Ureteral Calculi Research Articles

Evaluation of continuous blood purification in patients with urosepsis caused by ureteral calculi and heart failure after catheterization.

To detect the continuous blood purification (CBP)'s application value in patients with urosepsis caused by ureteral calculi and heart failure after catheterization. This is a clinical comparative study. Sixty patients with ureteral calculi complicated with heart failure and urosepsis were admitted at Affiliated Hospital of Hebei University from January 2021 to March 2023 randomly split into control and experimental group(n=30). Based on conventional treatment after indwelling the DJ tube, the experimental group was treated with CBP therapy. The control group dealt with conventional anti-inflammatory, oxygen inhalation and other treatments only. Compared and analyzed in terms of alterations in blood inflammatory factors, cardiac function, BNP prior to and after therapy, blood pressure, blood WBC recovery time, and so on. TNF-a, CRP, and PCT levels in the control and experimental groups were substantially more prominent than the average reference value prior to treatment. They decreased considerably at distinct time points after therapy, with substantial distinctions (p< 0.05). A more meaningful decrease was noticed in the experimental group in comparison with the control group (p< 0.05). BNP and cardiac function were improved in both groups prior to and after therapy, and the amelioration of indexes in the experimental group was more substantial than that in the control group after therapy, with statistically considerable distinctions. The improvement time in experimental group was earlier than in the control group, with statistically substantial differences. Patients with urosepsis complicated with heart failure after indwelling DJ tube have their inflammatory factors improved significantly, with more thorough excretion by using conventional treatment combined with CBP therapy.

Trifecta in flexible ureteroscopy for treatment of renal and upper ureteral calculi: A multicenter study

ABSTRACT Purpose To determine predictors for missing trifecta in patients who underwent flexible ureteroscopy (FURS) for treatment of renal and upper ureteric calculi. Patients and Methods The data of adult patients with renal or upper ureteral stones who underwent FURS from June 2021 through December 2022 were retrospectively reviewed. Stone-free status (no residual stones > 3 mm) was evaluated after 3 months with non-contrast CT. Modified Clavien classification was used to grade complications. A stone-free status after a single intervention of FURS without complications was defined as trifecta. Patients were divided into two groups (trifecta and non-trifecta). Risk factors for missing trifecta were compared between both groups using univariate and multivariate analyses. Results Three hundred twenty-three patients with mean age 48.9 ± 13 years and mean stone length 16 ± 5.9 mm were included. The trifecta criteria were applicable for 250 patients (71%). On multivariate analysis, risk factors for missing trifecta were stone multiplicity (OR: 3.326, 95%CI: 1.933–5.725) and non-experienced surgeons (OR: 1.819, 95%CI: 1.027–3.220). Conclusions Multiple stones and performance of FURS by non-experienced surgeons are the independent risk factors for missing trifecta of FURS.

Composition analysis of renal and ureteral calculi in a single center in northern China in the past decade.

The current report aimed to evaluate the characteristics of stone composition in 3637 renal and ureteral calculi patients in a single center while clarifying its relationship with sex, age, and time. Out of 3637 cases of upper urinary tract stones, stone specimens were analyzed retrospectively. There were 2373 male patients aged 6 months-87 years, with an average age of 44.73 ± 15.63 years, and 1264 female patients aged 4 months-87 years, with an average age of 46.84 ± 16.00 years. The male-female ratio was 1.88:1. Five hundred twelve patients had ureteral calculi, and 3125 had renal calculi. The SPSS software helped analyze the relationship between renal and ureteral calculi composition and sex, age, and time. Stone composition demonstrated 2205 cases of calcium oxalate stones (60.6%), 518 carbonate apatite (14.2%), 386 uric acids (10.6%), 232 magnesium ammonium phosphate (6.4%), 117 calcium phosphate (3.2%), 76 cystine (2.1%), 47 sodium urate (1.3%), 31 others (0.9%), and 25 ammonium urate (0.7%) cases. The overall male-to-female sex ratio was 1.88:1. Stones in the upper urinary tract were significantly more frequent in men than in women between the ages of 31 and 60. However, such stones were significantly more frequent in women than men over 80 (P < .05). Cystine, Sodium urate, Carbonated apatite, and uric acid indicated significant differences between different age categories (all P < .001). Stone composition analyses revealed that the frequency of calcium oxalate calculi has increased annually, while cystine and carbonated apatite incidences have dropped annually over the past decade. The components of renal and ureteral calculi vary significantly based on age and sex, with calcium oxalate calculi being more frequent in men while magnesium ammonium phosphate stones are more frequent in female patients. The age between 31 and 60 years is the most prevalent for renal and ureteral calculi in men and women.

