Ureteral Stones Research Articles

Urinary stone assessment in a single-phase may replace the unenhanced and multiphase computed tomography protocol in painless visible haematuria.

Painless visible haematuria (VH) necessitates a computed tomography (CT) usually consisting of one unenhanced and two to three contrast enhanced acquisitions to detect urinary tract stones and malignancy. Recently, we demonstrated that a single nephrographic phase (NP) CT sufficed in detecting malignancy in patients with painless VH. Now, we aim to evaluate the diagnostic performance of single NP CT in stone detection and size measurements in the same cohort. "A Prospective Trial for Examining Haematuria using Computed Tomography" (PROTEHCT) was a single-center prospective diagnostic study in patients with painless VH between September 2019 and June 2021. All underwent four-phase CT (reference standard) from which a single NP CT (experimental) was extracted. Two randomised readers independently assessed the experimental CT for urinary stones and size. Statistical analysis included diagnostic accuracies and inter-reader agreement (kappa) of experimental CT, and size correlation (Spearman's ρ) between experimental CT and reference standard. In 308 included patients (median age: 68 years, 250 males), urinary stones (median size 5 mm) were diagnosed in 21%. The per-patient experimental CT sensitivity was 86% (97% for stones ≥ 5 mm), specificity was 98% and accuracy was 96%. The experimental CT sensitivity for detecting kidney stones was 78% (89% for stones ≥ 5 mm), and 100% for bladder and ureteral stones. No missed stone required active treatment. The inter-reader agreement was almost perfect (96%, k = 0.85). The correlation in stone size was very strong (ρ = 0.91). Conclusions: A single NP CT is sufficient in detecting and measuring urinary stones in patients with painless VH.

Analysis of the nursing value of continuity care in the recovery of ureteral stone patients after Pneumatic ballistic lithotripsy: An observational study.

This study aims to assess nursing methods' effects on ureteral stone patients post-Pneumatic ballistic lithotripsy with double J-tube placement. Through comparing interventions' impact on recovery, complications, and overall quality of life, the study aims to establish a more effective nursing protocol for this patient group. This study investigates ureteral stone patients who underwent PL and subsequent double J-tube placement between January 2020 and October 2023. A total of 100 eligible subjects (n = 100), meeting the inclusion and exclusion criteria, were divided into an intervention group (n1 = 50) and a control group (n2 = 50) according to different treatments. The control group received routine in-hospital care combined with outpatient follow-up, while the intervention group underwent continuous care using the Omaha system. Nursing effects pre- and post-intervention were assessed using questionnaires, clinical indicators, and the Omaha evaluation system, evaluating aspects such as cognition, behavior, and status in terms of environment, psychosocial aspects, physiology, and health behavior. Additionally, complications during double J-tube placement and pain scores were compared among the patients. Prior to the intervention, no statistically significant differences were observed between the scores of both groups across environmental, psychosocial, physiological, and health behavioral domains. Subsequent to the nursing intervention on the first postoperative day, at discharge, and post-discharge, a statistically significant variance was evident between the groups across these domains (P < .05). Furthermore, the intervention group exhibited notably lower rates of infection, hematuria, and residual or fragmented stones, all significantly lower with a P-value of <.05, compared to the control group. While a reduction in tissue damage and acute kidney injury was observed in the intervention group compared to the control group, this difference did not reach statistical significance. Notably, 92% of patients in the intervention group reported no pain during the nursing intervention, in contrast to only 52% in the control group. Continuity care utilizing the Omaha system demonstrates favorable outcomes in managing double J stent placement post-PL among ureteral stone patients, notably leading to a significant reduction in both pain levels and the incidence of associated complications.

Comparison of the results of active surgical treatment and serial stenting for urolithiasis in pregnant women

