Treatment Of Ureteral Stones Research Articles

Uretroscopy with Laser vs ESWL in Management of Upper Ureteric Stones

Background Although SWL and Laser remain the most common modalities for the treatment of proximal ureteral stones, there is still an ongoing debate among the academicians and medical practitioners regarding the best treatment modality. Objective To compare the efficacy of ureteroscopy using holmium: YAG laser lithotripsy versus shock wave lithotripsy in management of proximal ureteric stones (≤10 mm) regarding surgical efficacy, safety and cost effectiveness. Patients and Methods This study was performed to compare ureteroscopy using holmium: YAG laser lithotripsy versus shock wave lithotripsy in management of proximal ureteric stones (≤10 mm) regarding surgical efficacy, safety and cost effectiveness. It included 52 patients with proximal ureteral stones and it was done in the period starting from September 2021 to February 2022. Results There was a statistically significant difference between the both modalities in favor of SWL as regarding the anesthesia, the overall procedural time and overall cost as SWL group were treated as an outpatient cases. There was a significant difference in used anesthesia (sedation for SWL and general anesthesia for Laser). Regarding Overall procedural time (hours), it was 4.55 ± 1.94 and was 36.88 ± 5.38 for SWL and Laser groups respectively. Overall cost; even if patients underwent three sessions of SWL, the cost between the two options was still significantly different. The overall cost of Laser was 15000 EP, with an efficiency of 80 %, while overall cost of SWL was (2500 EP), with an efficiency of 49.9 %. Conclusion Laser is more effective, has the advantage of the higher SFR from the first session without need of multiple hospital visits and prolonged radiation exposure time. SWL has lower treatment costs, while complications were comparable in both groups, so treatment decision depends on not only stone characteristics but also cost-effectiveness ratio and this should be considered when counseling the patient with proximal ureteric stone. Larger sample size is required for more convenience data.

Stone Density and Skin to Stone Distance in Non-Contrast Computed Tomography as Prognostic Indicators for the Success of Extra Corporeal Shockwave Lithotripsy in Ureteral Stone Disease

Background Ureteral stones are a major health concern with a worldwide rising prevalence. Ureteral stones formed in the kidney and then descending the ureter commonly manifest themselves as renal colic. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are the two primary treatment modalities for the management of symptomatic ureteral calculi, Aim of the Work In this study we tried to assess the prognostic value of patient and stone characteristics in potential candidates for ESWL in ureteral stones. Patients and Methods We studied the records of 66 patients with upper ureteral calculi who underwent ESWL. We considered patients being stone free (SF) or when < 4 mm fragments were detected. Age, gender, skin to-stone distance, maximum stone length, stone Hounsfield units (HU) were explored in uni- and multivariate regression analysis. Results We found that obesity (BMI > 29.3), high stone density (HU) >935, skin to stone distance >10 and presence of ureteral stent were all factors impeding success of treatment. On the other hand, higher shock intensity and number of shocks per session were positive predictors of treatment success. Conclusion It was concluded that the evaluation of patient and stone characteristics pre ESWL can predict the success of treatment for ureteric stones and we recommend thorough evaluation of the parameters before treatment to determine the best treatment modality for each patient. To date there seems to be value in using these variables to aid in better selecting patients for ESWL and thus improving the efficacy of ESWL. Our study was limited by the number of centers and participants. A wider range of participants would probably achieve more efficient results. Further studies on a larger scale would be better to further validate these results.

Comparison of the Effect of Hydroalcholic Extract of Alhagi maurorum and Hydrochlorothiazide on Excretion of 4-10 mm Kidney and Ureteral Stones in Adults: A Randomized Prospective Study.