Predictors for emergency readmission in patients with ureteral calculi: a focus on pain management and stone location.

The management of patients with ureteral calculi in the emergency department (ED) remains challenging due to high revisit rates. To identify predictors of revisits among patients with ureteral calculi in the ED. Data from patients who presented at a tertiary academic hospital in Seoul, Republic of Korea, between February 2018 and December 2019, were analyzed retrospectively. Variables, including the respiratory rate (RR), estimated glomerular filtration rate (eGFR), duration of pain, number of analgesic doses, location of ureteral calculi, and ED length of stay (LOS) were examined using logistic regression. We also examined some additional variables included in the STONE and CHOKAI scoring systems to examine their association with revisit. Significant predictors of revisits included the number of analgesic doses and the location of ureteral calculi. Patients who required multiple analgesic doses or those with proximal or mid-ureteral calculi were more likely to revisit the ED. Although the STONE and CHOKAI scores could predict uncomplicated ureteral calculi, we found that the CHOKAI score is a valuable tool for predicting the likelihood of patient revisits (p = 0.021). Effective pain management and consideration of calculi location are important for predicting patient revisits. More research is required to validate findings, develop precise predictive models, and empower tailored care for high-risk patients. In patients with ureteral calculi in the ED, the number of analgesics given and stone location predict return visits. Proximal ureteral calculi on CT may require early urologic intervention to prevent pain-related revisits.

Diagnostic accuracy of transabdominal ultrasonography in Urolithiasis, keeping CT KUB as Gold standard

Background: Every year, around half a million people visit hospitals for flank pain. According to studies, 1 out of 10 individuals have a risk of forming renal stones in their lifetime Objective: To find diagnostic accuracy of transabdominal ultrasound in urolithiasis, keeping CT KUB gold standard. Methodology: A cross-sectional analytical study was performed at University of Lahore teaching hospital, Lahore duration of 4 months. 114 patients included in study with flank pain, Ultrasonography was conducted on all patients with full urine bladders using the Transabdominal technique with comparison comprehensive KUB image of non-enhanced CT (Toshiba 64) was conducted from the abdomen to the pelvis. Results: Age of the study participants ranged between 12 to 85 years with mean age 39.3 + 16.4 years. Out of 114 participants 53 (46.5%) were females and 61 (53.5%) were males. On CT KUB, total 94 (82.5%) participants were positive for urolithiasis and 20 (17.5%) were negative. On ultrasound, 68 (59.6%) participants were found positive for urolithiasis and 46 (40.4%) were found negative. The sensitivity of ultrasound was 71.28%, specificity was 95%, PPV was 98.5%, NPV was 41.3% and diagnostic accuracy was found to be 75.4%. Conclusion: In our study, ultrasound showed a good diagnostic sensitivity of 71.2% for diagnosing urolithiasis. Preliminary diagnosis can be made through ultrasound, as it is safe and widely available modality. Key words: Non-enhanced Computed Tomography, Ultrasound, Ureteric Calculi, Radiation, Computed Tomography

Ureteral stricture formation after endoscopic removal of obstructing stones: could it be predicted with well-assessed radiological parameters?