Introduction. Renal colic during pregnancy is a common cause of pain in the lower back. Currently, with a diagnosed kidney or ureter stone, the standard treatment is serial drainage of the urine tract using an internal ureter stent, with replacement of the drainage before delivery, followed by surgery to remove the stone after delivery.Objective. To study the effectiveness and safety of ureteroscopic interventions in the treatment of urolithiasis in pregnant women in comparison with the method of serial drainage of the upper urinary tract during gestation followed by surgical treatment of urolithiasis 4 weeks after delivery.Materials &amp; methods. The study group consisted of 119 patients with a confirmed diagnosis of urolothiasis using instrumental diagnostic methods and a gestational age up to and including the 27th week. Two groups were formed based on treatment approaches for urolithiasis: group 1 included 59 patients (49.6%) who underwent surgical removal of the stone; group 2 included 60 patients (50.4%) who underwent internal ureteral stent replacement every 4 – 6 weeks prior to delivery and subsequent ureteroscopy There were no significant differences in age, body mass index, or number of pregnancies between the two groups.Results. The frequency of complete stone removal in groups 1 and 2 was 96.6 and 96.7%, respectively. The median amount of time spent on urolithiasis treatment in groups 1 and 2 was 60 [45; 72] and 97 [54; 105] minutes, respectively (p = 0.002). Migration of the ureteral stent in group 2 was observed in 13.3% of cases (p = 0.05). Among group 1 patients who underwent ureteroscopic intervention aimed at stone removal, the incidence of internal drainage dislocation was 3.4%. Encrustation of the ureteral stent in groups 1 and 2 was observed among 2 (3.4%) and 17 (28.3%) patients, respectively (p &lt; 0.001). The bed-day (median time in days spent in hospital for drainage replacement and time of surgical treatment of urolithiasis) in groups 1 and 2 was four and eight days, respectively (p &lt; 0.05). The frequency of natural childbirth in groups 1 and 2 was 81.35% and 55.0%, respectively (p = 0.002).Conclusion. Urolithiasis among pregnant women is a complex multifactorial disease that affects not only the health of the mother, but also the condition of the developing foetus. It is possible to perform surgical treatment with high efficiency and low complication rate, which improves the quality of life.

Comparison of Moses laser and Raykeen laser in patients with impacted upper ureteral stone undergoing flexible ureteroscopic holmium laser lithotripsy

BackgroundTo compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones.MethodsFrom March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien–Dindo score.ResultsThere were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P < 0.05). The stone-free survival rate did not differ significantly between the two groups (P = 0.722). Stone volume was found to be positively correlated with laser energy and lithotripsy time in both groups (P < 0.01). There was no significant correlation between laser energy and lithotripsy time or ureteral stone density (Hu) in the Moses laser group (P > 0.05) or the Raykeen laser group (P > 0.05).ConclusionsThe contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy.

3D dynamic diuretic renal scintigraphy using a hybrid whole body CZT SPECT/CT camera protocol in the evaluation of acute ureteric obstruction caused by ureteric stone

PurposeTo investigate the performance of dynamic 3D diuretic renal scintigraphy using a hybrid whole body CZT SPECT/CT for the evaluation of acute ureteric obstruction in patients with urinary stone disease.Methods20 patients who presented to the Emergency Department with acute renal colic due to urinary stone disease confirmed by means of CT were prospectively included. Three observers evaluated and graded hydronephrosis, hydroureter, perirenal stranding, and thickening of the renal fascia from the CT as well as the renal scintigraphy curves from the dynamic SPECT study. The normalized residual activity from dynamic SPECT was analysed at 16 min in all patients and at 20 min in suspected obstruction.ResultsRenal scintigraphy curves showed a sensitivity of 100%, specificity of 93%, PPV 83% and a NPV 100% for obstruction, while normalized residual activity showed a sensitivity of 100%, specificity of 73%, PPV 56% and a NPV 100%. All patients presented at least 2 secondary signs of obstruction on the CT, showing a PPV of only 25% for obstruction.ConclusionDynamic 3D diuretic renal scintigraphy CZT SPECT/CT provides valuable functional and anatomical information from one single examination. The combination of pathological renogram curves and high normalized residual activity values provide the most valuable imaging information to determine the presence of acute ureteric obstruction. The secondary signs of obstruction observed on CT are not specific and should not be used to confirm or discard obstruction in patients with urinary stone disease.Trial registration: ISRCTN15338358. Registration date 03/01/2024. Retrospectively registered. https://www.isrctn.com/ISRCTN15338358?q=miguel%20ochoa%20figueroa&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10

Audit of the Acute Management of Renal Colic in District Hospitals Within a National Health Service Trust.

