stones (76.9% vs. 26.7%, p < 0.001) was found in the SP group compared to that with persistent stones. Multivariable logistic regression analysis showed that distal ureteral stone location (OR 7.9, p < 0.01) and lower HU (OR 0.9, p < 0.01) were associated with SP, after accounting for stone volume. Patients with a distal stone of 500 HU had a 75% probability of SP. Stone passage occurred in 26% of patients with indwelling stent due to symptomatic ureteral stones. Lower stone density and distal stone location were independent predictors of stone passage. Patients with these criteria should be managed with follow-up imaging and stent removal instead of ureteroscopy.

Emergency treatment of symptomatic ureteral calculi: predictors of prolonged hospital stay

PurposeTo assess differences in the length of hospital stay (LOS) in patients who present emergently versus electively for a symptomatic ureteral stone and to explore underlying risk factors.MethodsBilling data were analyzed from patients with symptomatic ureteral calculi at our department from 2010 to 2021. Statistical analysis (U test, logistic regression) was performed.Results2274 patients (72% male, 28% female) with ureteral stones were analyzed (mean age of 52.9y). 1578 patients (69.4%) presented in an emergency setting and 696 patients (30.6%) electively. Arterial hypertension was seen in 31%, diabetes mellitus in 11% and hyperuricemia in 5% of the whole cohort. 46.5% of emergency patients were desobstructed (DJ/PCN), 35.4% underwent emergency ureteroscopy (URS), 13.4% had spontaneous passage (SP), and 4.8% underwent emergency shock wave lithotripsy (SWL). Of the electively treated patients, 58.6% underwent URS, 21.3% SWL, 18.5% DJ/PCN, and 1.6% had SP. Emergency stone treatment was associated with a significantly longer LOS when compared to primary desobstruction for patients admitted emergently. Also, LOS was significantly longer for each intervention of stone treatment in emergency patients vs. electively treated patients. Arterial hypertension was associated with a 1.8-fold increased risk of a hospital stay longer than 3 days, irrespective of hospital admission mode, whereas metabolic disorders did not influence LOS in this cohort.ConclusionFor emergency patients in contrast to the electively treated patients, the type of procedure had a significant impact on the length of hospital stay. Arterial hypertension is an independent significant risk factor for prolonged hospital stay.

A comparison between asymptomatic and symptomatic ureteral stones

To investigate the characteristics and impact of asymptomatic (silent) ureteral stones on renal function and compare them with those of symptomatic stones. We retrospectively reviewed the medical records of 677 patients who underwent ureteroscopic lithotripsy or laparoscopic ureterolithotomy for ureteral stones between 2016 and 2020. Patients were divided into two groups according to the presence of recognizable symptoms. We investigated the characteristics and impact of silent stones on post-treatment renal function recovery and compared them with those of symptomatic stones. Among the 677 patients, 43 (6.4%) had asymptomatic ureteral stones, and 634 (93.6%) had symptomatic ureteral stones. Compared to symptomatic stones, asymptomatic stones were larger (11.4 mm vs. 9.6 mm, p = 0.003), more commonly present in the upper ureter (62.7% vs. 48.0%, p = 0.04), and more commonly associated with high-grade hydronephrosis (32.8% vs. 12.3%, p < 0.001); however, no difference in metabolite composition was observed between the two group of stone. In the asymptomatic stone group, the mean preoperative estimated glomerular filtration rate (eGFR) was 77.37 ± 23.54 mL/min/1.73 m2, and the mean postoperative eGFR indicated no significant improvement at 1 day, 7 days, 3 months, and 12 months (76.66 ± 21.45, 77.89 ± 20.87, 77.29 ± 22.22, and 76.71 ± 24.21 mL/min/1.73 m2, respectively; p = 0.567, p = 0.613, p = 0.924, and p = 0.202, respectively). In the symptomatic stone group, the mean preoperative eGFR was 78.17 ± 28.25 mL/min/1.73 m2; the mean postoperative eGFRs at 1 day, 7 days, 3 months, and 12 months were 81.24 ± 26.38, 86.16 ± 25.61, 89.11 ± 25.43, and 89.50 ± 26.01 mL/min/1.73 m2, respectively and demonstrated significant improvement (p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively). Silent stones irreversibly impaired renal function, even after proper management. Therefore, active treatment strategies are required for all patients who are hesitant to receive treatment for silent stones because of their asymptomatic status to prevent permanent renal impairment.