The possible role of well-assessed radiological parameters in the prediction of ureteral stricture formation in cases with impacted obstructive ureteral calculi has been evaluated. 46 adult patients with or without ureteral stricture formation after ureteroscopic stone management were included. In addition to stone size and some certain radiological parameters including ureteral wall thickness (UWT) of the involved ureter at the impacted stone site was also measured and noted on computed tomography (CT) images. Parameters were evaluated in two subgroups of cases, namely: Group 1: patients in whom a ureteral stricture formed after endoscopic stone removal and Group 2: patients normal ureteral anatomy without any stricture formation. The possible relationship between the UWT values and degree of hydronephrosis (HN) with subsequent stricture formation was comparatively evaluated. All of the stones were proximal ureteral calculi in both groups. Both the degree of HN and proximal ureteral diameter (PUD) parenchymal was higher in cases with stricture formation. In addition, mean parenchymal thickness was lower and mean values of UWT measurements at the stone site were 3.70 ± 0.97mm and 2.17 ± 0.26mm in Groups 1 and 2, respectively. A cutoff value 2.49mm for UWT was found to be highly predictive for stricture formation. UWT value calculated at the obstructing stone site was found to be predictive enough for the likelihood of ureteral stricture formation with high sensitivity and specificity . This evaluation along with some other radiological parameters may enable the urologists to follow such cases on this aspect with necessary measures taken.

Safety and Efficacy of Bilateral Tubeless Supine Mini-Percutaneous Nephrolithotomy for the Management of Bilateral Renal Calculi in Renal Failure Patients

Background: To evaluate the safety, efficacy, feasibility, stone-free rate, and complications of bilateral tubeless supine mini-percutaneous nephrolithotomy (M-PCNL) for bilateral multiple renal calculi with renal failure as a single-stage procedure. Materials and Methods: We conducted aretrospective study from January 2020 to March 2022 in adult patients with bilateral renal or proximal ureteric calculi with renal failure who were subjected to bilateral supine tubeless M-PCNL. Patients on regular hemodialysis before the procedure were excluded. Data regarding the demographic profile, stone characteristics on non-contrast computed tomography (NCCT), duration of surgery, complications, and auxiliary procedures were retrieved from clinical records. Residual stone fragments of≤4mm in NCCT were considered clinically insignificant. The Clinical Research Office of the Endourological Society validation ofClavien score for PCNL complications was used. Results: A total of twenty-seven patients with a mean age of 45.9years were included in this study. The mean size of stone diameter per renal unit was 2.4 ± 0.4 cm. The mean preoperative serum creatinine was 2.8 mg/dL. A total of 62 tracts and 27 sessions were required for complete treatment of all 54 renal units in the 27 successfully treated patients. The average operating time was 75 (52–122) min on both sides. Serum creatinine drop at onemonth postsurgery was statistically significant (p &lt; 0.0001). Mean hospitalization time was 3.6 days [3–6 days]. The primary stone-free rate was 92.5%. Grade I, II, and IVA complications were recorded in three (11.1%), eight (29.6%), and two (7.4%) patients, respectively. Conclusion: Bilateral tubeless supine M-PCNL for bilateral renal calculi in selective patients with renal failure in a single session is a safe, feasible, and effective option which can be carried out without increased morbidity and can be attempted if the first-side M-PCNL has gone smoothly within a reasonable amount of time.

Statement of Retraction: Co (II)-coordination polymer: treatment and testing values on calculus of ureter by inhibiting the growth of urinary tract pathogens

Statement of Retraction: Co (II)-coordination polymer: treatment and testing values on calculus of ureter by inhibiting the growth of urinary tract pathogens

Retracted: Effects of Stone Removal via Different Approaches in the Treatment of Incarcerated Upper Ureteral Calculi: A Comparative Study.

[This retracts the article DOI: 10.1155/2022/7651215.].

Risk assessment and prevention of urolithiasis in urban areas of Baoding, China.

