Ureteral Calculi Research Articles

Pelvicalyceal system rupture due to obstruction by lower ureteric calculus

Abstract The most common cause of spontaneous non traumatic pelvicalyceal system rupture is distal obstruction by a ureteric calculus and should be included in the differential diagnosis of patients with acute flank pain and perinephric fluid on ultrasound and Contrast enhanced CT scan with delayed images should be done to confirm the diagnosis. We present a case of spontaneous non traumatic pelvicalyceal system rupture due to a tiny ureteric calculus managed with primary ureteroscopic lithotripsy.

PGE2 binding to EP2 promotes ureteral stone expulsion by relaxing ureter via the cAMP-PKA pathway

BackgroundThis study investigated the relaxation effect of PGE2 on the ureter and its role in promoting calculi expulsion following calculi development.MethodsBy using immunofluorescence and Western blot, we were able to locate EP receptors in the ureter. In vitro experiments assessed the impact of PGE2, receptor antagonists, and agonists on ureteral relaxation rate. We constructed a model of ureteral calculi with flowable resin and collected ureteral tissue from postoperative side of the ureter after obstruction surgery. Western blot analysis was used to determine the protein expression levels of EP receptors and the PGE2 terminal synthase mPGES-1. Additionally, PGE2 was added to smooth muscle cells to observe downstream cAMP and PKA changes.ResultsThe expression of EP2 and EP4 proteins in ureteral smooth muscle was verified by Western blot analysis. According to immunofluorescence, EP2 was primarily found on the cell membrane, while EP4 was found in the nucleus. In vitro, PGE2 induced concentration-dependent ureteral relaxation. Maximum diastolic rate was 70.94 ± 4.57% at a concentration of 30µM. EP2 antagonists hindered this effect, while EP4 antagonists did not. Obstructed ureters exhibited elevated mPGES-1 and EP2 protein expression (P < 0.01). Smooth muscle cells treated with PGE2 displayed increased cAMP and phosphorylated PKA.ConclusionsPGE2 binding to EP2 induces ureteral relaxation through the cAMP-PKA pathway. This will provide a new theoretical basis for the development of new therapeutic approaches for the use of PGE2 in the treatment of ureteral stones.

Clinical Advances and Current Status in the Treatment of Ureteral Calculi.

Ureteral calculi are a common urological disease with a consistently high incidence and an increasing trend each year. Ureteral calculi treatment is an essential and hot topic in the urology field and holds a vital status in the urological work system. Recently, with rapid advances in urology, there have been continuous updates and developments in treatment modalities, and many new methods and techniques have emerged and are being applied in clinical settings; This has effectively improved the clinical treatment outcomes of individuals with ureteral calculi. However, each treatment modality has its specific indications, and owing to the uneven distribution of medical resources and the effect of the patients' conditions and nature of the stones, standardization and randomness in selecting the treatment regimens for ureteral calculi are lacking. Therefore, selecting the diagnostic and therapeutic plan is vital for improving treatment efficacy. In this review, we summarize the findings of recent domestic and international studies to provide an outline of the progress and current status of ureteral calculi treatment from aspects such as pharmacotherapy, surgery, and minimally invasive treatment to provide a basis for treating this disease in clinical settings.

Comparative Study of Minimally Invasive Treatment of Ureteral Calculi in People’s Armed Police Officers and Soldiers

Comparative Study of Minimally Invasive Treatment of Ureteral Calculi in People’s Armed Police Officers and Soldiers

#3089 Radiological assessment of suspected acute pyelonephritis in the management of urosepsis and prevention of acute kidney injury