The prevalence of kidney stones and their complications is high. The review of the literature showed the therapeutic effects of Alhagi maurorum extract on urinary tract stones. This study reviewed the Alhagi plant's hydroalcholic extract's effect on eliminating kidney and ureteral stones compared to hydrochlorothiazide. In this randomized prospective study, from March 2019 to September 2021, 80 patients over 18 years of age with kidney stones in the upper ureter with a size of 4-10 mm were divided into two groups based on the block random allocation method. The first group received hydrochlorothiazide tablets (50 mg), and the second group received 1 gram/day of the hydroalcholic areal extract of Alhagi maurorum in a two-divided capsule. The mean size and number of stones, renal function tests, and side effects were checked and compared in both groups before and after the study. Mean age, sex, serum urea level (P=0.351), serum creatinine (P=0.393), stone size (P=0178), and the number of stones (P=0.052) before intervention were similar. After intervention, the size and number of stones diminished, up to 70% in both groups. However, there was not a statistically significant difference between the two groups. The study showed that Alhagi maurorum is as effective as hydrochlorothiazide in treatment of kidney and ureteral stones with no significant complications and is promising.

Validez actual de la litotricia extracorpórea como tratamiento de primera línea de la litiasis

ObjectiveTo evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones. MethodsRetrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed. Results1727 patients are included. Stone mean size was 9,5 mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; P=0.00), ureteral location of the lithiasis (OR=1.15; P=0.052) and number of waves (P=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; P=0.000), number of waves (OR=1.000; P=0.000), energy (OR=1.005; P=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (P=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571). ConclusionLithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.

Effect of Silodosin in the Treatment of Distal Ureteral Stone

Background: Ureteral stones are a common type of urinary tract stones, accounting for 20% of all cases. The majority of these stones, approximately 70%, are located in the distal ureter. Recent studies have shown that α1- Adrenergic blockers can enhance the spontaneous passage of distal ureteral stones. Objectives: This study was done to compare the outcomes of treating distal ureteral stone with Silodosin, an α1- A adrenergic blocker, versus without Silodosin. Materials and Methods: A total of 70 patients aged between 18 and 50 years, diagnosed with distal ureteral stone, were enrolled in the study, which took place at the Department of Urology, Dhaka Medical College, from October 2017 to March 2019. The patients were divided into two groups: Group A and Group B. Group A consisted of 35 patients who were instructed to drink 3 litres of water daily, while Group B received the same instruction and also received Silodosin 8 mg/day. The treatment duration was four weeks, during which patients were monitored weekly through history, serum creatinine levels, X-ray KUB, and ultrasonogram of KUB. The number of stone expulsions, duration of spontaneous stone passage through the ureter, analgesic dosages, and adverse effects were recorded. Results: The higher expulsion rate in Group B (91.4%) compared to Group A (71.4%) (P=0.031). The mean expulsion duration was significantly shorter in Group B (8.94±3.58 days) compared to Group A (13.08±7.26 days) (P<0.00298). Additionally, Group B required significantly lower analgesic dosages (115.71±75.51 mg) compared to Group A (255.71±108.31 mg) (P=0.00001). No adverse effects were observed in Group A, while two patients in Group B experienced adverse effects (retrograde ejaculation and postural hypotension). Conclusion: These results indicate that 8 mg/day of silodosin facilitates the expulsion of distal ureteral stone of about 5 to 10 mm in diameter in the largest dimension and significantly reduces the number of analgesic dosages.

Comparing the efficacy of extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy in the treatment of proximal ureteral stones in children: A retrospective study.

Ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy methods are commonly used in the treatment of proximal ureteral stones. There are no adequate studies showing which method is more effective in children. In our study, we aimed to evaluate and compare the efficacy of two treatment methods, commonly used for proximal ureteral stones in children. A total of 78 patients who underwent ureteroscopic lithotripsy (n = 38) and extracorporeal shock wave lithotripsy (n = 40) due to stones located in the proximal ureter between 2010 and 2021 were included in the study. Demographic data, clinical characteristics, and treatment outcomes were retrospectively analyzed. Kolmogorov-Smirnov, Chi-square, and Mann-Whitney U tests were used for statistical analysis. There was no statistical difference between the demographic characteristics of the groups, except for the mean age values (p = 0.008). A statistically significant difference was found in favor of the extracorporeal shock wave lithotripsy group in terms of stone-free rates after the first intervention, complication rates requiring intervention, re-intervention rates, and the average number of anesthesia sessions per patient until stone-free status (p = 0.043, p = 0.009, p = 0.017, and p < 0.001, respectively). The results of this retrospective study suggest that extracorporeal shock wave lithotripsy is the primary treatment option for single, non-complicated proximal ureteral stones.