Urolithiasis, or the formation of calculi in the urinary system, represents a prevalent urological condition frequently encountered among individuals aged 30 to 55 years. An in-depth analysis of the composition of these calculi holds significant promise in shedding light on the underlying etiological and pathogenic factors contributing to this ailment. The primary objective of this study was to delineate the principal components comprising urinary system calculi within a cohort of patients who sought medical intervention at a tertiary grade A hospital located in Baoding City. Furthermore, our investigation entailed a comprehensive examination of the physical and morphological characteristics exhibited by these calculi. In this study, a total of 2307 individuals afflicted with urinary system calculi were recruited as participants, and a corresponding number of 2307 calculous specimens were subjected to thorough examination. The specimens were examined using infrared spectroscopy. We collected and examined patient data including gender, age, location of the calculi, employment status, residential area, and other factors. The middle-aged demographic exhibited a conspicuous predilection for urinary system calculi, wherein a notable gender disparity was observed, with a male-to-female ratio of 1.63 to 1. Among the enrolled patients, kidney calculi were prevalent in 1270 cases, ureteral calculi were documented in 983 cases, and bladder calculi were encountered in 46 instances. Notably, the principal components comprising these calculi were identified as calcium oxalate and apatite, while uric acid and ammonium magnesium phosphate were comparatively less frequently encountered. Furthermore, the analysis of calculus composition across patients residing in distinct geographical regions did not reveal any statistically significant variations. The identification of components within upper urinary tract calculi plays a pivotal role in elucidating the root causes of calculus formation. This valuable information empowers healthcare professionals, particularly nursing staff, to provide personalized dietary and health guidance to patients, thereby enhancing the quality of care and promoting more effective management of this condition.

Application of novel burst wave lithotripsy and ultrasonic propulsion technology for the treatment of ureteral calculi in a bottlenose dolphin (Tursiops truncatus) and renal calculi in a harbor seal (Phoca vitulina)

Marine mammals may develop kidney stones, which can be challenging to treat. We describe burst wave lithotripsy (BWL) and ultrasonic propulsion to treat ureteral calculi in a 48-year-old female bottlenose dolphin (Tursiops truncatus) and to reduce renal stone burden in a 23-year-old male harbor seal (Phoca vitulina). BWL and ultrasonic propulsion were delivered transcutaneously in sinusoidal ultrasound bursts to fragment and reposition stones. Targeting and monitoring were performed with real-time imaging integrated within the BWL system. Four dolphin stones were obtained and fragmented ex vivo. The dolphin case received a 10-min and a 20-min BWL treatment conducted approximately 24 h apart to treat two 8–10 mm partially obstructing right mid-ureteral stones, using oral sedation alone. For the harbor seal, while under general anesthesia, retrograde ureteroscopy attempts were unsuccessful because of ureteral tortuosity, and a 30-min BWL treatment was targeted on one 10-mm right kidney stone cluster. All 4 stones fragmented completely to < 2-mm fragments in < 20 min ex vivo. In the dolphin case, the ureteral stones appeared to fragment, spread apart, and move with ultrasonic propulsion. On post-treatment day 1, the ureteral calculi fragments shifted caudally reaching the ureteral orifice on day 9. On day 10, the calculi fragments passed, and the hydroureter resolved. In the harbor seal, the stone cluster was observed to fragment and was not visible on the post-operative computed tomography scan. The seal had gross hematuria and a day of behavior indicating stone passage but overall, an uneventful recovery. BWL and ultrasonic propulsion successfully relieved ureteral stone obstruction in a geriatric dolphin and reduced renal stone burden in a geriatric harbor seal.

Retrospective Analysis of Risk Factors for Urinary Tract Infection after Ureteral Calculi Surgery.

Ureteral calculi are a common diagnosis in the field of urology worldwide, and they represent a prevalent subtype of urolithiasis. Ureteroscopic stone surgery is the cornerstone treatment, but postoperative urinary tract infection (UTI) remains a clinical concern. Our study aims to analyse specific risk factors associated with postoperative UTIs following ureteroscopic stone surgery. We conducted a case-control study and collected clinical data from 145 patients who underwent ureteroscopic lithotripsy at our hospital from January 2021 to January 2023. Binary logistic regression analysis was used to investigate risk factors for postoperative UTI. Receiver operating characteristic curves were plotted, and area under the curve (AUC) was calculated to evaluate the predictive value of each factor. Forty patients developed UTI after ureteroscopic stone surgery. Compared with the control group, the case group showed significant differences in stone size, history of diabetes mellitus and preoperative urine culture results (p < 0.05). Multivariable binary logistic regression analysis revealed that stone size (Odds Ratio (OR) = 1.952, p = 0.010), history of diabetes mellitus (OR = 2.438, p = 0.038) and preoperative urine culture (OR = 2.914, p = 0.009) were independent risk factors for postoperative UTI. The AUC values of stone size, history of diabetes mellitus and preoperative urine culture were 0.680, 0.627 and 0.630, respectively. The AUC of the combined prediction was 0.756. This study identified risk factors for postoperative UTI following ureteroscopic stone surgery and emphasised the importance of stone size, history of diabetes mellitus and preoperative urine culture in the diagnosis.