Development and validation of a predictive model for treatment outcome after emergency extracorporeal shockwave lithotripsy in patients with symptomatic ureteral stones during the COVID-19 pandemic: in a large prospective cohort.

The predictors of treatment outcome after emergency extracorporeal shockwave lithotripsy (SWL) are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting treatment outcome after emergency SWL in patients with symptomatic ureteral stones. The development cohort included 358 patients with symptomatic ureteral stones who underwent emergency SWL between June 2020 and August 2021 in our hospital. One hundred and twenty-nine patients with symptomatic ureteral stones participated in the validation cohort from September 2021 to April 2022. The data were prospectively recorded. The backward stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 15.6% (56/358) of patients in the development cohort and 14.0% (18/129) of those in the validation cohort suffered from stone-free failure after emergency SWL. We identified four predictors for stone-free failure: stone size, stone density, skin to stone distance (SSD), and degree of hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic (AUROC) curves of 0.935 (0.899-0.971) and good calibration (P = 0.059). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that stone size, stone density, SSD, and degree of hydronephrosis were predictors of treatment outcome after emergency SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of patients may increase the success rate of emergency SWL during the COVID-19 pandemic.

Безрентгеновская контактная уретеролитоторипсия при камнях мочеточника.

Introduction. The main treatment option for symptomatic ureteral stones is contact ureterolithotripsy (CULT), which is usually performed under Xray guidance. However, the risks of complications associated with radiation do not always justify the benefits obtained from its use, which justifies the study of the results of performing Х-ray-free ureterolithotripsy. Purpose. Evaluation of the efficacy and safety of non-fluoroscopic ureteroscopy in the treatment of symptomatic ureteral stones. Materials and methods. Data from 240 patients with ureterolithiasis who underwent CULT were retrospectively recruited. Clinical and demographic data of patients, stone parameters and intraoperative parameters were evaluated. A multivariate analysis of the above factors was carried out to determine their diagnostic value for predicting the results of CULT. Data collection and analysis was carried out using MS Excel and SPSS Statistics 22.0 tables, respectively. Results. The average stone size and density were 6,7±2,4 mm and 785,8±293,0 HU, respectively. The lasting of the surgery and the stone free rate were 39,5±14,6 min and 84,6%, respectively. Complications, in particular ureteral perforation, occurred in 17,0% and 6,7% of cases. According to the results of multivariate analysis, the following parameters influence the effectiveness of contact ureterolythotripsy (CULT) in symptomatic calculi: density, size and localization of the calculus, as well as the presence of ureteral stent (p &lt;0.05). The preoperative indicators presented below significantly determined the frequency of complications: the density and localization of calculus, the presence of a ureteral stent, and the lasting of the surgery (p &lt;0.05). Comparative analysis of CULT with and without fluoroscopy revealed identical results and the complications number. The repeated interventions were more frequent in patients without X-ray, but there were no a statistically significant differences between groups. Our data indicate that CULT without X-ray not compromising the effectiveness of the surgery. Conclusion. X-ray-free CULT for symptomatic ureteral stones eliminates possible complications from radiation without compromising the success of the operation itself

Predictors of successful emergency shock wave lithotripsy for acute renal colic

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6–12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.

Role of inflammatory markers and their trends in predicting the outcome of medical expulsive therapy for distal ureteric calculus.

