Obstructive Ureteral Stones Research Articles

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.

MP23-05 NONINVASIVE ACOUSTIC FORCEPS USING ULTRASOUND TO MANIPULATE OBJECTS IN THE URINARY TRACT

You have accessJournal of UrologyCME1 Apr 2023MP23-05 NONINVASIVE ACOUSTIC FORCEPS USING ULTRASOUND TO MANIPULATE OBJECTS IN THE URINARY TRACT Mohamed Ghanem, Arturo Holmes, Adam Maxwell, Michael Bailey, Mathew Sorensen, and Jonathan Harper Mohamed GhanemMohamed Ghanem More articles by this author , Arturo HolmesArturo Holmes More articles by this author , Adam MaxwellAdam Maxwell More articles by this author , Michael BaileyMichael Bailey More articles by this author , Mathew SorensenMathew Sorensen More articles by this author , and Jonathan HarperJonathan Harper More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ultrasonic propulsion has been demonstrated in clinical trials to noninvasively reposition renal stones along the direction of the probe. However, extracorporeal manipulation of stones causing ureteral stone obstruction requires controlled movement along a complex path in the urinary tract. Here, we evaluate the safety and utility of a method for controlled manipulation of stone models in vivo in a complex three-dimensional (3D) path using focused ultrasound beams. METHODS: A multi-element ultrasound array transducer with a 12-cm focus was used to produce an acoustic trap around a stone model (3 mm glass sphere) in the bladder of three pigs under anesthesia. The array was coupled to the pig by a water bath and synchronized with a P6-3 ultrasound imaging probe for targeting. A cystoscope was inserted into the bladder to visualize the motion. The sphere was acoustically trapped and steered along three different paths (Figure 1a-c). Deviation of the measured from the intended path was calculated to quantify the accuracy. The total energy exposure to manipulate the stone was low; at 1.5 MHz, the maximum exposure had a maximum peak pressure of 1.4 MPa and a pulse average intensity of 133 W/cm2. The bladder was then evaluated histologically. RESULTS: Spheres were levitated and moved in the three paths in all pigs for a total of 26 manipulations. The spheres were lifted and moved 1) laterally 3 mm and back down, 2) in a horizontal, and 3) in a vertical loop of 3 mm radius. The average discrepancy between the desired path and that observed on ultrasound was 0.24±0.07 mm, and by the cystoscope was 0.17±0.09 mm. The sphere was dragged for 5 cm along the bladder wall by moving the array mechanically (Figure 1d). The skin to stone depth was 2±0.5 cm. Histology showed no signs of injury to the bladder wall. CONCLUSIONS: This work demonstrated the controlled, noninvasive manipulation of stone models in vivo at safe ultrasound power levels. This work potentiates the use of noninvasive ultrasound tweezers to facilitate movement of stones in any direction which could expand the capabilities of ultrasonic propulsion alone. Source of Funding: Work supported by NIDDK P01 DK043881, K25 DK132416 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e307 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Ghanem More articles by this author Arturo Holmes More articles by this author Adam Maxwell More articles by this author Michael Bailey More articles by this author Mathew Sorensen More articles by this author Jonathan Harper More articles by this author Expand All Advertisement PDF downloadLoading ...

Retrograde ureteral catheterization under local anesthesia for emergency drainage in patients with infection and hydronephrosis secondary to ureteral calculi: Experience from a tertiary care hospital.

The aim is to evaluate the safety and efficacy of retrograde ureteral catheterization under local anesthesia in patients with urinary tract infections complicated by hydronephrosis caused by ureteral stone obstruction. From October 2020 to September 2021, a retrospective analysis of patients' medical records was performed. Records of past history, physical examination, laboratory tests, and imaging investigations were reviewed. Retrograde ureteric stent (RUS) was performed under local anesthesia using cystoscopes and guided by portable fluoroscopy. Real-time fluoroscopy was used to verify the double-J stent position and confirm a smooth process. The postoperative recovery and length of admission were also recorded. A total of 14 patients with ureteral stone obstruction with infective hydronephrosis received 15 total emergency RUS procedures (one bilateral). Intraoperative findings, operation times, and infection signs were recorded and analyzed. All patients met systemic infection criteria, with a mean body temperature of 38.7°C ± 1.7°C. Leukocytosis was noted in 8 (57.1%) patients. Elevated C-reactive protein (8.5 ± 6.3 mg/L) and procalcitonin (24.1 ± 22.0 ng/mL) were found in 13 (92.9%) and 9 (64.3%) patients, respectively. Mean stone size was 8.5 ± 6.3 mm, mostly localized to the upper ureter (upper: 12; middle: 0; lower: 3). Mean operation time was 14.1 ± 4.3 min. After emergency drainage, all patients improved and were discharged after infection was controlled. The average length of admission was 6.2 ± 2.2 days. RUS under local anesthesia is safe and effective for treating infective hydronephrosis due to ureteral stone obstruction. A randomized controlled trial with a large sample remains necessary to validate these findings.