Comparison of the effects of different lithotripsy protocols under ureteroscope on ureteral calculi and their effects on stress status and renal function of patients

Comparison of the effects of different lithotripsy protocols under ureteroscope on ureteral calculi and their effects on stress status and renal function of patients

Increased Lymphatic Vessels: A Risk Factor for Severe Renal Function Loss in Obstructive Nephropathy Patients.

Background: Obstructive nephropathy (ON), resulting from hindered urine flow, significantly contributes to both acute kidney injury (AKI) and chronic kidney disease (CKD). Research has consistently highlighted increased lymphatic vessels (LVs) density in diverse kidney diseases. However, the precise involvement of LVs in ON remains unclear. Methods: Patients diagnosed with ON were enrolled in this study from January 2020 to December 2023. LVs and histological pathology in renal biopsy tissues were detected through immunohistochemistry and Periodic Acid-Schiff staining. Patients were categorized into two cohorts based on their estimated glomerular filtration rate (eGFR) levels: one cohort included patients with eGFR < 90, while the other encompassed those with eGFR ≥ 90. Univariate and multivariable logistic regression analyses were conducted to determine the odds ratio (OR) and 95% confidence interval (CI) for the association between the two cohorts. Results: 239 patients were enrolled in the study. The density of LVs was elevated in ON, with even higher densities observed in patients with severe renal impairment. Additionally, several risk factors contributing to the deterioration of renal function in ON patients have been identified, including age, ureteral calculi (UC), alanine aminotransferase (ALT), and uric acid (UA). Furthermore, by leveraging LVs density, multiple robust models have been established to predict severe renal impairment in ON. Conclusions: Lymphatic vessels density is significantly elevated in ON, serving as an independent risk factor for the decline in renal function.

Indications for Intervention in Patients Undergoing Ureteroscopic Therapy for Ureteric Calculus: A Cross-sectional Study

Introduction: Urolithiasis is one of the most common urological problems worldwide. The fastest treatment modality to achieve stone clearance of ureteral stones is Ureteroscopic Lithotripsy (URSL). However, it is negated by both the cost burden and potential risk to the patient. Medical Expulsive Therapy (MET) is a treatment option for upto 10 mm stones but has failure rates of 40-60% in the literature. Aim: To analyse the various indications for surgery, whether MET was used or not, if used-its details, operative findings at ureteroscopy including the reason for the failure of MET. Materials and Methods: A cross-sectional study consisting of 72 patients with ureteric calculi undergoing URSL was analysed from June 2017 to December 2018 at Mazumdar Shaw Medical Centre, Bangalore , Karnataka, India. Indications were assessed at the time of admission. During ureteroscopy, factors like impaction, distal obstruction, and unusual findings were studied, which could have contributed to the failure of MET. The Chi-square test was used as a test of significance for categorical data. The Analysis of Variance (ANOVA) test was used as a test of significance to identify the mean difference between continuous variables. The p-value of &lt;0.05 was considered statistically significant. Results: The mean age in the study was 41.65±13.4 years (range 20-69 years), and the mean stone size was 10.03±3.34 mm. Large stone was the most common indication (41, 56.9%, p=0.004), followed by failed MET (35, 48.6%). Even though MET could have been continued for four weeks in 17 patients (23.6%), they were taken up for surgery. The impaction rate was 70.8% (51), with 48.6% (35) being large impacted stones and 22.2% (16) being small impacted stones. The overall stone clearance rate was 68 out of 72 (94.4%). Conclusion: Large stone size (≥10 mm) and failed MET were the main indications for surgery. One reason for the failure of MET was not waiting for a duration of four weeks. During ureteroscopy, impaction of the stone, irrespective of size, was the most common finding and was the reason for the failure of MET. Ureteric stones on MET should not be neglected as there are reasons for the failure of MET, and they will require URSL after four weeks