Abstract Background and Aims Sepsis, a serious complication of infection, may result in organ dysfunction and is responsible for almost 20% of global deaths. Identification of acute pyelonephritis (pyelo), requires early clinical assessment, diagnostics and antimicrobial therapy to prevent septic shock and potential death. In 2022, the American College of Radiology (ACR) published a revised appropriateness criteria for radiological imaging in suspected acute pyelo (1). Five variant [V] categories were defined according to presence of pregnancy, stone disease, renal transplantation, complicated (i.e. recurrent pyelo, DM, immunosuppression) and uncomplicated (first) presentation. The aim of this project was to establish the proportion of patients with suspected acute pyelonephritis undergoing radiological assessment, the selected modality and radiological findings, which could contribute to the diagnosis and management. Method This observational retrospective study of 55 cases with suspected acute pyelo over 6 months. Patients who were decanted to nephrology specialist care from the acute medical take were assessed. Patients were grouped into 5 categories [Variant 1-5] as per appropriateness criteria of the ACR (Table 1a). Patient demographics, renal function and signs of sepsis were recorded. The proportion undergoing radiological assessment, the modality and outcomes are outlined in Table 1. Results Demographically, 66% of patients were female, the median age was 49 years [IQR 30] and 93.6% were Caucasian. Pre-admission baseline Creatinine (Cr) was 75 µmol/l [IQR 75]. Admission Cr was 85 µmol/l [IQR 74}, with peak inpatient Cr 94 µmol/l. Sepsis parameters (hypotensive/ tachycardia/ high CRP) on admission were observed in 38% of patients. Modality Choice 92.7% of study participants received imaging over the course of their inpatient stay. The primary modality of choice was CTKUB (36.4%), with 25.5% of patients receiving targeted ultrasound. In the setting of uncomplicated acute pyelo (V1), CTKUB was the most common diagnostic modality. Patients with a history of renal calculi (V3) were imaged equally with CTKUB and targeted ultrasound (42.9% CTKUB vs. 42.9% USS). Patients with a history of renal transplant with a native kidney in-situ were most commonly investigated with targeted ultrasound to assess for acute pyelo 92.3%. Imaging Results 52.7% of imaging had positive findings. Most frequently recorded was pyelo (23.6%), renal/ureteric calculi (16.4%) and hydronephrosis (12.7%). In presumed uncomplicated acute pyelo (Variant 1), 29% of patients had radiological evidence of pyelo. 22.2% had newly diagnosed renal/ ureteric calculus. 11.1% had hydronephrosis. One patient had both stones and hydronephrosis. In known stone disease, two presented with hydronephrosis [V3]. Two transplant cases had hydronephrosis [V5]. Conclusion Early detection of pyelonephritis and its underlying aetiology is imperative in the management of urosepsis. Results suggest 22.2% had newly diagnosed renal/ ureteric calculus in those not known to have renal disease [V1]. In total 12% had hydronephrosis, and nearly a quarter had pyelo visible on imaging. No abscesses were observed which guided duration of antibiotic therapy. Early intervention including anti-microbial therapy and management of acute kidney injury were guided by imaging outcomes. Access to specialist services and early imaging is crucial in successful outcomes in urosepsis.

Effects of Cognitive Behavioural Therapy on Mental Health and Sleep in Acute Kidney Injury Patients with Ureteral Calculi in the Emergency Department: A Retrospective Study.

Acute kidney injury (AKI) resulting from ureteral stones in the emergency department is typically accompanied with anxiety and sleep issues in patients, which can have adverse effects on their mental health and quality of life. Cognitive behavioural therapy (CBT) is helpful in improving mental health and sleep. This work aims to analyse the effects of CBT on mental health and sleep of AKI patients caused by ureteral calculi in the emergency department. The clinical data of patients with AKI caused by ureteral calculi in the emergency department of our hospital from February 2021 to February 2023 were retrospectively analyzed. The patients were divided into the control group (routine nursing) and observation group (cognitive behavioural nursing) according to the different nursing methods of data recording. Propensity Score Matching (PSM) was used to balance the confounding factors of the two groups. After matching, the State Trait Anxiety Inventory (STAI), Insomnia Severity Index (ISI), Mishel Uncertainty in Illness Scale-Adult (MUIS) and 36-Item Short-Form Health Survey (SF-36) were compared between the two groups. After matching at a ratio of 1:1, 130 patients were included in the observation group and the control group, with 65 cases in each group. No significant difference was observed in STAI, ISI, MUIS and SF-36 scores between the two groups before nursing (p > 0.05). After nursing, the STAI, ISI and MUIS scores of the observation group were lower than those of the control group (p < 0.05). Furthermore, the SF-36 score of the observation group was higher than that of the control group (p < 0.05). Cognitive behavioural nursing for patients with AKI caused by ureteral calculi in the emergency department may help in retrieving patients' anxiety, reducing the severity of disease uncertainty and insomnia, improving the quality of life of patients and providing theoretical reference for clinical practice.

AB015. SOH24AB_138. A clinical audit on the pre- and post-operative length of stay for patients presenting with obstructing renal or ureteric calculus in a level four university teaching hospital in Ireland

AB015. SOH24AB_138. A clinical audit on the pre- and post-operative length of stay for patients presenting with obstructing renal or ureteric calculus in a level four university teaching hospital in Ireland

Application Analysis of Low-Pressure Perfusion Combined with Occluder in Holmium Laser Lithotripsy for Patients with Middle and Upper Ureteral Calculi.