A systematic review and meta-analysis on the outcomes of extracorporeal shock wave compared to ureteroscopic lithotripsy for the treatment of ureteral stones

ObjectivesIn this systematic review and meta-analysis, we sought to identify whether extracorporeal shockwave lithotripsy (ESWL) or ureteroscopic lithotripsy (URSL) is the most appropriate method for treating ureteral stones. MethodsWe identified relevant literature by searching the Google Scholar and PubMed databases in accordance with PRISMA guidelines. We focused on the outcomes of extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy. For each method, we compared complications, hematuria, perforation, failure, stone clearance, initial stone-free, operating time, stone size, auxiliary procedures, and overall stone-free outcomes. Our analysis involved meta-analysis, heterogeneity testing, subgroup analysis, meta-regression sensitivity analyses, Egger's tests, Smoothed Variance Egger's (SVE) testing, and Smoothed Variance Thomson (SVT) testing. In addition, we detected publication bias for all outcomes related to the two procedures. ResultsBased on ten eligible studies, we conducted a meta-analysis on a total of 1509 patients. Extracorporeal shockwave lithotripsy was used to treat 677 patients; the remaining 832 patients were treated by the ureteroscopic lithotripsy procedure. Considering the meta-analysis statistical parameters including odds ratio (OR), standardized mean difference (SMD), Q, I2 and their p-values, the overall stone-free, operating time, stone size outcomes were identified with significant OR, SMD, and Q values. The hematuria, failure, and stone clearance outcomes were determined to have significant Q values. The perforation and initial stone free outcomes had significant OR values. And, complications and auxiliary urinary procedures were not significant in terms of OR and Q values. ConclusionsAnalysis indicated that ESWL and URSL procedures are essential for the treatment of ureteral stones, even though the perforation rate is higher for URSL than for ESWL. Overall stone-free rates were better for the URSL procedure.

Ureteric Stones less than 1.5 Cm: Comparison of Laser Vs. Pneumatic Lithotripsy: A Single Center Study

Background: Ureterorenoscopy (URS) and intracorporeal lithotripsy (ICL) is the first-choice treatment for ureteric stones less than 1.5 cm. Various options forintracorporeal lithotripsy exist such as pneumatic, Laser and Ultrasonic. Aim: To assess the safety and efficacy of laser versus pneumatic lithotripsy in treating ureteric stones of less than 1.5cm via Ureterorenoscopy. Methods: A total of 182 patients who underwent URS and intracorporeal in the department of UROLOGY LRH to were reviewed retrospectively from December 2021-December 2022 after ethical approval. Two groups were made on the basis of type oflithotripsy used (112 patients in the pneumatic lithotripsy (PL) group and 70 patients in the Laser lithotripsy (LL) group. Stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), and complications rate were evaluated for both groups. Results: Mean age of LL Patients was 41.1±3.9 years and PL patients 38.2±4.5 years. 68.4% of the study participants were males. LL had more upper ureter stones 17 (24.4%). LL's drawbacks outweighed its benefits in treating proximal ureteral calculi. Table 2 outlines postoperative complications and efficacy. Comparing the complications more PL patients had ureteric perforations (4.4%), postoperative fever (2.9%) and mucosal injury (5.7%) with p-value ≥0.05%. Mean operation time and hospital stay were less in LL patients, an immediate stone-free rate more (93.3%) in LL patients while stone migration more in PL patients 20(28.6%) with a statistically significant (p-value ≤0.05). Practical implication: Patients with renal stones will easily be treated with laser and pneumatic with less complications rate and short hospital stay than open surgery. Conclusion: For the treatment of ureteral stones, the PL and LL methods were effective and safe. However, it's possible that the LL class' SFR was higher.. Keywords: Ureteric Stones, Laser Lithotripsy, Pneumatic Lithotripsy, Comparison

Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review.

The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords "ureteral stone", "ureteral calculus", "impacted stone", "ureteral stenosis", "ureteroscopic lithotripsy", "impacted calculus", and "ureteral strictures" singly or in combination. After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures. Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones.

