Treatment Of Distal Ureteral Stones Research Articles

Efficacy of sexual stimulation in the treatment of distal ureteral stones: A meta-analysis

IntroductionThis study aimed to compare the clinical efficacy of sexual stimulation with that of placebo in the treatment of distal ureteral stones. MethodsWe searched PubMed, Web of Science, Cochrane Library, and Google Scholar from January 1, 2000 to December 31, 2022 for studies comparing the efficacy of sexual stimulus with that of placebo for the treatment of distal ureteral stones. RevMan 5.3 software was used to pool the data. The study protocol was registered on PROSPERO (Registration Number: CRD42023432408). ResultsA total of six randomized controlled trials comprising 535 cases of distal ureteral stones were included in this study. Among these, 273 cases were associated with sexual intercourse or masturbation 3–4 times a week, while 262 cases only received symptomatic treatment. The pooled results showed that the 2-week [risk ratios (RR) = 1.77, 95 % confidence interval (CI): 1.34, 2.33] and 4-week [RR = 1.48, 95 % CI: 1.29, 1.69] ureteral stone expulsion rates of the sexually stimulated group were significantly higher than those of the placebo group (ps < 0.01). Additionally, sexual stimulation was associated with a shorter ureteral stone expulsion time [weighted mean differences (WMD) = −3.74, 95 % CI: −6.27, −1.22, p < 0.01] and a decreased prevalence of renal colic attacks [WMD = −0.61, 95 % CI: −1.01, −0.22, p < 0.01] compared with those of the placebo group. ConclusionAppropriate sexual stimulation can enhance the spontaneous expulsion of distal ureteral stones in patients presenting with tolerable pain.

The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?

IntroductionThe optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment outcomes.Materials and methodsThe retrospective study included records of 115 patients with distal ureteral stones, 5 mm to 18 mm in size, undergoing 223 ESWL sessions as an outpatient procedure. Early fragmentation and three-month follow-up stone-free rate (SFR) was assessed through radiographic imaging. Treatment was successful if there were no residual fragments or they were ≤4 mm, three months after the last session.ResultsThe mean ±standard deviation (range) stone size was 9.68 ±3.10 (5.00-18.0) mm. The mean body mass index (BMI) was 24.3 ±2.67 (18.4-29.8) kg/m² with a significant correlation between BMI and stone size (r2 =0.324, p <0.001). Patients underwent ESWL an average of 1.7 ±1.36 times (1-5), while 68 patients (59.1%) became stone-free after one session. The overall SFR was 82.6%; for patients with stone sizes ≤10 mm and >10 mm, it was 99% and 9.4%, respectively. Cumulative SFR after the second session was 77%. In 20 (17%) patients the treatment was a failure. Complications occurred in 10.4%, while auxiliary procedures were needed in 8.7% of cases, both significantly affected by the stone size (p <0.001). The efficiency quotient (EQ) was 0.76. Treatment outcome was significantly different depending on stone size, BMI, number of sessions, complications, and auxiliary procedures (p <0.001, p =0.022, p <0.001, p <0.001, p <0.001, respectively). Univariate regression analysis identified stone size and BMI as significant predictors of treatment outcome (odds ratio (OR) 3.84, 95% confidence interval (CI): 2.31-8.97, p =0.001, and OR 1.25, 95% CI: 1.04-1.54, p =0.024, respectively).ConclusionsExtracorporeal shock wave lithotripsy continues to be a safe and effective option for managing simple calculi in distal ureters with a diameter of ≤10 mm. The stone size and BMI remain significant predictors of treatment outcome.

Ultrasound versus fluoroscopy-guided ureteroscopy for distal ureteric stones in adults