Ureteroscopic holmium laser lithotripsy has become one of the main methods of treating ureteral calculi. However, in the treatment of middle and upper ureteral calculi, ureteroscopy is difficult to operate owing to the high location of calculi. Thus, how to improve the treatment effect and reduce the stone migration has become the focus in clinical settings. On this basis, we evaluated the application effect of low-pressure perfusion combined with occluder in holmium laser lithotripsy for patients with middle and upper ureteral calculi. This retrospective study selected 107 patients with middle and upper ureteral calculi who underwent low-pressure perfusion combined with ureteroscopic holmium laser lithotripsy from January 2021 to December 2022. We excluded 7 patients who did not meet the criteria, and ultimately included 100 patients. According to whether the occluder was used during the surgery, 100 patients were divided into groups A (n = 52, occluder) and B (n = 48, without occluder). The stone-migration rate during surgery, stone-clearance rate at 3 months after surgery, perioperative indicators, postoperative complication rate, and postoperative quality of life between the two groups were compared. The stone-migration rate in group A was significantly lower than that in group B, with statistically significant difference (p < 0.05). Both groups had no significant difference in stone-clearance rate at 3 months after surgery (p > 0.05). Group A had a significantly lower index of EuroQol (EQ) Five Dimensions Questionnaire and significantly higher score of EQ-Visual Analogue Scale than group B (all p < 0.001). Compared with the simple application of low-pressure perfusion, the combined application of low-pressure perfusion and occluder in ureteroscopic holmium laser lithotripsy can effectively reduce the stone migration and improve the postoperative quality of life.

Ureteric Calculi in a 24 Year Old Man: A Case Study

Abstract: Introduction: Ashmari is one among the eight most difficult to cure diseases (Ashtamahagada) described in Ayurveda classical texts. The symptomatology of Ashmari resembles the clinical features of Urolithiasis mentioned in contemporary medical science. Urolithiasis is the third most common disease of the urinary tract. Aim &amp; objectives: Conventional management of Urolithiasis does not have any effect on the pathogenesis of this disease and therefore, recurrence of disease occurs very commonly. To find out effective management of Ashmari with Ayurvedic medicines with no adverse events. Case Presentation: In this present study an effort is made to cure ureter calculi (4.8 mm). On Ayurvedic parlance, 24 year male patient was diagnosed as Ashmari based on the signs and symptoms. Patient was prescribed the Ayurvedic medicines. Patient were advised to follow-up initially after 07 days. Result: Improvement in clinical features was there within 07 days. Patient showed complete relief in his complaints on third follow up visit. Repeat Ultrasonography scan did not reveal any ureteric calculus. Conclusion: Chandraprabha Vati, Gokshuradi Guggulu and Kulathadi Ghrit, the administered drugs have effectively disintegrated the pathogenesis of Ashmari and lead to expulsion of the Ashmari from the urinary tract.

Chronic back pain in untreated gout

A 41-year-old man with a 10-year history of untreated chronic tophaceous gout presented with acute flare of gouty arthritis. He has chronic low back pain which has become more severe for the past 1 year. Clinically he has tenderness at lower lumbar spine although there was no neurological deficit. Laboratory test revealed raised inflammatory markers (ESR 70mm/hour) and C-reactive protein 287.1 mg/L, reactive thrombocytosis and leucocytosis, renal impairment and elevated serum uric acid (780 μmol/L). He had microscopic hematuria and ultrasound showed right mild hydronephrosis without any calculi identified. Computerized Tomography Urogram (CTU) confirmed the findings of an obstructive right hydronephrosis and hydroureter due to a right ureteric calculus. Incidentally, CTU revealed a lobulated, heterogenous hyperdense soft tissue ossified mass measuring (4.6x7.3x8.1 cm) at lumbar vertebral bodies (L2-L4) with overhanging edge erosions of adjacent vertebra mainly involving the facet joints, pedicles and lamina (Figure 1).

Extracorporeal Shockwave Lithotripsy versus Ureteroscopic Laser Lithotripsy in Proximal Ureteric Calculus of 10 to 20 mm in Size: A single centre experience

Extracorporeal Shockwave Lithotripsy versus Ureteroscopic Laser Lithotripsy in Proximal Ureteric Calculus of 10 to 20 mm in Size: A single centre experience

Laser Lithotripsy for the Management of Ureteric Calculus

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size &lt;10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size &lt; and ≥ 10 mm, stone density &lt; and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

Clinicopathological Study of Helicobactor Pylori Infection and Gastric Carcinoma at a Tertiary Care Hospital in Kathmandu

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size &lt;10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size &lt; and ≥ 10 mm, stone density &lt; and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

The safety and efficacy of Sotn ureteroscopy for renal and upper ureteral calculi: a prospective multicenter randomized controlled trial.