An innovative approach for combined endoscopic treatment of pediatric ureteral stones

An innovative approach for combined endoscopic treatment of pediatric ureteral stones

Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study

IntroductionUreteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. Material and methodsPatients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. ResultsA total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%, p=.127) or postoperative complication rate (35.0% vs 31.5%, p=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR 0.991; 95% IC 0.407–2.411; p=.983), when adjusted for procedure type, stone size and stone number. ConclusionURS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.

URERTEROSCOPIC LASER LITHOTRIPSY IS BETTER THAN PNEUMATIC LITHOTRIPSY FOR URETRIC STONES

Background: Among various intra-corporeal lithotripters, pneumatic lithotripter has become the widely used tool for the treatment of urinary stones. Recently the holmium: YAG laser has been used with a wide range of potential urological applications, including intra-corporeal lithotripsy of urinary calculi. Aims and objective: Compare the effectiveness and complications of treatment for ureteric stones between holmium laser lithotripsy and pneumatic lithotripsy. Material and Methods: Comparison of 100 patients presented with ureteric stones, group one (50) of whom were treated with pneumatic lithotripsy and group two (50) with holmium laser was done and the effectiveness and complications of both were analyzed. Results: There was no difference in patient age, sex, stone size and location of stones between the two groups. The immediate stone free rates were 86% in the holmium: YAG group and 64% in the pneumatic lithotripsy group (p = 0.011).. The mean operative time in the holmium: YAG group (35.7±3.2) was shorter than those with pneumatic lithotripsy group (50.2±5.3). Postoperative stay in hospital was less than 24 hours in holmium: YAG group (74%) and shorter than those for pneumatic group (36%) (p &lt; 0.002). Post treatment complications such as ureteral perforation were encountered in only three patients who underwent pneumatic lithotripsy. Other complications, such as mucosal injury, ureteral perforation and postoperative fever; there was no statistically signicant difference between the two groups. While light hematuria was found more frequently in the pneumatic group (10%) in comparison to laser group (4%) (p = 0.045). On the other hand, the overall complication rates between the two groups was statistically signicant (10%) laser group vs. (36%) pneumatic group (p = 0.002). Conclusions: Holmium: YAG laser lithotripsy was associated with shorter operation time and postoperative hospitalization period. We believe that Holmium: YAG laser lithotripsy is an excellent treatment modality for managing ureteral calculi in central Rajasthan where stone formation rate is quite high. Drawback of holmium laser lithotripsy is its cost and maintainance

Eficacia y seguridad de la ureteroscopia y la cirugía retrógrada intrarrenal sin fluoroscopia para el tratamiento de la urolitiasis: estudio comparativo

IntroductionUreteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. Material and methodsPatients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. ResultsA total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%; P=.127) or postoperative complication rate (35.0% vs 31.5%; P=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR: 0.991; 95%IC: 0.407-2.411; P=.983), when adjusted for procedure type, stone size and stone number. ConclusionURS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.

Efficacy of emergency extracorporeal shock wave lithotripsy in the treatment of ureteral stones: a meta-analysis

ObjectiveTo compare the clinical efficiency and safety of emergency extracorporeal shock wave lithotripsy (eESWL) and delayed extracorporeal shock wave lithotripsy (dESWL) in the treatment of ureteral stones.MethodsCochrane Library, PubMed, Google Scholar, and Web of Science were searched from January 1, 1992 to September 30, 2022, and all comparative studies involving eESWL and dESWL for ureteral calculi were included. Statistical analysis was performed using Review Manager 5.3 software. Funnel plot was used to evaluated publication bias.ResultsA total of 9 articles involving 976 patients diagnosed with ureteral stones were included. The results showed that the stone-free rate (SFR) after four weeks was significantly higher in the eESWL group than in the dESWL group [relative risk (RR) = 1.22, 95% confidence interval (CI): 1.13–1.32, P < 0.01]. In subgroup analysis of different stone locations, proximal ureteral calculi [RR = 1.25, 95% CI: 1.14–1.38, P < 0.01] and mid-to-distal ureteral calculi [RR = 1.18, 95% CI: 1.03–1.34, P < 0.05] all showed a higher SFR in the eESWL group. eESWL significantly shortened the stone-free time(SFT) [mean difference (MD) = -5.75, 95% CI: -9.33 to -2.17, P < 0.01]. In addition, eESWL significantly reduced auxiliary procedures [RR = 0.53, 95% CI: 0.40–0.70, P < 0.01]. No significant difference in complications was found between the two groups [RR = 0.90, 95% CI: 0.69–1.16, P > 0.05].ConclusioneESWL can significantly improve SFR, shorten SFT, and reduce auxiliary procedures.