ABSTRACT Objective To evaluate the safety and efficacy of ultrasound (US) as alternative to fluoroscopy for guidance of ureteroscopy (URS) during treatment of distal ureteric stones in adults. Materials and methods This study enrolled 80 patients older than 18 years presented with a single distal ureteric radio-opaque stone of ≤15 mm in longest diameter. Patients were randomized and allocated into two groups: the fluoroscopy group and the ultrasound group (n = 40 patients in each group). Patients with bilateral ureteric stones, solitary kidney, ureteric congenital anomalies, history of failed ureteroscopy, history of ureteric surgery, patients with uremia and pregnant women were excluded. Patients’ demographics, stone characteristics, operative data, stone-free status, hospital stay and complications were evaluated in both groups. Results No statistically significant difference between both groups was found regarding patients’ demographics and stone characteristics. Also there was no statistically significant difference in comparing fluoroscopy group versus ultrasound group regarding operative time (29.48 ± 15.3 versus 31.28 ± 18.24 min; P = 0.83), stone-free rate (97.5% versus 95%; P = 1.0), overall complications (15% versus 12.5%; P = 0.75), or hospital stay (1.17 ± 0.6 versus 1.02 ± 0.16 days; P = 0.12). Four patients (10%) in the ultrasound group required the addition of fluoroscopy beside ultrasound. Conclusion Ultrasound is effective in guidance during ureteroscopy for distal ureteric stones. It was comparable to fluoroscopy in terms of stone free rate, operative time, overall complications, and hospital stay. However, fluoroscopy must be available to be used when needed.

Efficacy of supine trans-abdominal pronated shock head ESWL for treatment of distal ureteric stones: A pilot study.

To evaluate the efficacy of extracorporeal shockwave lithotripsy (ESWL) in supine trans-abdominal approach for distal ureteric calculi and to determine the variables that could affect the outcome results. Between November 2019 and January 2021, 172 patients with a solitary distal ureteric calculus were treated with ESWL in supine position with a pronated shock wave head against the anterior abdominal wall. The outcome of treatment evaluated and the clinical and radiological findings, as well as stone characteristics, were reviewed and correlated with the stone-free rate (SFR). Overall SFR was 84.84% (140/165). Those with stone clearance, 83.57% (117/140) cleared after one session and 16.42% (23/140) needed more than one session. Only three factors had a significant impact on SFR, that is stone length, stone width, stone attenuation. For stone length ⩽ 9 mm SFR was 93.44% (114/122) compared to 60.46% (26/43) for stone length of 10-12 mm (p < 0.00001). There were statistically significant increased SFR for stones with attenuation of <0.0001 and for the mean stone width of 8.02 mm (p < 0.00001). Stone localisation was easy with good patient comfort. Supine trans-abdominal ESWL is a new, effective and safe form of treatment for distal ureteric calculi. The stone length, stone width along with stone attenuation were the only significant predictors of stone free status in supine position.

Comparison of the Efficacy of Medical Expulsive Therapy for the Treatment of Distal Ureteric Stones with and without Mirabegron

Comparison of the Efficacy of Medical Expulsive Therapy for the Treatment of Distal Ureteric Stones with and without Mirabegron

Predictive Factors for Requirement of Ureteral J Stenting in Ureteroscopic Treatment of Distal Ureteral Stones.

We aimed to investigate the factors predicting the need for ureteral J stent placement in the treatment of distal ureteral stones by ureteroscopy (URS). Between January 2007 and June 2018, 550 consecutive patients who underwent URS with the diagnosis of distal ureteral stone disease were evaluated in a single center. The patients were divided into two groups as; group 1 who received a ureteral J stent, and group 2 without ureteral J stent. The two groups were compared in terms of possible preoperative, perioperative and postoperative risk factors. History of systemic disease, stone disease and extracorporeal shock wave lithotripsy (SWL) were significantly higher in group 1 (P<0.001, P=0.009, P=0.016). The operation time was longer in group 1 (P<0.001). The rate of impacted stones was higher in group 1 (61.7% vs 15.6%; P<0.001). In multivariate analysis, co-morbidities, previous SWL history, presence of impacted ureteral stone and prolongation of the operation time were found to be statistically significant in predicting ureteral J stent placement. In the treatment of distal ureteral stones by URS, not only perioperative complications, prolongation of the operation time, and the presence of residual stones but also preoperative factors, such as systemic disease, and impacted ureteral stones should be considered as predictive factors in assessing the need for a ureteral J stent and to avoid unnecessary stent procedures.

Comparison of the efficacy of silodosin and a terpene combination in the medical expulsive therapy of distal ureteral stones.