Evaluation of Risk Factors for Fever and Sepsis after Ureteroscopic Lithotripsy: A Prospective Observational Study

Introduction: Ureteroscopic Lithotripsy (URS) is gaining popularity for the management of ureteral stones and even renal stones due to its high efficacy and minimal invasiveness. While this procedure is generally considered safe with a low complication rate, febrile Urinary Tract Infection (UTI) after URS is not rare. Aim: The aim of the present study is to analyse the risk factors for sepsis and febrile UTI after URS. Materials and Methods: A prospective observational study was conducted at a tertiary referral centre in Jaipur, Rajasthan, from July 1, 2021, to July 1, 2022. The study included 148 patients with obstructive ureteral stones who underwent Ureteroscopy and Laser Stone Lithotripsy (URSL). The patients were divided into two groups: Group-A consisted of patients who developed urosepsis and fever after URSL, and Group-B consisted of patients who underwent URSL without urosepsis. Various risk factors like history of Percutaneous Nephrolithotomy (PCNL), types and sizes of stones, stone locations, duration of operation, mean catheter removal time, and hospital stays were recorded and compared. Chi-square tests and multifactorial logistic regression analyses were used. Results: The incidence of febrile UTI was 12.16% (18 out of 148 patients). The mean age was 42.2±7.2 years in the postoperative febrile group and 42.75±7.44 years in the postoperative non- febrile group. Statistically significant differences were observed between the groups in terms of stone size (p&lt;0.001), duration of operation (p&lt;0.007), stone number (p=0.002), and stone location (p=0.013), which consequently led to an increase in mean catheter removal time (p&lt;0.001) and length of hospital stay (p&lt;0.001). Conclusion: The present study identified several notable risk factors associated with the development of fever and sepsis following URS. Identifying these factors enables healthcare providers to identify patients who may be at a higher risk of postoperative complications and implement appropriate preventive measures.

QSOFA and SOFA scores are valuable tools for predicting postoperative sepsis resulting from ureteroscopic lithotripsy (URSL)

The sequential organ failure assessment (SOFA) and quick sequential organ failure assessment (qSOFA) scores are new tools which are used to assess sepsis based on the Third International Consensus Definitions for Sepsis and Septic Shock Task Force. This study aimed to evaluate the feasibility of using the SOFA and qSOFA to predict post-ureteroscopic lithotripsy (URSL) sepsis. Patients who underwent URSL due to ureteral stone obstruction were retrospectively reviewed using SOFA and qSOFA scores. Patient characteristics including age, gender, comorbidities, American Society of Anesthesiologists Classification, stone burden, stone location, hydronephrosis status, infectious status, preoperative SOFA and qSOFA score were collected. Preoperative factors were analyzed to determine if they were correlated with postoperative sepsis. A total of 830 patients were included in this study, of whom 32 (3.9%) had postoperative sepsis. Multivariate analysis revealed that older age, proximal ureteral stones, severe hydronephrosis, and high preoperative qSOFA or SOFA score were significantly associated with postoperative sepsis. The areas under the curves of a qSOFA score ≥ 1 and SOFA score ≥ 2 for predicting postoperative sepsis were 0.754 and 0.823, respectively. Preoperative qSOFA and SOFA scores are convenient and effective for predicting post-URSL sepsis. Further preventive strategies should be performed in these high-risk patients.

Factors Affecting the Outcome of Medical Treatment in Cats with Obstructive Ureteral Stones Treated with Tamsulosin: 70 Cases (2018-2022).