Renal colic is a prevalent acute urological emergency caused by urinary stones and commonly manifests as severe loin pain. This audit assesses the management of acute renal colic at a National Health Service (NHS) Trust in the West Midlands, England, comparing practices against theNational Institute for Clinical Excellence (NICE) and the British Association of Urological Surgeons (BAUS) guidelines. This retrospective audit reviewed 417 patients with suspected renal colic over a month. Data collected included patients' demographics, time to complete CT scan, laboratory investigations requested and management modalities. Patients assessed were either admitted through the Emergency Department, Surgical Assessment Unit, or previously admitted for other conditions on the wards. The audit benchmarked against NICE and BAUS guidelines, focusing on diagnostic timeliness and management, including essential blood investigations. Data analysis performed using SPSS (IBM Corp., Armonk, NY, USA) included descriptive statistics and Chi-square tests, with significance set at p < 0.05. A total of 417 patients met the inclusion criteria. The average age of patients was 47.4 years with slightly higher male population (51.1%). The diagnostic rate for renal or ureteric stones using computed tomography of the kidneys, ureters, and bladder (CT-KUB) was 41.2%. The positive detection rate was significantly higher in males (54%) compared to females (27.5%) while females have more alternate diagnosis than males (13.7% vs 6.1%). The average completion time of CT-KUB was nine hours with 7.7% of patients having their CT-KUB beyond the 24-hour benchmark. Most patients (48%) were managed conservatively with analgesia, 32% received tamsulosin as medical expulsive therapy and others had interventions like ureteric stent insertion (9.3%), nephrostomy (6.4%) or primary ureteroscopy (4.1%). The audit of renal colic management at our centre revealed a 41.2% diagnostic rate for renal or ureteric stones via CT-KUB, with a significantly higher rate in males than females. Diagnostic delays were minimal, with only 7.7% of scans exceeding 24 hours. Conservative management was common, however non-steroidal anti-inflammatory drugs (NSAIDs) were underutilized despite guideline recommendations. There was a notable gender disparity in diagnostic and alternate findings rates. The results showed the need for adherence to pain management protocols and highlight the effectiveness of existing renal colic protocol, while also pointing to potential areas for improvement in treatment uniformity and guideline adherence.

Quercus dentata Thunb. leaves extract inhibits CaOx crystallization and ameliorates ethylene glycol-induced CaOx kidney stones via the OPN/CD44 and NLRP3 pathways

Ethnopharmacological relevanceThe leaves of Quercus dentata Thunb. (QD), a member of the Fagaceae family and genus Quercus, with distributions in China, Japan, Korea, and other regions. As recorded in the Ben Cao Gang Mu (Compendium of Materia Medica) and other classical Chinese medical texts, QD has been traditionally employed in Traditional Chinese Medicine (TCM) for their hemostatic and diuretic effects and has been used to treat urinary stones (Lin Zheng). It is also the main ingredient of the Mishitong capsule (MST), a Chinese patent drug, used for kidney stones and ureteral stones. Nonetheless, the specific active ingredients and the mechanisms of QD in treating kidney stones remain to be elucidated, which is crucial for advancing the scientific understanding and clinical application of this traditional medicine. Aim of studyThis study aimed to identify the active constituents of QD water extract (QDWE), explore its inhibitory effects on kidney stones through in vitro and in vivo studies, and elucidate the underlying mechanisms of the OPN/CD44 axis and the NLRP3 signaling pathway to provide a full understanding of its potential as a novel treatment approach against kidney stones. Materials and methodsThe micromolecular components in the supernatant of QDWE (QDS) were analyzed by UPLC-Q-Exactive-Orbitrap-MS and the monosaccharide composition of the macromolecular polysaccharide components in the crude polysaccharide (QDP) was determined by pre-column derivatization in HPLC. The effects of QDWE, QDS and QDP on the shape, size, and structure of calcium oxalate (CaOx) crystals in vitro were explored by XRD, FTIR and SEM. The effects of QDWE, QDS and QDP on CaOx kidney stones in SD rats induced by ethylene glycol and VD3 were compared in vivo. Furthermore, the underlying mechanisms of OPN/CD44 and NLRP3 pathways were investigated by Western blot analysis. ResultsThere were 32 compounds identified in QDS. The monosaccharide composition ratio of QDP was Man: L-Rha: D-GlcA: D-GalA: D-Glc: D-Gal: L-Ara = 1.01: 22.52: 8.27: 38.61: 3.43: 17.80: 6.38, indicating a mixture of pectin-type acidic heteropolysaccharides. QDP had a more significant inhibitory effect on CaOx crystals in vitro than QDWE, which can inhibit the formation of CaOx monohydrate crystals (COM) and convert them into thermodynamically unstable CaOx dihydrate (COD) crystals. The high dose of QDWE exhibited significant in vivo efficacy (P < 0.05), including anti-calculus, diuretic effects, and kidney protection, marked by decreased calcification and stone formation, alongside improved kidney vitality. Furthermore, the protective effects of QDWE were demonstrated to be associated with the OPN/CD44 and NLRP3 pathways. ConclusionThe studies identified and analyzed the active constituents of QDWE. Among these, QDP significantly inhibited CaOx crystal generation in vitro and could be a potential component for the treatment of urinary stones in QDWE. Moreover, the results indicated that QDWE had a remarkable therapeutic effect on CaOx stones by modulating the OPN/CD44 axis to affect stone formation and the NLRP3 signaling pathway to mediate inflammation, providing an experimental basis for the mechanism of anti-urinary stone and deep development of QD.