Sotn ureteroscopy is a new lithotripsy procedure developed on the basis of ureteroscopy and includes a rigid ureteral access sheath, standard mirror, lithotripsy mirror, and Sotn perfusion aspirator. Thus, we performed a prospective multicenter randomized controlled trial comparing the safety and efficacy of Sotn ureteroscopy in the treatment of renal and upper ureteral calculi. In this study, 224 patients with renal and upper ureteral calculi were randomly divided equally into study and control groups from March 2018 to March 2022. All the patients were approved by the hospital ethics committee (proof number: ZF-2018-164-01 and ZF-2018-165-01) of the Second Affiliate Hospital of Guangzhou University of Chinese Medicine in China. The primary outcome was stone-free rate (SFR) assessed by computed tomography on the 1st day and month after treatment and operation duration. The secondary outcome was postoperative complication rate. In total, for upper ureteral calculi, the SFR of 1 day after operation of the Sotn ureteroscopy group was significantly higher than the rigid ureteroscopy group (83.6% vs. 60%, P=0.006). Moreover, operative time (33.7±1.80 vs. 52.9±2.73 min, P<0.005) of the Sotn ureteroscopy group was significantly lower than the rigid ureteroscopy group. Additionally, the SFR of 1 day after operation and operative time for the study group (Sotn ureteroscopy combined with flexible ureteroscopy) and the control group (flexible ureteroscopy alone) were 63.2% and 36.8% (P=0.005), 65.6±4.06 and 80.3±4.91 (P=0.023), respectively. However, there were no significant differences in the SFR of 1 month after operation, success rate of ureteral access sheath placement, and postoperative complications between the two groups (P>0.05). In subgroups with stone diameters ≥1.5 cm and stone CT values ≥1000 Hounsfield units, Sotn ureteroscopy showed more advantages in terms of the SFR of 1 day after operation. Importantly, complications such as ureteral injury, sepsis, fever, and severe hematuria were not statistically different between the two groups (P>0.05). For renal and upper ureteral calculi, Sotn ureteroscopy has the advantage of a higher SFR of 1 day after the operation and a shorter operative time, suggesting that the Sotn ureteroscopy may have further potential applications in clinics.

Predictors of forniceal rupture in patients with obstructing ureteral calculi: Analysis of multicenter data.

Renal forniceal rupture (FR) is a unique complication of obstructive uropathy. This study aimed to identify the predictors of FR among patients presenting with renal colic due to obstructing ureteral calculi. After obtaining ethics approval, electronic records of patients from three National Guard hospitals in Saudi Arabia were reviewed between 2016 and 2020 to identify patients who presented with renal colic and were diagnosed with FR due to obstructive ureteric stones (FR group). An equivalent number of consecutive patients presenting with renal colic due to obstructing ureteric stones without FR was selected as a control group (non-FR group). Patients were grouped according to age group (<30, 30-40, 41-50, and >50 years), body mass index (BMI) class, gender, comorbidities, grade of hydronephrosis, location of the stone in the ureter, size of the stone (<3 mm, 3-7 mm, and >7 mm), and stone former status. Baseline patients' and stone characteristics were compared, and a regression analysis was performed to identify predictors of FR. A total of 50 patients with FR were identified, and a control group of 50 patients without FR were selected. The baseline patients' and stone demographic characteristics in terms of age (P = 0.42), gender (P = 0.275), BMI (P = 0.672), comorbidity, grade of hydronephrosis (P = 0.201), and stone location (P = 0.639) were comparable between the FR group and the non-FR group. However, the stone size was statistically significant between both groups (P = 0.014). On multivariable analysis, it was found that the stone size was associated with a significantly higher increase in the incidence of FR (odds ratio [OR]: 6.5 [1.235-34.434]; P = 0.027). Furthermore, the age group between 30 and 40 years was potentially at a lower risk for FR (OR: 0.262 [0.069-0.999]; P = 0.049). This multicenter study showed that the stone size 3-7 mm had a six-fold increase in the chance of FR, and the age group between 30 and 40 years is potentially at a lower risk for FR.

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.

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.