Simple SummaryOther than surgical approaches the treatment options for feline ureterolithiasis are limited compared to those of human medicine. After various studies on ureteral muscle relaxation drugs, tamsulosin has been used as a treatment for distal ureteral stones in human medicine. However, the available clinical veterinary data on the efficacy of drugs that relax the ureter are limited. Thus, this study aimed to investigate the factors affecting the outcome of tamsulosin treatment for feline ureterolithiasis. With tamsulosin treatment, the ureteric stone passage was confirmed in 22 out of 70 cats, with a success rate of 31.43%. Negative factors with statistical significance for stone passage in this study were high baseline creatinine levels, female sex, proximal location of stones, and large diameter stones. The results of this study suggest that tamsulosin can be considered for the treatment of ureterolithiasis in cats with small distal ureteral stones. In addition, this study serves as an important reference for determining whether medical treatment of feline ureteral obstruction using tamsulosin can be attempted.The incidence of diseases associated with feline ureteral obstruction is increasing; however, non-surgical treatment options are limited. This study evaluated the outcome of medical treatment in cats with obstructive ureteral stones treated with tamsulosin and identified potential factors predicting spontaneous stone passage. We retrospectively reviewed 70 client-owned cats treated at the Western Referral Animal Medical Center, Seoul, Korea, from 2018 to 2022. All the cats had obstructive ureterolithiasis and were treated using tamsulosin. The baseline characteristics of the cats, stone diameter and location, and stone passage outcomes were analyzed. Stone passage occurred in 22 cats; the remaining 48 cats showed no change in stone locations. Sex, creatinine, and diameter and location of stones were potential risk factors associated with successful stone passage, but age, weight, and side of the stone were not. No serious adverse events related to tamsulosin treatment were observed. This is the first study to identify the risk factors predictive of the spontaneous stone passage of cats with obstructive ureterolithiasis after tamsulosin treatment. Tamsulosin could be an alternative treatment for ureteral obstruction in male cats with smaller distal ureteral stones and low baseline serum creatinine levels. These findings could help develop guidelines for treating feline ureterolithiasis.

Design of a fully intraureteral stent and proof-of-concept in vivo evaluation.

BackgroundUreteral stents are employed regularly to facilitate urine drainage and ureteral healing in a wide variety of endourological procedures, associated mainly with ureteral stone obstruction. However, stent use frequently impairs patient quality of life, which is generally attributed to the presence of anchoring stent curls in the bladder and/or kidney. The purpose of this study was to examine the potential effectiveness and safety of a newly designed, fully intraureteral stent, in an initial proof-of-concept in vivo evaluation.Methods“Yoticurl” stents were synthesized from copolymeric, commercially-available ureteral stents. A first test to confirm the intended expansion of the spiral curls in a ureter was performed on a pig cadaver. Subsequently, a preliminary in vivo evaluation in a single pig model was completed to test stent viability, over a period of 25 days. Two stents were inserted to fully intraureteral positions into the two ureters, by standard human endourological procedure. Daily observational checks of the pig, and regular radiographic analyses were performed; the animal was then euthanized and examined by explorative laparotomy, followed by histological analysis of kidney, ureter and bladder tissue samples.ResultsThe pig displayed normal activity, appetite and sleep patterns, and radiography indicated free flow of urine, and no significant stent migration nor anatomical abnormalities. Subsequent histology found only mild inflammation in the ureter.ConclusionsThe innovative stent design tested here, if ultimately proven safe and effective for human use, may offer an alternative to currently available stents for multiple indications.

Consensus Statement on Urinary Stone Treatment During a Pandemic: A Delphi Process from the Endourological Society TOWER Research Initiative.

Introduction: The novel coronavirus disease (COVID-19) pandemic has had a significant impact on the care of patients with urolithiasis. Recommendations and prioritization of endourologic surgical procedures vary among regions, and a comprehensive overall international directive is needed. We used the Delphi method to obtain international consensus on managing urolithiasis patients during the pandemic. Methods: A three-round Delphi process was used to elicit expert consensus (53 global key opinion leaders within the Endourological Society from 36 countries) on an extensive survey on management of endourologic patients in a pandemic. Questions addressed general management, inpatient and outpatient procedures, clinic visits, follow-up care, and best practices for suspension and resumption of routine care. Results: Consensus was achieved in 64/84 (76%) questions. Key consensus findings included the following: consultations should be delivered remotely when possible. Invasive surgical procedures for urolithiasis patients should be reserved for high-risk situations (infection, renal failure, etc.). To prevent aerosolization, spinal anesthesia is preferred over general, whenever feasible. Treatment of asymptomatic renal stones should be deferred. Primary definitive treatment of obstructing or symptomatic stones (both renal and ureteral) is preferred over temporizing drainage. Extracorporeal shockwave lithotripsy should be continued for obstructive ureteral stones. There was consensus on treatment modalities and drainage strategies depending on location and size of the stone. Conclusion: International endourologist members of the Endourological Society participated in this Delphi initiative to provide expert consensus on management of urolithiasis during a pandemic. These results can be applied currently and during a future pandemic.