Microureteroscopy in the treatment of upper urinary tract stones in pediatric patients younger than 3years of age.

The aim of this study is to evaluate the usefulness of microureteroscopy (m-URS) in the treatment of renal and ureteral stones in children younger than 3years of age. A retrospective analysis of pediatric patients aged < 3years with upper urinary tract calculi who underwent lithotripsy was performed. The children were divided into the m-URS group (4.85 F, n = 41) and the ureteroscopy (URS) group (4.5/6.5 F, n = 42) according to the type of ureteroscope used. The mean age of the patients was 23.5 ± 10.7months in the m-URS group and 20.6 ± 7.1months in the URS group (P = 0.212). The success rate of one-stage surgery was 80.5% (33/41) for m-URS and 38.1% (16/42) for URS (P < 0.001). The success rates of m-URS were 60.0%, 69.2%, and 91.3% for stones located in the renal pelvis/calix, upper ureter, and mid-lower ureter, respectively. Eight children in the m-URS group and 26 children in the URS group underwent the second-stage ureteroscopic surgery. The mean operation time was 50 (30-60) min in the m-URS group and 40 (34-60) min in the URS group (P = 0.287). The complication rates were 4.9% and 7.1% in the m-URS and URS groups, respectively (P = 1.000). The stone-free rate at 1 month after lithotripsy was 87.8% in the m-URS group and 83.3% in the URS group (P = 0.563). The mean anesthesia session was 2.1 in the m-URS group and 2.5 in the URS group (P = 0.002). M-URS can effectively reduce the number of anesthesia sessions and is considered an alternative treatment for upper urinary tract calculi in selected pediatric patients younger than 3years of age.

Investigating ESWL success rate in the treatment of renal and ureteral stones in children.

Extracorporeal shock wave lithotripsy (ESWL) is one of the most important methods of treatment for stone in children. Therefore, this study was conducted to determine the success rate of ESWL in the treatment of kidney and ureteral stones in children referred to Hasheminejad kidney center during the second half of 2018. This observational prospective study was conducted on 144 children referred to Hasheminejad kidney center during the 2018. The patients were selected using the convenience sampling method. The study was investigating the success rate of ESWL in the treatment of kidney and ureteral stones and effective factors in this regard. A total of 133 patients (92.4%) had stone passage and 37.5% of patients had residual stones, 28.5% of which were less than 5 mm in diameter. Successful results were seen in 131 cases (91%). Successful results were significantly higher in males (p = 0.011) and lower in simultaneous stones in the middle calyx and lower calyx (p = 0.0001). According to the results of this study, it can be inferred that ESWL success rate was above 90% in the treatment of kidney and ureteral stones in children in such a way that with an ESWL session in patients who have been properly selected for this procedure, a success rate of about 62.5% will be available to remove any residual fragments, and nearly 28.5% have residual fragments with a diameter of smaller than 5 mm, which is basically hopeful for a high urinary passage. The present study shows that type and stone location are the factors contributing to the successful ESWL and shows the female gender and the presence of stone in the lower and middle calyx are the risk factors for the lower ESWL success rate.