Operative outcomes 24 hours after retrograde intrarenal surgery for solitary renal calculi using a flexible and navigable suction ureteral access sheath. A prospective global multicenter study by the European Association of Urology Section on Urolithiasis.

Suction techniques showed potential to improve outcomes of retrograde intra-renal surgery (RIRS). We assessed the 24-hour stone-free rate (SFR) and complications after RIRS using flexible and navigable suction ureteral access sheaths (FANS-UAS). Sixteen centers prospectively contributed to data (August 2023-October 2023). Inclusion criteria: age ≥18 years, single renal stone, pre and 24-hour post-RIRS CT scan. Exclusion criteria were: ureteral stone, anomalous kidney, multiple stones. SFR was divided into: 1) grade A - no fragments; 2) grade B - fragments ≤2 mm; 3) grade C - fragments 2.1-4 mm; and 4) grade D - fragments >4 mm. A multivariable logistic regression analysis model was performed to assess factors associated with the odds of having grade A stone-free status. Data are expressed as median (interquartile range), absolute numbers and frequencies, odds ratio (OR), and 95% confidence interval (CI). One hundred forty-two patients with a median age of 52 years (40-61) were enrolled. 61.3% were males. Median stone volume was 1165 mm3 (656-1936). Median operative time was 48.5 (36.25-71.75) min. Transient fever (37°C-37.5°C) occurred in 10 (7%) patients. No sepsis case occurred. 96.5% of patients were stone-free (Grade A+B). Grade A SFR was 52.8%. All patients were discharged within 48 hours. Bone window (OR 3.156 95% CI 1.177-9.130, P=0.027) was the only factor significantly associated with higher odds of 100% SFR, while stone volume (OR 0.999, 95% CI 0.999-1.000, P=0.007) was significantly associated with lower odds. Imaging and clinical evidence demonstrate excellent perioperative outcomes just 24 hours post RIRS with FANS-UAS. The technique demonstrates a good safety profile, ability for immediate high SFR, and a low rate of infective complications.

‘Out of Scope’ – Operative Challenges in Ureteric Stone Management for Patient With Abnormal Ureteric Anatomy Post Multiple Urinary Diversion Procedures for Posterior Urethral Valves

‘Out of Scope’ – Operative Challenges in Ureteric Stone Management for Patient With Abnormal Ureteric Anatomy Post Multiple Urinary Diversion Procedures for Posterior Urethral Valves

Predictive factors for prolonged operative time in ureteroscopic lithotripsy for ureteral stones A retrospective cohort study.

A prolonged operative time of lithotripsy with ureteroscopy for urolithiasis increases the risk of infectious complications; however, few reports have investigated the factors prolonging the operative time for ureteral stones. We investigated the factors associated with longer operative time in ureteroscopy for ureteral stones. This retrospective cohort study analyzed patients who underwent retrograde ureteroscopic lithotripsy for ureteral stones and achieved an endoscopic stone-free status between April 2019 and July 2022. Patients were classified into two groups based on an operative time of ≥90 minutes or <90 minutes. We compared the patient and stone characteristics and surgical outcomes, and investigated the factors associated with a prolonged operative time. The cohort comprised 519 patients, with 58 patients in the group with an operative time of ≥90 minutes. Compared to the shorter operative time group, the longer operative time group had a significantly greater proportion of males, stone diameter, stone volume, and Hounsfield units of stone; additionally, the longer operative time group had higher prevalences of endoscopic findings of edema, polyps, and mucosa-stone adherence. Multivariable analysis showed that stone size >10 mm (odds ratio 4.05), polyps (odds ratio 2.40), and mucosal adherence (odds ratio 3.51) were significantly associated with an operative time exceeding 90 minutes. There were no significant differences between the two groups in the incidences of postoperative fever and systemic inflammatory response syndrome. Stone size, endoscopic findings of polyps, and mucosa-stone adherence were independent factors associated with a longer operative time.