Comparative Analysis of Robot Assisted Laparoscopy and Laparoscopic Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction

Through the comparison with laparoscopic pyeloplasty, this paper discusses the clinical value of robot assisted laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction (UPJO). 82 patients with UPJO admitted to the First Affiliated Hospital of Medical College of Zhejiang University from January 2012 to December 2018 were retrospectively analyzed, including 43 patients who underwent robot assisted laparoscopic pyeloplasty (RALP group); Laparoscopic pyeloplasty was performed in 39 cases (LP group). The operation time, reconstruction suture time, intraoperative bleeding, postoperative drainage, postoperative intestinal recovery time, postoperative hospitalization time, hospitalization expenses, surgical complications and follow-up were compared and analyzed between the two groups. There was no significant difference between the two groups in operation time, renal pelvis reconstruction time, intraoperative bleeding, postoperative drainage tube stopping time, postoperative drainage volume and intestinal recovery time (P > 0.05); and the postoperative indwelling time of urinary catheter and postoperative hospital stay in RALP group were shorter than those in LP group (P < 0.05); The hospitalization cost in RALP group was significantly higher than that in LP group. Clavien Grade II complications occurred in 8 cases in LP group, Clavien Grade II complications occurred in 2 cases in RALP group, and there was 1 case of Grade III complications in both groups. The complication rate was 6.79% in RALP group and 23.07% in LP group. There was significant difference between the two groups (P < 0.05). During the postoperative follow-up, hydronephrosis was aggravated in 1 patient in RALP group half a year after operation, and hydronephrosis was aggravated in 1 patient in LP group due to ureteral stone obstruction. Another patient in LP group was found to have more hydronephrosis than before. The success rate was 97.7% in RALP group and 94.8% in LP group. There was no significant difference between the two groups (P > 0.05). Compared with laparoscopy, robot assisted laparoscopic pyeloplasty is a better surgical option. With the reduction of cost, it will gradually replace laparoscopic pyeloplasty.

Minimally invasive removal of obstructive ureteral stones by lithotripsy in horses: Three cases

Minimally invasive removal of obstructive ureteral stones by lithotripsy in horses: Three cases

Ultrasound Diagnosis and Active Ureteroscopy for Obstructive Ureteral Calculi During Pregnancy: Multicenter Experience.

Objectives: To evaluate the safety and efficacy of ultrasound (US) and primary ureteroscopy (URS) in the management of symptomatic obstructive ureteric stones during pregnancy. Patients and Methods: A prospective multicenter study was performed between June 2013 and December 2019, including all consecutive pregnant patients admitted to three urology centers with intractable renal colic with obstructed ureter secondary to obstructive ureteral calculi. Color Doppler ultrasound was used to evaluate renal Resistive Index (RI) and ureter jet. Primary URS was performed to remove the blocking stones. The safety and effectiveness of the procedures were assessed, as well as the stone-free rate (SFR) and the condition of the upper tract after delivery. Results: A total of 111 pregnant patients were included with a mean age of 27.4 ± 4.4 years and a mean renal RI of 0.78 ± 0.02. US diagnosed stones in 46.8% of patients, while 100 (90%) patients had altered lower ureter urinary jet, including 86.5% who had URS-confirmed ureteric stones; SFR was 95.8% with no serious urologic, fetal, or obstetric complications. Nine percent of patients had premature delivery, which was significantly correlated with postoperative urinary tract infection and premature uterine contraction (p ˂ 0.0001). In the third-month follow-up of US, all patients showed no residual hydronephrosis. Postoperative follow-up procedures were required in 15.3% of patients. Conclusion: Obstructive ureteral stones during pregnancy can be detected safely and appropriately with a combined elevated renal RI and absent ureteral jet detected by Doppler US. Definitive URS is an efficient and safe alternative option for those who fail in conservative management.