Objective:Symptomatic ureteric stones cause surrounding inflammation-promoting obstruction. C-reactive protein (CRP), white blood cell count (WC), and neutrophil percentage (NP) tend to rise after inflammatory response. Monitoring response during the course of medical expulsive therapy (MET) may help in deciding early intervention, thereby decreasing morbidity. We assessed the role and trends of these markers in predicting the outcome of MET.Materials and Methods:One hundred and ninety-two patients with distal ureteric calculus of size >5 mm were included in this prospective study from April 2017 to March 2018 after ethical committee approval. CRP, NP, and WC were measured on day 1, 7, and 14 of MET, and analysis was done.Results:On univariate analysis, stone size and mean values of CRP, WC, and NP on day 1, 7 and 14 in stone nonpassers were significantly higher compared to stone passers (P < 0.05). Receiver operator curve analysis showed area under the curve value of 0.798 (P = 0.001) for CRP and cut off value determined was 1.35 mg/dL. Multivariate analysis of different variables showed significant association of higher CRP (>1.35 mg/dL) and larger stone size (>7 mm) with MET failure. Decreasing trend of CRP was seen in both groups, but values were higher in stone nonpassers. WC and NP showed decreasing trend in stone passers but persistently high in stone nonpassers.Conclusions:Higher CRP and larger stone size were associated with failure of MET. WC and NP showed decreasing trend in stone passers and persistently higher in nonpassers, which may potentially predict failure of MET, however, their role need to be further studied.

Resolution of Hydronephrosis and Pain to Predict Stone Passage for Patients With Acute Renal Colic

ObjectiveTo study patients who presented to the Emergency Department with acute renal colic to determine if resolution of hydronephrosis and pain accurately predicts stone passage on follow-up CT. Materials and MethodsThis is a secondary analysis of a multicenter prospective randomized clinical trial of patients diagnosed by computed tomography (CT) scan with a symptomatic ureteral stone < 9 mm in diameter. Participants were followed after randomization to evaluate for analgesic use and to assess stone passage and hydronephrosis on a repeat CT scan obtained at 29-36 days. ResultsFour-hundred-three patients were randomized in the original study and patients were included in this analysis if they did not have surgery for stone removal and had a CT scan and information on pain medication at follow-up (N = 220). Hydronephrosis was detected in 181 (82%) on initial CT. At follow-up CT, 43 (20%) participants had a persistent ureteral stone. Of these patients, 36 (84%) had no pain, 26 (60%) did not have hydronephrosis, and 23 (53%) had neither pain nor hydronephrosis. Resolution of hydronephrosis was associated with stone passage (RR 4.6, 95% CI 1.9, 11.0), while resolution of pain was not (RR 1.1, 95% CI 0.9, 1.4). ConclusionIn patients with urinary stone disease, stone passage is associated with resolution of hydronephrosis but not resolution of pain. In patients with persistent ureteral stones, neither pain nor hydronephrosis are consistently present. These findings have important implications on follow-up imaging of patients with urinary stone disease.

Safety and efficacy of flexible and semi-rigid ureteroscopy with laser lithotripsy for the management of ureteral calculi in pregnancy

BackgroundSymptomatic ureteric stone during pregnancy can present a clinical challenge because of potential risks to both the mother and foetus. Ureteroscopy with laser and stone basket extraction represents an emerging strategy for definitive stone management in pregnancy, with minor complications. We aimed to evaluate the safety and efficacy of ureteroscopy with auxiliary procedures as a primary treatment for pregnant women with symptomatic ureteric stones who have failed conservative management.MethodsA prospective analysis was conducted in the Urology Department of Sulaymaniyah Teaching Hospital from June 2017 to November 2019 to evaluate pregnant patients who were treated with ureteroscopy and holmium laser lithotripsy for symptomatic ureteric stone.ResultsTwenty-six pregnant women aged between 18 and 34 years presented with renal colic (22 patients, 84.61%), severe hydronephrosis (3 patients, 11.53%), and progressive hydronephrosis (1 patient, 3.8%), suggesting ureteric stones. The diagnosis was established by abdominal ultrasonography. The mean stone size was 7.38 mm, ranging from 6–12 mm. The stones were located in the proximal ureter (n = 6, 23.1%), middle ureter (n = 0), and distal ureter (n = 20, 76.9%). Complete stone fragmentation was achieved in all patients. The overall procedure success rate was 87%, the stone-free rate was 23 out of 26 cases (88.46%), and no major obstetric or urologic complications were encountered.ConclusionsUreteric stone in pregnancy requires a high index of suspicion for a prompt and correct diagnosis. Ureteroscopy: flexible or semirigid endoscopy combined with holmium: YAG laser lithotripsy or with stone extraction are a preferred modality for the definitive treatment of symptomatic ureteric stone in pregnancy.