In vitro experimental study on interventional ultrasound-mediated microbubble cavitation lithotripsy

Abstract Ultrasound-mediated microbubble cavitation lithotripsy as a new minimally invasive approach has received great attention for the treatment of urinary stones. However, the attenuation of ultrasonic waves in human tissues and stone displacement during lithotripsy are two key issues limiting the development of this technology. In this paper, a method of interventional ultrasound-mediated microbubble cavitation lithotripsy is proposed, which can realize the in-situ delivery of ultrasonic waves and microbubbles. A piezoelectric ultrasound transducer with the center frequency of 461 kHz and output peak to peak acoustic pressures of 3.2 MPa is fabricated, and microbubbles with the concentration of 1.33×109/ml are synthesized. An extracorporeal experiment platform is built and in vitro tests of ultrasound mediated microbubble cavitation lithotripsy are conducted by using microbubbles with different concentrations and water. The results show that the proposed interventional ultrasound-mediated microbubble cavitation lithotripsy is an efficient method for the fragmentation of ureteral stones. The maximum mass reduction of the stone is 9.4 mg within 30 minutes of treatment under the combined action of ultrasound with the peak-negative pressure of 1.6 MPa and center frequency of 461 kHz and microbubbles with the concentration of 3.325×107/ml. The research results will provide a technical basis for further optimization of subsequent tentative schemes, in vivo experiments with animals and future clinical applications.

Retrospective study of ureteral stenosis after holmium laser lithotripsy.

To identify the factors influencing postoperative ureteral stenosis following holmium laser lithotripsy. A retrospective study was conducted of 106 patients who underwent ureteroscopic holmium laser lithotripsy. The effects of variables including stone location, stone size, the duration of surgery, water intake, disease duration, and stone-associated polyps were investigated. Logistic regression analysis revealed significant associations of ureteral stenosis with stone location, stone size, duration of surgery, water intake, disease duration, and stone-associated polyps. Patients with proximal stones, with large stones, who underwent long surgical procedures, who drank a large amount of water, who had long-term disease, and who had stone-related polyps were more likely to develop postoperative ureteral stenosis. Significant perioperative complications of holmium laser lithotripsy are associated with prolonged disease, large ureteral stones, long incarceration periods, and the presence of polyps. Surgeons should consider these risk factors during the preoperative evaluation of patients and surgical planning to minimize the risk of postoperative ureteral stenosis.

Assessing the safety of ureteral stent placement for obstructive urolithiasis in patients during the COVID-19 pandemic.

Patients with an active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] infection are at a higher risk of post-operative mortality. In this retrospective case-control study, we analyzed the post-operative safety of patients undergoing cystoscopy with ureteral stent placement for obstructing ureteral calculi who tested positive for COVID-19. We retrospectively identified patients who underwent cystoscopy and ureteral stent placement between June 5, 2020 and December 31, 2022 as an add-on case. Patients were stratified by whether they had a positive COVID-19 test on admission. Baseline characteristics were compared using Students t-test for continuous variables and Pearson chi-square test for categorical variables. Univariate and multivariate logistic regression analysis was performed to identify predictors of postoperative 30-day mortality. A total of 1,408 patients underwent add-on cystoscopy with ureteral stent placement for an obstructing calculus, of which 55 (3.9%) patients had a positive COVID-19 test. When stratified by COVID-19 status, both groups were similar with regards to age, sex, race, co-morbidities, indications, procedure duration, and type of anesthesia administered. Of the 137 patients that were admitted to the intensive care unit (ICU), 9 patients were COVID-19 positive (16.4% vs. 9.5%, P=0.09). On multivariate logistic regression, patients with COVID-19 had a higher odds of 30-day mortality [odds ratio (OR) =7.06; 95% confidence interval (CI): 2.03-24.47; P=0.002] when controlling for age, co-morbidities, vaccination status, anesthesia type, and indication for the stent. Patients that underwent cystoscopy and ureteral stent placement for an obstructing ureteral stone with a concurrent COVID-19 diagnosis had an increased risk of perioperative 30-day mortality.