The Relationship between Ureteral Obstruction Time and Secondary Signs in Computed Tomography due to Ureteral Stone Obstruction.

To investigate the relationship between numerical values obtained using computed tomography (CT) in stone-related urinary obstruction and the duration of obstruction. Cross-sectional study. Department of Urology, Alanya Alaaddin Keykubat University, Turkey, from January 2018 to September 2019. Eighty-three patients were investigated. Commencement of obstruction was defined as time of onset of pain. Cases with less than seven days elapsed between onset of obstruction; and CT were classified as acute obstruction; and those with durations of seven days or more as chronic obstruction. Bilateral renal parenchymal and renal fatty tissue densities were measured in three planes. Acute obstruction was present in 53 patients and chronic obstruction in 30. Median renal parenchymal densities in the obstructive and non-obstructive kidneys were 33 and 37 Hounsfield unit (HU), respectively; and median perirenal densities were 99 and 108 HU, the differences being statistically significant (p <0.05). Median perirenal density were 96 HU in acute obstruction and 104.5 HU in chronic obstruction and the difference was statistically significant (p <0.05). No statistically significant difference was determined between renal parenchymal density in acute and chronic obstruction (p >0.05). A low perirenal density on CT indicated prolonged duration of urinary obstruction. Key Words: Computed tomography, Hounsfield unit, Kidney stone, Ureter, Ureteral stone.

Early ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi

We aimed at comparing the success and complications of early semirigid ureteroscopy (URS) and elective URS in ureteral calculi with renal colic that do not respond to analgesics. We retrospectively analyzed the data of 690 patients with obstructive ureteral stones who underwent URS with stone retrieval. 247 patients who underwent early URS within the first 12h were classified as group I and 443 patients who underwent elective URS as group II. Both groups were compared in terms of age, sex, creatinine, eGFR, stone size, laterality, location and number of stones, type of lithotriptor, presence of hydronephrosis and success and complication rates. The mean age of the patients was 50.4 (18-89years) (p > 0.05). There was no statistically significant difference between the groups in terms of age, eGFR, side, presence of hydronephrosis, fever, mucosal damage, stone migration, perforated ureter, ureteral avulsion, ureteral stent insertion at the end of the surgery and sepsis (p > 0.05). Both groups had male dominance (p > 0.05). Creatinine was significantly lower in Group I (p < 0.05). The mean stone size was also significantly lower in Group I (p < 0.05). Middle and proximal ureteral calculi were more common in Group II (p < 0.05). Multiple stones were higher in Group II (p < 0.05). The dominant type of lithotriptor used was pneumatic in Group I and laser in Group II (p < 0.05). Stone-free rates (SFRs) were higher in Group I (98% vs 90% in the first month) (p < 0.05). Postoperative hematuria and infection were more common in Group II (p < 0.05). In selected cases, early ureteroscopy is an effective and safe method for distal ureteral calculi smaller than 10mm that are painful and resistant to analgesic treatment.

A Meta-analysis of laparoscopic lithotomy and transurethral ureteroscope lithotripsy in the treatment of upper ureteral obstructive stones

Objective To systematically compare the differences of clinical efficacy in the treatment of obstructive upper ureteral stones by laparoscopic lithotomy and transurethral ureteroscope lithotripsy. Methods The search strategy and the inclusion and exclusion criteria were made by two independent reviewers. We searched online PubMed, EMBASE, Cochrane Clinical Controlled Trials Database, China National Knowledge Infrastructure(CNKI), Wang fang and VIP citation database from the inception to September 2017 for randomized controlled trials(RCT)studies, which assessing the efficacy of laparoscopic ureterolithotomy (LU) and transurethral ureteroscope lithotripsy (URSL) for obstructive upper ureteral calculus. RevMan 5.3 software was used to perform a clinical meta-analysis of relevant literature data. Results Nine randomized controlled trials (RCTs) were included, a total of 994 cases of related patients, including LU group of 501 cases, URSL group of 493 cases. The results showed that URSL contained a shorter time of surgery[WMD=31.34 min, 95%CI(16.83, 45.85), P<0.01] and length of hospital stay[WMD=1.88 d, 95%CI(0.93, 2.82), P<0.01] compared with LU group. However, LU group had a lower postoperative complications[OR=0.47%, 95%CI(0.32, 0.70), P<0.01] and higher stone clearance rates[OR=6.63%, 95%CI(3.91, 11.25), P<0.01]than URSL group. Conclusions Although URSL requires less operative time and hospital stay than LU for the treatment of obstructive upper ureteral stones, the postoperative complication and stone clearance rate performance are poor in URSL. Key words: Ureteral Calculi; Laparoscopy; Ureteroscopy