We aimed to compare the efficacy of silodosin and a terpene combination in the treatment of distal ureteral stones. The data of the patients admitted to the urology policlinic with renal colic, diagnosed with distal ureteral stones, and followed up with medical expulsive therapy between December 2017 and June 2018 were retrospectively reviewed. The patients were divided into two groups: Group 1 comprised 72 patients that received 8mg/day silodosin and Group 2 consisted of 51 patients that were given three capsules of a terpene combination daily. The groups were compared in terms of the patients' demographic characteristics, medical history, localisation of the present stone, renal collecting system status, daily fluid intake, number of emergency service visits, number of additional analgesic applications needed, number of pain attacks, number of days off work, stone expulsion rate and time to stone expulsion. Of the total 123 patients, 98 (79.7%) were stone-free. The stone-free rate was 75.0% in Group 1 and 86.3% in Group 2, with no statistical difference between the two groups. However, the number of visits to the emergency service because of pain, number of additional analgesic applications required, number of days off work, and time to stone expulsion were statistically significantly lower in Group 2 than in Group 1. The treatment of distal ureteral stones with silodosin is as effective as the terpene combination. However, the terpene combination is more effective than silodosin in managing pain and accelerating stone expulsion.

Direct Comparison of Pneumatic and Ho:YAG Laser Lithotripsy in the Management of Lower Ureteric Stones

Introduction: Besides extracorporeal shockwave lithotripsy, semi-rigid ureteroscopy (URS) has become an equal therapy of choice for the treatment of most distal ureteric stones. Before the wide availability of laser lithotripsy as a tool for stone fragmentation, pneumatic lithotripsy was, and still is, widely used. In a country like Iraq, availability and affordability are the huge questions asked. Besides the capital investment for a laser machine, the pneumatic device is reusable, whereas the laser fibers are limited in their reusability. This makes pneumatic lithotripsy a more cost-effective option, at least in our setting. The question remains whether both options, compared in our setting with our limited resources, are equally effective and beneficial to our patients. Patients and Methods: Fifty patients were included in our prospective study who underwent URS for the treatment of a distal ureteric stone. Half each (n = 25) underwent pneumatic (group A) or laser lithotripsy (group B). Inclusion criteria were a single distal ureteric stone measuring 7–20 mm in largest diameter, no anatomical abnormality, age >18 years, and an unsuccessful attempt of medical expulsion therapy. Patients with signs of urinary infection and pregnant women were excluded. All patients were operated upon under spinal anesthesia. Data recorded included operation time, stone size, type of scope and lithotripter, complications, hospital stay, and stone-free rate. Results: Both groups did not show statistically significant differences in patient demography, stone size, operation time, complications, and stone-free rates (p > 0.05). Conclusion: Both pneumatic and Ho:YAG laser lithotripsy are equally effective and safe in treating distal ureteric stones in our setting. If the cost and availability of laser treatment is an issue, pneumatic lithotripsy is a viable and more cost-effective option.

Efficacy of combination terazosin and nifedipine therapy in postoperative treatment of distal ureteral stones after transurethral ureteroscopic lithotripsy.

ObjectiveTo investigate the efficacy of combination terazosin and nifedipine therapy in postoperative treatment of distal ureteral stones after transurethral ureteroscopic lithotripsy.MethodsThis prospective single-blinded randomized study enrolled 165 patients undergoing transurethral ureteroscopic lithotripsy in our hospital. Patients were randomized into three groups: control, terazosin, and combination treatment (terazosin and nifedipine). Stone discharge rates and times were recorded, along with side effects and complications. Visual Analogue Scale (VAS) score was used to evaluate pain for 7 days postoperatively. International Prostatic Symptoms Score (IPSS) was used to evaluate prostatic function; quality of life (QOL) was evaluated preoperatively and at 7 days postoperatively.ResultsThe stone discharge rate was significantly higher in the combination group than in other groups; moreover, mean discharge time was shorter in the combination group. Beginning at 3 days postoperatively, VAS scores were dramatically lower in the combination group than in other groups; IPSS and QOL scores were also lower in the combination group. Edema recurrence was significantly less common in combination and terazosin groups than in the control group. Side effects were similar among groups.ConclusionCombination terazosin and nifedipine therapy was safe and effective in postoperative treatment of distal ureteral stones after transurethral ureteroscopic lithotripsy.

The evaluation of the effectiveness of Gilaburu (Viburnum opulus L.) extract in the medical expulsive treatment of distal ureteral stones.