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.

Effect of Alpha-Blocker on Distal Ureteric Calculi: A Comparative Study

Introduction Silodosin is a recently introduced selective alpha- blocker in Medical Expulsive Therapy for the management of distal ureteric calculi. The efficacy and safety of silodosin compared to tamsulosin are controversial, however the former is considered to be more effective. The objective of the study is to assess the efficacy and safety of silodosin compared to tamsulosin in the treatment of ureteral stones less than 10mm.  Methods This prospective randomized study was conducted in the Department of General Surgery, Navodaya Medical College, Raichur, Karnataka. Sixty patients were included in the study who presented with abdominal or loin pain and were diagnosed with unilateral solitary distal ureteric stone measuring &lt;10mm with no complications. Participants in Group I received Tablet Silodosin 8mg OD until the passage of stone or up to two weeks, and Group II received Tablet Tamsulosin 0.4mg OD until the passage of stone or up to two weeks. Analgesic Tablet Diclofenac sodium 50mg was given to both patients on demand.  Results A total of 60 patients were included in the study, divided into 30 patients in each group of Silodosin and tamsulosin respectively. In Group I (silodosin), out of 30 patients, 25 patients expelled the calculus, whereas in Group II (tamsulosin), out of 30 patients, 15 patients expelled the calculus. Group I showed a significantly higher rate of expulsion, with a p-value of 0.005. Stone expulsion time was notably shorter in Group I compared to Group II, with averages of 4.73 days versus 6.33 days (p=0.009). Additionally, analgesic use during the medical expulsive therapy was lower in Group I, averaging 8.25 compared to 4.13 (p=0.0001) in the tamsulosin group. Significant differences were observed in the outcomes such as stone expulsion time, and analgesic requirement. However, no significant differences were found when comparing the groups based on age, gender, stone size, and side of the ureter involved. The 20 patients who failed the medical management underwent ureterorenoscopy with 100% clearance. 3 patients in Group II experienced orthostatic hypotension, and zero patients experienced any side effects in Group I. Compared to tamsulosin, silodosin provides significantly higher stone expulsion rates, fewer colic episodes, and shorter stone expulsion duration than tamsulosin.

Applying Bulldog Clamps to Prevent Stone Migration in Laparoscopic Upper Ureteral Stone Surgery

Background: Urolithiasis can be managed by endoscopic, laparoscopic, percutaneous, or open approaches. We introduce an effective and safe method for stone migration during laparoscopic ureterolithotomy. Description of Technique: We used laparoscopic intraperitoneal approach, with three ports. Stone is localized and the ureter occluded proximally and distally to the stone using bulldog clamps to minimize the risk of stone migration. Patients and Methods: Case 1 had a 15 mm left upper ureteral stone — refractory to ESWL. Case 2 had a 17mm right upper ureteral stone without previous stone procedure. Case 3 had a history of failed ESWL for a 17mm left upper ureteral stone. Results: Mean operation time was 55 minutes, mean hospital stay was two days, and SFR was 100%. No complications occurred during this minimally invasive surgery, either intra-operatively or post-operatively. Conclusion: This is a safe and effective maneuver, increasing the stone-free rate of the procedure, which facilitates stone surgery by releasing the surgeon’s hands and preventing stone migration.

Predictive value of NCCT quantitative analysis for proximal and middle impacted ureteral stones.