Analgesic and Opioid Use for Patients Discharged from the Emergency Department with Ureteral Stones.

Objective: The aim of this study was to describe and characterize the analgesic and opioid use for patients discharged from the emergency department (ED) with renal colic due to ureteral stone. Methods: This is a secondary analysis of a multicenter prospective trial of ED patients diagnosed by CT scan as having a symptomatic ureteral stone <9 mm in diameter. Participants were contacted after randomization on days 2, 7, 15, 20, and 29 and reported opioid and nonopioid analgesic use and stone passage. CT scan was repeated on day 29 to 36 to confirm passage. Results: Of 403 participants, 314 (77.9%) took an analgesic after discharge and 199 (49.4%) took opioids. Opioids were more commonly used by younger patients (p = 0.04) and those with a family history of stones (p = 0.003). Stone size and tamsulosin use were not associated with analgesic utilization. Shorter time to passage and more distal stone location were associated with less analgesic and opioid use. For those who did not expel a stone, 55.0% took opioids at any time, and for those who did expel a stone, 31.9% took opioids before the stone was expelled and 15.7% took opioids at any time after the stone was expelled. Conclusions: Factors associated with increased use of analgesics in patients discharged from the ED include a longer time to stone passage, no spontaneous passage, and proximal position of the stone in the ureter. Some patients continued to use analgesics after the stone had passed, but most stopped using analgesics by day 29. The study has been registered at https://clinicaltrials.gov (NCT00382265).

Laparoscopic ureterolithotomy: bridging the gaps between open surgery and ureteroscopy and/or shock wave lithotripsy

Background Ureteroscopic procedures together with shock wave lithotripsy are the standard of care for patients with symptomatic ureteral stones; in cases with large (>20 mm) and/or impacted stones, laparoscopic ureterolithotomy can be considered an alternative to open surgery, as it is less morbid with high stone-free rates. Patients and methods A retrospective study of patients enlisted for active ureteral stone treatment was conducted. Files of 945 patients were reviewed and analyzed in term of stone size, number, and history of previous stone procedures. A total of 73 patients were included; they had transperitoneal ureterolithotomy for either proximal or distal ureteral stone(s). Results Mean stone size was 31.7±8.5 mm, and median stone number was 1 (1–3). A total of 48 patients had proximal ureteric stones, whereas 25 had distal ones. Mean operative time was 96±19.2 min, stone-free rate was estimated to be 97%, and procedure was aborted in two patients. Complications were reported in 16%, with no grade 3 complications according to Clavian–Dindo classification. Mean hospital stay was 3.2±1.1 days. Conclusion Laparoscopic ureterolithotomy is to be considered for the treatment of large ureteric stone when other minimally invasive modalities are not available; it can bridge the gap between the minimally invasive procedures and conventional open surgery.

Medical Expulsive Therapy for Urinary Stone Disease in Children

The rising incidence of urinary stone disease in children requires pediatric practitioners to keep abreast of management recommendations which are generally geared towards adults. Medical expulsive therapy (MET) is a non-surgical therapeutic option that can be trialed in patients who present with uncomplicated symptomatic ureteral stones. Seminal articles published and indexed in Medline on the topic of MET were extracted and reviewed. Studies suggest a potential benefit of alpha-blockade for the expulsion of distal ureteral stones that are >5 mm but ≤10 mm in adults and possibly >4 mm in children. Conversely, there does not seem to be any added benefit for MET in smaller stones (<5 mm) in which the spontaneous passage rate is high. Conclusions: The off-label use of these medications is one of the several barriers which contribute to the underutilization of MET in children. However, these may be a reasonable option in particular for older children and adolescents with the appropriate-sized stones.