Management and outcome of obstructive ureteral stones in the emergency department: Emphasis on urine tests and antibiotics usage

BackgroundKidney stone related complaints in the Emergency Department (ED) are common. Current guidelines recommend antibiotic therapy for infected obstructive stones and stone removal in a timely fashion, but there is no clear recommendation for prophylactic antibiotic use for bacteriuria or pyuria in the setting of obstructive ureteral stones. ObjectivesThe aim of this study is to evaluate the current management of patients with obstructive ureteral stones in a single ED with emphasis on urine tests and antibiotics use. MethodsThe picture archiving and communication system (PACS) was used to filter the list of patients who received a computed tomography (CT) scan of the abdomen and pelvis that positively identified obstructive ureteral stones. Demographics and clinical data were also recorded and analyzed. ResultsOf the patients discharged, 278 patients did not receive antibiotics in the ED or a prescription. Of these, 8 patients had positive culture, 4 patients followed up, and one developed and was treated for a urinary-tract infection. One hundred ninety two patients were not given antibiotics in the ED but received an antibiotics prescription, and 4 patients had positive cultures grow. Two followed up and had no infection-related complications. Fourteen patients were discharged without a prescription after receiving a single dose of antibiotics in the ED, with no positive urine cultures and 9 patients following up without complication. ConclusionAntibiotics were given at the discretion of the provider without clear pattern. A high rate of infectious complication did not occur in the followed up patient group.

Bilateral Obstructive Ureteral Stones After Using a Dose of Frozen Adalimumab in a Patient With Crohnʼs Disease

Bilateral Obstructive Ureteral Stones After Using a Dose of Frozen Adalimumab in a Patient With Crohnʼs Disease

Spontaneous Rupture of Renal Pelvis: A Rare Complication of Obstructive Ureteral Stone

Spontaneous Rupture of Renal Pelvis: A Rare Complication of Obstructive Ureteral Stone

Emergency extracorporeal shockwave lithotripsy as opposed to delayed shockwave lithotripsy for the treatment of acute renal colic due to obstructive ureteral stone: a prospective randomized trial.

The aim of this study was to assess the efficacy of emergency extracorporeal shockwave lithotripsy (eSWL) as first-line treatment in patients with acute colic due to obstructive ureteral stone. Seventy-four patients were randomized to emergency SWL within 12 hours (eSWL group) and deferred SWL later than 3 days (dSWL group). Follow-up included ultrasound, KUB (kidney-ureter-bladder) radiography and CT (computed tomography) scan at 24 hours, 7 days, 1 and 3 months from the treatment. When necessary, repeated SWL (re-SWL) or ureteroscopy (auxiliary-URS) was performed. Preoperative and postoperative data were compared and stone free rates (SFR) and efficiency quotients (EQ) were evaluated. Analyses were performed using SAS software. Complete data of 70 patients were collected. 36 underwent eSWL and 34 dSWL. The mean patient age was 48.7. Mean stone size was 9.8 mm (CI 95%: 8.9-10.8). 25 (35.7%) were proximal and 45 (64.3%) distal. Mean SWL energy was 19.2 kV (CI 95%: 18.5-19.9) and mean number of shocks was 2657 (CI 95%: 2513-2802). eSWL patients needs less auxiliary-URS than dSWL patients (13.9% vs. 44.1%, P=0.039) and less re-SWL sessions (8.3% vs. 32.4%, P=0.093). SFR at 24 hours was 52.8% and 11.8% (P<0.001) and the EQ at 3 months was 79.1% and 57.5% in the eSWL and dSWL group respectively. Patients from the dSWL group spent more time in the hospital (2.21 vs. 1.36 days, P=0.046) and complication rates between the two groups were similar. eSWL is a safe procedure and delivers high SFR even within 24 hours especially for <10 mm stones. It is able to reduce the number of auxiliary procedures and hospitalization.