The purpose of the study was to explore the predictive value of preoperative quantitative NCCT analysis for proximal and middle ureteral stone impaction. Data of 128 patients who diagnosed with proximal and middle ureteral stones were analyzed. Stone size, upper diameter of the ureter(D1), lower diameter of the ureter (D2), CT attenuation of the ureter above the stone (HA, 'HU above'), CT attenuation of the ureter below the stone (HB, 'HU below'), CT attenuation values of the stone's proximal segments (C1), CT attenuation values of the stone's distal segments (C2), and ureteral wall thickness(UWT)were recorded. Logistic regression was used to perform univariate and multivariate analyses of the data to determine the independent predictors of proximal and middle ureteral stone impaction. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance. Among the 128 patients, 52 (40.6%) had impacted stones, while 76 (59.4%) did not. Multivariate logistic regression analysis showed that stone size > 9.45mm (OR = 1.372, 95% CI = 1.071-1.756, P = 0.012), UWT > 3.22mm (OR = 4.217, 95% CI = 2.165 ~ 8.213, P < 0.001)、DDR > 2.10 (OR = 4.901, 95% CI = 1.797 ~ 13.365, P = 0.002)and HBA > 1.58 (OR = 5.237,95% CI = 1.502 ~ 18.259, P = 0.009)were independent risk factors for predicting ureteral stone impaction. In conclusion, stone size, UWT, DDR, and HBA show crucial predictive value for impaction of stones.

Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature.

To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies. A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: 'costs of different procedures: SWL, URS, PCNL', 'costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices', 'costs of KSD treatment in the emergency setting: emergency stenting versus primary URS'. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS. Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays' practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.

Follow-Up Survey for Conservatively Managed Ureteric Stones.

Introduction Currently, there are no agreed-upon investigations and follow-up guidelines for the conservative management of ureteric stones. This study used common themes identified in previous works to investigate whether there is a consensus amongst urology consultants in the United Kingdom. Methods This was a questionnaire-based survey study. An online questionnaire was disseminated nationally to urological consultants practicing in the United Kingdom to explore a range of common factors. The initial sample size was 81 UK-based urological consultants with an interest in endourology and stone surgery. Of the initial 81, 20 participants did not complete the survey and therefore the final sample size was 61. Descriptive analysis was used to analyze the data. Results Our survey found that the main factors influencing the follow-up of conservatively managed ureteric stones were stone size 98% (60), stone location 92% (56), and the degree of altered renal function 79% (48). Regardless of stone size, most participants chose to follow up at 2-4 weeks with asymptomatic patients requiring imaging with discrepancies about the modality. Regarding biochemical markers, most participants only repeated renal function tests if this was deranged on presentation. Calcium and uric acid levels were checked regularly. Diclofenac was the analgesia of choice 93% (55). Regarding the availability of acute ESWL services, over half (59%) were able to offer acute ESWL within the week. The majority offer services at least three or more lists per week. Conclusion Our results demonstrate that there is still no overarching consensus in the follow-up of conservatively managed ureteric stones.Several factors backed by high-level evidence are already consistent across the population of urology consultants and considered "best practice." However, before any all-encompassing national guidelines are formalized, further studies in the form of randomized control trials will be needed to yield high-level evidence.

Applying urinary ultrasound to predict the risk of spontaneous ureteral stone passage: a retrospective cohort study

BackgroundTo assess the value of urological ultrasound in predicting the risk of spontaneous passage of ureteral stones.MethodsClinical and ultrasound data were collected consecutively from patients receiving conservative treatment for ureteral stones, and the outcome of spontaneous passage was followed up for 1 month. Ultrasound variables independently associated with the risk of spontaneous stone passage were screened. A logistic regression prediction model was constructed based on the independent risk factors, and the discriminative efficacy and clinical utility of the prediction model in inferring the risk of spontaneous passing were assessed by the receiver operating characteristic (ROC) curve, calibration curve and clinical decision curve.ResultsA total of 163 patients undergoing conservative treatment for ureteral stones were included in the study, with a mean age of 45.95 ± 13.01 years. Among them, 47 cases (28.83%) experienced failure of spontaneous stone passage. Multivariable analysis revealed that stone length (OR: 2.622, P = 0.027), distal stone location (OR: 0.219, P = 0.003), and ureteral jetting frequency (OR: 6.541, P < 0.001) were independent risk factors for spontaneous stone passage. A prediction model incorporating stone length, stone location, and affected ureteral jetting frequency was developed to assess the risk of spontaneous stone passage. The area under the ROC curve was 0.814 (95% CI: 0.747–0.882), indicating good discriminatory power. The prediction model also demonstrated favorable net clinical benefit.ConclusionA prediction model based on ultrasound-derived stone length, location, and ureteral jetting frequency can accurately evaluate the risk of spontaneous stone passage in patients with ureteral stones, providing a basis for optimizing the clinical decision-making on ureteral stones, and has reliable clinical application value.