When is observation indicated over intervention in adults with symptomatic ureteral stones?

When is observation indicated over intervention in adults with symptomatic ureteral stones?

PD14-02 EARLY SURGICAL INTERVENTION FOR SYMPTOMATIC RENAL AND URETERAL STONES REDUCES NARCOTIC REQUIREMENT RELATIVE TO MEDICAL EXPULSIVE THERAPY

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (PD14)1 Apr 2020PD14-02 EARLY SURGICAL INTERVENTION FOR SYMPTOMATIC RENAL AND URETERAL STONES REDUCES NARCOTIC REQUIREMENT RELATIVE TO MEDICAL EXPULSIVE THERAPY Crystal Valadon*, Charles Nottingham, Tim Large, and Amy Krambeck Crystal Valadon*Crystal Valadon* More articles by this author , Charles NottinghamCharles Nottingham More articles by this author , Tim LargeTim Large More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000848.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Given the substantial burdens of the current opioid crisis, clinicians are tasked with reducing excessive narcotic analgesia. The purpose of this study was to evaluate if medical expulsive therapy or initial surgical intervention resulted in less narcotic analgesia utilization in patients with acute renal colic due to stone disease. METHODS: We retrospectively evaluated patients at our institution who presented with acute renal colic due to a renal or ureteral stone. We excluded patients who required surgical intervention for acute kidney injury or infection. Patients are standardly offered medical expulsive therapy (MET) or surgical intervention with ureteral stenting or ureteroscopy (URS) at the time of diagnosis. Our standard practice following surgery is to provide no narcotics upon discharge except for pain refractory to non-narcotic analgesics. We compared rates of narcotic prescription over the entire treatment course for patients electing MET versus surgery at initial diagnosis. We secondarily analyzed rates surgical intervention among initial MET patients. RESULTS: We included 144 patients for analysis, with 77 (53.5%) electing MET as initial treatment, 39 (27.1%) stent with delayed URS, and 28 (19.4%) primary URS. Ultimately, 45 (58.4%) MET patients underwent URS at a median time of 18 days (IQR 6.5-33.5 days) from diagnosis. A significantly higher proportion of MET patients required a narcotic prescription (59.7% vs 25.6% vs 35.7%, respectively; p=0.001) compared to patients electing initial stent or URS. CONCLUSIONS: Patients electing initial treatment with MET for renal colic due to stone disease were more likely to require a narcotic prescription than patients electing initial surgical intervention. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e272-e273 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Crystal Valadon* More articles by this author Charles Nottingham More articles by this author Tim Large More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

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.

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 .

Accuracy of Patient Reported Stone Passage for Patients With Acute Renal Colic Treated in the Emergency Department

ObjectiveTo study patients who initially presented to the Emergency Department with acute renal colic to determine if patient-reported stone passage detects stone expulsion as accurately as follow-up computed tomography (CT) scan. MethodsThis is a secondary analysis of a multi-center prospective trial of patients diagnosed by a CT scan with a symptomatic ureteral stone <9 mm in diameter. Patient-reported stone passage, defined as capture or visualization of the stone, was compared to CT scan-confirmed passage performed 29-36 days after initial presentation. ResultsFour-hundred-three patients were randomized in the original study and 21 were excluded from this analysis because they were lost to follow-up or received ureteroscopic surgery. Of the 382 remaining evaluable patients, 237 (62.0%) underwent a follow-up CT scan. The mean (standard deviation) diameter of the symptomatic kidney stone was 3.8 mm (1.4). In those who reported stone passage, 93.8% (91/97) demonstrated passage of the symptomatic ureteral stone on follow-up CT. Of patients who did not report stone passage, 72.1% (101/140) demonstrated passage of their stone on follow-up CT. ConclusionsFor patients who report capture or visualization of a ureteral stone, a follow-up CT scan may not be needed to verify stone passage. For patients who do not capture their stone or visualize stone passage, imaging should be considered to confirm passage.