Salivary Neutrophil Gelatinase-Associated Lipocalin Sampling Feasibility in Acute Renal Colic.

Neutrophil gelatinase-associated lipocalin (NGAL) levels in the serum and urine are predictive biomarkers of acute kidney injury with correlation to complication and survival in major surgery. Salivary levels of NGAL during acute renal colic may reflect the degree of renal injury as it appears in different compartments encompassing body response in time perspective. Our aim is to evaluate and examine the feasibility and correlation of salivary NGAL with serum and urine levels in acute renal colic event. A prospective controlled study of all patients presenting to the emergency room with acute renal colic event diagnosed with single ureteral stone obstruction by noncontrast CT. Saliva, urine, and blood samples were collected in patients and a control group during the first morning of admission. The study groups consisted of 44 patients and 13 controls, mean age 47 ± 15 years, body mass index 29 ± 6, mean stone size 6 ± 4 mm, mean creatinine levels 1.3 ± 0.7 mg/dL, mean white blood count 10,900 ± 3100 counts per field, and C-reactive protein 29 ± 55. Serum (190 ± 120 ng/mL vs 81 ± 24; p < 0.001) and predominantly salivary (474 ± 185 vs 328 ± 134 ng/mL; p < 0.05) NGAL levels were significantly elevated in patients compared with controls. Salivary NGAL sampling is feasible during the acute phase of renal colic. High levels of salivary NGAL are observed in a single sampling during acute ureteral stone obstruction and may advance clinical decision-making.

MP10-18 SEPTIC SHOCK FOLLOWING SURGICAL DECOMPRESSION OF OBSTRUCTING URETERAL STONES: A PROSPECTIVE ANALYSIS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I1 Apr 2018MP10-18 SEPTIC SHOCK FOLLOWING SURGICAL DECOMPRESSION OF OBSTRUCTING URETERAL STONES: A PROSPECTIVE ANALYSIS Paulo Moscardi, Victor Srougi, Giovanni Marchini, Ricardo Haidar, Fabio Torricelli, Miguel Srougi, William Nahas, and Eduardo Mazzucchi Paulo MoscardiPaulo Moscardi More articles by this author , Victor SrougiVictor Srougi More articles by this author , Giovanni MarchiniGiovanni Marchini More articles by this author , Ricardo HaidarRicardo Haidar More articles by this author , Fabio TorricelliFabio Torricelli More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , William NahasWilliam Nahas More articles by this author , and Eduardo MazzucchiEduardo Mazzucchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.364AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate risk factors for septic shock and death in patients with obstructive pyelonephritis due to ureteral stone, who underwent urinary tract decompression. METHODS We prospectively enrolled patients who presented at the emergency room of our institution with clinical signs of pyelonephritis, systemic inflammatory reaction syndrome (SIRS) and obstructive ureteral stone confirmed by computed tomography. Forty patients that underwent urinary tract decompression were included. Demographical, medical and laboratorial characteristics were recorded; antibiotics regimen and time from presentation to decompression were compared between patients with septic complications and patients with uneventful outcomes. RESULTS Septic shock and death occurred in 6 (15%) and 2 (5%) patients, respectively. Gender, age and co-morbidities were not associated with septic complications. Urinary culture was negative in 40% of the cohort and the most prevalent pathogen was Escherichia coli (Table 1). Administration of antibiotics other than cephalosporines was associated with septic shock (p=0.02). There was no difference between groups regarding the time of antibiotics use (p = 0.63) and time from presentation to urinary tract decompression (4.0±6.9 vs. 1.4±1.8; p=0.07; Table 2). Preoperative leucocyte count receiver operator curve for intra-operative and post-operative septic shock revealed AUC = 0.879 (p = 0.014) and AUC = 0.788 (p = 0.027), respectively (Figure 1A,B). CONCLUSIONS Time of antibiotics use and time from presentation to urinary tract decompression were not determinant to preclude patients of septic shock. Patients with elevated serum leukocytes are at substantial risk of septic shock and should undergo prompt surgical intervention. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e124 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Paulo Moscardi More articles by this author Victor Srougi More articles by this author Giovanni Marchini More articles by this author Ricardo Haidar More articles by this author Fabio Torricelli More articles by this author Miguel Srougi More articles by this author William Nahas More articles by this author Eduardo Mazzucchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...