Medical expulsive therapy is an important non-invasive treatment modality that facilitates the passage of ureteral stones. The aim of the present study was to evaluate the efficacy of Gilaburu (Viburnum opulus) extract in the treatment of distal ureteral stones <10 mm. Data of 103 patients were retrospectively analyzed. Patients were divided into two groups: those given V. opulus 1000 mg peroral 3×2 and diclofenac 50 mg peroral on-demand (n=53) and those given only diclofenac sodium 50 mg peroral on-demand (n=50). Comparisons of stone expulsion rates and the elapsed time until the expulsion between the groups were determined as primary outcome measures. The comparison of the need for additional treatment [ureteroscopy (URS) or extracorporeal shock wave lithotripsy (ESWL)], the need for emergency admission, analgesic requirement, and the complication rates in additional treatment were determined as secondary outcome measures. The mean age of the patients was 45.8±14.5 years. The rate of stone expulsion was significantly higher (82% vs. 66%, p=0.026), and elapsed time to stone expulsion was significantly shorter (9±1.8 vs. 14±2.3 day, p=0.018) in the V. opulus group. The need for additional treatment (URS and ESWL) and analgesic requirement was less in the V. opulus group (9.4% vs. 20%, p=0.038 and 24.5% vs. 44%, p=0.042, respectively). V. opulus is an herbal treatment alternative that facilitates the passage of ureteral stones <10 mm. Prospective, randomized studies are needed to support these results.

Editorial Comment to Successful percutaneous flexible ureteroscopy for treatment of distal ureteral stones under modified Valdivia position after Cohen reimplantation.

Editorial Comment to Successful percutaneous flexible ureteroscopy for treatment of distal ureteral stones under modified Valdivia position after Cohen reimplantation.

Meta-analysis of the efficacy of sexual intercourse for distal ureteric stones.

ObjectiveThis meta-analysis was performed to evaluate the efficacy of sexual intercourse for treatment of distal ureteral stones.MethodsRandomized controlled trials (RCTs) of sexual intercourse for treatment of distal ureteral stones were searched using PubMed, EMBASE, and the Cochrane Controlled Trials Register.ResultsThree RCTs comprising 240 patients were included in the meta-analysis, which showed that sexual intercourse was effective in treating distal ureteral stones. The expulsion rate of distal ureteral stones at the second week (odds ratio [OR] = 6.61, 95% confidence interval [CI]: 3.66 to 11.94), expulsion rate of distal ureteral stones at the fourth week (OR = 4.00, 95% CI: 2.09 to 7.64), and number of analgesic injections (mean difference [MD] = −0.79, 95% CI: −1.51 to −0.08) indicated that sexual intercourse was more effective than placebo. However, the mean expulsion time of distal ureteral stones (MD = −3.98, 95% CI: −8.77 to 0.81) showed no difference between sexual intercourse and placebo.ConclusionsCompared with placebo, sexual intercourse exhibited greater efficacy for the treatment of distal ureteral stones, whilst potentially alleviating pain.

Ureterorenoscopic Treatment of Distal Ureteral Stones in Morbidly Obese

Ureterorenoscopic Treatment of Distal Ureteral Stones in Morbidly Obese

Medical Expulsive Therapy for Distal Ureteral Stones: Tamsulosin Versus Silodosin in the Turkish Population.

IntroductionOur aim was to contribute a study that includes a higher patient population to the limited number of studies comparing tamsulosin and silodosin in the treatment of distal ureteral stones.Material and methodsPatients who presented with renal colic to the urology emergency clinic and were diagnosed with ureteral stones and followed-up with conservative treatment between January 2010 and January 2016 were retrospectively screened. According to the inclusion-exclusion criteria, the patients were divided into three groups. Group 1: 150 patients followed with watchful waiting (WW), Group 2: 156 patients who received 0.4 mg of tamsulosin daily, and Group 3: 159 patients who received 8 mg of silodosin daily. The side effects of the used drugs, duration of stone reduction, and expulsion rates were evaluated and compared separately.ResultsA total of 465 patients were included in the study. No statistically significant difference was found in terms of age, gender, and stone size among the groups. The patient characteristics and results are shown in Table 1. The differences in stone expulsion rate between the groups in the first week were calculated using the Chi-square test and found to be non-significant (p = 0.155); whereas, the stone expulsion rates between Group 1 versus Group 2 and Group 1 versus Group 3 were found to be significantly different after the second and third week.ConclusionAccording to our results, no statistically significant superiority between tamsulosin and silodosin was shown in the treatment of distal ureteral stones in the Turkish population.

Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial

BackgroundRecent large high-quality trials have questioned the clinical effectiveness of medical expulsive therapy using tamsulosin for ureteral stones. ObjectiveTo evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo. Design, setting, and participantsWe conducted a double-blind, placebo-controlled study of 3296 patients with distal ureteral stones, across 30 centers, to evaluate the efficacy and safety of tamsulosin. InterventionParticipants were randomly assigned (1:1) into tamsulosin (0.4mg) or placebo groups for 4 wk. Outcome measurements and statistical analysisThe primary end point of analysis was the overall stone expulsion rate, defined as stone expulsion, confirmed by negative findings on computed tomography, over a 28-d surveillance period. Secondary end points included time to stone expulsion, use of analgesics, and incidence of adverse events. Results and limitationsAmong 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; p<0.001) for distal ureteral stones. Subgroup analysis identified a specific benefit of tamsulosin for the treatment of large distal ureteral stones (>5mm). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (p<0.001), required lower use of analgesics compared with placebo (p<0.001), and significantly relieved renal colic (p<0.001). No differences in the incidence of adverse events were identified between the two groups. ConclusionsOur data suggest that tamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5mm, but no effect for stones ≤5mm. Patient summaryIn this report, we looked at the efficacy and safety of tamsulosin for the treatment of distal ureteral stones. We find that tamsulosin significantly facilitates the passage of distal ureteral stones and relieves renal colic.

Silodosin in the treatment of distal ureteric stones in children: A prospective, randomised, placebo-controlled study

ObjectivesTo evaluate the possible role of silodosin (a highly selective α1A-adrenoceptor antagonist) in facilitating the passage of distal ureteric stones (DUS) in children, as the role of α-blockers as medical expulsive therapy is well known in adults. Patients and methodsIn all, 40 paediatric patients (27 boys and 13 girls) diagnosed with unilateral, single, radiopaque DUS of <10mm were included in the study. Their mean (SD, range) age was 8.1 (2.7, 5–17)years. The patients were randomly divided into two groups: Group A, received silodosin 4mg as a single bedtime dose; and Group B, received placebo as a single bedtime dose. Ibuprofen was prescribed to both groups on-demand for pain episode relief. Patients were followed up biweekly for 4weeks. The stone expulsion time and rate, pain episodes, analgesic use, and any adverse effects were recorded. ResultsThe mean (SD) stone size in Group A was 6.6 (1.7)mm and in Group B was 6.7 (1.4)mm (P=0.4). Two patients were lost to follow-up (one from each group), and one patient in Group A refused to complete the study. The stone-free rate at end of the 4-week treatment period was 88.8% in Group A vs 73.6% in Group B (P=0.4). The mean (SD) stone expulsion time was 7.0 (4.3) vs 10.4 (4.7)days in groups A and B, respectively (P=0.02). The mean (SD) number of pain episodes requiring ibuprofen was 2.3 (1.4) vs 4.7 (2.6) episodes in groups A and B, respectively (P<0.001). Adverse effects (headache and dizziness) were recorded in three patients (16.7%) in Group A, which were mild and none of them discontinued treatment, whilst no adverse effects were recorded in Group B. ConclusionsThe data in the present study show that silodosin can be safely used in the treatment of DUS in children for decreasing time to stone expulsion, pain episodes, and analgesic requirement.

Determine the Effectiveness of Low Dose Tamsulosin as a Medical Expulsive Therapy in Patients with Lower Ureteric Stones