Is tamsulosin effective for the passage of symptomatic ureteral stones: A systematic review and meta-analysis.

Background:Some trials have stated that there is no benefit to tamsulosin administration for clearing ureteral stones, which is contrary to previous studies. To confirm the efficacy of tamsulosin for treating symptomatic ureteral stones, we performed this review.Methods:We searched the PubMed, Embase, and Cochrane Library databases to identify all studied variables, including tamsulosin, urinary stones, expulsion, and side effects. In addition, for all patients and different stone sizes, the treatment efficacy, expulsion rate, and expulsion time were also recorded for this treatment.Results:Forty-nine studies involving 6436 patients met the inclusion criteria. The data synthesized from these studies indicated that tamsulosin improved the renal stone clearance rate (80.5% vs 70.5%; mean difference (MD), 1.16; 95% confidence interval (CI), 1.13–1.19; P <.00001) and reduced the expulsion time (MD, −3.61; 95% CI, −3.77 to −3.46; P ≤.00001). Regarding complications, no significant difference was found between the 2 groups in terms of the total side effects (MD, 1.15; 95% CI, 0.97–1.35; P = .10) or divided complications, including retrograde ejaculation (P = .01), hypotension (P = .52), dizziness (P = .07), diarrhea (P = .58), vomiting (P = .88), headache (P = .84), nausea (P = .91), and fatigue (P = .10).Conclusions:Tamsulosin should be strongly recommended for patients with ureteral stones to increase treatment efficacy. The side effects were not significantly different between the tamsulosin and control treatments.

Первоначальный опыт клинического применения тулиевой контактной литотрипсии в трансуретральном доступе в лечении мочекаменной болезни

The choice of an effective and safe method of disintegration of stones in upper and lower urinary tract is very important in the context of continuous scientific and technological progress. In current clinical urological practice, various lithotriptors with rigid and flexible probes are used for contact disintegration of stones, having both advantages and disadvantages. This study aimed to analyze the first results of the clinical application of the native Tm: fiber Urolaz laser (STA IRE-Polyus, Russia) for contact transurethral lithotripsy. The study comprised 56 patients who underwent transurethral contact thulium laser lithotripsy for 68 stones of the upper and lower urinary tracts between April and September 2017. Forty-four patients had kidney and ureteral stones, and twelve patients had urinary bladder stones. Twenty-four kidney stones were removed by retrograde intrarenal surgery using ureteral casing, flexible ureteropyeloscope and thulium laser, 32 stones in various ureteral segments - by rigid contact thulium laser ureterolithotripsy and 12 bladder stones - by thulium laser cystolithotripsy. The size of the upper urinary tract stones varied from 0.6 to 1.8 cm, bladder stones measured from 1.1 to 3.5 cm. Also, experimental studies were carried out to investigate the effects of the fiber thulium and holmium laser on the stone displacement and temperature environment during lithotripsy. Full stone fragmentation was achieved in 100% of patients. 47.7% of patients required additional lithoextraction of fragments; there was no retrograde migration of large stones. The mean duration of stone disintegration was 19 minutes. Postoperatively, 15.9% of patients had an exacerbation of pyelonephritis, which was successfully managed by conservative measures. The mean postoperative hospital stay was 2.4+/-1.1 days. At follow-up examination 4-6 weeks after surgery, one patient was found to have a residual symptomatic ureteral stone, which required extracorporeal short-wave lithotripsy. The experimental study showed that fiber thulium laser lithotripsy produced much less propulsion of artificial stone than Holmium laser lithotripsy. With the use of therapeutic power, neither of the lasers resulted in "dangerous" rises of the washing fluid temperature during stone disintegration. Using the universal thulium laser system "Urolaz" provides a significant improvement in the effectiveness of endourologic upper urinary tract interventions and significantly reduces the likelihood of intraoperative trauma and postoperative complications, which contributes to improving the quality of specialized urological care.