Comparing silodosin and mirabegron as medical expulsive therapy for distal ureteral calculus: a prospective, randomised study.

In this study we aimed to compare the efficacy of mirabegron and silodosin as medical expulsive therapy (MET) for distal ureteric calculus ≤10 mm. A total of 114 patients who met the inclusion criteria were prospectively randomised into 2 groups, 58 patients in the silodosin group and 56 patients in the mirabegron group. The drugs were given for a maximum of 4 weeks. The primary endpoint was the stone expulsion rate, and secondary endpoints were stone expulsion time and number of pain episodes. There were no statistically significant differences between the two groups in terms of mean age, gender, mean stone size, side, or hydronephrosis. Both groups exhibited similar rates of stone expulsion and expulsion time. Regarding pain management, the frequency of renal colic episodes was significantly lower with mirabegron compared to silodosin (2.3 ±0.2 vs 1.9 ±0.2, P <0.0001). Six patients were excluded from the study due to adverse drug reactions: 4 (6.15%) in the silodosin group (retrograde ejaculation, hypotension) and 2 (3.27%) in the mirabegron group (hypertension). In among patients with distal ureteric stones measuring 5-10 mm, mirabegron did not demonstrate superiority in stone expulsion rate or expulsion time compared to silodosin. However, mirabegron significantly reduced the frequency of renal colic episodes. Therefore, mirabegron may be considered a preferable option for medical expulsive therapy for distal ureter stones over silodosin.

Sonographic determination of the association between grades of hydronephrosis and detection of kidney and ureteric calculi.

Objective: To correlate the grades of hydronephrosis and the detection of urinary stones by ultrasound imaging. Study Design: Cross-sectional, Retrospective study. Setting: Watim General Hospital, Rawat. Period: Jan 1, 2023 and Mar 31, 2023. Material &amp; Methods: All patients on whom a renal sonogram showed hydronephrosis and nephrolithiasis between Jan-Mar 2023 &gt; 18 years of age and &lt; 70 years of age were included. The data were obtained retrospectively from the ultrasound department records. All patients were scanned while lying flat on their backs. Data regarding hydronephrosis grades and the presence of nephrolithiasis was obtained. Results: There were 248 individuals with hydronephrosis due to nephrolithiasis whose ultrasounds were included in this investigation. All patients had urinary stones and as hydronephrosis progressed from grade 1 to 3, the detection rate of stones increased, before declining in grade 4. Patients with grade 3 hydronephrosis had four times the risk of having urinary stones as grade 4 patients (Odds Ratio = 5.675, 95% Confidence Interval [Cl]=3.345-4.648). Conclusion: The sensitivity of sonography to identify grades of hydronephrosis and identify their underlying causes is of diagnostic importance. Hydronephrosis is often brought on by kidney stones or ureteric calculi, and a higher grade should raise clinical suspicion for the presence of renal calculi.

Giant Pyonephrosis Due to Calculus of Ureter: A Case Report

Giant pyonephrosis (GP) is a rare and severe form of pyonephrosis characterized by a massive enlargement of the affected kidney due to the accumulation of infected fluid. This study presents case of a 51-year-old male patient with giant pyonephrosis who underwent nephrectomy as treatment. The clinical manifestations of giant pyonephrosis are nonspecific, necessitating the use of imaging and laboratory techniques to aid in diagnosis. Nephrectomy is the preferred treatment option for these patients. One week after nephrectomy, the laboratory results showed improvements. Making the right treatment decision is challenging in this particular case.