Introduction: The human ureter contains a high number of α-adrenergic receptors, especially α1d -receptors at the lower part of the ureter. Tamsulosin is a combined α1a- and α1d- selective adrenergic antagonist that is an alternative to other medications, such as calcium channel blockers, corticosteroids, and analgesic and anti-inflammatory drugs, for the treatment of distal ureteric stones. Objective: To determine the effectiveness of low dose tamsulosin as a medical expulsive therapy in patients with lower ureteric stones. Setting: Department of Urology, Liaquat University of Medical and Health Sciences Jamshoro. Study design: Randomized controlled trial.Duration of study: 6 months Subjects and methods: All patients with either gender, age range 30-60 years and stone size 4-10 mm in the lower 1/3rd of the ureter determined on ultrasound were enrolled. Group A patients was offered low dose tamsulosin (0.2 mg) one tablet daily in the morning for a maximum of 4 weeks and group B served as control. The final outcome was measured at the end of 4th week of treatment. Patients were instructed to note the time and the date of expulsion of stone. Absence of echoic shadows on lower 1/3rd of ureteric line on ultrasound was taken as effectiveness (expulsion of stone). Results: In control group mean age was 45.52 ± 6.70 years whereas in low dose Tamsulin mean age was 46.72 ± 6.73 years. Frequency of male was higher in both control and low dose Tamsulin group, i.e. 39 (78%) and 21 (42%) respectively. In control group effectiveness was found 3 (6%) patients whereas in low dose Tamsulin group effectiveness was found in 47 (94%). Conclusion: In our study the effectiveness of low dose tamsulosin as a medical expulsive therapy in patients with lower ureteric stones was higher as compared to control.

The Role of the Tamsulosin in the Medical Expulsion Therapy for Distal Ureteral Stones.

Background:This research aims to evaluate the role of tamsulosin in the medical expulsion therapy for distal ureteral stones, including her effects in stone expulsion time, expulsion rates, stone size, pain episodes and analgesic dosage usage.Material and methods:The 104 patients with distal ureteral calculi were examined, with the size of the stones 4-10 mm. They were randomly divided into two groups: study group (n=52), received tamsulosin 0.4 mg in morning, for 28 days, analgesic (diclofenac 75 mg), high fluid intake and Control group (n=52) received analgesic (diclofenac 75 mg), high fluid intake.Results:There is no significant difference between groups, based on sex (P=0.835) and age (P=0.987). Average size of the stones was 6.5 mm (SD ± 1.6 mm), with no significant difference (P=0.996). Stone expulsion rate is 90.4% in the study group and 71.2% from the control group, with statistical significance (P=0.023). The average time of the expulsion of stones in the study group was 9.6 days (SD ± 7.1 days), control group 13.7 days (SD ± 7.3 days), with statistical significance, (P=0.034). Average dose of analgesics in the study group was 63.7 mg (SD ± 45.2 mg), control group is 109.2 (SD ± 53.3), with statistical significance (P=0.019).Conclusion:Our study reveals that tamsulosin is efficient for the treatment of distal ureteral stones. Tamsulosin decrease the number of ureteral colic episodes, by acting as a spasmolytic, increase and hasten stone expulsion rates, reduce days of stone expulsion, decrease analgesic dose usage.

Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study.

The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to "conventional" ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure.

LOWER URETERIC STONES

Aims &amp; Objectives: Placement of a ureteral stent is routinely done followed byureteroscopy. Recently, many researchers have questioned routine stenting after ureteroscopyfor management of distal ureteric stones? We report our outcomes of a randomized studycomparing ureteroscopy with and without placement of stents for management of distalureteric stones. Study Design: Randomized controlled trial. Setting: Department of Urology,Jinnah Hospital/ Allama Iqbal Medical College, Lahore. Period: March 2013 to February, 2015.Materials &amp; methods: Total 155 patients were prospectively divided into three groups to receivea double J stent (Group I, 54 patients), ureteral stent (Group II, 50 patients) and no stent (GroupIII, 51 patients), underwent ureteroscopic treatment of distal ureteric stones. Characteristics ofstones, operation time, postoperative pain, lower urinary tract symptoms, and analgesia needfor postoperative pain, hospitalization, stone free rate and late postoperative complicationswere all studied. Results: There were no significant differences in preoperative data. Therewas no statistical significant difference between three groups regarding hematuria, fever, flankpain, urinary tract infection and re-hospitalization. At 48 hours and 1 week, frequency/ urgencyand dysuria were significantly less group III. When comparing Group I and Group III, patientswith double J stent has statistically significant more bladder pain 0, frequency/ urgency 0,dyusuria 0 and need of analgesia 0. All patients of the three groups assessed postoperativelyby imaging did not suffer any obstruction or ureteral stricture. Conclusion: Uncomplicatedureteroscopy without stent placement for treatment of distal ureteral stones is a safe procedure.Patients without stents have significantly fewer irritative bladder symptoms and are not at riskof complications.