Percutaneous Nephrolithotomy (PCNL) in Older and Younger Patients at a Tertiary Hospital in Surabaya, Indonesia

Highlights: Percutaneous nephrolithotomy (PCNL) in older patients is as effective and safe as in younger patients. It is a viable option for managing renal stones in older patients with indications, although blood transfusions are frequently required. Abstract: Percutaneous nephrolithotomy (PCNL) for renal and proximal ureteral stone treatment among the elder population is considered challenging due to the complication risk associated with comorbidity and lower functional reserve. Patients older and younger than 60 years old were compared for efficacy and safety in following PCNL procedures. Consecutive patients who underwent PCNL from 2019-2021 in a single center were divided into patients aged at least 60 years (group I) and patients aged under 60 years (group II). Single stage fluoroscopic-guided PCNL were used for the entire study population. Patients’ habitus, stone-related, and operative characteristics were compared. The two groups’ PCNL success and complication rates were evaluated. A total of 245 patients, comprising 65 in group I and 180 in group II, were included for analysis. Diabetes mellitus prevalence was higher in group I (30.8% vs 18.9%). However, the study population did not show a significant difference in regard to comorbidity. Operative time, success rate (80% vs 74.4%), and complication rate (16.9% vs 15.6%) did not statistically differ (p&gt;0.05). Transfusion rate was higher among patients aged at least 60 years (p=0.018). Based on the multivariate analysis, stones located in the renal pelvis was the factor which contributed to the success rate. In conclusion, percutaneous nephrolithotomy is a safe and effective procedure for treating renal and proximal ureteral stones in the older population. Blood transfusions are more frequently given, in part, due to bleeding risk among older patients.

Meta-analysis of the efficacy and adverse drug reactions of adrenergic alpha-antagonists in treating children with ureteral calculi.

This meta-analysis investigated the efficacy and adverse drug reactions (ADRs) of three different adrenergic alpha-antagonists during the treatment of pediatric ureteral stones. Studies were retrieved from MEDLINE, EMBASE, and the Cochrane Controlled Trial Registry until January 2022. We identified 7 articles, including six RCTs and one cohort study. 610 children received either adrenergic alpha-antagonists or placebo. The results confirmed that the three different adrenergic alpha-antagonists could significantly increase the ureteral calculi expulsive rate and shorten the ureteral calculi expulsive time, regardless of the size of the stone "<5 mm" or "5-10 mm". Subgroup analysis suggested that all three adrenergic alpha-antagonists increased the ureteral calculi expulsive rate. Tamsulosin and silodosin also have the effect of shortening ureteral calculi expulsive time, while doxazosin has an insignificant effect on ureteral calculi expulsive time. Besides, tamsulosin and silodosin obviously reduced the number of pain episodes caused by ureteral calculi in children. We analyzed the treatment-emergent adverse events (TEAEs) caused by the treatment of three different adrenergic alpha-antagonists to explore their ADRs. The probability of ADRs was increased after treatment with adrenergic alpha-antagonists. Further subgroup analysis revealed the application of tamsulosin was positively correlated with ADRs in children with ureteral calculi, while the application of doxazosin and silodosin had no statistically significant effect on the probability of TEAEs. In a conclusion, this article systematically analyzed the efficacy and ADRs of three different adrenergic alpha-antagonists, and provided reference and guidance for the application of adrenergic alpha-antagonists to treat children ureteral calculi.

Renal and Ureteral Stone Treatment by Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy (ESWLs) results can be enhanced by the application of specific technological concepts and the selection of advantageous instances. This study's goal is to analyze the mechanisms of action of ESWL., indications and contraindications, success predictors, and consequences. ESWLs &amp; "calculi" were used as topics in a search between Jan. 1984 and Oct. 2013 in the Pubmed® database. Only human-conducted studies with a sufficient level of evidence, including clinical trials or reviews/meta-analyses, were considered for inclusion. To optimize the seek for the ESWL results, many technical factors, including the kind of ESWLs apparatus, the intensity &amp; frequency of the impulses, the connecting of patients to the device, the position of the stones, as well as the type of anesthesia, should be taken into consideration. Other patient-related variables, such as the density &amp; size of the stone, skin-to-stone distance, anatomy of the excretory system, and renal anomalies, are also significant. The insertion of a routine double J stent before the procedure is not typically advised, nor is antibiotic prophylaxis required. For stones larger than 10 mm, alpha-blockers, in particular, tamsulosin, are helpful. Following ESWL, minor problems are possible but often respond favorably to therapeutic therapy. It is unclear how ESWL affects those with diabetes or hypertension.

Renal and Ureteral Stone Treatment by Extracorporeal Shock Wave Lithotripsy

Renal and Ureteral Stone Treatment by Extracorporeal Shock Wave Lithotripsy