The influence of perioperative nursing intervention in patients with ureteral calculi treated with URSL and its correlation to adverse event incidence: A retrospective study

To evaluate the effectiveness of perioperative nursing intervention in patients undergoing ureteroscopic lithotripsy (URSL) for ureteral stones and its implications for the incidence of adverse events, a total of 144 patients with ureteral stones admitted to our hospital from January 2021 to December 2022 were selected for retrospective analysis. They were divided into 2 groups based on their different nursing methods, with 72 patients in each group. The control group (CG) received routine nursing intervention, while the study group (SD) received refined perioperative nursing intervention. The surgical situation, effective stone removal rate, postoperative pain, inflammatory factors, stress response, and incidence of adverse events were compared between the 2 groups. In comparison with the CG, the SD demonstrated a significant reduction in gastrointestinal recovery time, urinary catheter removal time, and hospitalization duration, all presenting statistically significant disparities (P &lt; .05). Notably, the SD exhibited a one-time stone removal rate significantly superior to that of the CG (P &lt; .05). Similarly, the postoperative pain index was significantly lower in the SD (P &lt; .05). Pre- and post-surgical serotonin (5-HT) levels in the SD were markedly lower than in the CG (P &lt; .05). Postoperative levels of Interleukin-10 (IL-10), C-reactive protein (CRP), and white blood cells (WBC) were elevated in both groups, and gradually declined as the patients recovered. However, postoperative levels of IL-10, CRP, and WBC were significantly lower in the SD (P &lt; .05). The SD also showed significantly lower levels of malondialdehyde and higher levels of superoxide dismutase (P &lt; .05). Postoperative levels of cortisol, adrenocorticotropic hormone, and norepinephrine were elevated and progressively returned to normal over time, and were significantly lower in the study group (P &lt; .05). Furthermore, the SD experienced a significant reduction in adverse event incidence compared with the CG (P &lt; .05). Implementing refined perioperative nursing interventions for patients undergoing URSL can effectively decrease the incidence of adverse events, diminish the surgical stimulation of inflammation markers and oxidative stress indicators, and foster patient recovery.

Assessment of Computed Tomography and Ultrasonography in Detection of Ureteric Calculi

Background: Urolithiasis, a common urological condition, presents diagnostic challenges. While CT scans are considered the gold standard for detecting ureteric calculi, the role of ultrasonography is also significant, especially in varied clinical scenarios. Objective: This study aims to assess the diagnostic accuracy of ultrasonography compared to CT scans in the detection of ureteric calculi. Methods: An observational study was conducted on 200 patients at the Combined Military Hospital, Peshawar. Participants included males and females aged 18-60 years, presenting with acute renal pain. Exclusion criteria included individuals without informed consent, multiple comorbidities, a history of kidney donations, or a family history of renal calculi. Ultrasonography was performed using an Ecoste Mylab 7 color Doppler machine with 3.5, 5, and 7.5 MHz probes. CT scans were conducted using the Siemens CT Somatom Sensation 64, without the administration of any contrast medium. Data were analyzed using SPSS version 26.0. Results: Ultrasonography detected ureteric calculi in 33% of patients (66 calculi), while CT scans detected 60% (118 calculi). The breakdown of calculi location for ultrasonography included 20 renal, 15 pelvic ureteric junction, 12 upper ureter, 8 lower ureter, 7 vesicoureteric junction obstruction, and 4 bladder. CT scan results showed 45 renal, 25 pelvic ureteric junction, 20 upper ureter, 11 lower ureter, 9 vesicoureteric junction obstruction, and 8 bladder calculi. The gender distribution in the study was 55% male and 45% female, with the mean age being 35 ± 16.79 years for males and 36 ± 17.24 years for females. The most common presenting complaints were flank pain (36%), lower back pain (25%), and burning micturition (15%). Conclusion: CT scans exhibit higher diagnostic accuracy for ureteric calculi compared to ultrasonography, thus reaffirming their role as the gold standard in this context. However, the radiation risks and economic implications of CT scanning necessitate a balanced approach to its use, emphasizing the importance of comprehensive patient evaluation and physician awareness of radiation risks.